Individual Level Child Health Behaviors

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One of the most well-studied pathways from SES to adolescent physical health is through adolescent health behaviors. For example, low SES adolescents are less likely to engage in physical activity (Abernathy et al, 2002; Janssen et al, 2006), thereby putting themselves at risk for overweight and related health problems. A recent study furthermore showed that adolescence is a period of significant decline in activity levels (Nader et al, 2009). Using accelerometers, the authors determined the time a sample of 9- to 15-year-old youth spent engaging in moderate-to-vigorous physical activity on a daily basis. While most 9-year olds showed evidence of healthy activity levels (about 3 h per day), 15-year-old study participants had dropped below the recommended time of 60 min of moderate-to-vigorous physical activity per day. Youth from low SES backgrounds also experienced somewhat faster decreases in physical activity over time. Sallis et al (1996) showed that one of the reasons for this lack of physical activity is the lack of resources low SES families have access to. Adolescents from more affluent school districts had more frequent and active physical education classes at school and were twice as likely to take other exercise-related classes outside of school. Low-income families, on the other hand, did not have the financial resources to provide their children with comparable opportunities.

Other studies have further clarified that there is a distinction between physical activity and sedentary behaviors and that sedentary behaviors are also important to appreciate. While a lack of physical activity indicates that people are not engaging in regular structured exercise, this does not mean they also lead a very sedentary lifestyle, which includes behaviors such as watching TV and playing computer games. Two studies have found that sedentary behaviors, but not physical activity, mediated the low SES - overweight relationship among adolescents (Hanson and Chen, 2006; Lioret et al, 2007). Targeting sedentary health behaviors may be particularly important among adolescents as research suggests that as children move into adolescence their physical activity levels decline and sedentary behaviors become more common (Brodersen et al, 2007).

Finally, other studies suggest that lack of exercise and sedentary behaviors are also related to other negative health behaviors among adolescents. Wang et al (2006) found that low SES African American youth were not only more likely to not exercise and engage in sedentary behaviors, such as watching TV and playing video games, but were also more likely to consume fried foods and soft drinks, both of which would be particularly unhealthy in the context of an already sedentary lifestyle. Delva et al (2006) reported similar results based on a nationally representative sample of adolescents and found that in addition to being less likely to engage in good dietary and exercise habits, low SES adolescents were also less likely to eat breakfast on a regular basis.

Another set of health behaviors that has been proposed to vary by SES relates to substance use. However, evidence with regard to associations between SES and substance use is somewhat mixed. Soteriades and DiFranza (2003) report that adolescent cigarette smoking increases as parent income and education decrease and that this relationship may be partially mediated by parental smoking habits. These results are supported by a national longitudinal study which also found inverse SES gradients for cigarette smoking and alcohol use (Goodman and Huang, 2002). However, this study also reported that the nature of the relationships was not consistent across all SES indicators. Longitudinally, Harrell et al (1998) found that low SES children and adolescents were more likely to be experimental smokers and to start smoking earlier. In contrast, some evidence suggests that substance use may be more common among adolescents from high SES families (Hanson and Chen, 2007), perhaps because it is easier for high SES youth to acquire cigarettes, alcohol, and other drugs due to greater financial resources or because youth from affluent backgrounds are not exposed to the negative consequences of drug use on a regular basis which may provide a deterrent for engaging in substance use behaviors (see also Luthar and D'Avanzo, 1999). In addition, Georgiades et al (2006) found that immigrant youth were subject to greater economic hardship, but nonetheless were less likely to smoke. Overall, large-scale studies suggest that low SES youth are more likely to engage in substance use behaviors such as cigarette use, though there may be some subgroups that are less vulnerable to substance use and some circumstances under which higher SES youth have greater access to substances.

with lower education and income (Goodman, 1999; Goodman et al, 2003; Kubik et al, 2003; Mendelson et al, 2008). Depression among adolescents, in turn, is associated with a series of other outcomes. For example, Goodman and Huang (2001) report that depressed adolescents experience fewer routine physical examinations and utilize fewer medical and more mental health resources. Depression has also been linked to adolescent substance use (Kubik et al, 2003) and Goodman and Huang (2002) reported that depressive symptoms may be one mechanism through which SES affects cigarette smoking and cocaine use among adolescents.

Adolescents growing up in low SES environments also experience greater stress in their lives (Goodman et al, 2005a), which may predispose low SES youth to certain negative psychological and physical health outcomes. Chen et al (2004) and Chen and Matthews (2003) showed that youth from low SES environments more readily make interpretations of threat when presented with ambiguous, but not negative, events, perhaps as a result of having grown up in a more hostile environment where there was greater exposure to chronic as well as acute daily stressors. These psychological traits have also been linked to physiological health outcomes, such that these youth also showed evidence of greater diastolic blood pressure and heart rate reactivity (Chen et al, 2004), as well as heightened levels of inflammatory markers implicated in asthma (Chen et al, 2006).

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