Associations Between Parental SES and Children's Health-Related Quality of Life

The Role of Objective and Subjective Social Status

Published in: Journal of Pediatric Psychology [Epub November 2017], jsx139. doi: 10.1093/jpepsy/jsx139

Posted on on December 15, 2017

by Kay W. Kim, Jan Wallander, Melissa F. Peskin, Paula Cuccaro, Marc N. Elliott, Mark A. Schuster

Read More

Access further information on this document at Journal of Pediatric Psychology [Epub November 2017]

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Question

  1. Is health-related quality of life (HRQOL) among children more closely associated with objective socioeconomic status of parents, such as income and educational attainment, or parental perceptions of their position in the social hierarchy (subjective socioeconomic status)?


We examined (1) the relationship that parental objective social status (OSS) and subjective social status (SSS) have with children's health-related quality of life (HRQOL), (2) whether SSS mediates the association between OSS and HRQOL, and (3) whether these associations differ among Black, Latino, and White children.


Data came from 4,824 Black, Latino, and White 5th graders in the Healthy Passages [trademark] study. OSS was measured as parent educational attainment and net equivalent household income. SSS was measured by parent rating of community and national standing on the MacArthur Scale of Subjective Social Status. Child HRQOL was measured with child report on the Pediatric Quality of Life Inventory (PedsQL) physical and psychosocial scales. Structural equation modeling path analysis was conducted using Mplus version 7.4.


The data supported the hypothesized measurement and structural models. Whereas parental OSS was positively related to psychosocial HRQOL for all three racial/ethnic groups and to physical HRQOL for Latino children, parental SSS was not related to either for any of the racial/ethnic groups. Therefore, mediation by SSS was not supported for any group.


OSS was confirmed to have stronger association with children's HRQOL than parental SSS. This is in contrast to some research on adults, raising the questions of how best to assess SSS relevant to children and at what point in development SSS may influence children's health and well-being. The persistent relationship found between parental OSS and child health suggests that efforts to improve low socioeconomic resources in families may contribute to improve children's health.

Key Findings

  • Among pre-adolescent children in the study, parents' objective social status (OSS) was closely related to children's HRQOL.
  • The association between parental OSS and psychosocial HRQOL was significant among Black, Latino, and White children; it was also significant for physical HRQOL among Latino children.
  • Parents subjective social status (SSS) was not significantly associated with children's HRQOL.
  • The lack of a significant relationship between SSS and HRQOL stands in contrast to prior studies among adults showing an association between psychosocial risk factors (such as depression, neuroticism, optimism, resiliency, or coping mechanisms) with SSS, and therefore health.
  • This correlational study cannot determine causation, and these findings may not generalize to the larger population.


Future research should examine the point in development at which parental SSS affects children's HRQOL independently of parental OSS.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.