1. The Effects of High Cortisol Levels in Low Income Families
Ashley Maciejewski
Public Health 320
October 23, 2015
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2. Abstract
Five articles are chosen for review on research regarding cortisol levels in people of low
income. Under normal conditions cortisol follows a diurnal or circadian rhythm pattern—a peak
in the morning shortly after waking then a downward slope until midnight (Adam, et al., 2015).
In individuals with chronic stress, cortisol levels remain at a constant level throughout the day
(Adam, et al., 2015). Living in poverty can cause one to experience chronic stress as she or he
does not have the means to be in control of his or her life. Abnormal cortisol levels are linked to
various health problems, which in turn impact the lives of low income families (Castro-Diehl,
Diez Roux, Seeman, et al., 2014). After review, there is a consensus that living in poverty
increases the likelihood of experiencing abnormal cortisol levels in the bloodstream; however,
information on the association of cortisol and health problems is lacking in the research of the
articles.
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3. The Effects of High Cortisol Levels in Low Income Families
Introduction
According to the Centers for Disease Control and Prevention, 22 percent of children and
13 percent of adults lived in poverty in 2010 (Sebelius, et al. 2011). Poverty is particularly
prevalent among those of whom identify as Black or Hispanic. People living in poverty are
exposed to various psychosocial stressors, which cause the body to release cortisol—a steroid
hormone produced in the cortex of adrenal glands (Maglione-Garves, Kravitz, and Schneider,
2005). Steady levels of cortisol in the bloodstream makes one crave foods high in fat and sugar;
and causes fat stores and circulating fat to be relocated and deposited in the abdomen (Maglione-
Garves, et al. 2005). When cortisol levels remain high, obesity is likely to occur in the individual
(Maglione-Garves, et al. 2005). In turn, visceral obesity puts individuals at a greater risk for
developing cardiovascular disease, type II diabetes mellitus, and cerebrovascular disease (Epel,
et al. 2000). With steady and increased cortisol levels, people in poverty have a greater chance of
becoming overweight and developing serious health problems with fewer means of healthcare
and resources than those of higher socioeconomic status.
Methods
Research is conducted through the PubMed database accessed through the University of
Massachusetts Amherst Libraries WorldCat database. “Stress” and “income” are used as search
terms to find relevant articles; however, the search results are broad and most do not pertain to
cortisol levels in particular. The search terms are changed to “cortisol levels” and “income.” 91
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4. articles are available, but the number decreased to 32 after applying the filter of free full text.
Free full text is necessary to conduct accurate research. Other search terms in use include
“socioeconomic status” and “social determinants of health” to find more results. Articles are
chosen for review based on relevancy and professionalism. Articles that are not peer-reviewed
are automatically discarded. The articles for review, combined, make for a varied view on the
topic while at the same time staying specific. Research conducted in articles needs to have
accurate scientific methods of measuring cortisol levels.
Results
Normally, basal cortisol levels follow a circadian rhythm—cortisol levels are high right
after waking and experience a fifty to sixty percent increase after thirty minutes of being awake
(Adam, et al., 2015). From there, cortisol levels decline and reach a low point around midnight
(Adam, et al., 2015). When basal cortisol levels do not follow the normal circadian rhythm but
rather, are lower than normal when waking and display a flat slope throughout the day, chronic
stress is prevalent in the individual (Adam, et al., 2015). Cortisol levels following a constant flat
slope are more excessive than cortisol levels following a circadian rhythm. Excessive cortisol
levels are related to various health problems, such as visceral obesity, insulin resistance, and
hypertension (Castro-Diehl, et al., 2014). In one article, socioeconomic status is measured with
an income-wealth index score, and those with a higher income-wealth index score consistently
have lower cortisol levels than those of a lower income-wealth index score (Castro-Diehl, et al.,
2014). Similarly, in another study examining adults with type II diabetes mellitus, socioeconomic
status displays a significant association with diabetes distress (p = 0.01) and perceived stress (p =
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5. 0.001) (Walker, Gebregziabher, Martin-Harris, and Egede, 2014). Those with low socioeconomic
status have a difficult time dealing with their type II diabetes, resulting in chronic stress (Walker,
et al., 2014). Two articles are focused on children, either preschool aged children or infants. In
the study with preschool aged children of low income families, the children experience lower
morning cortisol levels than normal, resulting in a pattern that does not follow circadian rhythms
(Lumeng, Miller, Peterson, et al., 2014). In turn, many of those children are overweight and
display eating behaviors that contribute to gaining weight (Lumeng, et al., 2014). Similarly,
infants of low income families have higher diurnal cortisol levels than those of high income
families with the p-value of 0.02 (Saridjan, Huizink, Koetsier, et al., 2010). Also, the infants of
families rated with high parenting stress have higher diurnal cortisol levels than the infants of
families with no rating of parenting stress (Saridjan, et al., 2010). Although these studies are
varied in perspective and methods, there is a trend of a positive correlation between high cortisol
levels and low income. In turn, some articles discuss the effects, physical and mental, of having
steady high levels of cortisol through the bloodstream. Along with visceral obesity, insulin
resistance, and hypertension cited earlier, depression and anxiety are also noted; however, more
studies are needed (Adam, et al., 2015).
Discussion
The articles reviewed display different ideas and methodology when conducting scientific
studies. Race and perceived racial discrimination, socioeconomic status, income, psychosocial
factors, weight, and age are studied in relation to cortisol levels and/or chronic stress in general.
While these factors often coincide with each other and similarities are noted, specifics are found
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6. in the association between low income and high cortisol levels. Stressors can easily be affected
by income. For example, the less money one has, the less control one has over one’s life. Low
income families likely pay bills on a paycheck to paycheck basis, making saving and unexpected
costs difficult. Living on a low income for a long period of time is likely to induce long term
stress. When stress remains constant, cortisol levels in the blood remain high and steady instead
of showing the declined cortisol level slope throughout the day after 30 minutes of waking. The
articles tried to link cortisol levels to different social statuses and health concerns; however, few
are successful in gaining a significant correlation. For example, health concerns are discussed in
the introduction and/or abstracts of articles, but there is not substantial evidence in the studies to
show a correlation. People with low incomes have less availability to quality healthcare, which
can result in health problems being left untreated. Not having money to access healthcare can be
the reasoning behind the association between low income and certain health problems, instead of
high cortisol levels and low income. Alternatively, people earning low incomes may not be able
to afford healthy food, resulting in poor diet. While there are links between abnormal cortisol
levels and health problems, these particular articles do not adequately address the correlations.
Further and more specific studies need to be conducted. For example, a case-control study can be
conducted where the health outcome is high and abnormal cortisol levels. A large sample size is
needed, and accurate and systematic cortisol testing will be conducted over the span of a month.
After data is collected and outliers are removed from the study, two groups—normal cortisol
levels and abnormal cortisol levels—will be gathered. Both groups will have health exams and
questionnaires. People with genetic illnesses or disorders and health problems due to injury or
self-inflicted harm will be removed from the study. The data will then be assessed to determine a
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7. p-value of the hypothesis: Abnormal, high cortisol levels adversely affect the health of
individuals. If the p-value is significant, then another study will be conducted to test the
hypothesis: Living in poverty affects the cortisol levels of an individual, in that levels will not
follow a circadian rhythm pattern as normal. If that p-value is also significant and those two
studies are reviewed, then one can assess the accuracy of high cortisol levels caused by living
with low income attributes to poor quality of health. On the other hand, studies related to one
specific disease, such as cardiovascular disease, and cortisol levels can be conducted to make for
more compelling research.
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8. References
Adam, E. K., Heissel, J. A., Zeiders, K. H., Richeson, J. A., Ross, E. C., Ehrlich, K. B., et al.
(2015). Developmental histories of perceived racial discrimination and diurnal cortisol
profiles in adulthood: A 20-year prospective study. Psychoneuroendocrinology, 62,
279-291. DOI:10.1016/j.psyneuen.2015.08.018
Castro-Diehl, C., Diez Roux, A. V., Seeman, T., Shea, S., Shrager, S., & Tadros, S. (2014).
Associations of socioeconomic and psychosocial factors with urinary measures of cortisol
and catecholamines in the multi-ethnic study of atherosclerosis (MESA).
Psychoneuroendocrinology, 41, 132-141. DOI:10.1016/j.psyneuen.2013.12.013
Epel, E. S., McEwen, B., Seeman, T., Matthews, K., Castellazzo, G., Brownell, K. D., et al.
(2000). Stress and body shape: Stress-induced cortisol secretion is consistently greater
among women with central fat. Psychosomatic Medicine, 62(5), 623-632.
Lumeng, J. C., Miller, A., Peterson, K. E., Kaciroti, N., Sturza, J., Rosenblum, K., et al. (2014).
Diurnal cortisol pattern, eating behaviors and overweight in low-income preschool-aged
children. Appetite, 73, 65-72. DOI:10.1016/j.appet.2013.10.016
Maglione-Garves, C. A., Kravitz, L., & Scheider, S. (2005). Cortisol connection: Tips on
managing stress and weight. ACSM's Health & Fitness Journal, 9(5), 20-23.
Saridjan, N. S., Huizink, A. C., Koetsier, J. A., Jaddoe, V. W., Mackenbach, J. P., Hofman, A., et
al. (2010). Do social disadvantage and early family adversity affect the diurnal cortisol
rhythm in infants? the generation R study. Hormones and Behavior, 57(2), 247-254.
DOI:10.1016/j.yhbeh.2009.12.001
Sebelius, K., Frieden, T. R., Sondik, E. J., Berstein, A. B., Makuc, D. M., Bilheimer, L. T., et al.
(2012). In Centers for Disease Control and Prevention (Ed.), Health, united states, 2011:
With special feature on socioeconomic status and health (National Center for Health
Statistics Trans.). (DHHS Publication No. 2012-1232 ed.). Hyattsville, MD: United States
Department Of Health And Human Services.
Walker, R. J., Gebregziabher, M., Martin-Harris, B., & Egede, L. E. (2014). Relationship
between social determinants of health and processes and outcomes in adults with type 2
diabetes: Validation of a conceptual framework. BMC Endocrine Disorders, 14,
82-6823-14-82. DOI:10.1186/1472-6823-14-82
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