Question:
You are given the full text of a scientific research paper.

    Summarize the study’s **policy implications**—how the research findings can inform policy or decision-making. Your response should:
    - Interpret what the results suggest for governments, regulators, or institutions
    - Highlight potential actions, strategies, or decisions informed by the study
    - Use policy-appropriate language without speculation beyond the study’s conclusions
    - Be clear, practical, and informative

    Write a short paragraph for the “Policy Implications” section of a policy brief.

    Scientific Research Paper:
    https://doi.org/10.1177/00221465241255946
Journal of Health and Social Behavior
2025, Vol. 66(1) 2–17
© The Author(s) 2024
DOI: 10.1177/00221465241255946
journals.sagepub.com/home/hsb
Original Article
As U.S. health disparities widen and the intergenera-
tional transmission of advantage in families and
communities strengthens, increasing attention is
being paid to the processes underlying these trends.
Of particular interest is early life, when children are
influenced by previous generations in ways that will
be consequential for decades to come. Sociological
research has pinpointed the shaping of children’s
everyday lives by parents in ways that foster chil-
dren’s long-term health and socioeconomic well-
being as one important mechanism of the
intergenerational transmission of advantage. Notions
of children as agents in their own lives, rather than
passive, innocent receptacles of socialization (see
Pugh 2014), and research on the importance of local
norms and institutions (Brown-Saracino 2015) con-
textualize families within communities as a site for
reproducing inequalities.
As scholars are increasingly emphasizing, the
concept of “health lifestyles” is useful for under-
standing how social and health inequalities play out
in individuals’ everyday lives (Cockerham 2005;
Krueger, Bhaloo, and Rosenau 2009; Weber [1922]
1978). Cockerham (2005:55) defined health life-
styles as “collective patterns of health-related
behavior based on choices from options available to
people according to their life chances.” Understand
ings of health lifestyles in early life and as part of
the intergenerational reproduction of inequalities
are still nascent. Furthermore, although a long theo-
retical tradition suggests that multiple lifestyle
options are available to people with similar social
1255946 HSBXXX10.1177/00221465241255946Journal of Health and Social BehaviorMollborn et al.
research-article2024
1Stockholm University, Sweden
2University of Colorado Boulder, Boulder, CO, USA
3U.S. Census Bureau, Washington, DC, USA
4Good Nutrition Ideas, Eugene, OR, USA
Corresponding Author:
Stefanie Mollborn, Department of Sociology, Stockholm
University, Stockholm, SE-106 91, Sweden.
Email: mollborn@sociology.su.se
Children’s Health Lifestyles
and the Perpetuation of
Inequalities
Stefanie Mollborn1,2
, Jennifer A. Pace3, and Bethany Rigles4
Abstract
Health lifestyles are a well-theorized mechanism perpetuating health and social inequalities, but empirical
research has not yet documented crucial aspects: (1) health lifestyles’ collective nature or content beyond
behaviors and (2) how people choose among available lifestyles in their social contexts. We conducted
interviews, observations, and focus groups with families in two middle- to upper-middle-class communities.
Contemporary class-privileged parenting involves constructing an individualized health lifestyle reliant on
an expansive understanding of health and composed of parents’ identities and narratives, children’s health
behaviors and identity expressions, and community norms. Children’s predominant health lifestyles in
our sample vary by focus on parent versus child identity expression and on future achievements versus
present well-being. Parents expect health lifestyles to influence future socioeconomic attainment and
health inequalities. Understanding how health lifestyles encompass more than behaviors and are locally
contextualized and how people choose them within structural constraints can inform research and policy.
Keywords
childhood, family, health behavior, health lifestyle, inequality, parenting

Mollborn et al.
3
class, most research has treated class-based parent-
ing and its implications for children as relatively
monolithic within class (e.g., Lareau 2011). With a
health lifestyles approach, scholars can articulate
variation within social categories and multilevel
conceptualizations of contexts to understand how
children’s everyday lives and health are shaped by
parents, children, and communities in ways that
may reinforce future inequalities—a phenomenon
about which not enough is yet known in childhood
(Pugh 2014).
Empirical work on health lifestyles lags behind
theory in crucial ways. Despite a growing consen-
sus that lifestyles likely extend beyond behaviors,
extant (mostly quantitative) research has measured
only health behaviors. Furthermore, although it has
long been understood that health lifestyles are col-
lective (Cockerham, Rütten, and Abel 1997;
Frohlich and Potvin 1999), empirical research has
examined them in individuals. Importantly, health
lifestyles are theorized to be contextually specific
(Cockerham et al. 2004), but almost all research has
used national or geographically dispersed samples.
Finally, Cockerham (2005:61) theorized, but empir-
ical work has not yet shown, that people “align their
goals, needs, and desires with their probabilities for
realizing them and choose a lifestyle according to
their assessments of the reality of their resources
and class circumstances.” This “interplay between
life choices and life chances” (Cockerham
2005:60), in which people choose lifestyles from
among available options, is fundamental to health
lifestyles theory but has not been empirically docu-
mented. We seek to address these gaps through a
study that situates families within community col-
lectivities and creates space for new understandings
of health, health behaviors, and health lifestyles to
arise from the data.
This study’s goals are to (1) articulate an induc-
tive model of the components of children’s health
lifestyles in two middle- to upper-middle-class
communities and (2) identify predominant health
lifestyles for community children, how they are
chosen, and potential longer-term implications. Our
qualitative interview, observational, and focus
group data from families with elementary-aged
children show that through health lifestyles, parents
attempt to shape children’s everyday lives in multi-
faceted ways that they imagine will affect long-
term well-being. Children’s health lifestyles are
distinct from adult lifestyles because they blend
parent and child identity expression and because of
the salience of later life for understanding how and
why they form.
We articulate an inductively derived theoretical
model of the components of children’s health life-
styles and describe their predominant types in study
communities. As Cockerham (2023) and others
(e.g., Krueger et al. 2009; Mollborn and Modile
2022) have foreshadowed, this model integrates
with and expands the standard definition of health
lifestyles beyond health-related behaviors to
include understandings of health and health-related
norms, narratives, and identities. Although we rely
primarily on interviews, multimethod data incorpo-
rating observed behavior, private narratives, and
public talk document parental identity work, com-
munity structures and normative processes, and
child identity expression. Through health lifestyles,
parents, schools, and communities together influ-
ence children’s behaviors, identities, and futures.
Health lifestyles are thus a pathway through which
social and health advantages persist across lives
and generations.
Background
The Transmission of Advantage in Early Life
U.S. socioeconomic inequalities have been increas-
ing, and intergenerational class mobility lags behind
that of peer countries (Saez 2008). Life expectancy
is falling (Muennig et al. 2018), and links between
socioeconomic status and health are tightening
(Masters, Hummer, and Powers 2012). Two impli-
cations of these trends motivate health lifestyles
research. First, strong processes transmit social
advantage and disadvantage across lives and gener-
ations. Lifestyle factors are important for under-
standing socioeconomic disparities in later health
(Puka et al. 2022). Second, socially advantaged par-
ents are experiencing increasing pressures to pre-
serve
children’s
socioeconomic
and
health
advantages to avoid worsening circumstances
among the disadvantaged (Link and Phelan 1995;
Nelson 2010). Alongside structural phenomena,
such as the intergenerational transmission of wealth
and persistent residential segregation, research has
focused on family processes—including health-
related parenting (Augustine, Prickett, and Kimbro
2017; Christensen 2004)—to understand intergen-
erational replications of social advantage. Indeed,
both healthy behaviors and socioeconomic advan-
tage are increasingly being consolidated in families
(Maralani and Portier 2021). The life course per-
spective, including theories on accumulation and
transmission of advantage, often grounds this work
(Elder 1994).

4
Journal of Health and Social Behavior 66(1)
Health Lifestyles
Contemporary intensive parenting and child iden-
tity development are manifested in health lifestyle
formation. Although children are infrequently
addressed, a long-standing literature has examined
individuals’ lifestyles as manifestations of social
class and other conditions. A lifestyle is an individu-
al’s collection of everyday behaviors, expressing
group-based identity, regulated by group norms, and
constrained by social structures (Cockerham 2013).
Social class results in a specific set of lifestyle
options being available, and individuals choose
among them as an expression of group membership
(Weber [1922] 1978). Cockerham (2005) and others
(e.g., Frohlich and Potvin 1999; Mollborn et al.
2014) have focused specifically on health lifestyles,
defined previously, as a core domain of lifestyles.
Previous research on health lifestyles focused on
adults can be extended to children. Children have
relatively less control over their health lifestyles but
exercise agency and express identities in conjunc-
tion with parental control (Pugh 2014).
National quantitative studies measuring behav-
iors abound, but little research examines health life-
styles in specific contexts or collectivities
(Cockerham 2023). One quantitative study found
that health lifestyle behaviors cluster in localized
ways (Lee et al. 2015), and another mapped health
lifestyles in two schools (adams et al. 2021). A
qualitative study found that Scottish adults under-
stood health lifestyles as reflecting identity and
lived experience (McGarrol 2020), and another
contrasted Norwegian youths’ health lifestyle for-
mation by class standing (Eriksen et al. 2024).
Research has not empirically documented aspects
of health lifestyles beyond behaviors or how people
choose them based on locally available options.
Health lifestyles are not just a resource for
future health but also a cultural symbol that itself
generates inequalities (Mollborn, Lawrence, and
Saint Onge 2021). Korp (2008) emphasized the
symbolic power of “healthy” lifestyles as both
manifestations of inequality and phenomena that
create inequality. Shared notions of “healthy” or
“unhealthy” lifestyles legitimize some behaviors
and delegitimize others. Lifestyles are an effective
form of class distinction (Abel 2008; Bourdieu
1986a), especially because of the increasing moral
value being placed on health (Luna 2019). Indeed,
laypeople consider “healthy” lifestyle behaviors
crucial to well-functioning families (Williamson
et al. 2018). Because parenting, like health, has strong
moral dimensions (Shirani, Henwood, and Coltart
2012), children’s health lifestyles create class dis-
tinctions (Mollborn, Rigles, and Pace 2021). Class-
advantaged parents use food to teach classed values
about discipline and enact distinction, linking nar-
ratives and behaviors (Elliott and Bowen 2018;
Fielding-Singh 2019; Wills et al. 2011). These pro-
cesses have longer-term implications, as Eriksen
et al. (2024:149) wrote: “The dense integration of
health lifestyle and family life instils a rigorous
health orientation in the upper-class child’s habitus,
a bodily disposition for health practices equipping
them to live—and to wish for—a healthy lifestyle
now and as they grow older.”
Conceptualizing lifestyles as a blend of struc-
ture and agency (Cockerham 2005), we find that
children’s health lifestyles are rooted in parents’
expansive understandings of health, which blur
boundaries across physical and psychological well-
being, social integration, and academic achieve-
ment (Pace, Mollborn, and Rigles 2022; Warner
2010). They are broader than researchers’ implicit
understandings of health when operationalizing
health lifestyles. Health lifestyles encompass chil-
dren’s behaviors (including traditional health
behaviors and others linked to wider conceptualiza-
tions of health, such as socializing and doing home-
work). Although content likely varies, norms in the
communities that we studied prescribe that chil-
dren’s health lifestyles must reflect substantial
parental identity investments and coherent parent-
ing narratives articulating the lifestyle’s benefits for
health, well-being, and future success. Children’s
identity expression is also dictated by community
norms. Health lifestyles create advantages for chil-
dren while simultaneously reaffirming parents’
advantaged class standing. Health lifestyles likely
have implications for socioeconomic attainment,
health, and future lifestyles and identities, fueling
the intergenerational perpetuation of inequalities.
Parenting and Inequalities
The literatures on health lifestyles and parenting
converse infrequently, and this study exemplifies
how they can inform each other. Parenting practices
reproduce advantages, instilling cultural, social, and
human capital and setting children up for success or
failure in interactions with social institutions
(Bourdieu 1986b; Lareau 2011) in what parents
view as an uncertain world (Nelson 2010). Structural
opportunities heavily constrain these practices.
Class-advantaged parents leverage resources to
select structures considered beneficial for children,
such as residential areas, child care, and schools

Mollborn et al.
5
(Augustine, Cavanagh, and Crosnoe 2009; Lareau,
Evans, and Yee 2016; Mirowsky and Ross 2015).
Beyond “status safeguarding” (Milkie and Warner
2014) via institutions, resource-advantaged parents
typically raise children in ways that intensify their
likelihood of future success. Schneider, Hastings,
and LaBriola (2018) identified larger class dispari-
ties in parental financial investments in children in
states with higher income inequality, driven by
increases among highest income parents.
This exemplifies “intensive parenting,” a strat-
egy in which advantaged parents, especially moth-
ers, leverage abundant resources to instill cultural
capital, health, and educational benefits in children
(Bourdieu 1986b; Hays 1996; Shirani et al. 2012).
Analyses of mothers’ time investments with chil-
dren suggests that they matter for academic and
behavioral outcomes (Fomby and Musick 2018).
Calarco (2014) found that parents’ strategies repre-
sented deliberate mobilization of class privilege. A
backdrop of growing economic insecurity height-
ens parents’ sense of risk (Cooper 2014).
Group-based identities (Stets and Burke 2000)
shape parenting. Collett, Vercel, and Boykin (2015)
articulated parenting identity processes for fathers.
A parent has a socially influenced identity standard
for a “good parent” and seeks to align their parent-
ing behaviors with the standard to minimize discrep-
ancies and verify their identity, reducing negative
emotions and social judgments and increasing posi-
tive ones. The more flexible the identity standard is,
the more leeway there is to avoid negative repercus-
sions. Tsushima and Burke (1999) emphasized the
importance for parenting identity of aligning parent-
ing tasks such as managing children’s time with
abstract goals like fostering autonomy. Resources
facilitate this alignment. Children’s identity expres-
sion can also intervene to complicate parents’ efforts
(Chin and Phillips 2004). Pugh (2009) found that
children pursued goals such as engaging with popu-
lar culture and being independent from adults’ con-
trol, which often conflicted with adults’ goals.
Expanding research on agency to include often
overlooked groups like children is important for life
course theory (Landes and Settersten 2019).
Health is not directly addressed in much parent-
ing literature, but some studies incorporate it.
Intensive parenting among socially advantaged par-
ents can be “individualist parenting” (Reich 2016),
reflecting a parent’s vision for the child’s future in
ways that are guided by experts but do not always
follow standardized recommendations. This can
sometimes result in advantaged parents making
child health decisions not driven by medical
interpretations of the child’s best interests (King,
Jennings, and Fletcher 2014; Reich 2016).
Data and Methods
Data and Procedures
To understand the empirical scope of health life-
styles, this study’s design was different from typical
health lifestyle approaches that focus on a specific
set of physical health-related behaviors and their
frequencies. We sought to collect qualitative data on
children’s health lifestyles, avoiding imposing pre-
existing notions around what constitutes health and
health behaviors for parents, what children’s health
lifestyles consist of, and whether parents talk about
health lifestyles. Recruitment materials said the
study was about “parents, kids, and well-being.”
Data collection strategies, procedures, and instru-
ments were refined through pilot research. The data
combined in-home family observations, parent
interviews and focus groups, and key informant
interviews in two neighboring middle-class com-
munities in the U.S. West—“Greenville” and
“Springfield”—from September 2015 to May 2016.
(All names and some potentially identifying details
have been altered.) Our primary data source was 55
parent interviews: 35 with parents who also partici-
pated in a home observation (N = 30 families; in 5
families, both parents requested to be interviewed
together) and 20 with parents who only participated
in an interview. We conducted six focus groups
(three for each community), including 21 parents
(some of whom had also done interviews and/or
observations). The nine key informants interacted
with families in the local area (e.g., sports coaches,
pediatricians, teachers). The 30 observation families
(typically observed from the end of school to the
start of the bedtime routine on one school night)
included a fourth or fifth grader age 9 to 11. Parents
in other interviews and focus groups had at least one
elementary-age child. We chose these ages because
family influences are still substantial but have been
joined by peers, school, and child agency.
We abductively revised our study design in
response to emergent evidence and methodological
considerations (Timmermans and Tavory 2012),
changing our sampling strategy to better balance
community data collection and create community-
specific parent focus groups. Our broad-based recruit-
ment strategies were designed to diversify the sample
(Lofland and Lofland 2006). Rather than relying pri-
marily on snowball sampling, we recruited partici-
pants online and through local parenting email

6
Journal of Health and Social Behavior 66(1)
listservs, personal contacts, referrals, and public fly-
ers. A few participants recommended the study to oth-
ers. When we reached 10 parent interviews from a
school, we stopped collecting data from its families.
The resulting nonrepresentative sample was sociode-
mographically varied, included many neighborhoods
and social networks, and incorporated families from
23 elementary schools and homeschoolers.
Our data collection team included one faculty
member and two graduate students (all White
women) and three undergraduates (an African
American woman, an Asian American man, and a
White man). Families received $200 for a home
observation with interview, and other participants
received $50. The study received institutional
review board approval. The faculty member or grad-
uate student conducted interviews and focus groups,
which were audio recorded and transcribed. The
semistructured interviews started with questions that
did not prompt about health, regarding the child’s
daily routine, how parents navigate the child’s pref-
erences, how their child’s life compares to their own
childhood, what parenting messages they try to con-
vey, and what parenting is like in their community.
Parents’ strong focus on health emerged unprompted
in these sections. Later, we prompted about health,
including how parents define “health” and “well-
being,” what shapes children’s health, and so on.
Observations were conducted by either the faculty
member or a graduate student and an undergraduate.
Observers followed different family members in dif-
ferent spaces, yielding two sets of field notes for
many interactions and one for others.
Parent participants’ average age was 43, and
80% were mothers. Seventy-seven percent were
married, 17% were divorced/separated, 4% were
single, and one parent was widowed. Eighty-six
percent of parents identified as White, 8% identi-
fied as Asian American, and 6% identified as
Latino; a substantial minority were foreign-born.
Children were 2 to 15 years old, with most in fourth
or fifth grade. Based on reported parent and partner
education and occupation and housing quality in
the family observations, we coded 59% of families
as upper-middle class, 29% as middle-class or
mixed (e.g., higher education but lower income),
and 12% as working class or poor. Most parents had
grown up in a similar social class as measured by
parental occupations, but some were class-mobile.
Field Sites
The study’s communities, both midsized cities in
the same large metropolitan area (U.S. Census
Bureau 2017), were middle- to upper-middle-class.
They were demographically quite similar, with
median household incomes close to the state aver-
age and high proportions of residents identifying as
White. Middle-class Springfield was more socio-
economically and ethnically diverse than upper-
middle-class Greenville; its median housing value
was half as high, and half as many residents had a
bachelor’s degree (U.S. Census Bureau 2017). Both
communities had unusually high rates of positive
health behaviors and low obesity rates and were
located in a geographic region that was considered a
politically liberal health mecca attracting highly
educated new residents.
Analysis
Electronic copies of transcriptions and field notes
were manually coded using NVivo qualitative soft-
ware and summary spreadsheets. Analysis of themes
reported here was inductive: We had no a priori
expectation about what children’s health lifestyles
consisted of, how health or health behaviors were
defined, or how they would vary. We analyzed
observational field notes together with parent inter-
views to compare personal accounts to observed
behaviors, allowing themes to arise organically and
coding for some predetermined themes. People’s
public and private accounts and behaviors are often
inconsistent in sociologically meaningful ways
(Swidler 2001). Because the communities’ health
lifestyles were similar even though distribution and
degree varied, we combined the communities here.
We viewed the interviews and focus groups as
opportunities for participants to actively construct
narratives (Holstein and Gubrium 1995). Through
narratives situated in specific social contexts, people
construct identities, justify actions, and manage oth-
ers’ impressions (Swidler 2001). Narratives, which
shed light on norms, individual and group identities,
and inequalities, turned out to be an important aspect
of children’s health lifestyles. Our goal was not to
adjudicate whether parenting, specific health life-
styles, or their consequences are good or bad.
Results
Many parents were familiar with the idea of a
healthy lifestyle, and there was some unprompted
use of the term. But mostly parents broadly articu-
lated “the way we raise them” (in Laura’s words),
often with eloquent narratives, identity statements,
and nuanced understandings of health and commu-
nity norms underlying the behavioral routines they

Mollborn et al.
7
carefully fostered and repeatedly linked to health
and well-being. Grounded in these data, we induc-
tively modeled the components of children’s health
lifestyles as articulated by parents and described
prevalent types in the study communities.
Components of Children’s Health Lifestyles
We found that children’s health lifestyles combine
behavioral and nonbehavioral aspects. Dan, a
White, upper-middle-class Springfield father, illus-
trates this complexity when describing 11-year-old
Brittany’s typical weekday routine:
She gets to sleep in. She gets to get a nice
homemade breakfast. We walk to school. I
personally—Mary [Brittany’s stepmother] and I
both feel—it’s a much better life for a child to
get a good, full night’s sleep and start the day
with a good breakfast. Have some family time . . .
organic, cage free, all that good stuff.
In representing Brittany’s everyday lifestyle, Dan
makes health salient and blends behavioral routines
with narratives, representing his parent identity, that
underlie and justify them. Dan continues, “Mary
and I are both—I will call it old-fashioned—but we
eat dinner together. I don’t answer the phone; nei-
ther of us will answer the phone at dinnertime. So
we talk during dinner, and we spend a lot of quality
time together, not just being under the same roof.”
Mealtime behaviors express his and Mary’s “old-
fashioned” identities. Dan implicitly distinguishes
his family’s lifestyle from his idea of a typical mod-
ern family that he believes eats separately.
Dan continues with a parenting narrative on
boundary setting, which he links to well-being
throughout his interview.
And ever since Brittany was really little, I’ve
always been—what’s the word? Fanatical? I
think kids do better with consistency, and you
can also add into that, boundaries. So she’s
always had a set bedtime, which has obviously
gotten a little later as she’s gotten older. . . . And
I think all human beings operate better, function
better with a routine.
Dan does repeated narrative work to distinguish his
parenting favorably from that of other parents,
whom he views as overly hands-off. He also
acknowledges the importance of community for
facilitating his desired health lifestyle: “One of the
reasons I bought this house is, it’s close to the ele-
mentary school, it’s close to middle school, it’s
close to the high school. So since she’s an only
child, I wanted her to grow up with a lot of friends in
her neighborhood that she would get to know all
through school.” Mary and Dan organize their work
schedules and exercise time to maximize interaction
with Brittany. We observed rooms dedicated to her
hobbies. Manifesting Dan and Mary’s parenting
identities and representing a broad understanding of
health from sleep and diet to family interactions and
peer contact, Brittany’s everyday routine is care-
fully curated to create a health lifestyle that they
believe sets her up for future success.
Reflecting this example, Table 1 describes our
inductively derived model of the components of
children’s health lifestyles. As contemporary health
lifestyles theory posits (Cockerham 2023), they
combine health behaviors and multiple nonbehav-
ioral aspects. Qualitative research on young adults
has suggested that “not just health behaviors, but
identities, narratives, norms, and understandings of
health [are] core aspects of health lifestyles”
(Mollborn and Modile 2022). But previous scholar-
ship has not systematically demonstrated how these
aspects integrate to create health lifestyles or form in
the interplay among parents, children, and commu-
nity collectivities. We address each aspect in turn.
Understandings of health (parent).  The first com-
ponent of children’s health lifestyles, understand-
ings of health, undergirds the others. As described,
our previous research (see Pace et al. 2022) has
articulated these expansive understandings of chil-
dren’s health that parents draw on to craft children’s
health lifestyles, including behaviors, identities,
narratives, and norms. Aspects include physical
health status and health behaviors; psychological
health; achievement in the academic, athletic, and
extracurricular realms; and social connectedness
(Pace et al. 2022). Sofia articulated such a multifac-
eted understanding: “I think everything has to be in
Table 1.  Inductively Derived Components of
Children’s Health Lifestyles.
Health Lifestyle Components
1. Understandings of health (parent)
2. Health behaviors (child)
3. Parenting narratives (parent)
4. Identities (parent and child)
5. Norms (community collectivities)

8
Journal of Health and Social Behavior 66(1)
balance to be healthy . . . I think it’s important to
have friends, it’s important to exercise, it’s impor-
tant to eat well, it’s important to . . . .” Her husband
jumped in: “to know other cultures.” Similarly,
Emma said, “Mental and emotional [health] is really
important, so we kind of focus on stress, health, and
healthy lifestyle.”
Health behaviors (child).  The previously empiri-
cally documented aspect of children’s health life-
styles is their health behaviors. Reflecting parents’
expansive understandings of health, we found that
parents related a wide variety of child behaviors to
health, including those typically related to physical
health, like diet and exercise, but also those related
to psychological well-being, academic achieve-
ment, and social connection. Brittany’s lifestyle
described previously is one example, as are Linda
and her 9- and 11-year-olds. Self-describing as
“probably an average family, average parent,” Linda
details her efforts to oversee a wide variety of
health-related behaviors in her children, focusing on
nutrition, sports participation, unstructured play,
sleep, curbing behaviors that she fears can lead to
food and technology addictions, and managing
behaviors that she relates to psychological resil-
ience, self-esteem, and the capacity to learn. We
cannot rigorously investigate the frequencies of
children’s health behaviors with our qualitative
data, a task for future research.
Parenting narratives (parent).  As in Linda’s and
Dan’s interviews, most parents link children’s
health to thoughtful, well-articulated, health-ori-
ented narratives around parenting. In our communi-
ties, intensive parenting—which falls mostly on
mothers, although some fathers, like Dan, are heav-
ily involved—entails constructing a narrative that
justifies their child’s individually tailored health
lifestyle. These narratives are similar to but more
complex and multifaceted than the health lifestyle
narratives class-privileged U.S. young adults (but
not those less privileged) said they had learned from
parents growing up (Mollborn and Modile 2022).
Reflecting other trends toward the neoliberal indi-
vidualization of lives (Reich 2016), parents do not
simply adopt available cultural templates for chil-
dren’s lifestyles. Rather, customized parenting
choices and narrative justifications are expected,
reflecting parents’ unique identities. Resource con-
straints on health lifestyle construction are mostly
invisible in parents’ narratives.
Andrea says her parenting is informed by “a lot
of reading” because “you just want them to be
healthy.” Andrea’s narrative highlights the “con-
stant struggle” of balancing children’s “mental,”
“physical,” and “spiritual” health. She focuses on
“the routines and their structure and how you talk to
them and how you get through those hard days and
nights where everything is just a nightmare. It’s so
key. And it really does pay off.” She responds when
asked if her 8- and 11-year-olds are healthy: “Yeah.
They have friends, they go to birthday parties,
they’re active. Thank God they don’t have ongoing
issues with dyslexia or learning disorders. I’m
blessed. I think they’re both a little overweight, but
I’m sure that will even out.” She went on to discuss
her efforts to “open up a conversation” with her
daughter (but not her son) about balancing her
desire to be sedentary and create art with the need
for cardiovascular activity. Andrea’s narrative pres-
ents her as a health-focused mother who applies
hard work and discipline to parent successfully.
Parents’ narratives complement behaviors and sub-
jective understandings of health as key aspects of
children’s health lifestyles in these class-privileged
communities.
Identities (parent and child).  A child’s health life-
style reflects parents’ identities, represented through
behaviors and narratives in a public way that is
appraised by other community members. But poten-
tial judgment is not the only reason parents’ identi-
ties are highly invested in constructing lifestyles:
Parents view health lifestyles as crucial for shaping
children’s well-being and success. Parent and child
identity expression through children’s health life-
styles is normatively prescribed in these communi-
ties: Parents should determine the best lifestyle to
reflect their identities, and it should also be por-
trayed as aligned with the child’s identity.
Parent identities are palpable throughout their
narratives, such as Andrea’s portrayal of her hard
work to parent successfully around health and
Dan’s self-promoting comparisons of his boundary-
setting efforts to make Brittany’s lifestyle healthier.
Similarly, Dawn discusses at length how her iden-
tity influences her parenting of her 9- and 5-year-
olds, from fostering resiliency and “a deep sense of
self-worth and self-love” to instilling respect and an
understanding of the importance of eating nutri-
tiously. Her narrative repeatedly cites outside evi-
dence that her children’s identities are developing
along these lines, from them happily drinking green
smoothies to a neighbor commenting on how “com-
fortable,” “gracious,” and “well adjusted” they are.
Dawn’s attention to her children’s identity
expressions is typical, but parent and child identity

Mollborn et al.
9
expressions often conflict. Children, by expressing
their own preferences, disrupt the smoothness of
parents’ attempted socialization into lifestyles. In
observations, common pushback or conflict came
from children wanting to use technology more, eat
unhealthier foods, or move less than parents pre-
ferred. Parents and children struggling for control
of children’s behaviors caused tensions. Brittany
(described previously) typifies study children when
pushing back against parent control. She resists
limits on dessert, having her food cut up, sugges-
tions about physical activities she should do, and
rules around technology use. Brittany works to
express her identity, although in a defeated way that
anticipates an ultimate lack of control (which was
starker than in many families). These realities of
child identity expressions complicate the neater
narratives parents often present, such as Dan’s
accounts of Brittany’s compliance.
Further complicating these dynamics, many par-
ents in our sample articulate a norm that a health
lifestyle should reflect the child’s identity. Parents
often work hard to make children’s behaviors both
fit their parent identities and credibly appear to
reflect the child’s identity. Christine describes the
intensive parenting efforts involved in accommo-
dating 10-year-old Noah’s preferences:
It took us a long time to find something Noah
wanted to do. When he was younger we had him
in gymnastics, tae kwon do, swimming. We tried
everything until we hit soccer, and then he just
loved it. So he really didn’t want to do anything
else until he hit basketball. And so now his entire
focus is basketball and soccer. And that’s what
he wants. . . . So all that is his choice.
Christine describes Noah’s sports involvement as
“his choice,” but Noah’s agency was actively con-
structed and constrained by his parents repeatedly
enrolling him in sports until he found two he enjoys.
Noah is being pressured to “prefer” a health lifestyle
that involves “loving” playing multiple sports. He
likely understood that his parents’ efforts to put him
on sports teams would not cease until he chose two
sports, which constrains his identity expression
even as Christine portrays him as choosing.
It would have been far easier for Christine sim-
ply to choose two sports, so she is expending con-
siderable effort to encourage Noah’s identity
expression. Thus, even though children’s identity
expression often causes problems for children’s
enactment of their parents’ preferred behaviors,
parents encourage it as an important facet of
middle-class health lifestyles. Participants differ,
however, in how highly they prioritize children’s
identity expression (see the following).
Norms (community collectivities).  Community, or
collectivity, norms are the final component of chil-
dren’s health lifestyles that we identified. They reg-
ulate what is acceptable in other aspects and are
tools used by parents to reinforce lifestyles. Many
parents explicitly rely on community norms to rein-
force their chosen lifestyle. Nick describes health-
related norms in Greenville as a draw for moving
there, such as valuing “exercise and organic and
growing food in your backyard . . . I feel like my
fifth grader, after being in a Greenville school, has
been fairly indoctrinated about the food, which I
never was growing up. You know, the food groups,
and creating a healthy meal, and eating different
colors when we’re eating, and the importance of
that.” Nick feels that strong norms in his son’s
school reinforce his health lifestyle.
Yet community norms can threaten chosen health
lifestyles, such as when an “achievement of indepen-
dence” lifestyle is condemned by other parents (see
the following). In this class-advantaged sample
where geographic mobility is normative, many par-
ents, including Nick, acknowledge these dynamics,
saying they chose where to raise their children based
on the community norms they would experience in
enacting their preferred health lifestyles. This exem-
plifies the formation of “overrider enclaves” resist-
ing the “default American lifestyle” posited by
Mirowsky and Ross (2015). Thus, parent preferences
can shape the community norms in the child’s life-
style. Hector says of Greenville’s norms that encour-
age healthy eating and physical activity, “We brought
them [the children] to the environment where the
values we valued are there. And they are getting
them, not just from us, which in hindsight has been
amazing. But it’s sort of what brought us here,
right?” Although she can feel judged for her lifestyle
approach (see the following), his wife, Sofia, echoes,
“I feel we have a lot in sync with other parents and
the way they teach their children here.” Many par-
ents note synergies or tensions between community
and family in fostering health lifestyles.
Parents sometimes acknowledge that commu-
nity resources facilitate norms. A Greenville focus
group parent described the community as “family
oriented.” Another parent tentatively linked that to
resources: “I wonder if it has something to do with that
it’s a more affluent community, and so, you know,
there’s more free time maybe, or more ability for
parents to be involved because they’re not trying to

10
Journal of Health and Social Behavior 66(1)
drag all of their jobs.” The first parent concurred,
and a third noted that “all that land”—public open
space—contributed to community cohesion and
norms. Parents’ understanding of community
aspects of children’s lifestyles is often nuanced,
articulating selection and causation and relating
resources to norms.
Localized Health Lifestyle Options
Understandings of health, behaviors, narratives,
identities, and norms together comprise children’s
health lifestyles, but the lifestyles’ actual content
varies within our sample. As health lifestyle theory
suggests, community norms prescribe that parents
should intensively construct a deliberate lifestyle
for their children from among acceptable options.
Before articulating differences, we emphasize that
these middle-class communities’ predominant life-
styles have important similarities in health-related
norms: (1) a strong focus on nutrition, exercise, and
academic achievement; (2) intensive parenting
efforts required to sustain the lifestyle; and (3) the
high salience of the child’s future for their health
lifestyle.
We summarize the four prevalent health life-
styles in our communities, primarily illustrated
using four families. Table 2 articulates the lifestyles
and the two dimensions that differentiate them: the
relative importance of parent versus child identity
expression and the relative focus on the future ver-
sus present. Although most parents blend elements
of multiple health lifestyles in constructing a life-
style, most children’s lifestyles primarily fall into
one type. We argue that the interweaving of differ-
ent health lifestyle components (understandings of
health, behaviors, narratives, identities, and norms)
strengthens the power of these lifestyles, likely
making them more effective for transmitting class
advantage into adulthood than a lifestyle solely
composed of behaviors would be.
We expect that different communities likely con-
tain different prevalent children’s health lifestyles
because societal notions around parenting intersect
with community demographics and localized cul-
tures (see Brown-Saracino 2015). Our communities’
cultural focus on physical health, athleticism, and
outdoor activities shapes health lifestyles, poten-
tially making them more salient for parenting than
elsewhere and attracting new families who seek
Table 2.  Typology of Childhood Health Lifestyles and Selected Associated Behaviors and Parent
Narratives Documented in Our Middle- to Upper-Middle-Class Communities.
Whose Identity Expression Is Prioritized?
Prevalent Behaviors and
Attitudes

Parent
Child
Temporal focus?
    Long-term
Elite achievement
lifestyle
Achievement of
independence
lifestyle
Behaviors: more structured
exercise, less unstructured
play, more (implicit) body
regulation
Narratives: competencies/
achievement focus
    Short-term
Family connection
lifestyle
Let kids be kids
lifestyle
Behaviors: more
unstructured exercise and
play, less body regulation
Narratives: well-being/stress
focus
Prevalent behaviors
and attitudes
Behaviors: more
restricted technology
use
Narratives: focus on
parents developing
child identity, parents
feeling less alone and
more successful
Behaviors: less
restricted technology
use
Narratives: focus on
child developing own
identity, parents
feeling more alone
and worried about
being successful

Mollborn et al.
11
such lifestyles. Family and community resources are
also important for enabling these lifestyles. The pre-
dominant lifestyles that we identify likely appear in
some other communities but are presumably joined
by additional lifestyles yet to be identified.
Elite achievement.  The most prevalent, norma-
tively dominant, and typically most resource-intensive
health lifestyle for community children, the “elite
achievement” lifestyle, combines a future-oriented
focus on skill building with high levels of parental
identity expression in everyday interactions (see
Table 2). Achievement is part of parents’ under-
standings of child health (Pace et al. 2022). Parents
from upper-middle-class childhood backgrounds
were disproportionately represented in this health
lifestyle. The elite achievement lifestyle has much
in common with Lareau’s (2011) “concerted culti-
vation” parenting style, which involves heavily
structured time spent on extracurricular activities
and school achievement. Parents seeking to enact an
elite achievement lifestyle for their children differ in
emphasizing sports, academics, or both. Unstruc-
tured playtime and technology use are limited. They
view their child’s current success, including in
achieving a fit body, as linked to future well-being
and sometimes compromise children’s current
health and stress levels to achieve these goals (Moll-
born et al. 2021). However, like parents in other life-
styles, they tend to view it as expressing their
children’s preferences and making them happy.
Elite achievement parents feel that they are crafting
a “normal” health lifestyle for their child and tend to
view their parenting as relatively successful.
For example, Laura and 10-year-old Jacob are
from a White, upper-middle-class Greenville family.
Laura says, “I feel like so much of our peer group is
pretty homogeneous” in their parenting and that she
follows the dominant norm. Jacob is “very active,”
playing on multiple sports teams many seasons and
doing supplemental academic work. Laura empha-
sizes Jacob’s identity expression in his lifestyle:
“My ultimate goal for my son is really just to have
fun with his activities.” She also links Jacob’s extra-
curricular involvement to future success: “If you
don’t get in on the ground floor in some of these
sports, you’re never going to have a shot at playing
in college.” Laura worries about the academic impli-
cations of Jacob’s problematically “too easy” work-
load, although he enjoys having little homework.
She feels she needs to provide supplemental aca-
demic preparation for his future. Finally, like parents
in other health lifestyles, Laura connects Jacob’s
health lifestyle to parent and child identities: “We’ve
just always gone really hard. Like, I just go really
hard. Their dad goes really hard. And that’s just kind
of the way we raise them. Yeah, a rolling stone gath-
ers no moss.” Similarly, Kaya enrolled a sometimes
reluctant 9-year-old Madeline in multiple sports to
combat overweight and her physical tendency to
“do the minimal amount of work necessary” while
also being “extremely involved” in fostering
Madeline’s academic achievement and interest in
nutritious cooking.
Achievement of independence.  Like elite achieve-
ment, the “achievement of independence” health
lifestyle focuses on the future and achievement, but
it emphasizes child identity expression in everyday
activities, working toward a distinct goal: the child’s
independent acquisition of skills and maturity to
facilitate successful adulthood. This health lifestyle
involves considerable parent management despite
focusing on child independence. Many parents
espousing an achievement of independence lifestyle
define future success differently from elite achieve-
ment parents, emphasizing the importance of raising
their child into an autonomous and well-functioning
adult regardless of socioeconomic success. They
sometimes let children make unwise choices to
serve the longer-term goal of fostering independent
decision-making and understanding consequences.
Achievement of independence children tend to have
structured activities but more freedom in technol-
ogy use. Parents typically feel more alone in their
parenting choices.
Jasmine, Aaron, and 9-year-old Evie belong to a
multiracial working- to middle-class Springfield
family. Aaron said, “We are super intentional with
what we do with the kids.” Evie does more chores
than most study children, often toward a stated goal
of fostering adult skills. When Evie asks Aaron
whether she is “done now” with toothbrushing,
Aaron responds, “You’re getting to the age where
you can decide if you’re done or not. Like, you
can’t keep on coming to me as an adult and be like,
‘Is two minutes long enough to brush?’ . . . I mean,
you have to answer these questions for yourself.”
Whether Evie brushes her teeth long enough today
is secondary to the future-oriented goal of indepen-
dently enacting appropriate health behaviors.
Jasmine is clear about the lifestyle they foster: “I
feel like we are ‘free range,’ if you want to put
labels on all these things. We really give our kids
the opportunity to learn by themselves. Not neces-
sarily alone, but I’m going to watch you try that and
see if you can do it.” Aaron articulates their goal of
future independence and competence: “I want her

12
Journal of Health and Social Behavior 66(1)
to be confident. I want her to be able to choose col-
lege if she chooses. I want her to choose to travel if
she wants to.” They feel on track with meeting
these goals because “I feel like she’s healthy in her
head, where she knows pretty much who she is.”
Yet Jasmine and Aaron sometimes feel the sting
of others’ judgement, suggesting that achievement
of independence is less normative than elite
achievement. Describing an outdoor interaction
with a hovering parent, Aaron says, “If I see you on
top of your kid, it’s not a big deal to me. But if they
see us letting the kids go, they definitely have to say
something [negative to me]. I just don’t understand
that.” Similarly, Sofia schedules many activities for
her children and seeks to instill hard work, but
when they are with other children, if “they’re not
getting into really dangerous situations, I let them
be.” She thinks friends judge her for “giving our
children too much freedom” and says “you get that
little smirk” from other parents.
Family connection.  The third prevalent health
lifestyle combines the focus on parent identity
expression that is similar to elite achievement with a
new parenting dimension: emphasizing the child’s
present over the future. Sometimes in explicit or
implicit resistance to elite achievement, “family
connection” parents prioritize current well-being
and lower stress over future considerations,
achieved by fostering social relationships, particu-
larly with family. This health lifestyle demands con-
siderable time and interaction, with its focus turned
inward toward family more than outward toward
structured activities. Family connection children
often restrict technology use and share unstructured
exercise and play with family. Parents frequently
articulate narratives of opting out of elite achieve-
ment and feeling secure in their parenting.
Sharon and 9-year-old Finn are in a White, mid-
dle- to upper-middle-class Springfield family.
Sharon’s family spends lots of time together engag-
ing in healthy behaviors: “The more we can be out-
doors together, the better. . . . We like to ski together
as a family and do little trips together.” Finn plays
on a traveling sports team. Although this activity
could signal elite achievement, Sharon situates his
involvement within their family connection life-
style, saying, “I love [traveling overnight to games
for] soccer because it has brought us together as a
family.” Sharon restricts Finn’s extracurricular
reading—supplemental academic preparation that
could foster future socioeconomic success—when
it threatens their “family time.” Like other family
connection parents, Sharon directly links her
parenting identity to family members’ healthy
lifestyles:
I think being healthy is having enough fresh air
in your day and having good food to eat, having
exercise, having family time, having friend time.
I feel that’s what I do in my life. For myself and
my family, I try to puzzle together—like balance
it out, so that we’re all getting nourished on all
those levels. . . . And sometimes it’s unbalanced.
So it’s like, okay, we need to have some family
time . . . I kind of orchestrate it, I think, in our
family.
Sharon carefully “orchestrates” balance in her fam-
ily to improve current well-being and health, talking
about “family time” as an antidote to stressors and
imbalances. Similarly, Mark and Rachel curtail tech-
nology use and encourage joint physical activities to
create more family time with their 7- and 9-year-
olds. Rachel says, “The message is that you’re a part
of this family, and you need to contribute. And that’s
part of how we are great together. There’s this mes-
sage that we work together, and it’s great, and we all
need to help each other.” Although many family con-
nection parents discuss opting out of some high-
pressure goals for their children’s future to reduce
stress, be healthier, and increase family interaction
time, they view their health lifestyle as equally inten-
sively constructed and challenging to maintain.
Let kids be kids.  The fourth health lifestyle simi-
larly focuses on present mental health and stress
levels, but the child’s identity expression, more than
the parents’, is considered crucial for well-being.
Despite some similarities to Lareau’s (2011) working-
class “accomplishment of natural growth” parenting
style, “let kids be kids” parents intensively manage
children’s lives, constructing the lifestyle to accom-
modate child preferences. Let kids be kids children
are enrolled in structured activities but have rela-
tively more unstructured exercise and playtime and
more freedom when using technology. Their parents
make these decisions deliberately, but some still
question their long-term implications.
Anna and 10-year-old Chloe are in a White,
upper-middle-class Greenville family. Anna articu-
lates her parenting goal as inculcating “that feeling
of, you’re okay just the way you are. . . . And every-
body has a unique gift to offer, and you just have to
figure out what it is.” These statements foreshadow
the future but foreground current well-being and
child identity expression. Anna says that like her,
Chloe is “introverted” and “usually wants to just

Mollborn et al.
13
come home after school” instead of going to sports
and playdates. Anna “puts [her children’s] prefer-
ences first,” but because Chloe has trouble making
friends, Anna has decided to schedule one playdate
a week with a friend of Chloe’s choosing. Chloe
wants to join a traveling sports team that Anna
thinks is “very intense, and I’m a little concerned . .
. but she loves this team. So we’re just going to go
for it.” Reflecting this lifestyle, Anna helps Chloe
express her identity even when privately critiquing
her choices. Yet Anna sounds conflicted when com-
paring herself to elite achievement parents—an
indication that this lifestyle may be less normative
in Greenville—worrying that her friends’ daughter
“is going to, like, Princeton or something, and
maybe I should be pushing more.”
Like Anna, Julie goes to great lengths to facili-
tate 9-year-old Callie’s identity expression. Callie
participates in multiple sports, and their family
focuses on nutrition, but self-expression is core to
Julie’s narrative. She says, “It’s very, very impor-
tant for Callie and I that she expresses herself. . . .
We believe in self-control and self-regulating as a
way of teaching her self-care. . . . It’s very impor-
tant that she knows when she’s in a situation that is
not okay, that she can speak up.” Reflecting this
emphasis, Julie says Callie is allowed several “per-
sonal days” when she can choose to miss school,
and there are no parental controls on family techno-
logical devices.
Discussion
Implications for Inequalities
This qualitative study innovates by documenting the
components and prevalent types of child health life-
styles in two middle-class communities. Well-
developed theory has posited that health lifestyles
extend beyond behaviors and that people choose
lifestyles from among options available by social
status, but empirical scholarship has not docu-
mented whether or how this happens. Our study
starts to bridge this gap, empirically unpacking the
last box in Cockerham’s (2023) theoretical model,
which contains the construct of health lifestyles and
links it to social reproduction. We found that parents
construct expansive understandings of “health” for
their children (Pace et al. 2022), which undergird
children’s health lifestyles that are further com-
prised of health-related behaviors, narratives, iden-
tities, and norms. Parents craft health lifestyles from
among locally available options and in concert with
child identity expression. Parents navigate potential
judgments of their health lifestyle choices and artic-
ulate awareness of community norms that inform
decisions. These lifestyles are likely important for
reproducing families’ and communities’ social,
socioeconomic, and health advantages.
Although our cross-sectional data cannot docu-
ment long-term effects, parents imagine that their
children’s health lifestyles matter for identities and
future lifestyles, health, and socioeconomic attain-
ment. We agree that this is likely. By prioritizing
child versus parent identity expression and present
well-being versus future competencies, parents feel
that their lifestyle choices inform their child’s
futures. Anna’s narrative of “trying to develop a
person who is intrinsically motivated to do this
stuff, not for me” drives her let kids be kids lifestyle
approach. She is attempting both to shape Chloe’s
behaviors and instill an identity that will presum-
ably shape her future lifestyle. Similarly, Laura
teaching her son to “go really hard” is about both
elite achievement and a narrative around discipline
and hard work, which can be used to justify advan-
taged class position (Luna 2019; Mollborn and
Modile 2022). Such mastery of behaviors and self-
presentations that match cultural logics of classed
institutions (Gage-Bouchard 2017) is linked to
socioeconomic attainment (Calarco 2018; Lareau
2011). Despite some differences, all health lifestyle
types in our study communities are class-privileged
and feature intensive parenting, socialization into
entitlement, and development of thin bodies
through diet and physical activity, which facilitate
class distinctions and privilege in adulthood
(Calarco 2014; Mollborn et al. 2021). Thus, con-
structing health lifestyles through behaviors, narra-
tives, identities, norms, and understandings of
health is a mechanism through which class and
health distinctions can perpetuate intergeneration-
ally and across life. Qualitative research comparing
class-advantaged and -disadvantaged young adults
has indeed found this mechanism to be salient
(Mollborn and Modile 2022). Collecting more data
directly from children and following them longitu-
dinally could help articulate these processes.
Implications for Health Lifestyles Research
This study’s effort to harmonize health lifestyles
theory with extant empirical research has research
implications. Most empirical health lifestyles work
is quantitative, using nationally representative data
and latent class analyses with specific health behav-
iors as inputs. This method identifies predominant
configurations of inputs, which researchers label as

14
Journal of Health and Social Behavior 66(1)
prevalent lifestyles in a national population but can-
not adjudicate whether each behavior should be part
of the lifestyle or if behaviors or other components
have been missed. This research has spurred many
advances, such as identifying frequent combinations
of healthy and unhealthy behaviors within individu-
als and articulating life course and network dynam-
ics of health lifestyles (for a review, see Mollborn et al.
2021). More progress is needed in several areas.
First, parents’ expansive understandings of chil-
dren’s health (Pace et al. 2022) justify incorporating
a wider variety of health behaviors. For example,
Cockerham’s (2023) expanded theoretical model
articulates technology use and COVID-related
social distancing as newly important behaviors for
health lifestyles. Behaviors related to psychological
well-being, social connection, and academic
achievement could also be included, according to
our parent participants. Latent class analysis frame-
works can accommodate broad operationalizations.
Second, both theory and our analysis suggest
that health lifestyles research should operationalize
lifestyles more broadly beyond behaviors. We found
that health lifestyles combine understandings of
health and health-related behaviors, identities, nar-
ratives, and norms (Cockerham 2023; Krueger et al.
2009; Mollborn and Modile 2022). Without this
expansive conceptualization, efforts to understand
health behaviors or parenting practices may lack
important context and be difficult to change through
policies. Qualitative research combining public and
private narratives with observations of behaviors
and interactions, as we have done, is promising for
articulating these processes. But quantitative
research can also make strides. On a related topic,
Lankes (2022) conducted latent class analyses iden-
tifying
prevalent
U.S.
intensive
parenting
approaches that incorporated a variety of behavioral
and attitudinal measures from survey data.
Behaviors and attitudes combined in interesting
ways that furthered theoretical understandings. We
argue that appropriate operationalizations of health
lifestyles depend on research context but should ide-
ally be grounded in target individuals’, rather than
researchers’, conceptualizations of health. These
understandings can set boundaries around a study’s
operationalization of health lifestyle by guiding the
selection of behaviors for inclusion and possible
measures of norms or attitudes, identities, and narra-
tives depending on the method.
Third, in moving beyond behaviors, research
can broaden beyond individuals to examine fami-
lies and communities or collectivities. Situating
individuals’ agency within linked lives is important
yet overlooked (Landes and Settersten 2019). And
health lifestyles are by definition collective
(Cockerham 2005; Frohlich and Potvin 1999), an
empirically neglected aspect. We found that par-
ents, children, and communities were all fundamen-
tal to components of children’s health lifestyles.
Although a few studies have examined collective
influences on individuals’ health lifestyles, future
research still needs to move beyond the individual
level to show how lifestyles themselves and their
structure–agency interplay are collective.
Fourth, this study joins a few qualitative and
quantitative investigations (e.g., adams et al. 2021;
Lee et al. 2015; McGarrol 2020) in identifying
localized health lifestyle options. We innovate in
exploring how people negotiate choosing among
options, but more research is needed. Almost noth-
ing is known about how local health lifestyle
options vary systematically or intersect with indi-
viduals’ characteristics when forming a person’s
health lifestyle. Most extant research is conducted
nationally, but theories expect health lifestyles to
play out locally. This means that many aspects of
our findings likely do not apply in socially disad-
vantaged settings. For example, Eriksen et al.
(2024) and Mollborn and Modile (2022) found that
narratives about health lifestyles linked to strongly
health-focused identities were prevalent among
young people from class-advantaged but not class-
disadvantaged
backgrounds.
Health
lifestyle
options should be examined using quantitative data
that include respondents clustered within widely
varying communities, and qualitative research
should document a diversity of local communities.
Eriksen et al’s (2024) longitudinal qualitative study
in Norway is one such step.
We argue that moving health lifestyles research
in these directions, using a variety of methods, can
more fully articulate the power of health lifestyles
for understanding how advantage is perpetuated
across lives and generations and how health life-
styles themselves are a tool that creates and props
up inequalities (Korp 2008). Class-advantaged chil-
dren’s health lifestyles in our communities involve
learning specific behaviors that community norms
deem “healthy” and worthy of reward, which
become embodied through thinness and fitness.
They also entail developing identities organized
around the fundamental importance of expansive
understandings of health and health behaviors,
which are expressed in narratives that link health to
discipline and moral worth. It is this combination of
characteristics, beyond specific health behaviors,
that propels children toward advantaged futures.

Mollborn et al.
15
Understanding health lifestyles in this way
could spur more effective and appropriate policy
efforts. Changing people’s health behaviors is noto-
riously difficult—in part because a target behavior
likely combines with other behaviors within a
health lifestyle that is also comprised of identities,
narratives, norms, and understandings of health.
Returning to Brittany, her behaviors have been
carefully planned and justified by Dan and Mary,
who relate their chosen lifestyle for Brittany to their
own traditional, family-oriented identities and their
moral worth as parents. Policy efforts from
Brittany’s community or school to change one of
her health behaviors are unlikely to succeed unless
they engage with her broader health lifestyle, its
links to both her present and future, her parents’
deep identity investment, her own identity expres-
sion, and the lifestyle’s embeddedness within local-
ized community norms. A successful effort to
change Brittany’s behavior must therefore move
well beyond the individual child and her family—
which is harder to implement but potentially much
more effective. This empirical reality could trans-
late into starkly different policy approaches to inter-
vening in social inequalities and children’s health.
Acknowledgments
We thank Joshua Goode, Fred Pampel, Richard Jessor,
Elizabeth Lawrence, Olowudara Oloyede, Kevin Le,
Andrew Bennett, and Amber Bunner.
Funding
The authors disclosed receipt of the following financial
support for the research, authorship, and/or publication of
this article: This study was supported by National Science
Foundation (NSF) Grants SES 1423524 and 1729463. We
also thank the Eunice Kennedy Shriver National Institute
of Child Health and Human Development (NICHD)-
funded University of Colorado Population Center (P2C
HD066613) and the Lund University Centre for Economic
Demography for development, administrative, and/or
computing support. The content is solely the responsibility
of the authors and does not necessarily represent the offi-
cial views of the NSF, NICHD, or the National Institutes.
ORCID iD
Stefanie Mollborn
 https://orcid.org/0000-0002-6683-9146
References
Abel, Thomas. 2008. “Cultural Capital and Social
Inequality in Health.” Journal of Epidemiology
and Community Health 62(7):e13. doi:10.1136/
jech.2007.066159.
adams, jimi, Elizabeth M. Lawrence, Joshua A. Goode,
David R. Schaefer, and Stefanie Mollborn. 2021.
“Peer Network Processes in Adolescents’ Health
Lifestyles.” Journal of Health and Social Behavior
63(1):125–41.
Augustine, Jennifer March, Shannon E. Cavanagh, and
Robert Crosnoe. 2009. “Maternal Education, Early
Child Care, and the Reproduction of Advantage.”
Social Forces 88(1):1–29.
Augustine, Jennifer March, Kate C. Prickett, and Rachel
Tolbert Kimbro. 2017. “Health-Related Parenting
among U.S. Families and Young Children’s Physical
Health.” Journal of Marriage and Family 79(3):816–32.
Bourdieu, Pierre. 1986a. Distinction: A Social Critique
of the Judgement of Taste. London, UK: Routledge
& Kegan Paul.
Bourdieu, Pierre. 1986b. “The Forms of Capital.” Pp.
241−58 in Handbook of Theory and Research for the
Sociology of Education, edited by J. G. Richardson.
New York, NY: Greenwood Press.
Brown-Saracino, Japonica. 2015. “How Places Shape
Identity: The Origins of Distinctive LBQ Identities
in Four Small U.S. Cities.” American Journal of
Sociology 121(1):1–63.
Calarco, Jessica McCrory. 2014. “Coached for the
Classroom:
Parents’
Cultural
Transmission
and
Children’s
Reproduction
of
Educational
Inequalities.”
American
Sociological
Review
79(5):1015–37.
Calarco,
Jessica
McCrory.
2018.
Negotiating
Opportunities: How the Middle Class Secures
Advantages in School. New York, NY: Oxford
University Press.
Chin, Tiffani, and Meredith Phillips. 2004. “Social
Reproduction and Child-Rearing Practices: Social
Class, Children’s Agency, and the Summer Activity
Gap.” Sociology of Education 77(3):185–210.
Christensen, Pia. 2004. “The Health-Promoting Family:
A Conceptual Framework for Future Research.”
Social Science & Medicine 59(2):377–87.
Cockerham, William C. 2005. “Health Lifestyle Theory
and the Convergence of Agency and Structure.”
Journal of Health and Social Behavior 46(1):51–67.
Cockerham, William C. 2013. “Bourdieu and an Update
of Health Lifestyle Theory.” Pp. 127−54 in Medical
Sociology on the Move: New Directions in Theory, edited
by W. C. Cockerham. Dordrecht, Netherlands: Springer.
Cockerham, William C. 2023. “Health Lifestyle Theory
in a Changing Society: The Rise of Infectious
Diseases and Digitalization.” Journal of Health and
Social Behavior 64(3):437–51.
Cockerham, William C., Brian P. Hinote, Pamela
Abbott, and Christian Haerpfer. 2004. “Health
Lifestyles in Central Asia: The Case of Kazakhstan
and Kyrgyzstan.” Social Science & Medicine
59(7):1409–21.
Cockerham, William C., Alfred Rütten, and Thomas
Abel. 1997. “Conceptualizing Contemporary Health
Lifestyles: Moving beyond Weber.” Sociological
Quarterly 38(2):321–42.

16
Journal of Health and Social Behavior 66(1)
Collett, Jessica L., Kelcie Vercel, and Olevia Boykin.
2015. “Using Identity Processes to Understand
Persistent Inequality in Parenting.” Social Psychology
Quarterly 78(4):345–64.
Cooper, Marianne. 2014. Cut Adrift: Families in Insecure
Times. Berkeley: University of California Press.
Elder, Glen H., Jr. 1994. “Time, Human Agency, and
Social Change: Perspectives on the Life Course.”
Social Psychology Quarterly 57(1):4–15.
Elliott, Sinikka, and Sarah Bowen. 2018. “Defending
Motherhood: Morality, Responsibility, and Double
Binds in Feeding Children.” Journal of Marriage
and Family 80(2):499–520.
Eriksen, Ingunn Marie, Kari Stefansen, Tonje Fjogstad
Langnes, and Kristin Walseth. 2024. “The Formation
of Classed Health Lifestyles during Youth: A Two-
Generational, Longitudinal Approach.” Sociology of
Health & Illness 46(1):137–52.
Fielding-Singh, Priya. 2019. “You’re Worth What You
Eat: Adolescent Beliefs about Healthy Eating,
Morality, and Socioeconomic Status.” Social Science
& Medicine 220:41–48.
Fomby, Paula, and Kelly Musick. 2018. “Mothers’ Time,
the Parenting Package, and Links to Healthy Child
Development.” Journal of Marriage and Family
80(1):166–81.
Frohlich, Katherine L., and Louise Potvin. 1999.
“Collective Lifestyles as the Target for Health
Promotion.” Canadian Journal of Public Health
90(Suppl. 1):S11–14.
Gage-Bouchard, Elizabeth A. 2017. “Culture, Styles
of Institutional Interactions, and Inequalities in
Healthcare Experiences.” Journal of Health and
Social Behavior 58(2):147–65.
Hays, Sharon. 1996. The Cultural Contradictions of
Motherhood. New Haven, CT: Yale University Press.
Holstein, James A., and Jaber F. Gubrium. 1995. The
Active Interview. Vol. 37. Thousand Oaks, CA: Sage.
King, Marissa D., Jennifer Jennings, and Jason
M.
Fletcher.
2014.
“Medical
Adaptation
to
Academic Pressure: Schooling, Stimulant Use, and
Socioeconomic Status.” American Sociological
Review 79(6):1039–66.
Korp, Peter. 2008. “The Symbolic Power of ‘Healthy
Lifestyles .’”Health Sociology Review 17(1):18–26.
Krueger, Patrick M., Tajudaullah Bhaloo, and Pauline
Vaillancourt Rosenau. 2009. “Health Lifestyles in
the United States and Canada: Are We Really So
Different?” Social Science Quarterly 90(5):1380–402.
Landes, Scott D., and Richard A. Settersten, Jr. 2019.
“The Inseparability of Human Agency and Linked
Lives.” Advances in Life Course Research 42:1–10.
Lankes, Jane. 2022. “Negotiating ‘Impossible’ Ideals:
Latent Classes of Intensive Mothering in the United
States.” Gender & Society 36(5):677–703.
Lareau, Annette. 2011. Unequal Childhoods: Class,
Race, and Family Life. Berkeley: University of
California Press.
Lareau, Annette, Shani Adia Evans, and April Yee.
2016. “The Rules of the Game and the Uncertain
Transmission of Advantage: Middle-Class Parents’
Search for an Urban Kindergarten.” Sociology of
Education 89(4):279–99.
Lee, Chung Gun, Dong-Chul Seo, Susan E. Middlestadt,
and Hsien-Chang Lin. 2015. “Does the Relationship
between Cigarette Smoking and Other Key Health
Behaviors Vary by Geographic Area among U.S.
Young Adults? A Multilevel Analysis.” International
Journal of Behavioral Medicine 22(4):481–88.
Link, Bruce G., and Jo Phelan. 1995. “Social Conditions
as Fundamental Causes of Disease.” Journal of
Health and Social Behavior 35:80–94.
Lofland, John, and Lyn H. Lofland. 2006. Analyzing
Social Settings. Long Grove, IL: Waveland Press.
Luna, Jessie K. 2019. “The Ease of Hard Work:
Embodied Neoliberalism among Rocky Mountain
Fun Runners.” Qualitative Sociology 42(2):251–71.
Maralani, Vida, and Camille Portier. 2021. “The
Consolidation of Education and Health in Families.”
American Sociological Review 86(4):670–99.
Masters, Ryan K., Robert A. Hummer, and Daniel A.
Powers. 2012. “Educational Differences in U.S.
Adult Mortality: A Cohort Perspective.” American
Sociological Review 77(4):548–72.
McGarrol, Sarah. 2020. “Contextualizing Lifestyles:
How Socially Contrasting Places in Fife, Scotland
Influence Lay Understandings of Lifestyle and
Health Behaviours in Relation to Coronary Heart
Disease.” Health & Place 66:102432. doi:10.1016/j.
healthplace.2020.102432.
Milkie, Melissa A., and Catharine H. Warner. 2014.
“Status Safeguarding: Mothers’ Work to Secure
Children’s Place in the Social Hierarchy.” Pp. 66–85
in Intensive Mothering: The Cultural Contradictions
of Modern Motherhood, edited by L. R. Ennis.
Toronto, Canada: Demeter Press.
Mirowsky, John, and Catherine E. Ross. 2015. “Education,
Health, and the Default American Lifestyle.” Journal
of Health and Social Behavior 56(3):297–306.
Mollborn, Stefanie, Laurie James-Hawkins, Elizabeth
Lawrence, and Paula Fomby. 2014. “Health
Lifestyles in Early Childhood.” Journal of Health
and Social Behavior 55(4):386–402.
Mollborn, Stefanie, Elizabeth M. Lawrence, and Jarron
M. Saint Onge. 2021. “Contributions and Challenges
in Health Lifestyles Research.” Journal of Health
and Social Behavior 62(3):388–403.
Mollborn,
Stefanie,
and
Adenife
Modile.
2022.
“‘Dedicated to Being Healthy’: Young Adults’
Deployments
of
Health-Focused
Cultural
Capital.” Social Science & Medicine 293:114648.
doi:10.1016/j.socscimed.2021.114648.
Mollborn, Stefanie, Bethany Rigles, and Jennifer A.
Pace. 2021. “‘Healthier Than Just Healthy’: Families
Transmitting Health as Cultural Capital.” Social
Problems 68(3):574–90.

Mollborn et al.
17
Muennig, Peter A., Megan Reynolds, David S. Fink,
Zafar Zafari, and Arline T. Geronimus. 2018.
“America’s Declining Well-Being, Health, and Life
Expectancy: Not Just a White Problem.” American
Journal of Public Health 108(12):1626–31.
Nelson, Margaret K. 2010. Parenting out of Control:
Anxious Parents in Uncertain Times. New York, NY:
NYU Press.
Pace, Jennifer A., Stefanie Mollborn, and Bethany Rigles.
2022. “‘I Just Want Her to Be Happy and Healthy’:
Deploying Broad Understandings of Health in Class-
Privileged Parenting.” SSM–Qualitative Research in
Health 2:100183. doi:10.1016/j.ssmqr.2022.100183.
Pugh, Allison J. 2009. Longing and Belonging: Parents,
Children,
and
Consumer
Culture.
Berkeley:
University of California Press.
Pugh, Allison J. 2014. “The Theoretical Costs of Ignoring
Childhood: Rethinking Independence, Insecurity,
and Inequality.” Theory and Society 43(1):71–89.
Puka, Klajdi, Charlotte Buckley, Nina Mulia, Aurélie M.
Lasserre, Jürgen Rehm, and Charlotte Probst. 2022.
“Educational Attainment and Lifestyle Risk Factors
Associated with All-Cause Mortality in the U.S.”
JAMA Health Forum 3(4):e220401. doi:10.1001/
jamahealthforum.2022.0401.
Reich, Jennifer A. 2016. Calling the Shots: Why Parents
Reject Vaccines. New York, NY: New York
University Press.
Saez, Emmanuel. 2008. “Striking It Richer: The
Evolution of Top Incomes in the United States.”
Pathways Magazine Winter:6–7.
Schneider, Daniel, Orestes P. Hastings, and Joe LaBriola.
2018. “Income Inequality and Class Divides in
Parental
Investments.”
American
Sociological
Review 83(3):475–507.
Shirani, Fiona, Karen Henwood, and Carrie Coltart. 2012.
“Meeting the Challenges of Intensive Parenting
Culture: Gender, Risk Management, and the Moral
Parent.” Sociology 46(1):25–40.
Stets, Jan E., and Peter J. Burke. 2000. “Identity Theory
and Social Identity Theory.” Social Psychology
Quarterly 63(3):224–37.
Swidler, Ann. 2001. Talk of Love: How Culture Matters.
Chicago, IL: University of Chicago Press.
Timmermans,
Stefan,
and
Iddo
Tavory.
2012.
“Theory Construction in Qualitative Research:
From Grounded Theory to Abductive Analysis.”
Sociological Theory 30(3):167–86.
Tsushima, Teresa, and Peter J. Burke. 1999. “Levels,
Agency, and Control in the Parent Identity.” Social
Psychology Quarterly 62(2):173–89.
U.S.
Census
Bureau.
2017.
“Data
Profiles.”
https://data.census.gov/profile?q=United%20
States&g=010XX00US.
Warner, Catharine H. 2010. “Emotional Safeguarding:
Exploring the Nature of Middle-Class Parents’
School Involvement.” Sociological Forum 25(4):
703–24.
Weber, Max. [1922]1978. Economy and Society:
An Outline of Interpretive Sociology. Berkeley:
University of California Press.
Williamson, Deanna L., Margo Charchuk, Kaysi
E. Kushner, Berna J. Skrypnek, and Nicole
Y. Pitre. 2018. “Families That Do Well: Lay
Conceptualizations of Well-Functioning, Healthy,
Strong, and Good Families.” Family Relations
67(4):467–82.
Wills, Wendy, Kathryn Backett-Milburn, Mei-Li
Roberts, and Julia Lawton. 2011. “The Framing
of Social Class Distinctions through Family Food
and Eating Practices.” The Sociological Review
59(4):725–40.
Author Biographies
Stefanie Mollborn, PhD, is a professor of sociology at
Stockholm University, Sweden and an affiliate of the
Institute of Behavioral Science at the University of
Colorado Boulder. She researches inequalities, well-
being, and health among young people and families in
Europe and the United States using quantitative and quali-
tative methods. Her current research projects focus on
health lifestyles and early life inequalities, sexual minority
health disparities and family structure, the life course
impacts of contraceptive access, and intensive parenting
attitudes.
Jennifer A. Pace, PhD, is a researcher at the Center for
Behavioral Science Methods at the U.S. Census Bureau.
Her research areas include family and childhood health,
identity construction, and inequalities. Her current proj-
ects focus on children’s health lifestyles, vaccination in
pregnancy, and women’s experiences with family care-
work during health crises.
Bethany Rigles, PhD, is the director of research and eval-
uation and co-owner of Good Nutrition Ideas. She uses
mixed research methodologies to explore health dispari-
ties among diverse people with disabilities and to create
health interventions for vulnerable populations.

    Policy Implications:

Answer: Changing people’s health behaviors is challenging. Our research recognizes that children’s behavior is embedded in a health lifestyle, a tool that reinforces social inequalities. Policy efforts from a class-advantaged child’s community or school to change her health behavior are unlikely to succeed unless they engage with her broader health lifestyle, its links to her present and future, her parents’ deep identity investment, her identity expression, and the lifestyle’s embeddedness in localized community norms that deem specific behaviors as “healthy” and deserving, embodied through thinness and fitness and expressed in narratives that link health to discipline and moral worth. This means successful efforts to change health behavior must move well beyond an individual child and her family—which is harder to implement but potentially much more effective.