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Weak and uneven associations of home, neighborhood, and school environments with stress hormone output across multiple timescales


The progression of lifelong trajectories of socioeconomic inequalities in health and mortality begins in childhood. Dysregulation in cortisol, a stress hormone that is the primary output of the hypothalamus–pituitary–adrenal (HPA) axis, has been hypothesized to be a mechanism for how early environmental adversity compromises health. However, despite the popularity of cortisol as a biomarker for stress and adversity, little is known about whether cortisol output differs in children being raised in socioeconomically disadvantaged environments. Here, we show that there are few differences between advantaged and disadvantaged children in their cortisol output. In 8–14-year-old children from the population-based Texas Twin Project, we measured cortisol output at three different timescales: (a) diurnal fluctuation in salivary cortisol (n = 400), (b) salivary cortisol reactivity and recovery after exposure to the Trier Social Stress Test (n = 444), and (c) cortisol concentration in hair (n = 1210). These measures converged on two moderately correlated, yet distinguishable, dimensions of HPA function. We tested differences in cortisol output across nine aspects of social disadvantage at the home (e.g., family socioeconomic status), school (e.g., average levels of academic achievement), and neighborhood (e.g., concentrated poverty). Children living in neighborhoods with higher concentrated poverty had higher diurnal cortisol output, as measured in saliva; otherwise, child cortisol output was unrelated to any other aspect of social disadvantage. Overall, we find limited support for alteration in HPA axis functioning as a general mechanism for the health consequences of socioeconomic inequality in childhood.

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Fig. 1: Our approach for measuring variation in cortisol and socioecological disadvantage.
Fig. 2: Patterns of within and between individual variability in diurnal and reactive cortisol trajectories calculated applying multilevel piecewise growth models.
Fig. 3: Correlations between variation in diurnal and reactive cortisol rhythm and hair cortisol.
Fig. 4: Association between second-order latent factors of cortisol, clustering variation common across latent growth parameters into chronic and diurnal cortisol levels, all paths are standardized, *p < 0.05, **p < 0.01.
Fig. 5: Correlations between multimodal cortisol output and the nine socioecological context indicators characterizing variation in the home, school, and neighborhood environments.

Data availability

While results, FIML summary data, analytic scripts, and generated outputs will be uploaded and instantly available for all researchers to use, our policy regarding the access of raw data files is separate. The data file related to this project contains particularly sensitive information, including each child’s geocoded neighborhood and school information and sensitive endocrinological data. To this end, researchers will be able to obtain the data file through managed access. Requests for managed access should be sent to EMT-D and KPH, joint principal investigators of the Texas Twin Project.

Code availability

Results, FIML summary data, analytic scripts, and generated outputs will be uploaded and instantly available for all researchers to use.


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We gratefully acknowledge all participant members of the Texas Twin Project. KPH and EMT-D are faculty research associates of the Population Research Center at the University of Texas at Austin, which is supported by a grant, 5-R24-HD042849, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. KPH and EMT-D are also supported by Jacobs Foundation Research Fellowships. This research was supported by NIH grant R01HD083613. MM is partly supported by the David Wechsler Early Career Award for Innovative Work in Cognition and by NIH grant R01HD083613 awarded to EMT-D and KPH.

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MM, KPH, and EMT-D designed the study; MM, LEE, KPH, and EMT-D contributed new reagents/analytic tools; MM, LEE, and EMT-D analyzed data; MM, LEE, LR, AS, ADG, DAB, JWM, SMF, MWP, KPH, and EMT-D performed the research; and MM, KPH, and EMT-D wrote the paper.

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Correspondence to Margherita Malanchini or Elliot M. Tucker-Drob.

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Malanchini, M., Engelhardt, L.E., Raffington, L.A. et al. Weak and uneven associations of home, neighborhood, and school environments with stress hormone output across multiple timescales. Mol Psychiatry (2020).

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