Being Poor and Coping With Stress: Health Behaviors and the Risk of Death

Objectives. Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Methods. Data were derived from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement, which involved a repre-sentative sample of the adult US population (n=40335) and was linked to pro-spective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. Results. High baseline levels of former smoking and physical inactivity in-creased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. Conclusions. The combination of high stress levels and high levels of former smok-ing or physical inactivity is especially harmful among low-SES individuals. Stress, un-healthy behaviors, and low SES independently increase risk of death, and they com-bine to create a truly disadvantaged segment of the population. (Am J Public Health