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Biological sex, socioeconomic position, and stress physiology among Native Americans: Findings from the Oklahoma Study of Native American Pain Risk III

Year: 2026
Type: article
Abstract: Native Americans (NAs) experience disproportionate exposure to chronic sociocultural stressors that may shape physiological stress systems and contribute to health disparities. Yet, little research has examined acute stress reactivity, stress recovery, and their predictors in NAs. The present study investigated the independent and joint effects of sex and socioeconomic position (SEP) on sympathetic-adrenomedullary (SAM), hypothalamic-pituitary-adrenal (HPA), and negative affective responses to the Trier Social Stress Test (TSST) in 120 healthy NA adults (74 women). SEP was assessed using objective (household income) and subjective (subjective social status) indicators. SAM (skin conductance level, heart rate, blood pressure), HPA (cortisol), and negative affect were measured during baseline, stress, and recovery. Men displayed robust stress responding across all measures, whereas women showed robust SAM and affective responses but blunted cortisol reactivity. Exploratory analyses suggested this difference was not likely explained by hormonal contraceptive use. Lower income was associated with heart rate blunting in both sexes and cortisol blunting among men. By contrast, cortisol blunting was consistent across the income gradient among women. Lower income was associated with poorer cortisol recovery in both sexes. Subjective social status was unrelated to stress outcomes. These findings suggest that sex and SEP jointly shape stress physiology among NAs and support an intersectionality-informed understanding of stress-system functioning. Future research is needed to further understand how sociocultural and structural stressors become biologically embedded in NA populations and contribute to stress-related health disparities, but to also identify sources of resilience.
DOI: 10.1016/j.psyneuen.2026.108027
Authors: Jamie L. Rhudy, Travis S. Lowe, Kayla N. Trevino, Parker A. Kell, Taylor V. Brown, Claudia N. Vore, Brandon W. Jones, Aleiyah Fields, William R. Lovallo, Joanna O. Shadlow
Institutions: University of Oklahoma - Tulsa, University of Oklahoma, University of Tulsa, Washington University in St. Louis, Oklahoma City VA Medical Center, Oklahoma State University, Oklahoma State University at Tulsa
Language: English
Open Access status: hybrid
Estimated APC paid: $3,830
Funders: Oklahoma Tobacco Settlement Endowment Trust, Washington University in St. Louis, University of Oklahoma, Tobacco Settlement Endowment Trust, National Institutes of Health, Stephenson Cancer Center, National Cancer Institute, National Center for Complementary and Integrative Health, Department of Anesthesiology, Washington University in St. Louis
OpenAlex ID: W7214992641
FWCI:
Cites: 44
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Related to: 10