The Potential Explanatory Role of Perceived Stress in Associations Between Subjective Social Status and Health-Related Quality of Life Among Homeless Smokers.
Stress is the middleman that turns feeling low on the social ladder into poorer health for homeless smokers.
01Research in Context
What this study did
Garey et al. (2016) gave a one-time survey to homeless adults who smoke. They asked how low people felt on the social ladder, how stressed they felt, and how healthy they felt day-to-day.
The team then ran a mediation test to see if stress acts like a bridge between low social standing and poor health-related quality of life.
What they found
Stress explained part of the link. Feeling lower on the social ladder raised stress, and that stress in turn lowered quality-of-life scores.
In plain words, stress is one reason why feeling 'less than' makes health feel worse for homeless smokers.
How this fits with other research
The pattern matches what Panpan et al. (2025) saw in parents of kids with ADHD: social support buffered stigma-driven stress. Both studies use the same cross-sectional mediation trick, just swapping caregivers for homeless smokers.
Lovell et al. (2012) also fit. They showed that higher social support predicted lower psychological distress and healthier cortisol in parents of kids with autism or ADHD. Together the three papers say: social support softens stress, no matter which stressed group you study.
Zhao et al. (2021) extend the story to resilience. In Chinese parents of children with disabilities, social support mediated the path from parenting stress to resilience. The mediator is the same—social support—even though the final outcome changes from quality of life to resilience.
Why it matters
If you serve homeless adults, add a brief stress and social-support screen to intake. Linking clients to even one supportive contact—a drop-in center volunteer, a quit-smoking buddy, or a caseworker—may chip away at the stress that drags down health. You do not need a new intervention; you just need to measure and leverage support that is already there.
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02At a glance
03Original abstract
Homeless individuals smoke at high rates relative to the general population and are at heightened risk of tobacco-related illnesses and poor health-related quality of life (HRQoL). Homeless smokers also report low subjective social status (SSS) or perceived social standing relative to others. SSS may contribute to poor HRQoL, potentially through perceived stress. The current study examined the role of perceived stress in the association of SSS and HRQoL among 227 (70.9% male, Mage = 43.2) homeless smokers. Participants completed self-report measures of SSS, perceived stress, and HRQoL. Perceived stress partially explained the relation between SSS (United States and Community) and HRQoL in covariate-adjusted analyses. Results suggested that perceived stress is a pathway through which SSS contributes to HRQoL among homeless smokers. Findings broaden current understanding of the impact of social disadvantage and perceived stress on HRQoL among homeless smokers.
Behavior modification, 2016 · doi:10.1177/0145445515612396