Beyond conventional socioeconomic status: examining subjective and objective social status with self-reported health among Asian immigrants

Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis

The purpose of this study was to examine (a) the socioeconomic status (SES)-related inequalities associated with handgrip strength (HGS); and (b) the extent to which several demographic, health, and behavioral factors contributed to such SES disparities in HGS among older adults in India. Data were drawn from the 2017-2018 wave 1 of the Longitudinal Ageing Study of India (LASI). The study sample included 27,707 older adults (13,199 men and 14,508 women) aged 60 years and older. HGS was assessed using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5 kg for men and 12.5 kg for women. Bivariate analysis showed the weighted percentage distribution of weak HGS across respondent characteristics. Multivariate logistic regression assessed factors linked to weak HGS. The concentration curve and index (CCI) was used to determine the inequalities in the prevalence of weak HGS by wealth index scores. Wagstaff's decomposition approach was used to test the contribution of each explanatory variable to weak HGS. Around 9% of older adults in this study reported a weak HGS. It was significantly higher among those aged 80 or older (19.21%) and males (15.55%). Weak HGS was concentrated among older adults from poor SES (CCI: 0.05, p < 0.001). A higher percentage of wealth-based inequality in weak HGS was explained by being underweight (38.83%), belonging to the richest wealth quintile (27.95%), and having a higher subjective social status (32.20%). Moreover, about 23.29% of the inequality in weak HGS was explained by Western region and 22.54% by female gender. Additionally, having a secondary level of education explained a higher percentage (22.09%) of inequality, followed by current working status (- 20.68%). Rural residence (13.08%), limitations in instrumental activities of daily living (IADL) (12.21%), and engagement in yoga-related activities (11.55%) explained a higher percentage of wealth-based inequalities. The findings provide evidence of significant SES-related inequalities in HGS and the contribution of various demographic, health, and behavioral factors to such inequality. As such, public health policies and programs focusing on reducing the burden of disability must consider the contribution of social and economic equity to the preservation of muscle strength among older adults.

Acculturation and self-rated health among Chinese and Korean immigrants aged 49 to 75

Background

Given the rapidly growing Asian populations in the U.S. due to immigration, and the aging demographic of Asian immigrants, it is crucial to understand how acculturation shapes health among older adult Asian immigrants. We study the relationship between acculturation and self-rated health (SRH) and moderating roles of age and Asian subgroup.

Methods

Our cross-sectional study consisted of 200 Chinese and 200 Korean immigrants aged 49-75 living in Baltimore-Washington DC metropolitan area, who were recruited from primary care physicians' clinics in Maryland and Northern Virginia. The participants completed the survey either in-person or by phone in their preferred language. Multidimensional proxies were used to measure acculturation: years living in the U.S. (≥23 years, <23 years), English proficiency (fluently/well, so-so, poorly/not at all), and ethnic identity (very Asian, mostly Asian, bicultural/westernized). SRH was measured using the question "How would you rate your general health?" (excellent/very good/good, fair/poor). Poisson regression models with robust error variance examined associations between acculturation and SRH, accounting for socioeconomic and health insurance factors.

Results

Speaking English so-so and fluently/well had 0.73 (95% confidence intervals (CI): 0.55-0.97) and 0.51 (95% CI: 0.30-0.87) times the prevalence of having fair or poor SRH compared to speaking English poorly/not at all, respectively. The magnitudes and statistical significance of these associations were stronger among Chinese participants than Korean participants. Moreover, individuals who self-identified as bicultural/westernized had 0.63 times the prevalence of having fair or poor SRH (95% CI: 0.43-0.92) as those who self-identified as very Asian. The association was more pronounced among older participants (≥58) compared to younger participants (<58).

Conclusion

Further research should identify the possible mechanisms linking acculturation with health to find effective strategies to enhance health among aging Asian immigrant populations.

Considering the role of integration experiences in shaping immigrants' post-migration food choices and eating practices

This article draws on data collected from qualitative interviews with 38 recent immigrants in two Ontario cities to provide an overview of recent immigrants' general dietary acculturation experiences. With insights from both Cockerham's health lifestyle theory and Berry's acculturation model, this article explores how structural inequalities related to integration and settlement may shape recent immigrants' post-migration food choices and eating practices. The results of this study revealed that immigrants from non-Western countries experienced greater challenges in healthy eating. Findings are in line with Cockerham's health lifestyle theory: immigrants' post-migration food choices and dietary acculturation strategies were not only bounded by socioeconomic status and cultural differences but were also shaped by various structural inequalities, especially those related to systematic barriers during the integration and settlement process. Overall, this paper provides a more holistic understanding of the multifaceted nature of immigrants' dietary acculturation experiences.

Association of relative deprivation with loneliness and its underlying mechanisms: Evidence from Chinese migrant children

Given the increase in the number of internal migrant children, the mental health problems (e.g., loneliness) of this population have received widespread attention. Relative deprivation is considered to be related to migrant children’s loneliness. However, the underlying mechanisms of this relationship remain unclear. Therefore, the present study tested the possible mediating role of self-esteem and the moderating role of belief in a just world in the association between relative deprivation and loneliness of migrant children. A total of 1,261 Chinese rural-to-urban migrant children (10–15 years old, Mage = 12.34 years, SD = 1.67; 52.0% males, 48.0% females; 23.55% fourth grade students, 16.49% fifth grade students, 19.59% sixth grade students, 15.54% seventh grade students, 13.80% eighth grade students, and 10.86% ninth grade students) were recruited to complete measures of relative deprivation, self-esteem, belief in a just world, loneliness, and demographic variables. Relative deprivation was significantly and positively correlated with migrant children’s loneliness, and this connection could be mediated by self-esteem. Moreover, the first part of the indirect effect of self-esteem on this link was moderated by belief in a just world. These effects were stronger for migrant children with higher levels of belief in a just world. This study reveals the potential mechanisms of relative deprivation affecting loneliness, while also providing insights into how to better help migrant children alleviate loneliness and improve their mental health.

The Effects of Subjective Social Class on Subjective Well-Being and Mental Health: A Moderated Mediation Model

In recent decades, China's rapid economic growth has substantially improved average living standards; however, this has not been accompanied by greater happiness among the Chinese population. This phenomenon is known as the Easterlin Paradox (i.e., there is no link between a society's economic development and its average level of happiness) in Western countries. This study examined the effects of subjective social class on subjective well-being and mental health in China. Consequently, we found that individuals in a relatively low social class had lower levels of subjective well-being and mental health; self-class discrepancy partially explains the relationship between subjective social class and subjective well-being and fully explains the relationship between subjective social class and mental health; and subjective social mobility moderates the path from self-class discrepancy to subjective well-being and mental health. These findings suggest that enhancing social mobility is an important method for reducing class differences in subjective well-being and mental health. These results have important implications, indicating that enhancing social mobility is an important method for reducing class differences in subjective well-being and mental health in China.

Association between socioeconomic status and mental health among China’s migrant workers: A moderated mediation model

Mental health problems are prevalent among China’s internal migrant workers. However, research on the relationship between socioeconomic status (SES) and mental health is insufficient. Therefore, this study, utilizing the China’s National Dynamic Monitoring Survey data from a sample of 15,997 migrant workers aged 15–59 years to explore differences in the relationship between migrants’ objective and subjective SES and mental health status in 2015. Both the mediating effect of perceived interpersonal discrimination and the moderating effect of age were examined through structural equation modeling. The results indicated that subjective SES has a stronger direct relationship with mental health than objective SES. Perceived interpersonal discrimination mediated the association between subjective SES and mental health. Furthermore, a much stronger relationship was found between subjective SES and perceived interpersonal discrimination among migrants older than 24 years of age than younger migrant groups. The results showed that, compared with traditional objective SES indicators, subjective SES could be a more sensitive index for identifying those migrant workers with a high risk of mental health problems. In addition, reducing interpersonal discrimination toward migrants can alleviate their mental health problems. And we should pay more attention to older migrant workers since they are more likely to prone to interpersonal discrimination and mental health issues.

Gender Disparity and the Association Between Socioeconomic Status, Mental Health, and the Need for Long-Term Services and Support Among the Older Koreans

BACKGROUND

Population aging-the inevitable increase in the percentage of older adults-is occurring all around the world as the fertility rate declines and life expectancy rises. This study examined the relationship between socioeconomic status (SES), mental health, and the need for long-term services and support (LTSS) among Korean older adults. It also aimed to provide evidence-based information for South Korea's long-term support services and programs.

METHODS

This study used the data on older adults aged over 60 years from the 2018 Korean Longitudinal Study of Aging (KLoSA). Ultimately, 5,527 older adults were included in the database (42.6% men, 57.4% women). To clarify the association between SES, mental health, and the need for LTSS among older Korean men and women, chi-squared test, t-test, and structural equation modeling (SEM) were performed.

RESULTS

The SEM analysis showed that a significant, negative association was observed between SES and the need for LTSS among these older adults-the higher SES groups would generally have less need for LTSS. Mental health had a strong, negative impact on the need for LTSS-better mental health status of the older individuals would indicate a lower need for LTSS, and the effect was stronger among older men. Meanwhile, the positive relationship between SES and mental health was verified-the higher the SES of these older adults the better their mental health.

CONCLUSIONS

Gender- and social class-sensitive impacts of mental health on the need for LTSS were observed in this study. These findings could provide an evidence-based reference for interventions targeting different genders and social classes in Korea's long-term care system, such as the enhancement of social welfare and mental health status of the older adults.

Subjective social status moderates back pain and mental health in older men

OBJECTIVES

Back pain and poor mental health are interrelated issues in older men. Evidence suggests that socioeconomic status moderates this relationship, but less is known about the role of subjective social status (SSS). This study examined if the association between back pain and mental health is moderated by SSS.

METHOD

We used a sample of community-dwelling older men (≥65 years) from the Osteoporotic Fractures in Men Study (N = 5994). Participants self-reported their back pain severity and frequency over the past 12 months. SSS was assessed with the MacArthur Scale of SSS. Mental health was assessed with the SF-12 Mental Component Summary (MCS).

RESULTS

Severe back pain was associated with lower SF-12 MCS scores (p = .03). Back pain frequency was not associated with SF-12 MCS scores. SSS moderated the back pain and mental health relationship. Among men with higher national or community SSS, the association between back pain severity and SF-12 MCS scores was not significant. However, among men with lower national or community SSS, more severe back pain was associated with lower SF-12 MCS scores (p's < .001). Among those with lower national or community SSS, greater back pain frequency was also associated with lower SF-12 MCS scores (p's < .05).

CONCLUSION

Where one ranks oneself within their nation or community matters for the back pain and mental health relationship. Higher SSS may be a psychosocial resource that buffers the negative associations of severe and frequent back pain on mental health in older men.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Examining the relation between the subjective and objective social status with health reported needs and health-seeking behaviour in Dande, Angola

BACKGROUND

Assessing subjective social status (SSS) may be easily accommodated in the context of a Health and Demographic Surveillance System (HDSS). To our knowledge, no prior studies have examined the association of SSS and health in Angola. Subjective socioeconomic measures may provide a rapid assessment of a relevant social status construct, important for studying health inequalities. In this study, we addressed social determinants of health by examining the relationship between the subjective and objective social status, reported health and healthcare-seeking behaviour.

METHODS

This research results from a cross-sectional study performed during 2015 in the Dande HDSS, in Angola. We tested the application of the MacArthur scale as a measure of SSS in a developing setting, in a sample of 12,246 households. First, we investigated its relation to objective socioeconomic indicators, and then we explored how subjective and objective social status associate with health reported needs and health-seeking behaviour of the surveyed population. Chi-square, ANOVA tests, and Receiver Operating Characteristics (ROC) Curves analysis were computed for testing relationships between subjective status ladder quartiles, sociodemographic and household characteristics. Logistic regression was used to examine the influence of subjective perception of status in self-reported health and health-seeking behaviour.

RESULTS

Our findings suggest that the SSS follows a gradient distribution obtained with more objective socioeconomic indicators. Additionally, we found that subjective perception of status influence health needs reporting and health-seeking behaviour and its significant effect remained after controlling for the objective socioeconomic markers. Individuals standing in the second quartile of the social ladder have more odds of reporting illness and those in the highest quartiles of the ladder were twice more likely (OR = 2.23, 95% CI = 1.52-3.26) to seek help from formal health services than those at the bottom of the ladder.

CONCLUSIONS

The MacArthur Scale is a valuable tool to measure SSS in the Dande HDSS, relevant for studying socioeconomic disparities and health inequalities. It is also an easier alternative to traditional measures such as income, usually difficult to measure in developing settings. The social perception of status should be considered as a complement with objective indicators when exploring social determinants of health.

Subjective Social Status and Cardiometabolic Risk Markers by Intersectionality of Race/Ethnicity and Sex Among U.S. Young Adults

BACKGROUND

Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships.

PURPOSE

To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex.

METHODS

Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24-32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1-10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification.

RESULTS

SSS-race/ethnicity-sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: -1.2 (0.4), p < .05) and BMI (-0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males.

CONCLUSIONS

SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk.

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N = 1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

Food Insecurity and Bullying Victimization Among 170,618 Adolescents in 59 Countries

Background: Bullying victimization can impose long-lasting impacts on adolescent's current and subsequent well-being. Understanding the correlates of bullying victimization and how to prevent its occurrence is an urgent need. Food insecurity, an indicator of low socioeconomic status, may be related to bullying victimization. However, research on the association between food insecurity and bullying victimization is limited. Using a representative global sample, this study aimed to investigate the association between food insecurity and bullying victimization in adolescents and whether the association varied between country income levels, sexes, and age groups. Methods: Using cross-sectional, school-based data by 170,618 adolescents in 59 countries from the Global School-based Student Health Survey, multivariable logistic regression and meta-analysis were conducted to investigate the overall, country-stratified, sex-stratified, and age-stratified associations. Results: The prevalence of bullying victimization was 33.3%. In the total sample, adolescents with food insecurity showed significantly higher odds for bullying victimization than those without no food insecurity with a pooled odds ratio (OR) being 1.37 (1.28, 1.47). Further, the association was stronger in higher-income countries, females, and older adolescents. Conclusions: Bullying victimization is prevalent among global adolescents with food insecurity being a significant correlate. The identification of adolescents with perceptions of food insecurity and remedying this condition may be important to reduce the prevalence of bullying. This highlights the need to design and implement sex- and age-specific interventions focusing on remedying food insecurity and bullying victimization among in-school adolescents by taking country income levels into account.

Profiles of Adolescent Identity at the Intersection of Ethnic/Racial Identity, American Identity, and Subjective Social Status

Ethnic/racial minority adolescents face the task of forming an identity in relation to their ethnic/racial group as well as to American society, while also developing awareness of their social status relative to salient social groups. Whereas previous studies have investigated individual social identity dimensions or examined how objective measures of ethnicity/race and socioeconomic status intersect, studies that take a holistic and person-centered approach to considering various configurations of multiple social identities with subjective measures have been less common. The current study addresses these gaps and explores profiles of ethnic/racial identity, American identity, and subjective social status among ethnic/racial minority adolescents. Next, differences in discrimination experiences, mental health and academic outcomes across these profiles were examined. Three distinct identity profiles emerged from the data - "weakly identified," "high ethnic/racial identity moderate American identity," and "moderate ethnic/racial identity and American identity." The "weakly identified" demonstrated the highest levels of past discrimination experiences and depressive symptoms, while the "moderate ethnic/racial identity and American identity" group reported the lowest levels of school engagement. Interpretation of the profiles and associated outcomes and implications are discussed.

Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Background: Prior research shows inconsistent associations between socioeconomic status (SES) and alcohol outcomes, particularly for immigrant populations. Conventional markers of SES may not fully capture how social position affects health in these groups. Objective: We examine: (1) the associations of two alternative indicators, subjective social status (SSS) and financial hardship, with problem drinking outcomes, heavy episodic drinking (HED) and alcohol use disorder (AUD), for Asian Americans and Latinos; and (2) moderation of these relationships by educational level and nativity status. Methods: Multiple logistic regression modeling was performed using nationally-representative Asian American (n = 2,095) and Latino samples (n = 2,554) from the National Latino and Asian American Study. Age, gender, nativity, individual-level SES (income and education), unfair treatment, racial discrimination, and social support were adjusted. Results: Financial hardship was independently associated with AUD in both Asians and Latinos. Lower SSS was associated with increased AUD risk among individuals with college degrees or with US nativity in both populations. The association between financial hardship and HED was positive for US-born Latinos and foreign-born Asians, and negative for foreign-born Latinos. Conclusions: SSS and financial hardship are indicators of SES that may have particular relevance for immigrant health, independently of education and income, with SSS particularly meaningful for AUD in the more conventionally advantaged subgroups. There may be underlying processes affecting Asian and other Latino subgroups with similar socioeconomic and nativity profiles and exposing them to common risk/protective factors of AUD.

Is childhood migration a mental health risk? Exploring health behaviors and psychosocial resources as pathways using the cross-sectional Canadian Community Health Survey

Drawing on the Stress Process Model, this study investigates the effect of early migration on health behaviors and psychosocial resources. Further, I consider whether health behaviors and psychosocial processes lead to higher psychological distress for childhood immigrants in adulthood. Cross-sectional data from the Canadian Community Health Survey-Mental Health 2012 (N = 4282) reveal that compared to adult immigrants, childhood immigrants are not only four times more likely to use drugs, but also experience greater interpersonal strain. However, health behaviors such as these contribute less to psychological distress than do psychosocial resources. Additionally, longer duration of migration is found to reduce psychological distress when controlling for age at migration, thus suggesting the migrant health literature should examine age-salient life challenges at the time of migration, instead of continuing to use duration of migration as a proxy for negative acculturation.

The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province-A Cross-Sectional Study

This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results.

Associations of socioeconomic and religious factors with health: a population-based, comparison study between China and Korea using the 2010 East Asian social survey

Background

Cross-national comparisons of the associations of socioeconomic and religious factors with health can facilitate our understanding of differences in health determinants between countries and the development of policies to reduce health differentials appropriate to each country. However, very few such studies have been conducted in East Asia.

Methods

This study set out to compare the associations of socioeconomic and religious factors with health in China and Korea using the 2010 East Asian Social Survey, which was based on nationally representative samples. The study participants included 4980 individuals, 3629 in China and 1351 in Korea, aged ≥20 years. The dependent variable, individuals’ self-rated health, was categorized into poor, good, and excellent. Socioeconomic (education, employment, household income, and self-assessed social class) and religious factors (affiliation) were used as independent variables of interest. A multinomial logistic regression was performed with and without adjustments for factors such as demographics, health-related risks, the health system, and social capital.

Results

According to the results, China had a higher proportion of individuals who reported excellent health than did Korea (57.4% vs. 52.0%). After adjusting for all studied confounders, we found that the employment, household income, and social class gradient in health were significant in China, whereas the education and religion gradients in health were significant in Korea. For example, the odds ratio for poor health versus excellent health among those in the highest social class was 0.47 (95% CI, 0.27–0.84), compared to that of people in the lowest social class in China; and this odds ratio in people with college education or higher was 0.28 (95% CI, 0.14–0.59) compared to that of people with elementary school education or lower in Korea.

Conclusions

These findings demonstrate the important role of socioeconomic and religious factors in health in China and Korea as well as clear differences in this regard. Further cross-national studies are needed to provide a better understanding of the relationship between socioeconomic and religious factors and health and to draft appropriate health improvement policies in both countries.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6380-y) contains supplementary material, which is available to authorized users.

Concurrent and face validity of the MacArthur scale for assessing subjective social status: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

This work assessed the concurrent and face validity of the MacArthur scale, which attempts to capture subjective social status in society, neighborhood and work contexts. The study population comprised a convenience sample made up of 159 adult participants of the ELSA-Brasil cohort study conducted in Minas Gerais between 2012 and 2014. The analysis was conducted drawing on Conceptual Metaphor Theory and using corpus linguistic methods. Concurrent validity was shown to be moderate for the society ladder (Kappaw = 0.55) and good for the neighborhood (Kappaw = 0.60) and work (Kappaw = 0,67) ladders. Face validity indicated that the MacArthur scale really captures subjective social status across indicators of socioeconomic position, thus confirming that it is a valuable tool for the study of social inequalities in health Brazil.

Social Class, Classism, Stigma, and College Students’ Attitudes Toward Counseling

This study tested two competing theoretically and empirically derived models of college students’ attitudes toward seeking counseling. It extends the literature in this area by assessing the influence of objective and subjective social class, classism, and stigma on attitudes. We used structural equation modeling to analyze self-reported archival data from 2,230 incoming college students at a large, public research university in the Eastern United States. The results demonstrated the superiority of the direct and indirect effects of social class over the competing indirect effects model of social class. The results further indicated that objective social class related to attitudes toward seeking professional help indirectly through subjective social class, classism, and stigma. Finally, the results also showed that objective social class, subjective social class, and classism operated differently in the model. We discuss study limitations, future directions for research, and recommendations for practice.

Is subjective social status a summary of life-course socioeconomic position?

Very little is known about the association between objective indicators of socioeconomic position in childhood and adolescence and low subjective social status in adult life, after adjusting for adult socioeconomic position. We used baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of 15,105 civil servants from six Brazilian states. Subjective social status was measured using the The MacArthur Scale of Subjective Social Status, which represents social hierarchy in the form of a 10-rung ladder with the top rung representing the highest subjective social status. Participants who chose the bottom four rungs in the ladder were assigned to the low subjective social status category. The following socioeconomic position indicators were investigated: childhood (maternal education), adolescence (occupational social class of the household head; participant's occupational social class of first job; nature of occupation of household head; participant's nature of occupation of first job), and adulthood (participant's occupational social class, nature of occupation and education). The associations between low subjective social status and socioeconomic position were determined using multiple logistic regression, after adjusting for sociodemographic factors and socioeconomic position indicators from other stages of life. After adjustments, low socioeconomic position in childhood, adolescence and adulthood remained significantly associated with low subjective social status in adulthood with dose-response gradients. The magnitude of these associations was stronger for intra-individual than for intergenerational socioeconomic positions. Results suggest that subjective social status in adulthood is the result of a complex developmental process of acquiring socioeconomic self-perception, which is intrinsic to subjective social status and includes current and past, individual and family household experiences.

Is subjective social status a unique correlate of physical health? A meta-analysis

OBJECTIVE

Both social stratification (e.g., social rank) as well as economic resources (e.g., income) are thought to contribute to socioeconomic health disparities. It has been proposed that subjective socioeconomic status (an individual's perception of his or her hierarchical rank) provides increased predictive utility for physical health over and above more traditional, well-researched socioeconomic constructs such as education, occupation, and income.

METHOD

PsycINFO and PubMed databases were systematically searched for studies examining the association of subjective socioeconomic status (SES) and physical health adjusting for at least 1 measure of objective SES. The final sample included 31 studies and 99 unique effects. Meta-analyses were performed to: (a) estimate the overlap among subjective and objective indicators of SES and (b) estimate the cumulative association of subjective SES with physical health adjusting for objective SES. Potential moderators such as race and type of health indicator assessed (global self-reports vs. more specific and biologically based indicators) were also examined.

RESULTS

Across samples, subjective SES shows moderate overlap with objective indicators of SES, but associations are much stronger in Whites than Blacks. Subjective SES evidenced a unique cumulative association with physical health in adults, above and beyond traditional objective indicators of SES (Z = .07, SE = .01, p < .05). This association was stronger for self-rated health than for biologically based and symptom-specific measures of health. Almost all available data were cross-sectional and do not allow for strong causal inference.

CONCLUSIONS

Subjective SES may provide unique information relevant to understanding disparities in health, especially self-rated health. (PsycINFO Database Record

Subjective assessments of income and social class on health and survival: An enigma

We examined the association between various measures of subjective social class identification (SSCI) and self-rated health as well as survival using the 2014 General Social Survey-National Death Index dataset (n = 21,108). We used multinomial logistic regression models to assess the association between SSCI and self-rated health and used Cox proportional hazards to assess the association between SSCI and survival. All analyses were adjusted for age, year at interview, race, gender, family income, and educational attainment level. The measures of SSCI that we had available were strongly correlated with self-rated health after controlling for objective measures of social status. For example, those who saw themselves as lower class were nine times as likely to self-report poor rather than excellent health status (odds ratio = 8.69; 95% confidence interval = 5.04-14.98) compared with those saw themselves as upper class. However, no such associations were observed for survival. While our alternative measures of SSCI were important predictors of self-rated health, they were not predictive of survival. This suggests that there may be potential confounding between two perceptions: SSCI and self-rated health.

A matter of perception: Perceived socio-economic status and cortisol on the island of Utila, Honduras

OBJECTIVES

Numerous studies link low objective and subjective socioeconomic status (SES) to chronic activation of the hypothalamic pituitary adrenal (HPA) axis. Here, we examine associations between objective and subjective SES and diurnal salivary cortisol, a primary HPA component, as well as demographic and ecological predictors associated with SES perceptions and changes in diurnal cortisol.

METHODS

Participants were residents (age 18-79, n = 61) of Utila, a Honduran island where economic disparities are overt and geographically contained. Objective SES was measured as a composite of income, education, and occupation. Subjective SES was measured with a MacArthur ladder and a perceived lifestyle discrepancy (PLD) scale. Salivary cortisol was collected three times per day for two days. Questions addressing demographic, social, and household characteristics were assessed as predictors of PLD.

RESULTS

Assessed independently, objective SES (P = .06) and PLD (P = .003) were associated with the steepness of diurnal cortisol changes, while PLD was also associated with higher cortisol area under the curve (AUC) (P = .036). Modeled together, only PLD predicted diurnal slope and AUC. PLD was associated with household sanitation, immigration status, food scarcity, objective SES, and owing money. Only access to sanitation and owing money had direct associations with cortisol that were not mediated by PLD.

CONCLUSIONS

For adults on Utila, perceptions of unmet need outweigh other social and economic status factors in predicting cortisol AUC and slope. In addition, the unmediated effects of access to sanitation and owing money on cortisol suggest that these distinct aspects of inequality are important to consider when seeking to understand how inequality can impact HPA function.

The Effects of Objective and Subjective Socioeconomic Status on Subjective Well-Being among Rural-to-Urban Migrants in China: The Moderating Role of Subjective Social Mobility

Although previous investigations have agreed that Chinese rural-to-urban migrants’ socioeconomic status (SES) increases with their migration, the association between SES and subjective well-being is uncertain. To address this research gap, the present study proposed that the association between objective SES and subjective well-being is mediated by subjective SES. This model was tested with a sample of 432 Chinese rural-to-urban migrants. The results indicate a significant association between objective SES and subjective well-being and a partial mediating effect of subjective SES. Furthermore, subjective social mobility, which is one’s expectation about the possibility to move upward in the social hierarchy, was found to moderate both the direct path from objective SES to subjective well-being and the indirect path from subjective SES to subjective well-being. These findings suggest that Chinese rural-to-urban migrants gained in subjective well-being not only because of direct financial achievement but also because of their perceptions and beliefs about their relative social status.

Ethnic-group socioeconomic status as an indicator of community-level disadvantage: A study of overweight/obesity in Asian American adolescents

Asian American children and adolescents are an under-investigated subpopulation in obesity research. Informed by a wide socioeconomic diversity among Asian American ethnic groups, this study explored ethnic-group socioeconomic status (SES) as an indicator of community-level disadvantage that may influence overweight/obesity in Asian American adolescents. We hypothesized that ethnic-group SES was inversely associated with overweight/obesity in Asian American adolescents. Multiple logistic regression models were fitted using a sample of 1525 Asian American adolescents ages 12-17 from pooled 2007-2012 California Health Interview Survey (CHIS) data. Age, gender, nativity, individual-level SES (income and education), and two lifestyle variables (fast food consumption and physical activity) were controlled for. We found that adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight/obese than those in low-SES ethnic groups. Further, these relationships were more pronounced for foreign-born adolescents but not significant for U.S.-born adolescents. Ethnic-group SES may be a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Does socioeconomic status moderate the relationships between school connectedness with psychological distress, suicidal ideation and attempts in adolescents?

OBJECTIVE

Research has indicated that school connectedness acts as a buffer against depressive symptoms and suicidality. However, little is known about the role of socioeconomic status (SES) on these links. The present study examined the moderating role of subjective SES and parental education on the relationships between school connectedness and psychological distress, suicidal ideation and suicide attempts.

METHODS

Data were gathered from 4955 participants within the 2013 cycle of the Ontario Students Drug Use and Health Survey, a province-wide repeated school-based survey of students in grade 7 to 12 across Ontario, Canada.

RESULTS

Results indicated that higher subjective SES is associated with high levels of school connectedness. Subjective SES is also a significant moderator of the association between school connectedness and psychological distress, but not between school connectedness and suicidal ideation or attempts. At low subjective SES, there was no difference in risk of psychological distress between students with high and low levels of school connectedness. However, at higher subjective SES, students with high levels of school connectedness have lower odds of psychological distress than those with low levels of school connectedness. The associations between school connectedness and each of the mental health outcomes did not significantly vary with parental education.

CONCLUSIONS

These findings suggest that the beneficial effects of school connectedness on mental health problems may be more strongly related to adolescents' status beliefs rather than parental education. Future research is needed to better understand the mechanism through which subjective SES and school connectedness influence psychological distress.

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.

Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems

OBJECTIVE

Subjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions.

METHODS

We conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up.

RESULTS

Women with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11-7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant.

CONCLUSION

Low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.

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.

Association between socioeconomic status (SES), mental health and need for long-term care (NLTC)-A Longitudinal Study among the Japanese Elderly

This study was carried out to explore the relationship between the SES, mental health and the NLTC of the Japanese elderly, with the aim of providing useful information to lower the NLTC. A longitudinal survey was carried out in Tama City, Tokyo in 2001 and 2004. Data were collected from the urban-dwelling older adults, aged 65 years old and above, through self-reported questionnaires, which was participated by 7905 respondents (47.6% male and 52.4% female). Chi-square test, Kendall tau-b correlation analysis and structural equation modeling (SEM) were used to identify the association between SES, mental health and NLTC. The results of the SEM analysis indicated that mental health would exert a negative effect on NLTC for both the elderly men and the elderly women, while the effect was stronger for the elderly women; SES was significantly and negatively associated to NLTC, both for the elderly men and elderly women; a significant and positive relationship was observed between SES and mental health for both genders, but slightly stronger for the elderly men. These findings have implications for targeting the interventions that are aimed to delaying the NLTC and the financing of LTC system.

The longer you stay, the worse your health? A critical review of the negative acculturation theory among Asian immigrants

Researchers have become increasingly interested in the health patterns of immigrants with longer residence in the United States, as this reveals the health consequences of integration processes. The negative acculturation effect has been the dominant interpretation of duration patterns, despite empirical and theoretical uncertainties about this assumption. This theory assumes that immigrant health declines with longer residence in the United States because of poorer health behaviors and health risks that reflect Americanized lifestyles. This paper reviews the empirical support for the negative acculturation theory among Asian immigrants to determine if and when it is an appropriate interpretation for duration patterns. I conclude that empirical inconsistencies and methodological issues limit the negative acculturation theory as the primary interpretation for duration patterns. First, there is no consistent evidence that health behaviors decline with time. There is also substantial group heterogeneity in duration patterns as well as heterogeneity across health outcomes. The literature has not adequately addressed methodological shortcomings, such as confounding by cohort effects or non-linear duration patterns. Length of residence in the United States is still an important aspect of Asian immigrant health, but the mechanisms of this relationship are still understudied. I propose alternative frameworks between duration and health that consider environmental influences and end with future research directions to explore research gaps.

Subjective social status, immigrant generation, and cannabis and alcohol use among adolescents

Research indicates that subjective perceptions of socioeconomic status (SES) affect aspects of health and behavior. There has been little research attention to how objective (e.g., education) and subjective aspects of SES may differ in their influence on the substance use of adolescent immigrants. The present study examined whether the associations between subjective SES and substance use, and between parental education and substance use varied by immigrant generation. Data were derived from the 2011 Ontario Student Drug Use and Health Survey, a representative survey of students in the 7th to 12th grade. The sample for this study consisted of 9177 students 12-19 years of age; 48.4 % were female, 66.4 % were White/European, 5.2 % Black/Afro-Caribbean, 16.4 % Asian and 12 % other. Results indicated that subjective SES was more strongly associated with cannabis and alcohol use among first-generation immigrants than among adolescents of other immigrant generations even after adjusting for parental education. First-generation immigrants with low subjective SES had a lower probability of cannabis and regular alcohol use, but there was no difference in use between immigrant generations at high subjective SES. The associations between parental education and cannabis and alcohol use did not significantly vary with immigrant generation. The findings highlight the importance of status beliefs among adolescents, particularly among first-generation immigrants, and suggest that further research attention to such beliefs would enhance our understanding of SES and its links to adolescent health risk behaviors.