Despite increased access to care and interventions aimed to change health behavior, socioeconomic health disparities have remained unchanged, even for preventable illness and disease. Health behavior theories and interventions heavily rely on perceptions of control over one's fate and thus ignore populations with low perceptions of personal control. Poverty is associated with an external locus of control (LOC), while both poverty and external LOC are associated with less health protective behavior. The purpose of this quantitative study was to explore the role of LOC as an adaptive response to poverty and to discover the risks and benefits to physical and psychological health associated with LOC orientation. Using cross-sectional survey methodology, 136 adult participants from the United States were recruited through snowball sampling to anonymously complete measures of the Multidimensional Locus of Control (MLOC), the Health Promoting Lifestyles II (LPII), the Kessler Psychological Distress Scale (KP10), and a demographic questionnaire. Hierarchical regression and bivariate analyses were used to test the hypotheses. According to the study findings, chance LOC mediated the relationship between socioeconomics and health lifestyles, while external-chance was associated with less healthy lifestyle choices than external-powerful others. Internality did not offer any psychological protections from anxiety and depression for low socioeconomic populations. Implications for social change are to further the understanding of the role of perceived control on health beliefs, behavior and psychological well-being for marginalized populations to promote the development of appropriately targeted, culturally sensitive health interventions.