Adolescents’ Perceptions of Social Status: Development and Evaluation of a New Indicator Elizabeth Goodman, MD*‡; Nancy E. Adler, PhD§; Ichiro Kawachi, MD, PhD¶; A. Lindsay Frazier, MD#; Bin Huang, MS*; and Graham A. Colditz, MD, DrPH ABSTRACT. Objective. Eliminating health dispari- ties, 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 sta- tus (SSS) and on initial exploratory analyses of the rela- tionship of SSS to adolescents’ physical and psycholog- ical health. Methods. A cross-sectional study of 10 843 adoles- cents 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 in- cluded depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression de- termined the association of SSS to overweight and obe- sity, 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 ( teen  7.2  1.3 vs  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 obe- sity (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 mea- sure SSS among adolescents. Social stratification as re- flected 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. Pediatrics 2001;108(2). URL: http:// www.pediatrics.org/cgi/content/full/108/2/e31; subjective social status, socioeconomic status, obesity, depression, adolescence. ABBREVIATIONS. SSS, subjective social status; SES, socioeco- nomic status; BMI, body mass index; GUTS, Growing Up Today Study; NHSII, Nurses’ Health Study II. T he elimination of health disparities among dif- ferent population segments, including differ- ences related to socioeconomic status (SES), is the second overarching goal of Healthy People 2010. Recently, the American Academy of Pediatrics also recognized and highlighted the importance of ad- dressing SES as an causative agent in the creation of health differentials and called for additional research to understand the impact of SES across the life course. 1 The inverse, graded relationship between SES and infant, child, and adult health is well established. 2–11 However, among adolescents, the SES gradient in health is present inconsistently. 12–15 A number of models have been proposed to explain the different patterning of SES effects on adolescent health. 2,16 Choosing the most appropriate model(s) has been hampered by 2 major barriers. First is the lack of understanding of the mechanisms underlying the SES– health relationship, in general. Second, there is a lack of youth-specific indicators of social status. A new, youth-specific measure of subjective percep- tions of social status—the MacArthur Scale of Sub- jective Social Status–Youth Version—allows us to ad- dress both of these barriers and assess the effects of social status among adolescents using a broader con- ceptualization of this construct. This article describes the development and initial testing of the MacArthur Scale of Subjective Social Status–Youth Version and discusses implications for future research on unrav- eling the mechanisms behind socioeconomic dispar- ities in health. From the *Children’s Hospital Medical Center and ‡Department of Pediat- rics, University of Cincinnati College of Medicine, Cincinnati, Ohio; §De- partment 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. Received for publication Dec 19, 2000; accepted Apr 3, 2001. Reprint requests to (E.G.) Division of Adolescent Medicine, Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: goodeØ@chmcc.org PEDIATRICS (ISSN 0031 4005). Copyright © 2001 by the American Acad- emy of Pediatrics. http://www.pediatrics.org/cgi/content/full/108/2/e31 PEDIATRICS Vol. 108 No. 2 August 2001 1 of 8 by guest on October 26, 2016 Downloaded from