Resilience in Adolescence, Health, and Psychosocial Outcomes

Reflections on resilience

Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.

When Common Becomes Normal: Weaker Association Between Neighborhood Stress and Body Mass Index Among Black Adolescents Compared to White Adolescents

Objective

This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents.

Methods

Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents.

Results

A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders.

Conclusions

The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.

Socioeconomic disadvantage and high-effort coping in childhood: evidence of skin-deep resilience

BACKGROUND

Low socioeconomic status (SES) is a risk factor for poor outcomes across development. Recent evidence suggests that, although psychosocial resilience among youth living in low-SES households is common, such expressions of resilience may not extend to physical health. Questions remain about when these diverging mental and physical health trajectories emerge. The current study hypothesized that skin-deep resilience - a pattern wherein socioeconomic disadvantage is linked to better mental health but worse physical health for individuals with John Henryism high-effort coping - is already present in childhood.

METHODS

Analyses focus on 165 Black and Latinx children (Mage  = 11.5) who were free of chronic disease and able to complete study procedures. Guardians provided information about their SES. Children reported on their John Henryism high-effort coping behaviors. They also provided reports of their depressed and anxious mood, which were combined into a composite of internalizing symptoms. Children's cardiometabolic risk was captured as a composite reflecting high levels of systolic or diastolic blood pressure, waist circumference, HbA1c, triglycerides, and low high-density lipoprotein cholesterol.

RESULTS

Among youth who reported using John Henryism high-effort coping, SES risk was unrelated to internalizing symptoms and was positively associated with cardiometabolic risk. In contrast, for youth who did not engage in high-effort coping, SES risk was positively associated with internalizing symptoms and was unrelated to cardiometabolic risk.

CONCLUSIONS

For youth with high-effort coping tendencies, socioeconomic disadvantage is linked to cardiometabolic risk. Public health efforts to support at-risk youth must consider both mental and physical health consequences associated with striving in challenging contexts.

Skin-deep Resilience and Early Adolescence: Neighborhood Disadvantage, Executive Functioning, and Pubertal Development in Minority Youth

Skin-deep resilience, in which youth overcome adversity and achieve success in psychological and academic domains but at a cost to their physiological well-being, has been documented in late adolescence and adulthood. However, its potential to emerge at earlier developmental stages is unknown. To address this gap, secondary data analyses were executed using waves 1 and 2 of the Adolescent Brain Cognitive Development study (n = 7712; ages 9-10 years at baseline [mean: 9.92; SD = 0.63]; 47.1% female; 66.1% White, 13.4% Black, and 20.6% Hispanic). The results indicated high levels of executive functioning were associated with improved psychological and behavioral outcomes at one-year follow-up. However, for racial and ethnic minority (i.e., Black or Hispanic) youth from disadvantaged neighborhoods, high levels of executive functioning were also associated with accelerated pubertal development. No significant interaction was observed among White youth. The findings suggest the skin-deep resilience pattern may be evident in early adolescence.

Perceived stress and resilience among college students: The roles of self-compassion and anxiety symptomatology

OBJECTIVE

The current study explored the role of self-compassion on the relationship between perceived stress and resilience among college students experiencing different levels of anxiety symptomatology.

PARTICIPANTS

Three hundred and forty-five undergraduate students (Mage= 19.66; 74.8% female) were recruited from a public university in the northeastern United States.

METHODS

Participants completed self-report measures assessing perceived stress, self-compassion, anxiety symptomatology, and resilience.

RESULTS

Self-compassion was found to indirectly affect the association between perceived stress and resilience at both low (b = -0.06, 95% CI [-0.08, -0.04]) and high levels (b = -0.03, 95% CI [-0.05, -0.01]) of anxiety symptomatology. The index of moderated mediation was significant (b = 0.005, 95% CI [0.001, 0.01]).

CONCLUSIONS

Results of the present study suggest that interventions to enhance resilience should incorporate strategies aimed at managing stress and anxiety and increasing self-compassion.

Resilience in children with chronic illness: Tests of the shift-and-persist and skin-deep resilience theories

This study investigated, and discusses the integration of, the shift-and-persist (SAP) and skin-deep resilience (SDR) theories. The SAP theory states that the combination of shifting (adjusting oneself to stressful situations through strategies like emotion regulation) and persisting (enduring adversity with strength by finding meaning and maintaining optimism) will be beneficial to physical health in children experiencing adversity. The SDR theory states that high striving/self-control will be beneficial to mental health but detrimental to physical health among those confronting adversity. This study investigated 308 children ages 8-17 experiencing the adversity of a chronic illness (asthma). SAP and SDR (striving/self-control) were assessed via questionnaires, and physical health (asthma symptoms, inflammatory profiles), mental health (anxiety/depression, emotional functioning), and behavioral (medication adherence, activity limitations, collaborative relationships with providers) outcomes were measured cross-sectionally. SAP was associated with better physical health, whereas SDR was associated with worse physical health. Both were associated with better mental health. Only SDR was associated with better behavioral outcomes. Implications of findings and discussion of how to integrate these theories are provided. We suggest that future interventions might seek to cultivate both SAP and SDR to promote overall better health and well-being across multiple domains in children experiencing adversity.

Family Risk Exposure Profiles During Early Childhood: Developmental Processes and Adolescent Well-Being

Although prior work indicates that exposure to multiple family risk factors negatively impacts adjustment in childhood and adolescence, few studies have examined whether children in high-risk families transition in and out of adversity during early childhood and whether patterns of change matter for adjustment in adolescence. Using data from a sample of 216 caregiver-child dyads participating in a study of prenatal cocaine exposure (116 exposed and 100 non-exposed; 50.9% girls), we used latent transition analysis to identify distinct profiles of early exposure to caregiver substance use (SU) and SU-related familial risk (caregiver psychological distress, exposure to violence, harshness, and low sensitivity) and the association between these profiles and adolescent well-being (i.e., hope, happiness, and life satisfaction). Assessments occurred when children were 13, 24, 36, and 48 months and during kindergarten (Mmonths = 66.16, SD = 4.47) and early adolescence (Myears = 13.26, SD = 0.88). Caregivers self-identified as 72.09% Black, 15.81% White, 10.23% Hispanic/Latinx, 1.40% other, and 0.47% American Indian. Four profiles of varying levels of exposure to caregiver SU and SU-related risks were identified from infancy to kindergarten: SU/family risks, no SU/low family risks, SU/negative parenting, and SU/low family risks. Most children stayed in the same profile (64.2%), while the rest transitioned between profiles. Children exposed to caregiver SU and family adversity had lower positive outcomes in adolescence. Stable membership in the SU/family risks profile had significant maladaptive consequences on adolescent well-being. Implications for research and the design of tailored interventions to promote well-being among at-risk youth are discussed.

Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review

OBJECTIVE

To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

MATERIALS AND METHODS

The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

RESULTS

A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

CONCLUSIONS

Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

Racial Disparities in School Belonging and Prospective Associations With Diabetes and Metabolic Syndrome

Importance

School belonging has important implications for academic, psychological, and health outcomes, but the associations between racial disparities in school belonging and health have not been explored to date.

Objective

To examine associations between school-level racial disparities in belonging and cardiometabolic health into adulthood in a national sample of Black and White children, adolescents, and young adults.

Design, Setting, and Participants

Prospective cohort study of a US national sample of 4830 Black and White students (National Longitudinal Study of Adolescent Health) followed up for 13 years. The study was conducted from 1994 to 1995 for wave 1 and in 2008 for wave 4. Data were analyzed from June 14 to August 13, 2021.

Main Outcomes and Measures

School-level racial disparities in belonging at baseline were calculated as the mean level of school belonging for Black students minus the mean level of school belonging for White students at the school that they attended when they were aged 12 to 20 years. Diabetes and metabolic syndrome were measured as outcomes for these same participants at 24 to 32 years of age.

Results

The study included 4830 students. For wave 1, mean (SD) age was 16.1 (1.7) years, and for wave 4, 29.0 (1.7) years. A total of 2614 (54.1%) were female, 2219 were non-Hispanic Black (45.9%), and 2611 were non-Hispanic White (54.1%). Among Black students, attending a school with a greater Black-White disparity in school belonging (more negative scores) was associated with an increased risk for diabetes (odds ratio, 0.66 [95% CI, 0.46-0.95]) and more risk factors for metabolic syndrome (rate ratio, 0.95 [95% CI, 0.90-1.00]) in adulthood 13 years later. These associations persisted above individual-level controls (age, sex, and body mass index) and school-level controls (school size, percentage of Black students, and percentage of Black teachers) and were not explained by either an individual's own perception of school belonging or the mean level of belonging across the whole school.

Conclusions and Relevance

In this prospective cohort study of US students, racial disparities in school belonging were associated with risks for diabetes and metabolic syndrome in Black students. Among students, fostering a more equal sense of school belonging across racial groups may have implications for health disparities in the cardiometabolic domain into adulthood.

Mentorship in adolescence and subsequent depression and adiposity among child maltreatment survivors in a United States nationally representative sample

Child maltreatment (CM) is associated with multiple adverse health outcomes. Hence, there is a great need to identify factors that promote resilience in CM survivors. Mentorship may promote positive coping in CM survivors, but this may vary by health outcome and mentor/mentee characteristics. Among participants in a United States nationally representative sample, the National Longitudinal Study of Adolescent to Adult Health, who retrospectively reported any CM before age 18 (sexual, emotional or physical, abuse or neglect; N = 3364), we examined associations between mentorship during adolescence and body mass index (BMI), obesity, and depressive symptoms at ages 24-32 (in 2008-2009). We utilized linear regression and predictive margins with complex sample weighting. Models were stratified by sex and race/ethnicity. Thirty-one percent and 40% of participants' most influential mentor was inside and outside the family, respectively, and 29% reported no mentor. Any mentorship was associated with decreased depressive symptoms in females (adjusted beta for any mentor = -0.78, 95% CI:-1.54,-0.02). By contrast, any mentorship was associated with increased adiposity, namely among Latinas (adjusted beta for BMI = 2.23, 95% CI:0.45,4.02, adjusted risk ratio for obesity = 1.42, 95% CI:1.03,1.97). The influence of mentorship in CM survivors is heterogeneous. While mentorship was associated with reduced psychopathology, it was also linked with worse physical health, underscoring that mentoring does not necessarily promote long-term resilience to physical health outcomes, particularly in minorities. A better understanding of how mentors influence specific mentee behaviors may be important in informing how mentors can promote better physical health and lower obesity risk among CM survivors.

Explaining Physical Health Disparities and Inequalities Over the First Half of the Life Course: An Integrative Review of Add Health Studies

This integrative review of research utilizing the National Longitudinal Study of Adolescent to Adult Health draws on previous research detailing pathways linking early socioeconomic adversity in childhood and adolescence (Wave 1 in 1995 and prior) to physical health outcomes in young adulthood (Wave 5 in 2015). Health outcomes considered included specific diseases, disease risk, and morbidity as prospectively measured by parent-reported and self-reported health outcomes as well as clinical biomarkers. A heuristic research framework was developed from the comprehensive review focused on 4 study designs and identifying total associations, physiological pathways, stress pathways, and resources pathways linking early socioeconomic adversity to physical health outcomes for young adults, as well as potential modifiers of these pathways. The appropriateness of different analytical strategies used in these research studies including approaches for analysis of change in health are discussed. Taken together, review findings suggest the merit of an integrated perspective taking a long view over early life course to explain cumulative physical health risk over the first half of the life course by assessing multiple pathways simultaneously. Looking forward, the review findings also emphasize the need for the investigation of the continuity and change in these pathways over the second half of the life course.

Cost of resilience: Childhood poverty, mental health, and chronic physiological stress

Childhood poverty is associated with elevated internalizing symptoms. Nevertheless, some children exposed to poverty evince remarkable resilience, demonstrating lower than expected levels of psychological distress. However, recent work suggests that coping with adversity can lead to undesirable physical health consequences. Specifically, successful adaptation in the context of early adversity, including socioeconomic disadvantage, appears to be associated with elevated chronic physiological stress and ill health. The current study adds to this emerging literature by examining in a longitudinal context whether low levels of internalizing symptoms in the face of childhood poverty is accompanied by elevated chronic physiological stress (allostatic load) during childhood, as well as over time from childhood to adulthood. Results (n = 341; M=9.2 years, 49 % female; 94 % Caucasian) show that childhood poverty was prospectively associated with higher allostatic load during adolescence, controlling for baseline allostatic load. Furthermore, greater duration of childhood poverty led to steeper, more elevated allostatic load trajectories from childhood to adulthood, for youth with lower levels of internalizing symptoms. Efforts to manage adverse sequelae of early adversity likely yield a complex array of benefits and costs.

Shift-&-Persist and discrimination predicting depression across the life course: An accelerated longitudinal design using MIDUSI-III

Life course theorists posit that sensitive periods exist during life span development where risk and protective factors may be particularly predictive of psychological outcomes relative to other periods in life. While there have been between-cohort studies trying to examine differences in discrimination and depressive symptoms, these studies have not been designed to identify these sensitive periods, which are best modeled by examining intra-individual change across time. To identify sensitive periods where discrimination and shift-&-persist (S&P) - a coping strategy that may protect against the negative impact of discrimination - are most strongly predictive of depressive symptoms, we employed latent growth curve modeling using an accelerated longitudinal design to track intra-individual change in depressive symptoms from ages 20-69. Participants were 3,685 adults measured at three time points ~10 years apart from the Midlife in the United States study (Mage = 37.93, SD = 6.948 at Wave I). Results identified two sensitive periods in development where high levels of S&P interacted with discrimination to protect against depressive symptoms; during the 30s and a lagged effect where 40's S&P protected against depressive symptoms when participants were in their 50s. Implications for the life course study of discrimination, coping, and depression are discussed.

Positive affect decreases the negative association between social mobility belief and physical health among Chinese rural-to-urban migrant adolescents

OBJECTIVE

The belief in upward social mobility promotes the mental health and social adaptation of disadvantaged adolescents. However, efforts for upward mobility may facilitate psychosocial adaptation while undermining physical health for minority youth from disadvantaged backgrounds. Therefore, we aimed to examine how social mobility belief is associated with mental and physical health among Chinese rural-to-urban migrant adolescents and explore whether positive affect acts as a protective factor moderating these relationships.

METHOD

A total of 158 rural-to-urban migrant adolescents aged 10-14 completed a self-report questionnaire and underwent medical examination.

RESULTS

Social mobility belief and positive affect were positively related to mental health (general self-efficacy). Positive affect interacted with social mobility belief in predicting physical health (self-rated health and allostatic load). For migrant adolescents with low levels of positive affect, strong belief in social mobility was associated with poor self-rated health and high allostatic load. For migrant adolescents with high levels of positive affect, their physical health was better and not associated with social mobility belief.

CONCLUSIONS

Social mobility belief showed a double-edged sword effect; it was positively associated with mental adaptation while negatively associated with physical health among Chinese rural-to-urban migrant adolescents. Positive affect acted as a protective factor for decreasing the negative association between social mobility belief and physical health.

Planful Self-Control, Metabolic Risk, and Psychosocial Outcomes Among Young, Black Men: A Test of Skin-Deep Resilience Theory

Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men's psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one's likelihood of obtaining a bachelor's degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.

Downward income mobility among individuals with poor initial health is linked with higher cardiometabolic risk

The effects of socioeconomic position (SEP) across life course accumulate and produce visible health inequalities between different socioeconomic groups. Yet, it is not well-understood how the experience of intergenerational income mobility between origin and destination SEP, per se, affects health outcomes. We use data from the National Longitudinal Study of Adolescent to Adult Health collected in the United States with the outcome measure of cardiometabolic risk (CMR) constructed from data on LDL Cholesterol, Glucose MG/DL, C-reactive protein, systolic and diastolic blood pressure, and resting heart rate. Intergenerational income mobility is estimated as the difference between Waves 1 and 5 income quintiles. Diagonal reference models are used to test if intergenerational income mobility, net of origin and destination income quintile effects, is associated with CMR. We find that individuals in the lowest and the highest income quintiles have, respectively, the highest and the lowest CMR; both origin and destination income quintiles are equally important; there are no significant overall income mobility effects for different gender and race/ethnicity groups, but downward income mobility has negative health implications for individuals with poor initial health. We conclude that downward income mobility can increase inequalities in CMR in the United States by worsening the health of those who had poor health before their mobility experiences.

Resilience and Family Socialization Processes in Ethnic Minority Youth: Illuminating the Achievement-Health Paradox

Youth in marginalized communities who "strive" to rise above adversity, including systemic racism and poverty, are considered "resilient." African-American, Latinx, and Asian-American youth often achieve admirable academic success despite limited social capital and high early life stress by adopting a "striving persistent behavioral style" (SPBS). SPBS may be supported by family socialization processes that facilitate reliance on self-regulation processes. Unfortunately, a young person's resilience in one domain (i.e., academic) can come at a cost in other domains, including physical and mental health morbidities that are under-identified and under-treated. Indeed, research suggests a link between SPBS in the face of adversity and later health morbidities among ethnic minority youth. Herein, we describe SPBS as an adaptation to minority stress that not only promotes social mobility but may also stoke physical and mental health disparities. We review how family processes related to academic, emotional, and ethnic-racial socialization can facilitate the striving persistent behavioral style. We emphasize the double bind that ethnic minority families are caught in and discuss directions for future research and clinical implications for individual and family-level interventions. While needed, we argue that individual and family-level interventions represent a near-term work around. Solutions and factors that shape the need for SPBS and its cost must be addressed structurally.

What Are the Health Consequences of Upward Mobility?

Health disparities by socioeconomic status (SES) have been extensively documented, but less is known about the physical health implications of achieving upward mobility. This article critically reviews the evolving literature in this area, concluding that upward mobility is associated with a trade-off, whereby economic success and positive mental health in adulthood can come at the expense of physical health, a pattern termed skin-deep resilience. We consider explanations for this phenomenon, including prolonged high striving, competing demands between the environments upwardly mobile individuals seek to enter and their environments of origin, cultural mismatches between adaptive strategies from their childhood environments and those that are valued in higher-SES environments, and the sense of alienation, lack of belonging, and discrimination that upwardly mobile individuals face as they move into spaces set up by and for high-SES groups. These stressors are hypothesized to lead to unhealthy behaviors and a dysregulation of biological systems, with implications for cardiometabolic health.

Effects of social support in an academic context on low-grade inflammation in high school students

Bolstering academic motivation is a high priority in school settings, but some evidence suggests this could take a toll on students' physical health. To address this, this study compared the effects of an experimental manipulation of academic motivation alone (AM) to academic motivation enhanced with social support (SS + AM) on markers of inflammation in a sample of 80 high school 9th graders. Outcomes included low-grade inflammation: C-reactive protein (CRP) and interleukin-6 (IL-6); a motivation measure; and grade point average (GPA), taken at baseline and follow-up (beginning and end of school year, respectively). Students in the SS + AM condition had lower levels of inflammation at follow-up (covarying baseline levels) compared to those in the AM condition. The two groups were equivalent on motivation and GPA at follow-up. This preliminary study suggests that incorporating social support into academic motivation programs has the potential to benefit inflammatory markers in young people while allowing them to maintain positive academic outcomes.

Socioeconomic position, social mobility, and health selection effects on allostatic load in the United States

The contemporaneous association between higher socioeconomic position and better health is well established. Life course research has also demonstrated a lasting effect of childhood socioeconomic conditions on adult health and well-being. Yet, little is known about the separate health effects of intergenerational mobility-moving into a different socioeconomic position than one's parents-among early adults in the United States. Most studies on the health implications of mobility rely on cross-sectional datasets, which makes it impossible to differentiate between health selection and social causation effects. In addition, understanding the effects of social mobility on health at a relatively young age has been hampered by the paucity of health measures that reliably predict disease onset. Analysing 4,713 respondents aged 25 to 32 from the National Longitudinal Study of Adolescent Health's Waves I and IV, we use diagonal reference models to separately identify the effects of socioeconomic origin and destination, as well as social mobility on allostatic load among individuals in the United States. Using a combined measure of educational and occupational attainment, and accounting for individuals' initial health, we demonstrate that in addition to health gradient among the socially immobile, individuals' socioeconomic origin and destination are equally important for multi-system physiological dysregulation. Short-range upward mobility also has a positive and significant association with health. After mitigating health selection concerns in our observational data, this effect is observed only among those reporting poor health before experiencing social mobility. Our findings move towards the reconciliation of two theoretical perspectives, confirming the positive effect of upward mobility as predicted by the "rags to riches" perspective, while not contradicting potential costs associated with more extensive upward mobility experiences as predicted by the dissociative thesis.

Risky family climates presage increased cellular aging in young adulthood

A scientific consensus is emerging that children reared in risky family climates are prone to chronic diseases and premature death later in life. Few prospective data, however, are available to inform the mechanisms of these relationships. In a prospective study involving 323 Black families, we sought to determine whether, and how, childhood risky family climates are linked to a potential risk factor for later-life disease: increases in cellular aging (indexed by epigenetic aging). As hypothesized, risky family climates were associated with greater outflows of the stress hormones epinephrine and norepinephrine at ages 19 and 20 years; this, in turn, led to increases in cellular aging across ages 20-27 years. If sustained, these tendencies may place children from risky family climates on a trajectory toward the chronic diseases of aging.

Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities

The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.

Youth academic achievement, social context, and body mass index

This study assesses the relationship between academic achievement and body mass index for age (BMI) trajectories across childhood and adolescence, and investigates how this relationship is moderated by social context. Specifically, we test the hypothesis that academic achievement is not associated with improved BMI among youth from disadvantaged social contexts. We test for differences by race/ethnicity, and examine the role of county-level economic mobility in shaping these patterns. We use data from the longitudinal Fragile Families and Child Wellbeing Study (FFCWS), an ongoing birth cohort study representative of children born in large US cities in 2000, and measure BMI, academic achievement, and social context at Years 5, 9, and 15. Estimating multilevel random effects linear regression models of BMI from childhood to adolescence, we find that youth who were exposed to social advantage displayed a negative association between academic achievement and BMI. In contrast, youth exposed to social disadvantage displayed no association between academic achievement and BMI. This difference was observed regardless of race/ethnicity. County-level economic mobility modified the observed relationship, such that youth living in places with low levels of mobility displayed higher BMI associated with high academic performance. The results suggest that the health costs of academic achievement among disadvantaged youth are concentrated in areas with low institutional support for upward mobility. The findings demonstrate that the unequal benefits of educational attainment begin early in life, while living in places that promote upward mobility can help individuals realize the health benefits of their own educational attainment.

Characterizing competence among a high-risk sample of emerging adults: Prospective predictions and biological considerations

Few conditions epitomize severe and chronic stress to a greater extent than child maltreatment, which can derail development across multiple domains of functioning and throughout the life course. Furthermore, child maltreatment tends to co-occur with other adversities, such as poverty. Many individuals grow up under the stressful conditions of these adversities and exhibit developmental competence. The current study prospectively charted the developmental progression of economically disadvantaged maltreated and nonmaltreated children from childhood to emerging adulthood, and examined patterns of competence across multiple developmental domains of functioning central to the period of emerging adulthood. The study investigated childhood precursors to these patterns of adaptation and maladaptation, as well as the physiological cost of these patterns of adaptation (i.e., C-reactive protein; CRP). Latent class analysis revealed four distinct classes of functioning: multifaceted competence across domains (Multifaceted Competence); (multifaceted maladaptation across domains (Multi-Problem); (c) and two classes with mixed patterns of competence and maladaptation (Externalizing Problems and Work/School Impairment). Maltreated individuals were less likely than nonmaltreated individuals to demonstrate patterns of multifaceted competence and more likely to demonstrate aggregate maladaptation across domains. Additionally, Black men who demonstrated a pattern of multifaceted psychosocial competence also evidenced higher levels of low-grade inflammation (indexed by CRP), suggesting physiological distress was associated with adaptation in the context of stress among these individuals. Findings demonstrate the heterogenous patterns of functioning and diverse developmental outcomes that follow early adversity.

How does the social world shape health across the lifespan? Insights and new directions

Decades of research highlight the connections between stressful life experiences-particularly those experienced in childhood-and physical health across the lifespan. In recent years, studies at the intersection of social and biomedical science have provided intriguing insights into the biological mechanisms that might explain how chronic and acute stressors give rise to health problems, sometimes decades later in life. To date, efforts to understand these connections have relied on a handful of study designs, and these studies have revealed important observations about how stressful experiences are thought to shape health. At the same time, these study designs have some drawbacks that limit the conclusions that can be drawn about the role of the social world for health. This article provides an overview of research on social determinants of health and includes a discussion of conceptual and methodological directions for the field to consider. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Retrospective development of a novel resilience indicator using existing cohort data: The adolescent to adult health resilience instrument

Background

Cohort studies represent rich sources of data that can be used to link components of resilience to a variety of health-related outcomes. The Adolescent to Adult Health (Add Health) cohort study represents one of the largest data sets of the health and social context of adolescents transitioning into adulthood. It did not however use validated resilience scales in its data collection process. This study aimed to retrospectively create and validate a resilience indicator using existing data from the cohort to better understand the resilience of its participants.

Methods

Questions asked of participants during one Add Health data collection time period (N = 15,701) were matched to items on a well-known and widely validated resilience scale called the Connor Davidson Resilience Scale. Factor analysis and psychometric analyses were used to refine and validate this novel Adolescent to Adult Health Resilience Instrument. Construct validity utilized participants’ answers to the 10 item Center for Epidemiologic Studies Depression Scale, which has been used to validate other resilience scales.

Results

Factor analysis yielded an instrument with 13 items that showed appropriate internal consistency statistics. Resilience scores in our study were normally distributed with no ceiling or floor effects. Our instrument had appropriate construct validity, negatively correlating to answers on the depression scale (r = -0.64, p<0.001). We also found demographic differences in mean resilience scores: lower resilience scores were seen among women and those who reported lower levels of education and household income.

Conclusions

It is possible to retrospectively construct a resilience indicator from existing cohort data and achieve good psychometric properties. The Adolescent to Adult Health Resilience Instrument can be used to better understand the relationship between resilience, social determinants of health and health outcomes among young adults using existing data, much of which is publicly available.

Adolescent college expectation and nutritional health in adulthood: The hidden power of social position

Few studies investigated whether expected college attendance in adolescence may generate comparable health benefits in early adulthood for the disadvantaged and the privileged. Using data from the National Longitudinal Study of Adolescent to Adult Health, this study examined the contingent associations of college attendance expectation with weekly fast food consumption (FFC), sugar-sweetened beverage consumption (SBC), physical activity (PA), and obesity in early adulthood based on four social position indicators: family poverty, neighborhood poverty, parental education, and race. Results suggested that family poverty, neighborhood poverty, and low parental education significantly compromised college expectation's associations with all outcomes except for PA. Further, college expectation's negative associations with FFC and SBC were lower for Blacks than for Whites; and college expectation's negative association with SBC and positive association with PA were lower for Hispanics than for Whites. These findings imply that the "ambition inflation" among American youth, often celebrated by the American culture for its acclaimed life changing power, may be not equally benefiting the disadvantaged and the privileged. Future behavioral interventions focusing on fostering a positive outlook in youth should consider possible effect heterogeneity based on social background.

Evidence for skin-deep resilience using a co-twin control design: Effects on low-grade inflammation in a longitudinal study of youth

This study tested the skin-deep resilience hypothesis - that low socioeconomic status (SES) youth who are working hard to succeed in life experience good psychological and educational outcomes but at a cost to their physical health - in a sample of monozygotic (MZ) twins. The National Longitudinal Study of Adolescent Health (Add Health) contained a sample of 226 MZ twin pairs at Wave 1 (M age = 16 years), of whom 141 pairs completed the Wave 4 assessment 13 years later (M age = 29 years). Family SES was measured at Wave 1 via income, education, and occupation. Conscientiousness was measured at Wave 4 as an indicator of those who were working hard to succeed in life. Outcomes measured at Wave 4 included low-grade inflammation (C-reactive protein, CRP), mental health (depression, problematic alcohol use), and academic success (educational attainment). A co-twin control design was utilized which directly compared within-twin differences in the association between conscientiousness and life outcomes. Main effects of between-twin conscientiousness were found such that higher levels of conscientiousness were associated with higher educational attainment, fewer symptoms of depression, and less problematic alcohol use, across all SES groups. An interaction between family SES and within-twin difference in conscientiousness was found for CRP, such that, among twins growing up in lower SES households, the twin with higher levels of conscientiousness had higher levels of CRP. These patterns provide support for the phenomenon of skin-deep resilience using a twin methodology that reduces the possibility of confounding by shared genetic and environmental factors.

Protective factors for youth confronting economic hardship: Current challenges and future avenues in resilience research

Economic hardship during childhood is associated with worse mental and physical health across the life span. Over the past decade, interdisciplinary research has started to elucidate the behavioral and biological pathways that underlie these disparities and identify protective factors that mitigate against their occurrence. In this integrative review we describe these advances, highlight remaining gaps in knowledge, and outline a research agenda for psychologists. This article has 3 aims. First, we consider the evolving psychobiological literature on protective factors and conclude that supportive relationships can mitigate against the physical health problems often associated with economic hardship. Second, we discuss recent empirical developments in health psychology, public health, and the biological sciences, which reveal trade-offs associated with adaptation and challenge the conception of what it means to be resilient. Finally, we outline a research agenda that attempts to integrate existing knowledge on health disparities with these newer challenges to inform both policy and practice for youth experiencing economic hardship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Persistence of skin-deep resilience in African American adults

OBJECTIVE

The skin-deep resilience pattern suggests that, for low-socioeconomic-status African American youths, the ability to maintain high self-control and to persist with efforts to succeed may act as a double-edged sword, facilitating academic success and adjustment while undermining physical health. We extend research by following a sample of rural African Americans, asking whether the skin-deep resilience pattern, evident during adolescence, persists into adulthood by increasing susceptibility to metabolic syndrome (MetS) and insulin resistance (IR).

METHODS

The sample included 368 11-year-old African Americans, their parents, and their teachers. Parents provided data on family poverty across ages 11-18 years. Teachers provided data on youths' planful self-control across ages 11-13 years. At age 27 years, participants completed questionnaires about educational attainment and psychological adjustment and provided a fasting blood sample from which MetS and IR were assessed.

RESULTS

Regardless of years spent living in poverty, planful self-control during childhood was associated with college graduation (p < .001) and with low levels of depressive symptoms (p = .016) and antisocial behavior (p = .028). For participants exhibiting high levels of self-control, however, living more years in poverty across adolescence was associated with a greater number of MetS components that met clinical cutoff criteria (p = .018) and greater IR (p = .016) during adulthood.

CONCLUSIONS

The skin-deep resilience pattern persists into adulthood, particularly among those who spent more of their adolescence living in poverty, and increases vulnerability to MetS and IR while it also promotes college graduation and positive psychological adjustment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Redefining Resilience and Reframing Resistance: Empowerment Programming with Black Girls to Address Societal Inequities

Black girls in the U.S. experience high levels of discrimination and adversity. Resilience is a term used within social work, psychology, and health professions to indicate positive adaptation to adversity, trauma, or stress. This article examines traditional and alternative models of resilience through analyses of quantitative and qualitative data from an evaluation of a year-long empowerment program for 33 Black girls (mean age = 14.97 years). Based on critical consciousness theory and Black feminism, this program was designed to empower participants through critical reflection and development of positive gendered racial identity. Quantitative analyses found no change over time in traditional measures of individual resilience. However, alternative measures of collective resilience show positive change. Specifically, quantitative analyses reveal that participants developed increased awareness of structural inequalities faced by Black girls/women and decreased adherence to neoliberal ideologies of personal responsibility and individual striving. Additionally, qualitative analyses show that participants critically reflected on their experiences of oppression, developed mutual support and positive gendered racial identity, and engaged in collective action. These findings demonstrate positive effects of empowerment-based programing, challenge the utility of traditional, individually-focused models of resilience, and reframe Black girls' resistance to injustice as an alternative, collective form of resilience.

A Strategic Plan for Strengthening America's Families: A Brief from the Coalition of Behavioral Science Organizations

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.

Childhood socioeconomic status and inflammation: Psychological moderators among Black and White Americans

OBJECTIVE

The current study examined race differences in how childhood socioeconomic status (SES) predicted midlife inflammation. It also tested psychological resources (purpose in life, optimism, and conscientiousness) as moderators of the association between childhood SES and inflammation among Black and White adults.

METHOD

Data came from the biomarker subsamples of the Midlife in the United States Core and Refresher studies (n = 1,578 White and n = 395 Black participants). Childhood SES was operationalized as a composite of parental education, perceived financial status, and welfare status. Outcomes included circulating IL-6 and CRP.

RESULTS

Childhood SES did not predict IL-6 or CRP among Black or White adults in fully adjusted models. Among Black adults with low optimism, lower childhood SES predicted higher IL-6 and CRP. Among Black adults with low purpose in life, lower childhood SES predicted higher CRP (but not IL-6). Conscientiousness did not moderate childhood SES-inflammation associations among Black adults. Among White adults with low conscientiousness or low optimism, lower childhood SES predicted higher IL-6 (but not CRP). Purpose in life did not moderate associations among White adults. Effect sizes were small (≤1% variance explained) and comparable to effects of clinical risk factors in this sample (e.g., age, chronic conditions).

CONCLUSIONS

Race differences in the childhood SES and inflammation association were not apparent. Childhood SES was linked to inflammation more strongly among those with fewer psychological resources across both racial groups. Psychological resources may be important moderators of inflammation in the context of early life SES disadvantage. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Youth Who Achieve Upward Socioeconomic Mobility Display Lower Psychological Distress But Higher Metabolic Syndrome Rates as Adults: Prospective Evidence From Add Health and MIDUS

Background

People with higher socioeconomic status generally enjoy better cardiovascular health across the life course than those with lower status. However, recent studies of upward mobility, where a child goes on to achieve higher socioeconomic status than his or her parents, suggest that it entails a tradeoff between better psychological well‐being and worse cardiometabolic health. In this study, we consider further evidence of this tradeoff in 2 multidecade studies, asking how upward income mobility relates to subsequent perceived stress, depressive symptoms, and metabolic syndrome. We ask parallel questions about downward mobility. Finally, given shifting patterns of mobility in recent generations, we also consider whether mobility's association with health outcomes differs for individuals born in the middle and later parts of the 20th century.

Methods and Results

We analyzed prospective data from Add Health (National Longitudinal Study of Adolescent Health; N=7542) and MIDUS (Midlife in the United States Study; N=1877). In both studies, evidence of the tradeoff was observed. Upward mobility presaged lower perceived stress and fewer depressive symptoms, in combination with higher metabolic syndrome rates. In contrast, downward mobility presaged worse outcomes on all health indicators. The magnitude of the mobility–health associations was similar across cohorts.

Conclusions

These findings provide evidence that upward income mobility is associated with a tradeoff between well‐being and cardiometabolic health. The similarity of the findings across cohorts suggests that this tradeoff is a generalized consequence of ascending the socioeconomic hierarchy, at least for Americans born in the middle and later parts of the 20th century.

The physical health costs of positive adaptation to childhood adversity

Theories of allostatic load suggest that recurrent adaptive adjustments in contexts of adversity may have a negative impact on physical well-being. To test this hypothesis, this study evaluated 6-year-old children's ego-resilience and physical abuse experiences on behavior problems and physical illness at the age of 8 years. A significant interaction between ego-resilience and physical abuse exposure indicated that, although ego-resilience buffered physically abused children from internalizing problems, it also predicted more physical illness in that group. Findings contribute to the growing body of evidence suggesting that efforts to mobilize an adaptive response in contexts of adversity may exact a cost on physical well-being.

Health-Risk Behaviors and Protective Factors Among Adolescents in Rural British Columbia

PURPOSE

This study explores the relationship between rural residency, selected protective factors (family and school connectedness along with prosocial peer attitudes), and health-compromising behaviors (alcohol and tobacco use and nonuse of seatbelt) among adolescents.

METHODS

A subsample of adolescents residing in remote areas was extracted from a province-wide, school-based survey in British Columbia (BC), Canada (weighted N = 2,999). We employed χ² statistic to test rural-urban differences separately by gender. Logistic regression analysis was used to examine the relationship between protective factors and behaviors compromising health.

FINDINGS

In boys, rural residency was associated with multiple problem behaviors (binge drinking, smokeless tobacco use, and nonuse of seatbelt), whereas for girls it was linked to riding without a seatbelt. The final logistic regression models confirmed that rural environment was a significant risk factor for not wearing a seatbelt among both boys and girls, and smokeless tobacco among boys (adjusted odds ratio between 1.44 and 3.05). Rurality, on the other hand, did not predict binge drinking. Logistic regression analyses also revealed that both school connectedness and prosocial peer attitude protected boys against binge drinking and smokeless tobacco, but the results were not as robust for girls.

CONCLUSIONS

These findings could provide information for location-based intervention efforts promoting adolescent health, highlighting the protective role of the school atmosphere and prosocial peer relationships, especially among boys.

The costs of high self-control in Black and Latino youth with asthma: Divergence of mental health and inflammatory profiles

Emerging evidence in psychology suggests a paradox whereby high levels of self-control when striving for academic success among minority youth can have physical health costs. This study tested the skin-deep resilience hypothesis in asthma- whether minority youth who are striving hard to succeed academically experience good psychological outcomes but poor asthma outcomes. Youth physician-diagnosed with asthma (N = 276, M age = 12.99; 155 = White, 121 = Black/Latino) completed interviews about school stress and a self-control questionnaire. Outcomes included mental health (anxiety/depression) and ex-vivo immunologic processes relevant to asthma (lymphocyte Th-1 and Th-2 cytokine production, and sensitivity to glucocorticoid inhibition). Physician contacts were tracked over a one-year follow-up. For minority youth experiencing high levels of school stress, greater self-control was associated with fewer mental health symptoms (beta = -0.20, p < .05), but worse asthma inflammatory profiles (larger Th-1 and Th-2 cytokine responses, lower sensitivity to glucocorticoid inhibition), and more frequent physician contacts during the one-year follow-up (beta's ranging from 0.22 to 0.43, p's < .05). These patterns were not evident in White youth. In minority youth struggling with school, high levels of self-control are detrimental to asthma inflammatory profiles and clinical outcomes. This suggests the need for health monitoring to be incorporated into academic programs to ensure that 'overcoming the odds' does not lead to heightened health risks in minority youth.

The effects of family dysfunction trajectories during childhood and early adolescence on sleep quality during late adolescence: Resilience as a mediator

RATIONALE

Sleep quality has been linked to several behavioral and psychological problems. No longitudinal study has examined the associations and underlying mechanisms between the trajectories of family characteristics and sleep quality in adolescents.

OBJECTIVE

This study investigates the effects of heterogeneous trajectories of family dysfunction on sleep quality in adolescents and examines whether resilience mediates these associations.

METHOD

Data came from 2280 adolescents participating in a longitudinal study across grades 2 through 11 in northern Taiwan. Group-based trajectory modeling was used to identify discrete developmental patterns of family dysfunction. Multiple linear regression was applied to examine the associations between family dysfunction trajectories and sleep quality. Mediation analysis was conducted to test whether resilience mediates the associations examined.

RESULTS

Four distinct trajectories of family dysfunction were identified: low persistent (26%), escalating dysfunction (21%), moderate stable (25%), and high persistent (28%). Compared to adolescents in the low-persistent trajectory, those in the escalating-dysfunction, moderate-stable, and high-persistent trajectories had significant lower levels of sleep quality (B = -0.19, p < .001, B = -0.14, p < .01, and B = -0.13, p < .05, respectively). Resilience significantly mediated the effects of all family dysfunction trajectories (relative to the low-persistent trajectory) on sleep quality (95% bootstrap confidence intervals are -0.06 to -0.02, -0.05 to -0.02, and -0.08 to -0.03 for escalating-dysfunction, moderate-stable, and high-persistent trajectories, respectively).

CONCLUSIONS

Family dysfunction conferred risks for poor sleep quality in adolescents and the negative effects, in part, were through decreasing resilience. Interventions to improve sleep quality in adolescents by targeting family function may be more effective when incorporating resilience.

Substance Use and Obesity Trajectories in African Americans Entering Adulthood

INTRODUCTION

The transition to adulthood can be stressful for minority adolescents, and many may cope through unhealthy behaviors, including substance use and obesity-related behaviors. This study tested substance use and obesity trajectories over time in African American youth, longitudinal associations of trajectories with mental and physical health in adulthood, and whether self-control and sex predict trajectories.

METHODS

Two longitudinal studies of 516 and 992 African American adolescents. In Study 1, substance use and obesity trajectories were assessed from ages 19 to 25 years. At age 25 years, internalizing and externalizing problems, metabolic syndrome, and inflammatory biomarkers were measured. In Study 2, substance use and obesity trajectories were assessed from ages 17 to 29 years. Depression, delinquency, diabetes, blood pressure, and inflammatory biomarkers were measured at age 29 years. Data analyses were conducted in 2017.

RESULTS

Across both studies, the majority of African American adolescents evinced poor health behavior trajectories (latent class growth analyses), with 23%-27% showing increasing substance use over time, 18%-27% showing increasing obesity over time, and 9%-11% showing increases in both. ANCOVAs for trajectory analyses revealed that males were more likely to evince increasing substance use, with females more likely to show increasing obesity. Substance use trajectories were associated with poorer mental health in adulthood; obesity trajectories with poorer physical health in adulthood. Those with good health behavior trajectories had higher self-control in early adolescence.

CONCLUSIONS

The transition to adulthood is a vulnerable period for many African Americans. Given the commonalities of substance use and obesity in their rewarding/stress-relieving properties, similar prevention efforts may help stem the rise of both in these youth.

Modelling interactions between procedures and resilience skills

Although work in complex socio-technical systems needs support from several "resources for action", the interactions between these are not usually managed systematically. This study introduces a six-step framework for analyzing the interactions between two key resources for action, namely the use of standardized operating procedures and resilience skills (RSs). The main steps for applying the framework involve: (i) a content analysis of the procedure, which allows for the identification of underspecified rules and situations that could be emphasized in scenario-based training focused on developing RSs; and (ii) the identification of factors that set the stage for the emergence of RSs, which could be accounted for by procedures and the broader work system design. An application of the framework is presented in the preparation and administration of intravenous medications in an emergency department. Data collection involved 98 h of observations, 14 interviews, and document analysis. Based on this field study, a model of the interactions between procedures and RSs is proposed as well as the lessons learned from applying the framework are discussed.

College completion predicts lower depression but higher metabolic syndrome among disadvantaged minorities in young adulthood

College graduates enjoy healthier, longer lives compared with individuals who do not graduate from college. However, the health benefit of educational attainment is not as great for blacks as it is for whites. Moreover, college completion may not erase the detrimental effects of early-life disadvantage for blacks and Hispanics. We use nationally representative data on young adults to test whether American minorities experience differential returns to educational attainment. We find that college completion predicts lower rates of depression for all racial groups. It also predicts lower metabolic syndrome among whites. However, college completion predicts higher metabolic syndrome among black and Hispanic adults from disadvantaged backgrounds, suggesting upward mobility may come at a health cost to young minorities in America.

Individuals with higher educational attainment live healthier and longer lives. However, not everyone benefits equally from higher education. In particular, the black–white gap in life expectancy is greater at higher levels of educational attainment. Furthermore, recent research suggests that disadvantaged African Americans in the rural Southeast who attend college have worse physical health than their similarly disadvantaged peers who do not attend college. The extent to which this pattern generalizes to a nationally representative, mixed-race sample is unknown. Using data from the National Longitudinal Study of Adolescent to Adult Health, we test whether the health benefits associated with college completion vary by level of childhood disadvantage for depression and metabolic syndrome in young adulthood, across race/ethnicity. We find uniform lower depression associated with college completion regardless of childhood disadvantage, and across non-Hispanic white, non-Hispanic black, and Hispanic young adults. College completion is associated with lower metabolic syndrome for whites across all levels of childhood disadvantage. In contrast, college completion is associated with higher metabolic syndrome among black and Hispanic young adults from disadvantaged childhood environments. Our findings suggest that, for minorities from disadvantaged backgrounds, finishing college pays substantial dividends for mental health but simultaneously exacts costs with regard to physical health. This pattern contrasts starkly with whites and minorities from more privileged backgrounds, for whom college completion is associated with benefits to both mental and physical health. These results suggest that racial disparities in health may persist in part because the health of upwardly mobile minorities is compromised in young adulthood.

Does striving to succeed come at a physiological or psychosocial cost for adults who experienced child maltreatment?

While striving to succeed in the face of adversity may provide individuals with outward benefits, it may come at a cost to individuals' physical health. The current study examines whether striving predicts greater physiological or psychosocial costs among those who experienced child maltreatment, a stressor that disrupts the caregiving environment and threatens relationship security. Using data from the National Longitudinal Study of Adolescent to Adult Health, we tested whether greater striving after childhood maltreatment would come at a cost, increasing underlying cardiovascular disease (CVD) risk and depressive symptoms despite showing outward success via income and college degree attainment. The study included 13,341 Black, Hispanic, and White adolescents who self-reported striving and their experiences of childhood neglect, physical abuse, and sexual abuse. As young adults, participants reported depressive symptoms, income, and college degree attainment and completed a health assessment from which a 30-year Framingham-based CVD risk score was calculated. Higher striving was associated with lower CVD risk and depressive symptoms, and higher income and college degree attainment, regardless of maltreatment history. These findings highlight the potential for striving as a target for interventions and support the need to examine multiple biological and behavioral outcomes to understand the multifaceted nature of resilience.