Weathering hypothesis

The weathering hypothesis was initially formulated by Arline Geronimus to explain the dire maternal health and birth outcomes of African American women that she observed in correspondence with increased age. While working part-time at a school for pregnant teenagers in Trenton, New Jersey, Geronimus first noticed that the teens who came to the school tended to have far more health problems than her classmates at Princeton University. She thus began to wonder whether the health conditions of the teens at that clinic may have been caused by their environment.{{Cite news |last=Demby |first=Gene |date=January 14, 2018 |title=Making The Case That Discrimination Is Bad For Your Health |url=https://www.npr.org/sections/codeswitch/2018/01/14/577664626/making-the-case-that-discrimination-is-bad-for-your-health |access-date=18 April 2018 |publisher=NPR}} Subsequent research on the disparity in maternal health between African American and white women led Geronimus to propose the weathering hypothesis. She proposed that the accumulation of cultural, social and economic disadvantages may lead to earlier deterioration of health among African American women compared to their non-Hispanic, white counterparts.{{Cite journal |last=Geronimus |first=Arline |date=1992 |title=The weathering hypothesis and the health of African-American women and infants: evidence and speculations |journal=Ethnicity & Disease |volume=2 |issue=3 |pages=207–221 |pmid=1467758 |via=Europe PMC}} Geronimus specifically chose the term weathering as a metaphor for the effects she perceived that exposure to stress was having on the health of marginalized people. While the weathering hypothesis was initially proposed based on observations of patterns in maternal health, academics have expanded its application as a framework to examine other health disparities as well.

While conducting research in the Department of Public Health Policy and Administration as a graduate student at the University of Michigan in 1992, Geronimus noticed a trend in disparities between the fertility of African American women versus White women.{{Cite journal |last=Geronimus |first=Arline T. |date=1996 |title=Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis |journal=Social Science & Medicine |volume=42 |issue=4 |pages=589–597 |doi=10.1016/0277-9536(95)00159-X |pmid=8643983 |issn=0277-9536}} She noted that, on average, White girls and women experience their highest fertility rates and lowest risk of pregnancy complications or neonatal mortality in their 20's and 30's, but African American women do not. Instead, African American girls and women, teenagers have higher fertility rates and healthy pregnancies. The data indicated a widening disparity in black-white infant mortality as maternal ages increase. Subsequently, Geronimus proposed the "weathering hypothesis", which she initially conceived as a potential explanation for the patterns of racial variation in infant mortality with increasing maternal age.

In the context of the weathering hypothesis, individual health is dynamic and shaped over time by social, economic, and environmental influences. These social determinants dictate what different demographics are exposed to as they develop and age. Racism and discrimination are two specific social determinants that lay the foundation for systemic inequality in access and upward mobility. This entrenchment of social inequities disproportionately impacts minorities and communities of color, who remain in environments of poverty that have significantly more stressors than those of wealthier, predominantly white communities. These stressors—and the associated burden of coping with them—manifest as physiological responses that have detrimental effects on individual health, often leading to a disproportionately high occurrence of chronic illness and shorter life expectancy in minority communities.{{Cite journal |last1=Geronimus |first1=Arline T. |last2=Pearson |first2=Jay A. |last3=Linnenbringer |first3=Erin |last4=Eisenberg |first4=Alexa K. |last5=Stokes |first5=Carmen |last6=Hughes |first6=Landon D. |last7=Schulz |first7=Amy J. |date=2020 |title=Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load |journal=The Milbank Quarterly |volume=98 |issue=4 |pages=1171–1218 |doi=10.1111/1468-0009.12484 |issn=1468-0009 |pmc=7772642 |pmid=33135829 |doi-access=free}} Multiethnic studies have yielded significant data demonstrating that weathering—accumulated health risk due to social, economic and environmental stressors—is a manifestation of social stratification that systemically influences disparities in health and mortality between dominant and minority communities.{{Cite journal |last=Williams |first=David R. |date=2012 |title=Miles to Go before We Sleep: Racial Inequities in Health |journal=Journal of Health and Social Behavior |volume=53 |issue=3 |pages=279–295 |doi=10.1177/0022146512455804 |issn=0022-1465 |pmc=3712789 |pmid=22940811}}

{{Further|Black maternal mortality in the United States}}

Maternal mortality is three to four times higher for Black mothers than white mothers in the United States.{{Cite web |last=Braithwaite |first=Patia |date=September 30, 2019 |title=The Stress of Racism Is Killing Black Mothers |url=https://www.self.com/story/weathering-and-its-deadly-effect-on-black-mothers |access-date=24 March 2021 |website=Self}} Infant mortality is also twice as high for infants born to non-Hispanic Black mothers compared to infants born to non-Hispanic white mothers.{{Cite journal |last1=Riggan |first1=Kirsten A. |last2=Gilbert |first2=Anna |last3=Allyse |first3=Megan A. |date=2021 |title=Acknowledging and Addressing Allostatic Load in Pregnancy Care |journal=Journal of Racial and Ethnic Health Disparities |volume=8 |issue=1 |pages=69–79 |doi=10.1007/s40615-020-00757-z| issn=2197-3792 |pmc=7647942 |pmid=32383045 }} Additionally, there are racial disparities for negative birth outcomes like low birth weight, which has been found to influence risk of infant mortality and developmental outcomes after birth, and preterm birth.{{Cite journal |last=Fishman |first=Samuel |date=2020 |title=An extended evaluation of the weathering hypothesis for birthweight |journal=Demographic Research |volume=43 |issue=31 |pages=929–968 |doi=10.4054/DemRes.2020.43.31 |issn=1435-9871 |doi-access=free}} Across all women, older maternal age is associated with higher rates of these negative outcomes during pregnancy, but studies have consistently found that rates rise more rapidly for Black women than white women.{{Cite journal |last1=Forde |first1=Allana T. |last2=Crookes |first2=Danielle M. |last3=Suglia |first3=Shakira F. |last4=Demmer |first4=Ryan T. |date=2019 |title=The weathering hypothesis as an explanation for racial disparities in health: a systematic review |journal=Annals of Epidemiology |volume=33 |pages=1–18.e3 |doi=10.1016/j.annepidem.2019.02.011 |pmid=30987864 |s2cid=109370791 |issn=1047-2797|pmc=10676285 }} The weathering hypothesis proposes that the accumulation of racial stress over Black women's lives contributes to this observed pattern of racial disparities in maternal health and birth outcomes that increase with maternal age. Research has consistently identified an association between preterm birth and low birth weight in Black women and maternal stress caused by experiences of racism, systemic bias, socioeconomic disadvantage, segregated neighborhoods, and high rates of violent crime. There is biological evidence of weathering, including the finding that Black women have shorter telomeres, a biological indicator of age, when compared with white women of the same chronological age. Though increased socioeconomic status serves as a protective factor against negative birth outcomes for non-Hispanic white mothers, disproportionate rates of preterm birth and low birth weight for non-Hispanic Black mothers have been found at every education and income level. The weathering hypothesis has also been used to explain this trend because upward socioeconomic mobility is associated with increased exposure to discrimination for women of color.

There is modest evidence supporting the effects of weathering on mothers from other minority groups, including for high birth weight outcomes among American Indian/Alaska Native women.{{Cite journal |last=Dennis |first=Jeff A. |date=2018 |title=Birth weight and maternal age among American Indian/Alaska Native mothers: A test of the weathering hypothesis |journal=SSM - Population Health |volume=7 |pages=004–4 |doi=10.1016/j.ssmph.2018.10.004 |issn=2352-8273 |pmc=6289957 |pmid=30560195}} Research has started to explore whether the weathering hypothesis could also explain racial disparities in the outcomes of assisted reproductive technologies, but so far the findings are inconsistent.{{Cite journal |last=Tierney |first=Katherine |date=2020 |title=Is there evidence of weathering among women seeking fertility treatments?: Evidence and insights |journal=Social Science & Medicine |volume=247 |pages=112816 |doi=10.1016/j.socscimed.2020.112816 |pmid=32014735 |s2cid=211025195 |issn=0277-9536|doi-access=free }}

Research shows that mental health disparities among marginalized communities exist. Daily discrimination faced by marginalized groups have been found to be associated with increased depressive symptoms and feelings of loneliness.{{Cite journal |last1=Lee |first1=Hedwig |last2=Turney |first2=Kristin |date=2012 |title=Investigating the Relationship between Perceived Discrimination, Social Status, and Mental Health |journal=Society and Mental Health |volume=2 |issue=1 |pages=1–20 |doi=10.1177/2156869311433067 |issn=2156-8693 |pmc=3418139 |pmid=22900235}} Low-income communities are more likely to have severe mental illnesses, which is frequently heightened by the inaccessibility to quality healthcare.{{Cite journal |last1=Burton |first1=Linda M. |last2=Whitfield |first2=Keith E. |date=2003 |title='Weathering' Towards Poorer Health in Later Life: Co-morbidity in Urban Low-income Families |journal=Public Policy & Aging Report |volume=13 |issue=3 |pages=13–18 |doi=10.1093/ppar/13.3.13 |issn=1055-3037}} Researchers found that persisting epigenetic changes lead to increased risk of postpartum depression as a result of adverse life events and cumulative life stress among Black, Latinx, and low-income women.{{Cite journal |last1=Guintivano |first1=J |last2=Sullivan |first2=PF |last3=Stuebe |first3=AM |last4=Penders |first4=T |last5=Thorp |first5=J |last6=Rubinow |first6=DR |last7=Meltzer-Brody |first7=S |date=2017 |title=Adverse Life Events, Psychiatric History, and Biological Predictors of Postpartum Depression in an Ethnically Diverse Sample of Postpartum Women |journal=Psychological Medicine |volume=48 |issue=7 |pages=1190–1200 |doi=10.1017/S0033291717002641 |issn=0033-2917 |pmc=6792292 |pmid=28950923}} In a study assessing African American men, experiences of racism were linked to a poorer mental health state.{{Cite journal |last1=Sellers |first1=Sherill L. |last2=Bonham |first2=Vence |last3=Neighbors |first3=Harold W. |last4=Amell |first4=James W. |title=Effects of Racial Discrimination and Health Behaviors on Mental and Physical Health of Middle-Class African American Men |journal=Health Education & Behavior |year=2009 |volume=36 |issue=1 |pages=31–44 |doi=10.1177/1090198106293526 |pmid=17130248 |citeseerx=10.1.1.836.6692 |s2cid=33199436}}

Black Americans often show mean level differences in cognition across multiple cognitive domains compared to non-Hispanic Whites.Letang, S. K., Lin, S. S. H., Parmelee, P. A., & McDonough, I. M. (2021). "Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways". Cognitive Research: Principles and Implications, 6(1), 1-17. {{doi|10.1186/s41235-021-00329-7|doi-access=free}}.Sachs-Ericsson, N., & Blazer, D. G. (2005). "Racial differences in cognitive decline in a sample of community-dwelling older adults: The mediating role of education and literacy". The American Journal of Geriatric Psychiatry, 13(11), 968–975. {{doi|10.1097/00019442-200511000-00007}}.Zahodne, L. B., Manly, J. J., Smith, J., Seeman, T., & Lachman, M. E. (2017). "Socioeconomic, health, and psychosocial mediators of racial disparities in cognition in early, middle, and late adulthood". Psychology and Aging, 32(2), 118–130. {{doi|10.1037/pag0000154}}. These cognitive disparities often are reduced or eliminated when factoring various social determinants of health such as stress, education quality, economic stability, or quality of healthcare. Black Americans also have higher rates of Alzheimer's disease and related dementias than non-Hispanic Whites.Steenland, K., Goldstein, F. C., Levey, A., & Wharton, W. (2016). "A meta-analysis of Alzheimer’s disease incidence and prevalence comparing African-Americans and Caucasians". Journal of Alzheimer's Disease, 50(1), 71-76. {{doi|10.3233/JAD-150778}}. These higher rates of Alzheimer's disease might be due to the impact of more negative and pronounced social determinants of health,Majoka, M. A., & Schimming, C. (2021). Effect of social determinants of health on cognition and risk of Alzheimer disease and related dementias. Clinical Therapeutics, 43(6), 922-929.Stites, S. D., Midgett, S., Mechanic-Hamilton, D., Zuelsdorff, M., Glover, C. M., Marquez, D. X., ... & Wolk, D. A. (2022). Establishing a framework for gathering structural and social determinants of health in Alzheimer’s disease research centers. The Gerontologist, 62(5), 694-703. including racial discrimination,McDonough, I. M., Byrd, D. R., & Choi, S. L. (2022). Resilience resources may buffer some middle-aged and older Black Americans from memory decline despite experiencing discrimination. Social Science & Medicine, 114998.Barnes, L. L., Lewis, T. T., Begeny, C. T., Yu, L., Bennett, D. A., & Wilson, R. S. (2012). Perceived discrimination and cognition in older African Americans. Journal of the International Neuropsychological Society, 18(5), 856-865. that might accelerate brain aging disproportionately in Black Americans.

Intersectionality is a term coined by Kimberlé Crenshaw to describe the interconnected nature of different systems of oppression, the layered effects of which can be seen in the healthcare system. Research indicates that lower class status and increased depressive symptoms are associated with higher levels of biological weathering among Black individuals in comparison to white individuals.{{Cite journal |date=2019 |title=Racial differences in weathering and its associations with psychosocial stress: The CARDIA study |journal=SSM - Population Health |volume=7 |pages=003–3 |doi=10.1016/j.ssmph.2018.11.003 |issn=2352-8273 |doi-access=free |last1=Forrester |first1=Sarah |last2=Jacobs |first2=David |last3=Zmora |first3=Rachel |last4=Schreiner |first4=Pamela |last5=Roger |first5=Veronique |last6=Kiefe |first6=Catarina I. |pmid=31294072 |pmc=6595283}} In a study exploring disparities in mental health, researchers found that Black sexual minority women reported higher frequencies of discrimination and decreased levels of social and psychological well-being than their white sexual minority women counterparts.{{Cite journal |last1=Calabrese |first1=Sarah K. |last2=Meyer |first2=Ilan H. |last3=Overstreet |first3=Nicole M. |last4=Haile |first4=Rahwa |last5=Hansen |first5=Nathan B. |date=2015 |title=Exploring Discrimination and Mental Health Disparities Faced By Black Sexual Minority Women Using a Minority Stress Framework |journal=Psychology of Women Quarterly |volume=39 |issue=3 |pages=287–304 |doi=10.1177/0361684314560730 |issn=0361-6843 |pmc=4584150 |pmid=26424904}} Black sexual minority women had decreased levels of social well-being and increased levels of depressive symptoms in comparison to Black sexual minority men. African American women are also more likely to contract COVID-19 than African American men and white women.{{Cite journal |last=Obinna |first=Denise N. |date=2021 |title='Essential and undervalued: health disparities of African American women in the COVID-19 era' |journal=Ethnicity & Health |volume=26 |issue=1 |pages=68–79 |doi=10.1080/13557858.2020.1843604 |issn=1355-7858 |pmid=33190539 |doi-access=}} The prevalence of medical racism and sexism (lack of quality healthcare, harmful experimentation, etc.) has led to negative relationships with healthcare systems and increased risk of negative sexual and reproductive health outcomes among African American women.{{Cite journal |last1=Prather |first1=Cynthia |last2=Fuller |first2=Taleria R. |last3=Jeffries |first3=William L. |last4=Marshall |first4=Khiya J. |last5=Howell |first5=A. Vyann |last6=Belyue-Umole |first6=Angela |last7=King |first7=Winifred |date=September 2018 |title=Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity |journal=Health Equity |volume=2 |issue=1 |pages=249–259 |doi=10.1089/heq.2017.0045 |issn=2473-1242 |pmc=6167003 |pmid=30283874 |doi-access=free}} Existing research show how systems of oppression work together to oppress marginalized groups within the healthcare system and, as a result, these groups disproportionately experience negative health effects. Aging adults experience further intersections with health, health care, and structural inequalities that exacerbates health in marginalized groups.McDonough, I. M., Harrell, E. R., Black, S. R., Allen, R. S., & Parmelee, P. A. (2022). Sources of nonreplicability in aging ethnoracial health disparities research. Psychology and Aging, 37(1), 60.

Arline Geronimus faced significant pushback for the weathering hypothesis from the medical community, economists, and sociologists, whose research had attributed racial differences in health outcomes to differing genetics, cultures, and life choices. Additionally, there was criticism regarding the quality of her data.{{Cite journal |last1=Small |first1=Mario Luis |last2=Newman |first2=Katherine |date=2001 |title=Urban Poverty after The Truly Disadvantaged: The Rediscovery of the Family, the Neighborhood, and Culture |journal=Annual Review of Sociology |volume=27 |pages=23–45 |doi=10.1146/annurev.soc.27.1.23 |jstor=2678613 |issn=0360-0572}} Others pushed back against the weathering hypothesis because its application to racial disparities in maternal health seemed to contradict what advocacy groups had been saying about the negative consequences of teen pregnancy on young mothers. A further criticism of this theory believes that Geronimus and others have not sufficiently demonstrated a link between weathering and racial and gender disparities in life expectancy.{{Cite journal |last=Thomas |first=Nigel Mark |date=2011 |title=What's missing from the weathering hypothesis? |journal=American Journal of Public Health |volume=96 |issue=6 |pages=955; author reply 955–6 |doi=10.2105/AJPH.2006.085514 |issn=0090-0036 |pmc=1470633 |pmid=16670215 |doi-access=free}}

The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the allostatic load model, which proposes that an individual's exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers. Research has tended to discuss allostasis and allostatic load as the molecular mechanism behind the weathering hypothesis, and Geronimus herself went on to study racial differences in allostatic load.{{Cite journal |last1=Phelan |first1=Jo C. |last2=Link |first2=Bruce G. |date=2015 |title=Is Racism a Fundamental Cause of Inequalities in Health? |journal=Annual Review of Sociology |volume=41 |issue=1 |pages=311–330 |doi=10.1146/annurev-soc-073014-112305 |issn=0360-0572|doi-access=free }} Another related theory is the life course approach, which emphasizes focus on cumulative life experiences rather than maternal risk factors as an explanation for birth outcome disparities.{{Cite journal |last1=St. Fleur |first1=Michelle |last2=Damus |first2=Karla |last3=Jack |first3=Brian |date=October 2016 |title=The future of preconception care in the United States: multigenerational impact on reproductive outcomes |journal=Upsala Journal of Medical Sciences |volume=121 |issue=4 |pages=211–215 |doi=10.1080/03009734.2016.1206152 |issn=0300-9734 |pmc=5098483 |pmid=27434227}} Researchers have also been interested in studying the possibility of children inheriting the epigenetic changes which result from their mother's cumulative life stress, which could relate the weathering hypothesis with transgenerational trauma.{{Cite journal |date=2021 |title=Understanding Racial Disparities of Preterm Birth Through the Placenta |journal=Clinical Therapeutics |volume=43 |issue=2 |pages=287–296 |doi=10.1016/j.clinthera.2020.12.013 |issn=0149-2918 |last1=Matoba |first1=Nana |last2=Mestan |first2=Karen K. |last3=Collins |first3=James W. |pmid=33483135 |doi-access=free}}

• Allostatic load
• Adverse childhood experiences
• {{slink|African Americans|Health}}
• Gender disparities in health
• Health equity
• Healthcare and the LGBT community
• Inequality in disease
• John Henryism
• Minority stress
• Post Traumatic Slave Syndrome
• Race and health
• Race and health in the United States
• Robert Sapolsky Research on Stress
• Seasoning (slavery)
• Slave health on plantations in the United States
• Slavery hypertension hypothesis
• Whitehall Study

{{Reflist}}

Category:Hypotheses

Category:Discrimination in the United States

Category:Race and health in the United States

Category:Psychological stress