社会经济地位调节健康认知对参与者健康行为的影响：两项多行为研究。

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

机构信息

Institute for Public Health and Nursing, University of Bremen, Bremen, Germany.

School of Medicine, University of Tasmania, Hobart, Australia.

出版信息

Ann Behav Med. 2020 Jan 1;54(1):36-48. doi: 10.1093/abm/kaz023.

DOI:10.1093/abm/kaz023

PMID:31260512

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.

摘要

背景

与健康相关的行为方面的社会经济差异是健康不平等的主要原因。然而，社会经济地位（SES）影响健康行为的机制（中介/调节）仍在争论之中。

目的

当前关于 SES 作为健康认知与健康行为关系的调节因素的研究结果并不一致。以往的研究存在 SES 和健康行为的操作多样化、人口统计学上样本狭窄以及基于个体的设计等局限性，无法解决个体内部的过程。本研究采用分层线性模型，在个体多行为框架内，通过两项研究解决了这些局限性。

方法

两项在线研究，一项是横断面研究，另一项是 4 周纵向研究，共评估了 1005 名（研究 1；亚马逊土耳其机器人；仅限美国）和 1273 名参与者（研究 2； prolific；国际）。使用自我报告的多种 SES 指标（教育程度、收入、职业状况；研究 1 中的邮政编码）、健康认知（来自计划行为理论）以及六项健康行为的测量来进行评估。跨水平交互的多层模型检验了健康认知和行为之间的个体内关系是否因个体间 SES 而异。