Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies

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Abstract

Background

Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.

Purpose

Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models.

Methods

Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES.

Results

Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES.

Conclusions

Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.

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Most cited references 34

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Conducting behavioral research on Amazon's Mechanical Turk.

Winter Mason, Siddharth Suri (2012)

Amazon's Mechanical Turk is an online labor market where requesters post jobs and workers choose which jobs to do for pay. The central purpose of this article is to demonstrate how to use this Web site for conducting behavioral research and to lower the barrier to entry for researchers who could benefit from this platform. We describe general techniques that apply to a variety of types of research and experiments across disciplines. We begin by discussing some of the advantages of doing experiments on Mechanical Turk, such as easy access to a large, stable, and diverse subject pool, the low cost of doing experiments, and faster iteration between developing theory and executing experiments. While other methods of conducting behavioral research may be comparable to or even better than Mechanical Turk on one or more of the axes outlined above, we will show that when taken as a whole Mechanical Turk can be a useful tool for many researchers. We will discuss how the behavior of workers compares with that of experts and laboratory subjects. Then we will illustrate the mechanics of putting a task on Mechanical Turk, including recruiting subjects, executing the task, and reviewing the work that was submitted. We also provide solutions to common problems that a researcher might face when executing their research on this platform, including techniques for conducting synchronous experiments, methods for ensuring high-quality work, how to keep data private, and how to maintain code security.

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The New Person-Specific Paradigm in Psychology

Peter Molenaar, Cynthia G. Campbell (2009)

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Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

S. Geyer (2006)

Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries. Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

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Author and article information

Journal

Title: Annals of Behavioral Medicine

Publisher: Oxford University Press (OUP)

ISSN (Print): 0883-6612

ISSN (Electronic): 1532-4796

Publication date Created: July 01 2019

Publication date (Electronic): July 01 2019

Affiliations

[1 ]Institute for Public Health and Nursing, University of Bremen, Bremen, Germany

[2 ]School of Medicine, University of Tasmania, Hobart, Australia

[3 ]Department of Psychology, University of Cambridge, Downing Street, Cambridge, UK

[4 ]School of Psychology, University of Leeds, UK

Article

DOI: 10.1093/abm/kaz023

PubMed ID: 31260512

SO-VID: 6a2dc039-3d47-4f98-9517-e149b8e48c9f

License:

https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies

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Abstract

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Most cited references 34

Conducting behavioral research on Amazon's Mechanical Turk.

The New Person-Specific Paradigm in Psychology

Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

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