to which there are differences in the distribution of health behaviors or social networks between blacks and whites in the United States and whether this differential distribution is related to underlying differences in socioeconomic status.
The paper is divided into several sections. First we review the evidence on the distribution of health-damaging and health-promoting behaviors among blacks and whites. We take a rather broad perspective on such behaviors, reviewing those that are traditionally called risk behaviors, such as cigarette and alcohol consumption, as well as health-promoting activities, such as physical exercise and maintaining social community ties.
In the second section we examine the distribution of health-damaging and health-promoting behaviors in a large study of older men and women, the New Haven Established Populations for the Epidemiologic Study of the Elderly (EPESE). In that section, we examine both traditional health behaviors and cardiovascular risk factors as well as social conditions related to social networks and socioeconomic status.
The Role Of Attitudes And Social Context In Behaviors That Damage Or Promote Health Among Blacks And Whites
Comparisons of the health practices of black and white older men and women should not be made without the following considerations:
- It is now becoming evident that knowledge and information are not the only determinants of behavior. A corollary is that a particular behavior does not necessarily reflect lack of information. People who are aware that exercise helps reduce the risk of heart disease may nonetheless maintain a sedentary lifestyle (Oldridge, 1982). Many cigarette smokers, aware of the association between coronary artery disease or lung cancer and tobacco, continue to smoke (Rigotti et al., 1994). Data about racial differences in knowledge of particular health risks must be considered in the context of other factors that influence the ability or desire to act on that knowledge. Poverty, poor access to medical care, perceived powerlessness and frustration, peer pressure, and differential access to alcohol, tobacco, and food all can impede the adoption of health-enhancing practices (Braithwaite and Lythcott, 1989; Blendon et al., 1989; Rogers, 1992).
- Even when knowledge and information are adequate, other factors on the health care side of the equation may lead to behavior that is associated with poor health outcomes. Both race and social position have been shown to correlate with the quality and type of screening and therapeutic recommendations that health care providers give their patients (Burstin et al., 1992; American Medical Association Council on Ethical and Judicial Affairs, 1990). Analyzing data from the 1988-1990 Behavioral Risk Factor Surveillance System, Giles et al. (1993) showed that adults consulting a physician for preventive care were less likely to