Impact of objective and subjective social status on obesity in a biracial cohort of adolescents.
OBJECTIVE
To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity.


METHODS
Cross-sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI > or =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.


CONCLUSIONS
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.
Goodman
Elizabeth
E
Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University MS 35, 415 South Street, Waltham, MA 02454-9110, USA. goodman@brandeis.edu
Adler
Nancy E
NE
Daniels
Stephen R
SR
Morrison
John A
JA
Slap
Gail B
GB
Dolan
Lawrence M
LM
D000293:Adolescent; D000328:Adult; D044383:Black People; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000523:psychology*; D010290:Parents; D012574:Schools; D012649:Self Concept; D012923:Social Class; D014505:Urban Population; D044465:White People