PEDIATRICS Vol. 108 No. 2 August 2001, p. e31

ELECTRONIC ARTICLE:
Adolescents' Perceptions of Social Status: Development and Evaluation of a New Indicator

Received Dec 19, 2000; accepted Apr 3, 2001.

Elizabeth Goodman^*, , Nancy E. Adler^§, Ichiro Kawachi^{, ¶}, A. Lindsay Frazier^{, #}, Bin Huang^*, and Graham A. Colditz

From the ^* Children's Hospital Medical Center and  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ^§ Department of Psychiatry, University of California, San Francisco, California;  Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, and ^¶ Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts; and ^# Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.

Objective.  Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health.

Methods.  A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES.

Results.  Mean society ladder ranking, a subjective measure of SES, was 7.2 ± 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 ± 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers (µ_teen = 7.2 ± 1.3 vs µ_mom = 6.8 ± 1.2; P = .002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rho_{teens <15 years} = 0.31 vs Spearman's rho_{teens 15 years} = 0.45; P < .001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratio_society = 0.89, 95% confidence interval = 0.83, 0.95; odds ratio_community = 0.91, 95% confidence interval = 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS.

Conclusions.  This new instrument can reliably measure SSS among adolescents. Social stratification as reflected by SSS is associated with adolescents' health. The findings suggest that as adolescents mature, SSS may undergo a developmental shift. Determining how these changes in SSS relate to health and how SSS functions prospectively with regard to health outcomes requires additional research.  Key words:  subjective social status, socioeconomic status, obesity, depression, adolescence.

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