Impact of objective and subjective social status on obesity in a biracial cohort of adolescents

Academic disparities and health: How gender-based disparities in schools relate to boys' and girls' health

RATIONALE

Recent research reveals that, although girls encounter some barriers in school (e.g., in science and math), on balance, boys perform worse academically. Moreover, other research has identified a correlation between exposure to a context characterized by large disparities in performance or resources and a range of negative outcomes, including negative health and well-being, among members of lower status groups.

OBJECTIVE

Building on these literatures, the present research tests the relationship between gender disparities in academic performance within a school and students' health outcomes. Specifically, we investigated whether boys had worse health when they attended schools where there was a greater disparity between boys' and girls' academic performance.

METHOD

We tested this hypothesis in two different samples with different health outcomes. In a sample of healthy eighth graders (Study 1; 159 girls and 81 boys), we assessed two indices of metabolic syndrome, and in a sample of children with asthma (Study 2; 122 girls and 153 boys), we assessed immune function (Th1 and Th2 cytokine production) and self-reported symptoms. Participants in both samples also reported the name of the school that they attended so that we could access publicly available information about the percentage of girls and the percentage of boys in each school who met expectations for their grade level on standardized tests.

RESULTS

In both samples, the greater the gap in a school between the percentage of girls and the percentage of boys who met expectations for their grade level on standardized tests, the worse boys' health. This pattern did not emerge among girls.

CONCLUSION

Results thus highlight the negative health correlates of academic disparities among members of lower-performing groups.

Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study

BACKGROUND

Low back pain is an important public health issue across the world. However, it is unclear whether socioeconomic status (SES) is associated with low back pain. This study determines an association between SES and low back pain among older people.

METHODS

We used cross-sectional data derived from the year 2013 across 30 Japanese municipalities. The survey was conducted between October 2013 to December 2013. Functionally independent community-dwelling older adults aged 65 and above (n = 26,037) were eligible for the study. Multilevel Poisson regression analysis with a robust variance estimator was used to examine the association between SES and low back pain. Self-reported low back pain in the past year was used as a dependent variable. Educational attainment, past occupation, equivalized household income, wealth, and subjective economic situation represented SES and were separately analyzed as independent variables, adjusted for covariates including age and sex.

RESULTS

The prevalence of low back pain was 63.4%. Overall, lower SES were more likely to suffer from low back pain compared with that for the highest. First, as for the educational attainment, the prevalence ratio (PR) (95% credible interval (CI)) for the lowest level was 1.07 (1.02-1.12). Second, as for the past occupation, the PR (95% CI) for the blue-collared workers compared with professionals was 1.06 (1.01-1.11). Third, as for the equalized household income, the PRs (95% CI) for lower middle and the lowest income levels were 1.08 (1.02-1.13) and 1.16 (1.10-1.23), respectively. Fourth, as for the wealth, the PRs (95% CI) for lower middle and the lowest wealth levels were 1.11 (1.04-1.19) and 1.18 (1.11-1.27), respectively. Fifth, as for the subjective economic situation, the PRs (95% CI) for lower middle and the lowest financial conditions were 1.18 (1.10-1.26) and 1.32 (1.22-1.44), respectively.

CONCLUSIONS

Significant socioeconomic inequalities were observed in low back pain among older individuals in Japan. Policymakers and clinicians must understand the nature of these inequalities.

Youth Subjective Social Status (SSS) is Associated with Parent SSS, Income, and Food Insecurity but not Weight Loss Among Low-Income Hispanic Youth

OBJECTIVE

Subjective social status (SSS), perceived rank in the social ladder, is associated with weight, but determinants of SSS in youth remain unknown. Relationships between youth SSS and income, food insecurity, parent SSS, and BMI change were investigated during an obesity intervention.

METHODS

Data came from a family-centered, community-based obesity intervention for low-income families. Parent and youth SSS were assessed using a validated, age-appropriate SSS scale. Food insecurity and socioeconomic factors were assessed in parents; child and parent weight-related data were measured at baseline and post intervention.

RESULTS

Participants included 110 primarily Hispanic (97%) low-income youth and their parents. Food insecurity was reported in 66.4% of families. Youth SSS was positively associated with parent SSS (P = 0.0014). In both parents and children, the association between income and SSS was moderated by food insecurity such that lower income was more strongly associated with lower SSS among food-insecure households (P = 0.0286 and P = 0.0327, respectively). Youth SSS was not associated with youth BMI reduction.

CONCLUSIONS

Youth SSS was not predictive of weight loss in this intervention. Intriguingly, the association between income and SSS was modified by food insecurity, suggesting that food insecurity shapes the contribution of socioeconomic factors to one's perceived social status.

Subjective social status and health: Multidisciplinary explanations and methodological challenges

Since the early 2000s, evidence has been accumulating that subjective social status – a person’s sense of their own position on the social ladder – affects health above and beyond objective socioeconomic status. To date, however, little is known about how these distinct health effects of subjective social status can be explained. This article narratively reviews different explanatory approaches and key methodological challenges, backed up by empirical findings and supplemented by the authors’ own reflections. Both social–psychological and psychoneurobiological explanations can make a theoretically plausible contribution to explaining the subjective social status–health relationship. Experimental and panel designs appear promising for addressing important methodological challenges in this strand of research.

Mind over matter. The impact of subjective social status on health outcomes and health behaviors

Recent insights have shown subjective status to impact health and health behavior. It is however unclear how this exactly happens. In this study we explore two mechanisms: this of a direct, mediating effect of subjective status explaining the impact of material class on health outcomes and behavior and an indirect, moderating impact on the relationship between material class and health outcomes and behavior. To test this empirically we conduct two studies, focusing on Great-Britain, using survey-data from the English Longitudinal Study of Ageing (N: 2709-3448) and the Whitehall II-study (N: 6275-6467). Our linear and logistic regression analyses show subjective status has a mainly direct impact on health outcomes and has both a direct, mediating and indirect, moderating impact on health behavior. In the conclusion of our article we reflect on the theoretical reasons why subjective status has a direct impact in certain cases, while playing an indirect role in other cases.

Belief in Social Mobility Mitigates Hostility Resulting From Disadvantaged Social Standing

Comparing economically unfavorably with similar others has detrimental consequences for an individual, ultimately resulting in low physical health, delinquency, and hostility. In four studies ( N = 2,032), we examined whether believing in a mobile society-one offering fair chances and opportunity-mitigates hostile emotions resulting from disadvantaged social standing. We find that with increasing mobility belief, negative comparisons have gradually less impact on hostility. Specifically, measured (Studies 1 and 4) and manipulated (Studies 2 and 3) social mobility belief moderated the link between induced high versus low social status, experiencing relative deprivation, and hostile affect. A positive outcome on the surface, social mobility belief may indirectly contribute to the maintenance of social inequality by appeasing anger about perceived injustice.

Cultural Values Moderate the Impact of Relative Deprivation

Relative deprivation (RD) is the judgment that one or one’s ingroup is worse off compared with some relevant standard coupled with feelings of dissatisfaction, anger, and resentment. RD predicts a wide range of outcomes, but it is unclear whether this relationship is moderated by national cultural differences. Therefore, in the first study, we used national assessments of individual-collectivism and power distance to code 303 effect sizes from 31 different countries with 200,578 participants. RD predicted outcomes ranging from life satisfaction to collective action more strongly within individualistic nations. A second survey of 6,112 undergraduate university students from 28 different countries confirmed the predictive value of RD. Again, the relationship between individual RD and different outcomes was stronger for students who lived in more individualistic countries. Group-based RD also predicted political trust more strongly for students who lived in countries marked by lower power distance. RD effects, although consistent predictors, are culturally bounded. In particular, RD is more likely to motivate reactions within individualistic countries that emphasize individual agency and achievement as a source of self-worth.

Associations of subjective social status with accelerometer-based physical activity and sedentary time among adolescents

This study examined the associations of subjective social status (SSS) with physical activity (PA) and sedentary time (ST) among adolescents. The study population consisted of 420 Finnish adolescents aged 13 to 14 years. The adolescents reported their own SSS within their school (school SSS) and their family's social position within society (society SSS) based on the youth version of the Subjective Social Status Scale. Adolescents' moderate- to vigorous-intensity physical activity (MVPA) and ST were measured objectively by accelerometers and analyzed separately for the whole day and the school day. The associations between SSS and MVPA and ST outcomes were analyzed using multilevel modeling. School SSS was positively associated with whole-day MVPA and negatively associated with school-time ST. Society SSS was not significantly associated with objectively measured MVPA or ST. Both MVPA and ST are important behavioral determinants of health. As an important correlate of MVPA and ST, school SSS should be addressed by providers when discussing obesity risk and healthy behaviors with adolescents.

Low subjective socioeconomic status stimulates orexigenic hormone ghrelin - A randomised trial

Recent evidence suggests that lower perceived socioeconomic status is linked to increased appetite and intake of greater calories. Yet, whether insecurity of socioeconomic resources directly influences regulatory systems of appetite and energy intake is not known. Considering psychological states, mindsets and beliefs have shown to meaningfully affect physiological responses to food, the present study tested the hypothesis that low subjective socioeconomic status (SSS) will have a direct influence on physiological responses, such as appetite-related hormones (ghrelin, pancreatic polypeptide and insulin). Forty-eight healthy males were randomly (crossover, counterbalanced) assigned, to two experimental conditions where participants were either experimentally induced to feel low SSS or not (control; CON). Feelings of low SSS resulted in an increase in active ghrelin (an orexigenic hormone) following the SSS manipulation compared with baseline, while no change in active ghrelin was observed in CON. Furthermore, participants reported lower fullness and satiety following low SSS compared with CON. Our findings demonstrate that SSS may influence hunger regulation and appetite, and suggest that physiological systems regulating energy balance (i.e. caloric resources) may also be sensitive to perceived deprivation or imbalances in critical non-food resources (socioeconomic resources).

Modern Social Hierarchies and the Spaces between: How Are Subjective Status Inconsistencies Linked to Mental Well-Being?

Higher socioeconomic status is linked to higher mental well-being, but modern individuals inhabit multiple hierarchies and reference groups—and thus well-being may be determined between as much as within socioeconomic statuses. Drawing on proprietary national data collected by Gallup in 2017, I find that inconsistency between one’s perceived standing in society and one’s standing in more local hierarchies based in neighbors or friends is quite common. Individuals with negative status inconsistency (lower perceived status among one’s neighbors or friends relative to society) exhibit diminished mental well-being relative to those without. Relational or interpersonal mechanisms, including lower closeness to others, anomie or social disengagement, and diminished meaning in life, appear to partially or mostly explain how status inconsistencies undermine well-being. However, these relational mechanisms vary in their explanatory importance across types of inconsistencies and types of well-being. Positive and negative status inconsistencies both show links to lower-quality social relations.

Body Mass Index and Subjective Social Status: The Coronary Artery Risk Development in Young Adults Study

OBJECTIVE

Subjective social status (SSS), or perceived social status, may explain, in part, the relationship between socioeconomic status (SES) and obesity. The objective of this study was to test whether SSS mediates the relationship between two indicators of SES (income and education) and body mass index (BMI).

METHODS

A cross-sectional, structural equation path analysis was applied to the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 2,624). The analysis tested whether SSS (MacArthur scale), education, and income were associated with BMI at the year 20 examination (adjusting for sex, age, and race), and it was hypothesized that the associations of education and income with BMI would be at least partly mediated by SSS.

RESULTS

SSS had a significant direct effect on BMI (-0.21, P = 0.018). Education had a significant direct relationship with SSS (0.11, P < 0.001) and a small but significant indirect relationship with BMI through SSS (-0.02, P = 0.022). Although income did not have a significant direct relationship with BMI, it did have a significant indirect relationship through SSS (b = -0.05, P = 0.019).

CONCLUSIONS

Results are consistent with the hypothesized model in which SSS partially mediates the relationship between SES indicators and BMI.

Association of Occupational Class with Healthcare Utilization among Economically Active Korean Adults from 2006 to 2014: A Repeated Cross-Sectional Study of Koreans Aged 19 Years and Older

BACKGROUND

To investigate the impact of indicators of occupational class on healthcare utilization by using longitudinal data from a nationally representative survey.

METHODS

Data were obtained from the Korean Welfare Panel Study conducted from 2006 (wave 1) through 2014 (wave 9). A total of 5,104 individuals were selected at baseline (2006). Analysis of variance and longitudinal data analysis were used to evaluate the following dependent variables: number of outpatient visits and number of days spent in the hospital per year.

RESULTS

The number of annual outpatient visits was 4.298 days higher (P<0.0001) in class IV, 0.438 days higher (P=0.027) in class III, and 0.335 days higher (P=0.035) in class II than in class I. The number of days spent in the hospital per year was 0.610 days higher (P=0.001) in class IV, 0.547 days higher (P<0.0001) in class III, and 0.115 days higher (P=0.136) in class III than in class I. In addition, the number of days spent in the hospital in class IV patients with unmet healthcare needs showed an opposite trend to that predicted on the basis of socioeconomic status (estimate,-8.524; P-value=0.015).

CONCLUSION

Patients whose jobs involved manual or physical labor were significantly associated with higher healthcare utilization. Thus, the results suggest that healthcare utilization in different occupational classes should be improved by monitoring work environments and promoting health-enhancing behaviors.

Genetic polymorphisms in genes related to risk-taking behaviours predicting body mass index trajectory among Mexican American adolescents

OBJECTIVES

Obesity is associated with multiple health problems and often originates in childhood. The purpose is to investigate the associations of genetic polymorphisms in genes related to risk-taking behaviours with body mass index (BMI) trajectory over adolescence among Mexican Americans.

METHODS

This study included 1229 Mexican American adolescents who participated in a large population-based cohort study in Houston, Texas. BMI data were obtained at baseline and two follow-ups. The median follow-up time was 59 months. Participants were genotyped for 672 functional and tagging variants in genes involved in the dopamine, serotonin and cannabinoid pathways.

RESULTS

After adjusting for multiple comparisons, three genetic variants, namely, rs933271 and rs4646310 in COMT gene, and rs9567733 in HTR2A gene were significantly associated with BMI growth over adolescence. Using those three variants, we created an allelic score, and the allelic score was associated with BMI growth over adolescence (P < 0.001). With the increase number of variant allele, the rate of BMI growth over adolescence was slower. Finally, we identified another two genetic variants, namely, rs17069005 in HTR2A gene and rs3776511 in SLC6A3A gene were associated with obesity at last follow-up.

CONCLUSIONS

The results suggest that genetic variants in selected genes involved in dopamine and serotonin pathways have noticeable effects on BMI over adolescence.

The Effect of Psychological Suzhi on Problem Behaviors in Chinese Adolescents: The Mediating Role of Subjective Social Status and Self-esteem

In this study, we examined subjective social status (SSS) and self-esteem as potential mediators between the association of psychological suzhi and problem behaviors in a sample of 1271 Chinese adolescents (44.5% male, grades 7–12). The results showed that SSS and self-esteem were fully mediating the relationship between psychological suzhi and problem behaviors. Moreover, the indirect effect was stronger via self-esteem than via SSS. These findings perhaps provide insight into the preliminary effect that SSS and self-esteem underlie psychological suzhi’s effect on adolescents’ problem behaviors, and also are important in helping school-teachers and administrators to develop a better understanding of problem behaviors in their schools as a pre-requisite to the development of more effective behaviors management practices from the perspective of psychological suzhi. Implications and limitations in the present study have also been discussed.

Subjective social status and its relationship to health and health behavior: comparing two different scales in university students

Background Little is known about the relationship between socioeconomic status (SES) and health in late adolescence. As it is difficult to measure SES in this age group directly, we used two subjective social status (SSS) scales with different reference groups for social comparison in the relatively homogeneous group of university students and analyzed the relationship with health and health behaviors. Methods We used two 10-rung ladders, a societal and a university one, to measure SSS in students (n = 689, 16-29 years). We compared the scales' ratings and analyzed relationships with sociodemographic factors, health outcomes and behaviors. Results On average, students rated their individual SSS higher on the university scale (6.87) than on the societal one (6.41). Regarding health outcomes and behaviors, we found similar results for both scales, while sociodemographic variables were more likely to be associated with the societal scale. Conclusion SSS seems to be a useful measure besides the objective SES. Our data suggest that both SSS scales are helpful in the framework of health inequality but differ slightly in what they measure. More detailed research may help to determine which scale is appropriate for individual study context.

Examining Pre-migration Health Among Filipino Nurses

The healthy immigrant hypothesis asserts that immigrants arrive in the receiving country healthier than same race/ethnic counterparts born there. Contemporary research, however, has not evaluated pre-migration health among migrants, nor has explicitly considered comparisons with non-migrants in the country of origin. Pre-migration health was examined among 621 Filipino nurses, including self-reported physical health, mental health, health behaviors, and social stress. Measures were compared by intention to migrate and also tested as predictors of actual migration using time-to-event analysis. Nurses intending to migrate had higher proportion of depression and reported higher general perceived stress compared to those not. Predictors of actual migration included age, mentally unhealthy days, social strain, and social support. Physical health and health behavior measures had no association with migration intention or actual migration. Findings suggest that, relative to those not intending to migrate, nurses intending to migrate have worse mental health status and social stress; and, do not have a physical health advantage. Future research must span the pre- to post-migration continuum to better understand the impact of moving from one country to another on health and well-being.

The severity and associated factors of participation restriction among community-dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF)

Background

The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people’s involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people.

Methods

A cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework.

Results

Among all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants’ status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants’ participation restriction.

Conclusion

Participation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature.

Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status

BACKGROUND

There is substantial evidence that lower objective socioeconomic status (SES)-as measured by education, occupation, and income-is associated with a higher risk of depression. Less is known, however, about associations between perceptions of social status and the prevalence of depression. This study investigated associations of both objective SES and subjective social status (SSS) with depressive symptoms among adults in Germany.

METHODS

Data were obtained from the 2013 special wave of the German Health Update study, a national health survey of the adult population in Germany. Objective SES was determined using a composite index based on education, occupation, and income. The three single dimensions of the index were also used individually. SSS was measured using the MacArthur Scale, which asks respondents to place themselves on a 10-rung 'social ladder'. Regression models were employed to examine associations of objective SES and SSS with current depressive symptoms, as assessed with the eight-item Patient Health Questionnaire depression scale (PHQ-8 sum score ≥10).

RESULTS

After mutual adjustment, lower objective SES and lower SSS were independently associated with current depressive symptoms. The associations were found in both sexes and persisted after further adjustment for sociodemographic factors, long-term chronic conditions, and functional limitations. Mediation analyses revealed a significant indirect relationship between objective SES and depressive symptoms through SSS. When the three individual dimensions of objective SES were mutually adjusted, occupation and income were independently associated with depressive symptoms. After additional adjustment for SSS, these associations attenuated but remained significant.

CONCLUSIONS

The findings suggest that perceptions of low social status in adults may be involved in the pathogenesis of depression and play a mediating role in the relationship between objective SES and depressive symptoms. Prospective studies are needed to establish the direction of effects and to address questions of causality.

Mere experience of low subjective socioeconomic status stimulates appetite and food intake

Among social animals, subordinate status or low social rank is associated with increased caloric intake and weight gain. This may reflect an adaptive behavioral pattern that promotes acquisition of caloric resources to compensate for low social resources that may otherwise serve as a buffer against environmental demands. Similarly, diet-related health risks like obesity and diabetes are disproportionately more prevalent among people of low socioeconomic resources. Whereas this relationship may be associated with reduced financial and material resources to support healthier lifestyles, it remains unclear whether the subjective experience of low socioeconomic status may alone be sufficient to stimulate consumption of greater calories. Here we show that the mere feeling of lower socioeconomic status relative to others stimulates appetite and food intake. Across four studies, we found that participants who were experimentally induced to feel low (vs. high or neutral) socioeconomic status subsequently exhibited greater automatic preferences for high-calorie foods (e.g., pizza, hamburgers), as well as intake of greater calories from snack and meal contexts. Moreover, these results were observed even in the absence of differences in access to financial resources. Our results demonstrate that among humans, the experience of low social class may contribute to preferences and behaviors that risk excess energy intake. These findings suggest that psychological and physiological systems regulating appetite may also be sensitive to subjective feelings of deprivation for critical nonfood resources (e.g., social standing). Importantly, efforts to mitigate the socioeconomic gradient in obesity may also need to address the psychological experience of low social status.

Family income and young adolescents' perceived social position: associations with self-esteem and life satisfaction in the UK Millennium Cohort Study

BACKGROUND

Self-esteem and life satisfaction are important aspects of positive mental health in young people, and both are socially distributed. However, the majority of evidence is based on socioeconomic characteristics of the family. As children enter adolescence and gain independence, perceptions of their own social position are likely to influence mental health.

DESIGN AND OBJECTIVES

Using data on 11-year-olds from the UK Millennium Cohort Study, we investigated associations of both family income and young adolescents' perception of their social position with self-esteem and life satisfaction. We hypothesised that there would be differences in the impact of perceived social position on positive mental health when investigating the full scale scoring distribution or the bottom of the distribution. Therefore, we estimated proportional odds for having greater positive mental health (across the distribution of scores) and ORs for poor outcomes (lowest 10% scores).

RESULTS

The likelihood of greater self-esteem and life satisfaction increased with income; similarly, the risk of having poor self-esteem and life satisfaction increased as income decreased. Young adolescents who perceived their family as poorer than their friends (instead of about the same) were less likely to have greater self-esteem and life satisfaction and were more likely to have poor outcomes. Young adolescents who perceived their family as richer were more likely to have poor self-esteem, but were not less likely to have greater self-esteem. For life satisfaction, young adolescents who perceived their families as richer were less likely to have greater and more likely to have poor life satisfaction.

CONCLUSIONS

Policies to redistribute income in families with children are likely to benefit the mental health of young people. However, it is also important to consider the impact of social comparison on young people's mental health as they enter adolescence.

Indicators of subjective social status: Differential associations across race and sex

Background

Subjective social status (SSS), or perception of rank on the social hierarchy, is an important indicator of various health outcomes. However, the psychosocial influences on this construct are unclear, and how these influences vary across different sociodemographic groups is poorly understood.

Methods

Participants were 2077 African-American and Whites (M age=47.85; 57% female; 58% African American, and 58% above poverty) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Multiple regression analyses examined (1) hypothesized psychosocial indicators of SSS and (2) the moderating effect of race and sex on the variables associated with SSS.

Results

In addition to the traditional measures of SES (i.e. income, employment, and education), psychosocial variables (i.e. depressive symptomatology, neighborhood satisfaction, and self-rated health) were significantly associated with SSS. However, some of these indicators varied with respect to race and sex. Three significant interactions were found: sex by employment, race by employment, and race by education, wherein objective measures of SES were more associated with SSS for Whites and men compared to African Americans and women.

Conclusion

Psychosocial measures may influence individuals’ perceptions of themselves on the social hierarchy. Additionally, SSS may vary by demographic group. When considering the impact of SSS on health, it is important to consider the unique interpretations that various demographic groups have when perceiving themselves on the social hierarchy.

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Subjective Social Status (SSS) is an important health indicator, but its psychosocial correlates are unknown.

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Additionally, it is unclear if indicators of SSS vary by demographic group (i.e. race and sex).

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Findings suggest that in addition to traditional measures of socioeconomic status (e.g. education), numerous psychosocial variables (e.g. depressive symptoms) were related to SSS.

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Indicators of SSS varied across race and sex, wherein objective measures of SES were more associated with SSS for Whites and men, than African Americans and women.

Family Environments and Children's Executive Function: The Mediating Role of Children's Affective State and Stress

There is increasing evidence that inadequate family environments (family material environment and family psychosocial environment) are not only social problems but also factors contributing to adverse neurocognitive outcomes. In the present study, the authors investigated the relationship among family environments, children's naturalistic affective state, self-reported stress, and executive functions in a sample of 157 Chinese families. These findings revealed that in inadequate family material environments, reduced children's cognitive flexibility is associated with increased naturalistic negative affectivity and self-reported stress. In addition, naturalistic negative affectivity mediated the association between family expressiveness and children's cognitive flexibility. The authors used a structural equation model to examine the mediation model hypothesis, and the results confirmed the mediating roles of naturalistic negative affectivity and self-reported stress between family environments and the cognitive flexibility of Chinese children. These findings indicate the importance of reducing stress and negative emotional state for improving cognitive functions in children of low socioeconomic status.

The effects of experimentally manipulated social status on acute eating behavior: A randomized, crossover pilot study

Both subjective and objectively measured social status has been associated with multiple health outcomes, including weight status, but the mechanism for this relationship remains unclear. Experimental studies may help identify the causal mechanisms underlying low social standing as a pathway for obesity. Our objective was to investigate the effects of experimentally manipulated social status on ad libitum acute dietary intakes and stress-related outcomes as potential mechanisms relating social status and weight. This was a pilot feasibility, randomized, crossover study in Hispanic young adults (n=9; age 19-25; 67% female; BMI ≥18.5 and ≤30kg/m(2)). At visit 1, participants consumed a standardized breakfast and were randomized to a high social status position (HIGH) or low social status position (LOW) in a rigged game of Monopoly™. The rules for the game differed substantially in terms of degree of 'privilege' depending on randomization to HIGH or LOW. Following Monopoly™, participants were given an ad libitum buffet meal and energy intakes (kcal) were estimated by pre- and post-weighing foods consumed. Stress-related markers were measured at baseline, after the game of Monopoly™, and after lunch. Visit 2 used the same standardized protocol; however, participants were exposed to the opposite social status condition. When compared to HIGH, participants in LOW consumed 130 more calories (p=0.07) and a significantly higher proportion of their daily calorie needs in the ad libitum buffet meal (39% in LOW versus 31% in HIGH; p=0.04). In LOW, participants reported decreased feelings of pride and powerfulness following Monopoly™ (p=0.05) and after their lunch meal (p=0.08). Relative to HIGH, participants in LOW demonstrated higher heart rates following Monopoly™ (p=0.06), but this relationship was not significant once lunch was consumed (p=0.31). Our pilot data suggest a possible causal relationship between experimentally manipulated low social status and increased acute energy intakes in Hispanic young adults, potentially influenced by decreased feelings of pride and powerfulness. Increased energy intake over time, resulting in positive energy balance, could contribute to increased risk for obesity, which could partially explain the observed relationship between low social standing and higher weight. Larger and longitudinal studies in a diverse sample need to be conducted to confirm findings, increase generalizability, and assess whether this relationship persists over time.

Socioeconomic Status and Cardiovascular Risk Control in Adults With Diabetes

OBJECTIVE

To examine the association between subjective social status (SSS) and objective social status (OSS) and cardiovascular disease (CVD) risk factors in adults with type 2 diabetes.

METHODS

Adult study participants (N = 358) were recruited from 2 primary care settings. The CVD risk factors included hemoglobin A1c (HbA1c), systolic blood pressure and diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-C). The OSS was assessed by income, education and employment. The SSS was measured using the validated MacArthur Scales of Subjective Social Status to demarcate self-reported perceptions of having the most money, education and respected job using a ladder scale (1 = rung 1, 10 = rung 10). Multiple linear regression was used to examine associations between CVD risk factors and SSC and OSS controlling for age, sex, race or ethnicity, marital status, employment status, income, study site, comorbidity, education and insurance status.

RESULTS

Fully adjusted models showed that rung 2 (P = 0.029), rung 3 (P = 0.032), rung 8 (P = 0.049) and rung 9 (P = 0.032) of the SSS to be significantly associated with poorer DBP. Annual income ≥ $75,000 was significantly associated with lower LDL-C (P = 0.021). Employment was associated with lower HbA1c (P = 0.036), but higher LDL-C (P = 0.002).

CONCLUSIONS

The SSS and OSSS levels are differentially associated with HbA1c, DBP and LDL-C. Findings provide new information about patients' perspectives of the relationship between social status and diabetes-related outcomes.

Socioeconomic Status, Risk of Obesity, and the Importance of Albert J. Stunkard

Albert J. Stunkard's influential career in obesity research spanned over 50 years and included several landmark studies on social factors related to obesity. This review discusses the important contributions Stunkard made to research on the relationship between socioeconomic status socioeconomic status and obesity, extensions of his work, and reflects on Stunkard's role in the mentoring of succeeding generations of scientists.

Relative deprivation and risk factors for obesity in Canadian adolescents

Research on socioeconomic differences in overweight and obesity and on the ecological association between income inequality and obesity prevalence suggests that relative deprivation may contribute to lifestyle risk factors for obesity independently of absolute affluence. We tested this hypothesis using data on 25,980 adolescents (11-15 years) in the 2010 Canadian Health Behaviour in School-aged Children (HBSC) study. The Yitzhaki index of relative deprivation was applied to the HBSC Family Affluence Scale, an index of common material assets, with more affluent schoolmates representing the comparative reference group. Regression analysis tested the associations between relative deprivation and four obesity risk factors (skipping breakfasts, physical activity, and healthful and unhealthful food choices) plus dietary restraint. Relative deprivation uniquely related to skipping breakfasts, less physical activity, fewer healthful food choices (e.g., fruits, vegetables, whole grain breads), and a lower likelihood of dieting to lose weight. Consistent with Runciman's (1966) theory of relative deprivation and with psychosocial interpretations of the health consequences of income inequality, the results indicate that having mostly better off schoolmates can contribute to poorer health behaviours independently of school-level affluence and subjective social status. We discuss the implications of these findings for understanding the social origins of obesity and targeting health interventions.

High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy

Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.

Obesity-Related Behaviors among Poor Adolescents and Young Adults: Is Social Position Associated with Risk Behaviors?

HighlightsDifferent measures of social position capture unique dimensions of relative rank among youth.Youth-specific measures of social position may be important in identifying the most at-risk for obesity.Lower social status youth are more likely to be at-risk for obesity-related behaviors compared to those with a higher rank. This cross-sectional study examines multiple dimensions of social position in relation to obesity-related behaviors in an adolescent and young adult population. In addition to using conventional measures of social position, including parental education and household expenditures, we explore the usefulness of three youth-specific measures of social position - community and society subjective social status and school dropout status. Data are taken from a 2004 house-to-house survey of urban households within the bottom 20th percentile of income distribution within seven states in Mexico. A total of 5,321 Mexican adolescents, aged 12-22 years, provided information on obesity-related behaviors (e.g., diet, physical activity, sedentary behavior) and indicators of subjective and objective social position. A parent in each household provided information on socioeconomic status of the parent and household. Ordinal logistic regressions are used to estimate the associations of parental, household and adolescent indicators of social position and obesity-related risk behaviors. Those adolescents with the highest odds of adopting obesity risk behaviors were the ones who perceived themselves as lower in social status in reference to their peer community and those who had dropped out of school. We found no significant associations between parental education or household expenditures and obesity-related risk behaviors. Immediate social factors in adolescents' lives may have a strong influence on their health-related behaviors. This study provides evidence for the usefulness of two particular measures, both of which are youth-specific. Adolescents and young adults who have dropped out of school and those with lower perceived relative social position within their community are more likely to be at-risk for obesity-related behaviors than those with higher relative social position. We conclude that youth-specific measures may be important in identifying the most at-risk among relatively homogeneous populations of youth.

An 8-Year Prospective Study of Depressive Symptoms and Change in Insulin From Adolescence to Young Adulthood

OBJECTIVE

To evaluate whether depressive symptoms predict change in fasting insulin among adolescents followed into young adulthood. We hypothesized that higher depressive symptoms would predict increased insulin and that puberty and race/ethnicity would moderate this relationship.

METHODS

Data came from the Princeton School District Study, a school-based longitudinal cohort of non-Hispanic black and white adolescents (2001-2011). Depressive symptoms, fasting insulin, and body mass index were measured at baseline (adolescence) and 8 years later (young adulthood) in 685 participants. Puberty was assessed using a validated protocol measuring sex steroids and physical changes. The primary outcome was change in fasting insulin. Analyses accounted for age, sex, race, parental education, baseline insulin, body mass index z score, puberty, and time to follow-up.

RESULTS

At baseline, depressive symptoms were correlated with insulin (ρ = 0.13, p = .001). High baseline insulin predicted insulin change (B = -11.50, standard error [SE] = 2.30, p < .001). Depressive symptoms also predicted insulin change, but only for pubertal adolescents (B = -0.23, SE = 0.11, p = .038). This relationship was moderated by race (p = .047); depressive symptoms predicted insulin change only among pubertal black adolescents (p = .030), not white (p = .49), and in the direction opposite that hypothesized (Bblacks = -0.51, SE = 0.23). Post hoc analyses revealed that pubertal black adolescents with high depressive symptoms had the highest baseline insulin, which stayed high across the follow-up period.

CONCLUSIONS

Among pubertal black adolescents, elevated depressive symptoms are associated with increased risk for sustained hyperinsulinemia from adolescence into adulthood. These youths may be particularly vulnerable for Type 2 diabetes.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

Developmental Trajectories of Subjective Social Status

BACKGROUND AND OBJECTIVE

Subjective social status (SSS), a person's sense of their (or for youth, abstract their family's) position in the socioeconomic hierarchy, is strongly related to health in adults but not health in adolescence. Understanding this developmental discrepancy requires first understanding the developmental trajectory of SSS. The objective of this study was to identify the number and shape of SSS trajectories as adolescents transition to adulthood and explore if trajectory membership affects health.

METHODS

Using data from 7436 assessments from the Princeton School District Study, a decade long cohort study of non-Hispanic black and white youth, latent class growth models with 3 to 7 SSS trajectories were developed. Model fit, trajectory structure, and shape were used to guide optimal model selection. Using this optimal model, the associations of trajectory membership with BMI and depressive symptoms in young adulthood were explored.

RESULTS

The 5-class model was optimal. In this model, trajectories were persistent high (7.8%),mid–high (32.2%), middle (43.4%), low–lower (7.4%), and high–low (9.1%). Non-Hispanic black race/ethnicity, lower household income, and low parent education were associated with membership in this high–low trajectory. High–low trajectory membership was associated with higher BMI and depressive symptoms in non-Hispanic white subjects but was not associated with depressive symptoms. It was associated with lower BMI only after adjustment for BMI in adolescence in non-Hispanic black subjects.

CONCLUSIONS

SSS is relatively stable in adolescence and the transition to adulthood, and it generally reflects objective markers of social advantage. However, socially disadvantaged youth with high SSS in early adolescence may be at increased health risk.

The effect of subjective and objective social class on health-related quality of life: new paradigm using longitudinal analysis

BACKGROUND

To investigate the impact of the gap between subjective and objective social status on health-related quality of life.

METHODS

We analyzed data from 12,350 participants aged ≥ 18 years in the Korean Health Panel Survey. Health-related quality of life was measured by EuroQol-Visual analogue scale. Objective (income and education) and subjective social class (measured by MacArthur scale) was classified into three groups (High, Middle, Low). In terms of a gap between objective and subjective social class, social class was grouped into nine categories ranging from High-High to Low-Low. A linear mixed model was used to investigate the association between the combined social class and health-related quality of life.

RESULTS

The impact of the gap between objective and subjective status on Health-related quality of life varied according to the type of gap. Namely, at any given subjective social class, an individual's quality of life declined with a decrease in the objective social class. At any given objective social class (e.g., HH, HM, HL; in terms of both education and income), an individual's quality of life declined with a one-level decrease in subjective social class.

CONCLUSION

Our results suggest that studies of the relationship between social class and health outcomes may consider the multidimensional nature of social status.

Adolescent Socioeconomic and School-Based Social Status, Smoking, and Drinking

PURPOSE

Relationships between subjective social status (SSS) and health-risk behaviors have received less attention than those between SSS and health. Inconsistent associations between school-based SSS and smoking or drinking might be because it is a single measure reflecting several status dimensions. We investigated how adolescent smoking and drinking are associated with "objective" socioeconomic status (SES), subjective SES, and three dimensions of school-based SSS.

METHODS

Scottish 13-15 years-olds (N = 2,503) completed questionnaires in school-based surveys, providing information on: "objective" SES (residential deprivation, family affluence); subjective SES (MacArthur Scale youth version); and three school-based SSS dimensions ("SSS-peer", "SSS-scholastic" and "SSS-sports"). We examined associations between each status measure and smoking (ever and weekly) and drinking (ever and usually five or more drinks) and investigated variations according to gender and age.

RESULTS

Smoking and heavier drinking were positively associated with residential deprivation; associations with family affluence and subjective SES were weak or nonexistent. Both substances were related to each school-based SSS measure, and these associations were equally strong or stronger than those with deprivation. Although SSS-peer was positively associated with both smoking and (especially heavier) drinking, SSS-scholastic and SSS-sports were negatively associated with both substances. There were no gender differences in the associations and few according to age.

CONCLUSIONS

Subjective school-based status has stronger associations with adolescent smoking and drinking than "objective" or subjective SES. However, different dimensions of school-based status relate to adolescent smoking and drinking in opposing directions, meaning one measure based on several dimensions might show inconsistent relationships with adolescent substance use.

How do we assign ourselves social status? A cross-cultural test of the cognitive averaging principle

Subjective social status (SSS), or one's perceived social standing, is linked robustly to mental and physical health and is thought to be determined in part by a cognitive average of one's past, present and expected socioeconomic status. However, this averaging principle awaits a formal test. Further, cultures differ with regard to how they perceive and discount time. In this study, I draw upon cross-sectional data from the United States and Japan (2005 MIDUS non-Hispanic whites and 2008 MIDJA), which measured subjective status in terms of one's perceived standing within a personally defined community. I compare equal and unequal cognitive averaging models for their goodness of fit relative to a traditional present-based model. Socioeconomic status is assessed broadly, in terms of past, present and expected overall work and financial situations. In the United States, averaging models do not fit the data consistently better than a present-based model of SSS. However, in Japan, averaging models do fit SSS consistently better. These fit conclusions are robust to controlling for negative affect.

"I Used to Be Wild": Adolescent Perspectives on the Influence of Family, Peers, School, and Neighborhood on Positive Behavioral Transition

Public health practice involving adolescents is largely focused on preventing or delaying the initiation of risk behavior. However, given the experimental and exploratory nature of this developmental period, this is often impractical. This paper focuses on behavioral transitions and the ways in which youth involved in risk behaviors shift to more promotive behaviors. Based on a positive youth development perspective, in-depth interviews with urban youth were conducted and analyzed to gain an understanding of the influences on behavior change. Specific family support, ability to detach from harmful peer relationships, and school connectedness and vocational support emerged as important to those youths who made a positive behavioral transition. These findings suggest the importance of understanding ways to support the cessation of involvement in risk behaviors and reinforce the significance of contextual influences on youth development.

Perceptions of social mobility: development of a new psychosocial indicator associated with adolescent risk behaviors

Social class gradients have been explored in adults and children, but not extensively during adolescence. The first objective of this study was to examine the association between adolescent risk behaviors and a new indicator of adolescent relative social position, adolescent "perceived social mobility." Second, it investigated potential underlying demographic, socioeconomic, and psychosocial determinants of this indicator. Data were taken from the 2004 urban adolescent module of Oportunidades, a cross-sectional study of Mexican adolescents living in poverty. Perceived social mobility was calculated for each subject by taking the difference between their rankings on two 10-rung ladder scales that measured (1) projected future social status and (2) current subjective social status within Mexican society. Adolescents with higher perceived social mobility were significantly less likely to report alcohol consumption, drinking with repercussions, compensated sex, police detainment, physical fighting, consumption of junk food or soda, or watching ≥4 h of television during the last viewing. They were significantly more likely to report exercising during the past week and using a condom during last sexual intercourse. These associations remained significant with the inclusion of covariates, including parental education and household expenditures. Multiple logistic regression analyses show higher perceived social mobility to be associated with staying in school longer and having higher perceived control. The present study provides evidence for the usefulness of perceived social mobility as an indicator for understanding the social gradient in health during adolescence. This research suggests the possibility of implementing policies and interventions that provide adolescents with real reasons to be hopeful about their trajectories.

The role of perceived discrimination during childhood and adolescence in understanding racial and socioeconomic influences on depression in young adulthood

OBJECTIVE

To describe levels of perceived lifetime discrimination among young adults and determine its role in understanding this racial/ethnic disparity.

STUDY DESIGN

Data were from the Princeton School District study, a 10-year cohort study in which investigators followed 545 non-Hispanic black (46%) and white initial 5-12 graders. Perceived lifetime racial discrimination was assessed with the General Ethnic Discrimination Scale and depressive symptoms with the Center for Epidemiological Studies Depression Scale. Stepped linear and logistic regression analyses assessed the relationships of race/ethnicity, parental education, and quintiles of discrimination to depressive symptoms. Stratification by race/ethnicity explored differences in the role of discrimination in explaining the relationship between parental education and depressive symptoms.

RESULTS

Black students from professionally educated families had the greatest discrimination scores, 1.8 times greater than among their white peers (meanblack = 42.1 vs meanwhite = 22.8; P < .0001). Greater parental education was associated with lower depressive symptoms in all regression models. Race/ethnicity became predictive of depressive symptoms only after adjusting for discrimination, which was strongly associated with depressive symptoms. Stratified analysis suggested discrimination accounted for the relationship of parental education to depressive symptoms among whites. Among black subjects, accounting for discrimination unmasked a buffering effect of parental education.

CONCLUSIONS

Greater levels of parent education are protective against depression for white youth. However, for black youth, greater parent education confers both risk and protective effects. The high discrimination among black youth from families with college or professionally educated parents overwhelms the protective effect of greater levels of parent education.

Breastfeeding duration and weight gain trajectory in infancy

BACKGROUND AND OBJECTIVES

Short breastfeeding duration may exacerbate accelerated early growth, which is linked to higher obesity risk in later life. This study tested the hypothesis that infants at higher risk for obesity were more likely to be members of a rising weight-for-length (WFL) z score trajectory if breastfed for shorter durations.

METHODS

This prospective, observational study recruited women from an obstetric patient population in rural central New York. Medical records of children born to women in the cohort were audited for weight and length measurements (n = 595). We identified weight gain trajectories for infants' WFL z scores from 0 to 24 months by using maximum likelihood latent class models. Individual risk factors associated with weight gain trajectories (P ≤ .05) were included in an obesity risk index. Logistic regression analysis was performed to investigate whether the association between breastfeeding duration (<2 months, 2-4 months, >4 months) and weight gain trajectory varied across obesity risk groups.

RESULTS

Rising and stable weight gain trajectories emerged. The obesity risk index included maternal BMI, education, and smoking during pregnancy. High-risk infants breastfed for <2 months were more likely to belong to a rising rather than stable weight gain trajectory (odds ratio, 2.55; 95% confidence interval, 1.14-5.72; P = .02).

CONCLUSIONS

Infants at the highest risk for rising weight patterns appear to benefit the most from longer breastfeeding duration. Targeting mothers of high-risk infants for breastfeeding promotion and support may be protective against overweight and obesity during a critical window of development.

Experimental Evidence That Low Social Status is Most Toxic to Well-being When Internalized

What makes low social status toxic to well-being? To internalize social status is to believe the self is responsible for it. We hypothesized that the more people internalize low subjective social status, the more their basic psychological needs are thwarted. Experiment 1 randomly assigned participants to imagine themselves in low, middle, or high social status and assessed their subjective social status internalization by independent ratings. The more participants internalized low status, the more they reported their basic psychological needs were thwarted. This effect did not appear among their higher status counterparts. Experiment 2 replicated and extended these findings using a behavioral manipulation of subjective social status and a self-report measure of internalization. We discuss implications for basic and action research.

The association between a living wage and subjective social status and self-rated health: a quasi-experimental study in the Dominican Republic

Poverty, both absolute and relative, is associated with poorer health. This is of particular concern in middle- and low-income countries facing a significant and growing burden of disease. There has been limited research specifically on whether interventions that increase income may foster better health outcomes. The establishment of a "living wage" apparel factory in the Dominican Republic provided a minimum income standard for factory workers, thus creating a natural experiment through which to study the effects of increased income on health indicators. The primary component of the intervention was a 350% wage increase, but apparel workers in the intervention factory also received education and professional development and were exposed to an enhanced occupational health and safety program. Workers at the intervention factory (n = 99) were compared with workers at a matched apparel factory (n = 105). Data were collected via in-person interviews in July and August of 2011, which was 15-16 months after workers were initially hired at the intervention site. Primary analyses used employment at the intervention factory as the independent variable and examined associations with two dependent variables: subjective social status and self-rated health. Results showed that receiving a 350% higher wage was associated with substantially higher subjective social status scores, as well as higher global and comparative self-rated health scores; effects were strongest in women. Subjective social status and self-rated health are associated with future health outcomes, so these results indicate that income increases for apparel workers may have positive long-term health outcomes, particularly for women.

Adolescent socio-economic and school-based social status, health and well-being

Studies of adults and adolescents suggest subjective socio-economic status (SES) is associated with health/well-being even after adjustment for objective SES. In adolescence, objective SES may have weaker relationships with health/well-being than at other life stages; school-based social status may be of greater relevance. We investigated the associations which objective SES (residential deprivation and family affluence), subjective SES and three school-based subjective social status dimensions (“SSS-peer”, “SSS-scholastic” and “SSS-sports”) had with physical symptoms, psychological distress and anger among 2503 Scottish 13–15 year-olds. Associations between objective SES and health/well-being were weak and inconsistent. Lower subjective SES was associated with increased physical symptoms and psychological distress, lower SSS-peer with increased psychological distress but reduced anger, lower SSS-scholastic with increased physical symptoms, psychological distress and anger, and lower SSS-sports with increased physical symptoms and psychological distress. Associations did not differ by gender. Objective and subjective SES had weaker associations with health/well-being than did school-based SSS dimensions. These findings underline the importance of school-based SSS in adolescence, and the need for future studies to include a range of school-based SSS dimensions and several health/well-being measures. They also highlight the need for a focus on school-based social status among those working to promote adolescent health/well-being.

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We examined associations between adolescent social status and several health measures.

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Models included objective and subjective socio-economic status and school peer, scholastic and sports status.

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School status had stronger associations with health than did socio-economic status.

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Different school status dimensions and health measures were associated in different ways.

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Studies should include a range of school status dimensions and health measures.