Background: Recent advances in cancer disparities research highlight the importance of understanding the relationship between race, SES, and cancer outcomes. However, SES is often difficult to operationalize in nuanced ways in health-related studies. This paper examines the utility of two emerging measures of subjective social status adapted from the MacArthur Foundation Research Network on Socioeconomic Status and Health Socio-demographic questionnaire. I also analyze responses of parents within the same family, and examine discrepancies in parental reports of SES.

Method: Data come from an IRB-approved mixed-methods study of parents of pediatric cancer patients. Patients were sampled through a Pediatric Oncology clinic at an NCI-designated Comprehensive Cancer Center in the Northeast US. For two-parent families we attempted to recruit both parents to the study. Data come from the survey component of the study, and analyses focus on respondents’ responses to income, education, and subjective social status measures. The first subjective social status measure asks participants to place themselves on a ladder that represents the US social hierarchy, and the second asks respondents to place themselves on a ladder that represents their self-defined community (Singh-Manoux et al. 2003; Singh-Manoux et al. 2005).

Findings: The final sample consisted of 74 parents of pediatric cancer patients. Seventy-eight percent of the sample was White, and 22% was Black. As expected, I find significant associations between respondent income and their subjective social status. The poorest respondents were significantly more likely to place themselves on the bottom third of both the US and community ladders, while respondents who made more than $50,000 annually were more likely to put themselves in the top of both ladders (US ladder: x2 = 34.646, p <.001; Community ladder x2 = 16.356, p<.050). Education was significantly associated with respondents’ responses to the US ladder (x2 = 16.023, p <.010), but not the community ladder. Black respondents were significantly more likely than White respondents to place themselves in the bottom third of the US ladder (x2 = 12.536, p < .010) but there was no significant difference between White and Black respondents’ responses to the community ladder. Twenty-five of the families in the sample were represented by two parents, which allowed examination of discrepancies in parental reporting of income and both measures of subjective social status. Parents with lower household income were significantly more likely to have discrepancies between parents in responding to the community ladder (x2 = 26.449 p< .010), but not the US ladder. Black respondents were significantly more likely to have discrepancies between parental reports of household income (x2 = 11.431 p< .010), and responses to the community ladder (x2 = 22.546 p< .001), than white respondents. There were no significant associations between respondent income or education and parental discrepancies in responses to items measuring total household income, or the US ladder.

Conclusions: Findings have important implications for measurement and design of future cancer disparities research. The associations between income, education and the US ladder were in the expected directions. For this sample, the US ladder seems to be capturing a traditional conception of class. Parents in two-parent families were fairly consistent in their responses to the US ladder, suggesting reliability of the measure. The parents’ responses to the community ladder were less predictable, and suggest that this measure may be capturing a distinct dimension of SES beyond acting as a proxy for income or education. Results suggest that the MacArthur US ladder item may be an appropriate measure used to triangulate respondent SES, or in place of income or education items in studies where researchers want to use alternate SES measures.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B20.