Background Contrasting with findings from adults and children, most studies of adolescents find little variation in health according to conventional (objective) socio-economic status (SES) measures. Adolescent smoking is patterned by SES, but relationships between SES and drinking are weaker or non-existent. Subjective status captures perceptions of relative rank and may also be important for health. Most studies of health and subjective status focus on adults, use subjective SES and explore self-reported health rather than behaviours. However, subjective school-based status may be more important than subjective SES for health in adolescence. This study examines the relative importance of objective SES, subjective SES and school-based social status for adolescent self-reported health and health behaviours.
Methods Data were obtained via schools-based self-completion questionnaires in 2010 with follow-up in 2011 when 2,503 (85% of baseline) 13–15 year olds participated. Variables allowing derivation of family affluence were included in 2010; all other data were obtained in 2011. Scottish Index of Multiple Deprivation (SIMD) was derived via postcodes. Pupils rated subjective SES via the MacArthur Scale of Youth Subjective Social Status, a 10-rung ladder with the top representing ‘the best off people in Scotland’. Seven ladders asked them to rate various aspects of their own status, compared to their school year-group. Questionnaires also asked about self-rated health, psychological distress (GHQ–12), smoking and drinking. Analyses suggested three subjective school-based social status dimensions: ‘peer’, ‘scholastic’ and ‘sports’. Objective SES and all social status measures were each collapsed into three categories for inclusion in logistic regression analyses which were conducted on those with full data (N=1,819) on these measures.
Results Correlations between objective SES and all subjective status measures were weak. In preliminary multivariate logistic regression analyses, adjusted for gender and age, family affluence was not associated with health, smoking or drinking and deprivation was not associated with health. However, each subjective school-based status measure was associated with both health and behaviours. For example, odds (95% confidence intervals) of fair/poor self-rated health among those ‘low’ compared with ‘high’: family affluence 1.1 (0.68–1.81); SIMD 1.23 (0.86–1.76); subjective SES 1.42 (0.97–2.08); subjective ‘peer’ status 1.73 (1.20–2.50); ‘scholastic’ 2.93 (2.01–4.27); ‘sports’ 2.93 (1.98–4.35). Odds of ever smoking among those low (vs. high): family affluence 1.43 (0.93–2.21); SIMD 2.28 (1.67–3.13); subjective SES 1.20 (0.84–1.71); ‘peer’ 0.30 (0.21–0.42); ‘scholastic’ 11.80 (8.05–17.29); ‘sports’ 2.00 (1.41–2.84).
Conclusion Subjective school-based social status is more important for adolescent health and substance use than either objective or subjective SES measures.
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