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Social class gradients in health during adolescence
  1. B Starfield,
  2. A W Riley,
  3. W P Witt,
  4. J Robertson
  1. Department of Health Policy and Management, Johns Hopkins University, Baltimore, USA
  1. Correspondence to:
 Dr B Starfield, Department of Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 452, Baltimore, MD 21205, USA;


Study objective: To review existing data on social class gradients in adolescent health and to examine whether such gradients exist in new data concerning US adolescents.

Design: Review of relevant publications and unpublished data; regression analyses using adolescent self reported health status data to determine whether there are gradients by social class, using three classes categorised by adolescent reported parental work status and education.

Participants: Adolescents of ages 11–17.

Main results: Findings from the literature indicate the presence of social class gradients in some but not all aspects of adolescent health. Results from new data showed social class gradients in several domains of health and in profiles of health. The likelihood of being satisfied with one's health, of being more resilient (better family involvement, better problem solving, more physical activity, better home safety), having higher school achievement, and of being in the best health profiles were significantly and progressively greater as social class rose. Moreover, the probability of being in the poorest health profile type group was progressively higher as social class declined.

Conclusions: The review of existing data and the new findings support the existence of social class gradients in satisfaction with one's health, in resilience to health threats, in school achievement, and in being in the best health overall (as manifested by the health profiles composed of four major domains of health). The study had two especially notable findings: (1) the paucity of studies using the same or similar indicators, and (2) the consistent existence of social class gradients in characteristics related to subsequent health, particularly intake of nutritional foods and physical activity. The sparseness of existing data and the different aspects of health investigated in the relatively few studies underscore the need for (1) the development of conceptual models specifically focused on adolescent health and social class; (2) additional inquiry into the measurement of social class and adolescent perceptions of class; (3) inclusion of contextual variables in study design; and (4) longitudinal cohort studies to better understand the specific determinants of health during adolescence.

  • social class gradients, adolescent health
  • profiles of health

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