No abstract

Objective Hypertension represents a gateway diagnosis to more serious health problems that occur as people age. We examine educational differences in three health behavior changes people often make after receiving this diagnosis in middle or older age, and test whether these educational differences depend on (a) the complexity of the health behavior change and (b) gender. Method We use data from the Health and Retirement Study and conduct logistic regression analysis to examine the likelihood of modifying health behaviors post diagnosis. Results We find educational differences in three behavior changes—antihypertensive medication use, smoking cessation, and physical activity initiation—after a hypertension diagnosis. These educational differences in health behaviors were stronger among women compared with men. Discussion Upon receiving a hypertension diagnosis, education is a more important predictor of behavior changes for women compared with men, which may help explain gender differences in the socioeconomic gradient in health in the United States.

In this article we present two sets of empirical analyses that consider the extent to which socioeconomic gradients in self-assessed health and child mortality changed since the beginning of the twentieth century in the United States. This empirical issue has important and wide-ranging research and policy implications. In particular, our results speak to the value of considering the role of broader social, economic, and political inequalities in generating and maintaining socioeconomic disparities in morbidity and mortality. Despite dramatic declines in morbidity and mortality rates in the United States across the twentieth century, we find that socioeconomic-status gradients in morbidity and mortality declined only modestly (if at all) during that period.

Smoke-free air laws and the denormalization of smoking are important contributors to reductions in smoking during the 21st century. Yet, tobacco policy and denormalization may intersect in numerous ways to affect smoking. We merge data from the National Longitudinal Survey of Youth 1997, Tobacco Use Supplement of the Current Population Survey, American Nonsmokers' Right Foundation, and Census to produce a unique examination of the intersection of smoking bans and denormalization and their influence on any smoking and heavy smoking among young adults. Operationalizing denormalization as complete unacceptability of smoking within nightlife venues, we examine 1) whether smoking bans and denormalization have independent effects on smoking, 2) whether denormalization mediates the influence of smoking bans on smoking, and 3) whether denormalization moderates the impact of smoking bans on smoking. For any smoking, denormalization has a significant independent effect beyond the influence of smoking bans. For heavy smoking, denormalization mediates the relationship between smoking bans and habitual smoking. Denormalization does not moderate the relationship of smoking bans with either pattern of smoking. This research identifies that the intersection of denormalization and smoking bans plays an important role in lowering smoking, yet they remain distinct in their influences. Notably, smoking bans are efficacious even in locales with lower levels of denormalization, particularly for social smoking.

Education affords a range of direct and indirect benefits that promote longer and healthier lives, and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that "move upstream" to apply universally regardless of individual educational attainment, here tobacco clean air policies, are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.

Mental health parity laws require insurers to extend comparable benefits for mental and physical health care. Proponents argue that by placing mental health services alongside physical health services, such laws can help ensure needed treatment and destigmatize mental illness. Opponents counter that such mandates are costly or unnecessary. The authors offer a sociological account of the diffusion and spatial distribution of state mental health parity laws. An event history analysis identifies four factors as especially important: diffusion of law, political ideology, the stability of mental health advocacy organizations and the relative health of state economies. Mental health parity is least likely to be established during times of high state unemployment and under the leadership of conservative state legislatures.

Health inequalities persist, in part, because people in socioeconomically advantageous positions possess resources to avoid new health risks when medicine advances. Although these health decisions rarely occur in isolation, we know less about the specific role of networks. We examine whether social capital mediates the relationship between individual educational attainment and decisions about a medical advance: H1N1 vaccination during pregnancy. Building on prior work that defines social capital as the resources of network members, we examine two mechanisms through which social capital may affect health decisions, facilitating information flow and exerting influence. Using egocentric network data collected from 225 pregnant women during the 2009-10 H1N1 pandemic, we measure social capital as the proportion of networks that are college-educated H1N1 discussants (information flow) and the proportion of college-educated H1N1 supporters (influence). Findings reveal that college-educated women knew more college-educated H1N1 discussants and supporters. Further, both measures of social capital predicted higher probabilities of vaccination, with the latter mechanism emerging as a particularly strong predictor. Our findings provide evidence that health decisions are shaped by individual resources as well as social capital available through network ties, offering a unique perspective of the ways that social networks contribute to producing, and potentially reproducing, unequal health.

Although we know much about demographic patterns of smoking, we know less about people's explanations for when, how and why they avoid, develop, or alter smoking habits and how these explanations are linked to social connections across the life course. We analyze data from in-depth interviews with 60 adults aged 25-89 from a large southwestern U.S. city to consider how social connections shape smoking behavior across the life course. Respondents provided explanations for how and why they avoided, initiated, continued, and/or quit smoking. At various times, social connections were viewed as having both positive and negative influences on smoking behavior. Both people who never smoked and continuous smokers pointed to the importance of early life social connections in shaping decisions to smoke or not smoke, and viewed later connections (e.g., marriage, coworkers) as less important. People who quit smoking or relapsed tended to attribute their smoking behavior to social connections in adulthood rather than early life. People who changed their smoking behavior highlighted the importance of transitions as related to social connections, with more instability in social connections often discussed by relapsed smokers as a reason for instability in smoking status. A qualitative approach together with a life course perspective highlights the pivotal role of social connections in shaping trajectories of smoking behavior throughout the life course.