Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. This study examined whether smoking, alcohol use and physical inactivity moderate the relationship between perceived stress and the risk of death in the U.S. population as a whole and across socioeconomic strata.
Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult U.S. population (n= 40,335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. The study identified that high baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population, as well as among those of low socioeconomic status (SES), but not middle or high SES.
The authors conclude that a combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.