play outside but the neighborhood may be unsafe. As Chapter 7 details, Americans do not make product choices in a vacuum, and they face both environmental supports and barriers to healthy behaviors. Advertising and marketing of tobacco, alcohol, and unhealthy foods; sexualized content in television, film, and musical entertainment; and exposure to violence and stress have known consequences to health (Gordon et al., 2010; Harris et al., 2009; Lovato et al., 2003; Mosher, 2011; Nestle, 2007; Robinson et al., 2007; Spano et al., 2012; Vermeiren et al., 2003).
Socioeconomic conditions also limit choices and play an important role in the prevalence of unhealthy behaviors and their effect on mortality (Lantz et al., 2010). Tobacco use and other unhealthy behaviors are significantly more prevalent among adults with limited education and limited incomes (National Center for Health Statistics, 2012; Pampel et al., 2010) (see Chapters 6 and 7). Barriers in access to medical care generally, which is discussed in Chapter 4, and to specific health care services (e.g., pharmacotherapy for smoking cessation, substance abuse counseling, oral contraceptives) also limit the ability of individuals to adopt and sustain behavioral changes. Finally, policy and culture are important factors in understanding why health behaviors might differ between high-income countries: these are discussed in Chapter 8.