[Concept of living conditions or social strata?--which approach is more suitable for describing unhealthy living circumstances of mothers?].

The aim of this study was to identify living conditions associated with elevated health risks for mothers. Following up the debate on appropriate characterisation of social structure in modern societies, two different approaches, namely the 'social strata concept' and the 'concept of living conditions', were considered. Of particular interest was the question if the concept of living conditions, which is based on a broader definition of social status, allowed a more precise description of health-related living circumstances. The study was based on clinical data from 6,094 inpatients in Mother-Child rehabilitation centres in Germany. Taking socioeconomic status, household characteristics and psychosocial stressors into account seven typical living conditions of mothers could be identified by cluster analysis. Social status was measured by the Winkler Index. A moderate health-related gradient of increasing health risks with decreasing social position could be found for psychological and bodily disabilities. The approach of living conditions revealed that two living circumstances of mothers could be identified as being related to extremely poor health. These are i) dissatisfied single mothers with high degrees of psychosocial distress and lack of social support, and ii) married mothers with conflicts within the family and self-perceived lack of appreciation. Different from these findings, a pronounced social gradient could be found for overweight and smoking. Here the concept of social strata revealed in part excessive risks compared to the concept of living conditions. Overall, the integration of further social determinants allowed a more detailed insight into health-related living conditions, which are not solely determined by socioeconomic position. A global answer about the adequacy of the 'social strata concept' versus 'concept of living conditions' for identifying unhealthy living conditions could not be given because the relevance of both conceptual frameworks depended on the health outcomes considered.