Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load.

Policy Points Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches. Targeted universalism, wellness-based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions. State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan. CONTEXT: US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience. METHODS: Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience. FINDINGS: White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks. CONCLUSIONS: Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.

Jedi Public Health: Co-creating an Identity-Safe Culture to Promote Health Equity.

The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects on cognition and emotion, undermining self-confidence and diminishing academic performance. This impact reduces opportunities for social mobility, while ensuring those who "beat the odds" pay a physical price for their positive efforts. Recent applications of social identity theory toward closing racial, ethnic, and gender academic achievement gaps through changing features of educational settings, rather than individual students, have proved fruitful. We sought to integrate this evidence with growing social epidemiological evidence that structurally-rooted biopsychosocial processes have population health effects. We explicate an emergent framework, Jedi Public Health (JPH). JPH focuses on changing features of settings in everyday life, rather than individuals, to promote population health equity, a high priority, yet, elusive national public health objective. We call for an expansion and, in some ways, a re-orienting of efforts to eliminate population health inequity. Policies and interventions to remove and replace discrediting cues in everyday settings hold promise for disrupting the repeated physiological stress process activation that fuels population health inequities with potentially wide application.

Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample.

Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents' TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes.

The role of socioeconomic factors in Black-White disparities in preterm birth.

OBJECTIVES: We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB). METHODS: We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables. RESULTS: Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups. CONCLUSIONS: Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

Race/ethnicity, socioeconomic characteristics, coethnic social ties, and health: evidence from the national Jewish population survey.

OBJECTIVES: We explored whether a White ethnic group with a history of structural disadvantage, Jewish Americans, shows evidence of continuing health impact independent of socioeconomic position (SEP), whether coethnic social ties appear health protective, and whether the strength of any protection varies by SEP. METHODS: In a series of ordered logistic regressions, we analyzed data from the National Jewish Population Survey, 2000-2001, regressing self-rated health on race/ethnicity, education, and income for US Blacks, Jews, and other Whites and, for Jews alone, indicators of coethnic social ties. RESULTS: controlling for SEP indicators, the self-rated health of Jews converged with that of Blacks and was significantly worse than that of other Whites. Access to coethnic social ties was associated with better self-rated health among Jews, with the strongest estimated association among those of lower SEP. CONCLUSIONS: The finding that a White ethnic group with a favorable socioeconomic profile reported significantly worse health than did other Whites, after controlling for SEP, calls for better understanding of the complex interplay of cultural, psychosocial, and socioeconomic resources in shaping population health.

Do US Black Women Experience Stress-Related Accelerated Biological Aging?: A Novel Theory and First Population-Based Test of Black-White Differences in Telomere Length.

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women's Health Across the Nation (SWAN), we estimate that at ages 49-55, black women are 7.5 years biologically "older" than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited.

Stress, Allostatic Load and Health of Mexican Immigrants.

OBJECTIVE: To assess whether the cumulative impact of exposure to repeated or chronic stressors as measured by allostatic load, contributes to the "unhealthy assimilation" effects often observed for immigrants with time in the United States. METHODS: We analyzed data from the National Health and Nutrition Examination Survey, 1988-1994, to estimate multivariate logistic regression models of the odds of having a high allostatic load score among Mexican immigrants, stratified by adult age group, according to length of residence in US, controlling for demographic, socioeconomic, and health input covariates. RESULTS: Estimates indicate that 45-60 year old Mexican immigrants have lower allostatic load scores upon arrival than US-born Mexican Americans, non-Hispanic whites, and non-Hispanic Blacks, and that this health advantage is attenuated with duration of residence in the US. CONCLUSIONS: The findings of our analysis are consistent with the hypothesis that repeated or chronic physiological adaptation to stressors is one contributor to the "unhealthy assimilation" effect observed for Mexican immigrants.