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      How does education lead to healthier behaviours? Testing the mediational roles of perceived control, health literacy and social support

      1 , 1 , 2 , 3
      Psychology & Health
      Informa UK Limited

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          Abstract

          <p class="first" id="d5367358e85">Educational attainment is increasingly recognised as a unique dimension of socioeconomic status (SES) and a powerful determinant of health behaviour-and thus physical health and mortality. However, very little is known about the specific pathways through which education influences these health behaviours. </p>

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          Most cited references46

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          The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

          In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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            The social determinants of health: coming of age.

            In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants-including economic resources, education, and racial discrimination-that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions. Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through knowledge linkage, testing multidimensional interventions, and addressing political will as a key barrier to translating knowledge into action.
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              Socioeconomic Disparities in Health Behaviors.

              The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.
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                Author and article information

                Journal
                Psychology & Health
                Psychology & Health
                Informa UK Limited
                0887-0446
                1476-8321
                February 22 2019
                November 02 2018
                November 19 2018
                November 02 2018
                : 33
                : 11
                : 1416-1429
                Affiliations
                [1 ] Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA;
                [2 ] Department of Health Disparities, MD Anderson Cancer Center, Unit 1440, UT MD Anderson Cancer Center, Houston, Texas, USA;
                [3 ] Department of Psychology, George Washington University, Washington, DC, USA
                Article
                10.1080/08870446.2018.1510932
                30450977
                6efde2ab-58c3-4077-844e-7ecb393da218
                © 2018
                History

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