Psychosocial and Individual Level Factors
Psychosocial stress can be a deleterious or demanding condition that taxes or exceeds behavioral resources . Psychosocial life stressors related to race may have negative effects on health outcomes [38, 39]. Compared to Whites, minorities report greater exposure to stressful life events [40, 41]. Many researchers contend this may be due, at least in part, to differences in socioeconomic position [42-44]. Individuals in low socioeconomic position may be more vulnerable to the effects of maladaptive health behaviors such as smoking, physical inactivity, and alcohol consumption. Smoking rates are highest among Native American/Alaska Natives  and physical inactivity rates are higher among African Americans and Hispanics/ Latinos relative to Whites . Alcohol consumption in the form of heavy drinking is highest among Native Americans/Alaska Natives and lowest among Asian Americans and African American women . Psychosocial stressors such as perceived discrimination are also more common in minorities than Whites and associated with poorer cardiovascular [48-50] and cognitive health . Many maladaptive behaviors decline with age, yet the effects of health behavior in early-life and midlife may have a cumulative effect on health and well-being in late-life. Moreover, studies of stress physiology show chronic psychosocial stressors activate the hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary systems, physiological systems designed to adaptively respond to acute episodes of stress . Chronic activation of these systems, which often occurs with chronic psychosocial stress, is associated with metabolic dysfunction, increased susceptibility to diseases and mortality .