Date of Award

1-1-2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Aniyizhai Annamalai

Abstract

Cortisol is an important part of the body’s physiological response to stress. Chronic exposure to race-based discrimination and stress is thought to explain, in part, minority health disparities. Hair cortisol concentration (HCC) can be used as an objective proxy of a participant’s chronic stress prior to recruitment. It has not to our knowledge been used to investigate stress following an unexpected political event. President Trump issued in his first week in office multiple Executive Orders targeting minorities and immigrants. The Gallup-Sharecare Well-Being Index also showed significant declines in Democrats but not in Republicans, and in women but not in men, as well as greater declines in blacks and Hispanics than in whites, and in lower-income households. We set out to characterize the utility of HCC as a retrospective, longitudinal, and objective biomarker of the subjective experiences of and biological reactions to stress in a population of predominantly minority and immigrant women during the first year of the Trump presidency. We hypothesized that the highest hair cortisol levels would be measured in those individuals reporting the highest stress levels, and that the largest increases in hair cortisol over our study period will be observed among immigrants, who face the most acute politically-related stress. We conducted surveys and collected hair samples from 64 women at the Yale Primary Care Center between September and November, 2017. The surveys assessed for demographic characteristics, political leaning, Perceived Stress Scale (PSS), and Everyday Discrimination Scale, and the hair samples were segmented and assayed for cortisol concentrations. We found that white women reported higher perceived stress (20.12) compared to Hispanic (15.13) or black (16.08) women (P=0.0921), and that Hispanic women reported lower everyday discrimination (1.44) compared to white (2.76) or black (3.00) women (P=0.0101). Overall HCC were not statistically significantly different across demographic strata, but PSS scores demonstrated dose-dependent relationships with overall HCC. PSS scores were also significantly predictive of overall HCC in the multivariate robust regression, with the highest PSS scores having a mean overall HCC 7.66 pg/mg higher than the lowest PSS scores (P=0.0304). Of all strata examined, the 15 foreign-born women were the most likely to have an increase in HCC (93%), and also had the largest relative increases over baseline (97%). Women with the most negative political leaning scores (indicating negative perceptions of Republican and Trump administration policies) had the greatest absolute increase in HCC (4.81 pg/mg) of any strata examined. In the stepwise logistic regression, birthplace was found to significantly impact the odds of experiencing a positive HCC trend (P=0.0126), and women in the less negative political leaning categories were significantly less likely to experience an increase in HCC over the study period compared to women in the most negative political leaning category (P=0.0235). In conclusion, we advocate for the use of HCC trends, controlling for baseline HCC levels as a confounder, as a more sensitive biomarker for the acute stress that may be associated with sudden and unanticipated political events or policy changes. Foreign-born women had the lowest mean overall HCC of any subpopulation of the study but also had the sharpest increase in HCC of any demographic strata. We believe that our exploration supports anecdotal evidence about the impact of macro-environmental political changes on female minorities and immigrants in New Haven, and provides a window into a possible mechanism for the deleterious effects of politics on health.

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