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Stress and Health Behaviors

The first article I read was written by Patrick M. Krueger and Virginia W. Chang. They wrote an article named “”Being Poor and Coping With Stress: Health Behaviors and the Risk of Death on the relationship between stress and the possibility of dying. Their focal point is based on pointing out the negative effects of health behaviors as a gateway that unites stress with death. Krueger and Chang made observations on different Socioeconomic Status groups by breaking down data that represent the population of the United States.

This article indicates that apparent stress can lead to harmful behaviors as an effort to relieve or manage life with stress. Higher levels of perceived stress are accompanied with greater risk of death. Unhealthy behaviors, like smoking and physical inactivity, are associated with increased risk of death (Krueger and Chang, 2008:889). The research question for this study was to figure out if the effect of harmful behaviors exacerbated the outcome of stress on death. They wanted to distinguish if it was done differently by SES (Krueger and Chang, 2008:889).

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The researchers used nationally representative survey data from 1990 that was linked to death records. This allows them to examine the survey responses of those who hadn’t died within their study time frame compared to those who did die within the time frame. A nationally representative and grander sample allowed the researchers to use statistical analysis and draw conclusions about the U.S. population as a whole (Krueger and Chang, 2008:889).

The authors mention the double jeopardy hypothesis explaining that when multiple factors combined it becomes more harmful than any one risk factor (Krueger and Chang, 2008:894). They also mention the Blaxter hypothesis. This hypothesis states that the effects of health behaviors are not as important for low SES people because so many other social and environmental factors matter more for their mortality risk (Krueger and Chang, 2008:889).

The authors describe the survey questions that asked people about stress. Two questions were used. These questions had to do with how much stress one was experiencing between two different time frames (Krueger and Chang, 2008:890). They observed 3 health behaviors Cigarette smoking (current, former, never), Number ofalcoholic drinks (in a day of drinking) and Physical inactivity (based on 3 questions about exercise) (Krueger and Chang, 2008:889).

Their findings support the double jeopardy hypothesis on how unhealthy behaviors exacerbate the effect of stress on mortality. Findings are contrary to the Blaxter hypothesis because with their study they determined that Low SES people are most harmed by combination of high stress that is apparent and detrimental behaviors. Unhealthy behaviors did not significantly intensify the effects of stress on mortality for middle SES and high SES Americans (Krueger and Chang, 2008:889).

Stress and Birth Outcomes

The second article I read was written by Michael C. Lu and Neal Halfon. They wrote an article named “”Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective on the racial and ethnic disparities in birth outcomes. They discuss topics such as low birth weight, very low birth weight, infant mortality and preterm birth. This article presents a systematic literature review on the scientific research of the topics listed above. It also incorporates a life course framework. Their purpose is to showcase how differences in the results of birth are due to the different routes people take throughout the beginning stages of life as well as the collective process of achieving stability throughout life (Lu and Halfon, 2003:13).

Furthermore, their study shows that the cause is unknown as to why certain differences occur but evidence points to a variety of influences during a pregnancy, influences such as psychosocial stress, SES, maternal risk behaviors, prenatal care and perinatal infections. Evidence shows that SES matters for birth outcomes but is only part of the story for racial disparities in birth outcomes (Lu and Halfon, 2003:13). On average, African American women have lower SES than White American women. Lower SES is associated with the worst birth outcomes, on average. High SES black women have birth outcomes worse than low SES white (non-Hispanic) women. Race differences are seen even after taking SES into account, statistically equalizing the SES of women (Lu and Halfon, 2003:20).

The researchers also indicate evidence that demonstrates risky health behaviors during a pregnancy. Health behaviors plays a small role in racial disparities in birth outcomes. On their own, risky behaviors negatively affect pregnancy outcomes (Lu and Halfon, 2003:21). Examples includes maternal cigarette smoking, drug and alcohol use. Most evidence finds black women no more likely to engage in these behaviors than white women. Lu and Halfon (2003) also found evidence showing that late intake and/or insufficient prenatal care can worsen birth outcomes but does not close the race gap. Improved prenatal care of the last several decades has not significantly reduced poor birth outcomes amongst blacks. Higher rates of infant mortality occur even when black women get early prenatal care. According to the authors, evidence does not consistently demonstrate a relationship between poor birth outcomes and stress experienced during pregnancy (Lu and Halfon, 2003:21). To add on, black women do not report significantly higher rates of stress exposure. Stressful life events, perceived stress, anxiety during pregnancy works through hormone production which is released in the body to cause preterm labor and through effects on immune functions and health behaviors to cope with stress (Lu and Halfon, 2003:22).

This article also touches upon all the different mechanisms that describes why certain stressors impact early birth of a child and/or infant mortality. The early programming mechanism is based on when the body is exposed to things early in utero through childhood. This matters for the person over the course of their lives, especially when experienced during critical or sensitive development periods. Theoretically, if early exposure matter for adult’s health then they should matter for a person’s reproductive outcomes but no human represents this (Lu and Halfon, 2003:16). The cumulative pathway mechanism is based on when the body is exposed to things as a result of disadvantage and inequality that accumulate to negatively influence health over the course of the person’s life. Biological mechanisms are not well understood but allostatic load is thought to play an important role because they should matter for reproductive outcomes (Lu and Halfon, 2003:16-17).

With their study, the authors could support the weathering hypothesis which was proposed by Arlene Geronimus following a series of studies on Low Birth Weight and Very Low Birth Weight. They found out that underprivileged African American women’s experience to chronic stress and strain wears out the body. They believe that the effects of those experiences and exposures are as important, if not more important, for birth outcomes as the experiences and exposures that the woman has during a pregnancy (Lu and Halfon, 2003:17). Evidence and theory suggests that earlier exposures in utero and childhood matter, cumulative exposures adding up throughout life matter and maternal experiences matter. Furthermore, the authors synthesize these ideas into one theoretical model, the life-course health development model. They also recommended using the model to re-examine racial disparities in birth outcomes (Lu and Halfon, 2003:18).

Lu and Halfon (2003) suggest that the life course perspective has important implications for research, policy, and practice. The implications for research is important because it can identify effective targets for substantially reducing, if not eliminating disparities in birth outcomes. The implications for practice is important because in can provide clinical and public health interventions that reduce adverse exposures before and during a pregnancy. The implication for policy is important it helps improve social conditions to reduce allostatic load. Furthermore, it provides expanded coverage to ensure a continuum of care (Lu and Halfon, 2003:24-26).

Stress and Childhood

The third article I read was written by Kammi K. Schmeer and Jacob Tarrence. They wrote an article named “”Racial-ethnic Disparities in Inflammation: Evidence of Weathering in Childhood? presenting original, quantitative research. This article as well, as the previous one, includes the weathering hypothesis. The authors apply it to the study of inflammation in children, which is a novel application of the hypothesis/theory. They associate black, Hispanic and other race children to white children and they isolated minority children by parents’ place of birth.

Schmeer and Tarrence apply the idea of weathering hypothesis to frame their study in order to see if there are race/ethnic and parental origin distinctions in low grade inflammation, measured by c reactive protein which is due, in part, to chronic stress exposure, among children aged 2-10 before other significant influences on inflammation such as health behaviors or chronic diseases (Schmeer and Tarrence, 2018:412). Also, they used it to examine social mechanisms such as SES, parental marital status, access to health insurance and household size. Biological mechanisms such as body mass index that may influence inflammation differently for children by race ethnicity and/or parental nativity was examined as well.

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This article demonstrates that stress health research has mixed results. This research documents stressful conditions for children of immigrants because of factors such as discrimination, lack of resources, economic hardship, access to services, social and linguistic isolation and undocumented status (Schmeer and Tarrence, 2018:413). Research also show the health benefit immigrants have in some health outcomes related to culture, social ties, parental health behaviors and recency of immigration. They go on mentioning that family structural conditions are sources of economic and social stressors that disproportionately affect minorities (Schmeer and Tarrence, 2018:413-414). To add on, they touch upon the complex mechanisms ranging from parenting styles to time spent with children and relationship quality to insurance coverage or overcrowded household. The body mass index is associated with inflammation and tends to be higher in minority child population. Physical health exams with blood sample collections from 1999 to 2010 were analyzed to conduct this study (Schmeer and Tarrence, 2018:415).

This study finds race/ethnicity disparities in the percent of the child population with low grade inflammation even after taking into account the statistical data relating to the population, illness and conditions during birth. They also found that there is no support for immigrant health advantage (Schmeer and Tarrence, 2018:423). Furthermore, parental education, family structure and BMI were significant mediators because they were important mechanisms that would reduce race/ethnic disparities if groups did not differ these factors (Schmeer and Tarrence, 2018:422). The study has some important limitations but contributes to building scientific evidence of biosocial processes linking stress and health, with process beginning in childhood. Research like this points to targets for interventions that can have lifelong consequences for individuals but also for population level health disparities (Schmeer and Tarrence, 2018:423).

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