Social class and preventive health behaviour: a British example

To test the relationship between social class and preventive health behaviour in a British national sample and identify which set of more specific socioeconomic factors best "explained" any observed relationship(s).

Secondary analysis from a national cross sectional survey of the health attitudes and health behaviour of men and women aged 18 years and over living in private households in England, Scotland, and Wales. A selection of addresses was made randomly from the electoral register using a three stage design, and then one individual in each household was sampled. A total of 12,254 addresses yielded interviews with 9003 individuals, a response rate of 73.5%. Compared with the census population, the single and divorced/separated are slightly under-represented but otherwise sources of bias are small.

The subset selected was 1671 women and 1026 men aged between 20-45 years with at least one child under 17 living at home.

Social class was strongly associated with the health practices index (HPI, used as a measure of health behaviour) both for women and men (p < 0.001). The set of factors identified for both sexes as having an impact on this relationship were education, tenure, residential overcrowding index, and salience of lifestyle. In addition, their partner's employment status and household income were relevant for women only. These groups of factors did not totally explain the observed relationship but the proportion of variance in HPI attributable to social class was considerably reduced.

Descriptions of the association between social class and health behaviour(s) are of little use to those wishing to mount more effective interventions in health promotion. Multivariable analysis can indicate which specific factors account for much of the social class effect on health behaviour and thereby assist better understanding and targeting of resources.