Determinants of Social Status among Homeless Adults Alexis Moisiuc; Lorraine R. Reitzel, PhD; Darla E. Kendzor, PhD; Sarah Childress; Michael S. Businelle, PhD

Objectives: To examine determinants of subjective social status (SSS) among 394 sheltered homeless adults. Methods: Demographics, socioeconomic status, homelessness, and other life factors were examined as potential determinants of US and Community SSS using parametric tests. Results: Higher income, African-American/other race, having health insurance, being employed, having longer duration of homelessness, having children, and being of non-veteran status were each significantly associated with higher SSS-US. African-American/ other race and having health insurance

I

ndividuals’ perception of their relative standing in society is known as subjective social status (SSS). SSS is commonly measured using 2 ladders; the United States (US; SSS-US) and the community (SSS-community) versions of the MacArthur Scale of SSS.1 Specifically, individuals are presented with a picture of a ladder and are asked to rank themselves on a scale of 1 (bottom of ladder) to 10 (top of ladder) relative to others. The SSS-US ladder assesses how individuals perceive themselves compared to others in the US, whereas the SSS-community ladder assesses how individuals perceive themselves relative to others in their self-defined communities. SSS, as measured by both ladders, has been associated with health behaviors and health outcomes over and above the Alexis Moisiuc, Undergraduate Research Assistant, Lorraine R. Reitzel, Associate Professor, and Sarah Childress, Undergraduate Research Assistant, The University of Houston, College of Education, Department of Educational Psychology, Houston, TX. Darla E. Kendzor, Assistant Professor, and Michael S. Businelle, Assistant Professor, The University of Texas Health Science Center, School of Public Health, Dallas, TX. Lorraine R. Reitzel, Darla E. Kendzor, and Michael S. Businelle are the joint senior scientists on this work. Lorraine R. Reitzel was affiliated with The University of Texas MD Anderson Cancer Center in Houston, TX at the time of data collection. Correspondence Dr Reitzel; [email protected]

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were significantly associated with higher community SSS. Variables maintained significance in multivariate models except homelessness duration (for SSS-US). Conclusions: Given known relations of SSS and negative health behaviors and outcomes, understanding the correlates of SSS among homeless adults may facilitate targeted interventions. Key words: social status; homeless; health promotion; socioeconomic status; insurance; veteran; social determinants Am J Health Behav. 2015;39(1):148-156 DOI: http://dx.doi.org/10.5993/AJHB.39.1.16

influence of other traditional socioeconomic status (SES) factors such as income and education within diverse populations. For example, higher scores on the SSS-US ladder have been incrementally associated with better self-rated mental health among women who quit smoking due to pregnancy,2 greater consumption of fruits and vegetables and more physical activity in a large African-American sample,3 a greater likelihood of nondaily (versus daily) smoking,4 and higher odds of smoking cessation in a racially/ethnically diverse group of smokers.5,6 Likewise, the SSS-community ladder has been incrementally associated with quitting smoking among African-American light smokers of low SES.7 Several other observational and experimental studies also support the incremental association of the SSS ladders with mental health, physical health (eg,8-14), and health behaviors15 over and above traditional SES indicators.16,17 Several studies have examined determinants of SSS to clarify causes for the observed relations between SSS and health behaviors and outcomes. For example, SSS may be an incremental predictor over SES because it taps into health-relevant factors that transcend traditional SES indicators (eg, a person’s role or value within a community, occupational prestige, experience of societal inequities).1,17 Research indicates that indicators of SES, like income, education, and employment,

Moisiuc et al

Table 1 Participant Characteristics (N = 394) Predictor Variables

SSS-US

SSS-Community

Total (Whole) Sample

Mean (SD)

Mean (SD)

% [N] or Mean (SD)

.

.

43.34 (11.80)

Men (REF)

3.95 (2.31)

5.06 (2.44)

71.8 [283]

Women

4.36 (2.53)

5.32 (2.56)

28.2 [111]

White (REF)

3.58 (2.12)

4.71 (2.50)

29.9 [118]

African-American/other

4.27 (2.45)

5.31 (2.45)

69.8 [275]

Not married (REF)

4.07 (2.38)

5.13 (2.45)

94.9 [374]

Married

3.90 (2.38)

5.25 (2.97)

5.1 [20]

 

 

 

.

.

11.88 (1.79)

$0

3.74 (2.34)

5.16 (2.54)

41.6 [164]

$1 to $499

3.83 (2.42)

4.87 (2.45)

27.7 [109]

>$500

4.89 (2.23)

5.47 (2.35)

27.4 [108]

Any type of insurance (REF)

4.94 (2.37)

5.89 (2.32)

23.6 [93]

No insurance

3.79 (2.32)

4.90 (2.47)

76.4 [301]

5.33 (2.46)

5.28 (2.71)

9.9 [39]

3.92 (2.33)

5.12 (2.45)

90.1 [355]

 

 

 

Length of homelessness (months)a

.

.

39.10 (49.57)

Episodes of homelessness

.

.

2.94 (2.99)

Yes

4.05 (2.55)

4.65 (2.69)

14.5 [57]

No (REF)

4.07 (2.35)

5.21 (2.43)

85.5 [337]

Pavilion (REF)

3.97 (2.33)

5.11 (2.51)

69.5 [274]

Transitional

4.28 (2.47)

5.19 (2.40)

30.5 [120]

 

 

(Continued on next page) 

  Demographics Age Sex

Race

Partner Status

 

 

Socioeconomic Status Years of education Last month’s income

Insurance status

Employment status At least part-time No employment (REF)  

 

Homelessness

First homelessness as youth

Residence/Housing

 

 

also are correlated with the SSS-US ladder.1 However, factors such as everyday altruistic practices and respect received from others tend to be more

highly correlated with the SSS-community ladder.1,18 Both SSS ladders also may be influenced by life satisfaction, psychosocial resources, such

Am J Health Behav.™ 2015;39(1):148-156

DOI:

http://dx.doi.org/10.5993/AJHB.39.1.16

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Determinants of Social Status among Homeless Adults

Table 1 (continued) Participant Characteristics (N = 394) Predictor Variables

SSS-US

SSS-Community

Total (Whole) Sample

Mean (SD)

Mean (SD)

% [N] or Mean (SD)

Yes

4.32 (2.91)

5.15 (2.22)

23.1 [84]

No (REF)

3.99 (2.37)

5.13 (2.54)

78.7 [310]

Yes

3.12 (1.26)

4.69 (2.31)

8.1 [32]

No (REF)

4.15 (2.43)

5.17 (2.49)

91.9 [362]

Yes

4.06 (2.31)

5.09 (2.45)

68.3 [269]

No (REF)

4.06 (2.52)

5.22 (2.52)

31.7 [125]

Current (REF)

4.08 (2.38)

5.20 (2.50)

75.9 [299]

Former/Never

4.02 (2.36)

4.92 (2.39)

24.1 [95]

0 (REF)

3.67 (2.32)

4.91 (2.64)

34.3 [135]

>=1

4.27 (2.38)

5.25 (2.38)

65.7 [259]

 

 

 

  Other Life Factors Incarceration within last year

Veteran status

Serious mental illness

Smoking status

Parent status

 

 

Subjective Social Status US ladder Community ladder

 

.

.

4.06 (2.37)

.

.

5.13 (2.47)

Note. a = represents raw data prior to log transformation as a result of positive skewness.

as social trust, self-esteem, and self-worth, and hopefulness for a change in future status.4,8,13,17-19 Thus, both traditional SES indicators and current life circumstances influence SSS rankings. However, SSS determinants also can be affected by unique characteristics of a target population (eg, acculturation among Latinos),20 supporting the investigation of SSS determinants among distinctive population groups, especially those at risk of health disparities. Although several studies have focused on the determinants of SSS among domiciled populations,8,17,20 to our knowledge, no studies have examined determinants of SSS rankings among homeless adults. Homelessness is a major public health issue, with between 2 and 3.5 million US adults experiencing homelessness on an annual basis.21,22 Homeless individuals are at significantly increased risk of premature morbidity and mortality, and they are more likely to engage in health risk behaviors (eg, cigarette smoking, other sub-

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stance use) relative to domiciled populations.23,24 Determinants of SSS may be particularly relevant to certain marginalized groups such as homeless adults due to the high potential for limited variability in traditional indicators of SES (eg, income, education, employment status) in this population. Initial research has indicated that higher SSSUS ladder rankings (but not SSS-community ladder rankings) were incrementally associated with a higher likelihood of making a quit smoking attempt in a sample of homeless adults enrolled in a cessation intervention study.25 In addition, higher rankings on both ladders have been linked with readiness to quit smoking among homeless adult smokers who were not participating in an active cessation program.26 Because of the strong association between SSS and health in domiciled populations, and the emerging associations between SSS and health outcomes among homeless adults, it is of interest to improve our understanding of the potentially unique determinants of SSS among

Moisiuc et al individuals experiencing homelessness. The purpose of this exploratory study was to examine determinants of SSS among sheltered homeless adults using the 2 SSS ladders (SSS-US and SSS-community). Potential determinants included demographics (age, sex, race, and partner status), SES (educational attainment, last month’s income, insurance status, and employment status), homeless variables (length of homelessness, number of episodes of homelessness, first homelessness as youth, and residence/housing status), and other life factors (incarceration within the last year, veteran status, serious mental illness, smoking status, and parental status). The selection of these potential determinants was informed by prior literature (eg, sex, race, SES, smoking status)1,3,9 and factors of potential relevance to the target population (eg, homeless variables, serious mental illness, insurance status, marital status, veteran status, incarceration history).27-31 METHODS Participants The current study used data (N = 394) that were collected to examine attitudes and behaviors before and after a partial smoking ban was implemented at a homeless shelter in Dallas, TX.32 Recruitment was achieved by posting study flyers around the shelter. Shelter residents were eligible to participate if they were >18 years old and English speaking with >7th grade literacy as indicated by a score of >4 on the Rapid Estimate of Adult Literacy in Medicine-Short Form.33 Procedures Participants completed questionnaires on a laptop or tablet computer. Data were collected in June 2013 and August 2013 and each participant received a $20 gift card for completing study questionnaires. Measures Demographics. Participant demographics included age, sex, race (white vs. African-American/ other, based on the predominance of these groups within the sample), and partner status (not married [divorced, separated, widowed, single] vs married). Socioeconomic status. Socioeconomic variables included years of education, last month’s income ($0, $1 to $499, or >$500), insurance status (any type; yes/no), and employment status (not employed vs employed at least part time). Homelessness variables. Homelessness variables included the length of time homeless over the lifetime (in months), the number of discrete episodes of homelessness, whether the first homeless episode occurred 1 children in lifetime). Subjective social status ladders. SSS was measured with the US and community versions of the MacArthur Scale of Subjective Social Status.1 The SSS-US ladder presents a 10-rung ladder that represents where people stand in the US, with higher rungs indicating higher status (ie, more money, more education, and better jobs). Participants select the rung that best represents where they think they stand relative to others in the US. The SSS-Community ladder also presents a pictorial 10-rung ladder to represent where people stand in their communities, with higher rungs indicating higher status. Participants select the rung that best represents where they think they stand relative to others in their self-defined community. The SSS-Community ladder was administered prior to the SSS-US ladder. These ladders have been used in several studies with racially/ethnically diverse participants, and have demonstrated adequate reliability and validity.1,3,4,17,25,34 The correlation between the SSS-US ladder and the SSS-Community ladder in this sample was .47 (p < .01). Analyses Descriptive statistics were used to examine participant characteristics. Main analyses consisted of a series of linear regressions and t-tests to assess associations of each participant characteristic and each SSS ladder. Two final models (one for each SSS ladder) included all variables that were significantly related to the ladder in a single analysis. All analyses were conducted using SPSS, version 19 (IBM, NY) and statistical significance was set at p < .05 given the exploratory nature of this study. RESULTS Participants (N = 394) were 43.3 (+11.8) years of age on average. The sample was largely men (72%) and of African-American/other race (70%; 89.8% of whom were African-American). Participants reported almost 3 separate periods of homelessness and a mean of 39.1 months (median=29 months) of homelessness over their lifetime. A log transformation was applied to the length of time homeless over the lifetime variable to normalize the distribution for analyses. The average SSS-US ranking was 4.06 (+2.37) and the average SSS-Community ranking was 5.13 (+2.47) as Table 1 shows. Intercorrelations between study variables are presented in Table 2. Results (Table 3) indicated that having higher income, being of African-American/other race,

DOI:

http://dx.doi.org/10.5993/AJHB.39.1.16

151

152 .062 -.208 -.007

10. Episodes of homelessness

11. 1 homelessness as youth

12. Residence/ Housing

.087

-

4

-.037 .328 .068 -.015

16. Smoking status

17. Parent status

18. US ladder

19. Community ladder .049

.078

.024

.021

-.005

.111*

.011

.134* -.016

.044

-.003

.006

.024

-.006

-.078

-.085

.077

-.024

-.058

-.036

-.048

-.084

.056

.041

-.022

-.060

-

9

.049

.010

.041

.040

-.171**

.073

.007

.072

.170** .232**

-

10

-.065

.028

.083

.004

.020

.044

.032

.095

.067

-.042

-.084 .170** .129*

-.099*

-.007

.150*

.009

-.047 .417**

-.076

-

8

.194** -.204** .178** .101*

.011

-.005

-.012

.065

-.032

.179

-.022

-.085

.044

-

7

-

12

-.080

-.002

-.007

.013

.110

-.043

.016

.059

.025

-.065

.060

-.055

.103* -.075

.010

-

11

.005

.057

-.068

.091

.089

-.064

-

13

-

15

.071 .056

-

16

-

17

-

18

-.054 -.023 .049 .065 .474**

-.118* .000 .010 .119*

.058

.124* .075

.023

-

14

Note. Interrelations among participant characteristics were evaluated using Pearson correlations for continuous-continuous variable associations, Point-biserial for continuous-binary associations, Phi coefficients for binary-binary associations, Spearman correlations for continuous-categorical and Rank bi-serial coefficients for binary-categorical associations. Reference groups for binary or categorical variables were as follows: sex = male, race = white, partner status = not married, income = $0, insurance = any type of insurance, employment = no employment, first homelessness as youth = no, residence/housing = pavilion, incarceration within last yr. = no, veteran status = no, serious mental illness = no, smoking status = current smoker, parent status = 0 children.

*p < .05, ** p < .001

-.047

15. Serious mental illness .009

-.026

-.043

.025

.227**

.004 -.191** -.044

.162** -.145* .197** -.027

.084

-.034 -.165** -.019

14. Veteran status .012

-

6

.150* -.404**

.015

-

5

-.036 -.102*

.040

.074

.166** -.053

-.030

.028

.096

.087

-.038

.154* -.029

-.015

-.101*

-

3

-.007

.002

.015

.107*

-.084

.038

-.024

-.092

.032

.087

-.119*

-

2

13. Incarceration in last year -.174** -.106* -.038

st

.203**

.041

6. Last month’s income

9. Length of homelessness

.087

5. Years of education -.015

-.049

4. Partner status

-.120*

-.038

3. Race

8. Employment status

-.127*

2. Sex

7. Insurance status

-

1

1. Age

Table 2 Intercorrelations between Study Variables

Determinants of Social Status among Homeless Adults

Moisiuc et al

Table 3 Determinants of US and Community SSS Ladder Rankings  

SSS-US

Predictor Variables

 

Test Statistic

SSS-Community Test Statistic

 

t or B (SE)

p-value

t or B(SE)

Age

.014 (.010)

.179

-.0003 (.011)

.772

Sex

-1.557

.120

-.967

.334

Race

-2.669

.008

-2.204

.028

.316

.752

-.219

.827

.032 (.067)

.635

.009 (.070)

.898

$1 to $499

1.182

.238

1.294

.196

>=$500

-4.336

Determinants of social status among homeless adults.

To examine determinants of subjective social status (SSS) among 394 sheltered homeless adults...
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