Higher Subjective Social Status Research Articles

Relations of Subjective Social Status and Brooding with Blood Pressure.

Brooding, a type of rumination, and subjective social status (SSS) may be two interacting factors for cardiovascular disease (CVD). Our goal was to examine the relations of brooding and SSS with systolic blood pressure (SBP) and diastolic blood pressure (DBP), two measures of CVD. We predicted that [1] brooding and SSS are each related to SBP and DBP and [2] the interaction of brooding and SSS is linked to SBP and DBP. In this cross-sectional study, college student participants (n = 240; 58.6% female, age: M = 23.95years, SD = 8.62) completed demographics questionnaires, the Ruminative Response Scale, and MacArthur Subjective Social Status scale, and gave blood pressure samples. Linear models suggested that, for participants low in SSS, high brooding and DBP were positively related. For participants high in SSS, high brooding and low DBP were negatively related. There were no relations between SSS, brooding, and SBP. As predicted, for individuals with low SSS, more brooding was associated with higher DBP. Yet, in individuals with high SSS, more brooding was associated with lower DBP. There was no relation between SSS, brooding, and SBP. Our results suggest that brooding may serve as diathesis for some symptoms of CVD (i.e., high DBP but not high SBP) in individuals with low SSS. We discuss how other factors, like burnout or defensive pessimism, may contribute to the relation between high SSS, high brooding, and low DBP.

Social patterning of acute respiratory illnesses in the Household Influenza Vaccine Evaluation (HIVE) Study 2014-2015.

Social patterning of infectious diseases is increasingly recognised. Previous studies of social determinants of acute respiratory illness (ARI) have found that highly educated and lower income families experience more illnesses. Subjective social status (SSS) has also been linked to symptomatic ARI, but the association may be confounded by household composition. We examined SSS and ARI in the Household Influenza Vaccine Evaluation (HIVE) Study in 2014-2015. We used SSS as a marker of social disadvantage and created a workplace disadvantage score for working adults. We examined the association between these measures and ARI incidence using mixed-effects Poisson regression models with random intercepts to account for household clustering. In univariate analyses, mean ARI was higher among children <5 years old (P < 0.001), and females (P = 0.004) at the individual level. At the household level, mean ARI was higher for households with at least one child <5 years than for those without (P = 0.002). In adjusted models, individuals in the lowest tertile of SSS had borderline significantly higher rates of ARI than those in the highest tertile (incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 0.98-1.92). Households in the lowest tertile of SSS had significantly higher ARI incidence in household-level models (IRR 1.46, 95% CI 1.05-2.03). We observed no association between workplace disadvantage and ARI. We detected an increase in the incidence of ARI for households with low SSS compared with those with high SSS, suggesting that socio-economic position has a meaningful impact on ARI incidence.

Subjective Socioeconomic Status and Early Life Conditions

We study the role of subjective social status on health and its determinants, with a particular emphasis on the predictive power of early-life conditions on subjective social status. A well-established literature links early-life conditions to later-life objective measures of socioeconomic status, but little attention has been paid to the effects on subjective socioeconomic status. We find that socioeconomic factors during childhood are extremely important predictors of subjective social status, even after controlling for contemporaneous socioeconomic conditions. In particular, experiencing good health, having access to electricity, and having married parents during childhood increases one's chance of being in high subjective social status during adulthood, which leads to better health, even after conditioning for objective social status. The results therefore show an additional psychological and behavioral channel through which early-life conditions influence later outcomes, and which has not been yet studied in sufficient detail.

Abstract P114: Association of Subjective Social Status With Cardiovascular Health in Hispanics/Latinos

Introduction: Evidence suggests that subjective social status (SSS)—perceived status in the social hierarchy—may be more strongly associated with health than objective markers of social status (OSS), income and education. Compared to persons with high SSS, those with low SSS report poorer self-rated physical health and have higher rates of medical comorbidities. Little is known about the relationship between SSS and ideal cardiovascular health (CVH) profiles defined by the American Heart Association (AHA), particularly among diverse Hispanic/Latino adults. Hypothesis: Higher SSS will be associated with more favorable CVH profiles. Methods: We analyzed baseline HCHS/SOL data † on adults ages 18-74 in 2008-11 (N=15,440). SSS was assessed using the McArthur Scale, a 10-rung “social ladder” to specify social rank (scores range from 1-10; higher scores indicate higher SSS). CVH was defined based on levels of 7 metrics: diet, body mass index (BMI), physical activity, cholesterol, blood pressure, fasting glucose, and smoking status; levels of each metric were categorized as ideal, intermediate and poor using AHA criteria. A composite CVH score was calculated by summing across metrics (scores range from 0-14; higher scores indicate better CVH). Linear and logistic regressions were used to examine cross-sectional associations of SSS with CVH (overall and single metrics), after adjusting for OSS, demographics, Hispanic/Latino group, study center, marital status, insurance, prevalent coronary heart disease, and depressive symptoms (CESD). Results: In multivariate-adjusted models, each one unit increase in SSS* was associated with a higher overall CVH score (β = 0.03, 95% CI 0.004, 0.057, p <0.05); higher SSS was also positively associated with ideal levels of BMI, physical activity, and fasting blood glucose levels (see Table 1). Conclusions: These findings suggest an association between SSS and CVH among diverse Hispanic/Latino adults. Future studies will explore the mechanisms through which SSS may influence CVH.

Low childhood subjective social status and telomere length in adulthood: The role of attachment orientations.

Low subjective social status (SSS) in childhood places one at greater risk of a number of health problems in adulthood. Theoretical and empirical evidence indicates that exposure to supportive parenting may buffer the negative effects of low childhood SSS on adult health. Given the importance of supportive caregivers and close others for the development of attachment orientations throughout the lifespan, attachment theory may be important for understanding why some individuals are resilient to the negative effects of low childhood SSS on adult health while others are not. We examined if attachment anxiety and attachment avoidance altered the association between childhood subjective social status (SSS) and length of telomeres in white blood cells in adulthood. Shorter telomere length is associated with increased risk of age-related diseases including cancer, type 2 diabetes, and cardiovascular disease. Participants (N = 128) completed self-report measures of childhood SSS and attachment orientations, as well as a blood draw. We found that among those with low childhood SSS, low attachment anxiety was associated with longer telomere length in white blood cells in comparison to high attachment anxiety controlling for participant age, sex, race, body mass index, and adult SSS. Among those with high childhood SSS, low attachment anxiety was associated with a slight decrease in telomere length. Attachment avoidance was unrelated to length of telomeres. Such findings provide further evidence for the role that close relationships may have on buffering SSS related health disparities.

An exploration of the subjective social status construct in patients with acute coronary syndrome

BackgroundPerception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association.MethodsWe conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS). Data on access to care and SSS variables were obtained at baseline. Readmission data were obtained 12 months post-discharge. We conducted multivariable logistic regression to model the odds of access to care and readmission outcomes in those with low versus high societal SSS.ResultsOne thousand ninety patients admitted with ACS provided both societal and community SSS rankings. The low societal SSS cohort had greater odds of reporting that their health was affected by lack of health care access (OR 1.48, 95% CI 1.11, 1.97) and of experiencing cardiac readmissions (1.88, 95% CI 1.15, 3.06). Within the low societal SSS cohort, there was a trend toward fewer access to care barriers for those with discordantly high community SSS though findings varied based on the outcome variable. There were no statistically significant differences in readmissions based on community SSS rankings.ConclusionLow societal SSS is associated with increased barriers to access to care and cardiac readmissions. Though attenuated, these trends remained even when adjusting for clinical and sociodemographic factors, suggesting that perceived low societal SSS has health effects above and beyond objective socioeconomic factors. Furthermore, high community SSS may potentially mitigate the risk of experiencing barriers to access to health care in those with low societal SSS, though these associations were not statistically significant. Subjective social status relative to society versus relative to the community seem to represent distinct concepts. Insight into the differences between these two SSS constructs is imperative in the understanding of cardiovascular health and future development of public health policies.

Spouse's subjective social status predicts older adults’ prospective cognitive functioning

ABSTRACTObjectives: The current study aims to investigate the association between subjective social status (SSS) and prospective cognitive functioning of older adults and their spouses, and to explore the potential mediating roles of health habits and physical activities in this association.Method: Using the longitudinal data of 512 pairs of community-dwelling older couples aged 65–91 years (M = 72.2 ± 4.6), we tested the effects of SSS in cognitive functioning using an Actor-Partner Interdependence Model. SSS was measured by a self-anchoring social ladder, and cognitive functioning was measured by the Mini-Mental State Examination at baseline and 4-year follow-up. Socioeconomic status (i.e. education) was tested as a moderator, and physical activity (measured by the Physical Activity Scale for the Elderly) as well as health habits (i.e. tobacco and alcohol consumption) were included as potential mediators.Results: A partner effect of SSS was found only in the low-education group, in which the wife's higher level of SSS in the community was associated with the husband's better cognitive functioning in the follow-up. A small proportion of this effect was found to be partially mediated by participation in housework, such that the wife's higher SSS was associated with the husband's increased housework activity, which was related to higher prospective cognitive functioning.Conclusion: By examining the dyadic effects of SSS with a longitudinal design, our findings extended the understanding on how subjective social status influenced older couples’ cognitive health, and provided evidence-based insights for future studies on cognitive health in later life.

Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study.

This research examines whether unobserved time-stable influences confound the association between chronic pain and psychological distress in older adults as well as how race and ethnicity combine with subjective social status (SSS) to modify the association. In a nationally representative longitudinal survey, holistically controlling for unobserved time-stable influences using fixed-effects models substantially reduces the pain-depression relationship and eliminates the overall pain-anxiety relationship. The association with depression is stronger for Black and Hispanic elders, illustrating a process of double-jeopardy. Black elders with severe pain experience lower anxiety, as do Black elders with moderate pain and low SSS, which we suggest may be due to the enervating effects of undermanaged pain. Black elders at high SSS experience greater anxiety with moderate pain. This research suggests that undermanagement of chronic pain among racial and ethnic minorities differentiates the association between pain and distress in late life and especially creates stronger associations with depression.

Agency as a mediator in the pathway from transactional sex to HIV among pregnant women in Swaziland: a multigroup path analysis.

Introduction: Transactional sex is a structural driver of HIV for women and girls in sub-Saharan Africa. In transactional relationships, sexual and economic obligations intertwine and may have positive and negative effects on women’s financial standing and social status. We conducted a clinic-based survey with pregnant women in Swaziland using a locally validated transactional sex scale to measure the association between subjective social status, transactional sex, and HIV status, and to assess whether this association differed according to a woman’s agency within her relationship.Methods: We recruited a convenience sample of 406 pregnant women at one rural and one urban public antenatal clinic in Swaziland and administered a behavioural survey that was linked to participant HIV status using clinic records. We then conducted a multigroup path analysis to test three hypotheses: (1) that more engagement in transactional sex is associated with decreased condom use and increased subjective social status; (2) that subjective social status mediates the relationship between transactional sex and HIV status; and (3) that these relationships are different across groups according to whether or not a woman reported any indicator of constrained agency within her relationship.Results: The amount and value of material goods received from a sexual partner was significantly and positively associated with higher subjective social status among all participants. As the amount of material goods received from a partner increased, women who reported no indicators of constrained agency were less likely to use condoms. Conversely, there was no relationship between transactional sex and condom use among women who reported any indicator of constrained relationship agency. Among women who reported any indicator of constrained agency, HIV was significantly associated with lower subjective social status.Conclusions: Relationship agency likely plays a key role in determining which mechanisms create HIV risk for women in transactional relationships. Interventions to mitigate these risks must address social forces that penalize women who engage in sexual relationships as well as structural drivers of gendered economic disparity that reduce women’s agency within their sexual and romantic relationships.

Subjective Social Status and Cardiovascular Reactivity: An Experimental Examination.

The present experiment examined the causal influence of subjective social status (SSS) on variables related to cardiovascular health [i.e., blood pressure, heart rate variability (HRV)]. Participants were randomly assigned to one of two conditions involving a social comparison that either induced a temporary shift toward high SSS or toward low SSS. Cardiovascular variables were measured before (baseline), throughout, and after the manipulation (recovery). Participants in the low SSS condition had a significantly lower HRV during experimental manipulation than at baseline (p = 0.001). They also showed a significantly stronger HRV reactivity compared to participants in the high SSS condition (p = 0.027). Our results suggest that already temporary shifts of one's SSS have measureable effects on cardiovascular variables. They support the notion that social status plays a causal role in the development of cardiovascular disease.

Correlates of Physical Activity Differ by Sex and Country of Birth Among Mexican-Heritage Youth.

Barriers to physical activity (PA) may be experienced differently by sex and country of birth. We examine psychosocial correlates of PA in four groups based on sex (boy/girl) and country of birth [Mexico/United States (U.S.)]. 1154 Mexican heritage adolescents residing in Houston, Texas provided psychosocial data in 2008-09 and PA (number of days per week active for at least 60min) in 2010-11 (N=1001). Poisson regression models were fitted for each groups. Among boys, English language preference (p US-born =0.045, p Mexico-born =0.008) and higher subjective social status (p US-born =0.002, p Mexico-born =0.031) were associated with increased PA. Body image dissatisfaction was associated with decreased PA in Mexico-born girls (p=0.007). Sensation-seeking tendencies were associated with increased PA among all groups; anxiety was associated with decreased PA among all but U.S.-born boys. Tailoring PA interventions to key sex-specific psychosocial correlates rather than country of birth may enhance efficacy of interventions to increase PA levels among Mexican heritage adolescents.

Subjective social status predicts inflammatory responses to acute stress only in non-white individuals

Background Previous research indicates that ethnic differences in subjective social status (SSS), inflammatory markers, and stress reactivity may exist. However, no studies have examined the relationship between SSS and ethnicity in the context of IL-6 responses to repeated stress. Methods Eighty-five adults (51% female, mean age = 37.9 years) completed the Trier Social Stress Test (TSST) on two consecutive days. Blood samples were collected at 1 minute prior and 30 minutes and 2 hours post-TSST for measurement of plasma IL-6. Community and United States SSS were assessed using MacArthur ladders. Results The sample consisted of n = 80 participants (n = 51 white, n = 29 non-white). Both TSSTs induced increases in plasma IL-6 (F = 65.1, p 0.001 ), with higher responses to the second exposure (F = 7.85, p = 0.006). Community SSS was positively associated with IL-6 responses to the first TSST (r = 0.24, p = 0.03) but not the second (r = −0.01, p = 0.9). Whites rated themselves higher than nonwhites in SSS (Community, trend, p = 0.053; US, p = 0.009). Regression analyses revealed a significant SSS by NW interaction predicting IL-6 responses to the first TSST (beta = 0.82, p = 0.046), with higher SSS predicting elevated IL-6 responses only in non-whites. Conclusions Subjective Social Status ratings were sensitive to race and predicted IL-6 responses to the TSST in only non-white individuals. Ethnicity and SSS may play a role in social evaluation, a key component of social stress. More research is needed to determine the nature these associations.

Developmental Trajectories of Subjective Social Status.

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. 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. 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. 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.

Demographic, psychosocial, and genetic risk associated with smokeless tobacco use among Mexican heritage youth

BackgroundDespite well-established negative health consequences of smokeless tobacco use (STU), the number and variety of alternative non-combustible tobacco products on the market have increased tremendously over the last 10 years, as has the market share of these products relative to cigarettes. While STU among non-Hispanic white youth has decreased over the last 10 years, the prevalence has remained constant among Hispanic youth. Here we examine demographic, psychosocial, and genetic risk associated with STU among Mexican heritage youth.MethodsParticipants (50.5 % girls) reported on psychosocial risk factors in 2008–09 (n = 1,087, mean age = 14.3 years), and smokeless tobacco use in 2010–11 (mean age = 16.7 years). Participants provided a saliva sample that was genotyped for genes in the dopamine, serotonin and opioid pathways.ResultsOverall 62 (5.7 %) participants reported lifetime STU. We identified five single nucleotide polymorphisms that increased the risk for lifetime use. Specifically, rs2023902 on SERGEF (OR = 1.93; 95 % CI: 1.05-3.53), rs16941667 on ALDH2 (OR = 3.14; 95 % CI: 1.65-5.94), and rs17721739 on TPH1 (OR = 1.71; 95 % CI: 1.00-2.91) in the dopamine pathway, rs514912 on TRH-DE (OR = 1.84; 95 % CI: 1.25-2.71) in the serotonin pathway, and rs42451417 on the serotonin transporter gene, SLC6A4 (OR = 3.53; 95 % CI: 1.56-7.97). After controlling for genetic risk, being male (OR = 1.86; 95 % CI: 1.02-3.41), obesity status (OR = 2.22; 95 % CI: 1.21-4.09), and both higher levels of anxiety (OR = 1.04; 95 % CI: 1.01-1.08) and social disinhibition (OR = 1.26; 95 % CI: 1.07-1.48) were associated with increased use. High subjective social status (OR = 0.78; 95 % CI: 0.64-0.93) was protective against use, while higher parental education (OR = 2.01; 95 % CI: 1.03-3.93) was associated with increased use.ConclusionsThese data suggest that use of genetic risk, along with psychosocial, demographic, and behavioral risk factors may increase our ability to identify youth at increased risk for STU, which in turn may improve our ability to effectively target prevention messages to Mexican heritage youth.

Socioeconomic determinants of bullying in the workplace: a national representative sample in Japan.

Bullying in the workplace is an increasingly recognized threat to employee health. We sought to test three hypotheses related to the determinants of workplace bullying: power distance at work; safety climate; and frustration related to perceived social inequality. A questionnaire survey was administered to a nationally representative community-based sample of 5,000 residents in Japan aged 20–60 years. The questionnaire included questions about employment, occupation, company size, education, household income, and subjective social status (SSS). We inquired about both the witnessing and personal experience of workplace bullying during the past 30 days. Among 2,384 respondents, data were analyzed from 1,546 workers. Multiple logistic regression analyses were used to examine the social determinants of workplace bullying. Six percent and 15 percent of the total sample reported experiencing or witnessing workplace bullying, respectively. After adjusting for gender and age, temporary employees (Odds Ratio [OR]: 2.45 [95% Confidence Interval (CI) = 1.03–5.85]), junior high school graduates (OR: 2.62 [95%CI: 1.01–6.79]), workers with lowest household income (OR: 4.13 [95%CI:1.58–10.8]), and workers in the lowest SSS stratum (OR: 4.21 [95%CI:1.66–10.7]) were at increased risk of experiencing workplace bullying. When all variables were entered simultaneously in the model, a significant inverse association was observed between higher SSS and experiencing bullying (p = 0.002). Similarly in terms of witnessing bullying; SSS was significantly inversely associated (p = 0.017) while temporary employees reported a significantly higher risk of witnessing bullying compared to permanent workers (OR: 2.25 [95%CI:1.04 to 4.87]). The significant association between SSS and experiencing/witnessing workplace bullying supports the frustration hypothesis. The power distance hypothesis was also partly supported by the finding that temporary employees experienced a higher prevalence of workplace bullying.

Associations of Subjective Social Status with Nondaily and Daily Smoking

To explore associations between subjective social status (SSS) and smoking level among 2274 adult current smokers. Associations were investigated using a covariate-adjusted proportional odds cumulative logit model. Moderation (via race/ethnicity or sex) and mediation (via depressive symptoms, social/emotional support, or life satisfaction) were explored in additional models. Higher SSS was associated with greater likelihood of nondaily versus light daily or moderate/ heavy daily smoking (p = .017). Life satisfaction partially mediated the association of SSS and smoking level (p = .003). Higher SSS was associated with greater likelihood of nondaily relative to light daily or moderate to heavy smoking, potentially via greater life satisfaction. Additional studies are needed to confirm these findings.

Subjective social status and substance use severity in a young adult sample.

Subjective social status (SSS), an individual's subjective view of standing in society, has been shown to better predict health outcomes compared to objective measures of socioeconomic status (SES), including educational attainment and income. This study examines the relationship between SSS and severity of tobacco, alcohol, and marijuana use after controlling for objective measures of SES. Young adults (N = 1,987) aged 18-25 who reported smoking at least one cigarette in the past 30 days were recruited and surveyed anonymously online. Three separate structural equation models examined whether SSS was associated with severity of tobacco, alcohol, and marijuana use, controlling for personal and household income, years of education, employment status, and parental education. Household income (b = .31), employment status (b = .07), years of education (b = .09), and parental education (b = .16) were positively associated with SSS (all p values < .001); personal income was not significantly associated with SSS (p = .11). All three models adequately fit the data. SSS was negatively associated with severity of tobacco (b = -.13, p < .001) and marijuana use (b = -36, p = .02), but not alcohol use severity (b = .01, p = .56). Among young adults, higher subjective social status is associated with less severe tobacco and marijuana use, whereas alcohol use severity appears to be similar across socioeconomic class.

Association of Subjective and Objective Socioeconomic Status with Subjective Mental Health and Mental Disorders Among Japanese Men and Women

An inverse association between socioeconomic status (SES) and mental health has been previously well reported, but the evidence is limited in Asian populations. We therefore investigated the association of SES and subjective mental health and prevalence of any mental disorders in the general population of Japan. We used data from the World Mental Health Japan Survey of 1,496 randomly selected people aged 20 years and older in Japan. Information on education level and household income were used as objective SES indicators, and subjective social status (SSS) was measured by responses to a question regarding social position. We calculated odds ratios of SES indicators for poor subjective mental health and 12-month prevalence of any mental disorders. The adjusted odds ratio (OR) (95 % confidence interval (CI)) of respondents who rated themselves as lower than middle status in the country (low SSS group) for poor subjective mental health was 2.24 (95 % CI: 1.41, 3.57) with reference to those who rated themselves as higher than middle status (high SSS group). Similarly, inverse associations of education level and household income with poor subjective mental health were identified. A J-shaped association was confirmed between SSS and 12-month prevalence of any mental disorders. The adjusted OR (95 % CI) of SSS for any mental diseases was 0.53 (95 % CI: 0.32, 0.86) for the middle SSS group and 1.61 (95 % CI: 0.96, 2.72) for the low SSS group, compared with the high SSS group. Those associations were not attenuated when objective SES indicators were adjusted. We found inversely linear associations between subjective and objective SES and poor subjective mental health among Japanese men and women. SSS was not significantly associated with 12-month prevalence of any mental disorders. Substantial social inequalities in mental health were identified in Japan, which has been considered an egalitarian society with relatively few inequalities in health.

Subjektiver Sozialstatus und gesundheitsbezogene Lebensqualität bei Erwachsenen in Deutschland

The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status. The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2 827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position. Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52-8.99; women: OR=2.95; 95% CI=1.74-4.99; depressiveness: men: OR=2.86; 95% CI=1.60-5.10; women: OR=2.75; 95% CI=1.65-4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07-2.86 and OR=3.03; 95% CI=1.43-6.42, respectively). These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.

Subjective social status predicts long-term smoking abstinence

BackgroundThe relationship between subjective social status (SSS), a person's perception of his/her relative position in the social hierarchy, and the ability to achieve long-term smoking abstinence during a specific quit attempt is unknown. The purpose of this study was to examine the relationship between SSS and long-term smoking abstinence among 421 racially/ethnically diverse smokers undergoing a specific quit attempt, as well as the interactive effects of race/ethnicity and sex.MethodsThe main effects and moderated relationships of SSS on biochemically-confirmed, continuous smoking abstinence through 26 weeks post-quit were examined using continuation ratio logit models adjusted for sociodemographics and smoking characteristics.ResultsEven after adjusting for the influence of socioeconomic status and other covariates, smokers endorsing lower SSS were significantly less likely to maintain long-term smoking abstinence during a specific quit attempt than those with higher SSS (OR = 1.14, 95% CI: 1.00 - 1.28; p = 0.044). The statistical significance of this relationship, however, did not vary by race/ethnicity or sex.ConclusionsSSS independently predicts long-term smoking abstinence during a specific quit attempt. SSS may be a useful screener to identify smokers at elevated risk of relapse who may require additional attention to facilitate long-term abstinence. More research is needed to understand the mechanisms underlying the relationship between SSS and long-term smoking abstinence in order to appropriately tailor treatment to facilitate abstinence among lower SSS smokers.