Protective Factors for Youth Confronting Economic Hardship: CurrentChallenges and Future Avenues in Resilience Research

Camelia E. HostinarUniversity of California, Davis

Gregory E. MillerNorthwestern University

Economic hardship during childhood is associated with worse mental and physical healthacross the life span. Over the past decade, interdisciplinary research has started to elucidatethe behavioral and biological pathways that underlie these disparities and identify protectivefactors that mitigate against their occurrence. In this integrative review we describe theseadvances, highlight remaining gaps in knowledge, and outline a research agenda for psy-chologists. This article has 3 aims. First, we consider the evolving psychobiological literatureon protective factors and conclude that supportive relationships can mitigate against thephysical health problems often associated with economic hardship. Second, we discuss recentempirical developments in health psychology, public health, and the biological sciences,which reveal trade-offs associated with adaptation and challenge the conception of what itmeans to be resilient. Finally, we outline a research agenda that attempts to integrate existingknowledge on health disparities with these newer challenges to inform both policy andpractice for youth experiencing economic hardship.

Public Significance StatementChildhood poverty is prevalent in the United States and can have lasting negative effects on physicaland mental health. Although some children in poverty exhibit resilient functioning, particularly whenthey have access to supportive relationships, research has also revealed limits to resilience. Preven-tion and intervention efforts should focus on promoting both physical and psychological well-beingand intervene early on multiple fronts to create a healthy foundation for children’s development.

Keywords: socioeconomic status, children, physical health, mental health, resilience

Roughly 21% of American children live below the federalpoverty level, defined by the government as earning$24,300 annually for a family of four (Jiang, Granja, &Koball, 2017). An even larger number of children (43%)

grow up in low-income families, which are defined asearning less than twice the poverty level (Jiang et al., 2017),an amount that is also estimated to be inadequate for meet-ing the basic needs of a family with children, includinghousing, child care, food, health care, transportation, dailynecessities, and taxes (Gould, Tanyell, & Kimball, 2015).Nevertheless, growing up in a low-income family is thenorm for many American children, especially if they aremembers of racial and ethnic minority groups. Indeed, 63%of African American and 61% of Hispanic children meet thelow-income definition.

Children contending with economic hardship show worseoutcomes in multiple domains, including education, mentalhealth, and criminal justice system involvement (De Coster,Heimer, & Wittrock, 2006; Duncan & Murnane, 2011;Goodman, Slap, & Huang, 2003). A less studied correlate ofchildhood hardship is physical health problems, which arethe main focus in the current review. Fast-accumulatingevidence from health psychology, developmental psychol-ogy, and epidemiology reveals that low childhood socioeco-

Editor’s note. This article is part of a special section, “Psychology’sContributions to Understanding and Alleviating Poverty and EconomicInequality,” published in the September 2019 issue of American Psychol-ogist. Heather E. Bullock served as guest editor, with Diane M. Quinn asadvisory editor.

Authors’ note. X Camelia E. Hostinar, Department of Psychology,University of California, Davis; Gregory E. Miller, Department of Psy-chology and Institute for Policy Research, Northwestern University.

Authors’ effort was supported by National Institutes of Health GrantsF32 HD078048, R01 HL122328, and P30 DA027827 and National ScienceFoundation Grant 1327768.

Correspondence concerning this article should be addressed to CameliaE. Hostinar, Department of Psychology, University of California, Davis,135 Young Hall, One Shields Avenue, Davis, CA 95616. E-mail:cehostinar@ucdavis.edu

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American Psychologist© 2019 American Psychological Association 2019, Vol. 74, No. 6, 641–652ISSN: 0003-066X http://dx.doi.org/10.1037/amp0000520

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nomic status (SES) is linked to higher rates of morbidity andmortality from multiple conditions across the life span(Adler, 2013; Braveman, Cubbin, Egerter, Williams, & Pa-muk, 2010; Galobardes, Smith, & Lynch, 2006; Goodmanet al., 2003; G. E. Miller, Chen, & Parker, 2011; Hertzman& Boyce, 2010; Repetti, Taylor, & Seeman, 2002). Thesehealth disparities begin at birth, with marked SES differ-ences in preterm delivery, growth restriction, and infantmortality, and continue through childhood, where they man-ifest in common pediatric conditions like obesity, injury,and asthma (Braveman et al., 2010; Schreier & Chen, 2013).They also persist into adulthood, during which childhoodSES forecasts higher rates of coronary heart disease, stroke,and premature mortality, independently of adult SES (Ga-lobardes et al., 2006).

However, the pathways leading from low SES to poorhealth and the protective factors that might alter thesepathways and improve health trajectories for economicallydisadvantaged youth are only beginning to be understood.In recent decades, psychological research has begun toilluminate several of these pathways and protective factors.This analysis focuses on these protective factors, whichcould reduce SES-based health disparities, and has threeprimary goals. First, we describe and assess the evolvingpsychobiological literature on psychosocial protective fac-tors for the physical health and well-being of youth con-fronting economic hardship. Second, we discuss recent em-pirical developments in health psychology, public health,and biological sciences, which reveal trade-offs associatedwith adaptation and challenge the conception of what itmeans to be resilient. Finally, we outline a research agendathat attempts to integrate existing knowledge with these

newer challenges and inform both policy and practice foryouth experiencing economic hardship. To contextualizeresearch on resilience under economic hardship, we beginwith a brief introduction to the current understanding of thepathways between low SES and poor health.

Pathways From Economic Hardship to Life SpanHealth Problems

Extensive research has documented a gradient in healthoutcomes by SES, such that for most—though not all—outcomes, those in higher SES strata enjoy better health(Adler et al., 1994). SES is a multidimensional constructthat is frequently defined in psychology as a combination ofthree objective indicators: income, education, and occupa-tional status (APA Task Force on Socioeconomic Status,2007). Increasingly, it has also been conceptualized in morecomplex ways that include subjective social status (individ-uals’ perceptions of where they stand on the social ladder),household- and neighborhood-level indices of SES, the in-tersections between SES and race or ethnicity, and combi-nations of childhood and adult SES, as well as fluctuationsin SES over time (Adler, 2013). It is important to note thatthe SES�health gradient is observed across varying opera-tionalizations of SES and is not simply a reflection of racialand ethnic disparities in health (Braveman et al., 2010). Itis the case that for many health indicators, African Amer-icans show worse outcomes compared to Whites, andthey do so at each level of income or education (Brave-man et al., 2010). But even within populations ofWhites—and African Americans— health outcomes gen-erally pattern by SES.

Several recent psychobiological theories of how SES“gets under the skin” to affect health have converged on thenotion that the differential activation of stress-mediatingsystems may be a key pathway and thus possibly an inter-vention target. Although describing each theory is beyondthe scope of this review, the most relevant formulationsinclude allostatic load theory (Seeman, Epel, Gruenewald,Karlamangla, & McEwen, 2010), biological embedding the-ory (G. E. Miller, Chen et al., 2011; Hertzman, 1999;Hertzman & Boyce, 2010), the risky families model (Repettiet al., 2002), the multiple risk exposure model of childhoodpoverty (Evans & Kim, 2010), and neurocognitive models(Hackman, Farah, & Meaney, 2010; McEwen & Gianaros,2010; Taylor, 2010).

Other relevant theories focus on behavioral adaptations toeconomic hardship, such as greater reactivity to presentconditions and a tendency to not delay gratification, accord-ing to the experiential canalization model (Blair & Raver,2012); reduced investment in marital and parent–child re-lationships, according to the family stress model (Conger,Conger, & Martin, 2010); and shifts in life history strategies

Camelia E.Hostinar

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642 HOSTINAR AND MILLER

such as earlier reproduction, which would maximize evolu-tionary fitness in adverse environments, according to theadaptive calibration model (Del Giudice, Ellis, & Shirtcliff,2011). Together, these models and their accompanying ev-idence suggest a complex picture that challenges pure “def-icit” models of how children develop under economic hard-ship. Instead, it is becoming increasingly clear that somelow-income children are resilient and do not show poorhealth outcomes (Chen & Miller, 2013). Furthermore, chil-dren’s behavior may have adaptive value in the environmentin which it develops. As examples, not delaying gratifica-tion is adaptive when resources are scarce or their availabil-ity is unpredictable and hypervigilance increases survival indangerous settings, despite the costs of overgeneralizing itto safer contexts. Additionally, some of the adaptations canbe considered socially desirable. For instance, low-incomechildren exhibit higher levels of altruistic and charitablebehavior compared to their wealthy counterparts (J. G.Miller, Kahle, & Hastings, 2015), perhaps due to perceivinggreater interdependence with others or empathizing morewith others’ needs (Piff & Robinson, 2017). Thus, it appearsthat experience canalizes behavior (Blair & Raver, 2012),leading to “developmental trade-offs” that involve bothgains and losses (Blair & Raver, 2012, p. 312). We suggestthat although these adaptations yield “gains” in particularecological settings, they impose costs, too, which are re-flected in disparities in academic performance, mentalhealth, and physical health. As we discuss later, understand-ing the nature of these trade-offs is essential if psychologistsare to design effective interventions and provide usefulpolicy recommendations.

Protective Factors Against ChildhoodEconomic Hardship

Despite the well-established evidence that children grow-ing up poor are more vulnerable to life span physical illness,some poor children remain in good health despite the odds(Chen & Miller, 2013). This was illustrated in a study inwhich adults were exposed to a rhinovirus and then moni-tored in quarantine for emergence of the common cold(Cohen, Doyle, Turner, Alper, & Skoner, 2004). Partici-pants who had experienced low childhood SES were morelikely to become infected with the virus and show coldsymptoms compared to those who grew up in high-SEShomes. However, despite this greater risk, 50% of thosegrowing up in low-SES conditions did not get sick. Thesefindings raise questions about the factors that may protectthe health of children confronting economic hardship.

Factors Promoting Psychological Resilience

Resilience has been defined as positive adaptation despiteadversity and is thought to be a dynamic process thatreflects multiple transactions between environmental con-ditions and individual characteristics leading to successfuloutcomes and not simply a trait of the individual (Cicchetti,2013; Luthar, Crossman, & Small, 2015; Masten &Narayan, 2012; Rutter, 2012). Classic theories and the firstwaves of empirical research on psychological resilienceamong poor children have focused on protective factors thatexplain unexpectedly positive mental health or school out-comes (Garmezy, 1991; Luthar et al., 2015; Masten, 2001,2007; Rutter, 2012; Werner, 2005). Positive, close relation-ships appear to be a cornerstone of positive adaptationdespite adversity. In early childhood, caregivers who aresensitive and responsive, set limits, and maintain stablefamilies are a foundational asset for developmental pro-cesses, as shown by many longitudinal studies in multiplecountries (Luthar et al., 2015; Masten, 2001; Werner, 2005).Later in development, emotionally supportive peers, teach-ers, role models, and romantic partners can buffer againstthe strains and stresses of economic hardship (Luthar et al.,2015; Rutter, 2012). Outside the family, cohesive neighbor-hood communities and organizations such as churches andyouth clubs that reward children for competence and par-ticipation can also serve as protective factors (Garmezy,1991; Werner, 2005). Schools with supportive climates,effective classroom management, and positive teacher ex-pectations can promote children’s academic achievementand offset environmental adversities (Garmezy, 1991; Lu-thar et al., 2015).

At the individual level, a number of personal character-istics have also been associated with resilience, and many ofthese characteristics are themselves shaped by children’sproximal and distal social environments. Children exhibit-ing resilience tend to have some combination of the follow-

Gregory E.Miller

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643RESILIENCE TO ECONOMIC HARDSHIP

ing: active, sociable temperaments that respond positivelyto others; curiosity and intelligence; self-esteem; an internallocus of control; effective interpersonal and communicationskills; achievement motivation related to school or otherspecial talents; a belief system or a sense of meaning in life;strong self-control; and coping skills (Garmezy, 1991; Lu-thar et al., 2015; Masten & Narayan, 2012; Rutter, 2012;Werner, 2005).

Although some children exhibit resilient functioning, re-search has also revealed limits to resilience. For instance,children who appear successfully adjusted at one time pointcan have a breakdown in functioning at later stages or innew life circumstances (Cicchetti, 2013; Luthar et al.,2015). Furthermore, children who appear resilient in onepsychological domain may not show resilience across multi-ple domains. An intensely debated issue in current research ishow common resilience is (Galatzer-Levy & Bonanno, 2016;Infurna & Luthar, 2016). Because investigators have idiosyn-cratic definitions of resilience and use different statistical ap-proaches, the literature contains radically different preva-lence estimates (Galatzer-Levy & Bonanno, 2016; Infurna& Luthar, 2016). Further complicating the issue is thenumber of domains considered (e.g., mental health, physicalhealth). For instance, one study revealed prevalence esti-mates of 16% to 56%, depending on the outcome consid-ered, but only 5% if five domains were considered toclassify participants as resilient (Infurna & Luthar, 2017).Including physical health as a facet of resilience is raisingnovel questions about what it means to be resilient, a topicwe turn to next.

Factors Promoting Resilience to Health Problems

In the past decade, research in health psychology hasbegun examining similar processes and factors that mightpromote children’s physical health resilience, which couldbe defined as exhibiting positive indicators of physicalhealth despite adversity. Some protective factors, such assupportive caregivers and role models, have been linked toboth psychological and physical well-being. Other factors,such as self-control, appear to have divergent effects formental and physical health, as we discuss in more depthlater.

Many of the health problems linked to childhood eco-nomic hardship (e.g., coronary heart disease, stroke, diabe-tes) can take decades to develop and to begin to manifestclinically. However, resilience to these health problems canbe studied early in development by tracking intermediatebiological processes that are known to contribute to diseaseprogression. For instance, studies have examined indices ofstress system functioning (hypothalamic�pituitary�adre-nocortical [HPA] axis, autonomic, cardiovascular), as wellas multisystem composite measures of allostatic load. Ad-ditional interest has been dedicated to markers of future

cardiovascular and metabolic health problems, includingsystemic inflammation, elevated blood pressure, insulin re-sistance, obesity, and health-compromising behaviors (e.g.,smoking). A few studies have assessed more specific mark-ers of disease severity (e.g., asthma impairment) or novelepigenetic markers of cellular aging.

Consistent with findings on psychological resilience, ob-servational studies have consistently revealed what seem tobe protective influences of early life supportive relation-ships, especially parental warmth. Many of these studieshave methodological limitations, including cross-sectionaldesigns, inadequate control for earlier health problems,and/or retrospective accounts of early caregiving, raisingquestions about the veridicality of reports. Nevertheless,their results consistently suggest a scenario whereby earlylife maternal warmth operates as a buffer, weakening theusual association between economic hardship and out-comes, including allostatic load in adolescence (Evans,Kim, Ting, Tesher, & Shannis, 2007), proinflammatorysignaling in adulthood (Chen, Miller, Kobor, & Cole, 2011),and risk of metabolic syndrome in middle and old age (G. E.Miller, Lachman, et al., 2011). Similarly, in prospectivestudies of adolescents, perceived emotional support fromparents, peers, and mentors has emerged as a buffer againstthe cardiometabolic risks associated with neighborhoodpoverty (Brody, Lei, Chen, & Miller, 2014). Among disad-vantaged racial and ethnic minority youth, both parent sup-port and a positive racial identity act as buffers, weakeningthe association between exposure to racial discriminationand disease-relevant biomarkers, including low-grade in-flammation and immune cell aging (Brody, Miller, Yu,Beach, & Chen, 2016; Brody, Yu, Miller, & Chen, 2015).

These observations raise questions about the psychobio-logical characteristics that supportive early caregiving in-stantiates. Research on early life attachment patterns hasshown that receiving sensitive, responsive, and consistentcaregiving teaches children that they live in a safe, predict-able environment where their needs will be met (Sroufe,Egeland, Carlson, & Collins, 2005). Children who receivethis type of care show dampened stress responses when theirparents are present (for a review, see Hostinar, Sullivan, &Gunnar, 2014). Conversely, children experiencing insensi-tive or abusive care are more likely to show patterns ofcognitive processing and social�emotional developmentthat suggests they are hypervigilant to threat (Cicchetti &Valentino, 2007; Dodge & Pettit, 2003; Pollak, 2008). Inturn, frequent activations of threat�response systems likethe HPA axis, autonomic nervous system, and the immunesystem are known to contribute to pathogenic processesinvolved in cardiovascular and metabolic diseases via mul-tiple mechanisms (G. E. Miller, Chen et al., 2011). Consis-tent with the role of buffered threat responsivity as a pro-tective factor, one study found that low childhood SES wasassociated with higher rates of metabolic syndrome in adult-

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644 HOSTINAR AND MILLER

hood. However, these excess risks were not apparent forlow-SES participants who had relatively low threat vigi-lance (Hostinar, Ross, Chan, Chen, & Miller, 2017).

Although most of these findings on buffering via support-ive relationships are correlational, results from several ran-domized intervention studies strengthen confidence in theircausal structure. For instance, a recent randomized trialshowed that a family-oriented intervention implementedwith a disadvantaged sample of 11-year-old African Amer-ican youth from the rural southern United States reducedtheir inflammation levels 8 years later. The effects werepartially mediated by improvements in parenting (G. E.Miller, Brody, Yu, & Chen, 2014). Additionally, a recentreview discussed interventions that aimed to improve thesocial environment for children experiencing adversity (pri-marily through parent training) and that assessed HPA axisfunctioning as an outcome (Slopen, McLaughlin, &Shonkoff, 2014). The review showed that the majority ofthese parenting interventions were able to improve cortisolregulation in children experiencing adversity, compared tovarious comparison groups.

Finally, there is an emerging literature on the role ofself-regulation skills in resilience to health problems, butthe findings are mixed and appear to depend on the facet ofthe construct assessed and the population studied. One po-tentially beneficial set of self-regulation skills has beencalled “shift-and-persist,” which consists of the emotionregulation strategy of reappraising current stressors morepositively (shifting), while simultaneously persisting withan optimistic focus on the future (Chen & Miller, 2012, p.135). Among low-SES children, greater use of shift-and-persist strategies was associated with lower levels ofasthma-related inflammation at baseline and less asthmaimpairment 6 months later (Chen, Strunk, et al., 2011).Similarly, in middle-aged adults who had experienced lowchildhood SES, shift-and-persist strategies were associatedwith lower allostatic load scores (Chen, Miller, Lachman,Gruenewald, & Seeman, 2012). Consistent with these re-sults, one study found that better self-regulation skills wereassociated with fewer chronic respiratory symptoms amongschool-aged homeless children (Barnes et al., 2017).

Other findings on self-regulation are less encouraging. Inone study, self-regulation skills assessed through a delay ofgratification task at age 9 did not moderate the associationbetween poverty and allostatic load, even though it pre-dicted better adult working memory (Evans & Fuller-Rowell, 2013). Additional studies have found that low-SESAfrican American adolescents exhibiting high levels of self-control might even show worse physical health (Brody etal., 2013; G. E. Miller, Yu, Chen, & Brody, 2015), asdiscussed later in the “Skin-Deep” Resilience section.

It is important to note the caveat that many of thesepresumptive buffers of hardship are themselves affected byhardship. For instance, we discussed evidence that sensitive

parenting attenuates the association between low childhoodSES and poor health outcomes. However, economic con-tractions increase the prevalence of harsh parenting (Lee,Brooks-Gunn, McLanahan, Notterman, & Garfinkel, 2013)and child maltreatment (Brooks-Gunn, Schneider, & Wald-fogel, 2013). Similarly, self-regulation has emerged as aprotective factor for the mental health of low-SES youth.But many studies have also suggested that economic hard-ship interferes with the development of these characteris-tics. For instance, one longitudinal study following childrenfrom birth showed that higher chronicity of family povertywas associated with proportionally lower child self-regulation as early as age 4 (Raver, Blair, & Willoughby,2013). These associations between low SES and reducedperformance on self-regulation tasks continue to be ob-served across childhood and into adolescence (Evans &English, 2002; Hackman, Gallop, Evans, & Farah, 2015).This suggests that these buffers may be weakened under themost adverse conditions.

Another caveat is that although the benefits of nurturingparenting or self-regulation might be obvious, there aremany causal pathways to suboptimal parenting or to self-regulation failure. Parental addiction, depression, and fam-ily conflict may require different intervention approaches(Luthar & Eisenberg, 2017; see articles in the special sec-tion organized by these editors in the journal Child Devel-opment for examples of such tailored interventions).

Finally, another caveat is that even though psychologistshave traditionally focused on parenting or other behavioralinterventions as solutions, the uptake and effectiveness ofthese interventions may be limited if parents’ basic needsfor food and a safe home are not met first. For instance, itis increasingly clear that not only does food insecuritypredispose to physical health problems, but it is robustlylinked to worse mental health status in adults and behaviorproblems in children (Jones, 2017). In 2016, approximately16.5% of families with children in the United States werefood-insecure, according to the U.S. Department ofAgriculture (Coleman-Jensen, Rabbitt, Gregory, & Singh,2017); thus, this is a pervasive problem that could under-mine the uptake of behavioral interventions and, if ad-dressed, could result in numerous beneficial outcomes.

The Challenges of Integrating Research onPsychological and Physical Health Resilience

Findings documenting better health outcomes for low-income youth who have access to protective factors arecertainly promising. However, recent discoveries in publichealth and the biological sciences are raising challenges tothe integration of research on psychological and physicalhealth resilience. Next we discuss three major challengesand propose some future avenues for finding solutions tothese challenges.

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645RESILIENCE TO ECONOMIC HARDSHIP

A common language. One potential challenge prevent-ing the current integration of research on psychological andphysical health resilience is the lack of a common languageand common taxonomy for protective factors. Historically,children’s academic success, mental health, and physicalhealth have been studied along parallel tracks, and this isreflected in diverging scientific constructs used to explainthese phenomena. For instance, in psychology the termbuffer is used to mean any protective factor or moderator ofthe effects of adversity, whereas in stress biology buffer hasa narrower meaning as a factor that reduces physiologicalstress reactivity (Kiyokawa & Hennessy, 2018). In devel-opmental psychology, terms like turning points (Rutter,2012) or windows of opportunity refer to major life changesthat offer chances for altering developmental trajectories forthe better. It is unclear what the corresponding biologicalprocesses might be, but arguably the concepts of behavioraland neural plasticity might be helpful to link up with theseconstructs (McEwen, Gray, & Nasca, 2015). We believethat adopting a common language focused on the process ofadaptation and the protective factors that promote it wouldhelp advance research in this area.

To spur efforts to develop a common language on pro-tective factors, we consolidate prior literature on resiliencefrom developmental psychology (Garmezy, 1991; Luthar etal., 2015; Masten & Narayan, 2012; Rutter, 2012) andneuroscience�stress biology (Lyons, Parker, Katz, &Schatzberg, 2009; McEwen et al., 2015) and define a set ofprotective factors based on their timing and their hypothe-sized mechanism of action in relation to the onset of aspecific stressor. Although prior literature has often definedsuch protective factors in terms of statistical methods of

detection (e.g., interaction vs. main effects) and has oftencalled for more research on underlying mechanisms (Cic-chetti, 2013; Luthar et al., 2015; Masten, 2007), we believethe way to move forward with this research agenda is tothink of these factors in terms of the underlying neurobio-logical mechanisms they engage over time as adaptationefforts proceed. Next we provide examples of how theseprotective factors might operate to promote adaptation,drawing upon both human and nonhuman animal research(see Figure 1 for an illustration of the temporal dimension ofadaptation, which shows when each factor acts).

Inoculating factors (Lyons et al., 2009; Rutter, 2012)occur before stressor onset and “steel” or “immunize” indi-viduals by dampening stress responses to future adversity.One such inoculation protocol was developed for squirrelmonkeys and consisted of brief intermittent separationsfrom the mother during the juvenile period. This mild ex-posure to stressors was associated with resilience later indevelopment, as indicated by lower levels of anxiety andcortisol and increased exploration of novel environments(Lyons et al., 2009). There is some emerging evidence fromhumans that early life exposure to brief and mild stressorsmight similarly inoculate them against exaggerated laterstress reactivity (Koss & Gunnar, 2018). In monkeys, dif-ferential myelination of the prefrontal cortex as a result ofsuccessful prior coping with stress appears to be one ofseveral promising neurobiological mechanisms worth ex-ploring (Lyons et al., 2009), but more research is needed inhumans.

In contrast, stress buffers can be defined as factors thatdampen stress responses and the negative impact of adversecircumstances while they are occurring (Kiyokawa & Hen-

Figure 1. Illustration of protective factors promoting adaptation to adversity as they relate to a hypotheticaltimeline surrounding the onset of an acute stressor. Inoculating factors occur before stressor onset and “steel”or “immunize” individuals by dampening stress responses to future adversity. Stress buffers are factors thatdampen stress responses and the negative impact of adverse circumstances while they are occurring. Repairfactors can be defined as factors that restore aspects of biological or psychological functioning and promotefaster recovery after stressful events. Compensatory factors can begin to act after the repair stage is completedand can counterbalance effects of adversity that may be persistent. Windows of opportunity refers to major lifechanges that afford chances for improved outcomes, often long after the experience of adversity. Promotivefactors provide continuous benefits for child development under both low-stress and high-stress conditions. Seethe online article for the color version of this figure.

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646 HOSTINAR AND MILLER

nessy, 2018). Across many mammalian species, includinghumans, the presence or assistance of a conspecific candampen stress responses, as shown through experimentalprotocols (Hostinar et al., 2014; Kiyokawa & Hennessy,2018). To date, most human studies on stress buffers havebeen conducted with adults and children from low-riskenvironments (Hostinar et al., 2014). The neurobiologicalcircuits involved in dampening stress responses are increas-ingly being revealed in both nonhuman animals (Kiyokawa& Hennessy, 2018) and in humans (Hostinar et al., 2014)and appear to involve different processes depending ondevelopmental stage, though more research is needed tofully characterize these processes. Another important futuredirection would to be to identify various subtypes of stressbuffers based on the stage of the stress response withinwhich they operate. Researchers could test which bufferswork best during the initial cognitive appraisal stage, versusthe active coping stage, versus the recovery phase thatoccurs toward the end of a stress response.

Once the stressor has subsided, repair factors begin toact. Repair factors can be defined as factors that restoreaspects of biological or psychological functioning and pro-mote faster recovery from stressful events. For instance,there is some emerging evidence that the negative effects ofstress activation on the body can be contained and mini-mized after the fact by physical exercise and dietary factorssuch as antioxidants in fruits and vegetables (Kiecolt-Glaser, 2010). Little is known about such repair�recoveryfactors in children and adolescents, particularly those ex-posed to socioeconomic disadvantage. This is an importantarea of future research.

Compensatory factors can begin to act after the repairstage is completed and can counterbalance effects of adver-sity that may be persistent. They have been conceptualizedas additive influences that are independent from the effectsof adversity and provide alternative resources to assist withadaptation (Masten, 2001). For instance, cultural resilience(understood as a measure of retaining one’s culture despiteoutside challenges) can act as a compensatory factor for theeffects of racial discrimination on stress levels in FirstNations communities in Canada (Spence, Wells, Graham, &George, 2016). More research is needed to examine suchcompensatory factors for children confronting economicadversity and how cultural representations affect stress ap-praisals and downstream physiological processes.

Another useful concept is that of windows of opportunity,or “turning points” in development (Rutter, 2012, p. 340),which refers to major life changes that afford chances forimproved outcomes, often long after the experience of ad-versity. This likely occurs through processes of behavioralflexibility and neural plasticity (McEwen et al., 2015),though more research is needed to understand what allowssome individuals to retain their capacity for change andadaptability (McEwen et al., 2015). Pursuit of higher edu-

cation, new career opportunities, psychotherapy and mar-riage to a supportive spouse from a high-functioning familyare some examples of such opportunities that can radicallyalter trajectories for the better, even after prior exposure tosignificant economic adversity (Rutter, 2012).

Finally, promotive factors have been defined as predictorsof positive outcomes under both low-risk and high-riskconditions (Masten & Narayan, 2012). That is, they providecontinuous benefits for everyone, and they act before, dur-ing, and after stress exposure and irrespective of general lifecircumstances. Warm, supportive relationships can bethought of as one such factor, which is not only beneficialfor low-income children but also a basic ingredient ofhealthy development for middle-class and high-SES chil-dren (Luthar et al., 2015).

As we reviewed earlier, sensitive parenting is the bestcharacterized protective factor for health problems in low-SES children, but little is understood about how it operates.Although the best parents probably serve all of the previ-ously mentioned functions (e.g., they inoculate, buffer, re-pair), each of these effects likely has different underlyingmechanisms, and more research is needed to fully describetheir roles. This will require a combination of experimentalstudies and multiwave, process-oriented longitudinal inves-tigations that can tease apart various streams of parentalinfluence on child physiology and health.

“Skin-deep” resilience. Another current challenge inresilience research is a phenomenon that has been namedskin-deep resilience, whereby disadvantaged youth showoutward signs of competence, including high levels of self-control, academic excellence, and social success, but later indevelopment evince poor health in biomarker studies(Brody et al., 2013; G. E. Miller et al., 2015). For instance,one longitudinal study of 489 African American youth fromthe rural South identified a group of low-SES preadoles-cents who could be considered psychologically resilientbecause they were rated by their teachers as high on self-control and on scholastic and social competence at ages 11,12, and 13 (Brody et al., 2013). They also exhibited lowlevels of depressive and externalizing symptomatology atage 19. However, this resilient group also showed the high-est allostatic load scores at age 19, as reflected in their highblood pressure, high body mass index, and elevated levelsof overnight stress hormones, including cortisol, epineph-rine, and norepinephrine (Brody et al., 2013). A subsequentfollow-up of this cohort further revealed that the resilientindividuals who were enrolled in college despite exposureto adolescent neighborhood poverty exhibited better psy-chosocial outcomes but higher allostatic load at age 20(Chen, Miller, Brody, & Lei, 2015). Similar results werefound in a different cohort of 292 African American youthwho were followed from age 17 to 22. For all participants,higher self-control at ages 17–20 predicted better subse-quent mental health in multiple domains, ranging from

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depressive symptoms to substance use to aggressive behav-ior. But self-control’s association with physical health, asmeasured by epigenetic aging of immune cells, differedaccording to SES. Among the most disadvantaged youth,self-control was associated with faster cellular aging, rem-iniscent of the earlier findings on allostatic load. Among theless disadvantaged youth, self-control forecasted slower cel-lular aging; in other words, it appeared beneficial for bothmental and physical health outcomes (G. E. Miller et al.,2015).

These patterns have now been replicated in samples fromother geographic regions in the United States and with otherhealth outcomes. For instance, an analysis of 9,301 partic-ipants from the representative National Longitudinal Studyof Adolescent to Adult Health (Add Health) revealed thatAfrican American youth from the most disadvantaged back-grounds who showed high levels of striving and persever-ance in academic pursuits at age 16 were more likely tosuffer from Type 2 diabetes at age 29, despite exhibitingbetter mental health and higher SES compared to their lessstriving counterparts (Brody, Yu, Miller, & Chen, 2016).However, this pattern was not observed in the White sub-sample, where striving was associated with better mentaland physical health. Using data from the same cohort,Gaydosh, Schorpp, Chen, Miller, and Harris (2018) ob-served that college completion was associated with lowerrisk of depression at ages 24–32 for respondents from allracial and ethnic groups. However, the association betweencollege completion and cardiometabolic risk varied acrossgroups. Among Non-Hispanic Whites, finishing college wasassociated with lower metabolic syndrome. The same pat-tern was observed for African Americans and HispanicAmericans from middle- and upper-class backgrounds. Bycontrast, for minority respondents from disadvantagedchildhood environments, college completion was associatedwith higher metabolic syndrome rates at ages 24–32. Sim-ilarly, a study of adults from the metropolitan Pittsburgharea (G. E. Miller, Cohen, Janicki-Deverts, Brody, & Chen,2016) revealed a skin-deep resilience pattern in low-SESAfrican Americans, who showed greater risk of developingupper respiratory infection after exposure to a rhinovirus,but better psychosocial and educational outcomes, if theywere high in conscientiousness. Again, this pattern was notevident in Whites (G. E. Miller et al., 2016). Because so farthe skin-deep resilience pattern has been largely observed inAfrican American samples, with only one study testing forsimilar patterns in disadvantaged Hispanic young adults(Gaydosh et al., 2018), future research should examine thegeneralizability of this phenomenon to other racial�ethnicgroups. Nevertheless, these findings challenge the view ofresilience as an all-or-nothing phenomenon and suggest acomplex pattern of interactions between school functioning,mental health, and physical health that is not necessarilybeneficial for minority youth. We suggest some future di-

rections for research that would promote a deeper under-standing of these patterns and inform efforts to remediatethese trade-offs for high-achieving, psychologically resil-ient minority youth.

First, to uncover the explanations for these hidden costsof upward mobility, research needs to incorporate assess-ments of racial discrimination and stereotype threat thatmay be triggered or amplified when racial and ethnic mi-norities achieve successful outcomes. In addition, exploringthe unique coping styles and challenges faced by upwardlymobile African Americans and Hispanics compared to Non-Hispanic Whites could shed additional light on these pro-cesses. For example, studies have shown that newly up-wardly mobile African Americans face unique challengessuch as greater risk of slipping into poverty, living inneighborhoods with higher rates of poverty and violencedespite achieving higher SES, and perceiving more obliga-tions to assist relatives who are struggling financially (Hard-away & McLoyd, 2009). Race�ethnicity is a constructassociated with numerous differences in sociocultural pro-cesses, physical appearance, immigration status, and soforth (García Coll et al., 1996). The fact that the skin-deepresilience pattern is observed among both African Americanand Hispanic groups is an important clue that, among themany factors embedded in racial and ethnic identification,having minority status may play an key role. More inter-vention studies that aim to improve mental and physicalhealth simultaneously for racial and ethnic minority youthwill be needed, because only with such designs can hypoth-eses about the interplay between these domains be testedand the mechanisms underlying any trade-offs probed. Lon-gitudinal studies that assess all three domains of functioning(educational, mental health, physical health) at each wavewill also be needed to examine when and why biomarkersstart showing a decline in health, as well as possible mod-erating influences.

Synergistic interactions. Another challenge arises fromevidence of synergistic interactions among social–environmental and individual factors that need to be consideredjointly to understand the emergence of socioeconomic healthdisparities. To illustrate these interactions, living in a low-incomeneighborhood where processed, high-carbohydrate foods are af-fordable and abundant can interact with an individual’sstress-mediated shift toward “comfort foods” to promotedietary patterns that lead to poor glycemic control anddiabetes. Environmental stressors can also bring about de-pression in vulnerable individuals, reducing motivation toexercise and interacting with neighborhood threats to fostera sedentary lifestyle, worsening symptoms of diabetes anddepression. In turn, depressive symptoms can impair indi-viduals’ ability to work, worsening economic hardship andreinforcing a vicious cycle.

Most research on these types of synergistic interactionshas been conducted with adults, and more studies with

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648 HOSTINAR AND MILLER

children and adolescents are clearly needed. Some evidencefrom pediatric samples documents synergies between envi-ronmental, psychological, and biological conditions for dis-advantaged children. For instance, childhood asthma onsetand symptomatology is affected by interactions of air pol-lution with parental stress, neighborhood violence exposure,and general life stress (see Schreier & Chen, 2013, for areview). Additionally, there is new evidence of interactionsbetween psychological and chemical stressors (e.g., lead ornitrate exposure) such that the former appears to lower thethreshold at which the latter begins to harm health andcognition (Gump et al., 2009; McEwen & Tucker, 2011).

Due to these interactions, there is a need to invest inmultipronged interventions that can tackle socioeconomic,psychological, and health problems simultaneously becausethese domains are causally interrelated. Targeting a singlepsychological outcome such as parenting or self-regulationskills may not substantially reduce socioeconomic inequal-ity if the ecology that surrounds disadvantaged youth con-tinues to foster other health, social, and educational prob-lems that might, over time, reinstantiate the originalproblem that the intervention was trying to address. Un-doubtedly, interventions that focus on a single process havegreater internal validity because they can confidently isolatethe causal factor driving the outcomes. Furthermore, whenameliorating a process that is influential for many develop-mental domains (e.g., supportive parenting), interventionsmight also initiate positive developmental cascades in otherdomains (Masten & Cicchetti, 2010), as suggested by thecorrelational studies reviewed earlier. Nevertheless, thepresence of synergistic interactions suggests that these pro-grams might be even more beneficial if they were part ofmultifactorial interventions that tackled psychological, bio-logical, and socioeconomic conditions simultaneously (e.g.,ameliorate psychological processes related to economichardship, provide medical prevention�care, reduce expo-sure to toxins, and give cash assistance). However, moreresearch is needed to evaluate the hypothesis that thesemultipronged interventions are more efficacious and cost-effective than the sum of single-outcome interventions.

Conclusions and Policy Implications

In sum, recent research reveals increasingly complex pat-terns of interaction between socioeconomic, psychological,and biological levels of organization. Some data revealtrade-offs or inverse associations between mental and phys-ical health (skin-deep resilience findings). Other studies aresuggestive of mutually reinforcing cycles of worseningmental and physical health problems (synergistic interac-tions results). These findings suggest two broad take-homemessages for research and policy: Focus on promoting bothphysical and psychological health and intervene early onmultiple fronts.

Focus on Promoting Both Physical andPsychological Health

From a research standpoint, there is a need to embrace amore holistic, interactive, and dynamic view of the adapta-tion processes that enable at-risk children to become resil-ient in various domains. To develop this view, a commonlanguage around protective factors and how they operatewill be needed, and we have proposed the beginnings ofsuch an effort here. Additionally, to make progress in thisarea, the very nature of the interactions between differentlevels of analysis needs to become the explicit focus ofresearch, where clear hypotheses about how various levelsinteract with or trade off with each other over time arespecified and tested. Prior studies on children in economichardship have either assessed “deficits” in functioning ordocumented resilience, but few studies have studied thesejointly to understand the process of adaptation itself,whereby children deliberately or unintentionally sacrificeone domain of functioning to optimize another. Withoutunderstanding these “developmental trade-offs” (Blair &Raver, 2012, p. 310), interventions may replace behaviorsthat serve an adaptive function without providing any alter-natives for coping with a specific problem in the environ-ment. Understanding not just the causes but the functions ofbehaviors will be necessary to ensure a beneficial net resultwhen children return to the social contexts they live in. Todesign these types of interventions and move this researchagenda forward, interdisciplinary teams will be needed, andpsychologists have an important role to play in accuratelyrepresenting the role of psychological processes in the in-tegrative models that will need to be developed.

Intervene Early on Multiple Fronts

From a policy perspective, recent findings have suggestedthat a compartmentalized, single-issue approach to the med-ical, psychological, academic, and economic problems ofdisadvantaged children may be less effective than integra-tive solutions that address multiple needs simultaneously, ina holistic and context-informed manner. If recent evidencefrom psychology and public health is any indication, thereneeds to be a renewed commitment to multipronged socialprograms that can create enough positive synergies withineconomically marginalized communities to help ensure thatchildren and families can adapt and withstand the shocksthat do occur. Furthermore, economic analyses have sug-gested that intervention in the first few years of life mayyield the greatest return on investment for society due todevelopmental plasticity in these stages and the hierarchicalnature of development, which ensures that “skills begetskills” (Heckman & Mosso, 2014; Knudsen, Heckman,Cameron, & Shonkoff, 2006, p. 10156). However, theseanalyses are based on human capital outcomes such aseducational attainment and lifetime earnings, and it remains

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649RESILIENCE TO ECONOMIC HARDSHIP

to be seen whether health outcomes follow a similar trajec-tory, particularly for the low-income youth of color whoshow the skin-deep resilience pattern. The biological “wearand tear” affecting their bodies may be difficult if notimpossible to reverse, and later interventions may need tofocus on repair factors and compensatory factors, whereasearly life interventions could focus on promoting inoculat-ing factors and stress buffers.

Finally, the benefits of intervening on multiple frontshave been shown through experimental programs like thePerry Preschool and Abecedarian projects. These programsprovided a strong foundation for healthy development ofeconomically disadvantaged children in multiple domains(social and cognitive, as well as physical) and have beenshown to not only have long-lasting benefits into adulthoodbut provide returns on investment for society that wouldmake up for their cost (Knudsen et al., 2006). Despite thisevidence, national programs like Head Start have beenstripped of many of the social services, medical care, andhealth education components they provided to parents whenthe program was launched, and today its beneficial impactsfor children are weaker. Given the accumulating evidenceon the interrelations between children’s physical, cognitive,and social well-being, we believe policymakers should pro-pose new programs or increase investment in existing mul-tipronged programs for young children and families facingeconomic hardship. Children’s resilience will then remainpossible because a healthy foundation exists and protectivefactors have been bolstered at multiple levels.

References

Adler, N. E. (2013). Health disparities: Taking on the challenge. Perspec-tives on Psychological Science, 8, 679–681. http://dx.doi.org/10.1177/1745691613506909

Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn,R. L., & Syme, S. L. (1994). Socioeconomic status and health: Thechallenge of the gradient. American Psychologist, 49, 15–24. http://dx.doi.org/10.1037/0003-066X.49.1.15

APA Task Force on Socioeconomic Status. (2007). Report of the APA taskforce on socioeconomic status. Washington, DC: American Psycholog-ical Association.

Barnes, A. J., Lafavor, T. L., Cutuli, J. J., Zhang, L., Oberg, C. N., &Masten, A. S. (2017). Health and self-regulation among school-agechildren experiencing family homelessness. Children, 4, 70. http://dx.doi.org/10.3390/children4080070

Blair, C., & Raver, C. C. (2012). Child development in the context ofadversity: Experiential canalization of brain and behavior. AmericanPsychologist, 67, 309–318. http://dx.doi.org/10.1037/a0027493

Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E.(2010). Socioeconomic disparities in health in the United States: Whatthe patterns tell us. American Journal of Public Health, 100(Suppl. 1),S186–S196. http://dx.doi.org/10.2105/AJPH.2009.166082

Brody, G. H., Lei, M.-K., Chen, E., & Miller, G. E. (2014). Neighborhoodpoverty and allostatic load in African American youth. Pediatrics, 134,e1362–e1368. http://dx.doi.org/10.1542/peds.2014-1395

Brody, G. H., Miller, G. E., Yu, T., Beach, S. R. H., & Chen, E. (2016).Supportive family environments ameliorate the link between racial dis-crimination and epigenetic aging: A replication across two longitudinal

cohorts. Psychological Science, 27, 530–541. http://dx.doi.org/10.1177/0956797615626703

Brody, G. H., Yu, T., Chen, E., Miller, G. E., Kogan, S. M., & Beach,S. R. H. (2013). Is resilience only skin deep? Rural African Americans’socioeconomic status-related risk and competence in preadolescence andpsychological adjustment and allostatic load at age 19. PsychologicalScience, 24, 1285–1293. http://dx.doi.org/10.1177/0956797612471954

Brody, G. H., Yu, T., Miller, G. E., & Chen, E. (2015). Discrimination,racial identity, and cytokine levels among African-American adoles-cents. Journal of Adolescent Health, 56, 496–501. http://dx.doi.org/10.1016/j.jadohealth.2015.01.017

Brody, G. H., Yu, T., Miller, G. E., & Chen, E. (2016). Resilience inadolescence, health, and psychosocial outcomes. Pediatrics, 138(6),e20161042. http://dx.doi.org/10.1542/peds.2016-1042

Brooks-Gunn, J., Schneider, W., & Waldfogel, J. (2013). The Great Re-cession and the risk for child maltreatment. Child Abuse & Neglect, 37,721–729. http://dx.doi.org/10.1016/j.chiabu.2013.08.004

Chen, E., & Miller, G. E. (2012). “Shift-and-persist” strategies: Why lowsocioeconomic status isn’t always bad for health. Perspectives on Psy-chological Science, 7, 135–158. http://dx.doi.org/10.1177/1745691612436694

Chen, E., & Miller, G. E. (2013). Socioeconomic status and health:Mediating and moderating factors. Annual Review of Clinical Psychol-ogy, 9, 723–749. http://dx.doi.org/10.1146/annurev-clinpsy-050212-185634

Chen, E., Miller, G. E., Brody, G. H., & Lei, M. (2015). Neighborhoodpoverty, college attendance, and diverging profiles of substance use andallostatic load in rural African American youth. Clinical PsychologicalScience, 3, 675–685. http://dx.doi.org/10.1177/2167702614546639

Chen, E., Miller, G. E., Kobor, M. S., & Cole, S. W. (2011). Maternalwarmth buffers the effects of low early-life socioeconomic status onpro-inflammatory signaling in adulthood. Molecular Psychiatry, 16,729–737. http://dx.doi.org/10.1038/mp.2010.53

Chen, E., Miller, G. E., Lachman, M. E., Gruenewald, T. L., & Seeman,T. E. (2012). Protective factors for adults from low-childhood socioeco-nomic circumstances: The benefits of shift-and-persist for allostatic load.Psychosomatic Medicine, 74, 178–186. http://dx.doi.org/10.1097/PSY.0b013e31824206fd

Chen, E., Strunk, R. C., Trethewey, A., Schreier, H. M. C., Maharaj, N., &Miller, G. E. (2011). Resilience in low-socioeconomic-status childrenwith asthma: Adaptations to stress. Journal of Allergy and ClinicalImmunology, 128, 970 –976. http://dx.doi.org/10.1016/j.jaci.2011.06.040

Cicchetti, D. (2013). Annual research review: Resilient functioning inmaltreated children—Past, present, and future perspectives. Journal ofChild Psychology and Psychiatry, 54, 402–422. http://dx.doi.org/10.1111/j.1469-7610.2012.02608.x

Cicchetti, D., & Valentino, K. (2007). Toward the application of amultiple-levels-of-analysis perspective to research in development andpsychopathology. In A. S. Masten (Ed.), Multilevel dynamics in devel-opmental psychopathology: Pathways to the future (pp. 243–284). Mah-wah, NJ: Erlbaum.

Cohen, S., Doyle, W. J., Turner, R. B., Alper, C. M., & Skoner, D. P.(2004). Childhood socioeconomic status and host resistance to infectiousillness in adulthood. Psychosomatic Medicine, 66, 553–558. http://dx.doi.org/10.1097/01.psy.0000126200.05189.d3

Coleman-Jensen, A., Rabbitt, M. P., Gregory, C. A., & Singh, A. (2017).Household food security in the United States in 2016 (Economic Re-search Report No. 237). Retrieved from Economic Research Servicewebsite: https://www.ers.usda.gov/publications/pub-details/?pubid�84972

Conger, R. D., Conger, K. J., & Martin, M. J. (2010). Socioeconomicstatus, family processes, and individual development. Journal of Mar-

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

650 HOSTINAR AND MILLER

riage and Family, 72, 685–704. http://dx.doi.org/10.1111/j.1741-3737.2010.00725.x

De Coster, S., Heimer, K., & Wittrock, S. M. (2006). Neighborhooddisadvantage, social capital, stress context, and youth violence. Socio-logical Quarterly, 47, 723–753. http://dx.doi.org/10.1111/j.1533-8525.2006.00064.x

Del Giudice, M., Ellis, B. J., & Shirtcliff, E. A. (2011). The adaptivecalibration model of stress responsivity. Neuroscience and Biobehav-ioral Reviews, 35, 1562–1592. http://dx.doi.org/10.1016/j.neubiorev.2010.11.007

Dodge, K. A., & Pettit, G. S. (2003). A biopsychosocial model of thedevelopment of chronic conduct problems in adolescence. Developmen-tal Psychology, 39, 349–371. http://dx.doi.org/10.1037/0012-1649.39.2.349

Duncan, G. J., & Murnane, R. J. (2011). Whither opportunity? Risinginequality, schools, and children’s life chances. New York, NY: RussellSage Foundation.

Evans, G. W., & English, K. (2002). The environment of poverty: Multiplestressor exposure, psychophysiological stress, and socioemotional ad-justment. Child Development, 73, 1238–1248. http://dx.doi.org/10.1111/1467-8624.00469

Evans, G. W., & Fuller-Rowell, T. E. (2013). Childhood poverty, chronicstress, and young adult working memory: The protective role of self-regulatory capacity. Developmental Science, 16, 688–696. http://dx.doi.org/10.1111/desc.12082

Evans, G. W., & Kim, P. (2010). Multiple risk exposure as a potentialexplanatory mechanism for the socioeconomic status-health gradient.Annals of the New York Academy of Sciences, 1186, 174–189. http://dx.doi.org/10.1111/j.1749-6632.2009.05336.x

Evans, G. W., Kim, P., Ting, A. H., Tesher, H. B., & Shannis, D. (2007).Cumulative risk, maternal responsiveness, and allostatic load amongyoung adolescents. Developmental Psychology, 43, 341–351. http://dx.doi.org/10.1037/0012-1649.43.2.341

Galatzer-Levy, I. R., & Bonanno, G. A. (2016). It’s not so easy to makeresilience go away: Commentary on Infurna and Luthar (2016). Per-spectives on Psychological Science, 11, 195–198. http://dx.doi.org/10.1177/1745691615621277

Galobardes, B., Smith, G. D., & Lynch, J. W. (2006). Systematic review ofthe influence of childhood socioeconomic circumstances on risk forcardiovascular disease in adulthood. Annals of Epidemiology, 16, 91–104. http://dx.doi.org/10.1016/j.annepidem.2005.06.053

García Coll, C., Lamberty, G., Jenkins, R., McAdoo, H. P., Crnic, K.,Wasik, B. H., & Vázquez García, H. (1996). An integrative model forthe study of developmental competencies in minority children. ChildDevelopment, 67, 1891–1914. http://dx.doi.org/10.2307/1131600

Garmezy, N. (1991). Resiliency and vulnerability to adverse developmen-tal outcomes associated with poverty. American Behavioral Scientist, 34,416–430. http://dx.doi.org/10.1177/0002764291034004003

Gaydosh, L., Schorpp, K. M., Chen, E., Miller, G. E., & Harris, K. M.(2018). College completion predicts lower depression but higher meta-bolic syndrome among disadvantaged minorities in young adulthood.Proceedings of the National Academy of Sciences of the United States ofAmerica, 115, 109–114. http://dx.doi.org/10.1073/pnas.1714616114

Goodman, E., Slap, G. B., & Huang, B. (2003). The public health impactof socioeconomic status on adolescent depression and obesity. AmericanJournal of Public Health, 93, 1844–1850. http://dx.doi.org/10.2105/AJPH.93.11.1844

Gould, E., Tanyell, C., & Kimball, W. (2015). What families need to getby: EPI’s 2015 family budget calculator. Retrieved from http://www.epi.org/files/2015/epi-family-budget-calculator-2015.pdf

Gump, B. B., Reihman, J., Stewart, P., Lonky, E., Granger, D. A., &Matthews, K. A. (2009). Blood lead (Pb) levels: Further evidence for anenvironmental mechanism explaining the association between socioeco-

nomic status and psychophysiological dysregulation in children. HealthPsychology, 28, 614–620. http://dx.doi.org/10.1037/a0015611

Hackman, D. A., Farah, M. J., & Meaney, M. J. (2010). Socioeconomicstatus and the brain: Mechanistic insights from human and animalresearch. Nature Reviews Neuroscience, 11, 651–659. http://dx.doi.org/10.1038/nrn2897

Hackman, D. A., Gallop, R., Evans, G. W., & Farah, M. J. (2015).Socioeconomic status and executive function: Developmental trajecto-ries and mediation. Developmental Science, 18, 686–702. http://dx.doi.org/10.1111/desc.12246

Hardaway, C. R., & McLoyd, V. C. (2009). Escaping poverty and securingmiddle class status: How race and socioeconomic status shape mobilityprospects for African Americans during the transition to adulthood.Journal of Youth and Adolescence, 38, 242–256. http://dx.doi.org/10.1007/s10964-008-9354-z

Heckman, J. J., & Mosso, S. (2014). The economics of human developmentand social mobility. Annual Review of Economics, 6, 689–733. http://dx.doi.org/10.1146/annurev-economics-080213-040753

Hertzman, C. (1999). The biological embedding of early experience and itseffects on health in adulthood. Annals of the New York Academy ofSciences, 896, 85–95. http://dx.doi.org/10.1111/j.1749-6632.1999.tb08107.x

Hertzman, C., & Boyce, T. (2010). How experience gets under the skin tocreate gradients in developmental health. Annual Review of PublicHealth, 31, 329 –347. http://dx.doi.org/10.1146/annurev.publhealth.012809.103538

Hostinar, C. E., Ross, K. M., Chan, M., Chen, E., & Miller, G. E. (2017).Threat vigilance and socioeconomic disparities in metabolic health.Development and Psychopathology, 29, 1721–1733. http://dx.doi.org/10.1017/S0954579417001353

Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. (2014). Psychobiologicalmechanisms underlying the social buffering of the hypothalamic-pituitary-adrenocortical axis: A review of animal models and humanstudies across development. Psychological Bulletin, 140, 256–282.http://dx.doi.org/10.1037/a0032671

Infurna, F. J., & Luthar, S. S. (2016). Resilience to major life stressors isnot as common as thought. Perspectives on Psychological Science, 11,175–194. http://dx.doi.org/10.1177/1745691615621271

Infurna, F. J., & Luthar, S. S. (2017). Parents’ adjustment following thedeath of their child: Resilience is multidimensional and differs acrossoutcomes examined. Journal of Research in Personality, 68, 38–53.http://dx.doi.org/10.1016/j.jrp.2017.04.004

Jiang, Y., Granja, M. R., & Koball, H. (2017). Basic facts about low-income children: Children under 18 years. New York, NY: NationalCenter for Children in Poverty, Columbia University Mailman School ofPublic Health.

Jones, A. D. (2017). Food insecurity and mental health status: A globalanalysis of 149 countries. American Journal of Preventive Medicine, 53,264–273. http://dx.doi.org/10.1016/j.amepre.2017.04.008

Kiecolt-Glaser, J. K. (2010). Stress, food, and inflammation: Psychoneu-roimmunology and nutrition at the cutting edge. Psychosomatic Medi-cine, 72, 365–369. http://dx.doi.org/10.1097/PSY.0b013e3181dbf489

Kiyokawa, Y., & Hennessy, M. B. (2018). Comparative studies of socialbuffering: A consideration of approaches, terminology, and pitfalls.Neuroscience and Biobehavioral Reviews, 86, 131–141. http://dx.doi.org/10.1016/j.neubiorev.2017.12.005

Knudsen, E. I., Heckman, J. J., Cameron, J. L., & Shonkoff, J. P. (2006).Economic, neurobiological, and behavioral perspectives on buildingAmerica’s future workforce. Proceedings of the National Academy ofSciences of the United States of America, 103, 10155–10162. http://dx.doi.org/10.1073/pnas.0600888103

Koss, K. J., & Gunnar, M. R. (2018). Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. Journal of

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

651RESILIENCE TO ECONOMIC HARDSHIP

Child Psychology and Psychiatry, 59, 327–346. http://dx.doi.org/10.1111/jcpp.12784

Lee, D., Brooks-Gunn, J., McLanahan, S. S., Notterman, D., & Garfinkel,I. (2013). The Great Recession, genetic sensitivity, and maternal harshparenting. Proceedings of the National Academy of Sciences of theUnited States of America, 110, 13780–13784. http://dx.doi.org/10.1073/pnas.1312398110

Luthar, S. S., Crossman, E. J., & Small, P. J. (2015). Resilience andadversity. In R. M. Lerner & M. E. Lamb (Eds.), Handbook of childpsychology and developmental science (7th ed., pp. 247–286). http://dx.doi.org/10.1002/9781118963418.childpsy307

Luthar, S. S., & Eisenberg, N. (2017). Resilient adaptation among at-riskchildren: Harnessing science toward maximizing salutary environments.Child Development, 88, 337–349. http://dx.doi.org/10.1111/cdev.12737

Lyons, D. M., Parker, K. J., Katz, M., & Schatzberg, A. F. (2009).Developmental cascades linking stress inoculation, arousal regulation,and resilience. Frontiers in Behavioral Neuroscience, 3, 32. http://dx.doi.org/10.3389/neuro.08.032.2009

Masten, A. S. (2001). Ordinary magic: Resilience processes in develop-ment. American Psychologist, 56, 227–238. http://dx.doi.org/10.1037/0003-066X.56.3.227

Masten, A. S. (2007). Resilience in developing systems: Progress andpromise as the fourth wave rises. Development and Psychopathology,19, 921–930. http://dx.doi.org/10.1017/S0954579407000442

Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Develop-ment and Psychopathology, 22, 491–495. http://dx.doi.org/10.1017/S0954579410000222

Masten, A. S., & Narayan, A. J. (2012). Child development in the contextof disaster, war, and terrorism: Pathways of risk and resilience. AnnualReview of Psychology, 63, 227–257. http://dx.doi.org/10.1146/annurev-psych-120710-100356

McEwen, B. S., & Gianaros, P. J. (2010). Central role of the brain in stressand adaptation: Links to socioeconomic status, health, and disease.Annals of the New York Academy of Sciences, 1186, 190–222. http://dx.doi.org/10.1111/j.1749-6632.2009.05331.x

McEwen, B. S., Gray, J., & Nasca, C. (2015). Recognizing resilience:Learning from the effects of stress on the brain. Neurobiology of Stress,1, 1–11. http://dx.doi.org/10.1016/j.ynstr.2014.09.001

McEwen, B. S., & Tucker, P. (2011). Critical biological pathways forchronic psychosocial stress and research opportunities to advance theconsideration of stress in chemical risk assessment. American Journal ofPublic Health, 101(Suppl. 1), S131–S139. http://dx.doi.org/10.2105/AJPH.2011.300270

Miller, G. E., Brody, G. H., Yu, T., & Chen, E. (2014). A family-orientedpsychosocial intervention reduces inflammation in low-SES AfricanAmerican youth. Proceedings of the National Academy of Sciences ofthe United States of America, 111, 11287–11292. http://dx.doi.org/10.1073/pnas.1406578111

Miller, G. E., Chen, E., & Parker, K. J. (2011). Psychological stress inchildhood and susceptibility to the chronic diseases of aging: Movingtoward a model of behavioral and biological mechanisms. PsychologicalBulletin, 137, 959–997. http://dx.doi.org/10.1037/a0024768

Miller, G. E., Cohen, S., Janicki-Deverts, D., Brody, G. H., & Chen, E.(2016). Viral challenge reveals further evidence of skin-deep resiliencein African Americans from disadvantaged backgrounds. Health Psychol-ogy, 35, 1225–1234. http://dx.doi.org/10.1037/hea0000398

Miller, G. E., Lachman, M. E., Chen, E., Gruenewald, T. L., Karlamangla,A. S., & Seeman, T. E. (2011). Pathways to resilience: Maternal nur-turance as a buffer against the effects of childhood poverty on metabolic

syndrome at midlife. Psychological Science, 22, 1591–1599. http://dx.doi.org/10.1177/0956797611419170

Miller, G. E., Yu, T., Chen, E., & Brody, G. H. (2015). Self-controlforecasts better psychosocial outcomes but faster epigenetic aging inlow-SES youth. Proceedings of the National Academy of Sciences of theUnited States of America, 112, 10325–10330. http://dx.doi.org/10.1073/pnas.1505063112

Miller, J. G., Kahle, S., & Hastings, P. D. (2015). Roots and benefits ofcostly giving: Children who are more altruistic have greater autonomicflexibility and less family wealth. Psychological Science, 26, 1038–1045. http://dx.doi.org/10.1177/0956797615578476

Piff, P. K., & Robinson, A. R. (2017). Social class and prosocial behavior:Current evidence, caveats, and questions. Current Opinion in Psychol-ogy, 18, 6–10. http://dx.doi.org/10.1016/j.copsyc.2017.06.003

Pollak, S. D. (2008). Mechanisms linking early experience and the emer-gence of emotions: Illustrations from the study of maltreated children.Current Directions in Psychological Science, 17, 370–375. http://dx.doi.org/10.1111/j.1467-8721.2008.00608.x

Raver, C. C., Blair, C., & Willoughby, M. (2013). Poverty as a predictor of4-year-olds’ executive function: New perspectives on models of differ-ential susceptibility. Developmental Psychology, 49, 292–304. http://dx.doi.org/10.1037/a0028343

Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families:Family social environments and the mental and physical health ofoffspring. Psychological Bulletin, 128, 330–366. http://dx.doi.org/10.1037/0033-2909.128.2.330

Rutter, M. (2012). Resilience as a dynamic concept. Development andPsychopathology, 24, 335–344. http://dx.doi.org/10.1017/S0954579412000028

Schreier, H. M. C., & Chen, E. (2013). Socioeconomic status and the healthof youth: A multilevel, multidomain approach to conceptualizing path-ways. Psychological Bulletin, 139, 606–654. http://dx.doi.org/10.1037/a0029416

Seeman, T., Epel, E., Gruenewald, T., Karlamangla, A., & McEwen, B. S.(2010). Socio-economic differentials in peripheral biology: Cumulativeallostatic load. Annals of the New York Academy of Sciences, 1186,223–239. http://dx.doi.org/10.1111/j.1749-6632.2009.05341.x

Slopen, N., McLaughlin, K. A., & Shonkoff, J. P. (2014). Interventions toimprove cortisol regulation in children: A systematic review. Pediatrics,133, 312–326. http://dx.doi.org/10.1542/peds.2013-1632

Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). Thedevelopment of the person: The Minnesota study of risk and adaptationfrom birth to adulthood. New York, NY: Guilford Press.

Spence, N. D., Wells, S., Graham, K., & George, J. (2016). Racial dis-crimination, cultural resilience, and stress. Canadian Journal of Psychi-atry/La Revue canadienne de psychiatrie, 61, 298–307. http://dx.doi.org/10.1177/0706743716638653

Taylor, S. E. (2010). Mechanisms linking early life stress to adult healthoutcomes. Proceedings of the National Academy of Sciences of theUnited States of America, 107, 8507–8512. http://dx.doi.org/10.1073/pnas.1003890107

Werner, E. E. (2005). What can we learn about resilience from large-scalelongitudinal studies? In S. Goldstein & R. B. Brooks (Eds.), Handbookof resilience in children (pp. 91–105). http://dx.doi.org/10.1007/0-306-48572-9_7

Received September 16, 2017Revision received July 12, 2019

Accepted July 15, 2019 �

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652 HOSTINAR AND MILLER