Abstract
Appropriate measurement of socioeconomic status (SES) in health research can be problematic. Conventional SES measures based on ‘objective’ indicators such as income, education, or occupation may have questionable validity in certain populations. The objective of this investigation was to determine if a relatively new measurement of SES, subjective social status (SSS), was more consistently and strongly associated with multiple health outcomes for low income mothers. Data available from a large scale community-based study examining maternal and infant health for a low income urban population were used to examine relationships between SSS and a wide range of postpartum physical and emotional health outcomes. Crosstabulations and multivariate analyses focused on the breadth and depth of these relationships; in addition, the relative strength of the relationships between SSS and the health outcomes was compared to that of conventional measures of SES, including both income and education. SSS was significantly related to all physical and emotional health outcomes examined. The overall pattern of findings indicated that these relationships were independent of, as well as more consistent and stronger than, those between conventional measures of SES and postpartum health outcomes. SSS represents an important dimension of the relationship between SES and postpartum physical and emotional health. In low income populations the failure to account for this dimension likely underestimates the influence of SES on postpartum health. This has important implications for the interpretation of findings in empirical studies which seek to control for the effects of SES on maternal health outcomes.
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Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology (pp. 13–35). New York: Oxford University Press.
Braveman, P. A., Cubbin, C., Egerter, S., et al. (2005). Socioeconomic status in health research: One size does not fit all. JAMA, 294, 2879–2888.
Shavers, V. L. (2007). Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association, 99, 1013–1023.
Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity and Disease, 2, 207–221.
Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56, 133–136.
Geronimus, A. T., Hicken, M., Keene, D., et al. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health, 96, 826–833.
Astone, N. M., Misra, D., & Lynch, C. (2007). The effect of maternal socio-economic status throughout the lifespan on infant birthweight. Paediatric and Perinatal Epidemiology, 21, 310–318.
Tiedje, L. B. (2003). Psychosocial pathways to prematurity: Changing our thinking toward a lifecourse and community approach. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 650–658.
Adler, N. E., Epel, E. S., Lynch, C., et al. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women. Health Psychology, 19, 586–592.
Singh-Manoux, A., Adler, N. E., & Marmot, M. G. (2003). Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Social Science and Medicine, 56, 1321–1333.
Kawachi, I. (1999). Social capital and community effects on population and individual health. Annals of the New York Academy of Sciences, 896, 120–130.
Jackson, P. B. (2005). Health inequalities among minority populations. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, 63–67.
Schnittker, J., & Bhatt, M. (2008). The role of income and race/ethnicity in experiences with medical care in the United States and United Kingdom. International Journal of Health Services, 38, 671–695.
Schnittker, J., & McLeod, J. D. (2005). Health inequalities among minority populations. Journals of Gerontology, 60B, 63–67.
Singh-Manoux, A., Marmot, M. G., & Adler, N. E. (2005). Does subjective social status predict health and change in health status better than objective status? Psychosomatic Medicine, 67, 855–861.
Kramer, M. S., Seguin, L., Lyndon, J., et al. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14, 194–210.
Parker, J. D., Schoendorf, K. C., & Kiely, J. L. (1994). Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States. Annals of Epidemiology, 4, 271–278.
Starfield, B., Shapiro, S., & Weiss, J. (1991). Race, family income, and low birth weight. American Journal of Epidemiology, 134, 1167–1174.
Ostrove, J. M., Adler, N. E., Kuppermann, M., et al. (2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19, 613–618.
Chung, E. K., McCullum, K. F., Elo, I. T., et al. (2004). Maternal depressive symptoms and infant health practices among low-income women. Pediatrics, 113, e523–e529.
Culhane, J. F., Raugh, V., McCullum, K. F., et al. (2002). Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women. American Journal of Obstetrics and Gynecology, 187, 1272–1276.
Operario, D., Adler, N. E., & Williams, D. R. (2004). Subjective Social Status: Reliability and predictive utility for global health. Psychology and Health, 19(2), 237–246.
Campbell, S. B., & Cohn, J. F. (1991). Prevalence and correlates of postpartum depression in first-time mothers. Journal of Abnormal Psychology, 100, 594–599.
Radloff, L. S. (1977). The CES-D scale. Applied Psychological Measurement, 1, 385–401.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.
Agresti, A. (1996). An introduction to categorical data analysis (2nd ed.). New York: Wiley-Interscience.
Stata. (2007). Stata statistical software: Release 10.0. In STATA. College Station, TX: Stata Corporation.
Chen, E., & Paterson, L. Q. (2006). Neighborhood, family, and subjective socioeconomic status: How do they relate to adolescent health? Health Psychology, 25, 704–714.
Demakakos, P., Nazroo, J., Breeze, E., et al. (2008). Socioeconomic status and health: The role of subjective social status. Social Science and Medicine, 67, 330–340.
Kopp, M. S., Skrabski, A., Kawachi, I., et al. (2005). Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality. Journal of Epidemiology and Community Health, 59, 675–678.
Krieger, N. (2005). Stormy weather: Race, gene expression, and the science of health disparities. American Journal of Public Health, 95, 2155–2160.
Krieger, N. (2007). Why epidemiologists cannot afford to ignore poverty. Epidemiology, 18, 658–663.
Acknowledgments
This work was supported by the National Institutes of Health and Human Development [R01HD36462-01 A1]; The National Institute of Nursing Research [K23 NR010747-01A1] and the Center for Disease Control and Prevention/ATPM [TS-0626, and TS-0561].
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Dennis, E.F., Webb, D.A., Lorch, S.A. et al. Subjective Social Status and Maternal Health in a Low Income Urban Population. Matern Child Health J 16, 834–843 (2012). https://doi.org/10.1007/s10995-011-0791-z
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DOI: https://doi.org/10.1007/s10995-011-0791-z