Certain social/environmental factors put some groups at extraordinary risk for adverse health outcomes, creating health disparities. We present a downward causal model, originating at the population level and ending at disease, with psychological and behavioral responses linking the two. This approach identifies how specific social environments "get under the skin" to cause disease, illustrated with the disparity in mortality from aggressive premenopausal breast cancer suffered by black women. Broadening our lens to consider the entire chain of causal factors, spanning multiple levels and interacting across the life span, heightens our ability to craft specific interventions to address group differences in health. [Health Affairs 27, no. 2 (2008): 339-349; 10.1377/hlthaff.27.2.339] H e a lt h d i s pa r i t i e s o c c u r by r ac e , ethnicity, sex, socioeconomic status, and sexual orientation, with inequities in screening, incidence, treatment, and mortality across a number of diseases and conditions, including cancer, diabetes, cardiovascular disease, infant mortality, and HIV/AIDS. A black/white gap in mortality from common cancer sites has been noted since 1975, for instance, when cancer data were first collected systematically by race and ethnicity. In 1975, black women experienced 39.2 more deaths per 100,000 population from breast cancer than white women. By 2004, that gap had increased to 44.1 excess deaths per 100,000. During the same time period, breast cancer mortality rates among white women decreased from 31.8 to 23.8 per 100,000. Mortality rates

Significant previous research has focused on how individuals experience stigma when interacting with the public sphere and service agencies; the purpose of this grounded theory study is to explore how formerly incarcerated mothers with histories of substance use experience stigmas from their intimate relationships with family and romantic partners. Using an intersectionality lens, this study reveals that the women perceived multiple stigmas due to their previous substance use, incarceration, and other addiction-related behaviors that challenged their roles as mothers and romantic partners. Compounding the behavioral-related stigmas were race and class-based stereotypes of black criminality that also challenged women’s ability to embody key motherhood and womanhood roles. As a result, the women employed resistance strategies to safeguard against stigma and preserve their recovery. The implications for practice underscore the significance of addressing personal experiences of stigma, complex relational dynamics, and understanding the needs of support systems that are also shaped by the women’s cycles of incarceration and illness.

There is a growing literature that has documented diminishing health returns on upward social mobility among Black Americans. Due to historical policies and practices, upward social mobility is often an arduous, isolating process for Black Americans, especially as they navigate predominately white educational and workplace settings. This paper advances the literature in several meaningful and innovative ways. The goal of this paper is to provide a qualitative account of the health costs of upward social mobility and describe how these costs could diminish health returns despite greater levels of socioeconomic resources. Focus groups and surveys were the data collection methods for the study. Inclusion criteria for the study were that respondents identified as African American or Black, were 24 years or older and had completed college. The total sample was 32 college-educated Black men (n = 12) and women (n = 20). The mean age for men was 39 (range = 26–50) and 33 years of age (range = 24–59) for women. Key findings highlighted in this paper include (1) hypervisibility and subsequent vigilance; (2) uplift stress; and (3) health costs associated with social mobility. The sum of these stressors is posited to affect multiple health outcomes and elucidate the mechanisms through which socioeconomic returns on health are diminished.

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