Du Bois Review: Social Science Research on Race

Moving Forward in Studying Racial Disparities in Health


How Much Does Stress Really Matter?1

Michelle J. Sternthala1 c1, Natalie Slopena2 and David R. Williamsa3

a1 Department of Environmental Health, Harvard School of Public Health

a2 Center on the Developing Child, Harvard University

a3 Department of Society, Human Development, and Health, Harvard School of Public Health; Departments of African and African American Studies and of Sociology, Harvard University


Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

(Online publication April 15 2011)


  • Race;
  • Ethnicity;
  • Stress;
  • Health;
  • Health Inequalities;
  • Cumulative Stress


c1 Michelle J. Sternthal, 1656 Park Road NW, Washington, DC 20010. E-mail: msternth@hsph.harvard.edu

Michelle J. Sternthal is a Postdoctoral Research Fellow in the Department of Environmental Epidemiology at Harvard School of Public Health. Her research focuses on social determinants of physical and mental health, using a life course perspective, and their connection to racial and socioeconomic health disparities. Her most recent research explores the biosocial pathways through which cumulative exposure to stress impacts childhood asthma susceptibility and onset.

Natalie Slopen is a Postdoctoral Fellow at the Center on the Developing Child at Harvard University. She completed her PhD in the Department of Society, Human Development, and Health at Harvard School of Public Health. Her research focuses on socioeconomic, racial, and gender disparities in health, and how early life conditions influence mental and physical health over the life course. She is currently engaged in research on the biological and psychological effects of early stress, and the mechanisms by which these experiences are embedded to create long-term health risks.

David R. Williams is the Florence and Laura Norman Professor of Public Health and Professor of African and African American Studies and of Sociology at Harvard University. His prior academic appointments were at Yale University and the University of Michigan. His research has focused on trends and determinants of socioeconomic and racial disparities in health, the effects of racism on health and the ways in which religious involvement can affect health. He is the author of more than 250 scholarly papers in scientific journals and edited collections and he was ranked as the Most Cited Black Scholar in the Social Sciences in 2008. He is an elected member of the Institute of Medicine and of the American Academy of Arts and Sciences.


1 This study was in part supported by the National Institute of Child Health and Human Development grants HD38986 and HD050467. M. J. Sternthal was supported by grant T32-ES07069-29 and the Leaves of Grass Foundation.