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Social Disparities, Stress & Health


Racial Disparities in School Belonging and Long-Term Health Profiles  

What are the implications of students’ sense of belonging in school on their health outcomes? In a study published in JAMA Pediatrics, IPR health psychologist Edith Chen, former IPR graduate research assistant and Carnegie Mellon University professor Phoebe Lam, and their colleagues, investigate whether racial disparities in students’ sense of belonging at school are associated with cardiometabolic health in adulthood. Chen and her colleagues analyzed data from the National Longitudinal Study of Adolescent Health that spanned from 1994–2008, focusing on 4,830 Black and White students between seventh and twelfth grade. The research team examined school-wide questionnaires that students completed to determine average sense of belonging by racial groups at schools across the U.S. The researchers then analyzed blood samples collected from the 4,830 participants when they were between the ages of 24 and 32 years old in 2008 to evaluate the connection between gaps in school belonging across racial groups and the risk for diabetes in adulthood. The researchers discovered that Black students who attended a school where, on average, Black students felt that they belonged less than White students were more likely to be diagnosed with diabetes in adulthood and they also displayed more risk factors for metabolic syndrome, a condition which increases risk of heart disease and stroke in adulthood. The researchers argue that U.S. schools that foster a more equitable and inclusive sense of school belonging among different racial groups may help reduce health disparities among students. Chen is the John D. and Catherine T. MacArthur Professor of Psychology. 

The Human Microbiome and Health Inequities

Understanding the biological processes that cause and maintain socially driven health inequities is essential to address them. In the Proceedings of the National Academy of Science, anthropologist and IPR associate Katherine Amato, IPR anthropologist Christopher Kuzawa, and IPR health psychologist Greg Miller and their colleagues explore how taking into account the gut microbiome, the community of microbes that inhabits the human gastrointestinal tract, can improve health inequities. The gut microbiome is affected by diet, daily behaviors, and physical environments, and it influences nutrition, immune function, and behaviors in the body. Reduced microbiome diversity has been linked to chronic diseases, so alterations to the microbiome may be a way to prevent poor health outcomes. In a review of relevant studies, the researchers highlight the role the microbiome can play in perpetuating health disparities in undernutrition, obesity, asthma, neurological development, mental health, and COVID-19. For example, children who do not have access to fresh produce and other high-fiber foods will not have as diverse or resilient a microbiome as children who eat more nutritious diets. Each of these areas reveals that health disparities are caused not only by the socioeconomic, but factors such as discrimination and stress, which show up in the gut microbiome. To address health inequities, they suggest implementing policies such as encouraging breastfeeding and improving access to non-processed food in urban areas, both of which create more diversity in the microbiome and improve health. The researchers urge policymakers to incorporate knowledge about the microbiome in public health policies and suggest microbiome research aim for a broader understanding of what is microbially “healthy” or “unhealthy.” Kuzawa is the John D. MacArthur Professor of Anthropology. Miller is Louis W. Menk Professor of Psychology.

Learning From ‘Garbage-Dump’ Baboons 

A diet high in simple sugars and fats but low in fiber is known to have significant health effects, many of which may operate through changes in the collection of microorganisms in the gut, known as microbiota. In Scientific Reports, anthropologist and IPR associate Katherine Amato and her colleagues examine the gut microbiota in wild baboons that have access to trash containing processed food high in sugar and fat in Rwanda’s Akagera National Park. Baboons’ gut microbiota are like human ones, making them a good model for understanding the impact of diet. The researchers divided the park baboons into three groups, according to their access to human food: animals with unlimited access—“garbage-dump baboons”—those with limited access, and those with no access. Feces samples from each group, which ranged from 24 to 41 or more individuals, were collected and analyzed for microbes. Results indicated that baboons with unlimited access to human food had lower microbial diversity and fewer microorganisms involved in breaking down fiber and in producing short chain fatty acids (SCFA), which protect the gut. Baboons with limited access, however, showed only minimal changes in their gut microbiota. The findings suggest that eating processed food can change the gut microbiota among baboons, but, importantly, the amounts must be of a certain magnitude or frequency to have a strong impact. The researchers conclude that a similar “dosing threshold” could also exist for humans eating processed foods.  

The Connection Between Long COVID and Employment Status 

Symptoms of post–COVID-19 condition, commonly called long COVID, have become a prevalent symptom after getting the COVID-19 virus, but little is known about how long COVID has impacted the ability to function long-term. In JAMA Network Open, IPR political scientist James Druckman and his colleagues investigate the prevalence of unemployment among individuals who did and did not develop long COVID after getting the virus. The researchers analyzed eight waves of survey data from the COVID States Project, a national survey looking at Americans’ attitudes, between February 2021 and July 2022. The 15,308 respondents they focused on had COVID-19 at least 2 months prior, and of that group, 2,236, or 14.6%, reported long COVID symptoms, including 1,027 people or (45.6%) who reported symptoms of brain fog or impaired memory. Overall, 1,418 of the total respondents reported that they were unemployed including 276, or 12.3%, of those with long COVID and 1,142, or 8.4%, or those without it. The results reveal that having long COVID symptoms was associated with a greater likelihood of being unemployed and not being employed full time. Since individuals with long COVID were more likely to have been employed before the pandemic, it’s unlikely that they were unemployed because of economic reasons, suggesting that their long COVID symptoms played a role in their inability to work. The evidence highlights the importance of developing solutions for long COVID and for employers to consider how the symptoms can affect productivity. Druckman is the Payson S. Wild Professor of Political Science.

A Multidisciplinary Roadmap for Global Mental Health 

Mental health issues are on the rise around the globe, despite tens of billions of dollars of research funding that has gone toward addressing them over the past several decades. In Nature Mental Health, IPR psychologist Robin Nusslock and his colleagues present a model for addressing mental health on a global scale that is targeted, personalized, and scalable. The researchers developed an approach they call the “circuits-to-communities model,” which aligns six disciplines to create targeted and personalized mental health interventions. The six disciplines are neuroscience, cognitive science, developmental science, social science, intervention science, and implementation science. They propose that bridging knowledge in these areas is key to creating more precise treatments and argue that the framework considers neurocognitive circuits and functions and the way social and environmental stressors affect emotions for a more holistic approach to mental health problems. For example, a mental health professional might ask patients suffering from depression to record their symptoms in an app, which also includes information about their life stage, any early adversity, and their ongoing stressors. This type of model can lead to alignment across disciplines, which can help scholars and healthcare providers understand the causes, prevention, and treatment of mental health problems. 

Improving Mental Health with Food Security

Various complex factors, including biology and the environment, lead to depression. An association between food security and mental health is known, but is food insecurity a cause of depression? In Public Health Nutrition, IPR anthropologist Sera Young and her colleagues evaluate whether access to food protects women against depressive symptoms. The researchers used longitudinal data from four annual household surveys in rural Tanzania conducted between 2016 and 2019. The study included 548 married women with children who were food secure, and one-third of the participants had depressive symptoms at the start of the study. They all participated in a nutrition-sensitive agriculture intervention, which typically focuses on providing nutritionally rich foods and improving one’s dietary diversity. In addition to studying food security and mental health, the program had a few extra components, including peer mentoring in sustainable farming practices and lessons on gender equity and women’s wellbeing. The results show the intervention reduced the odds of women’s depressive symptoms by 43%. These are the first results showing that nutrition-agricultural interventions and decreasing food insecurity have broader effects beyond nutrition.

Racial and Ethnic Differences in Eating Duration and Meal Timing

Eating breakfast has been connected with better cardiometabolic health, and cardiometabolic diseases are disproportionately experienced by minority groups. In Nutrients, anthropologist and IPR associate Kristen Knutson and her colleagues explore the racial and ethnic differences in meal timing and meal duration. Using the National Health and Nutrition Examination Survey collected between 2011–18, they examined the responses of 13,084 participants, which are representative of the U.S. population. In the survey, the participants were asked to record what they ate for two non-consecutive 24-hour periods and include the time of their first and last meal. Overall, 68% of the participants were White and had some college education, and 55% were female. Compared to White adults, all the other racial and ethnic groups eat their first meal of the day significantly later, but the delay was larger during weekdays. The researchers also find that for Black and Hispanic Americans, the average time between their first and last meal was shorter than for White Americans. Because research shows that eating earlier in the day is linked to better health and late-night eating has been associated with poor metabolic health, these results highlight how meal timing could play a role in disparities in cardiometabolic health. They researchers argue that future research should examine the role of meal timing and racial and ethnic disparities in cardiometabolic health.

Racial Disparities in Sleep

Previous research shows racial disparities in sleep, but few studies have examined whether psychological distress is the pathway linking discrimination and rest. Anthropologist and IPR associate Kristen Knutson and Northwestern University postdoctoral fellows Michael Mead and Emily Vargas examine whether experiences of discrimination and psychological distress contribute to racial disparities in sleep in the Journal of Racial and Ethnic Health Disparities. Knutson and her colleagues analyzed data collected in 2010 from the Health Retirement Study, a nationally representative longitudinal aging study. They focused on a group of 7,749 Black and White respondents who filled out a questionnaire asking about everyday discrimination, loneliness, ongoing chronic stressors, depressive symptoms, and self-reported sleep health. On average, participants were 67 years old, and the majority were White (82.9%) and female (58.4%). Black respondents reported higher experiences of discrimination, which in turn was associated with greater psychological distress and linked to poorer sleep quality. The evidence shows that discrimination may be uniquely detrimental to sleep, even after accounting for psychological distress. This study builds on previous research by demonstrating that racial disparities in sleep can be explained by greater experiences of discrimination, contributing to greater psychological distress. The researchers suggest that future research continue to examine how discrimination impacts sleep duration, continuity, and timing, and how psychological distress plays into those relationships.


Emotional Pathways to the Biological Embodiment of Racial Discrimination 

Image of a stressed out womanDiscrimination may be a powerful trigger of feelings of embarrassment and shame, or negative social-evaluative (NSE) emotions. In a study published in Psychosomatic Medicine, IPR developmental psychologist Emma Adam and Emily Hittner, a former PhD student in human development and social policy, examine whether average and day-to-day changes in NSE emotion are pathways by which experiences of perceived racial discrimination get under the skin. They examined a sample of 102 Black and White adults taken from a larger longitudinal study of over 1,400 adolescents followed for over 20 years. Of the sample, 45% were Black, 61% were female, and the average family income was $75,905. Cortisol, the body’s main stress hormone, was measured from saliva samples from participants right after waking, 30 minutes after waking, and before bed each day for one week. Participants’ experiences of racial discrimination were assessed in work and school environments, and they were asked to self-report their emotional experiences each day that week. The findings show that discrimination was associated with NSE emotions, and NSE emotions were related to flatter cortisol slopes (less decline in cortisol levels across the day), which have been linked to poor mental and physical health. The researchers show NSE emotions are the link between perceived racial discrimination and cortisol. NSE emotions reported at the end of one day were also associated with flatter cortisol slopes the next day. These results suggest that negative emotions, and particularly NSE emotions, are important pathways through which racial discrimination gets under the skin. Adam is the Edwina S. Tarry Professor of Human Development and Social Policy.

Stress and High-Stakes Testing Among Students from Low-Income Backgrounds

Student doing homeworkTesting impacts students’ lives in many ways, including graduation and college admissions, but few studies have explored how students physically respond to tests. In Education Finance and Policy, Adam, Figlio, and Jennifer Heissel, former IPR graduate research assistant, now at the Naval Postgraduate School, compare the stress levels of 93 students in grades 3­–8 during a typical school week, a low-stakes testing week, and a high-stakes testing week, as well as their test performance. To determine students’ stress levels, the researchers collected saliva to measure the stress hormone cortisol. During each week, participants provided six saliva samples over 24 hours. All the students attended a charter school in New Orleans, and most were Black and from low-income backgrounds. The results show that students’ stress was 18% higher during a high-stakes testing week than the non-testing week, with male students’ stress rising the most. The researchers find that male stress increased 31% during low-stakes testing and 33% during high-stakes testing. Females had no significant changes. Compared with girls, boys’ stress is 35% higher during testing weeks.  Also, the results show a decrease in test scores on high-stakes tests when students’ stress increased or decreased by more than 10%. As high-stakes testing continues to play a role in students’ lives, this research helps schools and policymakers understand how students physically respond to tests and their test performance. Additionally, the researchers propose how schools can help reduce stress among students, including mindfulness programs, mental health interventions, and yoga.

Family-Centered Prevention and Mental Health in Black Adolescents 

Mental health problems often develop in Black adolescents who experience frequent racial discrimination. In JAMA Network Open, IPR psychologists Edith Chen and Greg Miller and their co-authors investigate the effects of protective caregiving practices on mental health outcomes in individuals facing racial discrimination. They conducted a secondary analysis of information on 869 Black adolescents from two randomized clinical trials, run between 2006 and 2008, that tested family-centered prevention programs. The researchers show that participation in these programs was associated with protection of Black adolescents from the effects of racial discrimination on conduct problems and on depression and anxiety symptoms. These findings indicate that family-centered prevention programs reduce the effects of racial discrimination on subsequent increases in mental health problems among Black adolescents. Chen and Miller’s work suggests that the mental health problems brought on by racial discrimination can be buffered by supportive parenting. Chen is the John D. and Catherine T. MacArthur Professor of Psychology. Miller is the Louis W. Menk Professor of Psychology.

When Does Striving for Success Have a Cost?

Among twins from low-income backgrounds, the one who works harder to achieve successes in life may experience a physiological toll, according to a study by IPR health psychologists Edith Chen and Miller in Brain, Behavior, and Immunity. Chen and Miller, along with IPR research study coordinators Rebekah Siliezar, Johanna Dezil, and Jane Drage, compared identical twins to determine if personality differences played a role in their life outcomes. The researchers examined 141 sets of twins’ personality traits, mental health, educational attainment, and inflammation from two waves of data from the National Longitudinal Study of Adolescent Health. They assessed inflammation by using blood spots to measure levels of C-reactive protein (CRP), which is associated with health problems such as Type 2 diabetes and strokes. The findings show that twins with higher conscientiousness—a personality trait associated with success, including being hardworking, careful, and self-controlled—had more education, fewer symptoms of depression, and less alcohol use, regardless of their income level. However, among twins from low-income backgrounds, the twin with a higher level of conscientiousness had elevated CRP. In contrast, among twins from high-income backgrounds, the twin with higher conscientiousness had lower levels of CRP. The twin design helps to ensure that differences in outcomes are not due to genetics or family environments that are shared between twins. This research shows that while conscientiousness is typically viewed as a positive trait for many life outcomes, among those who grow up under adversity, it may have a physical health cost. Chen is the John D. and Catherine T. MacArthur Professor of Psychology.

The Effects of Social Support on Inflammation in High School Students

Academic success is crucial to improving one’s life circumstances, but it can also come at a cost to some students’ physical health. IPR health psychologist Edith Chen, IPR social psychologist Mesmin Destin, and their colleagues study how a program designed to encourage academic motivation along with social support, or a social network to help cope with stress, impacts students’ health in the Journal of Behavioral Medicine. In this study, 80 ninth graders from a diverse public high school completed questionnaires and had their blood drawn at the beginning of the fall semester. The students were then divided into two groups and each group attended a program consisting of four one-hour sessions. Both programs encouraged academic motivation, but one group had an additional emphasis on social support during its sessions. At the end of the spring semester, the students completed the same questionnaires and had their blood drawn again. The researchers found that students who attended the program encouraging academic motivation with an added emphasis on social support had lower levels of low-grade inflammation, or biomarkers linked to chronic diseases in adulthood, in the spring semester compared to students who attended the program only focused on academic motivation. There was no difference in students’ motivation or grades. The results suggest that social support may help promote achievement in ways that contribute to physical health. Future studies should test whether more sustained opportunities that encourage motivation and social support could have a more lasting impact on students’ health. Chen is the John D. and Catherine T. MacArthur Professor of Psychology.

Examining a Disorder's Link to Trauma, Mental Health, and Social Stressors

Women represent about 80% of patients diagnosed with Functional Neurological Disorder (FND or Conversion)—a disorder in which people experience seizures, numbness, and other symptoms that resemble neurological disorders but without a clear organic cause. While FND is poorly understood, research suggests it may be connected to distress stemming from a history of trauma, mental illness, and social stressors—including relationship and work stressors. FND patients tend to be stigmatized and dismissed by healthcare professionals as not having a “real” illness. IPR anthropologist Rebecca Seligman is investigating the sociocultural factors contributing to FND, specifically how socially learned expectations, meanings, and roles influence the ways in which people interpret their symptoms and describe their experiences. Her proposed research includes qualitative interviews, structured questionnaires, and Ecological Momentary Assessment—periodic self-reports by patients done in real-time, as well as interviews with caregivers. Seligman’s research will shed light on the day-to-day interactions influencing women’s health and place patients’ experiences at the center of her work. Her results aim to contribute to better understanding the mind-body dynamics at the root of FND and development of more productive treatments for FND and other somatic symptom disorders. This project is funded by the National Science Foundation. 

Parents’ Education and Adolescents’ Stress During the COVID-19 Pandemic

After the COVID-19 pandemic disrupted daily life for Americans, many were concerned about how these changes would affect children. In the Journal of Adolescent Health, IPR graduate research assistant Sarah Collier Villaume, Adam, and their colleagues study changes in adolescents’ perceived stress and mood at the beginning of the pandemic. The researchers recruited 128 Midwestern high school students from an ongoing, longitudinal study. The students were enrolled at two suburban high schools—one public and one private—and over half were a racial-ethnic minority. The students completed questionnaires about their daily stress and mood before the pandemic between December 2017­–March 2020 and at the beginning of the pandemic between March–July 2020. They also ranked their parents’ education level. The researchers discovered that adolescents living in low to moderate education households reported an increase in family and health-related stress that was four times as high as adolescents in high education households. Adolescents in low and moderately educated households also reported feeling more ashamed, caring, and excited than before the pandemic, with adolescents from high education households reporting decreases in anger and excitement. They conclude the burden imposed by COVID-19 was not equal across households, with adolescents from lower-educated households experiencing more stress and negative moods than their peers from higher-educated households, possibly because of concerns about family finances or health risk. The researchers propose that school-based health centers and mental health facilities can play a role in supporting students struggling emotionally during the pandemic.

Trauma and Systemic Inflammation in Mental Health

Traumatic experiences are strongly associated with various mental health problems, such as depression, anxiety, and post-traumatic stress disorder (PTSD). What are the underlying neurobiological mechanisms that explain how people respond in different ways to trauma? IPR faculty Thomas McDade, an anthropologist, Brian Mustanski, a professor of medical social sciences, as well as ISGMH postdoctoral fellow Joshua Schrock and their colleagues investigate the role of systemic inflammation in the impact of trauma on mental health in Brain, Behavior, and Immunity. The study subjects were 518 LGBTQIA+ youth ages 16–29, assigned male at birth—a population especially at risk for trauma. The researchers measured systemic inflammation through blood samples, the severity of depression symptoms, and perceived stress in the participants. One year later, they were asked to report traumatic events they had experienced in the last year. Over one-quarter (27%) of the participants reported one or more traumatic events, such as an unexpected death, being mugged, or being kicked out the house, in the year past. The researchers learned that higher baseline inflammation amplified the severity of depression symptoms and perceived stress. Understanding that prior active inflammation may make people more vulnerable to mental health issues after experiencing a traumatic event may lead to new ways to prevent and treat those who have suffered trauma. McDade is the Carlos Montezuma Professor of Anthropology.