臺灣博碩士論文加值系統

研究目的：一個人的社經地位高低是影響其健康的重要因子之一，社經地位較低的族群可能會有較差的自評健康與生活型態。過去的研究使用客觀社經地位指標或是主觀社經地位指標皆顯示出相似的趨勢。本研究以主觀與客觀社經地位之間可能產生不一致現象做為基礎，檢驗在不同的客觀社經地位條件下，主觀社經地位對自評健康的影響程度是否有所不同。

研究方法：本研究資料來源為「臺灣社會變遷調查資料庫」2012 年以健康與醫療照護為調查主題之樣本，包含 2199 名具有代表性的樣本，其中將回答 A 卷的樣本與 B 卷樣本分別分析。本研究將以羅吉斯回歸檢驗在控制了客觀社經地位(可支配所得、教育年數)以及社會人口學特質(性別、年齡、籍貫、婚姻狀態後、居住地發展程度)後，主觀社經地位與自評健康之間的關係。並且以客觀社經地位進行分層分析，檢驗在不同的客觀社經地位條件下，主觀社經地位之影響力是否有所不同。

研究結果：在控制了客觀社經地位指標以及社會人口學特質後，主觀社經地位越高的樣本其自評健康佳的比例也越高，A 卷樣本與 B 卷樣本的主觀社經地位對自評健康的勝算比分別為 0.82(p=0.0001)與 0.90(p=0.0051)。以客觀社經地位進行分層分析後，以客觀社經地位較高的樣本，主觀社經地位與自評健康之間的關聯性較強。

結論：主觀社經地位為影響自評健康的重要因素。而客觀社經地位的不同將使主觀社經地位與自評健康關聯強度產生差異，以客觀社經地位高的樣本關聯較強。

Background:Social status is an important factor that influences health. People whose social status is low will have bad self-rated health and lifestyle. Other researches which use objective social status indicator or subjective social status indicator show the same pattern. Concerning that there is inconsistency between subjective social status and objective social status, this study want to examinate whether subjective social status will have different influence on self-rated health under the condition of objective social status.

Methods: Data for the analysis came from the Taiwan Social Change Survey consist of 2199 samples. This study analyzed sample A and sample B respectively. This study used logistic regression to test the association between subjective social status and self-rated health after controlling for objective social status and demographic variables such as gender, age, race, marital status and development level of living place. Next, I tested whether subjective social status will have different impact on self-rated health under the condition of objective social status by using stratified analysis.

Results: After controlling for objective social status indicators and demographic varibles, the sample whose subjective social status is high has better self-rated health. Logistic regressions show that the odds ratio in sample A and sample B by high subjective social status are 0.82 and 0.90 for bad self-rated health. Stratified analysis shows that the association between subjective social status and self-rated health is stronger in high objective social status than in low objective social status.

Conclusion: Subjective social status is an important factor that influences health. The strength of association between subjective social status and self-rated health is altered by objective social status. The association is stronger in high objective social status.

口試委員會審定書..........................................i
謝辭.....................................................ii
中文摘要................................................iii
英文摘要.................................................iv
圖目錄.................................................viii
表目錄.................................................viii
第一章 緒論..............................................1
第一節 研究背景..........................................1
第二節 研究目的與重要性..................................3
第三節 論文架構..........................................4
第二章 文獻回顧..........................................5
第一節 社經地位的概念與理論..............................5
第二節 社經地位的測量...................................10
第三節 社經地位影響健康的機制與實證.....................23
第四節 自評健康的影響因素...............................35
第三章 材料與方法.......................................39
第一節 研究問題與假說...................................39
第二節 資料來源.........................................41
第三節 研究變項定義.....................................45
第四節 資料分析方法.....................................49
第四章 研究發現.........................................51
第一節 樣本特性分布.....................................51
第二節 雙變項分析結果...................................57
第三節 多變項分析結果...................................61
第五章 結果與討論.......................................64
第一節 研究主要發現.....................................64
第二節 研究比較.........................................69
第三節 研究限制.........................................73
第四節 研究建議.........................................75
參考文獻.................................................77
中文部分.................................................77
英文部分.................................................77

中文部分
林宗弘，2013，失落的年代：臺灣民眾階級認同與意識形態的變遷，人文及社會科學集刊。
張峰彬、關秉寅，2012，高教擴張、失業與主觀社會地位變遷，台灣的社會變遷 1985-2005：社會階層與勞動市場，台灣社會變遷基本調查系列三之3，頁 63-92。台北：中央研究院社會學研究所。
黃毅志，2008，如何精確測量職業地位？「改良版台灣地區新職業聲望與社經地位量表」之建構，臺東大學教育學報，19(1)，151-160。
瞿海源，1985，台灣地區職業地位主觀測量之研究，發表於社會科學會議，台北市：中央研究院三民主義研究所，1985。

英文部分
Adler N.E. &; Stewart J. (2007). The MacArthur Scale of Subjective Social Status. http://www.macses.ucsf.edu.
Adler, N. E., &; Ostrove, J. M. (1999). Socioeconomic status and health: what we know and what we don''t. Annals of the New York academy of Sciences, 896(1), 3-15.
Adler, N. E., &; Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12(4), 119-123.
Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., &; Syme, S. L. (1994). Socioeconomic status and health: the challenge of the gradient. American psychologist, 49(1), 15.
Adler, N. E., Epel, E. S., Castellazzo, G., &; Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women. Health psychology, 19(6), 586.
Arnadottir, S., Gunnarsdottir, E., Stenlund, H., &; Lundin-Olsson, L. (2011). Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning. BMC public health, 11(1), 670.
Baer, H. A., Singer, M., &; Susser, I. (2003). Medical anthropology and the world system. Greenwood Publishing Group.
Baer, L., Eitzen, D. S., Duprey, C., Thompson, N. J., &; Cole, C. (1976). The Consequences of Objective and Subjective Status Inconsistency. The Sociological Quarterly, 17(3), 389-400.
Blocker, T. J., &; Riedesel, P. L. (1978). The Nonconsequences of Objective and Subjective Status Inconsistency: Requiem for a Moribund Concept. The Sociological Quarterly, 19(2), 332-339.
Buttenheim, A. M., Wong, R., Goldman, N., &; Pebley, A. R. (2010). Does social status predict adult smoking and obesity? Results from the 2000 Mexican National Health Survey. Global public health, 5(4), 413-426.
Centers, R. (1949). The psychology of social classes: A study of class consciousness (Vol. 7). Taylor &; Francis.
Collins, R., &; Annett, J. (1975). Conflict sociology: Toward an explanatory science (p. 351). New York: Academic Press.
Cundiff, J. M., Smith, T. W., Uchino, B. N., &; Berg, C. A. (2013). Subjective Social Status: Construct Validity and Associations with Psychosocial Vulnerability and Self-Rated Health. International journal of behavioral medicine, 20(1), 148-158.
Davis, K., &; Moore, W. E. (1945). Some principles of stratification. American sociological review, 10(2), 242-249.
Davis, R. M. (1993). When doctors smoke. Tobacco Control, 2(3), 187.
Demakakos, P., Nazroo, J., Breeze, E., &; Marmot, M. (2008). Socioeconomic status and health: the role of subjective social status. Social science &; medicine, 67(2), 330-340.
Dennis, E. F., Webb, D. A., Lorch, S. A., Mathew, L., Bloch, J. R., &; Culhane, J. F. (2012). Subjective social status and maternal health in a low income urban population. Maternal and child health journal, 16(4), 834-843.
Dowd, J. B., &; Zajacova, A. (2010). Does self-rated health mean the same thing across socioeconomic groups? Evidence from biomarker data. Annals of epidemiology, 20(10), 743-749.
Eriksson, I., Und&;eacute;n, A. L., &; Elofsson, S. (2001). Self-rated health. Comparisons between three different measures. Results from a population study. International Journal of Epidemiology, 30(2), 326-333.
Evans, M. D., &; Kelley, J. (2004). Subjective social location: data from 21 nations. International Journal of Public Opinion Research, 16(1), 3-38.
Evans, M. D., Kelley, J., &; Kolosi, T. (1992). Images of class: Public perceptions in Hungary and Australia. American Sociological Review, 461-482.
Franzini, L., &; Fernandez-Esquer, M. E. (2006). The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Social science &; medicine, 63(3), 788-804.
Garbarski, D. (2010). Perceived social position and health: Is there a reciprocal relationship? Social Science &; Medicine, 70(5), 692-699.
Giatti, L., do Valle Camelo, L., de Castro Rodrigues, J. F., &; Barreto, S. M. (2012). Reliability of the MacArthur scale of subjective social status-Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC public health, 12(1), 1096.
Goodman, E., Adler, N. E., Kawachi, I., Frazier, A. L., Huang, B., &; Colditz, G. A. (2001). Adolescents'' perceptions of social status: development and evaluation of a new indicator. Pediatrics, 108(2), e31-e31.
Gross, N. (1953). Social class identification in the urban community. American Sociological Review, 18(4), 398-404.
Hanibuchi, T., Nakaya, T., &; Murata, C. (2012). Socio-economic status and self-rated health in East Asia: a comparison of China, Japan, South Korea and Taiwan. The European Journal of Public Health, 22(1), 47-52.
Hodge, R. W., &; Treiman, D. J. (1968). Class identification in the United States. American Journal of Sociology, 535-547.
Hu, P., Adler, N. E., Goldman, N., Weinstein, M., &; Seeman, T. E. (2005). Relationship between subjective social status and measures of health in older Taiwanese persons. Journal of the American Geriatrics Society, 53(3), 483-488.
Idler, E. L., &; Benyamini, Y. (1997). Self-rated health and mortality: a review of twenty-seven community studies. Journal of health and social behavior, 21-37.
Jackman, M. R., &; Jackman, R. W. (1985). Class awareness in the United States (Vol. 343). Univ of California Press.
J&;uuml;rges, H., Avendano, M., &; Mackenbach, J. P. (2008). Are different measures of self-rated health comparable? An assessment in five European countries. European journal of epidemiology, 23(12), 773-781.
Jylh&;auml;, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social science &; medicine, 69(3), 307-316.
Kahl, J. A., &; Davis, J. A. (1955). A comparison of indexes of socio-economic status. American Sociological Review, 20(3), 317-325.
Kelley, J., &; Evans, M. (2008). Economic development reduces tolerance for inequality: A comparative analysis of 30 nations. Available at SSRN 1305394.
Kelley, J., &; Evans, M. D. (1995). Class and class conflict in six western nations. American Sociological Review, 157-178.
Kennedy, B. P., Kawachi, I., Glass, R., &; Prothrow-Stith, D. (1998). Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. Bmj, 317(7163), 917-921.
Kerbo, H. R. (2009). Social stratification and inequality: class conflict in historical, comparative, and global perspective. Boston: McGraw-Hill.
Kluegel, J. R., Singleton Jr, R., &; Starnes, C. E. (1977). Subjective class identification: A multiple indicator approach. American Sociological Review, 599-611.
Krieger, N., Williams, D. R., &; Moss, N. E. (1997). Measuring social class in US public health research: concepts, methodologies, and guidelines. Annual review of public health, 18(1), 341-378.
Lenski, G. E. (1954). Status crystallization: a non-vertical dimension of social status. American sociological review, 19(4), 405-413.
Lenski, G. E. (1956). Social participation and status crystallization. American Sociological Review, 21(4), 458-464.
Lenski, G. E. (1966). Power and privilege: A theory of social stratification. UNC Press.
Lenski, G. E., Lenski, J., &; Nolan, P. (1995). Human societies: An introduction to macrosociology.
Liberatos, P., Link, B. G., &; Kelsey, J. L. (1988). The measurement of social class in epidemiology. Epidemiologic reviews, 10(1), 87-121.
Mackenbach, J. P., Martikainen, P., Looman, C. W., Dalstra, J. A., Kunst, A. E., &; Lahelma, E. (2005). The shape of the relationship between income and self-assessed health: an international study. International Journal of Epidemiology, 34(2), 286-293.
Macleod, J., Davey Smith, G., Metcalfe, C., &; Hart, C. (2005). Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Social science &; medicine, 61(9), 1916-1929.
Maniecka-Bry&;#322;a, I., Drygas, W., Bry&;#322;a, M., &; Dziankowska-Zaborszczyk, E. (2011). Determinants of Self-Rated Health among the Elderly Living in a Big City Environment. Polish J. of Environ, 20(3), 691-699.
Marmot, M. G., Rose, G., Shipley, M., &; Hamilton, P. J. (1978). Employment grade and coronary heart disease in British civil servants. Journal of epidemiology and community health, 32(4), 244-249.
Marmot, M. G., Shipley, M. J., &; Rose, G. (1984). Inequalities in death—specific explanations of a general pattern? The Lancet, 323(8384), 1003-1006.
Miething, A. (2013). The Relevance of Objective and Subjective Social Position for Self-Rated Health: A Combined Approach for the Swedish Context. Social Indicators Research, 111(1), 161-173.
Nobles, J., Weintraub, M. R., &; Adler, N. (2013). Subjective socioeconomic status and health: Relationships reconsidered. Social Science &; Medicine, 82, 58-66.
Oakes, J. M., &; Kaufman, J. S. (Eds.). (2006). Methods in social epidemiology (Vol. 1). Wiley. com.
Operario, D., Adler, N. E., &; Williams, D. R. (2004). Subjective social status: Reliability and predictive utility for global health. Psychology &; Health, 19(2), 237-246.
Organization for Economic Co-operation and Development. (2011). Divided We Stand: Why Inequality Keeps Rising. Paris, France: OECD.
Ostrove, J. M., Adler, N. E., Kuppermann, M., &; Washington, A. E. (2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19(6), 613.
Power, C., Matthews, S., &; Manor, O. (1998). Inequalities in self-rated health: explanations from different stages of life. The Lancet, 351(9108), 1009-1013.
Prus, S. G. (2011). Comparing social determinants of self-rated health across the United States and Canada. Social science &; medicine, 73(1), 50-59.
Ritterman, M. L., Fernald, L. C., Ozer, E. J., Adler, N. E., Gutierrez, J. P., &; Syme, S. L. (2009). Objective and subjective social class gradients for substance use among Mexican adolescents. Social science &; medicine, 68(10), 1843-1851.
Sakurai, K., Kawakami, N., Yamaoka, K., Ishikawa, H., &; Hashimoto, H. (2010). The impact of subjective and objective social status on psychological distress among men and women in Japan. Social Science &; Medicine, 70(11), 1832-1839.
Schereschewsky, J. W., Warren, B. S., &; Sydenstricker, E. (1916). Health of garment workers: The relation of economic status to health. Public Health Reports (1896-1970), 1298-1305.
Singh-Manoux, A., Adler, N. E., &; Marmot, M. G. (2003). Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Social science &; medicine, 56(6), 1321-1333.
Singh-Manoux, A., Marmot, M. G., &; Adler, N. E. (2005). Does subjective social status predict health and change in health status better than objective status?. Psychosomatic Medicine, 67(6), 855-861.
Stalsberg, R., &; Pedersen, A. V. (2010). Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evidence. Scandinavian journal of medicine &; science in sports, 20(3), 368-383.
Stringhini, S., Dugravot, A., Shipley, M., Goldberg, M., Zins, M., Kivim&;auml;ki, M., &; Singh-Manoux, A. (2011). Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS medicine, 8(2), e1000419.
Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M., &; Singh-Manoux, A. (2010). Association of socioeconomic position with health behaviors and mortality. JAMA: the journal of the American Medical Association, 303(12), 1159-1166.
Subramanian, S. V., Kim, D., &; Kawachi, I. (2005). Covariation in the socioeconomic determinants of self rated health and happiness: a multivariate multilevel analysis of individuals and communities in the USA. Journal of Epidemiology and Community Health, 59(8), 664-669.
Szwarcwald, C. L., Souza-J&;uacute;nior, P. R. B. D., Esteves, M. A. P., Damacena, G. N., &; Viacava, F. (2005). Socio-demographic determinants of self-rated health in Brazil. Cadernos de Sa&;uacute;de P&;uacute;blica, 21, S54-S64.
Theodossiou I. &; Zangelidis A. (2009). The social gradient in health: the effect of absolute income and subjective social status assessment on the individual''s health in Europe. Econ Hum Biol. 7(2), 229-37.
Todorova, I. L., Tucker, K. L., Jimenez, M. P., Lincoln, A. K., Arevalo, S., &; Falc&;oacute;n, L. M. (2013). Determinants of self-rated health and the role of acculturation: implications for health inequalities. Ethnicity &; health, (ahead-of-print), 1-23.
Tumin, M. M. (1953). Some principles of stratification: A critical analysis. American Sociological Review, 18(4), 387-394.
WHO Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Final Report of the Commission on Social Determinants of Health. World Health Organization.
Wilkinson, R. G., &; Marmot, M. G. (2003). Social determinants of health: the solid facts. World Health Organization.
Winkleby, M. A., Jatulis, D. E., Frank, E., &; Fortmann, S. P. (1992). Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American journal of public health, 82(6), 816-820.
Wolff, L. S., Subramanian, S. V., Acevedo-Garcia, D., Weber, D., &; Kawachi, I. (2010). Compared to whom? Subjective social status, self-rated health, and referent group sensitivity in a diverse US sample. Social Science &; Medicine, 70(12), 2019-2028.
World Health Organization. (2012). WHO global report: mortality attributable to tobacco. Geneva: World Health Organization.
Zhang, X. (2008). Status inconsistency revisited: an improved statistical model. European sociological review, 24(2), 155-168.