Life can be so measured and mean to so many, it’s a wonder some of us can cope at all.

By Christine Suh

Where Nadya Gray grew up, life was framed by violence.

“In the projects, we call it the television because there’s always going to be a fight. Someone’s going to get shot. There’s just always something going on,” Gray said.

Her immediate family lived in the middle-class outskirts of an agricultural town of about 7,000 people. They owned a home and had five cars in the garage and driveway. But as an adolescent, Gray hung out with her cousins in a public housing complex so often that she considered it home, too. At least as a kid.

Now the 19-year-old Florida State student is anxious to leave Quincy, Fla., far behind when she graduates, she said.

But she might never make a totally clean break from her hometown.

Social scientists have long known that stress of all kinds—from witnessing shootings to being abused to failing a grade—can plague a person for life.

Violence doesn’t faze her anymore, Gray said. She doesn’t even remember the first time she saw a fight or a shooting, but off the top of her head, Gray can quickly name two people who have been shot in Quincy. One was a close high school friend.

That alone could sink someone into depression. Researchers already know that a stressful event—the death of someone close or losing a home to a hurricane—in the short term can drive a person to drinking, drugs and depression.

But until now they’ve underestimated to an alarming degree just how much stress added up over time can damage our health, said R. Jay Turner, professor of epidemiology and sociology in FSU’s College of Social Sciences.

For nearly a decade, Turner’s research team has been drawing the most comprehensive picture of stress—who gets hit the hardest—and its long-term consequences.

The ugliest part of the picture is that stress discriminates. It hits black Americans like Gray the hardest—harder than anyone previously understood—Turner has found. And the black population already carries the brunt of physical health disparities in this country.

As Sen. Edward Kennedy put it last year in a commentary pushing for action, “Minorities live sicker and die sooner… The state of U.S. minority health is an embarrassment to the nation.”

Still Unequal

They remain invisible to many, but the health disparities that blacks such as Gray have lived with all their lives scar their communities in ways hard to ignore.

In 2003 Gray’s hometown, which was 64 percent black in the 2000 census, drew the attention of a national magazine as an example of the poor state of minority health. Essence, which described a Quincy liquor store’s patrons as “crack addicts, single moms, laborers in uniform, alcoholics, retirees, teenage truants and streetwalkers,” made an example of the town to shed light on rising HIV infections among black women.

When Gray tells people in Tallahassee she’s from Quincy, just 25 miles away, she braces herself for that raised eyebrow, sometimes coupled with a question to match the curiosity in their faces.

Most ask her whether it’s true that everyone in Quincy has sex with everyone else or even if she has AIDS, she said. As much as she wants to get away from Quincy, Gray said she finds herself constantly defending it.

The stereotypes hardly apply to all African-Americans in Quincy. Not by a long shot. But the town’s rising rate of HIV infections among black women does represent a larger trend.

While health improves across the board in the United States with advancing technology and research, the chasm in health between many minorities, especially blacks, and whites stubbornly persists. In 2005, the Centers for Disease Control and Prevention reported that the rate of AIDS diagnoses for black women was 23 times higher than the rate for white women. Infant mortality for black babies is almost two-and-a-half times higher than for whites. Blacks are expected to live 10 years fewer than whites and are more likely to die of cancer and heart disease than whites. All totaled, health equality could save the lives of more than 80,000 blacks each year, one team of researchers reported the policy journal Health Affairs last spring.

From Gray’s perspective, diet and poverty account for the differences.

“It’s the southern cooking,” she said. Everything is fried, she explained. Plus, “There’s no money to go get that pap smear or that cancer screening.”

The most recent census data for Quincy back up Gray’s latter argument. The numbers from 1999 show the town’s median family income was almost $20,000 less than the national average. Close to 17 percent of Quincy’s families were living in poverty, almost twice the national average.

Poverty undoubtedly plays a part in health disparities, but researchers say the picture is far more complicated. It’s discrimination coupled with poor health care and compounded by a lack of research and communication.

The details aren’t cut and dried, but all agree it is a shameful side of the country’s otherwise rosy profile.

Parsing the Problem

Turner’s study presents an intensive search for root causes so policy makers can get a clearer idea of what to target.

His search started with another researcher’s glimpse into the lives of more than 10,000 pre-teens and early teens in south Florida in the early 1990s.

Turner picked up where this study left off. In 1998, he and his team of researchers got back in touch with many of the original subjects, now around 19 years old, curious about how their lives were turning out.

Turner sampled participants in this prior study such that four groups were equally represented: one being non-Hispanic whites, another of Cuban origin, one of non-Cuban Hispanics and one of African-Americans. Cubans comprised a group distinct from other Hispanics, Turner explained, because in south Florida, they represent fully half of all Hispanic residents, have been in this country longer on average and tend to be better off financially and socially. Ultimately, more than 1,800 subjects participated in the study.

What was the common denominator—if there were one—among the men and women who fell into drugs and alcohol abuse, among those who slid into depression?

Turner’s team of researchers sat down with each subject for intense, two-hour interviews designed to recreate each person’s life history. Two years later, they followed up with another interview session.

By 2002, Turner’s team finished the bulk of the interviews for the long-term $4 million dollar study, funded by the National Institute on Drug Abuse. They’ve recently received additional funding and extra time to analyze more completely the data they’ve collected. But already, the results found by Turner, along with FSU sociologists Donald Lloyd, John Taylor, John Reynolds and Anne Barrett, have contributed the most complete understanding to date of the long-term consequences of stress on mental health and substance abuse—the intuitive as well as the unexpected.

Total Toll

Gray, who was not a subject in Turner’s study, figures the stress from witnessing violence in her formative years has hardened her from its nasty effects.

“I guess in a way I’m kind of numb,” she said. “If somebody called me and was like, ‘Somebody in Quincy got shot,’ I’d be OK. I’m so used to seeing it; it’s nothing new.”

But Turner believes the health threat might be more insidious than Gray realizes.

What Turner’s study found was truly bad news for people like Gray: The stress slate can never be wiped clean, and its effects can devastate.

For the first time, Turner’s team showed that taking the sum of emotional blows over many years better predicts whether a person will use drugs or alcohol, develop a mental disorder, such as post-traumatic stress disorder, or commit a crime.

Until now, when figuring out what role stress plays in our health, research studies have considered only recent stressful events—abuse, divorce, failing a grade—within the past year of a person’s life.

“We argue that (recent stress) only accounts for a small slice of the stress pie,” Turner said.

He found that the more stress subjects endured during their lifetime, the more likely they were to develop mental disorders or drug dependence, which can ultimately affect physical health. The effect of recent stress turned out to be minimal in comparison.

Turner’s data, for example, showed that someone who lived through eight stressful events over the years was about twice as likely to develop depression or anxiety as someone who lived through just one.

The study demonstrated that prior research has tended to underestimate the elevation in stress experienced by blacks relative to whites by almost 300 percent. Most prior studies have omitted consideration of lifetime experiences of major and potentially traumatic events, enduring or chronic stressors and discrimination stress. Turner showed that while white, Cuban and other Hispanic kids in south Florida encounter more than seven stressful events in their lives, blacks on average experience more than 10 incidents such as abuse, divorce and witnessing violence.

Double-Edged Data

While the raw numbers, at first glance, don’t bode well for black Americans, there’s more to the story, Turner found.

Seemingly against the odds, black Americans fared better than others for certain disorders Turner studied.

For example, he found that only 6.5 percent of black subjects ended up addicted to drugs compared to 16 to 18 percent in the other study groups.

Blacks were also less depressed and anxiety-ridden. About 15.6 percent of blacks had long-term depression or anxiety problems compared to 20 to 22 percent in the other groups.

The results are counterintuitive, but earlier studies, such as those summarized in a 2001 Surgeon General’s report, have come up with similar numbers.

What accounts for the paradox? Are blacks just more emotionally resilient by nature than others?

No one knows exactly what to make of the data yet, Turner conceded. One theory proposes that in blacks, all of that stress transforms into physical, rather than mental, illness—which might partly explain why blacks tend to fall victim to more physical ailments than others, Turner said. Another theory argues that blacks grow so used to high levels of stress that its effects are dampened. Another suggests that blacks are less willing than others to open up about drug use or depression.

Gray’s guess? Life’s unrelenting realities—and limited time. Her cousins who didn’t have the chance to go to college found work instead and manage to keep a positive attitude, Gray said.

“You can’t just sit down and mope about it,” she said. “You don’t have time to be depressed. You still need to get up and go to work in the morning. You still need to take care of your kids. You don’t have time to be depressed.”

Formidable Fix

Just thinking about the country’s health disparities is depressing enough. Blacks make up 13 percent of the U.S. population but accounted for half of the new HIV/AIDS diagnoses in 2004, the CDC has reported. Blacks are almost twice as likely to die from diabetes as whites. In 2002, the Institute of Medicine reported that blacks and Hispanics receive lower quality of care than whites. More than 30 percent of Hispanics in this country are uninsured compared to 15 percent of white Americans. And as Turner has found, blacks get hit with the most stress.

But rather than overwhelm, the numbers feed Turner’s optimism.

The best part of his research, he explained, is in its potential to induce change. Uncovering a problem’s cause can lead to solutions.

“This has immense implications for what you think you should do about it,” he said. “It suggests that you shouldn’t spend all your time trying to teach people how to adapt better to stress. You should spend some more of your time trying to fix things up so people aren’t exposed to so much stress.”

Gray said depression isn’t an issue for her, but she is tired of standing out for all the wrong reasons. To escape the stereotypes that cling to her as long as she stays close to home, she plans to move to the bright lights of New York City after she graduates.

It turns out it may be just what the doctor should order.