Runninghead:SOCIOECONOMICSTATUSANDHEALTHYBEHAVIORS

Therelationshipbetweensocioeconomicstatusandhealthybehaviors:
Amediationalanalysis
JennRisch
AshleyPapoy
HanoverCollege

Priorresearchhasdemonstratedthatsocioeconomicstatus(SES)andhealtharerelated
suchthatpositivehealthattitudesandbehaviorsaremoreprevalentamonghigherSES
thanamonglowerSESindividuals.Thepresentstudywasdesignedtoexaminethe
reasonsforthisrelationship.Participantscompletedaquestionnairethatassessed
socioeconomicstatus,severalhealthbehaviors(e.g.,smoking),andseveralvariables
proposedtomediatetheassociationbetweensocioeconomicstatusandhealth(e.g.,
education).FindingsindicatethatSESpredictedthenumberofvegetableseateneach
dayandhowfrequentlyeachparticipantexercised.Findingsalsoindicatedthatthe
relationshipbetweenSESandexercisewasmediatedbyaparticipantshealth
consciousness.Noneofthemediatorswerefoundtoexplaintherelationshipbetween
SESandthenumberofvegetableseateneachday.Thisresearchisimportantin
encouragingpositivehealthbehaviorsandattitudesacrossalllevelsofsocioeconomic
status.

Therelationshipbetweensocioeconomicstatusandhealthybehaviors:
AMediationalanalysis
ThereisaproblemintheUnitedStatesinvolvingthehealthlifestylesof
Americans.Theoverallhealthofthenationisrapidlydeclininganddirectreasonsfor
thisdeclinearenotwellunderstood.Forexample,instudiescollectedbytheCenterfor
DiseaseControlin2004,itwasfoundthatsmokingintheUnitedStateshasdeclined
since1974.However,about23%ofAmericanswerestillsmokersbetween1999and
2001,andthestatisticislikelytobesimilartoday.Itwasalsoshownthatcalorie
consumptionhasincreased22%forwomensince1971.Althoughpeopleareconsuming
morecalories,60%ofadultsalsodonotengageintherecommendedamountofphysical
activity.Infact,approximately25%ofadultsdonotengageinanyactivityatall.
Physicalactivityisimportantforindividualsbecauseitcanhelptoboosttheimmune
systemandreducecertaindiseases,suchasheartdisease,whichhasbeenthenumberone
causeofdeathsince1980.TheCenterforDiseaseControlalsofoundthatonethirdof
adultsareconsideredobese.
Importantly,thestatisticsfromtheCenterforDiseaseControlsuggestthat
socioeconomicstatus(SES)andhealthbehaviorsmayberelated.Forexample,research
completedin 2004foundthatmenwhowerebelowpovertylevelweretwiceaslikelyto
smokeasmenwhowereinthehighestlevelofincomethatwassurveyed.Thesame
resultswerefoundforwomen.Similarly,studiesbytheCenterforDiseaseControl
comparingleisuretimephysicalactivityandincomelevelfoundthatadultswithincomes
fourtimesormoreabovethepovertylevelwereabouttwiceaslikelythanthosebelow
thepovertyleveltoengageinregularphysicalactivity.Itwasalsofoundthatadultswith
incomesfourtimesormoreabovethepovertylevelweremorethantwotimesaslikelyas

theadultsbelowpovertyleveltoengageinrigorousphysicalactivitythreetofourtimes
perweek.Intermsofbodyweight,itwasfoundthatwomenbelowthepovertylevel
weremuchmorelikelythanwomeninthehighestlevelsofincometobeoverweight.
Theresultsforobesityfollowedthesametrend.Womenbelowthepovertylevelwere
morelikelytobeobese.Allofthesefindingsshowthattheproblemwithpoorhealth
needstobereversed,focusingparticularattentiononindividualsinlowerSESgroups.
ThisstudywillexaminetherelationshipbetweenSESandhealthylifestyles,
focusing,inparticular,onidentifyingreasonswhylowSESandpoorhealthappeartobe
related.Wearedefininghealthylifestyleasthebehaviorsorattitudesthatareconducive
toorpromotehealthintermsoflongevityandaholisticexistence. Thedifferent
behaviorsthatwillbeevaluatedinthisstudyincludediet,exercise,obesity,and
substanceabuse.Thesebehaviorshavebeenshowninpreviousresearchtobecorrelated
withSES.However,itisimportanttounderstandwhythesecorrelationsoccurbecause,
althoughpeoplearenotalwaysincontrolofthesocioeconomicenvironmentinwhich
theylive,theymaybeabletocontrolvariables(e.g.,stress)thatunderlietherelationship
betweenSESandhealth.Doctors,nutritionists,andpatientsshouldbemadeawareof
thesecontributingvariablesandtrainedhowtotalkwiththeirpatientsabouttheireffects
onpatientshealth.Thismightinturnleadtoanoverallhealthierlifestyleforthe
individualandcontributetoahealthiernation.
SocioeconomicStatusandHealthyLifestyles
Althoughhealthproblemsareevidentacross thepopulation,theproblemsare
especiallyevidentamongthenationspoor.Infact,acorrelationbetweenSESandhealth
behaviorshasbeenwellestablished,notonlybytheCenterforDiseaseControlbutina

widerangeofstudies.InonestudyCairney(2000)foundthatpeoplewithalowerSES
weremorelikelytoreportpoorhealth.Thosewhoreportedpoorhealthweremore
likelytoneglectpersonalhealthcare,suchasgoingtothedoctor.Thesecharacteristics
arealsooftenpredictorsofmortality.Cairey(2000)alsofoundthatparticipantswitha
lowerSESweremorelikelytoreportphysicalailmentscomparedtotheparticipantsina
highersocioeconomicstatus.LowSESparticipantswerealsomorelikelytotakepartin
unhealthybehaviorssuchaseatingfastfoodmorefrequently,smoking,orchoosingnot
toexercise. SimilarresultswerefoundbyDrukkerandvanOs(2003).These
researchersexaminedassociationsbetweenneighborhoodSESandhealthrelatedquality
oflife.They foundthatwhenneighborhoodlevelSESwaslow,individualsreporteda
lowerqualityofmentalandphysicalhealth. Finally,Lindstrom(2001)foundthat
individualsinlowerSESgroupshavelessleisuretimephysicalactivitythanthoseina
higherSESgroup.
MediatorsoftheRelationBetweenSESandHealthyLifestyles
ThereasonsforthelinkbetweenSESandhealthbehaviorsarenotwell
understood.PriorresearchbyWardleandSteptoe(2003)hassuggestedthateducation,
healthconsciousness,healthlocusofcontrol,futuresalience,expectationsoflongevity,
selfratedhealth,andstressmightplayaroleinmediatingtherelationshipbetweenSES
andhealthbehaviors.
Thereisempiricalevidencethatthesevariablesmaybeinfluential.Forexample,
supportingtheideathatfuturesalienceandhealthlocusofcontrolmightplayarole,
WardleandSteptoe(2003)foundthatlowSESparticipantswerelesslikelythanhigh
SESparticipantstothinkaboutthefutureandmorelikelytobelievethatgoodhealthwas

theresultofluckratherthantheresultofpersonalityresponsibility(e.g.takingcareof
oneself).Thesebeliefswere,inturn,associatedwithhealthbehaviors.Specifically,
participantswhorarelythoughtaboutthefutureweremorelikelytoengageinsmoking
andpooreatinghabitsthanthosewhofrequentlythoughtaboutthefuture.Similarly,
participantswhobelievedthatgoodhealthwastheresultofluckweremorelikelyto
smoke,leadasedentarylifestyle,andhaveadietlowinfruitsandvegetables.
EvidencethateducationmayplayaroleisprovidedbyDobiasetal.(2001).They
foundthatwhenthreelevelsofliteraturewereprovidedtoaudiencesofdifferent
educationalexperience,theamountofpersonalhealthcareandconsciousnesswas
affected(Dobiasetal.2001).Specifically,participantswithalowereducationlevelwere
unabletosufficientlyunderstandthemoredifficultliteratureand,asaresult,lesslikelyto
recognizehealthproblems.Also,thosewithlowereducationwerenotaslikelytoreport
anyhealthdifficultiesthattheywereexperiencingtoadoctor(Dobiasetal.,2001).
SimilarevidenceforthemediatingeffectsofeducationarereportedbyHawkesand
Holm(1993)whofoundthatlowerlevelsofeducationwereassociatedwithless
participationinphysicalactivityandwithpooreroverallhealth.
Stresshasalsobeenlinkedtohealthbehaviors.Forexample,astudyby
Cartwrightetal.(2003)foundthatwhenpeopleareinstressfulsituationssuchas
academicexaminations,workenvironments,orparentingdecisionstheyweremorelikely
toengageinunhealthyeatinghabits.Unhealthyeatinghabitsconsistedofeatingfatty
foods,snackingoften,andskippingbreakfast.Theresultsofthisstudyalsofoundthat
peoplewhowereobeseweremorelikelytoeatmoreoftenwhenstressedthanpeoplethat
wereoflowtoaverageweight(Cartwrightetal.,2003).Resultsfromthisstudymakeit

clearthatthereisarelationshipbetweenstressandunhealthyeatingbehaviors.The
unhealthyeatingbehaviorswouldthenleadtomoreserioushealthproblemsinthefuture.
StudieslikethatconductedbyWardleandSteptoe(2003),Dobiasetal.(2001),
HawkesandHolms(1993),andCartwrightetal.(2003)areimportantinsuggesting
variablesthatmayleadlowerSESindividualstohavepoorhealthhabits.However,these
typesofstudiesdonotempiricallyestablishtheselinkagesasclearlyastheymight.Todo
so,mediationalanalysesarerequired.Mediatorsarevariablesthatexplainthecauseof
therelationshipbetweentwoothervariables.Forexample,inthiscase,thedegreeto
whichanindividualthinksaboutthefuture(themediator)mayexplaintherelationship
betweenSES(theindependentvariable,orIV)andhealthbehaviors(thedependent
variable,orDV).Thatis,lowerSESindividualsmayengageinmoreunhealthy
behaviorsbecausetheyarenotfuturefocusedandfailtoconsiderhowtheirunhealthy
habitsmaythreatentheirfuture.BaronandKenny(1986) offerthreecriteriathatneedto
bemetinorderforavariabletobeempiricallyestablishedasamediator.First,theIV(in
thiscase,SES)mustbecorrelatedwiththeDV(inthiscase,healthbehaviors).Second,
themediator(inthiscase,thinkingaboutthefuture)mustbecorrelatedwiththeDV
controllingfortheDV.Finally,thecorrelationbetweentheIVandtheDVmustbe
reducedtononsignificantlevelsafteranalysesadjustforthemediator.Thisstudywill
usemediationalanalysestodeterminethecauseoftherelationshipbetweenSESand
healthbehaviorsandattitudes.Bydoingso,thisresearchwillleadusonestepfurtherin
findingwaystoreachthesamelevelofhealthbehaviorsandattitudesacrossalllevelsof
socioeconomicstatuses.

TheCurrentStudy
Forthisstudy,wehypothesizethatpeoplewithahighersocioeconomicstatuswill
leadahealthierlifestylethanpeoplewithalowersocioeconomicstatus.Inorderto
determineifsocioeconomicstatusplaysaroleinthehealthybehaviorsandattitudesof
individuals,wewillcorrelatesocioeconomicstatuswithseveralhealthbehaviors,
includingexercise,nutrition,smoking,andobesity.Wealsohypothesizethatthe
relationshipbetweensocioeconomicstatusandhealthbehaviorswillbemediatedby
severalfactors.Thevariablesthathavebeenchoseninthisstudyaspotentialmediators
oftherelationbetweenSESandhealthybehaviorsincludeeducation,health
consciousness,futuresalience,expectationsoflongevity,andstress.
Examiningthesepotentialmediatorsisimportantbecause,whileitisdifficultto
changeapersonssocioeconomicstatus,themediatorsthataffecttheoverallhealthofa
personcanoftenbealtered.Wehopetobeabletofindvariablesthatcouldbeaddressed
inthefuturetopromoteahealthierlifestyleforindividualsand,inturn,leadthegeneral
healthoftheUnitedStatestobeginincreasing.
Methods
Participants
ParticipantsinthisstudyrepresentedaconveniencesamplefromMadison,
IndianaBedford,IndianaIndianapolis,IndianaandCincinnati,Ohio.Participantswere
selectedatrandomfromawarehouseanddowntowninCincinnati.Participantswere
alsoobtainedthroughacquaintances.Thesampleconsistedof39adultsbetweentheages
of23and68yearsold.Themeanageoftheparticipantswas46yearsold.59%ofthe
participantsweremaleand41%werefemale.Thesampleofparticipantsincluded87%

Caucasian,8%Hispanic,and5%Black.Incomeoftheparticipantsrangedfrom$16,000
to$350,000withamedianof$49,000.
Measures
Participantswereaskedtofilloutaquestionnairethatassessedsocioeconomic
status,severalhealthbehaviors(e.g.,frequencyofexercise),andseveralvariables
proposedtomediatetheassociationbetween socioeconomicstatusandhealth(e.g.
educationlevel).Thequestionnairewascomposedofseventeenquestionsand
participantsansweredusingLikertscale,fillintheblank,oryesornoresponseformats.
AfullcopyofthequestionnaireisincludedinAppendixA.
SocioeconomicStatus.Toassesssocioeconomicstatus,participantswereasked
toprovidefamilyincomelevelandoccupation.
HealthBehaviors.Fourhealthbehaviorswereassessed.Specifically,participants
wereaskedthenumberofservingsoffruitsandvegetablesthattheyconsumeeachday
(diet),thenumberoftimesthattheyexerciseeachweek(exercise),theirheightand
weightsothattheirbodymassindex(BMI)couldbecalculated,andwhethertheysmoke
cigarettes(substanceabuse).
ProposedMediators.FivepotentialmediatorsoftherelationbetweenSESand
healthbehaviorswereassessed.First,educationwasassessedbyaskingeachparticipant
hisorherhighestlevelofeducation.Second,eachparticipantsexpectationoflongevity
wasdeterminedbyaskingtheparticipantstowhatagetheyexpectedtolive.They
answeredwithanumericalresponse.Third,futuresaliencewasassessedbyasking
participantshowoftentheythinkaboutthefuture.Participantsrespondedbyusingthe
options:allthetime,veryoften,sometimes,orhardlyatall.Fourth,health

education/consciousnesswasassessedbyaskingeachparticipant,Howoftendoyou
thinkaboutthingsthatyoumightdotokeepyourselfhealthyorimproveyourhealth?
Participantsrespondedona7pointLikertscalethatrangedfromrarelyornotatallto
severaltimesperday.Finally,stresswasdeterminedbyaskingtheparticipants,How
stresseddoyoufeel?Theparticipantsansweredusinga4pointLikertscalethatranged
fromextremelystressedtonotstressedatall.
Procedure
Theprocedureofthestudywasexplainedtotheparticipantsandtheyweretold
thatthestudywasconcernedwithhealthandindividuallifestyle.Beforethe
questionnaireswerehandedouttotheparticipants,allparticipantswereaskedtoread
overtheinformedconsentformandsigntheformagreeingtothetermsprovided.
Completingthequestionnairetookaboutfivetotenminutes.Followingcompletionof
thequestionnaire,participantsweregivenawrittendebriefing,afterwhichtheywere
dismissed.
Results
ToassessthedegreetowhichSESpredictedeachofthefivehealthbehaviors,a
seriesofregressionanalyseswasperformed.Theseanalysescontrolledfornumberof
dependentssothatincomelevelsweremorecomparableacrossindividualsnoneorfew
versusmanychildren.AsseeninTable1,theseanalysesindicatedthatSESpredicted
thenumberofvegetableseateneachdayandhowfrequentlyeachparticipantexercised.
Specifically,higherSESindividualsatesignificantlymorevegetablesandexercisedmore
oftenthanlowerSESindividuals.Asecondsetofregressionanalyseswasperformedin
ordertodetermineifanyofthefiveproposedmediatorsexplainedtherelationship

betweenSESeithernumberofvegetableseatenorexercise.AsshowninFigure1,the
relationshipbetweenSESandexercisewasmediatedbyaparticipantshealth
consciousness.EachofthethreecriteriaformediationsuggestedbyBaronandKenny
(1986)weremet.First,theIV(inthiscase,SES)predictedtheDV(inthiscase,
exercise),=.51, t(39)=2.67, p<.01.Second,themediator(inthiscase,health
consciousness)predictedtheDV,controllingfortheIV,=.39, t(39)=2.51, p<.017.
Finally,thecorrelationbetweentheIVandtheDVwasreducedtononsignificantlevels
afteranalysesadjustforthemediator,=.35,t(39)=1.87, p<.07.ASobelTest(1982)
wasconductedtodeterminewhetherthemagnitudeofthereductionwassignificantly
differentfromzero.Therewasasignificantdecline,z=2.50, p<.01,furtherconfirming
thatthehealthconsciousnesswasamediatorfortherelationshipbetweenSESand
exercise.Noothervariableswerefoundtomediatetherelationshipbetween SESand
exercise.Moreover,noneofthemediatorswerefoundtoexplaintherelationshipbetween
SESandthenumberofvegetableseateneachday.
Discussion
OurfindingsconcludedthatSESwascorrelatedwithboththenumberof
vegetableseatenperday andthefrequencyofexerciseperweek.Althoughnothingwas
foundtomediatetherelationshipbetweenSESandthenumberofvegetableseatenper
day,ourfindingsdidindicatethathealthconsciousnesswasamediatorforthe
relationshipbetweenSESandexercise.Therefore,itwasnotmerelyapersonsSESthat
wasthecauseoftheirfrequentexercise,itwasthepeoplewiththehigherSESthatwere
moreabletothinkaboutthingsthatwouldimprovetheirhealth.Thisconscioushealth
thoughtiswhatledhigherSESparticipantstoexercisemorefrequently.Thismaybe

becausehigherSESindividualsthinkabouthealthduetotheresourcesthatsurround
themandencouragehealthyactivity.Also,theymighthavemoreleisuretimethatwould
allowthemthetimetoexercise.
Onereasonthatwemightnothavefoundsignificanceinallofthevariablesthat
wewereexaminingisbecausewedidnothaveenoughvariabilityinsomeofour
samples.Forexample,wefoundonlythreeofthethirtynineparticipantstobesmokers.
Becausewedidnothavemanyparticipantsthatsmokedwecouldnotdrawconclusions
aboutsmokersandtheirhealth.
Also,wefoundthattheBMImeasurementwasnotagoodenoughpredictorof
obesityandoverallhealth.Thereismuchmorethatshouldbeconsideredwhen
evaluatingapersonshealththanjusttheirheightandweightproportion.Forinstance,
theBMItestdoesnotaccountformusclemass.Therefore,someonewithmuchmuscle
massmightbeconsideredobesebecausetheyweighmorethansomeonewiththesame
weightandlessmuscle.
OnereasonthatwedidnotfindsignificanceinthecorrelationbetweenSESand
thenumberofservingsoffruiteateneachdaymayhavebeenbecauseofthecurrentdiet
fadthatenforceslittletonocarbohydrateconsumption.Therefore,whileweconsidered
highfruitintakeasahealthybehavior,othersmighthavefoundeatingfruitasadiet
restrictionwhilestillbeingconsciousofeatinghealthyandwatchingtheirweightclosely.
BecausehealthconsciousnesswasfoundtomediatetherelationshipbetweenSES
andexercise,itwouldseembeneficialtoprovideprogramsthatwouldencouragepeople
tothinkmoreabouttheirhealth.Theseprogramsmightincludeschoolinterventionsthat
wouldencouragehealthylivingforchildren,startingatanearlyage.Itwouldalsobe

importanttoencourageadvertiserstomarkethealthierproductsandactivitiesinareasthat
havelowerSEScircumstances.Targetedadvertisementsmighthelptolowertheeffect
thatSEShasonhealthattitudesandbehaviors.
Futureresearchshouldincludealargersamplesizewithagreatervariabilityin
thosesamples.Itwouldalsobebeneficialtousealongitudinalstudyinordertobetter
examineothercausesfortherelationshipbetweenSESandthedifferenthealthbehaviors.
Usingalongitudinalstudyandexaminingparticipantsonamoreregularbasiscould
examineabroadervarietyofhealthbehaviors.Finally,itwouldbebeneficialfora
longitudinalstudytoincludegroupsofparticipantswhoareexposedtodifferenthealth
programs.Examiningsuchprogramsmayhelpresearchersdeterminetheonesmost
beneficialforpromotinghealthconsciousness.

Table1.Therelationshipbetween
SESandhealthbehaviors.

HealthBehaviors
t
Fruits
0.18 0.86
Vegetables
0.60* 3.28
Exercise
0.51** 2.67
Obesity
0.08 0.38
Smoking
0.26 1.27
*significantatthep<.05level
**significantatthep<.01level

HealthConsciousness

=.41*

SES

=.39**

=.51**

Exercise

=.35NS
Figure1.ThereisasignificantrelationshipbetweenSESandexercise.Thisrelationshipismediated
byapersonshealthconsciousness.Oncethemediatorisaddedin,therelationshipbetweenSESand
exercisedropstononsignificantlevels.ThereisalsoasignificantrelationshipbetweenSESand
healthconsciousnessandasignificantrelationshipbetweenexerciseandhealthconsciousness.This
furthershowsthathealthconsciousnessisamediatoroftherelationshipbetweenSESandexercise.
*significantatthep<.05level
**significantatthep<.01level

AppendixA
Age________
Sex:MaleFemale
Race__________________
Whatisyouroccupation?____________________
Whatistheoccupationofyourspouse?(ifapplies)_________________
Whatisyourfamilyincome?(optional)_________________
Doyousmoke?YesNo
Howmanyservingsoffruitsdoyoueatperday?______________
Howmanyservingsofvegetablesdoyoueatperday?________________
Onaverage,howfrequentlydoyouexerciseeachweek?
5ormoretimes/week34times/week12times/weekNotatall
Whatisyourheight?________
Whatisyourweight?________
Whatisyourhighestlevelofeducation?________________
Howoftendoyouthinkaboutthingsthatyoumightdotokeepyourselfhealthyor
improveyourhealth?
Severaltimes/dayAtleastonce/dayEvery23daysOnce/week
Once/monthEveryfewmonthsRarelyornever
Howoftendoyouthinkaboutthefuture?
AllthetimeVeryoftenSometimesHardlyatall
Towhatagedoyouexpecttolive?_______________
Onaverage,howstresseddoyoufeel?
Extremelystressed

ModeratelystressedAlittlestressedNotatallstressed

References
Baron,R.&Kenny,M.(1986).TheModeratorMediatorVariableDistinctioninSocial
PsychologicalResearch:Conceptual,Strategic,andStatisticalConsiderations.
JournalofPersonalityandSocialPsychology,51,11731182.
Cairney,J.(2000).SocioeconomicstatusandselfratedhealthamongolderCanadiens.
CanadienJournalonAging,19,456478.
Cartwright,M.,Wardle,J.,Steggles,N.,Simon,A.,Croker,H.,&Jarvis,M.(2003).
StressandDietaryPracticesinAdolescents.HealthPsychology,22,362369.
HealthStatistics.CenterforDiseaseControlandPrevention.RetrievedNovember22,
2004atwww.cdc.gov.
Dobias,K.,Moyer,C.,McAchran,S.,Katz,S.,&Sonnad,S. (2001). Mammography
MessagesinPopularMedia:ImplicationforPatientExpectationsandShared
ClinicalDecisionMaking.HealthExpectations,4,131140.
Drukker,M.&VanOs,J.(2003).MediatorsofNeighbourhoodSocioeconomic
DeprivationandQualityof Life.SocialPsychiatry&PsychiatricEpidemiology,
38,698706.
Hawkes,J.&Holm,K.(1993).Genderdifferencesinexercisedeterminants.Nursing
Research,42,166172.
Lindstrom,M.,Hanson,B.,&Ostergren,P.(2001).Thesocioeconomicdifferencesin
leisuretimephysicalactivity:Theroleofsocialparticipationandsocialcapitalin
shapinghealthrelatedbehaviour.SocialScienceandMedicine,52,441451.
Wardle,J.&Steptoe,A.(2003).Socioeconomicdifferencesinattitudesandbeliefsabout
healthylifestyles.JournalofEpidemiologyandCommunityHealth,57,440443.