Health locus of control beliefs and socio-economic differences in self-rated health Wouter Poortinga a, ⁎ , Frank D. Dunstan b , David L. Fone b a Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK b Department of Primary Care and Public Health, Centre for Health Sciences Research, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK Available online 4 December 2007 Abstract Background. Social inequalities in health are well documented in the social epidemiology literature. However, less is known about the mechanisms linking individual and area-level socio-economic status to health. In this paper we examine whether health locus of control (HLC) beliefs can help to explain socio-economic differences in self-rated health using the multidimensional HLC scale. Methods. Data for this study come from the Caerphilly Health and Social Needs Survey (n = 10,892). Multilevel modelling was used to examine the variation in HLC beliefs across different socio-demographic groups and levels of neighbourhood socio-economic status, and to investigate whether HLC beliefs mediate the health effects of individual and neighbourhood socio-economic position. Results. This study found that the HLC scales were significantly associated with individual and neighbourhood socio-economic status, as well as with self-rated health. HLC beliefs appeared to mediate some of the health effects of individual socio-economic status and to a lesser extent the health effects of neighbourhood socio-economic status. Conclusions. Some evidence was found that HLC forms part of the pathway between individual and neighbourhood socio-economic status and health. Future research should further explore the psychological consequences of living in economically deprived conditions, alongside material, social and behavioural processes, and examine how this impacts upon people's health and well-being. © 2007 Elsevier Inc. All rights reserved. Keywords: Health locus of control; Socio-economic status; Self-rated health; Multilevel modelling Introduction Social inequalities in health are well documented in the social epidemiology literature. An impressive body of research has shown that both individual and neighbourhood socio-eco- nomic status are associated with a wide range of health indi- cators (e.g., Shouls et al., 1996; Macintyre, 1998; Reijneveld, 1998; Marmot and Wilkinson, 1999; Yen and Syme, 1999; Pickett and Pearl, 2001). Several factors may account for the observed socio-eco- nomic differences in health. Most of the available explanations focus on the link between neighbourhood socio-economic sta- tus and individual health. For example, it has been suggested that people living in areas with a low socio-economic status have poorer health because they have fewer material resour- ces to their disposal. People living in neighbourhoods with a low socio-economic status often live in poorer quality hous- ing and have poorer access to amenities that are necessary to maintain good health, such as sports centres, ‘healthy’ shops, and health care facilities (Molinari et al., 1998; Bosma et al., 2001; Cummins and Mcintyre, 2002; Drukker and van Os, 2003; Mackenbach and Howden-Chapman, 2003). Social fac- tors also appear to play a role in explaining health inequalities (Wilkinson, 1999; Cattell, 2001). In particular, social capital and cohesion have been found to be positively associated with community health (Subramanian et al., 2002; Kawachi et al., 2004; Poortinga, 2006a,b; Fone et al., 2007), with low neigh- bourhood socio-economic status generally being detrimen- tal to neighbourhood relations, trust and cohesion (Ross et al., 2001; Brisson and Usher, 2005). Another pathway is via life- style or behavioural factors. Research has shown that unhealthy Available online at www.sciencedirect.com Preventive Medicine 46 (2008) 374 – 380 www.elsevier.com/locate/ypmed ⁎ Corresponding author. Fax: +44 29 2087 4623. E-mail address: PoortingaW@Cardiff.ac.uk (W. Poortinga). 0091-7435/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2007.11.015