MacArthur Scale Research Articles

Subjective social status, race, and metabolic syndrome in women with breast cancer.

To evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Multicenter cross-sectional study (10 US hospitals) in women (n = 1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identified as non-Hispanic White or Black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history, and behavioral risks. SSS was measured with the 10-rung MacArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. Average age was 58years. On average, the SSS of Black women, given equivalent level of income and education, was lower than the SSS of White women: 6.6 (6.1-7.0) vs 7.7 (7.54-7.79) among college graduates and 6.8 (6.4-7.2) vs 7.6 (7.5-7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet, and physical activity, increasing SSS was associated with a decrease in MetS-Zscore, -0.10 (-0.16 to -0.04) per every 2 rung increase in the MacArthur scale. Black women with breast cancer rank their SSS lower than White women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.

Parental Objective, Subjective, and Contextual Socioeconomic Status and Children's Mental Health in Iran: The Mediating Effect of the Subjective Measure

Background: Children from lower socioeconomic status (SES) households are at greater risk for mental illnesses. Socioeconomic status has different dimensions: Objective SES, subjective SES, and contextual SES. Evidence suggests that subjective SES partially mediates the impact of objective SES on mental health. However, these hypotheses have not been tested in Middle Eastern cultures, including Iran. Objectives: We aimed to investigate: (1) if there is an association between parental objective, subjective, and contextual SES measures and their children's mental health in a network of general practitioners' clients, (2) if such an association exists for objective or contextual indicators, is it partially or fully mediated through subjective measure? and (3) if such an association exists, is it affected by children's age? Methods: We assessed 1,103 parent-child pairs in the general practitioners' network of clients. The child's mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ) and parental objective SES by education level, subjective SES by the MacArthur scale, and contextual SES by the household neighborhood. Linear regression models were used to investigate the impact of different SES measures on the SDQ score both bivariately and adjusted for each other. A mediation analysis was performed for objective SES' indirect effect on SDQ score through subjective SES. Results: We found a significant association between objective and subjective SES and the SDQ score, which remained significant after adjusting for each other. Both objective and subjective measures had a small effect size (Cohen's f-squared = 0.03). There was no association between contextual SES and SDQ scores in our sample. Conclusions: Socioeconomic status impacts children and adolescents' mental health. However, SES is a multi-dimensional concept. Further research considering different dimensions is needed to understand the interplay of these dimensions in different cultures and contexts. Addressing such exploratory questions may help pave the way for detecting and addressing these social determinants in primary care settings.

Subjective socioeconomic status: an alternative to objective socioeconomic status

BackgroundSubjective “ladder” measurements of socio-economic status (SES) are easy-to-administer tools that ask respondents to rate their own SES, allowing them to evaluate their own material resources and determine where it places them relative to their community. Here, we sought to compare the MacArthur Scale of Subjective Social status to the WAMI, an objective measure of SES that includes data on water and sanitation, asset ownership, education, and income.MethodsLeveraging a study of 595 tuberculosis patients in Lima, Peru, we compared the MacArthur ladder score to the WAMI score using weighted Kappa scores and Spearman’s rank correlation coefficient. We identified outliers that fell outside the 95th percentile and assessed the durability of the inconsistencies between scores by re-testing a subset of participants. We then used Akaike information criterion (AIC) to compare the predictability of logistic regression models evaluating the association between the two SES scoring systems and history of asthma.ResultsThe correlation coefficient between the MacArthur ladder and WAMI scores was 0.37 and the weighted Kappa was 0.26. The correlation coefficients differed by less than 0.04 and the Kappa ranged from 0.26 to 0.34, indicating fair agreement. When we replaced the initial MacArthur ladder scores with retest scores, the number of individuals with disagreements between the two scores decreased from 21 to 10 and the correlation coefficient and weighted Kappa both increased by at least 0.03. Lastly, we found that when we categorized WAMI and MacArthur ladder scores into three groups, both had a linear trend association with history of asthma with effect sizes and AICs that differed by less than 15% and 2 points, respectively.ConclusionOur findings demonstrated fair agreement between the MacArthur ladder and WAMI scores. The agreement between the two SES measurements increased when they were further categorized into 3–5 categories, the form in which SES is often used in epidemiologic studies. The MacArthur score also performed similarly to WAMI in predicting a socio-economically sensitive health outcome. Researchers should consider subjective SES tools as an alternative method for measuring SES, particularly in large health studies where data collection is a burden.

Turning their backs on the 'ladder of success'? Unexpected responses to the MacArthur Scale of Subjective Social Status.

Subjective social status measures a person's perception of their social class relative to other people and has theoretically and empirically been positively associated with health and wellbeing. A widely used measure of this construct is the MacArthur Scale of Subjective Social Status, which asks people to report their social status by placing themselves on a ladder which represents the social hierarchy of their society or community; the scale has been used with many different populations across many countries. In this research note, we describe two cases where we encountered unexpected reactions to the MacArthur Scale that we believe highlight (a) the salience of relative social status for people's wellbeing in contemporary society and (b) the concomitant sensitivities raised by measuring this subjective experience. We discuss the implications of these observations for future research.

Abstract P254: Mental Well-Being of Caregivers With Overweight and Obesity is Associated With Cognitive Stimulation Provided to Children in the Home

Introduction: Parents with poor mental health are less likely to engage in cognitively enriching parenting behaviors, such as reading and playing with their children. This, in turn, is associated with increased risk of obesity in the child and poor treatment outcomes for children enrolled in behavioral weight management. Parents and caregivers with obesity also have worse mental health and lower life satisfaction than their non-obese counterparts. Among parents with overweight and obesity who have a child with overweight/obesity, the relationship between parent mental health and cognitive enrichment provided in the home is unknown. Hypothesis: We hypothesize that higher depressive symptoms and lower subjective well-being scores among parents will be associated with less cognitive enrichment provided to children. Further, we hypothesize that these relationships will be moderated by the sex of the parent. Methods: This study was a secondary analysis of baseline data from 452 parent-child dyads with overweight/obesity enrolled in a family-based behavioral treatment study for obesity. Depression symptoms and subjective well-being were assessed using the Patient Health Questionnaire-9 scale and the MacArthur Scale of Subjective Social Status, respectively. Cognitive stimulation was measured with the Cognitive Stimulation subscale of the Environmental Enrichment scale. Univariable relationships were assessed using Pearson correlations. Multivariable linear regression models were used to control for study site, parent characteristics (age, BMI, sex, race/ethnicity, education), child characteristics (age, and sex), and family characteristics (health insurance status and household income). Results: Higher depression symptom score was correlated with lower cognitive stimulation (ρ = -0.165, p < 0.001), whereas higher subjective well-being was associated with higher cognitive stimulation (ρ = 0.377, p < 0.001). These relationships were maintained even after controlling for covariates in the multivariable models, with each one-unit increase in depression symptoms associated with a 0.16 unit decrease in cognitive stimulation (95% CI -0.27 to -0.06, p = 0.003) and each one-unit increase in subjective well-being associated with a 0.04 unit increase in cognitive stimulation (95% CI 0.01, 0.07, p = 0.01). Parent sex did not moderate these effects. Conclusions: Mental well-being of parents and caregivers with overweight/obesity is associated with the degree of cognitive enrichment provided to the child in the home, though the effect sizes after controlling for covariates were modest. Thus, interventions targeting parental wellbeing offer a potential avenue to improve their child’s cognitive wellbeing and response to obesity treatment.

Socioeconomic status and depressive symptoms and suicidality: The role of subjective social status

BackgroundLow socioeconomic status (SES) confers access to material resources and social standing and is an established risk factor of both depressive symptoms and suicidality. Subjective social status (SSS) assesses how people perceive their position within the social hierarchy and has been proposed to impact mental health. This study examined the relationship between SES and depressive symptoms and suicidality and tested whether SSS mediated these associations. MethodsThis study drew on publicly available survey data from the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were surveyed at baseline in 2008 (N = 4948; aged 28.8 years) and at followed up in 2016–2018 (N = 3509; aged 37.8 years). SES was gauged using personal and household income, assets, education, and job prestige. SSS was assessed using the MacArthur Scale. Depressive symptoms were assessed using four-items from the Centre for Epidemiological Studies Scale of Depression (CESD) and participants reported suicidal ideation and suicide attempts in the past year. ResultsBoth low SES and SSS were associated with elevated levels of depressive symptoms, suicidal ideation, and suicide attempts in cross-sectional and prospective analyses. SSS explained 27 % of the association between SES and depressive symptoms, 51 % of the relationship between SES and suicidal ideation, and 37 % of the link between SES and suicide attempts on average. ConclusionsThese findings contribute to understanding the long-term effects of SSS and suggest that perceptions of status may be a key mechanism through which low SES forecasts the development of depressive symptoms and suicidality.

Turning their backs on the 'ladder of success'? Unexpected responses to the MacArthur Scale of Subjective Social Status.

Subjective social status measures a person's perception of their social class relative to other people and has theoretically and empirically been positively associated with health and wellbeing. A widely used measure of this construct is the MacArthur Scale of Subjective Social Status, which asks people to report their social status by placing themselves on a ladder which represents the social hierarchy of their society or community; the scale has been used with many different populations across many countries. In this research note, we describe two cases where we encountered unexpected reactions to the MacArthur Scale that we believe highlight (a) the salience of relative social status for people's wellbeing in contemporary society and (b) the concomitant sensitivities raised by measuring this subjective experience. We discuss the implications of these observations for future research.

Effects of economic regional differences and family on adolescents' aggressive behaviors: Perspective of ecosystem integration.

Based on the ecological systems theory and cumulative risk model, the current study aimed to determine the mediating effects of parenting styles, peer relationship, and psychological capital on family socioeconomic status and adolescents' aggressive behaviors, as well as the moderating effects of economic regional differences. In a cross-sectional design, 1271 Chinese adolescents were recruited to complete the MacArthur Scale, the short-form Egna Minnen av Barndoms Uppfostran, the Positive PsyCap Questionnaire, the peer support subscale in the Student Personal Perception of Classroom Climate, and the Aggression Questionnaire. After controlling for gender and age, parenting style, peer relationship, and psychological capital not only mediated, but also constituted multiple chains mediation between family socioeconomic status and aggressive behaviors. Moreover, economic regional differences moderated the multiple chains mediation model between family socioeconomic status and aggressive behaviors. The accumulation of multiple adverse factors increases the probability of inducing aggressive behaviors, and the development of psychological capital helps reduce the occurrence of aggressive behaviors in adolescents.

SUBJECTIVE SOCIAL STATUS MODERATES BACK PAIN AND MENTAL HEALTH: A LONGITUDINAL ANALYSIS OF OLDER MEN

Abstract Objectives. This study tested the longitudinal relationship between back pain and mental health and examined the moderating role of subjective social status (SSS). Method. Community-dwelling older men from the MrOS Study provided four study visits of data collected between 2000-2016 (15,975 observations nested within 5,979 participants). Back pain frequency and severity were assessed at visits 1-4. General mental health was measured at each visit by the 12-item Short Form Survey Mental Component Score (SF-12 MCS; higher scores representing better mental health). National and community SSS were assessed at visits 1 and 3 with the MacArthur Scale. Growth curve models tested longitudinal within-person change associations after accounting for the repeated measures within each person. Age was used as the primary time variable. Results. At baseline, those with higher back pain-frequency/severity reported lower SF-12 MCS. After accounting for this between-person difference, there were bidirectional within-person associations between back pain frequency/severity and SF-12 MCS. On follow-up visits when back pain frequency/severity increased from baseline, participants reported lower SF-12 MCS (p<.001). On follow-up visits when SF-12 MCS decreased from baseline, participants also reported higher back pain frequency/severity (p<.001). Higher national and community SSS at baseline and having increases or consistently higher SSS over time attenuated the negative relationships between back pain frequency/severity and SF-12 MCS. Results were consistent after controlling for an extensive list of baseline health covariates and pain medications. Discussion. These findings highlight how self-perceived social status may buffer the relationship between greater back pain frequency/severity and lower mental health.

“Hablemos de Alzheimer”: Words Mexican Americans use to talk about Alzheimer’s disease genetic testing. Implications for precision medicine education.

AbstractBackgroundEffective Alzheimer’s disease (AD) diagnosis and therapy will require a tailored approach to each person’s unique AD manifestation, known as AD precision medicine (PM). PM‐associated comprehensive genetic testing is currently restricted to the research domain and not readily available to minoritized Hispanics/Latinos (H/L). Successful AD precision medicine programs benefitting everyone require culturally appropriate patient outreach/education materials. We investigated the words H/L use to talk about AD genetic testing.MethodWe conducted freelisting interviews with 14 Spanish‐preferring Mexican American adults (female, 85.7%; mean age, 49.3±16.8 years, range = 19‐73; completed less than or at most a high school education, 35.7%). Participants were presented with vignettes about a H/L father of varied ages (5th‐7th decade) and degrees of cognitive impairment (no memory deficits to severe memory loss) who received genome sequencing results. During freelisting, participants were given prompts about the vignettes, and were asked to list all words that came to mind when they thought about the prompts. Responses were reviewed for semantically related words. Discrepancies were resolved by consensus agreement. Among sociodemographic data collected, familism and perceived social status were measured by the Pan‐Hispanic Familism Scale and scored (1‐strongly disagree to 5‐strongly agree, max score 25), and the MacArthur Scale of Subjective Social Status (SSS; each item: 1‐lowest to 10‐highest), respectively.ResultsHighest frequency unique word/word clusters (n = 151) for one vignette (father: age 70 with cognitive slowing, prompt: father’s reaction to his own moderate risk result) included worry (17.2%), age/aging/older (15.9%), family (12.6%), high/medium/low chance (12.6%), Alzheimer’s (10.6%), and normal/well/healthy (7.9%). High frequency of family‐related worry aligned with high familism scores (M = 23.2±2.6, range = 15‐25). Moderate frequency words of participants, 78.6% of whom perceived they held social standing in the top half of the community (SSS>5), reflected action orientation: do (6.6%), seek (1.7%), inform (1.5%), and manage (1.1%).ConclusionSpanish‐preferring Mexican Americans respond robustly to information about family. Family‐centered educational materials about AD precision medicine, including information about healthy aging versus neurodegeneration, risk magnitude categories, and action words, could have high impact. Additional research to learn words used by diverse Spanish‐preferring H/L is needed.

Childhood measures of socioeconomic status and cognitive decline in the LifeAfter90 Study

AbstractBackgroundChildhood socioeconomic status (SES) is associated with cognitive functioning in adulthood. It is not known if this relationship endures in the oldest old. We examined the associations of subjective and objective childhood SES with baseline cognition and cognitive decline in the LifeAfter90 (LA90) cohort.MethodLA90 is an ongoing diverse cohort of individuals aged 90+ without dementia diagnoses at recruitment. In our analytic sample (n = 341), we operationalized objective childhood SES as maternal education (range 0‐20 years); paternal education was substituted in 14% of cases missing maternal education. Subjective childhood SES was assessed using the MacArthur Scale of Subjective Social Status in which participants ranked their childhood SES using an unnumbered 10‐rung ladder picture (coded continuously with 1 = lowest SES and 10 = highest SES). Executive function (EF), semantic memory (SM), and verbal episodic memory (VEM) were assessed using the Spanish and English Neuropsychological Assessment Scales and z‐standardized to baseline. Mixed effects models estimated the associations between each childhood SES marker and level and change in each cognitive domain, adjusting for baseline age, time since baseline, gender, race and ethnicity, practice effects, and interview mode (phone vs. in‐person). We tested for the association between childhood SES measures and cognitive change by interacting SES measures with time.ResultParticipants completed an average of 3 visits (range 1‐6) each 6 months apart. On average, participants were about 93 years old (SD = 2.2), and 63% were female (Table 1). Mean parental education was 9.8 years (SD = 4.6; range = 0‐20); mean ladder score was 7.1 (SD = 2.4). Higher objective childhood SES was associated with better baseline EF (Figure 1: β = 0.03; 95% CI = 0.02, 0.05) and SM (β = 0.03; 95% CI = 0.02, 0.05). Having higher subjective childhood SES was associated with a slower decline in EF (Table 2: β = 0.02; 95% CI = 0.01, 0.04).ConclusionObjective measures of childhood SES were associated with baseline cognition and subjective childhood SES was associated with slower EF decline among the oldest‐old. High childhood SES may increase chances of surviving past age 90, a selection bias which would attenuate the associations we observed. Our results suggest the long arm of childhood may extend throughout the first century of life.

Subjective social status and nocturnal blood pressure dipping

ObjectiveLow social status has been linked to cardiovascular disease. Subjective social status (SSS), which represents one's perceived position in a social hierarchy, has been suggested to predict health outcomes beyond objective measures of socioeconomic status. The present study examined if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. MethodsIn this cross-sectional study, a community sample of 53 healthy adults underwent 24-h ambulatory BP monitoring. All participants provided information on SSS and objective measures of socioeconomic status (i.e., education, occupation, and income). SSS was measured in comparison to others in the country (national SSS) as well as in comparison to one's social environment (local SSS) using the German versions of the MacArthur Scales. ResultsAnalyses found that participants with low local SSS exhibited attenuated nocturnal diastolic blood pressure dipping (β = 0.29, 95% CI [0.01, 0.57], p = .043) and mean arterial pressure dipping (β = 0.29, 95% CI [0.01, 0.57], p = .041). These associations remained significant after adjusting for objective socioeconomic status. No significant associations between national SSS and cardiovascular measures were observed. ConclusionIn conclusion, one's perceived social position in the social environment (i.e., local SSS) is associated with nocturnal BP dipping. Therefore, local SSS may be an important psychosocial factor linking social inequality and cardiovascular health.

Association between fear of COVID-19 and hoarding behavior during the outbreak of the COVID-19 pandemic: The mediating role of mental health status.

Hoarding behavior can effectively improve people's ability to resist risks, so as to reduce the negative effects of risks. However, excessive hoarding behavior will seriously reduce people's quality of life. The COVID-19 pandemic can cause excessive hoarding in a large number of people in a short period of time, and also cause a series of economic problems such as social material shortage. It is unclear how hoarding levels are linked to fear and negative emotions caused by COVID-19 among people of different educational backgrounds and social status. The purpose of this study was to explore the relationship between fear of COVID-19 and hoarding behavior in different populations in school and social contexts, as well as the mediating role of negative emotions and the moderating role of subjective/objective social status and education level in this process. An online cross-sectional survey was conducted in various provinces in China in January 2022. Demographic information, the MacArthur Scale of Subjective Social Status, the Fear of COVID-19 scale, the Depression Anxiety Stress-21, and the Saving Inventory-Revised were used to evaluate the severity of individual hoarding symptoms, the frequency of hoarding, the degree of fear, and the negative emotions (depression, anxiety, stress) caused by COVID-19. Research data showed that fear of COVID-19 was significantly correlated with hoarding behavior (p < 0.05). Fear of COVID-19 was significantly lower in the student sample than in the nonstudent sample (p < 0.05). Negative emotions played a mediating role in the relationship between fear of COVID-19 and hoarding behavior (p < 0.05). Educational and economic levels moderated this process, but social status did not. Compared with the student sample, educational background and income had less of a moderating effect on the depression, anxiety, and stress caused by fear of COVID-19 in the nonstudent sample. However, these factors had a more regulative effect on the clutter and excessive acquisition behavior caused by depression, anxiety, and stress, although not on difficulty discarding. These findings suggest that reduce negative emotions in the population, improve cognitive levels, and provide financial support from governments may be effective ways to reduce hoarding symptoms.

The relationship between subjective socioeconomic status and health in adults with and without intellectual disability.

This study investigated if subjective socioeconomic status (SSS) is related to self-rated health (SRH) and objective indicators of health in people with and without intellectual disability. Participants were 217 adults with, and 2350 adults without intellectual disability in Jersey. In the intellectual disability sample, 85 (39.2%) participants consented independently, while 132 (60.8%) participants consented through proxy procedures. The MacArthur Scale of Subjective Social Status was used to measure SSS. The Euro-Qol EQ-5D-5L and a five-point scale ranging from poor to excellent health were used to measure SRH. Higher SSS and younger age were predictors of better SRH for the proxy-report intellectual disability group. Being employed was associated with higher EQ-5D-5L index values for all intellectual disability groups. As SSS was only related to SRH in the proxy intellectual disability group, further research with a larger intellectual disability sample is needed to explore its utility further.

Vulnerable populations during COVID-19 response: Health-related quality of life among Chinese population and its influence due to socio-demographic factors and loneliness.

BackgroundInfection control policy affected people's wellbeing during the COVID-19 pandemic, especially those vulnerable populations. This study aimed to compare the health-related quality of life (HRQoL) of the Hong Kong (HK) Chinese population under the pandemic with the normative profiles and explore its influencing factors, including socio-demographic characteristics, loneliness, and the interaction between them.MethodsA cross-sectional questionnaire survey (301 online and 202 in-person) was conducted between June and December 2020 among the adult Chinese population during the 2nd wave of COVID-19 in HK. HRQoL was measured by a Hong Kong validated EQ-5D-5L instrument (EQ-5D-5L HK). Loneliness was measured by a single-item question regarding the frequency of the participants reporting feeling lonely and their subjective social status was measured by the MacArthur Scale of Subjective Social Status. A series of Tobit regressions was conducted. The interaction terms between socio-demographics and loneliness were also examined to decide their association with HRQoL.ResultsA total of 503 responses were collected. The level of HRQoL of the respondents was significantly lower than the referred norms profile among the local general population. The findings identified that younger age, single, a higher subjective social status, and a lower level of loneliness were significantly associated with better HRQoL. Moreover, age and marital status were significant moderators in the relationship between loneliness and HRQoL.ConclusionThe present study found that some population groups face additional vulnerabilities during the pandemic in terms of declined HRQoL. In addition, reducing loneliness can protect the HRQoL during the pandemic, especially among older people. This article provides useful information for policy-makers to design and promote effective services or provide education to improve the connection of people and recover from the global pandemic.

Subjective Social Status, Area Deprivation, and Gender Differences in Health among Chinese Older People.

This study examined the gender differences in the main and interactive effects of subjective social status and area deprivation on health among older adults in Hong Kong. Data for this study came from the baseline of MrOs and MsOs studies, including 4000 Chinese men and women ≥ 65 in Hong Kong. Subjective social status was assessed using the MacArthur Scale of subjective social status scale. Our results reaffirm that subjective social status is an independent indicator of health after adjusting for objective SES measures (e.g., education and income). Perceived rank on the community ladder was more closely related to health among older people than was the society ladder, particularly for women. Although area-level social deprivation was not significantly associated with the health of older people, it may moderate the effect of subjective social status on health. Women with a lower perceived status in the community were more likely to experience depressive symptoms but better grip strength when living in more deprived neighborhoods. The findings suggested that subjective social status provides important information for the physical and mental health of the older population. Policymakers may implement interventions to enhance the subjective social status of older adults. Given the greater contribution of relative status in the community to the health of women, these policies and interventions should target to improve women’s perceived status in the community.

P144 A Heathy Meal Kit Intervention Improves Subjective Social Status of Rural and Suburban Participants with Low-income

<h3>Background</h3> The MacArthur Scale of Subjective Social Status (SSS) is a two-item measure that assesses a participant's perceived rank relative to a group and is positively correlated with a participant's mental and physical health. <h3>Objective</h3> To evaluate the impact of a meal kit intervention on SSS of participants with low income in two communities. <h3>Study Design, Setting, Participants</h3> Main preparers of food from rural (n = 40) and suburban (n = 23) communities with low income and at least one child, recruited through local partners, participated in a six-week meal kit intervention. Weekly kits contained three recipes with enough ingredients to feed a family of four. Participants completed a demographic and SSS survey at baseline and post-intervention. Participants ranked themselves on a scale of 1-10 correlating with how highly they perceived themselves as members of their community and society. <h3>Measurable Outcome/Analysis</h3> An independent samples t-test was conducted to determine differences in SSS at baseline between communities. A paired samples t-test was used to determine differences between baseline and post-intervention SSS scores for each community. <h3>Results</h3> Participants were 46.1 ± 12.8 years, primarily female (88%) and non-Hispanic (98.4%). A majority (85.7%) of participants reported an annual income below $35,000. Overall participant SSS scores improved from baseline to post-intervention from 4.7 ± 1.8 to 5.1 ± 1.7 (<i>P =</i> 0.008) within the community and 4.4 ± 1.7 to 4.9 ± 1.7 (<i>P =</i> 0.049) within society. Rural participant community and society SSS scores improved from baseline to post-intervention (5.1 ± 1.9 to 5.6 ± 1.6; <i>P =</i> 0.008 and 4.6 ± 1.6 to 5.3 ± 1.7; <i>P =</i> 0.024, respectively). Suburban participant SSS scores did not improve. <h3>Conclusions</h3> This intervention improved perceived SSS, which was largely driven by rural participants. Rural residents may have less access to resources such as a meal kit program potentially leading to a stronger improvement in SSS. These data suggest that access to a novel food program typically not accessible to SNAP-eligible families may improve perceived social standing and subsequently health outcomes, which warrants further research. <h3>Funding</h3> Walmart Foundation

The Influence of Subjective Social Status on Self-Rated Health: Evidence from China

Subjective Social Status (SSS) inevitably affects the self-rated health of individuals and /or societal groups. Based on the evidence from China, this paper aims to 1) assess the influence of Objective Social Status and Subjective Social Status on differences in self-rated health in China; 2) to examine the correlations between Subjective Social Status and perceived health. The data from the Chinese General Social Survey (CGSS) 2010 are selected to achieve the two aims with SSS measured by Subjective Family Economic Status (SFES, using the Likert scale) and Subjective Social Class (SSC, using the MacArthur scale), and Health Status measured by a continuous ill score calculated by the standard logarithmic normal distribution index conversion of self-rated health. Advanced statistical modeling using the nested multiple robust regression model and interaction analysis is used to deal with heteroscedasticity from the CGSS data. It is found that: 1) lower SSS is associated with poor health status and SSS is a more comprehensive predictor of health status; 2) aging has more apparent influences on the health of lower SSS groups; 3) lower SSS groups have received higher health returns from their educational attainment than higher SSS groups though they tend to be in poorer health status; 4) once have a chronic disease the health of lower SFES groups will suffer more deterioration than higher ones.

The Influence of Subjective Social Status on Self-Rated Health: Evidence from China

Subjective Social Status (SSS) inevitably affects the self-rated health of individuals and /or societal groups. Based on the evidence from China, this paper aims to 1) assess the influence of Objective Social Status and Subjective Social Status on differences in self-rated health in China; 2) to examine the correlations between Subjective Social Status and perceived health. The data from the Chinese General Social Survey (CGSS) 2010 are selected to achieve the two aims with SSS measured by Subjective Family Economic Status (SFES, using the Likert scale) and Subjective Social Class (SSC, using the MacArthur scale), and Health Status measured by a continuous ill score calculated by the standard logarithmic normal distribution index conversion of self-rated health. Advanced statistical modeling using the nested multiple robust regression model and interaction analysis is used to deal with heteroscedasticity from the CGSS data. It is found that: 1) lower SSS is associated with poor health status and SSS is a more comprehensive predictor of health status; 2) aging has more apparent influences on the health of lower SSS groups; 3) lower SSS groups have received higher health returns from their educational attainment than higher SSS groups though they tend to be in poorer health status; 4) once have a chronic disease the health of lower SFES groups will suffer more deterioration than higher ones.

Socioeconomic Status Association With Dependency From Objective and Subjective Assessments: A Cross-Sectional Study.

BackgroundThe effect of socioeconomic status (SES) on dependency is still complex and not fully clear. The purposes of this study are to assess the association between SES and dependency personality disorder (DPD) using both objective and subjective assessments.MethodsA cross-sectional study was conducted in 27 locations in China among 1,276 general residents aged 60 years and above through a complex multistage sampling design. Data were collected using a questionnaire by well-trained investigators through face-to-face interviews. The DPD was assessed using a standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II scale. Objective SES was assessed by the combination of education levels, individual income, preretirement occupation, and medical insurance. Subjective SES was measured using the MacArthur Scale. The logistic regression analysis was used to evaluate the association between objective SES and DPD. Analysis of covariance was conducted to compare the mean of DPD scores in different levels of SES.ResultsThe results of the chi-squared test showed that the levels of objective SES were associated with DPD, depression, social resources, and region. The logistic regression analysis showed a significant negative association between the levels of objective SES and DPD. The odds ratio was 1.84 (95% confidence interval, 1.07–3.18) after adjusting for important confounding factors. The analysis of covariance showed differences in the mean of DPD scores among different groups defined by different levels of SES.ConclusionThe levels of SES were negatively associated with DPD, and subjective SES had a stronger association with DPD than objective SES. The effect of subjective SES on DPD is possibly associated with the perception of position in the social hierarchy.