poor diet, high alcohol consumption, and inadequate cancer screening practices. We selected these factors because of their effect on other chronic disease risk factors (hypertension, high cholesterol, diabetes) and important chronic disease outcomes (heart disease, stroke, cancer). While the underlying causes of these behaviors are not yet fully understood, they are all preventable, and change at any age can result in improved health.
In this chapter, we argue that fundamental explanations for racial/ ethnic disparities in health behaviors are largely socioeconomic in nature. Despite a consensus that race and ethnicity are sociopolitical constructs, as opposed to biological categories (Muntaner, Nieto, and O’Campo, 1996; Williams, 1996), some researchers and policy makers have interpreted racial/ethnic disparities in health behaviors, either implicitly or explicitly, as reflecting inherent genetically based differences (for a critique of this approach, see Krieger, 2001). Rather, racial/ethnic disparities may reflect the consequences of a historical pattern of discrimination, by individuals as well as institutions (Geronimus, 1992; Lynch, Kaplan, and Shema, 1997). The consequences of discrimination are expressed through a variety of mechanisms, including differences in population-level SES (Jones, 2000) (e.g., blacks and Hispanics in the United States are far more likely to be poor than whites) and residential environments (e.g., blacks and Hispanics in the United States are far more likely to live in poor communities than whites). Such differences in SES and residential environments have been shown repeatedly to be associated with unhealthy behaviors for whites as well as populations of color (Conference of Socioeconomic Status and Cardiovascular Health and Disease, 1995; Cubbin, Hadden, and Winkleby, 2001; Kaplan and Keil, 1993; Marmot and Elliot, 1992; Winkleby, Kraemer, Ahn, and Varady, 1998). Racial/ethnic disparities in health behaviors may also reflect differences in cultural norms and values. This interpretation may be particularly relevant for groups who have recently immigrated to the United States; for example, foreign-born Mexican Americans may have healthier diets and exercise patterns than those who are born in the United States.
We present data for the three largest racial/ethnic groups in the United States: white non-Hispanics, black non-Hispanics, and Hispanics (with a focus on Mexican Americans when possible). We do not present data on other racial/ethnic groups because data are limited from nationally representative samples across broad age groups. We base our main observations on data from two national data sets, the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES III) and the 2000 Behavioral Risk Factor Surveillance System (BRFSS).
In the first section of this chapter, we (1) present population projections from Census data for selected racial/ethnic and age groups in the United States for the next 50 years; (2) review selected scientific literature on racial/