Social Hierarchy and Health among Adolescents: The Role of Perceived Class Identity

Author(s): Ritterman, Miranda Lucia | Advisor(s): Syme, Leonard; Fernald, Lia | Abstract: There is a well-established inverse graded relationship between social class and infant, child, and adult health but this gradient is inconsistent and understudied among adolescents. The empirical inquiry into health inequalities among adolescents is of particular significance because health in adulthood is strongly influenced by early life circumstances. Current research suggests that social stratification, as reflected by adolescent perceived class identity, may be an important determinant of adolescent health independent of traditional objective social class indicators. This dissertation research was conducted using data Mexican adolescents living in poverty with the following objectives: 1) to examine the associations between adolescent risk behaviors and adolescent perceived class identity, using two subjective social status (SSS) scales and introducing a new indicator: "anticipated social mobility"; 2) to examine whether or not these associations persist after controlling for traditional indicators of socioeconomic position; and 3) to investigate demographic, psychosocial and socioeconomic correlates of adolescent class identity within a new national context and among a socioeconomically homogenous cohort. Adolescents were from households that qualified for the Mexican government's poverty alleviation program, "Oportunidades". Individual, household and neighborhood data were collected on urban households in seven states in Mexico in 2004 as part of the evaluation of this welfare program. The adolescent module was completed by approximately 7900 adolescents aged twelve to twenty-two. This dissertation highlights the known and unknown dimensions of adolescent class identity and health, filling in gaps in the scientific understanding of the social gradient in health during adolescence. Chapter 1 provides an overview of the dissertation. Chapter 2 reports on the shape of social class gradients for substance use among Mexican adolescents. Multiple logistic regressions are used to estimate the associations of objective indicators of socioeconomic status (SES) and SSS--at both community and societal levels-with smoking, alcohol and drug use. Chapter 3 examines multiple dimensions of social position in relation to obesity-related behaviors. Multiple objective and subjective measures of social position are used including parental education, household expenditures, community and society SSS, and school dropout status. Ordinal logistic regressions are used to estimate the associations between parental, household and adolescent indicators of social position and obesity risk. The first objective of Chapter 4 is to examine the association between adolescent risk behaviors and a new indicator of adolescent relative social position, adolescent anticipated social mobility. Anticipated social mobility was calculated for each subject by taking the difference between their rankings on two 10-rung ladder scales that measured (1) projected future social status and (2) current SSS within Mexican society. This chapter then investigates potential underlying demographic, socioeconomic and psychosocial determinants of this indicator. Multiple logistic regression analyzes are used to estimate the strength of associations in this chapter. Chapter 5 provides a summary of the findings from Chapters 2, 3 and 4. In addition, suggested future research directions and policy implications are discussed.This dissertation has contributed to the literature on health inequities by providing data on cross-sectional associations between objective and subjective indicators of social class and multiple risk behaviors in a vulnerable urban adolescent population. Findings provide evidence that there is a social gradient in health during adolescence. Adolescents who have dropped out of school and perceive themselves as having little control over their destinies are more likely to perceive themselves as having low social status and being downwardly mobile. Subjective measures of adolescent class identity, including subjective social status and anticipated social mobility, may be more effective than conventional indicators of social class in explaining the association between social position and health during this transitional period. The conclusion from this work suggests the usefulness of subjective indicators of adolescent class identity for further studies of adolescent populations, particularly those with a restricted range of socioeconomic statuses.