"White Box" Epidemiology and the Social Neuroscience of Health Behaviors: The Environmental Affordances Model

Abstract

Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health.

Keywords: allostatic load; mental health; race/ethnicity; stress-buffering effects.

Figure 1

Lifetime prevalence of common psychiatric and chronic medical conditions by race/ethnicity: National Comorbidity Survey–Replication (2001–2003). Note: Analysis is limited to adults aged 40 and older, and values are adjusted for sampling weights. MDE = major depressive episode; GAD = generalized anxiety disorder.

Figure 2

The Environmental Affordances Model. Note: The Environmental Affordances Model incorporates status-based stressors, coping, and mental and physical health.

Figure 3

Predicted probability of depression at follow-up by race, number of poor health behaviors (PHB), and life stress at baseline for A) whites and B) blacks in the Baltimore Epidemiologic Catchment Area Study. Note: From the American Journal of Epidemiology (2010), 172(11):1238–49. Reprinted with permission of Oxford University Press.