Adolescents’ Perceptions of Social Status: Development and Evaluation of a New Indicator Elizabeth Goodman, MD*‡; Nancy E. Adler, PhD§; Ichiro Kawachi, MD, PhDʈ¶; A. Lindsay Frazier, MDʈ#; Bin Huang, MS*; and Graham A. Colditz, MD, DrPHʈ ABSTRACT. Objective. Eliminating health dispari- Conclusions. This new instrument can reliably mea- ties, including those that are a result of socioeconomic sure SSS among adolescents. Social stratification as re- status (SES), is one of the overarching goals of Healthy flected by SSS is associated with adolescents’ health. The People 2010. This article reports on the development of a findings suggest that as adolescents mature, SSS may new, adolescent-specific measure of subjective social sta- undergo a developmental shift. Determining how these tus (SSS) and on initial exploratory analyses of the rela- changes in SSS relate to health and how SSS functions tionship of SSS to adolescents’ physical and psycholog- prospectively with regard to health outcomes requires ical health. additional research. Pediatrics 2001;108(2). URL: http:// Methods. A cross-sectional study of 10 843 adoles- www.pediatrics.org/cgi/content/full/108/2/e31; subjective cents and a subsample of 166 paired adolescent/mother social status, socioeconomic status, obesity, depression, dyads who participated in the Growing Up Today Study adolescence. 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 in- ABBREVIATIONS. SSS, subjective social status; SES, socioeco- cluded depressive symptoms and obesity, respectively. nomic status; BMI, body mass index; GUTS, Growing Up Today Linear regression analyses determined the association of Study; NHSII, Nurses’ Health Study II. SSS to depressive symptoms, and logistic regression de- termined the association of SSS to overweight and obe- sity, controlling for sociodemographic factors and SES. he elimination of health disparities among dif- Results. Mean society ladder ranking, a subjective -ferent population segments, including differ ؎ measure of SES, was 7.2 1.3. Mean community ladder ences related to socioeconomic status (SES), is ranking, a measure of perceived placement in the school T .community, was 7.6 ؎ 1.7. Reliability of the instrument the second overarching goal of Healthy People 2010 was excellent: the intraclass correlation coefficient was Recently, the American Academy of Pediatrics also 0.73 for the society ladder and 0.79 for the community recognized and highlighted the importance of ad- ladder. Adolescents had higher society ladder rankings dressing SES as an causative agent in the creation of ؎ ؍ ␮ ؎ ؍ ␮ than their mothers ( teen 7.2 1.3 vs mom 6.8 1.2; health differentials and called for additional research ؍ P .002). Older adolescents’ perceptions of familial to understand the impact of SES across the life placement in society were more closely correlated with 1 maternal subjective perceptions of placement than those course. The inverse, graded relationship between SES and ؍ of younger adolescents (Spearman’s rhoteens <15 years 11–2 ؍ 0.31 vs Spearman’s rhoteens >15 years 0.45; P < .001 for infant, child, and adult health is well established. both). SSS explained 9.9% of the variance in depressive However, among adolescents, the SES gradient in symptoms and was independently associated with obe- health is present inconsistently.12–15 A number of ؍ ؍ sity (odds ratiosociety 0.89, 95% confidence interval models have been proposed to explain the different confidence %95 ,0.91 ؍ odds ratio ;0.95 ,0.83 community patterning of SES effects on adolescent health.2,16 For both depressive symptoms and .(0.97 ,0.87 ؍ interval obesity, community ladder rankings were more strongly Choosing the most appropriate model(s) has been associated with health than were society ladder rankings hampered by 2 major barriers. First is the lack of in models that controlled for both domains of SSS. understanding of the mechanisms underlying the SES–health relationship, in general. Second, there is a lack of youth-specific indicators of social status. A From the *Children’s Hospital Medical Center and ‡Department of Pediat- new, youth-specific measure of subjective percep- rics, University of Cincinnati College of Medicine, Cincinnati, Ohio; §De- tions of social status—the MacArthur Scale of Sub- partment of Psychiatry, University of California, San Francisco, California; ʈChanning Laboratory, Department of Medicine, Brigham and Women’s jective Social Status–Youth Version—allows us to ad- Hospital, and Harvard Medical School, and ¶Department of Health and dress both of these barriers and assess the effects of Social Behavior, Harvard School of Public Health, Boston, Massachusetts; social status among adolescents using a broader con- and #Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts. ceptualization of this construct. This article describes Received for publication Dec 19, 2000; accepted Apr 3, 2001. the development and initial testing of the MacArthur Reprint requests to (E.G.) Division of Adolescent Medicine, Children’s Scale of Subjective Social Status–Youth Version and Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: discusses implications for future research on unrav- goodeØ@chmcc.org PEDIATRICS (ISSN 0031 4005). Copyright © 2001 by the American Acad- eling the mechanisms behind socioeconomic dispar- emy of Pediatrics. ities in health. http://www.pediatrics.org/cgi/content/full/108/2/Downloaded from www.aappublications.org/newse31 by guestPEDIATRICS on September Vol. 26, 2021 108 No. 2 August 2001 1of8 RATIONALE FOR INSTRUMENT DEVELOPMENT social inequalities in health and, often, parental be- Although income, education, and occupation (the liefs and behaviors, as well. As an adolescent’s self- traditional variables used to measure SES) are only conceptualization matures, perceptions of social sta- moderately correlated with each other, all are asso- tus may be based on both parental SES and the ciated with health in a similar manner. This suggests adolescent’s sense of his or her own standing. In that all 3 individually reflect an underlying common addition, beliefs, behaviors, and physiologic changes component of social status.17,18 Although the SES that develop in adolescence have great potential to gradient in health has been studied widely, how have an impact on health. Thus, it is likely that social status causes poorer health is not clear. This differences between family (parent-based) measures may be, in part, because social status has been de- and self (adolescent-specific) measures would de- fined as SES, which is an external, purely objective velop during the teenage years. The lack of a consis- measure that does not account for subjective, inter- tent graded effect of SES on adolescent health may be nalized perceptions of social status. Wilkinson19,20 because most analyses that assess the SES–health argued that these subjective perceptions of relative gradient among adolescents use parental measures ranking may be more important determinants of of SES, which do not tap the adolescent’s emerging 33 health than objective indicators, such as income, self-concept of social stratification. which assess material resources.21 Despite the vast literature on SES’s effects on MacARTHUR SCALE OF SUBJECTIVE SOCIAL health, little is known about people’s perceptions of STATUS–YOUTH VERSION their placement in the social hierarchy, what deter- To address the need for a youth-specific indicator mines these perceptions, or how these perceptions of subjective social status, we modified the relate to health. This is true for both adults and MacArthur Scale of Subjective Social Status to be adolescents. Research has been hampered by a lack applicable to adolescents. We did this because use of of indicators of subjective social status. Studies have the adult scale, which asks the individual to place relied, instead, on measures of social class identifica- him- or herself relative to others in American society tion and have focused on political and cultural atti- 22–30 with regard to education, income, and occupation, is tudes and behavior. Almost none have looked at not appropriate for adolescents, the vast majority of health. Two major problems exist with the use of whom are still in school, are not financially indepen- class identification as a proxy for social status. The dent, and are not employed full time. categorical nature of the measures of social class Like its adult counterpart, this instrument has 2 identification does not adequately tap the full spec- ladders (Fig 1). The first ladder assesses familial trum of socioeconomic stratification. In addition, so- placement in US society and is meant to parallel the cially charged language is used to describe the dis- adult ladder assessing personal placement within crete classes. Social desirability may be figuring society. This ladder is a measure of subjective SES. prominently in an individual’s choice of middle ver- Comparisons between adolescent and adult re- sus upper class, working versus lower class. The sponses to this ladder are meaningful as both the MacArthur Scale of Subjective Social Status was de- adult and adolescent society ladders anchor the lad- veloped to address these problems and assess per- der to the same reference group: US society. The ceived placement within the social hierarchy among second