Department of Health, Education, and Welfare, 1979) indicated that health behaviors and lifestyle account for more of the variation in health than medical care and genetic factors combined. Similarly, the Report of the Secretary’s Task Force on Black and Minority Health (U.S. Department of Health and Human Services, 1985) concluded that most of the major risk factors responsible for the excess level of disease and death within Black and minority populations are behavioral, and thus potentially preventable. Behavioral risk factors are typically measured at the individual level; and much research on health behaviors views them simply as individual characteristics. Research is needed that would seek to understand the constraints on individual choice and the ways in which the larger social environment is consequential in the initiation and maintenance of unhealthy practices (McKinlay, 1990; Williams, 1990).

For example, cigarette smoking and alcohol use were risk factors in five of the six causes of death responsible for the 60,000 annual excess deaths in the Black population compared to the White population (U.S. Department of Health and Human Services, 1985). Alcohol and tobacco are mood altering substances frequently used to alleviate stressful working and living conditions created by social structures and processes. Research is needed that would elucidate the ways in which the cooperative efforts of governmental and commercial interests to initiate and maintain the use of these substances within disadvantaged populations combine with their adverse living and working conditions to produce particular patterns of risk behavior. Research is also needed to rigorously assess the relative contribution of behavioral factors to racial disparities in health. One study using a national sample found that although health behaviors varied by SES, individual behaviors played only a minimal role in accounting for SES differences in mortality (Lantz et al., 1997). Some limited research suggests that although behavioral factors are related to race and SES and to health status, modification of these risk factors without changes in the larger social institutions that drive them will give rise to new intervening factors that will maintain social inequalities in health (Williams, 1997).

Research on social support and other psychosocial factors that can affect health also needs to attend to the ways in which these characteristics are shaped by social conditions. For example, marital status is a powerful predictor of health; married persons enjoy lower levels of ill health and lower rates of mortality than unmarried persons. Marriage rates, however, are shaped by economic conditions. Unemployment, declines in income, and high job turnover are all associated with increased rates of marital dissolution; female-headed households decline when male earnings rise and rise when male unemployment increases (Bishop, 1977). Rates of female-headed households within the Black population are in-