Shift-and-persist model

Broadly, "shift" strategies encompass a variety of cognitive and emotion self-regulation approaches that individuals use to deal with stress, including cognitive restructuring, reframing, reappraisal, and acceptance strategies, which change the meaning of a stressor or reduce its emotional impact. These shift strategies particularly focus on changing one's response to a stressor, instead of attempting to change the situation or stressor itself.{{Cite journal|last1=Heckhausen|first1=J.|last2=Schulz|first2=R.|date=1995|title=A life-span theory of control|journal=Psychological Review|volume=102|issue=2|pages=284–304|doi=10.1037/0033-295x.102.2.284|issn=0033-295X|pmid=7740091}}{{Cite journal|last1=Heckhausen|first1=Jutta|last2=Wrosch|first2=Carsten|last3=Schulz|first3=Richard|date=2010|title=A motivational theory of life-span development|journal=Psychological Review|volume=117|issue=1|pages=32–60|doi=10.1037/a0017668|issn=1939-1471|pmc=2820305|pmid=20063963}} As shift strategies depend more on internal processes (self-control and regulation), than external resources, it is hypothesized that shift strategies may be particularly adaptive responses to the chronic, uncontrollable stressors that are associated with low socioeconomic status.

According to Chen and Miller, "persist" strategies are any strategies that help individuals to maintain optimism about the future, create meaning from their experiences of challenge and hardship, and persist "with strength in the face of adversity."

To evaluate the combination of shift-and-persist strategy use, distinct "shift" and "persist” constructs were initially measured separately by using multiple, self-report measures of reappraisal, emotional reactivity, and future orientation in early research on this model.

In 2015, Chen and colleagues published the Shift-and-Persist Scale, which is a combined self-report measure that assesses both shift and persist strategies.{{Cite journal|last1=Chen|first1=Edith|last2=McLean|first2=Kate C.|last3=Miller|first3=Gregory E.|date=2015|title=Shift-and-Persist Strategies: Associations With Socioeconomic Status and the Regulation of Inflammation Among Adolescents and Their Parents|journal=Psychosomatic Medicine|language=en|volume=77|issue=4|pages=371–382|doi=10.1097/PSY.0000000000000157|pmid=26167560|pmc=5890430|issn=0033-3174}} The Shift-and-Persist Scale has been validated for use with adults and teenagers. The questionnaire asks respondents to rate how well 14 statements about various approaches to dealing with life stressors apply to them on a 1-4 scale.{{Cite web|url=http://sparqtools.org/mobility-measure/shift-and-persist-teen-adult/|title=Shift and Persist (Teen, Adult) {{!}} SPARQTools|last1=University|first1=© Stanford|last2=Stanford|website=sparqtools.org|language=en|access-date=2019-11-08|last3=California 94305}} Out of the 14 items on the measure, 4 assess a respondent's use of shift strategies, 4 load onto persist strategies, and 6 items are non-relevant distractors that are ignored during scoring. When scoring the Shift-and-Persist Scale, one item (#4) is reverse-scored. This scale is publicly available online.

A simplified 5-item Shift-and-Persist scale has also been published for use with younger children and adolescents (ages 9–15).{{Cite web|url=http://sparqtools.org/mobility-measure/shift-and-persist-child/|title=Shift and Persist (Child) {{!}} SPARQTools|last1=University|first1=© Stanford|last2=Stanford|website=sparqtools.org|language=en|access-date=2019-11-08|last3=California 94305}} Total scores on this version of the Shift-and-Persist Scale range from 0-20, such that higher scores are indicative of greater use of shift-and-persist strategies. This scale is also publicly available online and has been previously used in research with children from kindergarten through 8th grade.{{Cite journal|last1=Kallem|first1=Stacey|last2=Carroll-Scott|first2=Amy|last3=Rosenthal|first3=Lisa|last4=Chen|first4=Edith|last5=Peters|first5=Susan M.|last6=McCaslin|first6=Catherine|last7=Ickovics|first7=Jeannette R.|date=2013|title=Shift-and-persist: A protective factor for elevated BMI among low-socioeconomic-status children|journal=Obesity|language=en|volume=21|issue=9|pages=1759–1763|doi=10.1002/oby.20195|issn=1930-739X|pmc=4325991|pmid=23671041}}

The shift-and-persist model mainly hypothesizes that these strategies have protective effects for the health of low socioeconomic status individuals because they affect biological and physiological stress response tendencies that are relevant for disease. There is some evidence that shift responses (e.g., reappraisal) to acute stressors are associated with attenuated physiological responses to stress, including reduced cardiovascular reactivity.{{Cite journal|last=Gross|first=J. J.|date=1998|title=Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology|journal=Journal of Personality and Social Psychology|volume=74|issue=1|pages=224–237|doi=10.1037/0022-3514.74.1.224|issn=0022-3514|pmid=9457784}}{{Cite journal|last1=El-Sheikh|first1=Mona|last2=Harger|first2=JoAnn|date=2001|title=Appraisals of marital conflict and children's adjustment, health, and physiological reactivity.|journal=Developmental Psychology|volume=37|issue=6|pages=875–885|doi=10.1037/0012-1649.37.6.875|pmid=11699760|issn=1939-0599}} Specifically, reappraisal has been linked to a "healthier" pattern of hypothalamic–pituitary–adrenal axis response characterized by a rapid return to homeostasis (i.e., faster cortisol recovery) in the wake of a stressor.{{Cite journal|last1=Raymond|first1=Catherine|last2=Marin|first2=Marie-France|last3=Juster|first3=Robert-Paul|last4=Lupien|first4=Sonia J.|date=2019-05-04|title=Should we suppress or reappraise our stress?: the moderating role of reappraisal on cortisol reactivity and recovery in healthy adults|journal=Anxiety, Stress, & Coping|language=en|volume=32|issue=3|pages=286–297|doi=10.1080/10615806.2019.1596676|pmid=30908108|s2cid=85513998|issn=1061-5806}} Persist tendencies, such as optimism, have also been associated with adaptive immune responses and faster cortisol recovery.{{Cite journal|last1=Segerstrom|first1=Suzanne C.|last2=Taylor|first2=Shelley E.|last3=Kemeny|first3=Margaret E.|last4=Fahey|first4=John L.|date=1998|title=Optimism is associated with mood, coping, and immune change in response to stress.|journal=Journal of Personality and Social Psychology|volume=74|issue=6|pages=1646–1655|doi=10.1037/0022-3514.74.6.1646|pmid=9654763|s2cid=7826535|issn=1939-1315}}{{Cite journal|last1=Puig-Perez|first1=Sara|last2=Villada|first2=Carolina|last3=Pulopulos|first3=Matias M.|last4=Almela|first4=Mercedes|last5=Hidalgo|first5=Vanesa|last6=Salvador|first6=Alicia|date=2015|title=Optimism and pessimism are related to different components of the stress response in healthy older people|journal=International Journal of Psychophysiology|volume=98|issue=2|pages=213–221|doi=10.1016/j.ijpsycho.2015.09.002|pmid=26348260|issn=0167-8760}} By constraining the magnitude and duration of biological stress responses, including cardiovascular, hypothalamic–pituitary–adrenal axis, and inflammatory responses to stress, shift-and-persist responses are hypothesized to prevent the wear and tear on these systems that increases allostatic load and risk for chronic diseases of aging.

Cross-sectional studies provide some evidence that greater emotion regulation abilities are associated with reduced health risk on a variety of indicators of allostatic load.{{Cite journal|last1=Kinnunen|first1=Marja-Liisa|last2=Kokkonen|first2=Marja|last3=Kaprio|first3=Jaakko|last4=Pulkkinen|first4=Lea|date=2005|title=The associations of emotion regulation and dysregulation with the metabolic syndrome factor|journal=Journal of Psychosomatic Research|volume=58|issue=6|pages=513–521|doi=10.1016/j.jpsychores.2005.02.004|pmid=16125518|issn=0022-3999}}{{Cite journal|last1=Roy|first1=Brita|last2=Riley|first2=Carley|last3=Sinha|first3=Rajita|date=2018-08-07|title=Emotion regulation moderates the association between chronic stress and cardiovascular disease risk in humans: a cross-sectional study|journal=Stress|volume=21|issue=6|pages=548–555|doi=10.1080/10253890.2018.1490724|pmid=30084712|pmc=6367063|issn=1025-3890}} Similarly, self-reported trait levels of optimism and purpose in life have been linked to better concurrent health and health trajectories over time.{{Cite journal|last1=Bower|first1=Julienne E.|last2=Kemeny|first2=Margaret E.|last3=Taylor|first3=Shelley E.|last4=Fahey|first4=John L.|date=1998|title=Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men.|journal=Journal of Consulting and Clinical Psychology|volume=66|issue=6|pages=979–986|doi=10.1037/0022-006x.66.6.979|pmid=9874911|issn=0022-006X}}{{Cite journal|last1=Ryff|first1=Carol D.|last2=Singer|first2=Burton H.|last3=Dienberg Love|first3=Gayle|date=2004-09-29|title=Positive health: connecting well-being with biology|journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences|volume=359|issue=1449|pages=1383–1394|doi=10.1098/rstb.2004.1521|issn=0962-8436|pmc=1693417|pmid=15347530}}{{Cite journal|last1=Räikkönen|first1=K.|last2=Matthews|first2=K. A.|last3=Flory|first3=J. D.|last4=Owens|first4=J. F.|last5=Gump|first5=B. B.|date=1999|title=Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life|journal=Journal of Personality and Social Psychology|volume=76|issue=1|pages=104–113|doi=10.1037/0022-3514.76.1.104|issn=0022-3514|pmid=9972556}}{{Cite journal|last1=Friedman|first1=Elliot M.|last2=Hayney|first2=Mary|last3=Love|first3=Gayle D.|last4=Singer|first4=Burton H.|last5=Ryff|first5=Carol D.|date=2007|title=Plasma interleukin-6 and soluble IL-6 receptors are associated with psychological well-being in aging women|journal=Health Psychology |volume=26|issue=3|pages=305–313|doi=10.1037/0278-6133.26.3.305|issn=0278-6133|pmid=17500617|s2cid=8874656}}{{Cite journal|last1=Sims|first1=Mario|last2=Glover|first2=LáShauntá M.|last3=Norwood|first3=Arnita F.|last4=Jordan|first4=Christina|last5=Min|first5=Yuan-I|last6=Brewer|first6=LaPrincess C.|last7=Kubzansky|first7=Laura D.|author7-link=Laura Kubzansky|date=2019|title=Optimism and cardiovascular health among African Americans in the Jackson Heart Study|journal=Preventive Medicine|volume=129|pages=105826|doi=10.1016/j.ypmed.2019.105826|pmid=31473218|issn=0091-7435|pmc=6985922}} However, most of the health benefits associated with shift-and-persist consistent strategies are only seen in low socioeconomic status samples.{{Cite journal|last1=Grewen|first1=Karen|last2=Girdler|first2=Susan S.|last3=West|first3=Sheila G.|last4=Bragdon|first4=Edith|last5=Costello|first5=Nancy|last6=Light|first6=Kathleen C.|date=2000|title=Stable Pessimistic Attributions Interact with Socioeconomic Status to Influence Blood Pressure and Vulnerability to Hypertension|journal=Journal of Women's Health & Gender-Based Medicine|volume=9|issue=8|pages=905–915|doi=10.1089/152460900750020946|pmid=11074957|issn=1524-6094}}{{Cite journal|last1=Morozink|first1=Jennifer A.|last2=Friedman|first2=Elliot M.|last3=Coe|first3=Christopher L.|last4=Ryff|first4=Carol D.|date=2010|title=Socioeconomic and psychosocial predictors of interleukin-6 in the MIDUS national sample.|journal=Health Psychology|volume=29|issue=6|pages=626–635|doi=10.1037/a0021360|pmid=20954777|pmc=2991411|issn=1930-7810}}

Another alternative, but not mutually exclusive hypothesis, is that shift-and-persist strategies affect health by increasing or up-regulating biological responses that enhance stress recovery and resilience. In particular, the parasympathetic nervous system's functioning may be enhanced by shift-and-persist response tendencies. Emotion regulation abilities that are consistent with shift-coping have been linked to greater parasympathetic nervous system functioning at rest, as indexed by higher levels of high-frequency heart rate variability.{{Cite journal|last1=Appelhans|first1=Bradley M.|last2=Luecken|first2=Linda J.|date=2006|title=Heart Rate Variability as an Index of Regulated Emotional Responding|journal=Review of General Psychology|volume=10|issue=3|pages=229–240|doi=10.1037/1089-2680.10.3.229|s2cid=3926266|issn=1089-2680}} Further, the parasympathetic nervous system is highly integrated with, and may contribute to the down-regulation of hypothalamic–pituitary–adrenal axis and immune system stress responses that influence allostatic load over time.{{Cite journal|last1=THAYER|first1=J. F|last2=STERNBERG|first2=E.|date=2006-11-01|title=Beyond Heart Rate Variability: Vagal Regulation of Allostatic Systems|journal=Annals of the New York Academy of Sciences|volume=1088|issue=1|pages=361–372|doi=10.1196/annals.1366.014|pmid=17192580|issn=0077-8923|bibcode=2006NYASA1088..361T|s2cid=30269127}}{{Cite journal|last=Tracey|first=Kevin J.|date=2009|title=Reflex control of immunity|journal=Nature Reviews. Immunology|volume=9|issue=6|pages=418–428|doi=10.1038/nri2566|issn=1474-1741|pmc=4535331|pmid=19461672}} Although parasympathetic nervous system activity is correlated with aspects of shift-and-persist coping, it is not yet established that the use of these strategies actually increases parasympathetic nervous system activity.

The oxytocin system has also been identified as another potential mechanism by which shift-and-persist strategies could influence health outcomes. Oxytocin is a hormone that has been linked to a wide range of positive social and emotional functions and can be used to effectively attenuate hypothalamic–pituitary–adrenal axis and sympathetic nervous system responses to stress.{{Cite journal|last1=Ditzen|first1=Beate|last2=Schaer|first2=Marcel|last3=Gabriel|first3=Barbara|last4=Bodenmann|first4=Guy|last5=Ehlert|first5=Ulrike|last6=Heinrichs|first6=Markus|date=2009-05-01|title=Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict|journal=Biological Psychiatry|volume=65|issue=9|pages=728–731|doi=10.1016/j.biopsych.2008.10.011|issn=1873-2402|pmid=19027101|s2cid=22547391}}{{Cite journal|last1=Ross|first1=Heather E.|last2=Young|first2=Larry J.|date=2009-10-01|title=Oxytocin and the neural mechanisms regulating social cognition and affiliative behavior|journal=Frontiers in Neuroendocrinology|series=Hormones & Social Behavior|volume=30|issue=4|pages=534–547|doi=10.1016/j.yfrne.2009.05.004|pmid=19481567|pmc=2748133|issn=0091-3022}}{{Cite journal|last1=Gutkowska|first1=Jolanta|last2=Jankowski|first2=Marek|date=2008|title=Oxytocin revisited: It is also a cardiovascular hormone|journal=Journal of the American Society of Hypertension |volume=2|issue=5|pages=318–325|doi=10.1016/j.jash.2008.04.004|issn=1933-1711|pmid=20409913}} However, there is little research examining the interplay between shift-and-persist strategy use and the oxytocin system.

It has also been proposed that shift-and-persist strategies may buffer health outcomes in individuals of low socioeconomic status by affecting health behaviors. Previous research has demonstrated that, regardless of socioeconomic status, individuals with emotion regulation difficulties are also likely to engage in poorer health behaviors, including over-eating, sedentary lifestyle, risky sexual health behaviors, and drug use.{{Cite journal|last1=Rizor|first1=Asha|last2=Callands|first2=Tamora|last3=Desrosiers|first3=Alethea|last4=Kershaw|first4=Trace|date=2017-07-03|title=(S)He's Gotta Have It: Emotion Regulation, Emotional Expression, and Sexual Risk Behavior in Emerging Adult Couples|journal=Sexual Addiction & Compulsivity|volume=24|issue=3|pages=203–216|doi=10.1080/10720162.2017.1343700|pmid=31662601|pmc=6818717|issn=1072-0162}}{{Cite journal|last1=Casagrande|first1=Maria|last2=Boncompagni|first2=Ilaria|last3=Forte|first3=Giuseppe|last4=Guarino|first4=Angela|last5=Favieri|first5=Francesca|date=2019-08-31|title=Emotion and overeating behavior: effects of alexithymia and emotional regulation on overweight and obesity|journal=Eating and Weight Disorders|volume=25|issue=5|pages=1333–1345|doi=10.1007/s40519-019-00767-9|issn=1590-1262|pmid=31473988|s2cid=201692793}}{{Cite journal|last1=Harvey|first1=Samuel B.|last2=Hotopf|first2=Matthew|last3=Øverland|first3=Simon|last4=Mykletun|first4=Arnstein|date=2010|title=Physical activity and common mental disorders|journal=British Journal of Psychiatry|language=en|volume=197|issue=5|pages=357–364|doi=10.1192/bjp.bp.109.075176|pmid=21037212|issn=0007-1250|doi-access=free}}{{Cite journal|last=Bechara|first=Antoine|date=2005-10-26|title=Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective|journal=Nature Neuroscience|volume=8|issue=11|pages=1458–1463|doi=10.1038/nn1584|pmid=16251988|s2cid=641014|issn=1097-6256}} Individuals of low socioeconomic status who learn to regulate their emotions more effectively, by using "shift" strategies in childhood, may be more likely than their peers with emotion regulation difficulties to establish and sustain positive health behaviors throughout development. Similarly, persist strategies that help individuals to maintain a positive focus on the future may also affect wellbeing through health behaviors. Prior studies have linked being "future-oriented" to lower levels of drug use and sexual risk behaviors.{{Cite journal|last1=Robbins|first1=Reuben N.|last2=Bryan|first2=Angela|date=2004-07-01|title=Relationships Between Future Orientation, Impulsive Sensation Seeking, and Risk Behavior Among Adjudicated Adolescents|journal=Journal of Adolescent Research|volume=19|issue=4|pages=428–445|doi=10.1177/0743558403258860|issn=0743-5584|pmc=1317100|pmid=16429605}} Therefore, it is possible that individuals who regularly use shift-and-persist strategies will be more likely to practice positive health behaviors, which promote healthy development and aging.{{cn|date=May 2023}}

However, it is important to note that the relationships between emotion regulation abilities and health behavior are bidirectional. Health behaviors, such as physical activity and sleep hygiene, can also have powerful effects on our capacity to successfully regulate emotions.{{Cite journal|last1=Bernstein|first1=Emily E.|last2=McNally|first2=Richard J.|date=2018-10-01|title=Exercise as a buffer against difficulties with emotion regulation: A pathway to emotional wellbeing|journal=Behaviour Research and Therapy|volume=109|pages=29–36|doi=10.1016/j.brat.2018.07.010|pmid=30081242|s2cid=51925259 |issn=0005-7967}}{{Cite journal|last1=Vantieghem|first1=Iris|last2=Marcoen|first2=Nele|last3=Mairesse|first3=Olivier|last4=Vandekerckhove|first4=Marie|date=2016-04-18|title=Emotion regulation mediates the relationship between personality and sleep quality|journal=Psychology & Health|volume=31|issue=9|pages=1064–1079|doi=10.1080/08870446.2016.1171866|pmid=27021392|s2cid=4969511|issn=0887-0446|url=https://biblio.vub.ac.be/vubirfiles/24715103/Emotion_regulation_mediates_the_relationship_between_personality_and_sleep_quality.pdf }}

Since 2012, integrative research groups concerned with clinical health psychology, social psychology, psychoneuroimmunology, and public health have begun to evaluate the relationships postulated by the shift-and-persist model. The majority of empirical studies on this topic test whether shift-and-persist strategies are associated with differential health outcomes in low vs. high socioeconomic status samples.

Thus far, high levels of shift-and-persist strategy use have been linked to:

• Lower total allostatic load in adults who grew up in low, but not high, socioeconomic status households.{{Cite journal|last1=Chen|first1=Edith|last2=Miller|first2=Gregory E.|last3=Lachman|first3=Margie E.|last4=Gruenewald|first4=Tara L.|last5=Seeman|first5=Teresa E.|date=2012|title=Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load|journal=Psychosomatic Medicine|volume=74|issue=2|pages=178–186|doi=10.1097/PSY.0b013e31824206fd|issn=1534-7796|pmc=3273596|pmid=22286848}}
• Lower body mass index in children from low, but not high, socioeconomic status families.{{Cite journal|last1=Kallem|first1=Stacey|last2=Carroll-Scott|first2=Amy|last3=Rosenthal|first3=Lisa|last4=Chen|first4=Edith|last5=Peters|first5=Susan M.|last6=McCaslin|first6=Catherine|last7=Ickovics|first7=Jeannette R.|date=2013|title=Shift-and-persist: A protective factor for elevated BMI among low-socioeconomic-status children|journal=Obesity|volume=21|issue=9|pages=1759–63|doi=10.1002/oby.20195|pmid=23671041|pmc=4325991|issn=1930-7381}}
• Reduced low-grade inflammation in adolescents (and parents) from low socioeconomic status families.{{Cite journal|last1=Chen|first1=Edith|last2=McLean|first2=Kate C.|last3=Miller|first3=Gregory E.|date=2015|title=Shift-and-Persist Strategies|journal=Psychosomatic Medicine|volume=77|issue=4|pages=371–382|doi=10.1097/psy.0000000000000157|pmid=26167560|pmc=5890430|issn=0033-3174}}{{Cite journal|last1=Chen|first1=Edith|last2=Lee|first2=William K.|last3=Cavey|first3=Lisa|last4=Ho|first4=Amanda|date=2012-12-20|title=Role Models and the Psychological Characteristics That Buffer Low-Socioeconomic-Status Youth From Cardiovascular Risk|journal=Child Development|volume=84|issue=4|pages=1241–1252|doi=10.1111/cdev.12037|pmid=23278857|s2cid=37643787|issn=0009-3920}}
• A "healthier" profile of hypothalamic–pituitary–adrenal axis functioning, as indexed by diurnal cortisol in children from low socioeconomic status families.{{Cite journal|last1=Chen|first1=Lihua|author2-link=Xiaoming Li|last2=Li|first2=Xiaoming|last3=Imami|first3=Ledina|last4=Lin|first4=Danhua|last5=Zhao|first5=Junfeng|last6=Zhao|first6=Guoxiang|last7=Zilioli|first7=Samuele|date=2019|title=Diurnal Cortisol in a Sample of Socioeconomically Disadvantaged Chinese Children: Evidence for the Shift-and-Persist Hypothesis|journal=Psychosomatic Medicine|volume=81|issue=2|pages=200–208|doi=10.1097/PSY.0000000000000659|issn=1534-7796|pmc=6355348|pmid=30531205}}
• Lower levels of asthma-related impairment and inflammation in children from low, but not high, socioeconomic status families.{{Cite journal|last1=Chen|first1=Edith|last2=Strunk|first2=Robert C.|last3=Trethewey|first3=Alexandra|last4=Schreier|first4=Hannah M. C.|last5=Maharaj|first5=Nandini|last6=Miller|first6=Gregory E.|date=2011|title=Resilience in low-socioeconomic-status children with asthma: adaptations to stress|journal=The Journal of Allergy and Clinical Immunology|volume=128|issue=5|pages=970–976|doi=10.1016/j.jaci.2011.06.040|issn=1097-6825|pmc=3205307|pmid=21824649}}
• Better asthma profiles in children and teens from families reporting low, but not high, perceived social status.{{Cite journal|last1=Lam|first1=Phoebe H.|last2=Miller|first2=Gregory E.|last3=Chiang|first3=Jessica J.|last4=Levine|first4=Cynthia S.|last5=Le|first5=Van|last6=Shalowitz|first6=Madeleine U.|last7=Story|first7=Rachel E.|last8=Chen|first8=Edith|date=2018-08-06|title=One size does not fit all: Links between shift-and-persist and asthma in youth are moderated by perceived social status and experience of unfair treatment|journal=Development and Psychopathology|volume=30|issue=5|pages=1699–1714|doi=10.1017/s0954579418000913|pmid=30078386|issn=0954-5794|doi-access=free}}
• Lower levels of depressive symptoms in Latinx youth from low, but not high, income families.{{Cite journal|last1=Christophe|first1=N. Keita|last2=Stein|first2=Gabriela Livas|last3=Martin Romero|first3=Michelle Y.|last4=Chan|first4=Michele|last5=Jensen|first5=Michaeline|last6=Gonzalez|first6=Laura M.|last7=Kiang|first7=Lisa|date=2019-08-01|title=Coping and Culture: The Protective Effects of Shift-&-Persist and Ethnic-Racial Identity on Depressive Symptoms in Latinx Youth|journal=Journal of Youth and Adolescence|language=en|volume=48|issue=8|pages=1592–1604|doi=10.1007/s10964-019-01037-8|pmid=31134561|pmc=9154352 |s2cid=167219801|issn=1573-6601}}

Although it has been proposed that a variety of psychological interventions for at-risk youth of low socioeconomic status may reduce health disparities, in part, by increasing shift-and-persist tendencies in families, the majority of studies on shift-and-persist have been cross-sectional. Therefore, it remains unknown if shift-and-persist strategies play a causal role in reducing the negative impact of low socioeconomic status on health.{{Cite journal|last1=Miller|first1=Gregory E.|last2=Brody|first2=Gene H.|last3=Yu|first3=Tianyi|last4=Chen|first4=Edith|date=2014-08-05|title=A family-oriented psychosocial intervention reduces inflammation in low-SES African American youth|journal=Proceedings of the National Academy of Sciences|language=en|volume=111|issue=31|pages=11287–11292|doi=10.1073/pnas.1406578111|issn=0027-8424|pmid=25049403|pmc=4128159|bibcode=2014PNAS..11111287M|doi-access=free }} More longitudinal and treatment studies are needed to evaluate directional and causal hypotheses based upon the shift-and-persist model.

• Social Determinants of Health
• Socioeconomic Status and Mental Health
• Stress
• Emotional Regulation
• Allostatic Load
• Psychoneuroimmunology

Category:Social status

Category:Public health