- Cardiovascular Reactivity
- Coping Strategies
- Measures of Depression as a Clinical Disorder
- Personal Control
- Measures of Psychological Stress
- Purpose in Life
- Social Support
- Social Conflict
- Subjective Social Status
- Exposure to Violence
- Vitality and Vigor
The MacArthur Scale of Subjective Social Status
Summary prepared by Nancy Adler and Judith Stewart in collaboration with the Psychosocial Working Group. Last revised March, 2007.
Theories of social class and social stratification suggest a variety of bases for social hierarchies. On an empirical basis, different indicators of socioeconomic status each show similar graded relationships with health despite the fact that they are only moderately interrelated. Education, income and occupation provide specific resources. In addition, they locate individuals in relevant social hierarchies where relative position may itself be a risk or protective factor. The MacArthur Network on SES & Health developed a measure of subjective social status to try to capture individuals' sense of their place in the social ladder which takes into account standing on multiple dimensions of socioeconomic status and social position.
The MacArthur Scale of Subjective Social Status was developed to capture the common sense of social status across the SES indicators. In an easy pictorial format, it presents a "social ladder" and asks individuals to place an "X" on the rung on which they feel they stand. There are two versions of the ladder, one linked to traditional SES indicators (SES ladder) and the second linked to standing in one's community (community ladder). The difference between these two ladders may be of particular interest in poorer communities in which individuals may not be high on the SES ladder in terms of income, occupation, or education, but may have high standing within their social groups such as a religious or local community. Insofar social standing has beneficial effects on biological processes related to health, standing on the community ladder may be as important as standing on the SES ladder. Ideally, it would be best to use both ladders (and, if so, one should have participants complete the community ladder first so responses to it aren't keyed to the SES indicators which are described for the SES ladder). If the research is investigating traditional SES, it will be of particular importance to use the SES ladder to be able to make comparisons between objective and subjective SES.
Relationship to SES
Relationship of objective indicators of SES to the SES ladder.
Several studies have examined predictors of the SES ladder. We would expect there to be a significant but not perfect relationship of traditional indicators of SES (e.g., measures of education, individual and family income, occupation and wealth) and subjective social status. Ladder rankings should reflect but not be redundant with the objective indicators. The SES ladder provides a summative measure of social status. Individuals are asked to summate across those indicators and each may assign different weights to the various components of SES. In addition, people may have a deeper understanding of the meaning of their standing on a given aspect of SES. Thus just like self-rated health predicts mortality even when adjusted for all known objective risk factors (Idler and Benyamini, 1997), subjective social status may be a "value added" of the individual's evaluation of their status and the actual implications of the objective indicators. For example, measures of educational attainment treat "high school graduation" as the same value whether one graduated from an elite prep school or an inner city high school, and "college graduation" the same for graduation from a top-ranked college or a diploma-mill. Yet the life chances of these graduates are quite different and are likely to be more sensitively captured by the ladder ranking than by the rather crude educational levels.
Whitehall II Study of British civil servants SES ladder scores are predicted by employment grade, education, household and personal income, household wealth, satisfaction with standard of living, and feelings of financial security. Childhood SES is also related to ladder ranking. Education and income are more strongly related to objective SES (as assessed by occupational grade) while a feeling of financial security is more strongly related to subjective SES as assessed by the SES ladder. Childhood SES and wealth are almost equally related to objective and subjective SES. Singh-Manoux, Marmot, Adler, (2005) suggest that the stronger association between subjective SES and the feeling of financial security in this middle-aged cohort suggests that subjective SES provides a better assessment of a person's future prospects, opportunities, and resources than objective SES.
In the US, predictors differ for White and Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA). Financial security, material deprivation and education are significant predictors of ranking on the SES ladder for both white and black participants. However, household income and wealth predict subjective social status for Whites in CARDIA but not for Blacks (Adler, Singh-Manoux, Schwartz, Stewart, Matthews & Marmot, 2008). Unlike the results in Whitehall II where psychosocial factors were not related to ladder scores, in CARDIA ladder rankings were associated with optimism for both groups, and with control in Whites and mental health for Blacks.
Qualitative investigation of criteria used for SES ladder rankings. In an exploratory qualitative study done for the MacArthur Network, Snibbe, Stewart & Adler (in preparation 2007) explored the criteria people say they use to decide their position on the SES and Community ladders. In an interview, 60 participants in the CARDIA study narrated how they ranked themselves on the SES ladder.
The most frequently mentioned source of subjective social status on the SES ladder was material wealth, mentioned by over 90% of participants (however about a fifth of participants also rejected materialism). The next most frequently mentioned sources of subjective social status were occupation (72%) and education (62%). Almost a quarter of participants indicated using their spirituality or ethical values, and a fifth of the sample used the extent to which they give to others and their health as considerations when determining ranking on the SES ladder. It is not surprising that respondents thought about financial, educational and occupational standing in answering the question of where they stand on the SES ladder since these are the dimensions the scale specifically mentions. The categories of ethics/spirituality, health and social responsibility or altruism ("giving") which were spontaneously generated have more to do with personal qualities and a subjective sense of self-worth than objective markers of status. As indicated such factors may play a not insignificant role in subjective social status.
Definition of "community" and criteria used for Community ladder rankings. In addition to the SES ladder a second ladder asks people to indicate how they stand in their communities. No criteria are given either for the nature of community or the dimensions of status to be used. The qualitative analyses revealed that the majority of participants defined community as their neighborhood (57%). Significantly more African American participants (80%) than European American participants (33.33%) used this definition. The next most popular definition of community was city or town (37%), followed by religious groups (22%), social supporters (20%), workplace (18%), family (18%), friends (12%), people who share their interests (12%), their region (12%), and, finally the nation or world (10%). Additionally, almost half of the participants generated idiosyncratic definitions of community that did not fit in any one category. There were no gender or race differences in mentions of categories other than "neighborhood."
Unlike their responses to the SES ladder, participants relied little on their wealth (25%), education (7%), or occupation (22%) when deciding where to place themselves on the Community ladder. Instead, they most frequently mentioned the everyday ways they give to others—as volunteers, as donors, as good citizens, and as good neighbors with close to 87% mentioning participation in giving activities. A second frequently mentioned source of subjective social status was how well-liked or respected they are by others (52%), followed closely by admissions of feeling as if they do not give enough to their community (50%). (Interestingly, "being respected" was a high frequency content code for the Community ladder but not for the SES ladder.) The remaining categories, in order of frequency, were giving as a leader (37%), giving as a parent (32%), and 12% rejected materialism as contributing to Community subjective social status. Health was not mentioned as a source of subjective social status on the Community ladder as it had been on the SES ladder.
Analyses of the Community ladder narratives revealed that more African American (36.67%) than European American (13.33%) participants mentioned materials / money, and conversely, more European American (13.33%) than African American (0.00%) participants mentioned education. Finally, a trend-level effect showed that more African Americans (33.33%) mentioned spirituality and ethics than did European Americans. The best predictor of the Community ladder rankings was SES ladder ranking, which alone explained 33% of the variance with two of the "giving" variables—giving as a parent and complaining of not being active enough—increasing the explained variance to 47%.
The qualitative study gives some hints about answers to important questions such as how people define community and what dimensions they use in placing themselves on the Community ladder.
Relationship of the SES and Community ladders. To date relatively little research has been done using the Community ladder. In the few studies where both ladders have been used they have been found to be correlated. Goldman, Cornman and Chang (2006) in a Taiwanese sample showed that although the two ladders were highly correlated (with a Pearson correlation, equal to the Spearman rank correlation of 0.78), their sample of middle-aged and older Taiwanese residents ranked their social position within their community an average of 0.4-rung higher than they ranked their position within Taiwan. Analyses of ladder rankings from CARDIA at the Year l5 exam show the two ladders were correlated 0.54. In this group of over 3,000 participants African-American men and women ranked themselves an average of 0.92 rungs higher on the Community than SES ladders whereas European-American men and women demonstrated more similar SES and Community ratings, 0.19 and 0.34 differences respectively (personal communication J.Schwartz).
Relationship to Health
A growing literature is emerging on the linkage between subjective socioeconomic status and health. The SES ladder has been used in a number of studies with populations that range from British civil servants (Singh-Manoux, Adler & Marmot, 2003; Singh-Manoux, Marmot & Adler, 2005), to pregnant women from four different US ethnic groups (Ostrove, Adler, Kuppermann & Washington, 2000), to adolescents in the US Midwest (Goodman, Adler, Kawachi, Frazier, Huang & Colditz, 2001; Goodman, Adler, Daniels, Morrison, Slap & Dolan, 2003; Goodman, McEwen, Dolan, Schafer-Kalkhoff & Adler, 2005), to elderly residents of Taiwan (Hu, Adler, Goldman, Weinstein & Seeman, 2005), to residents of small towns in three provinces in China (Yip & Adler, 2005), to low-income rural Mexicans (Jamison, J., Fernald, L., Burke, H., & Adler, N.E., July 2005), to older retired residents of Britain (Wright & Steptoe, 2005) and representative samples of individuals in the United States (Operario, Adler & Williams, 2004), and Hungary (Kopp, Skrabski, Rethelyi, Kawachi & Adler, 2004; Kopp, Skrabski, Kawachi & Adler, 2005). The results have shown that subjective status is related to a range of health indicators, including poor self-rated health, higher mortality, depression, cardiovascular risk, diabetes and respiratory illness. For example, in the Whitehall II Studies of British civil servants higher SES ladder scores were associated for men and women with lower prevalence of angina, diabetes, GHQ depression, and better perceived general health. Higher SES ladder scores were also associated with lower prevalence for men of respiratory problems.
In several of the studies subjective status showed a stronger relationship with the health indicators than did objective status and remained significant when objective indicators of SES were entered simultaneously into analytic models. In one study, for example, the ladder metric did a better job of predicting heart rate, body fat distribution, and cortisol responses to stress than did objective SES measures ( Adler, Epel, Castellazzo, & Ickovics, 2000). Other studies show that the relationship between the ladder and health outcomes remains robust even when researchers statistically control for objective SES indicators (Ostrove, Adler, Kuppermann, & Washington, 2000; Singh-Manoux, Adler, & Marmot, 2003). In the Whitehall study of British civil servants, subjective social status predicted change in health status even controlling for occupational grade (Singh-Manoux, Marmot, Adler, 2005). Wright & Steptoe (2005) showed that the impact of subjective social status on the cortisol response to awakening was independent of age, body mass index, smoking, time of waking, educational qualifications, financial strain, number of chronic illnesses and medication count in an older retired sample. They note that in older adults, subjective social status may be particularly useful in providing an aggregate estimate of lifetime social experience not so effectively captured by objective markers of SES.
Differences by race/ethnicity. Although the ladder has been used with a variety of samples, there is some evidence that it may not operate in the same way for all groups. Ostrove, etal (2000) found that subjective SES was significantly related to self-rated health among four groups of women (White, Chinese American, African American and Latina). Subjective social status was a significant predictor of self-rated health after the effects of objective indicators were accounted for among White and Chinese American women, however, among African American and Latina women, household income was the only significant predictor of self-rated health. After accounting for the effects of subjective social status on health, objective indicators made no additional contribution to explaining health among White and Chinese American women however household income continued to predict health after accounting for subjective social status among Latina and African American women.
What the ladders are capturing. The research to date provides evidence that the ladder ratings are picking up something meaningful for health, but it is not clear what these ratings reflect. One concern, of course, is whether these ratings are simply reflections of other variables with which they are confounded. There are two plausible types of variables which could account for an association of ladder scores and health outcomes.
One potential confounder is response bias. It could be that individuals who rate themselves high on the ladder also report better health because of a response set or social desirability. If so, we would expect to find associations of ladder rankings with self-rated variables, such as global health, but not with variables measured independently, such as physiological functioning or mortality. Ladder scores show significant associations with both types of variables suggesting that response bias alone cannot account for the association of subjective social status and health. In addition Singh-Manoux etal (2005) showed that ladder rankings predicted global health 3 years later, controlling for global health status as assessed at initial measurement. Since this controls for the shared variance of subjective social status and self-rated global health, the prediction of subsequent global health ratings would be independent of any shared association due to response bias or other confounders.
A second potential confounder is negative affect. Individuals who are depressed or who experience negative affect may both rate themselves low on the ladder and rate their health as poor. There is a relationship between ladder scores and negative affect and depression. However, it appears that this is more likely to be due to the influence of low subjective status on affect than vice verse. As above, findings from studies with outcomes that are not self-report and the longitudinal study suggest that negative affect is not a major confounder. In addition, several studies demonstrate a significant association of ladder rankings with self-rated health even when negative affect is controlled for. Operario, etal (2000) found that negative affect was not only related to subjective SES but also to objective SES indicators. Moreover, when adjusted for negative affect, both objective and subjective SES showed somewhat weaker associations with global health. This is consistent with a mediational model in which both objective and subjective status affect health in part by increasing negative affect.
Given that the SES ladder shows robust associations with health which are not simply due to confounding with response style or negative affect, it is important to know what the ladder rankings are capturing. Below we discuss quantitative and qualitative approaches to that question.
The SES ladder has become an integral measure in network research. We receive many requests to use the ladder in non-network research. Nancy Adler has consulted on the majority of studies noted in this review. New versions of the ladders, for example, for research with adolescents, and Spanish and Hungarian translation have been developed in the last few years.
Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women. Health Psychology, 19(6), 586-592.
Adler, N.E., Singh-Manoux, A., Schwartz, J.E., Stewart, J., Matthews, K. & Marmot, M.G. (2008). Social status and health: A comparison of British civil servants in Whitehall II with European- and African-Americans in CARDIA.
Goldman, N., Cornman, J.C. & Chang, M. (2006). Measuring subjective social status: A case study of older Taiwanese. J. Cross Cultural Gerontology, Mar-Jun;21(1-2):71-89.
Goodman, E., Adler, N.E., Kawachi, I., Frazier, A. L., Huang, B. & Colditz, G.A. (2001). Adolescents' perceptions of social status: Development and evaluation of a new indicator. Pediatrics, 108(2). http://www.pediatrics.org/cgi/content/full/108/2/e31
Goodman, E., Adler, N.E., Daniels, S.R., Morrison, J.A., Slap, G. B. & Dolan, L.M. (2003). Impact of objective and subjective social status on obesity in a biracial cohort of adolescents. Obesity Research, 11(8), 1018-1026.
Goodman, E., McEwen, B. S., Dolan, L. M., , Schafer-Kalkhoff, T. & Adler, N. E. (2005). Social disadvantage and adolescent stress. Journal of Adolescent Health, 37, 484-492.
Hu, P., Adler, N. E., Goldman, N, Weinstein, M. & Seeman, T. E. (2005). Relationship between subjective social status and measures of health in older Taiwanese persons. Journal of American Geriatrics Society, 53, 483-488.
Kopp, M., Skrabski, A., Rethelyi, J., Kawachi, I. & Adler, N. E. (2004). Self-rated health, subjective social status and middle-aged mortality in a changing society. Behavioral Medicine, 30, 65-70.
Kopp, M. S., Skrabski, A., Kawachi, I. & Adler, N. E. (2005). Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality. Journal Epidemiology Community Health, 59, 675-678.
Jamison, J., Fernald, L., Burke, H., & Adler, N.E. (July 2005). Relationship of objective and subjective socioeconomic status and health among poor Mexican women. Abstract presentation at 2005 International Health Economics Association World Congress, Barcelona, Spain.
Operario, D., Adler, N. E., & Williams, D. R. (2004). Subjective social status: Reliability and predictive utility for global health. Psychology & Health, 19(2), 237-246.
Ostrove, J. M., Adler, N. E., Kuppermann, M., & Washington, A. E. (2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19(6), 613-618.
Singh-Manoux, A., Adler, N. E., & Marmot, M. G. (2003). Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Social Science & Medicine, 56(6), 1321-1333.
Singh-Manoux, A., Marmot, M.G. & Adler, N.E. (2005). Does subjective social status predict health and change in health status better than objective status? Psychosomatic Medicine, 67, 855-861.
Snibbe, A.C., Stewart, J. & Adler, N.E. (2007). Where do I stand? How people determine their subjective socioeconomic status.
Yip, W. & Adler, N.E. (July 2005). Does social standing affect health and happiness in rural China? Abstract presentation at 2005 International Health Economics Association World Congress, Barcelona, Spain.
Wright, C. E. & Steptoe, A. (2005). Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population. Psychoneuroendocrinology, 30, 582-590.