Community psychologist Adolfo Cuevas is committed to uncovering why people of color in the U.S. have poorer health than their white counterparts. As the director of Tufts University’s Psychosocial Determinants of Health Lab, Cuevas leads a team of clinicians and researchers seeking to show how psychosocial factors like discrimination and other stressors cause physical health disparities, such as obesity and high blood pressure, particularly for people of color. Cuevas’s position at the Lab allows him to collaborate and support a diverse range of studies centered primarily on racial discrimination and health.
Could you share a summary on your most recent research?
I most recently authored a paper with David Williams from the Harvard T. H. Chan School of Public Health where we summarized the literature on discrimination and health, specifically looking at why black Americans have poorer health than white Americans. Researchers in the past assumed that this health gap was due to the lower socio-economic status of black Americans. However, at every gradient of the socioeconomic ladder—even for the most well-resourced black family—black Americans still have poorer health compared to white Americans. Dr. Williams developed a measure to examine how racial discrimination in different social contexts, such as receiving poorer service than other people at restaurants or stores, causes poor mental health. Since then, there has been a burgeoning of research in this area, examining the association between discrimination and a variety of health outcomes. In our review, we’ve found compelling evidence that discrimination is associated with negative health outcomes, such as higher blood pressure, greater likelihood of diabetes, higher rates of obesity, and poorer mental health. In summarizing this literature, we also discovered that discrimination is a risk factor for poor health across social identities—any sort of discrimination impacts health outcomes.
Through my position as director of Tufts’ Psychosocial Determinants of Health Lab, I am currently studying how discrimination and other psychosocial stressors affect obesity and the onset of obesity across several different projects. I believe that psychosocial stress has been understudied in obesity research, which makes the Lab’s work crucial. Right now, I’m working with my lab colleagues to examine stress comprehensively to see how it explains obesity disparities. Black and Hispanic Americans have greater rates of obesity compared to whites and what we’re finding is that factors such as lifetime discrimination, social relationship stress, and employment discrimination partially explain .
Could you tell us about your position as the director of Tufts’ Psychosocial Determinants of Health Lab?
The Lab is a multi-disciplinary team of researchers from across the globe, who are interested in understanding the bio-behavioral pathways that link psychosocial stress and health. As a team of clinicians, epidemiologists, and psychologists, we collaborate and analyze population-level datasets to understand the link between stress and health. In our work we look at behaviors that mediate the relationship between stress and health—as well as the biological mechanisms that link the two—with the ultimate goal of understanding why certain groups are much more vulnerable to stress than others.
As the director, my work is multi-dimensional. Within the Lab, I’m currently leading several manuscripts and data analyses looking at biological links between stress and obesity. I also support other projects. For example, one colleague, Kasim Ortiz, is investigating the interaction between race and social cohesion within the Latino community and how stress may explain race disparities within the Latino community. Through the Lab, I’m able to draw my attention to a diversity of work even if I’m not on the project. The goal of the lab is to foster collaborations across multiple disciplines.
What motivates you to do the work that you do?
Despite advances in medical care and technologies, we still see racial disparities in the U.S. Given our status as one of the wealthiest nations in the world, it’s an injustice that we still see differences in health based on race and other social identities. For me, it’s a lifelong career of understanding how different aspects of our socio-environment physiologically affects us and influence persistent racial/ethnic health inequities..
Who should read your research/article and why?
This work should not stay within the academic world—the goal is to get the information out into the wider population. Every time the Lab publishes a paper, our goal is to give a presentation about it to the community. We also use non-traditional forms of communication, such as presenting our work through podcasts and op-ed pieces. In June, I gave a presentation to community members and clinicians with the goal of making the findings relatable to everyone—I think that’s critical for research to have an impact in society. We must take research beyond a journal and place it in the hands of community members and policymakers.
My colleague Jonathan Purtle recently published a study investigating mayors’ and health commissioners’ perceptions of what contributes to social inequity. This paper is vital, and everyone should read it. Purtle reports that there’s little knowledge of what contributes to health inequity among politicians and leaders—30 percent of mayors thought that city policies could not impact health disparities, demonstrating a knowledge gap between researchers and public officials. We must begin connecting with community members and community leaders to enact change.
What is your favorite thing about conducting research with the Lab?
I really enjoy the whole process of research from developing the research question to interpreting the results. My favorite part, though, is the interpretation. Often, the results are unexpected or counterintuitive, which forces us to think about why our results don’t match our hypotheses. For example, in one study currently under review, , which was counter to our original hypothesis. We predicted that greater discrimination would lead to higher obesity across all groups given that discrimination operates like other stressors, increasing inflammation and leading to obesity. However, in this case, we found that the awareness of discrimination can be protective as it allows individuals to readily engage in effective coping strategies. This is not to say that discrimination isn’t a risk factor for these groups. In fact, it is quite the contrary. Therefore, we have to continue to better understand the biobehavioral pathways that link discrimination and health, which is what my lab is currently doing. It’s the complex and counterintuitive findings like these that I most intriguing because we are getting closer to understanding how discrimination and other stressors operate.
How does this work relate to a Culture of Health?
To bring about a culture of health, psychosocial factors must be included in the discussion. Our entire lived experiences are constructed through interactions with different forms of cultures, such as family, friends, our workplaces, and our communities. All of these cultures influence us. They particularly have influences on our health and health behaviors. To achieve a culture of good health we need to continue understanding how we interact and engage in these settings. Through this understanding, we can identify key moments or players that can help us improve our quality of life.