ABSTRACT. Objective. Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health.Methods. A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES.Results. Mean society ladder ranking, a subjective measure of SES, was 7.2 ؎ 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 ؎ 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers ( teen ‫؍‬ 7.2 ؎ 1.3 vs mom ‫؍‬ 6.8 ؎ 1.2; P ‫؍‬ .002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rho teens <15 years ‫؍‬ 0.31 vs Spearman's rho teens >15 years ‫؍‬ 0.45; P < .001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratio society ‫؍‬ 0.89, 95% confidence interval ‫؍‬ 0.83, 0.95; odds ratio community ‫؍‬ 0.91, 95% confidence interval ‫؍‬ 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS. T he elimination of health disparities among different population segments, including differences related to socioeconomic status (SES), is the second overarching goal of Healthy People 2010. Recently, the American Academy of Pediatrics also recognized and highlighted the importance of addressing SES as an causative agent in the creation of health differentials and called for additional research to understand the impact of SES across the life course. 1 The inverse, graded relationship between SES and infant, child, and adult health is well established. [2][3][4][5][6][7][8][9][10][11] However, among adolescents, the SES gradient in health is present inconsistently. 12-15 A number of models have been proposed to explain the different patterning of SES effects on adolescent health. 2,16 Choosing the most appropriate model(s) has been...

Depressed adolescents are at increased risk for the development and persistence of obesity during adolescence. Understanding the shared biological and social determinants linking depressed mood and obesity may inform the prevention and treatment of both disorders.

Parental report is a better indicator of obesity than teen report of weight status, but parental and teen reports are both poor predictors of adolescent obesity. Using BMI based on self-reported height and weight correctly classified 96% as to obesity status. Thus, studies can use self-reported height and weight to understand teen obesity and its correlates/sequelae.

OBJECTIVE: This study sought to determine whether socioeconomic status (SES) gradients exist among US adolescents for self-rated health and for 5 diseases that cause serious adolescent and continuing adult morbidity. METHODS: Baseline data from 15,483 adolescent and parental surveys from the National Longitudinal Study of Adolescent Health were used. SES indicators included parental education and occupation, and household income. Dependent variables included self-rated health and the presence of depression, obesity, asthma, suicide attempt in the past year, and prior sexually transmitted disease. RESULTS: SES gradients were found for self-rated health, depression, and obesity (P < .01). Suicide attempt was linearly associated with income (P < .01). After adjustment for other SES and sociodemographic factors, education and income remained independent correlates of both depression and obesity; income remained an independent correlate of attempted suicide. CONCLUSIONS: Differences in susceptibility to socially mediated etiologic mechanisms of disease may exist during adolescence. Understanding the sociostructural context and patterning of adolescents' lives is crucial to clearly understanding health and disease etiology throughout the course of life.

Objective: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. Research Methods and Procedures: Cross‐sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI ≥95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10‐point scales for society and school. A parent provided information on parent education and household income for SES. Results: Although there were no sex differences in SES, black students were more likely to come from families with less well‐educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06, 1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. Discussion: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status‐overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.

SES is associated with a large proportion of the disease burden within the total population.

Background-Factor analyses suggest that the structure underlying metabolic syndrome is similar in adolescents and adults. However, adolescence is a period of intense physiological change, and therefore stability of the underlying metabolic structure and clinical categorization based on metabolic risk is uncertain. Methods and Results-We analyzed data from 1098 participants in the Princeton School District Study, a school-based study begun in 2001-2002, who were followed up for 3 years. We performed factor analyses of 8 metabolic risks at baseline and follow-up to assess stability of factor patterns and clinical categorization of metabolic syndrome. Metabolic syndrome was defined using the current American Heart Association/National Heart, Lung, and Blood Institute definition for adults (AHA), a modified AHA definition used in prior pediatric metabolic syndrome studies (pediatric AHA), and the International Diabetes Federation (IDF) guidelines. We found that factor structures were essentially identical at both time points. However, clinical categorization was not stable. Approximately half of adolescents with baseline metabolic syndrome lost the diagnosis at follow-up regardless of the definitions used: pediatric AHAϭ56% (95% confidence interval [CI], 42% to 69%), AHAϭ49% (95% CI, 32% to 66%), IDFϭ53% (95% CI, 38% to 68%). In addition to loss of the diagnosis, new cases were identified. Cumulative incidence rates were as follows: pediatric AHAϭ3.8% (95% CI, 2.8% to 5.2%); AHAϭ4.4% (95% CI, 3.3% to 5.9%); IDFϭ5.2% (95% CI, 4.0% to 6.8%). Conclusions-During adolescence, metabolic risk factor clustering is consistent. However, marked instability exists in the categorical diagnosis of metabolic syndrome. This instability, which includes both gain and loss of the diagnosis, suggests that the syndrome has reduced clinical utility in adolescence and that metabolic syndrome-specific pharmacotherapy for youth may be premature.

An extensive literature documents the existence of pervasive and persistent child health, development, and health care disparities by race, ethnicity, and socioeconomic status (SES). Disparities experienced during childhood can result in a wide variety of health and health care outcomes, including adult morbidity and mortality, indicating that it is crucial to examine the influence of disparities across the life course. Studies often collect data on the race, ethnicity, and SES of research participants to be used as covariates or explanatory factors. In the past, these variables have often been assumed to exert their effects through individual or genetically determined biologic mechanisms. However, it is now widely accepted that these variables have important social dimensions that influence health. SES, a multidimensional construct, interacts with and confounds analyses of race and ethnicity. Because SES, race, and ethnicity are often difficult to measure accurately, leading to the potential for misattribution of causality, thoughtful consideration should be given to appropriate measurement, analysis, and interpretation of such factors. Scientists who study child and adolescent health and development should understand the multiple measures used to assess race, ethnicity, and SES, including their validity and shortcomings and potential confounding of race and ethnicity with SES. The American Academy of Pediatrics (AAP) recommends that research on eliminating health and health care disparities related to race, ethnicity, and SES be a priority. Data on race, ethnicity, and SES should be collected in research on child health to improve their definitions and increase understanding of how these factors and their complex interrelationships affect child health. Furthermore, the AAP believes that researchers should consider both biological and social mechanisms of action of race, ethnicity, and SES as they relate to the aims and hypothesis of the specific area of investigation. It is important to measure these variables, but it is not sufficient to use these variables alone as explanatory for differences in disease, morbidity, and outcomes without attention to the social and biologic influences they have on health throughout the life course. The AAP recommends more research, both in the United States and internationally, on measures of race, ethnicity, and SES and how these complex constructs affect health care and health outcomes throughout the life course.