Influence of Life Course Socioeconomic Position on Older Women's Health Behaviors: Findings From the British Women's Heart and Health Study

Objectives. We examined the association between health behaviors and socioeconomic status (SES) in childhood and adult life.Methods. Self-reported diet, smoking, and physical activity were determined among 3523 women aged 60 to 79 years recruited from general practices in 23 British towns from 1999 through 2001.Results. The most affluent women reported eating more fruit, vegetables, chicken, and fish and less red or processed meat than did less affluent women. Affluent women were less likely to smoke and more likely to exercise. Life course SES did not influence the types of fat, bread, and milk consumed. Adult SES predicted consumption of all foods considered and predicted smoking and physical activity habits independently of childhood SES. Childhood SES predicted fruit and vegetable consumption independently of adult SES and, to a lesser extent, predicted physical activity. Downward social mobility over the life course was associated with poorer diets and reduced physical activity.Conclusions. Among older women, healthful eating and physical activity were associated with both current and childhood SES. Interventions designed to improve social inequalities in health behaviors should be applied during both childhood and adult life.In 1977, the United Kingdom Department of Health commissioned an inquiry focusing on health inequalities in the country''s population. The resulting report—the Black Report, published in 1980—highlighted the marked association between adult socioeconomic status (SES) and mortality rates.¹ Such socioeconomic gradients in mortality rates persist today, tracking into old age.²Inequalities in health are a result of clearly identifiable social and economic factors that could potentially be modified to improve people''s quality and length of life. Employment, education, housing, transportation, environment, health care, and “lifestyle” (in particular smoking, exercise, and diet) all affect health and tend to be favorably distributed in advantaged groups.In the United Kingdom, the introduction of the National Service Framework for Coronary Heart Disease in 2000 was intended to reduce the prevalence of and social inequalities in coronary risk factors in the country''s population.³ Achieving these aims requires equitable access to and use of preventive care irrespective of SES, age, and gender. Health promotion initiatives such the “5-a-day” fruit and vegetable diet plan,⁴ smoking cessation clinics, and structured exercise plans have all been part of the drive to reduce the prevalence of coronary risk factors.Recent years have seen increased recognition of the potential implications of life course SES and a deeper understanding of the conceptual framework on which it is based.^5,6 There is growing evidence that coronary heart disease (CHD) risk is associated with life course SES,^7–10 with those in the most disadvantaged SES groups throughout life showing nearly 3 times greater risk than those in more advantaged groups.⁸ This raises the question of the extent to which behavioral CHD risk factors are similarly dependent on life course SES. We examined the effects of childhood and adulthood SES on various health behaviors (diet, smoking, and physical activity) of older British women.