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. 1999 Oct;89(10):1522–1528. doi: 10.2105/ajph.89.10.1522

The role of socioeconomic status gradients in explaining differences in US adolescents' health.

E Goodman 1
PMCID: PMC1508793  PMID: 10511834

Abstract

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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adler N. E., Boyce T., Chesney M. A., Cohen S., Folkman S., Kahn R. L., Syme S. L. Socioeconomic status and health. The challenge of the gradient. Am Psychol. 1994 Jan;49(1):15–24. doi: 10.1037//0003-066x.49.1.15. [DOI] [PubMed] [Google Scholar]
  2. Anderson N. B., Armstead C. A. Toward understanding the association of socioeconomic status and health: a new challenge for the biopsychosocial approach. Psychosom Med. 1995 May-Jun;57(3):213–225. doi: 10.1097/00006842-199505000-00003. [DOI] [PubMed] [Google Scholar]
  3. Anderson R., Dearwater S. R., Olsen T., Aaron D. J., Kriska A. M., LaPorte R. E. The role of socioeconomic status and injury morbidity risk in adolescents. Arch Pediatr Adolesc Med. 1994 Mar;148(3):245–249. doi: 10.1001/archpedi.1994.02170030015003. [DOI] [PubMed] [Google Scholar]
  4. Birmaher B., Ryan N. D., Williamson D. E., Brent D. A., Kaufman J., Dahl R. E., Perel J., Nelson B. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. 1996 Nov;35(11):1427–1439. doi: 10.1097/00004583-199611000-00011. [DOI] [PubMed] [Google Scholar]
  5. Craig T. J., Van Natta P. A. Presence and persistence of depressive symptoms in patient and community populations. Am J Psychiatry. 1976 Dec;133(12):1426–1429. doi: 10.1176/ajp.133.12.1426. [DOI] [PubMed] [Google Scholar]
  6. Crain E. F., Weiss K. B., Bijur P. E., Hersh M., Westbrook L., Stein R. E. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994 Sep;94(3):356–362. [PubMed] [Google Scholar]
  7. Cunningham J., Dockery D. W., Speizer F. E. Race, asthma, and persistent wheeze in Philadelphia schoolchildren. Am J Public Health. 1996 Oct;86(10):1406–1409. doi: 10.2105/ajph.86.10.1406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dietz W. H. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998 Mar;101(3 Pt 2):518–525. [PubMed] [Google Scholar]
  9. Egbuonu L., Starfield Child health and social status. Pediatrics. 1982 May;69(5):550–557. [PubMed] [Google Scholar]
  10. Ernst P., Demissie K., Joseph L., Locher U., Becklake M. R. Socioeconomic status and indicators of asthma in children. Am J Respir Crit Care Med. 1995 Aug;152(2):570–575. doi: 10.1164/ajrccm.152.2.7633709. [DOI] [PubMed] [Google Scholar]
  11. Erzen D., Carriere K. C., Dik N., Mustard C., Roos L. L., Manfreda J., Anthonisen N. R. Income level and asthma prevalence and care patterns. Am J Respir Crit Care Med. 1997 Mar;155(3):1060–1065. doi: 10.1164/ajrccm.155.3.9116987. [DOI] [PubMed] [Google Scholar]
  12. Feinstein J. S. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993;71(2):279–322. [PubMed] [Google Scholar]
  13. Garofalo R., Wolf R. C., Kessel S., Palfrey S. J., DuRant R. H. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics. 1998 May;101(5):895–902. doi: 10.1542/peds.101.5.895. [DOI] [PubMed] [Google Scholar]
  14. Gergen P. J., Mullally D. I., Evans R., 3rd National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics. 1988 Jan;81(1):1–7. [PubMed] [Google Scholar]
  15. Glendinning A., Love J. G., Hendry L. B., Shucksmith J. Adolescence and health inequalities: extensions to Macintyre and West. Soc Sci Med. 1992 Sep;35(5):679–687. doi: 10.1016/0277-9536(92)90006-c. [DOI] [PubMed] [Google Scholar]
  16. Goodman E., Amick B. C., Rezendes M. O., Tarlov A. R., Rogers W. H., Kagan J. Influences of gender and social class on adolescents' perceptions of health. Arch Pediatr Adolesc Med. 1997 Sep;151(9):899–904. doi: 10.1001/archpedi.1997.02170460037006. [DOI] [PubMed] [Google Scholar]
  17. Gortmaker S. L., Must A., Perrin J. M., Sobol A. M., Dietz W. H. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993 Sep 30;329(14):1008–1012. doi: 10.1056/NEJM199309303291406. [DOI] [PubMed] [Google Scholar]
  18. Hogan D. P., Astone N. M., Kitagawa E. M. Social and environmental factors influencing contraceptive use among black adolescents. Fam Plann Perspect. 1985 Jul-Aug;17(4):165–169. [PubMed] [Google Scholar]
  19. Johnston-Brooks C. H., Lewis M. A., Evans G. W., Whalen C. K. Chronic stress and illness in children: the role of allostatic load. Psychosom Med. 1998 Sep-Oct;60(5):597–603. doi: 10.1097/00006842-199809000-00015. [DOI] [PubMed] [Google Scholar]
  20. Kaplan G. A., Keil J. E. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]
  21. Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med. 1994 Oct;39(7):887–903. doi: 10.1016/0277-9536(94)90202-x. [DOI] [PubMed] [Google Scholar]
  22. Lang D. M., Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994 Dec 8;331(23):1542–1546. doi: 10.1056/NEJM199412083312302. [DOI] [PubMed] [Google Scholar]
  23. Lantz P. M., House J. S., Lepkowski J. M., Williams D. R., Mero R. P., Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998 Jun 3;279(21):1703–1708. doi: 10.1001/jama.279.21.1703. [DOI] [PubMed] [Google Scholar]
  24. Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
  25. Lowry R., Kann L., Collins J. L., Kolbe L. J. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA. 1996 Sep 11;276(10):792–797. [PubMed] [Google Scholar]
  26. Lynch J. W., Kaplan G. A., Cohen R. D., Kauhanen J., Wilson T. W., Smith N. L., Salonen J. T. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet. 1994 Feb 26;343(8896):524–527. doi: 10.1016/s0140-6736(94)91468-0. [DOI] [PubMed] [Google Scholar]
  27. Lynch J. W., Kaplan G. A., Salonen J. T. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997 Mar;44(6):809–819. doi: 10.1016/s0277-9536(96)00191-8. [DOI] [PubMed] [Google Scholar]
  28. Lynch J. W., Kaplan G. A., Shema S. J. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med. 1997 Dec 25;337(26):1889–1895. doi: 10.1056/NEJM199712253372606. [DOI] [PubMed] [Google Scholar]
  29. Marmot M. G., Kogevinas M., Elston M. A. Social/economic status and disease. Annu Rev Public Health. 1987;8:111–135. doi: 10.1146/annurev.pu.08.050187.000551. [DOI] [PubMed] [Google Scholar]
  30. Marmot M. G., Shipley M. J., Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. doi: 10.1016/s0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
  31. Marmot M. G., Smith G. D., Stansfeld S., Patel C., North F., Head J., White I., Brunner E., Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. doi: 10.1016/0140-6736(91)93068-k. [DOI] [PubMed] [Google Scholar]
  32. Montgomery L. E., Kiely J. L., Pappas G. The effects of poverty, race, and family structure on US children's health: data from the NHIS, 1978 through 1980 and 1989 through 1991. Am J Public Health. 1996 Oct;86(10):1401–1405. doi: 10.2105/ajph.86.10.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Must A., Dallal G. E., Dietz W. H. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr. 1991 Apr;53(4):839–846. doi: 10.1093/ajcn/53.4.839. [DOI] [PubMed] [Google Scholar]
  34. Neumark-Sztainer D., Story M., French S., Cassuto N., Jacobs D. R., Jr, Resnick M. D. Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations. Am J Public Health. 1996 Nov;86(11):1599–1606. doi: 10.2105/ajph.86.11.1599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Newacheck P. W. Improving access to health services for adolescents from economically disadvantaged families. Pediatrics. 1989 Dec;84(6):1056–1063. [PubMed] [Google Scholar]
  36. Newacheck P. W. Poverty and childhood chronic illness. Arch Pediatr Adolesc Med. 1994 Nov;148(11):1143–1149. doi: 10.1001/archpedi.1994.02170110029005. [DOI] [PubMed] [Google Scholar]
  37. Newacheck P., Jameson W. J., Halfon N. Health status and income: the impact of poverty on child health. J Sch Health. 1994 Aug;64(6):229–233. doi: 10.1111/j.1746-1561.1994.tb06191.x. [DOI] [PubMed] [Google Scholar]
  38. Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
  39. Power C. Social and economic background and class inequalities in health among young adults. Soc Sci Med. 1991;32(4):411–417. doi: 10.1016/0277-9536(91)90342-a. [DOI] [PubMed] [Google Scholar]
  40. Resnick M. D., Bearman P. S., Blum R. W., Bauman K. E., Harris K. M., Jones J., Tabor J., Beuhring T., Sieving R. E., Shew M. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA. 1997 Sep 10;278(10):823–832. doi: 10.1001/jama.278.10.823. [DOI] [PubMed] [Google Scholar]
  41. Roberts R. E., Lewinsohn P. M., Seeley J. R. Screening for adolescent depression: a comparison of depression scales. J Am Acad Child Adolesc Psychiatry. 1991 Jan;30(1):58–66. doi: 10.1097/00004583-199101000-00009. [DOI] [PubMed] [Google Scholar]
  42. Sallis J. F., Zakarian J. M., Hovell M. F., Hofstetter C. R. Ethnic, socioeconomic, and sex differences in physical activity among adolescents. J Clin Epidemiol. 1996 Feb;49(2):125–134. doi: 10.1016/0895-4356(95)00514-5. [DOI] [PubMed] [Google Scholar]
  43. Sanderson M., Placek P. J., Keppel K. G. The 1988 National Maternal and Infant Health Survey: design, content, and data availability. Birth. 1991 Mar;18(1):26–32. doi: 10.1111/j.1523-536x.1991.tb00050.x. [DOI] [PubMed] [Google Scholar]
  44. Schwartz J., Gold D., Dockery D. W., Weiss S. T., Speizer F. E. Predictors of asthma and persistent wheeze in a national sample of children in the United States. Association with social class, perinatal events, and race. Am Rev Respir Dis. 1990 Sep;142(3):555–562. doi: 10.1164/ajrccm/142.3.555. [DOI] [PubMed] [Google Scholar]
  45. Seeman T. E., Singer B. H., Rowe J. W., Horwitz R. I., McEwen B. S. Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging. Arch Intern Med. 1997 Oct 27;157(19):2259–2268. [PubMed] [Google Scholar]
  46. Troiano R. P., Flegal K. M., Kuczmarski R. J., Campbell S. M., Johnson C. L. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995 Oct;149(10):1085–1091. doi: 10.1001/archpedi.1995.02170230039005. [DOI] [PubMed] [Google Scholar]
  47. Troiano R. P., Flegal K. M. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998 Mar;101(3 Pt 2):497–504. [PubMed] [Google Scholar]
  48. Turner C. F., Ku L., Rogers S. M., Lindberg L. D., Pleck J. H., Sonenstein F. L. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science. 1998 May 8;280(5365):867–873. doi: 10.1126/science.280.5365.867. [DOI] [PubMed] [Google Scholar]
  49. West P. Health inequalities in the early years: is there equalisation in youth? Soc Sci Med. 1997 Mar;44(6):833–858. doi: 10.1016/s0277-9536(96)00188-8. [DOI] [PubMed] [Google Scholar]
  50. West P. Inequalities? Social class differentials in health in British youth. Soc Sci Med. 1988;27(4):291–296. doi: 10.1016/0277-9536(88)90262-6. [DOI] [PubMed] [Google Scholar]
  51. West P., Macintyre S., Annandale E., Hunt K. Social class and health in youth: findings from the west of Scotland twenty-07 study. Soc Sci Med. 1990;30(6):665–673. doi: 10.1016/0277-9536(88)90252-3. [DOI] [PubMed] [Google Scholar]
  52. West P., Macintyre S., Annandale E., Hunt K. Social class and health in youth: findings from the west of Scotland twenty-07 study. Soc Sci Med. 1990;30(6):665–673. doi: 10.1016/0277-9536(88)90252-3. [DOI] [PubMed] [Google Scholar]
  53. Wise P. H., Kotelchuck M., Wilson M. L., Mills M. Racial and socioeconomic disparities in childhood mortality in Boston. N Engl J Med. 1985 Aug 8;313(6):360–366. doi: 10.1056/NEJM198508083130605. [DOI] [PubMed] [Google Scholar]

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