Exploring the Relationship between Health Insurance, Social Connectedness, and Subjective Social Status among Residents of O'ahu.

Relative position in a social hierarchy, or subjective social status, has been associated with indicators of socioeconomic status and may be influenced by social connectedness. The primary purpose of this study is to explore the relationship between health insurance status and subjective social status, using the MacArthur Scale of Subjective Social Status (SSS, community version), in the state of Hawai'i with its highly insured population. The secondary purpose is to examine other social determinants that influence social status, including social connectedness. Data were drawn from a convenience sample of 728 O'ahu residents in 2011-12. Social connectedness was measured if participants stated that family, friends, or community were strengths that could address their social and health concerns. In the final adjusted linear regression model, those with Medicaid/Quest insurance (β -0.40; P<.05), those who had not completed high-school (β -0.51; P<.01), adults of working age (27-64 years) (β -0.59; P<.01), and Native Hawaiians (β -0.57; P<.05) ranked themselves lower on the SSS ladder. Social connectedness was highly valued, with over 30% of participants stating strong community and family ties as one of Hawai'i's greatest strengths. However, these strengths were not found to be statistically associated with subjective social status in our sample. Future studies should assess whether reinforcing social connectedness through public health and educational interventions improves subjective social status among low-income and ethnically diverse communities in Hawai'i.