Acculturation has been associated with health behaviors, and to a lesser extent, health outcomes among Latinos; however, inconsistencies exist regarding the nature of these relationships. Moreover, little is known about the underlying mechanisms linking acculturation to Latino health outcomes. The current study examined the relationship between acculturation, behavioral risk factors, and cardio-metabolic dysfunction in Mexican American women, and evaluated the contribution of social and economic pathways to observed associations. Participants were a random sample of 302 Mexican American women (mean age 49.77 years), recruited from communities with wide-ranging socioeconomic status (SES) located on the United States (US) side of the Tijuana (Mexico) — San Diego (US) border. Women underwent a clinical exam and completed a battery of questionnaires including demographic (age, US exposure, education, and income), cultural (language acculturation, familism, fatalism, religiosity), social (social support, sociability), and behavioral (leisure-time physical activity, sedentary behavior, walking, fruit and vegetable servings, and dietary fat) variables. Confirmatory factor analyses (CFA) and structural equation models (SEMs) were performed in the total sample. CFAs revealed single latent constructs for English language acculturation (childhood language, English proficiency, and adult language patterns), SES (education and income), resilient cultural values (familism and religiosity), and social resources (social support and sociability). SEMs showed statistically significant direct effects of English language acculturation to more sedentary behavior and resilient cultural values to more self-reported walking. In addition, the indirect effects of US exposure to more sedentary behavior through language acculturation, English language acculturation to more sedentary behavior through SES, and resilient cultural values to more fruit and vegetable servings through social resources were also significant (CFI = 0.90, RMSEA = .10, SRMR = 0.04). Finally, significant mediated effects were found for English language acculturation to lower cardio-metabolic dysfunction via higher SES, and higher SES to lower cardio-metabolic dysfunction via lower fatalism (CFI= .89, RMSEA = .11, SRMR = .04). Behavioral variables did not appear to mediate the acculturation and cardio-metabolic dysfunction relationship. Acculturation and related cultural variables were associated with behavioral risk factors and cardio-metabolic dysfunction in middle-aged Mexican American women. SES and social resources may represent relevant pathways in explaining these associations.