Socioeconomic determinants of healthy lifestyles: Does psychosocial stress matter

Healthy lifestyles are considered the most important determinants of health in industrialized nations. Individuals who do not smoke, do not binge drink, eat a lot of fruit and vegetables, and engage in regular physical activity are less likely to die prematurely and be exposed to illnesses and disabilities during their lifetime. Scientific evidence shows that health behaviours are associated with social and economic factors. However the socioeconomic pathways leading to risky behaviours are poorly understood. The aims of the present study are to: (a) study the interdependence of risky behaviours; (b) examine the relationship between socioeconomic status and a healthy lifestyle; (c) test the plausibility of the "psychosocial stress pathway" in mediating the relationship between socioeconomic status and a healthy lifestyle. The study is based on a Computer Assisted Telephone Interview (CATI) of 4002 civilians, non-institutionalized, adults living in the Veneto region (North-Eastern Italy). A series of logistic regression analyses was done to assess the relationship between social class and health behaviours and to determine how adjusting for psychosocial stress would affect the relationship. Results show that risky behaviours tended to be interrelated but most of the associations were weak. A healthy lifestyle was less prevalent among those with lower social class even controlling for demographics and other socioeconomic factors. However, the relationship between social class and health behaviours was neither linear nor consistent across all health behaviours. Psychosocial stress partially mediated the focal relationship among the lowest social classes. When considering behaviors singly, psychosocial stress varied in mediating the focal relationship according to the specific behavior and social class considered. The limited applicability of findings on the social gradient of health behaviors and the mediating effect of psychosocial stress is surprising. This may be due to the macroeconomic context of the Veneto region characterized by having a relatively low income inequality, a small percentage of people living below the poverty level and social safety mechanisms buffering lower social classes from the stress provoked by being low in the socioeconomic ladder. These results have important implications in terms of health promotion as well as public policies.