title: Are socioeconomic disparities in health behavior mediated by differential media use? Test of the communication inequality theory.
abstract: Communication inequality has been offered as one potential mechanism through which social determinants influence multiple health behaviors. The purpose of this study was to examine the underlying mechanisms between communication inequality and health behaviors.
  
  
  
  Data from a nationally representative cross-sectional survey of 18,426 people aged 18 years and above in the United States were used for secondary analysis. Measures included socio-demographic characteristics, social participation (structural social capital), health media use (TV, print, and the Internet), and five health behaviors (physical activity, cigarette smoking, alcohol use, and intake of fruit and vegetable). Path analysis was performed to examine the linkages between social determinants, health media use, social participation, and social gradients in health behaviors.
  
  
  
  Path analysis revealed that socioeconomic gradients in health behaviors is mediated by: 1) inequalities in health media use; 2) disparities in social participation, which leads to differential media use; and 3) disparities in social participation that are not mediated by media use.
  
  
  
  Consistent with the theory of communication inequality, socioeconomic disparities in media use partially mediate disparities in multiple health behaviors.
  
  
  
  To address health inequalities, it is important to utilize health media to target populations with low socioeconomic statuses.
authors.affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Cancer Scan, Shibuya-ku, Tokyo, Japan. Electronic address: ishikun@gmail.com.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kondo
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States; Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States.
authors.forename: Kasisomayajula
authors.initials: K
authors.lastname: Viswanath
mesh_terms: D000293:Adolescent; D000328:Adult; D003146:Communications Media / Q000706:statistics & numerical data*; D054626:Consumer Health Information; D003430:Cross-Sectional Studies; D015438:Health Behavior; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D008875:Middle Aged; D012923:Social Class; D058992:Social Participation; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Communication inequality; Multiple risk behaviors; Socioeconomic status