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Subjective Social Status and Maternal Health in a Low Income Urban Population

Maternal and Child Health Journal volume 16, pages 834–843 (2012)Cite this article

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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References

  1. Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology (pp. 13–35). New York: Oxford University Press.

    Google Scholar 

  2. 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.

    PubMed  Article  CAS  Google Scholar 

  3. Shavers, V. L. (2007). Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association, 99, 1013–1023.

    PubMed  Google Scholar 

  4. 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.

    PubMed  CAS  Google Scholar 

  5. 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.

    PubMed  CAS  Google Scholar 

  6. 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.

    PubMed  Article  Google Scholar 

  7. 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.

    PubMed  Article  Google Scholar 

  8. 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.

    PubMed  Article  Google Scholar 

  9. 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.

    PubMed  Article  CAS  Google Scholar 

  10. 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.

    PubMed  Article  Google Scholar 

  11. Kawachi, I. (1999). Social capital and community effects on population and individual health. Annals of the New York Academy of Sciences, 896, 120–130.

    PubMed  Article  CAS  Google Scholar 

  12. Jackson, P. B. (2005). Health inequalities among minority populations. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, 63–67.

    Article  Google Scholar 

  13. 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.

    PubMed  Article  Google Scholar 

  14. Schnittker, J., & McLeod, J. D. (2005). Health inequalities among minority populations. Journals of Gerontology, 60B, 63–67.

    Google Scholar 

  15. 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.

    PubMed  Article  Google Scholar 

  16. 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.

    PubMed  Article  CAS  Google Scholar 

  17. 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.

    PubMed  Article  CAS  Google Scholar 

  18. Starfield, B., Shapiro, S., & Weiss, J. (1991). Race, family income, and low birth weight. American Journal of Epidemiology, 134, 1167–1174.

    PubMed  CAS  Google Scholar 

  19. 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.

    PubMed  Article  CAS  Google Scholar 

  20. 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.

    PubMed  Article  Google Scholar 

  21. 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.

    PubMed  Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. Campbell, S. B., & Cohn, J. F. (1991). Prevalence and correlates of postpartum depression in first-time mothers. Journal of Abnormal Psychology, 100, 594–599.

    PubMed  Article  CAS  Google Scholar 

  24. Radloff, L. S. (1977). The CES-D scale. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  25. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.

    PubMed  Article  CAS  Google Scholar 

  26. Agresti, A. (1996). An introduction to categorical data analysis (2nd ed.). New York: Wiley-Interscience.

    Google Scholar 

  27. Stata. (2007). Stata statistical software: Release 10.0. In STATA. College Station, TX: Stata Corporation.

  28. Chen, E., & Paterson, L. Q. (2006). Neighborhood, family, and subjective socioeconomic status: How do they relate to adolescent health? Health Psychology, 25, 704–714.

    PubMed  Article  CAS  Google Scholar 

  29. 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.

    PubMed  Article  Google Scholar 

  30. 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.

    PubMed  Article  Google Scholar 

  31. Krieger, N. (2005). Stormy weather: Race, gene expression, and the science of health disparities. American Journal of Public Health, 95, 2155–2160.

    PubMed  Article  Google Scholar 

  32. Krieger, N. (2007). Why epidemiologists cannot afford to ignore poverty. Epidemiology, 18, 658–663.

    PubMed  Article  Google Scholar 

Download references

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].

Conflict of interest

None declared.

Author information

Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Erika Fitzpatrick Dennis & Scott A. Lorch

  2. Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    David A. Webb & Leny Mathew

  3. College of Nursing and Health Professions and School of Public Health, Drexel University, Philadelphia, PA, USA

    Joan R. Bloch

  4. Department of Pediatrics, University of Pennsylvania’s School of Medicine, Philadelphia, PA, USA

    Jennifer F. Culhane

  5. Center for Outcomes Research, Children’s Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA, 19104, USA

    Erika Fitzpatrick Dennis

Authors
  1. Erika Fitzpatrick Dennis
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  2. David A. Webb
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  3. Scott A. Lorch
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  4. Leny Mathew
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  5. Joan R. Bloch
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  6. Jennifer F. Culhane
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Correspondence to Erika Fitzpatrick Dennis.

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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

Keywords

  • Subjective social status
  • Socioeconomic status
  • Maternal health outcomes
  • Postpartum health
  • Low-income mothers