Accepted for/Published in: Journal of Participatory Medicine
Date Submitted: Dec 4, 2024
Date Accepted: Aug 9, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Community-Engaged Approach For Assessment of Cortisol Dynamic Range and Multi-level Chronic Stress in African Americans: The FAITH! Heart Health+ Ancillary Study
ABSTRACT
Background:
Chronic stress in African American (AA) individuals is multi-layered amid the context of experiences of racism and discrimination. Cortisol dynamic range (CDR) may be an indicator of chronic stress, but less is known about the association between stress and CDR in AA individuals, which is hypothesized to differ by sex.
Objective:
Using a community-engaged approach within the FAITH! Heart Health+ ancillary study we assessed the feasibility of participant-centric CDR collection, and its association with measures for individual, interpersonal, structural stress and exposure to racism in medically underserved AA women and men.
Methods:
Participants residing in the Minneapolis-St. Paul and Rochester, Minnesota areas provided survey data (everyday discrimination, perceived stress, mood, sleep quality, and high effort coping measures), and saliva samples (morning and afternoon) via at-home, self-collection kits for cortisol measurement. CDR was calculated as a difference in log cortisol levels (i.e., log of the cortisol diurnal peak-to-nadir ratio). Geospatial area deprivation index and distance lived from George Floyd Square in Minneapolis were calculated. Linear regression examined the association between CDR and outcome variables.
Results:
Of consented participants, 70% provided cortisol samples (37/53, mean age 57.5 years, 65% women). Lower (less dynamic) CDR in women (n=20) was associated with greater perceived stress (β=-0.07, p=0.01), greater anxiety (β=-0.06, p=0.01), higher Superwoman Schema score (β=-0.02, p=0.04), and greater distance from George Floyd Square (β=-0.02, p=0.01). No associations were observed in men (p>0.05).
Conclusions:
The current results suggest that CDR from participant-led saliva collection is feasible and may serve as a biomarker of chronic and physiological stress in AA women, particularly those residing in underresourced areas.
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