A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities

Abstract

We propose that executive dysfunction is an important component relating to the socio-economic status gradient of select health behaviors. We review and find evidence supporting an SES gradient associated with (1) negative health behaviors (e.g., obesity, excessive use of alcohol, tobacco and other substances), and (2) executive dysfunction. Moreover, the evidence supports that stress and insufficient cognitive resources contribute to executive dysfunction and that executive dysfunction is evident among individuals who smoke cigarettes, are obese, abuse alcohol, and use illicit drugs. Collectively these data support the dual system model of cognitive control, referred to here as the Competing Neurobehavioral Decision Systems hypothesis. The implications of these relationships for intervention and social justice considerations are discussed.

Keywords: Competing Neurobehavioral Decision Systems; Executive function decision system; Health disparities; Impulsive decision system; SES gradient.

Conflict of interest statement

Conflict of Interest

The authors declare no conflicts of interest.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

Conceptual Model of Relationship Between SES Gradient, Negative Health Behaviors, and the Competing Neurobehavioral Decision Systems. As SES increases the risk of negative health behaviors decreases linearly. One explanation for this relationship is a regulatory imbalance between the competing neurobehavioral decision systems. As shown, the impulsive limbic system may be relatively hyperactive and the executive prefrontal system relatively hypoactive in lower SES individuals.