Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov 25;25(1):4134.
doi: 10.1186/s12889-025-24919-y.

The association between social drivers of health, HIV status and physical activity with perceived stress in U.S. women with or without HIV

Deborah Konkle-Parker  1 , Katherine Hall  2 , Jung Hye Sung  2 , Masoumeh Karimi  2 , Jenni M Wise  3 , Andrew Edmonds  4 , Anjali Sharma  5 , Sheri D Weiser  6 , Ilene Brill  7 , Maria L Alcaide  8 , Marlene Camacho-Rivera  9 , Aruna Chandran  10 , Mardge Cohen  11 , Amanda Blair Spence  12 , Gina Wingood  13 , Melissa Klamm  14
Affiliations

The association between social drivers of health, HIV status and physical activity with perceived stress in U.S. women with or without HIV

Deborah Konkle-Parker et al. BMC Public Health. .

Abstract

Background: The physiological adaptation to chronic stress can have deleterious health effects. Although higher physical activity (PA) has been linked to lower stress, it is unknown whether social driver of health (SDOH) burden and HIV status impact the stress reduction effects of PA due to their unique contributions to stress.

Methods: Using a cross-sectional sample (n = 444) from the Women's Interagency HIV Study during 2014-2019, multivariate linear regression modeling was used to estimate the effect of SDOH burden and PA on stress. SDOH burden was defined as the sum of individual-level indicators: inadequate housing, income, and education as well as unemployment, and food insecurity.

Results: Unadjusted, there was a significant relationship between SDOH burden, Heavy PA and Moderate PA with stress (rs = 0.22 [p < .001], -0.10 [p < .05], and - 0.11 [p < .05] respectively) After adjusting for age, HIV status and race, and including both SDOH and PA, only SDOH predicted stress (β = 0.20, 95% CI [0.6, 1.87]; p < .001). Among this sample, food insecurity was the strongest predictor of stress, reducing the effects of PA when included in the model (β = 0.24, 95% CI [2.38, 5.99]; p < .001).

Conclusions: Findings indicated that, after adjusting for age, HIV status and race, SDOH burden reduced the association between PA and stress, and was a stronger predictor of stress in women living with HIV than those living without HIV. The impact of food insecurity appears to be a powerful driver of stress in both women living with and without HIV.

Keywords: HIV; Perceived Stress; Physical activity; Social Determinants of Health.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: In accordance with the Declaration of Helsinki, his study was approved by ethics committees at each institution involved in this study, and informed consent was obtained from each participant, including consent to publish from the data, without identifying information. Those Internal Review Boards were local review boards at the University of MS Medical Center, University of Alabama at Birmingham, Georgetown University, Johns Hopkins University, University of North Carolina at Chapel Hill, Albert Einstein College of Medicine, University of California San Francisco, University of Miami, SUNY Downstate Health Sciences University, Stroger Hospital of Cook County, and Columbia University. Consent for publication: Informed consent was obtained from each participant, including consent to publish from the data, without identifying information. Competing interests: The authors declare no competing interests.

References

    1. Reddy KP, Eberly LA, Julien HM, Giri J, Fanaroff AC, Groeneveld PW, et al. Association between Racial residential segregation and Black-White disparities in cardiovascular disease mortality. Am Heart J. 2023;264:143–52. - PMC - PubMed
    1. Thimm-Kaiser M, Benzekri A, Guilamo-Ramos V. Conceptualizing the mechanisms of social determinants of health: A heuristic framework to inform future directions for mitigation. Milbank Q. 2023;101(2):486–526. - PMC - PubMed
    1. Henderson ER, Subramaniam DS, Chen J. Rural-Urban differences in human immunodeficiency virus testing among US adults: findings from the behavioral risk factor surveillance system. Sex Transm Dis. 2018;45(12):808–12. - PubMed
    1. Edun B, Iyer M, Albrecht H, Weissman S. The South Carolina rural-urban HIV continuum of care. AIDS Care. 2017;29(7):817–22. - PubMed
    1. Gustafsson PE, San Sebastian M, Janlert U, Theorell T, Westerlund H, Hammarstrom A. Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks. Am J Public Health. 2014;104(5):904–10. - PMC - PubMed