Time and again, research shows that stress is not just in our minds but in our bodies, as Amy Schulz, professor of health behavior and health education and principal investigator for the Healthy Environments Partnership (HEP), explains here. HEP is a group of Detroit-based community organizations, residents, and health-service providers, as well as academic researchers from UM.
Findings: What’s the connection between income, health, and stress? Schulz: People with higher incomes tend to experience better health outcomes than people with low or moderate incomes. There’s growing evidence to suggest this tendency may be attributed, at least in part, to differences in exposure to chronic stress associated with economic insecurity and other living conditions.
How does this process manifest itself in the body?
When someone experiences stressful circumstances day in and day out for long periods of time, it exerts wear and tear on the body’s physiological systems. This can lead to an increased risk of high blood pressure, high lipid levels, excessive weight and obesity, and high glucose levels—all factors associated with a heightened risk of diabetes and cardiovascular disease.
You’ve been studying this phenomenon in Detroit. What are you finding?
The Healthy Environments Partnership has been working together since 2000 to understand and address the contributions of neighborhood environments to the excess risk of heart disease in Detroit. We’ve found that residents of neighborhoods with higher levels of poverty report significantly higher levels of adverse conditions in the built environment, and these adverse conditions can be an ongoing source of stress.
How does that stress work its way into the body?
The risk factors associated with chronic stress operate through physiological pathways that differ from the behavioral pathways, such as physical activity and diet, which are also associated with heart disease and diabetes. It follows that efforts to promote health must go beyond encouraging individuals to be physically active and to eat a healthy diet—as important as those actions are to maintaining good health. Policies and programs must also work to reduce the likelihood that individuals will be exposed to chronically stressful living conditions.
The Paradox of Expectations
SPH Assistant Professor Derek Griffith is exploring the extent to which chronic stressors —including discrimination, racism, job and financial insecurity, and neighborhood environment—may contribute to lower rates of life expectancy in African-American men. Despite shifting cultural expectations for both men and women, he notes, African-American men still tend to shape their identity around the traditional role of provider. So if they have trouble getting or keeping a job that helps provide for their family’s needs, “they’re more likely to struggle with the question of who they are as men.” Griffith hypothesizes that in response to the stress that accompanies such self-questioning, African-American men may engage in unhealthy coping behaviors such as drinking, smoking, and eating high-fat “comfort” foods.
Through Men 4 Health, an ongoing project funded by the American Cancer Society, Griffith and his team are studying the interrelated issues of eating, social support, physical activity, and stress among African-American men. Griffith is also conducting research in Detroit aimed at learning how African-American men’s ideas of masculinity change after they’ve been diagnosed with a chronic illness. He hopes to launch a third study examining how both national and local media shape health messages according to gender and race—with the ultimate goal of developing interventions and policy recommendations to help offset unhealthy messages.
Borderlands
Border towns face stressors other communities don’t. There’s the border itself—often, as in Detroit, Michigan, and Brownsville, Texas, bridges crammed with trucks spewing diesel fumes. There’s the stress associated with crossing an international border, especially if you’re poor and don’t have proper documentation, or if you have family members living on the opposite side of the divide, or if you live in a region—such as the Texas-Mexico border—where violence is a recurring threat.
Melissa Valerio and colleagues have studied health outcomes in both border areas and have observed many parallels, including high rates of cardiovascular disease, diabetes, obesity, and violence.
A Vicious Loop
While experts differ as to whether African Americans have a higher prevalence of post-traumatic stress disorder than whites, Lori Wallace, a third-year doctoral student in health behavior and health education, suspects PTSD is more prevalent among blacks but is “very much underdiagnosed and under-recognized.” She’s conducting research to test the accuracy of her hypothesis.
Wallace believes incarceration rates in the United States may be a key contributing factor to a heightened risk for PTSD among African Americans. In 2008, she notes, more than seven million Americans were in prison, in jail, on probation, or on parole, “which translates to one in 31 adults who were under some form of correctional control. For men it’s one in 18, and for blacks it’s one in 11.” The potential for PTSD is great not only for incarcerated individuals, who are exposed to the violence of prison, but also for their children. Studies show that kids who have an incarcerated parent are at greater risk of exposure to both physical and sexual abuse—traumatic stressors that can lead to PTSD. Kids who’ve been exposed to trauma are also at greater risk for juvenile delinquency.
“There’s this loop,” says Wallace.
If her hypothesis proves correct, she wants to develop interventions to reduce stress and provide financial and emotional support to children with incarcerated parents and their caregivers. “Another place to intervene would be in prisons themselves,” Wallace says.
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