What Predicts a Mayoral Official’s Opinion about the Role of Stress in Health Disparities?

  • Adolfo G. CuevasEmail author
  • Sarah Levine
  • Jonathan Purtle


High stress is a public health issue in the United States (US), that disproportionately affects socially-marginalized group members, including racial and ethnic minorities and those of low socioeconomic status. While city governments have the potential to reduce stress exposure and health disparities through municipal policies, very little is known about factors that are associated with mayor officials’ beliefs about stress as a determinant of disparities. This information is important because it can inform the design of interventions to educate city policymakers about evidence related to stress and health disparities. Using data from a 2016 survey of 230 mayor officials (101 mayors, 129 senior staff), multivariable logistic regression was used to determine the extent to which respondents’ individual characteristics (e.g., ideology, highest level of education) and the characteristics of their city’s population (e.g., percentage of residents non-white) were associated with their identification of stress as a factor that has a “very strong effect” on health disparities. Forty-four percent of respondents identified stress as having a very strong effect on health disparities. In the fully adjusted model, every percentage point increase in the proportion of a respondent’s city population that was non-White increased the odds of identifying stress as having a very strong effect on health disparities by 2% [adjusted odds ratio (aOR) = 1.02; 95% CI = 1.00,1.04]. Interventions are needed to increase city policymakers’ knowledge about the role of stress in the production of health disparities, which could, in turn, help cultivate political will for city policies that reduce disparities.


Stress Policy Policymakers Urban Health disparities 


Funding Information

Dr. Adolfo Cuevas was partially supported by the National Institute of Health 3R25CA057711. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The development of the manuscript was partially supported by Cancer Disparities Research Network/Geographic Management Program (GMaP) Region 4 funded by 3 P30 CA006927-52S2 and CTSI Mentored Career Development Award (KL2 TR002545). The study was supported by the Robert Wood Johnson Foundation (RWJF; grant 73,960). The views expressed here do not necessarily reflect the views of the RWJF.

Compliance with Ethical Standards

Conflict of Interest

No potential conflict of interest was reported by the authors.


  1. 1.
    American Psychological Association. Stress in America: coping with change. Stress Am Surv. 2017.Google Scholar
  2. 2.
    Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12.CrossRefGoogle Scholar
  3. 3.
    Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607–28.CrossRefGoogle Scholar
  4. 4.
    Kopp MS, Réthelyi J. Where psychology meets physiology: chronic stress and premature mortality—the central-eastern European health paradox. Brain Res Bull. 2004;62:351–67.CrossRefGoogle Scholar
  5. 5.
    Mariotti A. The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Sci OA. 2015;1:FSO23–3.Google Scholar
  6. 6.
    Sternthal MJ, Slopen N, Williams DR. Racial disparities in health: how much does stress really matter? Bois Rev Soc Sci Res Race. 2011;8:95–113.CrossRefGoogle Scholar
  7. 7.
    Turner RJ, Avison WR. Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender. J Health Soc Behav. 2003;44:488–505.CrossRefGoogle Scholar
  8. 8.
    Williams DR, Priest N, Anderson N. Understanding associations between race, socioeconomic status and health: patterns and prospects. Health Psychol. 2016;35:407–11.CrossRefGoogle Scholar
  9. 9.
    Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health. 2010;100:933–9.CrossRefGoogle Scholar
  10. 10.
    Cuevas AG, Williams DR. Perceived discrimination and health: integrative findings. Oxf Handb Integr Health Sci. 2018.Google Scholar
  11. 11.
    Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511.CrossRefGoogle Scholar
  12. 12.
    Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51:S41–53.CrossRefGoogle Scholar
  13. 13.
    Cohen S, Doyle WJ, Baum A. Socioeconomic status is associated with stress hormones. Psychosom Med [Internet]. 2006;68. Available from:
  14. 14.
    Grzywacz JG, Almeida DM, Neupert SD, Ettner SL. Socioeconomic status and health: a micro-level analysis o exposure and vulnerability to daily stressors. J Health Soc Behav. 2004;45:1–16.CrossRefGoogle Scholar
  15. 15.
    Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129:19–31.CrossRefGoogle Scholar
  16. 16.
    Purtle J, Henson RM, Carroll-Scott A, Kolker J, Joshi R, Diez Roux AV. US mayors’ and health commissioners’ opinions about health disparities in their cities. Am J Public Health. 2018;108:634–41.CrossRefGoogle Scholar
  17. 17.
    Booske BC, Robert SA, Rohan AMK. Awareness of racial and socioeconomic health disparities in the United States: the national opinion survey on health and health disparities, 2008-2009. Prev Chronic Dis. 2011;8:A73–3.Google Scholar
  18. 18.
    Williams DR. Miles to go before we sleep: racial inequities in health. J Health Soc Behav. 2012;53:279–95.CrossRefGoogle Scholar
  19. 19.
    Robert SA, Booske BC. US opinions on health determinants and social policy as health policy. Am J Public Health. 2011;101:1655–63.CrossRefGoogle Scholar
  20. 20.
    Anderson SE, Butler DM, Harbridge L. Legislative institutions as a source of party leaders’ influence. Legis Stud Q. 2016;41:605–31.CrossRefGoogle Scholar
  21. 21.
    Anderson SE, DeLeo RA, Taylor K. Policy entrepreneurs, legislators, and agenda setting: information and influence. Policy Stud J. 2019.Google Scholar
  22. 22.
    Niederdeppe J, Roh S, Dreisbach C. How narrative focus and a statistical map shape health policy support among state legislators. Health Commun. 2016;31:242–55.CrossRefGoogle Scholar
  23. 23.
    Pagel C, Bates DW, Goldmann D, Koller CF. A way forward for bipartisan health reform? Democrat and republican state legislator priorities for the goals of health policy. 2017;Google Scholar
  24. 24.
    Purtle J, Lê-Scherban F, Wang X, Shattuck PT, Proctor EK, Brownson RC. Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis. Implement Sci. 2018;13:121.CrossRefGoogle Scholar
  25. 25.
    Zhu JM, Chhabra M, Grande D. Concise research report: the future of Medicaid: state legislator views on policy waivers. J Gen Intern Med. 2018;33:999–1001.CrossRefGoogle Scholar
  26. 26.
    American National Election Studies. American National Election Studies. Liberal-conservative self-identification 1972–2016 [internet]. 2016 [cited 2019 May 11]. Available from:
  27. 27.
    Dixon J, Durrheim K, Tredoux CG, Tropp LR, Clack B, Eaton L, et al. Challenging the stubborn Core of opposition to equality: racial contact and policy attitudes. Polit Psychol. 2010;31:831–55.CrossRefGoogle Scholar
  28. 28.
    Northcutt Bohmert M, DeMaris A. Interracial friendship and the trajectory of prominority attitudes: assessing intergroup contact theory. Group Process Intergroup Relat. 2015;18:225–40.CrossRefGoogle Scholar
  29. 29.
    Colby SL, Ortman JM. Projections of the Size and Composition of the U.S: 2014–2060 [Internet]. Popul. Estim. Proj. 2017 [cited 2019 May 12]. Available from:
  30. 30.
    Avendano M, Kawachi I. Why do Americans have shorter life expectancy and worse health than do people in other high-income countries? Annu Rev Public Health. 2014;35:307–25.CrossRefGoogle Scholar
  31. 31.
    Murray CJ, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3:e260.CrossRefGoogle Scholar
  32. 32.
    Myers CA, Slack T, Martin CK, Broyles ST, Heymsfield SB. Regional disparities in obesity prevalence in the U nited S tates: a spatial regime analysis. Obesity. 2015;23:481–7.CrossRefGoogle Scholar
  33. 33.
    Singh GK, Kogan MD, van Dyck PC. A multilevel analysis of state and regional disparities in childhood and adolescent obesity in the United States. J Community Health. 2008;33:90–102.CrossRefGoogle Scholar
  34. 34.
    Skitka LJ, Mullen E, Griffin T, Hutchinson S, Chamberlin B. Dispositions, scripts, or motivated correction? Understanding ideological differences in explanations for social problems. J Pers Soc Psychol. 2002;83:470–87.CrossRefGoogle Scholar
  35. 35.
    Gollust SE, Cappella JN. Understanding public resistance to messages about health disparities. J Health Commun. 2014:1–18.Google Scholar
  36. 36.
    Rodriguez JM. The politics hypothesis and racial disparities in infants’ health in the United States. SSM - Popul Health [Internet]. 2019 [cited 2019 Aug 29];8. Available from:
  37. 37.
    Rodriguez JM. Health disparities, politics, and the maintenance of the status quo: a new theory of inequality. Soc Sci Med. 2018;200:36–43.CrossRefGoogle Scholar
  38. 38.
    Rodriguez JM, Geronimus AT, Bound J, Dorling D. Black lives matter: Differential mortality and the racial composition of the U.S. electorate, 1970–2004. Soc Sci Med. 1982;2015(136–137):193–9.Google Scholar
  39. 39.
    Golden SD, McLeroy KR, Green LW, Earp JAL, Lieberman LD. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Educ Behav. 2015;42:8S–14S.CrossRefGoogle Scholar
  40. 40.
    Purtle J, Goldstein ND, Edson E, Hand A. Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998–2013). SSM - Popul Health. 2017;3:136–40.CrossRefGoogle Scholar
  41. 41.
    Niederdeppe J, Bigman C, Gonzales A, Gollust S. Communication about health disparities in the mass media. Niederdeppe J, editor. J Commun 2013;63:8–30.Google Scholar
  42. 42.
    Bye L, Ghirardelli A, Fontes A. Promoting health equity and population health: how Americans’ views differ. Health Aff Proj Hope. 2016;35:1982–90.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Community HealthTufts UniversityMedfordUSA
  2. 2.Department of Health Management & Policy, Urban Health CollaborativeDrexel University Dornsife School of Public HealthPhiladelphiaUSA

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