Baylor University, Waco, TX, USA.
University of California-Riverside, Riverside, CA, 92521, USA.
Soc Sci Med. 2024 Nov;361:117396. doi: 10.1016/j.socscimed.2024.117396. Epub 2024 Oct 4.
Efforts to understand the relationship between socioeconomic status (SES) and health have expanded beyond traditional indicators of education, income, occupation, and wealth to individuals' own reports of where they stand. This more contemporary approach has enjoyed considerable success, in that self-reported SES standing, often measured on a ladder representing the entire U.S. socioeconomic hierarchy, is associated strongly with health even when traditional SES indicators are controlled. However, disparities in self-rated health across ladder measures typically are not assessed with regard to health behavior disparities. Here, we draw on two US national probability samples assessing diverse ladder reference groups, as well as a new ladder asking people to report how much respect, honor, or esteem they receive from other people. Respect or honor offers a distinct potential to measure social influence across circles of recognition. We find that U.S.-based ladder status is related to smoking currently or ever and to days of exercise. While friend, neighbor, and respect-based ladders do not relate to health behaviors net of U.S. ladder standing, they show relationships to ever smoking and physical activity, and self-rated health, in their own right. Physical activity accounts for 12-18% of self-rated health disparities by friend, neighbor, or country ladder status. Smoking and drinking do not robustly contribute to ladder-based disparities in self-rated health. Contrasting what is typically found for traditional SES measures, physical activity merits further research, as does the receipt of respect or honor. That status ladder health disparities go largely unexplained by behaviors suggests the potential roles of non-behavioral pathways including inflammation, hopelessness, or classism.
努力理解社会经济地位（SES）与健康之间的关系已经超越了教育、收入、职业和财富等传统指标，扩展到了个人对自身社会经济地位的自我报告。这种更为现代的方法取得了相当大的成功，因为自我报告的 SES 地位，通常是在代表整个美国社会经济阶层的阶梯上进行衡量，即使在控制了传统 SES 指标的情况下，也与健康密切相关。然而，在评估健康行为差异时，通常不会考虑到阶梯衡量标准之间的自评健康差异。在这里，我们借鉴了两个美国全国概率抽样调查，评估了不同的阶梯参照群体，以及一个新的阶梯调查，要求人们报告他们从其他人那里获得的尊重、荣誉或尊重程度。尊重或荣誉提供了一种独特的潜力，可以衡量在不同认可圈子中的社会影响力。我们发现，美国的阶梯地位与目前或曾经吸烟以及锻炼天数有关。虽然朋友、邻居和尊重阶梯与健康行为无关，除了美国阶梯地位之外，但它们与曾经吸烟和体育活动以及自评健康有关。体育活动占朋友、邻居或国家阶梯地位与自评健康差异的 12-18%。吸烟和饮酒并不能很好地解释基于阶梯的自评健康差异。与传统 SES 衡量标准通常发现的情况形成对比的是，体育活动值得进一步研究，就像尊重或荣誉的获得一样。行为并不能很好地解释地位阶梯健康差异，这表明可能存在非行为途径，包括炎症、绝望或阶级主义。
