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

• A dual decision system model is proposed as the mechanism linking SES and negative health behaviors.
• Negative health behaviors are associated with the SES gradient.
• Executive dysfunction is associated with the SES gradient.
• Some negative health behaviors are associated with executive dysfunction.
• SES related effects on executive function lead to more negative health behaviors.

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.