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Childhood Poverty and Health

Childhood Poverty and Health - PS YC HOLOGICA L SC IENCE...

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Research Report Childhood Poverty and Health Cumulative Risk Exposure and Stress Dysregulation Gary W. Evans and Pilyoung Kim Department of Design and Environmental Analysis and Department of Human Development, Cornell University ABSTRACT— A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms un- derlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by mul- tiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was over- night cortisol and the more dysregulated was the cardio- vascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent pov- erty (i.e., during adolescence) did not affect these physi- ological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumula- tive risk exposure accompanying childhood poverty. Poverty during early childhood is associated with increased morbidity and decreased life span in adulthood (Blane, Bartley, & Davey-Smith, 1997; Lawlor, Ronalds, Macintyre, Clark, & Leon, 2006). This association occurs irrespective of adults’ so- cial status (Kuh, Hardy, Langenberg, Richards, & Wadsworth, 2002; Poulton et al., 2002). Something in the early life experi- ences of low-income individuals sets them on a life trajectory of impaired health. Our focus in this article is on why this occurs. We suggest that poverty in early childhood harms health because stress regulatory mechanisms are damaged by excessive expo- sure to cumulative environmental risks during childhood. We tested this hypothesis by examining neuroendocrine and car- diovascular markers of stress regulation and cumulative phys- ical and social risk exposure in a longitudinal sample of low- and middle-income adolescents. Poverty and low socioeconomic status (SES) are associated with elevated basal measures of blood pressure in children un- der the age of 13 (Chen, Matthews, & Boyce, 2002). This link be- tween poverty and blood pressure vanishes by adolescence, although it reappears in adulthood (Chen et al., 2002). Two cross- sectional studies also have revealed elevated hypothalamic- pituitary-adrenocortical (HPA) axis activity among low-income, elementary-school-age children (Evans & English, 2002; Lupien, King, Meaney, & McEwen, 2000).
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