Or so it seemed. Dr. Geronimus, a professor in the school of public health at the University of Michigan and a member of the National Academy of Medicine, soon found two surprising incongruities. These girls — young, mostly black and Latina — were not unhappy to be pregnant. Some, she recalls, “had even worked to become pregnant.” And although they were in roughly the same age group, these young women seemed far older and sicker than what Geronimus calls her “healthy and advantaged” Princeton peers. Her pregnant students were battling ailments, such as high blood pressure and diabetes, that usually affect older people. RELATED: The United States of Stress: You’ll Never Think About Stress the Same Way Again When Geronimus learned more about the girls and their difficult daily lives, she saw that pregnancy wasn’t the problem. Coping with the daily, substantial challenges of poverty was. More than three decades later, Geronimus has named the accelerated aging phenomenon produced by living with adversity and made it her life’s work. Her research quantifies the biological effects of often unseen factors, such as gender and race inequality and material hardship, that add up to a corrosive, chronic stress-fueled accelerated aging — the phenomenon she calls “weathering.” Everyday Health: Unlike many of your Princeton peers, you weren’t from the upper crust of society, either. Arline Geronimus: No. The undergrads at Princeton were a very select group of healthy and advantaged young people, most whose fathers and grandfathers had attended Princeton or colleges like it. I didn’t completely fit in. I was in one of the first classes of women to enter the school. And I came from an extended immigrant family and was the first to attend an Ivy League school. EH: Did you understand what you were seeing — the weathering effects of adversity on health — at the time? AG: I wouldn’t have been able to articulate it right then. It was more that I had a sense of frustration with the fact that there was something going on that wasn’t right and needed to be attended to, and it wasn’t pregnancy, per se. But all anyone seemed to care about was pregnancy. EH: An understanding of stress and how environmental factors might play a role didn’t really exist at that point. How did you begin to put all the pieces together? AG: I earned a doctorate in public health at Harvard. And the best thing about that was that I got to take classes all over Harvard. I took courses in public health and also a lot in anthropology, education, and adolescent and developmental psychology. And I had my degree in political theory from Princeton, so I understood issues about power and politics and community. But I had to handcraft my education by myself. I was really very much alone at the time in trying to piece together how social inequity translated to health inequity. EH: What helped you the most to understand what you’d seen? AG: My anthropology courses, learning about other societies and their adaptive cultural responses to hardship and realizing that we have them here, too. Adaptive responses can result in different ideas about how we organize our families and when we should have our children. I also read a classic book from the ‘70’s called All Our Kin by Carol Stack, in which she conducted an ethnographic study in a Midwestern city. Stack showed why, if you don’t have enough income or wealth to survive, it’s adaptive to form these intricate and large webs going outside household boundaries to define who has obligations to help support children and families, instead of relying on only one household or nuclear family. Everyone else was saying that there were disorganized families in high-poverty areas, but Stack illustrated that if you looked closely, there was a web of kin that you could call on in times of need. And one of the things she talked about was how babies expanded that network. EH: So you started looking at data that might indicate that having babies earlier was actually adaptive and healthier for certain populations of women. AG: I began working with the Rural Infant Care Project, which was focused on how to intervene in high rates of low-birth-weight births, preterm births, and infant mortality in some of the poorest and high-risk communities across the county. Most people thought that the high rates of teen childbearing in these areas was a major cause of their very high infant mortality rates. Based on my earlier experience working with teen mothers, I thought it was more likely life circumstances that conveyed the risk of adverse birth outcomes, and that being a teen mother was no more risky than being an older mother in stressful life circumstances. What I found was that in terms of birth outcome, being a teen mom in these communities was not only not worse, it was better. For black moms in high-poverty areas, the lowest risks for low birth weight, preterm births, and infant mortality were in the late teen years, and then risk went up steadily, linearly, after that. EH: And this was the genesis of the idea of weathering, which is what you say is going on in this population and others exposed to similar circumstances. Can you define weathering? AG: Weathering is a physiological process that accelerates aging and increases health vulnerability. It is spurred by chronic toxic stress exposures over the life course and the tenacious high-effort coping [that] families and communities engage in to survive them, if not prevail. EH: Can you explain why you chose the word “weathering” to describe this phenomenon? AG: I picked it because it encapsulates two almost opposite meanings. I think of weathering as in how a rock weathers when eroded by environmental forces. It brought to mind, metaphorically, the different things I’d seen and measured that were eroding the health of people subjected to adverse life experiences. But I also liked the word “weathering” because of the other meaning, as in “weathering the storm.” They are actively coping with difficult situations and coming through it. I felt like that was also what I was seeing. People engaging in life, actively living their lives, even though it was hard, even though they were living in what looked like despairing conditions. EH: What was the next step in putting together the theory of weathering? AG: I began studies looking at maternal risk factors for poor pregnancy outcomes, like hypertension and high levels of circulating blood lead, and what the age trajectories of these risks were in these communities compared to national averages. Sure enough, the risk went up with age from the late teens through the twenties. I was seeing hypertension, usually thought of as a disease of middle or old age, in the twenties. Circulating blood lead levels went up with age in the twenties. So did behaviors such as smoking. Everyone thought teens did all the smoking. But in black populations, teens hardly ever smoked but were more likely to take it up in their twenties and thirties, when many of the white teens who smoked tended to quit. There were different age patterns of risk, no matter how you looked at it. Mortality rates, disability rates, and chronic illness were all quite different, if you looked across the life span. In different parts of the country, depending on the conditions people lived in, these were all different. EH: When you pointed out that babies born to teen moms in these communities were actually healthier, that didn’t go over too well. AG: No. I was vilified in the press and at professional meetings. Journalists wrote articles with headlines like “Research Queen Says Let Them Have Babies.” It was very swift. I gave a talk about my work at a meeting of the American Association for the Advancement of Science in the early ’90s. It was a huge honor to be invited to talk there. And I discovered that outside the room I was speaking in, while I was speaking, an advocate from the Children’s Defense Fund was giving a press conference, saying in effect that I should be tarred and feathered, actively working to discredit me. A lot of advocacy organizations were using the issue of preventing teen childbearing to get funds at a time when funding for social welfare programs was hard to come by. They saw my work as a threat to their organizational stability and survival. EH: But things got better once the field of stress research grew and scientists started being able to actually measure the physiological impact of stress, correct? AG: When I first talked about weathering, it was as a metaphor and in psychological, sociological, and anthropological terms. While the poor health outcomes I studied had to have a physiological basis, I hadn’t formulated what the actual physiological process of weathering was. Then in the late1990s, I started hearing about a scientist at Rockefeller University named Bruce McEwen, [who was] talking about allostatic load, which described physiologically what I was talking about. And I thought, That’s it! Professor McEwen gave a lecture at the University of Michigan in 2001 that I made sure to attend. I went up to him and introduced myself and told him about my work. And he said, “Well, allostatic load is just weathering.” It helped me understand how weathering literally happens at the physiological level. I learned an enormous amount from his work. EH: How did you incorporate allostatic load into your work? AG: I did a paper tracking the age trajectory of high allostatic load for white and black U.S. men and women. Sure enough, blacks and whites started with close probabilities of having a high allostic load score in their teens that increased gradually for white men and women but took off for black men and women starting in their twenties. By their late thirties and forties, U.S. black women had [a] substantially higher prevalence of high allostatic load than any other group EH: The telomere study was particularly brilliant. Can you explain it? AG: I read a seminal paper by Elissa Epel and Elizabeth Blackburn in which, in order to isolate any effects of perceived stress, they had cherry-picked a homogeneous sample of white and well-off mothers, half of whom were the parents of a special needs child, half of whom had children without special needs. They measured the length of their telomeres. Like protective caps on the ends of shoelaces, telomeres are caps at the end of each DNA strand that protect our chromosomes from becoming damaged. Your telomere length is an indicator of your biological age. Whatever your chronological age, having shorter telomere length suggests you may be biologically older. Epel and Blackburn found that even in this group of healthy, educated mothers with economic resources, telomere length was shorter in the group with this one stressor — caring for a special needs child. Those who had faced this responsibility longer or reported experiencing higher levels of stress had shorter telomeres, too. That was the first published paper saying that your telomere length, your aging process, could be affected by having a stressful life. For me, the light bulb went off immediately. If white, educated, well-off women with one major stressor can show this aging effect, imagine what was going on in the bodies of people I had seen, who had, from the beginning, dealt with chronically stressful lives across many dimensions, including considerable caretaking demands under conditions of hardship. EH: And what did your subsequent published paper find? AG: We aligned with a community-based partnership between colleagues of mine at the University of Michigan and several community-based organizations in Detroit [that] had conducted a far-ranging survey of a sample of the Detroit population, and we collected blood, saliva, and additional survey data from a subset of the original sample. We also collaborated on this study with Elissa Epel and Elizabeth Blackburn. The telomere lengths of our research participants were measured in the Blackburn lab with the same methodology and equipment that Epel and Blackburn had used in their original telomere study, allowing us to compare the telomere lengths of our participants to those in other studies done at the Blackburn lab. We don’t have great economic diversity in Detroit. It’s lower middle class and poor. We showed that everybody [in the Detroit sample] had shorter telomere length than seen in more advantaged samples, supporting the idea that stressors associated with life in high-poverty communities accelerated cellular aging. But the most intriguing findings went against what you might expect — but work within the context of weathering. EH: Such as? AG: We found that poor white Detroit residents had the shortest telomeres, even compared to poor black or Mexican residents of Detroit. The non-poor whites had the longest telomeres, as one might expect. However, in the Mexican population, we found the opposite. Non-poor Mexicans were less healthy, biologically, than poor Mexicans. One of my former students — who worked as the project director of this study, Dr. Jay Pearson, now a faculty member at Duke University — had actually predicted that poor Mexicans in Detroit might be healthier than those who were more upwardly socioeconomically mobile. But it makes sense. While available economic resources are an important part of what plays into weathering, additional critical contributors are the amount of psychosocial adversity you face every day and what resources, economic and noneconomic, you have to cope with it. In that context, it is not a surprise that different racial and ethnic groups with the same amount of scarce economic resources would be more or less likely to weather, if they differed in access to critical psychosocial resources. And there is reason to believe that among the poorest Detroiters, blacks and Mexicans would have greater psychosocial resources than the few and more isolated poor whites. EH: So it’s not just about poverty? It’s about race and support systems? AG: One of the unfortunate things about thinking about health inequalities in socioeconomic terms alone is that you think, If the poor just have more education and better jobs, they’ll be healthier. But if they have to leave their support systems to get those educations and deal with people who devalue them on a daily basis in those jobs, such psychosocial stressors will also weather them. Another former student, Dr. Edna Viruell Fuentes, has studied it in the Mexican population, specifically including in Detroit. She found that in addition to its material rewards, social mobility exposes people to deeper and more frequent experiences of being “othered” compared to those who remain in supportive ethnic enclaves. The issue is not simply having money or a higher education or a prestigious job. It’s how does the experience of having that job or living in that neighborhood or going to that school in a society that is not a level playing field affect you. You might have to engage in chronic high-effort coping just to deal with the injustices you see before your eyes, which can wear away at your health. EH: In our survey, the LGBTQ community, which is also a marginalized community, seemed less resilient than black Americans. How would you explain this in terms of weathering? AG: As a group, the LGBTQ community is stigmatized, discriminated against, oppressed, and subject to hate crimes, as are blacks or other racial and ethnic groups in the United States, but their psychosocial coping resources are likely to be different. They are unlikely to have been born and raised with a clear and socially affirmed understanding that they have an LGBTQ identity or community, for instance. Their identity as LGBTQ would most likely not have been shared by other members of their families and neighborhoods, nor would they have strong histories of collective, pooled, or adaptive responses to generations of marginalization passed down to them automatically by their families. Even as individuals, they cannot count on their families of origin being supportive or understanding, and even if they are or want to be, their family members are unlikely to have the means or wisdom to help them navigate the specific social threats that are visited on them as LBGTQ Americans because they have no personal history with such threats. Worse, in many cases, their families reject them. EH: So is there anything we can do to mitigate weathering? AG: I think so. But before we can really come up with and try out new things, I think we have to stop prejudging the family systems of members of marginalized groups. Given their circumstances, their behavior may differ from the dominant norms, both because they have to take weathering into account and because they need to mitigate weathering. For example, becoming a mother in your late teens has different ramifications if you have few socioeconomic opportunities, and meanwhile, your risk of developing chronic diseases in the near future that can harm your baby’s health or result in your disability or death at a relatively young age is very real. It can be misleading to judge different choices without knowing the actual options a group faces. In a case like this, policy efforts should focus on eliminating weathering, not on pregnancy or family structure, per se. EH: And beyond that? AG: To the extent that weathering is the physiological result of chronic toxic, environmental, and psychosocial stress exposure, we need to improve the physical and psychosocial environments of marginalized populations. Some of this can be taken literally — for example, eliminating the known and serious pollutants in air and water and soil that characterize many high-poverty and predominantly minority communities. Increasing the accessibility of healthy foods, green spaces, and healthcare are also important; cleaning up mold and decay in homes and schools — weatherizing homes. It also means changing social, workplace, and classroom environments so they are less likely to elicit stress responses in diverse members in integrated settings. Some such interventions are simple and inexpensive. There are studies on STEM [science, technology, engineering, and math] and women that show that if you put up nature posters in a STEM classroom, women are more motivated to do well, but if you put up Star Trek posters, they don’t perform as well and experience greater psychosocial distress. This compromises their test performance and potentially their health. Educational studies also show that if you ask whether you are female or male at the beginning of the math SATs versus waiting until the end, it affects scores. Women do better if the question is asked at the end. It’s on a very subliminal level. Somehow, by calling their attention to the fact that they are members of a group that has been stereotyped as poor in math, the stakes are raised for them to disprove the stereotype. The affective neural networks that are recruited to wrestle with social exclusion take precedence over recruiting neural networks that facilitate the successful completion of math-related cognitive tasks in the moment. Activation of affective neural networks can also activate physiological stress reactions. It’s best not to have the ideology that girls are incompetent in math. But even short of eradicating this ideology, you can do things to intervene in how it affects performance or stress reactivity in classes and schools.
