Recent work exploring the relationship between socioeconomic status and health has employed a psychosocial concept called perceived social position as a predictor of health. Perceived social position is likely the "cognitive averaging" (Singh-Manoux, Marmot, & Adler, 2005) of socioeconomic characteristics over time and, like other socioeconomic factors, is subject to interplay with health over the life course. Based on the hypothesis that health can also affect perceived social position, in this paper we used structural equation modeling to examine whether perceived social position and three different health outcomes were reciprocally related in the Wisconsin Longitudinal Study, a longitudinal cohort study of older adults in the United States. The relationship between perceived social position and health differed across health outcomes-self-reported health, the Health Utilities Index, and depressive symptoms-as well as across operationalizations of perceived social position-compared to the population of the United States, compared to one's community, and a latent variable of which the two items are indicators. We found that perceived social position affected self-reported health when operationalized as latent and US perceived social position, yet there was a reciprocal relationship between self-reported health and community perceived social position. There was a reciprocal relationship between perceived social position and the Health Utilities Index, and depressive symptoms affected perceived social position for all operationalizations of perceived social position. The findings suggest that the causal relationship hypothesized in prior studies-that perceived social position affects health-does not necessarily hold in empirical models of reciprocal relationships. Future research should interrogate the relationship between perceived social position and health rather than assume the direction of causality in their relationship.
Self-rated health (SRH)-for example, "in general would you say your health is excellent, very good, good, fair, or poor?"-is the most widely used measure of health across a range of survey research studies. This paper synthesizes extant research and provides a framework for future research on the measurement of health using SRH, focusing on four interrelated topics: the factors that influence respondents' health ratings, the survey measurement features of SRH, how SRH answers are analyzed, and the stated purpose of SRH as a proxy for more objective health or as a perception of health.Extant research on the health, psychological, and social factors influencing respondents' SRH answers is reviewed, as is research concerned with the survey measurement features of SRH that influence how respondents rate their health. The synthesis proposes a framework for future research that focuses on further explicating the factors that underlie respondents' SRH answers and improving features of SRH measurement and analysis in ways that are consistent with the various goals of the researchers who both collect and analyze the data.
Objectives This study aims to assess the impact of response option order and question order on the distribution of responses to the self-rated health (SRH) question and the relationship between SRH and other health-related measures. Methods In an online panel survey, we implement a 2-by-2 between-subjects factorial experiment, manipulating the following levels of each factor: 1) order of response options (“excellent” to “poor” versus “poor” to “excellent”); and 2) order of SRH item (either preceding or following the administration of domain-specific health items). We use chi-square difference tests, polychoric correlations, and differences in means and proportions to evaluate the effect of the experimental treatments on SRH responses and the relationship between SRH and other health measures. Results Mean SRH is higher (better health) and proportion in “fair” or “poor” health lower when response options are ordered from “excellent” to “poor” and SRH is presented first compared to other experimental treatments. Presenting SRH after domain-specific health items increases its correlation with these items, particularly when response options are ordered “excellent” to “poor.” Among participants with the highest level of current health risks, SRH is worse when it is presented last versus first. Conclusion While more research on the presentation of SRH is needed across a range of surveys, we suggest that ordering response options from “poor” to “excellent” might reduce positive clustering. Given the question order effects found here, we suggest presenting SRH before domain-specific health items in order to increase inter-survey comparability, as domain-specific health items will vary across surveys.
Previous research has proposed that the actions of sample members may provide encouraging, discouraging, or ambiguous interactional environments for interviewers soliciting participation in surveys. In our interactional model of the recruitment call that brings together the actions of interviewers and sample members, we examine features of actions that may contribute to an encouraging or discouraging environment in the opening moments of the call. Using audio recordings from the 2004 wave of the Wisconsin Longitudinal Study and an innovative design that controls for sample members' estimated propensity to participate in the survey, we analyze an extensive set of interviewers' and sample members' actions, the characteristics of those actions, and their sequential location in the interaction. We also analyze whether a sample member's subsequent actions (e.g., a question about the length of the interview or a "wh-type" question) constitute an encouraging, discouraging, or ambiguous environment within which the interviewer must produce her next action. Our case-control design allows us to analyze the consequences of actions for the outcome of the call.
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