RESEARCH AND PRACTICERace and Unhealthy Behaviors: Chronic Stress, the HPA Axis,RESEARCH AND PRACTICERace and Unhealthy Behaviors: Chronic Stress, the HPA Axis,and Physical and Mental Health Disparities
Over the Life CourseJames S. Jackson, PhD, Katherine M. Knight, PhD, and Jane A. Rafferty, MAThe strain of living under inhospitable environmental conditions is hypothesized to resultin physical health disparities among racialgroups.1â3 In addition, the inequities associatedwith inhospitable environmentsâinequalities inemployment, income, and educational opportunities that favor non-Hispanic Whites overBlacksâare hypothesized to cause not onlypoorer physical health but also worse mentalhealth among Blacks. However, epidemiologicaland clinical data show that in comparison withnon-Hispanic Whites, Blacks suffer the same orlower rates of most major mental disorders, evenwhile suffering higher rates of psychologicaldistress.4â7 These apparently contradictory disparities in physical and mental health statusesraise questions about the presumed relationshipsamong negative life conditions and stressors onthe one hand and poor physical health andmental disorders on the other.1,3Objectives. We sought to determine whether unhealthy behaviors playa stress-buffering role in observed racial disparities in physical and mentalhealth.Methods. We conducted logistic regressions by race on data from the first 2waves of the Americansâ Changing Lives Survey to determine whether unhealthybehaviors had buffering effects on the relationship between major stressors andchronic health conditions, and on the relationship between major stressors andmeeting the criteria for major depression.Results. Among Whites, unhealthy behaviors strengthened the relationshipbetween stressors and meeting major-depression criteria. Among Blacks,however, the relationship between stressors and meeting major-depressioncriteria was stronger among those who had not engaged in unhealthy behaviorsthan among those who had. Among both race groups there was a positiveassociation between stressors and chronic health conditions. Among Blacksthere was an additional positive association between number of unhealthybehaviors and number of chronic conditions.Conclusions. Those who live in chronically stressful environments often copewith stressors by engaging in unhealthy behaviors that may have protectivemental-health effects. However, such unhealthy behaviors can combine withnegative environmental conditions to eventually contribute to morbidi
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