Measuring lifetime stress exposure and protective factors in life course research on racial inequality and birth outcomes

The effects of childhood adversity on twenty-five disease biomarkers and twenty health conditions in adulthood: Differences by sex and stressor type

BACKGROUND

Although early adversity is now recognized as a major public health concern, it remains unclear if the effects of early-life stressors on disease biology and health differ by sex or stressor type. Because childhood stressors often covary, examining whether such stressors typically occur together (e.g., cumulative adversity) or in distinct multivariate patterns is needed to determine if and how different life stressors uniquely affect disease biology and health.

METHOD

To investigate, we conducted latent class analyses (LCA) to identify clusters of adults experiencing multiple childhood stressors (N = 2,111, Mage = 53.04, 54.8% female) in the Midlife in the United States (MIDUS) Study. We then tested how latent stressor exposure groups, and individual stressors, related to 25 biomarkers of inflammation, metabolism, and stress, and 20 major health conditions. Multivariate effect sizes were estimated using Mahalanobis's D.

RESULTS

Optimal LCA models yielded three female (Low-, Moderate-, and High-Stress) and two male (Low- and High-Stress) stressor exposure classes. The High-Stress classes had greater inflammation (male: D = 0.43; female: D = 0.59) and poorer metabolic health (male: D = 0.32-0.33; female: D = 0.32-0.47). They also had more cardiovascular (male: HR = 1.56 [1.17, 2.07]; female: HR = 1.97 [1.50, 2.58]), cancer (male: HR = 2.41 [1.52, 3.84]; female: HR = 2.51 [1.45, 4.35]), metabolic (male: HR = 1.54 [1.16, 2.03]; female: HR = 2.01 [1.43, 2.83]), thyroid (male: HR = 3.65 [1.87, 7.12]; female: HR = 2.25 [1.36, 3.74]), arthritis (male: HR = 1.81 [1.30, 2.54]; female: HR = 1.97 [1.41, 2.74]), and mental/behavioral health problems (male: HR = 2.62 [1.90, 3.62]; female; HR = 3.67 [2.72, 4.94]). Moreover, stressors were related to these outcomes in a sex- and stressor-specific manner.

CONCLUSIONS

Childhood adversity portends worse biological health and elevated risk for many major health problems in a sex- and stressor-specific manner. These findings advance stress theory, and may help inform precision interventions for managing stress and enhancing resilience.

Adverse childhood experiences (ACEs) and emotion dysregulation phenotypes: An intersectional analysis of race/ethnicity and gender in a nationally representative U.S. sample

BACKGROUND

Adverse childhood experiences (ACEs) are strong, preventable risk factors for emotion dysregulation in adolescence, but whether ACEs-emotion dysregulation associations differ by race/ethnicity or gender remains unclear.

OBJECTIVE

We examined (a) how race/ethnicity and gender jointly impact latent ACEs classes and emotion dysregulation phenotypes, and (b) how these ACEs classes in childhood (by age 9) transition to latent emotion dysregulation phenotypes in adolescence (at age 15).

PARTICIPANTS AND SETTING

Participants were 3,273 children from two waves of data from the Future of Families and Child Wellbeing Study, a large, nationally representative cohort. The sample consisted of 26.6% non-Hispanic (NH) Black boys, 25.4% NH Black girls, 12.9% Hispanic boys, 12.6% Hispanic girls, 11.8% NH White boys, and 10.7% NH White girls.

METHOD

We estimated latent class models to identify ACEs patterns across ten indicators and dysregulation phenotypes across affective, attentional, and behavioral domains. Latent transition analysis was used to examine how ACEs classes transitioned into dysregulation phenotypes from childhood into adolescence.

RESULTS

The findings revealed significant variation in the number and nature of latent classes of both ACEs and emotion dysregulation across the intersection of race/ethnicity and gender. NH Black and Hispanic children were more likely to be in the Poverty and Parental Separation class than NH White children. Hispanic boys had the highest prevalence of Severe Dysregulation (16%), whereas NH White boys had the highest prevalence of Low Symptoms (52%). Individuals in the Poverty and Parental Separation class had a higher probability of transitioning to the Low Symptoms class. In contrast, those in the Abuse and Family Dysfunction class were more likely to transition to the Severe Dysregulation class, with NH White girls showing the highest probability (.34), nearly twice that of NH Black girls (.19). These gender differences in these transition probabilities were observed for Whites but not Blacks.

CONCLUSIONS

These findings thus highlight the need for adopting an intersectional, person-centered approach when studying the effects of ACEs on adolescent development.

Black-white differences in chronic stress exposures to predict preterm birth: interpretable, race/ethnicity-specific machine learning model

BACKGROUND

Differential exposure to chronic stressors by race/ethnicity may help explain Black-White inequalities in rates of preterm birth. However, researchers have not investigated the cumulative, interactive, and population-specific nature of chronic stressor exposures and their possible nonlinear associations with preterm birth. Models capable of computing such high-dimensional associations that could differ by race/ethnicity are needed. We developed machine learning models of chronic stressors to both predict preterm birth more accurately and identify chronic stressors and other risk factors driving preterm birth risk among non-Hispanic Black and non-Hispanic White pregnant women.

METHODS

Multivariate Adaptive Regression Splines (MARS) models were developed for preterm birth prediction for non-Hispanic Black, non-Hispanic White, and combined study samples derived from the CDC's Pregnancy Risk Assessment Monitoring System data (2012-2017). For each sample population, MARS models were trained and tested using 5-fold cross-validation. For each population, the Area Under the ROC Curve (AUC) was used to evaluate model performance, and variable importance for preterm birth prediction was computed.

RESULTS

Among 81,892 non-Hispanic Black and 277,963 non-Hispanic White live births (weighted sample), the best-performing MARS models showed high accuracy (AUC: 0.754-0.765) and similar-or-better performance for race/ethnicity-specific models compared to the combined model. The number of prenatal care visits, premature rupture of membrane, and medical conditions were more important than other variables in predicting preterm birth across the populations. Chronic stressors (e.g., low maternal education and intimate partner violence) and their correlates predicted preterm birth only for non-Hispanic Black women.

CONCLUSIONS

Our study findings reinforce that such mid or upstream determinants of health as chronic stressors should be targeted to reduce excess preterm birth risk among non-Hispanic Black women and ultimately narrow the persistent Black-White gap in preterm birth in the U.S.

Climate change, human health, and the exposome: Utilizing OMIC technologies to navigate an era of uncertainty

Climate change is an anthropogenic phenomenon that is alarming scientists and non-scientists alike. The emission of greenhouse gases is causing the temperature of the earth to rise and this increase is accompanied by a multitude of climate change-induced environmental exposures with potential health impacts. Tracking human exposure has been a major research interest of scientists worldwide. This has led to the development of exposome studies that examine internal and external individual exposures over their lifetime and correlate them to health. The monitoring of health has also benefited from significant technological advances in the field of "omics" technologies that analyze physiological changes on the nucleic acid, protein, and metabolism levels, among others. In this review, we discuss various climate change-induced environmental exposures and their potential health implications. We also highlight the potential integration of the technological advancements in the fields of exposome tracking, climate monitoring, and omics technologies shedding light on important questions that need to be answered.

Variation in self-identified most stressful life event by outcome of previous pregnancy in a population-based sample interviewed 6-36 months following delivery

The majority of health research uses a deductive approach to measure stressful life events, despite evidence that perception of what is stressful varies. The goal of this project was to 1) describe the distribution of self-identified most stressful life events in a cohort of women who experienced a perinatal loss (stillbirth or neonatal death) or live birth in the previous three years and 2) test how childhood adversity influences participant selection of their most stressful life event. We used data from 987 women (282 with stillbirth, 657 without loss, and 48 with a neonatal death in the first 28 days) in the Stillbirth Collaborative Research Network - OASIS (Outcomes after Study Index Stillbirth) follow-up study, a population-based sample set in five U.S. states in 2009. We applied an inductive coding process to open-ended responses to a question about the most stressful event or major crisis that participants had ever experienced, resulting in a set of 15 categories. We compare psychologic wellbeing across self-identified most stressful life event, accounting for sampling and loss-to-follow-up weights. Overall, stillbirth was most commonly identified as the most stressful event (18.3% [95% CI: 15.6, 21.5]), followed by loss by death of someone other than a child (17.25% [95% CI: 13.9, 20.3]). For participants who experienced a perinatal loss, we fit multivariable logistic regression models to quantify the association between report of childhood maltreatment and identifying the perinatal loss as the most stressful life event, calculating risk ratios (RRs). Reporting any moderate or severe childhood maltreatment was associated with 24% lower risk of identifying the perinatal loss as the most stressful life event (adjusted RR: 0.76 [95% CI: 0.58, 1.01]), after adjusting for race/ethnicity, age, and education. These results demonstrate the value of combining standardized measures with open-ended, inductive approaches to measuring stress in large, population-based studies.

Beyond WEIRD: Associations between socioeconomic status, gender, lifetime stress exposure, and depression in Madagascar

OBJECTIVE

Although research has examined associations between socioeconomic status (SES), gender, and acute and chronic life stressors in depression, most studies have been conducted in Western, educated, industrialized, rich, democratic (WEIRD) populations.

METHOD

We addressed this issue by interviewing 65 adults (55 women, M _age  = 37) living in Madagascar, a typical low- and middle-income country.

RESULTS

As hypothesized, women experienced more life stressors and depressive symptoms, on average, than men, as did those from lower (vs. higher) SES backgrounds. Additionally, lifetime stress exposure was associated with greater symptoms of depression, accounting for 19% of the variability in depressive symptom levels. These effects differed for acute versus chronic and distal versus recent stressors. Finally, stress exposure significantly mediated the relation between SES and gender on depressive symptoms, accounting for 24.0%-70.8% of the SES/gender-depression association depending on stressor type.

CONCLUSION

These data extend prior research by describing how social stratification and gender relate to lifetime stress exposure and depressive symptoms in a non-WEIRD population.

Associations between historical redlining and birth outcomes from 2006 through 2015 in California

BACKGROUND

Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California.

METHODS

We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C.

RESULTS

The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race.

CONCLUSION

Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.

Associations between lifetime stress exposure and prenatal health behaviors

Prenatal health behaviors can strongly influence risk of poor pregnancy birth outcomes. Although stress has been implicated in structuring the likelihood that individuals will engage in various prenatal health behavior patterns, no studies to date have examined life stress exposure occurring across the entire lifespan, and few have investigated how different types of stressors are comparatively associated with these outcomes. To address these issues, we interviewed 164 women at one of two large Midwestern, urban hospitals after delivering their first infant. We used the Stress and Adversity Inventory (STRAIN) to assess women's lifetime stress exposure severity and ordinary least squares regression models to examine associations between participants' life stress exposure and prenatal health behaviors. As hypothesized, greater lifetime stress exposure was associated with engaging in more negative prenatal health behaviors and fewer positive prenatal health behaviors while controlling for relevant sociodemographic factors and current perceived stress levels. These effects were stronger for negative versus positive health behaviors, and they differed substantially as a function of stressor type, exposure timing, and primary life domain. Stressors occurring over the life course thus have negative consequences for prenatal health behaviors, but these effects are not uniform across different types of life stress exposure.

Social Safety Theory: A Biologically Based Evolutionary Perspective on Life Stress, Health, and Behavior

Social Safety Theory hypothesizes that developing and maintaining friendly social bonds is a fundamental organizing principle of human behavior and that threats to social safety are a critical feature of psychological stressors that increase risk for disease. Central to this formulation is the fact that the human brain and immune system are principally designed to keep the body biologically safe, which they do by continually monitoring and responding to social, physical, and microbial threats in the environment. Because situations involving social conflict, isolation, devaluation, rejection, and exclusion historically increased risk for physical injury and infection, anticipatory neural-immune reactivity to social threat was likely highly conserved. This neurocognitive and immunologic ability for humans to symbolically represent and respond to potentially dangerous social situations is ultimately critical for survival. When sustained, however, this multilevel biological threat response can increase individuals' risk for viral infections and several inflammation-related disease conditions that dominate present-day morbidity and mortality.

The Stress and Adversity Inventory for Adults (Adult STRAIN) in Brazilian Portuguese: Initial Validation and Links With Executive Function, Sleep, and Mental and Physical Health

It has been widely hypothesized that stressors occurring over the lifespan exert a cumulative impact on health, but little work has directly tested these theories given the difficulty associated with measuring cumulative stress exposure over the lifespan. We addressed this issue in Brazil by translating the Stress and Adversity Inventory for Adults (Adult STRAIN) into Brazilian Portuguese. We then examined the instrument's usability and acceptability; concurrent, discriminant, predictive, and incremental validity; and test-retest reliability. Participants were 330 Brazilian adults (238 women; M age = 32.16; range: 18-76 years old) who completed the Adult STRAIN in Brazilian Portuguese, Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Perceived Stress Scale (PSS). They also completed measures of socioeconomic status, personality, social desirability, negative affect, physical and mental health complaints, sleep quality, executive function, and doctor-diagnosed general health problems and autoimmune disorders. The STRAIN exhibited excellent usability and acceptability and was completed in 16 min and 27 s, on average. It showed good concurrent validity relative to the CTQ-SF and PSS (rs ≥ 0.377) and good discriminant validity, both with and without adjusting for covariates. In addition, the STRAIN significantly predicted all of the health outcomes assessed except for executive function and explained substantial variance in these outcomes over and above the CTQ-SF, PSS, and covariates assessed. Finally, the test-retest reliability indices for total lifetime stressor count and severity were outstanding (r icc = 0.936 and 0.953, respectively, over M = 34.86 days). The Adult STRAIN in Brazilian Portuguese thus exhibits excellent usability and acceptability, good concurrent and discriminant validity, strong predictive and incremental validity across a variety of health outcomes, and outstanding test-retest reliability. We therefore conclude that the STRAIN is a practical, valid, and reliable instrument for researchers and clinicians looking to efficiently assess cumulative lifetime stress exposure in Brazilian Portuguese.

Health care experiences and birth outcomes: Results of an Aboriginal birth cohort

OBJECTIVE

The aim of this study was to investigate the relationship between perceived discrimination in perinatal care and birth outcomes of women giving birth to an Aboriginal baby in South Australia using methods designed to respect Aboriginal culture and communities.

DESIGN AND SETTING

Population-based study of women giving birth to Aboriginal infants in South Australia, July 2011-June 2013. Women completed a structured questionnaire with an Aboriginal researcher. Study measures include: standardised measure of perceived discrimination in perinatal care; maternal smoking, cannabis use and exposure to stressful events and social health issues; infant birthweight and gestation.

PARTICIPANTS

344 women (mean age 25, range 15-43 years) living in urban, regional and remote areas of South Australia.

RESULTS

Half of women (51%) perceived that they had experienced discrimination or unfair treatment by hospitals or health services providing care during pregnancy and soon after childbirth. Women experiencing three or more stressful events or social health issues were more likely to perceive that care was discriminatory or unfair. Aboriginal women who perceived that they had experienced discrimination in perinatal care were more likely to have a baby with a low birthweight (Adj Odds Ratio 1.9, 95% CI 1.0-3.8) or small for gestational age (Adj Odds Ratio 1.9, 95% CI 1.0-3.5), adjusting for parity, smoking and cannabis use.

CONCLUSIONS

The study provides evidence of the 'inverse care law'. Aboriginal women most at risk of poor infant health outcomes were the least likely to perceive that they received care well matched to their needs. Building stronger evidence about what works to create cultural safety in perinatal health care is an urgent priority.

Stress measurement using speech: Recent advancements, validation issues, and ethical and privacy considerations

Life stress is a well-established risk factor for a variety of mental and physical health problems, including anxiety disorders, depression, chronic pain, heart disease, asthma, autoimmune diseases, and neurodegenerative disorders. The purpose of this article is to describe emerging approaches for assessing stress using speech, which we do by reviewing the methodological advantages of these digital health tools, and the validation, ethical, and privacy issues raised by these technologies. As we describe, it is now possible to assess stress via the speech signal using smartphones and smart speakers that employ software programs and artificial intelligence to analyze several features of speech and speech acoustics, including pitch, jitter, energy, rate, and length and number of pauses. Because these digital devices are ubiquitous, we can now assess individuals' stress levels in real time in almost any natural environment in which people speak. These technologies thus have great potential for advancing digital health initiatives that involve continuously monitoring changes in psychosocial functioning and disease risk over time. However, speech-based indices of stress have yet to be well-validated against stress biomarkers (e.g., cortisol, cytokines) that predict disease risk. In addition, acquiring speech samples raises the possibility that conversations intended to be private could one day be made public; moreover, obtaining real-time psychosocial risk information prompts ethical questions regarding how these data should be used for medical, commercial, and personal purposes. Although assessing stress using speech thus has enormous potential, there are critical validation, privacy, and ethical issues that must be addressed.

The Stress and Adversity Inventory for Adults (Adult STRAIN) in German: An overview and initial validation

Life stress is a key determinant of poor mental and physical health, but until recently no instrument existed for efficiently assessing cumulative stress exposure and severity across the entire lifespan. The Stress and Adversity Inventory (STRAIN) is an online, interview-based stress assessment system that was developed to address this need. We examined the concurrent, predictive, and discriminant validity of a German translation of the STRAIN by administering the instrument, along with several other measures of stress and health, to 298 adults (81 men, 217 women, M_age = 30.3 years). The German STRAIN demonstrated excellent concurrent validity, as evidenced by associations with other instruments assessing early adversity (|rs|≥.62, ps≤.001). It also correlated with instruments assessing recent life event exposure in adulthood (|rs|≥.48, ps≤.001), as well as recent perceived stress (|rs|≥ .25, ps≤.001) and recent chronic stress levels (|rs|≥ .19, ps≤.001). Additionally, the German STRAIN showed strong predictive validity in relation to anxiety symptoms (|rs|≥ .22, ps≤.001) and depressive symptoms (|rs|≥ .33, ps≤.001). Finally, the German STRAIN showed good discriminant validity, with lifetime stressor count being unrelated to personality features like neuroticism. These results demonstrate that the German version of the STRAIN is a valid tool for assessing lifetime stress exposure and severity. Additional research is needed to examine how the German STRAIN predicts psychological and biological stress reactivity and physical health outcomes.

Explaining the Relationship Between Minority Group Status and Health Disparities: A Review of Selected Concepts

Purpose: There is growing concern that value-based payment for health care may disadvantage health care organizations that serve populations with social risk. In the broader investigation of social risk factors, including income, education, neighborhood deprivation, and other risks, the focus on race and ethnicity as a risk factor for disparities in health and health care has diminished. Understanding the independent contribution of minority group status is critical to this discussion. This narrative review discusses four concepts-minority stress, resilience, epigenetics, and life course-that may help explain the contribution of minority group status and its association with health disparities. Methods: We briefly describe each concept and the supporting evidence. Results: Our results indicate that all four concepts have potential relevance for understanding and addressing health disparities. The life course perspective emphasizes the importance of understanding explanatory mechanisms and factors that contribute to health-including biological, physical, and social factors-over a person's life span. Both minority stress and resilience may influence health in either a negative or positive manner that potentially underlies health changes. Exposure to these factors and others may interact with and modify epigenetic regulation-biological processes that impact how our genes are expressed. This may increase the risk of disease and negative health outcomes, particularly among groups that may be at disproportionate risk because of social circumstances and environmental exposure over the life course. Conclusion: Despite these concepts' relevance, more research is needed to assess how they may explain the relationship between minority status and disparities in health. Such evidence is needed to focus interventions and to inform the design of delivery and payment models that can spur actions to reduce disparities.

Maternal Lifetime Trauma and Birthweight: Effect Modification by In Utero Cortisol and Child Sex

OBJECTIVES

To evaluate associations between maternal lifetime traumatic stress and offspring birthweight and examine modifying effects of third trimester cortisol and fetal sex.

STUDY DESIGN

Analyses included 314 mother-infant dyads from an ethnically mixed pregnancy cohort. Maternal lifetime trauma was reported via the Life Stressor Checklist-Revised. Fenton birthweight for gestational age z-scores (BWGA-z) were calculated. A 3-cm scalp-nearest maternal hair segment collected at birth was assayed to reflect cumulative third trimester cortisol secretion. Multivariable regression was used to investigate associations between maternal lifetime trauma and BWGA-z and examine 2- and 3-way interactions with cortisol and fetal sex. Because subjects with low or high cortisol levels could represent susceptible populations, varying coefficient models that relax the linearity assumption on cortisol level were used to assess the modification of maternal lifetime trauma associations with BWGA-z as a function of cortisol.

RESULTS

Women were primarily minorities (41% Hispanic, 26% black) with ≤12 years education (63%); 63% reported ≥1 traumatic event. Prenatal cortisol modified the association between maternal lifetime trauma and birthweight. Women with higher lifetime trauma and increased cortisol had significantly lower birthweight infants in males; among males exposed to the 90th percentile of cortisol, a 1-unit increase in trauma score was associated with a 0.19-unit decrease in BWGA-z (95% CI, -0.34 to -0.04). Associations among females were nonsignificant, regardless of cortisol level.

CONCLUSIONS

These findings underscore the need to consider complex interactions among maternal trauma, disrupted in utero cortisol production, and fetal sex to fully elucidate intergenerational effects of maternal lifetime trauma.

Assessing Lifetime Stress Exposure Using the Stress and Adversity Inventory for Adults (Adult STRAIN): An Overview and Initial Validation

OBJECTIVE

Numerous theories have proposed that acute and chronic stressors may exert a cumulative effect on life-span health by causing biological "wear and tear," or allostatic load, which in turn promotes disease. Very few studies have directly tested such models, though, partly because of the challenges associated with efficiently assessing stress exposure over the entire life course. To address this issue, we developed the first online system for systematically assessing lifetime stress exposure, called the Stress and Adversity Inventory (STRAIN), and describe its initial validation here.

METHODS

Adults recruited from the community (n = 205) were administered the STRAIN, Childhood Trauma Questionnaire-Short Form, and Perceived Stress Scale, as well as measures of socioeconomic status, personality, social desirability, negative affect, mental and physical health complaints, sleep quality, computer-assessed executive function, and doctor-diagnosed general health problems and autoimmune disorders.

RESULTS

The STRAIN achieved high acceptability and was completed relatively quickly (mean = 18 minutes 39 seconds; interquartile range = 12-23 minutes). The structure of the lifetime stress data best fit two latent classes overall and five distinct trajectories over time. Concurrent associations with the Childhood Trauma Questionnaire-Short Form and Perceived Stress Scale were good (r values = .147-.552). Moreover, the STRAIN was not significantly related to personality traits or social desirability characteristics and, in adjusted analyses, emerged as the measure most strongly associated with all six of the health and cognitive outcomes assessed except current mental health complaints (β values = .16-.41; risk ratios = 1.02-1.04). Finally, test-retest reliability for the main stress exposure indices over 2-4 weeks was excellent (r values = .904-.919).

CONCLUSIONS

The STRAIN demonstrated good usability and acceptability; very good concurrent, discriminant, and predictive validity; and excellent test-retest reliability.

Lifetime Stress Exposure and Health: A Review of Contemporary Assessment Methods and Biological Mechanisms

Life stress is a central construct in health research because it is associated with increased risk for a variety of serious mental and physical health problems, including anxiety disorders, depression, cardiovascular disease, autoimmune disorders, Alzheimer's disease, certain cancers, and other diseases of aging. In this review, we examine how lifetime stress exposure contributes to elevated disease risk, and explore ongoing measurement and scientific issues related to this topic. To accomplish these goals, we first review existing instruments that have been developed for assessing perceived stress, self-reported life events, interviewer-assessed life stressors, and lifetime stress exposure. Next, we describe laboratory-based tasks that have been used for characterizing individual differences in psychological and biological stress reactivity. These methods have yielded an enormous amount of data showing how life stress influences the activity of the hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis, sympathetic-adrenal-medullary axis, and immune system, and how such processes can in turn cause allostatic load and biological embedding of the stress effect at the level of the human brain and genome. At the same time, many critical measurement and scientific issues remain unresolved, and we discuss these topics last while describing some pressing issues and opportunities for future research on stress and health.

The effects of whiteness on the health of whites in the USA

Whites in the USA are the dominant racial group, with greater than average access to most material and social rewards. Yet, while whites have better outcomes than other racial groups on some health indicators, whites paradoxically compare poorly on other measures. Further, whites in the USA also rank poorly in international health comparisons. In this paper, we present a framework that combines the concept of whiteness-a system that socially, economically, and ideologically benefits European descendants and disadvantages people in other groups-with research from a variety of fields in order to comprehensively model the social factors that influence whites' health. The framework we present describes how whiteness and capitalism in the USA shape societal conditions, individual social characteristics and experiences, and psychosocial responses to circumstances to influence health outcomes. We detail specific examples of how social policies supported by whiteness, the narratives of whiteness, and the privileges of whiteness may positively and negatively affect whites' health. In doing so, we suggest several areas for future research that can expand our understanding of how social factors affect health and can contribute to the patterns and paradoxes of whites' health. By expanding research to include theoretically-grounded analyses of the dominant group's health, we can achieve a more complete picture of how systems of racial inequity affect health.