title: Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway.
abstract: Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative-the Community Child Health Network-to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions.
authors.affiliation: Department of Psychology, University of California, Los Angeles dunkel@psych.ucla.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Dunkel Schetter
authors.affiliation: New York Academy of Sciences, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Schafer
authors.affiliation: Department of Health Behavior, University of Alabama at Birmingham.
authors.forename: Robin Gaines
authors.initials: RG
authors.lastname: Lanzi
authors.affiliation: Section for Child and Family Health Studies, North Shore University Health System, Evanston, Illinois.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clark-Kauffman
authors.affiliation: Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland.
authors.forename: Tonse N K
authors.initials: TN
authors.lastname: Raju
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
keywords: ethnicity; health disparities; socioeconomic status (SES); stress