Elimination of social inequalities in health is one of the overarching goals of Healthy People 2010. Most past work has defined social status as socioeconomic status (SES), an external measure that does not account for subjective, internalized perceptions of social standing. Most studies also do not explain how lower social status causes poorer health. Using a new measure of subjective social standing developed by members of the investigative team, this study tests a novel explanatory model of social status' impact on health. The model identifies the HPA axis and autonomic nervous system as critical biologic systems in the creation of social inequalities in health. Social status, an environmental stress, causes stimulation of these systems which, in turn, leads to alterations in neurohormonal mediators of the social status-health relationship. The study dovetails to a new 4-year longitudinal cohort study of adolescent obesity and Type 2 diabetes in a racially and socioeconomically diverse school district in Ohio. Both of these diseases support this model.
The specific aims are 1 )To describe adolescents' perceptions of social standing and the developmental changes which occur in these perceptions over a four year period; 2) To characterize the associations between social status, measured both objectively and subjectively, and obesity and insulin resistance among adolescents; and 3) To determine the relationships between social status, measured both objectively and subjectively, and potential biologic mediators of social status' impact on health. To address these aims, yearly assessment of adolescents' subjective social standing will take place. In addition, in Years 1 and 4, potential primary and secondary biologic mediators (insulin, DHEA-S, blood pressure, total and HDL cholesterol, and glycosylated hemoglobin) will be obtained. Parents will provide information on SES and their own perceptions of social standing in Years 1 and 4. This study will provide unique, community-based information on potential biologic mediators of social status' influence on health. The population's diversity will enable us to differentiate the effects of race/ethnicity and social status. The innovative measurement of social status, which includes both subjective and objective components, may explain some of the inconsistency in the SES-obesity relationship and the secular trends in obesity and diabetes. This work will also lay the foundation for creation of effective primary prevention strategies by providing insight into the processes through which social inequalities in health are created.
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