Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles.

Concepción Moreno-Maldonado,Carmen Moreno,Pilar Ramos,Francisco Rivera

doi:10.3390/ijerph16091637

Concepción Moreno-Maldonado, Carmen Moreno + Show 2 more

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https://doi.org/10.3390/ijerph16091637

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Abstract

The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.

Highlights

The model proposed by the Commission on Social Determinants on Health (CSDH) [1] represents one of the most appropriate conceptual frameworks for studying social determinants on health and the relationships that are established between them
The data come from a representative sample of Spanish adolescents composed of 15,340 students aged 11–16 years old who participated in the 2014 edition of the Health Behavior in School-aged Children (HBSC) study
This association, especially low among objective indicators and socioeconomic status (SSS), is explained in a recent qualitative study conducted by Martin-Storey et al [67] which found that adolescents tend to perceive their own status placement based on traditional socioeconomic position (SEP) markers, they take into account other aspects such as societal factors, or values

Summary

Introduction

The model proposed by the Commission on Social Determinants on Health (CSDH) [1] represents one of the most appropriate conceptual frameworks for studying social determinants on health and the relationships that are established between them. Following this model, there are two groups of social determinants of health: structural and intermediary. Following the CSDH model, the socioeconomic and political context define a social hierarchy that includes factors such as social class, power, prestige, or discrimination that are unequally distributed across socioeconomic position, gender, Int. J. Public Health 2019, 16, 1637; doi:10.3390/ijerph16091637 www.mdpi.com/journal/ijerph

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