The human body is in a constant process of maintaining a dynamic equilibrium known as homeostasis [
1]. Sometimes, life events, environmental conditions, or other phenomena can knock this equilibrium out of place and activate the body′s natural stress responses. These phenomena are known as stressors. With this, an individual experiences “stress” anytime a stressor is present that challenges or threatens to challenge homeostasis [
1]. In response to stress, the body employs a chain of hormones through both the sympathetic nervous system (SNS) and the hypothalamic-pituitary adrenocortical (HPA) axis [
2]. Through this process, the body creates epinephrine through the SNS and cortisol through the HPA axis, which then work to create and reroute energy to the critical systems of the body [
2]. While these processes help the body deal with stressors in the short term, when these systems are active for too long or too often due to chronic stressors, significant damage can be done to the body [
2].
In addition to the SNS and the HPA axis, the body also uses adaptation to better respond to stressors and maintain homeostasis through a process called allostasis [
3]. Often, this may be achieved through an unhealthy use of a high level of stress hormones, and the cumulation of the consequent changes is called allostatic load. Allostatic load significantly impacts the body and, in the long term, can cause harm to the body [
1,
3]. In particular, it would appear that adolescents are especially vulnerable to these detrimental effects of stress, which may be because adolescents′ brains are still maturing, they are experiencing greater hormonal reactivity, and they may experience increased corticosterone sensitivity [
4]. It would appear that adolescence is a critical developmental period for stress [
1]. Strong and chronic stressors during this time period may lead to lifelong allostasis [
1], long-term impacts to one′s mental or physical health, and even death [
2].
1.1. Stress and Mental Health
Along with the impacts of chronic stress, general stress may also impact mental health, especially with regard to depression, self-esteem, and externalizing behaviors [
5]. According to the National Institute of Mental Health, approximately 17% of adolescents in the United States ages 12 to 17 experienced at least one major depressive episode during 2020 [
6]. In an attempt to identify factors of depression, studies [
5,
7] have found that this prevalent form of psychopathology appears to be heavily correlated with one′s stress levels. Specifically, various stressors can also predict depressive symptoms in youth, such as stressful life events [
8] and parent–child conflicts [
9]. Currently, there are multiple theories that suggest why this relationship between stress and depression may exist. Stress levels are positively correlated with proinflammatory cytokine levels, which in turn are connected to depressive symptoms [
2]. These researchers suggested that elevated cytokine levels could mediate the relationship between stress and depression. Other researchers found another mediatory relationship in which stressful life events predicted more use of disengaged coping, which predicted, in turn, depressive symptoms [
8]. They proposed that not only may stress itself be a factor when it comes to depression, but also the way in which an individual chooses to react to and cope with stressors.
Externalizing behaviors, including frustration and aggression, have also been associated with increased stress [
10,
11]. For example, family stressors such as conflict and instability have been associated with externalizing behaviors in adolescence [
12,
13]. Because adolescence is a time of autonomy-seeking and identity-formation, sources of stress can come from family, friends, and school. During adolescence, some youth may have a difficult time processing the various stressors that they experience, leading to an increased risk for reacting in unhealthy ways such as exhibiting externalizing behaviors [
14,
15].
In addition to depression and externalizing behaviors, stress also has been connected to lower self-esteem [
16,
17]. Specific stressors, such as family violence, family alcohol abuse, [
18] and parent–child conflict [
9], also show connections to lower self-esteem in some youth. These findings would suggest that stress is connected to one′s self-esteem, though other variables may influence or weaken that relationship, such as gender [
18].
1.2. Stress and Physical Health
Stress has also been shown to have detrimental effects on physical health, both in the long term and in more acute situations. Because the stress response invests energy into prepping the parts of the body necessary to cope with a stressor, the body activates other high-stress functions to take action against threats, such as increasing blood flow and strengthening the immune system [
2]. While these outcomes are important for assisting the body to cope with acute stress, they can prove unhealthy over time. During times of chronic stress, having the physiological stress-response systems activated for long periods of time has been shown to be harmful to physical health, leading to such problems as chronically elevated blood pressure and weakened or damaged immunity [
2]. Increased blood pressure from stress is linked to cardiovascular difficulties in particular [
2], and stress has also been linked to the development of autoimmune disorders [
19]. Over time, the stress response can prove unhealthy and dangerous to the body, especially with longer periods of stress.
One well-documented outcome of stress is obesity, which has multiple negative health outcomes as well. Stress has been linked to obesity through stress-induced disrupted brain function, hormone production, a lack of exercise [
20], and sleep deprivation [
21]. Poor self-regulation and cumulative risks in childhood are correlated with obesity later in life [
8], adding to research that links adverse childhood experiences with exacerbated stress responses [
22], showing that childhood could be a critical period for developing habits that could alleviate later risks for stress and obesity. Obesity can lead to other health problems, including hypertension, diabetes, breathing problems, and heart disease [
23]. While obesity is a widespread and significant threat to physical health and a major financial burden [
24], the connection obesity has to stress could be particularly notable in certain populations.
1.3. Culture and Stress
Acculturation and acculturative stress are involved in many aspects of life in a foreign culture. Language and intergenerational conflict are primary stressors in acculturation, particularly within first- and second- generation families [
25], but ethnic identity and cultural orientation have shown to be mediators and sources of resilience in acculturative stress [
25,
26]. Additionally, differences in acculturation in a household has been linked to other intergenerational conflict [
27], and differences in endorsed culture also predict lower self-esteem and higher aggression in children [
28]. Acculturation appears to influence stress in several different domains of life due to the complicated nature of culture and identity when living and adjusting to a foreign culture. Acculturative stress in adolescents has also been related to anti-social externalizing behaviors [
11].
It is known that acculturative stress, as well as allostatic load, is a trend not only found amongst Latinx individuals, but also within Latinx individuals across time. Comparing U.S.-born Hispanics to non-U.S.-born Hispanics shows that those born in the U.S. have a higher allostatic load, while those who immigrated show a positive correlation between allostatic load and time in the U.S. [
29]. A similar trend is found in obesity risk levels in Latinx immigrants. Numerous studies have shown that Latinx foreign-born adults have a lower risk of obesity compared to U.S.-born adults; however, the longer they reside in the U.S., the more the risk of obesity increases [
30,
31,
32,
33]. Although it is known that there is an uptrend in BMI among Latinx adults [
23] and that prevalence among Latinx youth shows 26.2% of Hispanic children are obese according to the Centers for Disease Control Prevention [
34], additional studies show a more concrete link between stress and obesity. This is especially concerning because the number of Latinx adults who are classified as obese is now approximately 45% [
35]. Allostatic load was shown to be associated with a higher risk of obesity among Latinx adults and children [
29]. Stress is shown to increase the risk of obesity, especially in Latinx individuals.
1.4. Culture and Mental Health
There could be many factors that influence individuals living in a foreign culture that affect their health for various reasons. Previous research has established links between culture and both physical and mental health. For example, Latinx adolescents show higher acculturative stress than non-Latinx adolescents [
28]. As previously mentioned, stress can have detrimental effects on a person [
2], but the type of stress that accompanies living in a foreign culture, or acculturative stress, has been studied in depth for health-related outcomes [
36].
Concerning how culture is related to mental health, there are multiple aspects to be considered, one of which is acculturation. Acculturation is generally defined as assimilating to a different culture, which is usually the dominant culture in that location. Numerous studies have discovered correlations between acculturation and depression [
7,
25,
36] or self-esteem [
26]. This relationship between acculturation and mental health continues to appear when the acculturation occurs within the context of the family. For example, the connection between acculturation and depressive symptoms was stronger when both the parent and child reported experiencing acculturative stress [
11]. Acculturative stress would be described as the negative stressors or health outcomes that are experienced by individuals who are going through acculturation. This association between acculturation and mental health appears to be particularly present with acculturative conflict in the family. When there is conflict between generations on the level of acculturation, individuals experience worse self-esteem [
26] and greater depression [
25,
37]. In addition, acculturation at times can reflect differences in adherence to cultural values. Some researchers found no direct relationship between acculturation and self-esteem, although they did report that differing cultural values between parents and children were associated with lower self-esteem [
38]. These findings indicate the important role that family can play in the relationship between culture and mental health.
In addition to acculturation and familial aspects of culture, the social factors of culture are also connected to one′s mental health. When looking at the impacts of discrimination, several studies have connected this social aspect of culture to low self-esteem and depression [
9,
39,
40,
41]. The connection to depression continues to hold, even when controlling for other potential stressors [
42]. Similar findings connected cultural invalidation with depression [
43]. Together, these findings highlight a possible connection between culture′s social manifestations and an individual′s mental health.
Ethnic identity may also play a role when it comes to one′s mental health; however, there appears to be some disagreement in the current literature. While some researchers have found that a strong ethnic identity is associated with less depression [
25] and that poor ethnic identity is correlated with increased depression [
44], others have found no connection between ethnic identity and depression [
42,
45]. Ethnic identity does, however, appear to influence adjacent factors. For example, despite not finding a connection between ethnic identity and depression, researchers found that stronger ethnic identity was correlated with improved personal recovery from depressive symptoms [
45]. This would suggest that while findings concerning the relationship between ethnic identity and mental health are contradictory, having a strong ethnic identity may at least better allow individuals to recover from their symptoms of psychopathology.
1.5. Culture and Physical Health
Possible relationships between culture and health extend beyond mental health and into physical health. Of particular interest to our study is the way culture may impact obesity and overweight. The association between culture and the physical health outcomes of being overweight and obese has been confirmed by a number of studies, though the conclusions regarding the relationship are not unanimous. In the majority of these studies, measures or proxies of acculturation are used to demonstrate the ways in which changes in the cultural orientation of a Latinx individual are related to adiposity or BMI. By using acculturation measures, these researchers can identify which of the two cultures involved in acculturation is more correlated with obesity and overweight risks. In the population of interest to our study, the cultures under examination are the mainstream culture of the United States (U.S.) and the cultures of origin for Latinx immigrants and their descendants.
A consideration of physical health as a whole and its relationship with culture has been pursued by fewer studies. The two studies we were able to find depended on participants reporting their perceptions about their own physical health. One of these studies discovered that greater acculturation among Latinx women was associated with perceptions of better physical health [
46], while the other found that more acculturated Latinx elders reported no better physical health than less acculturated Latinx elders [
47]. Despite their differing populations of interest, these studies offer contradictory findings with regard to Latinx individuals′ personal perceptions of physical health and their level of acculturation.
A few studies have found that greater acculturation does not correlate with higher risks of obesity and overweight for Latinx adolescents, though these studies employed relatively simple acculturation proxies. One found that Mexican-born adolescents in the U.S. did not have lower overweight or obesity risk compared to U.S.-born Latinx adolescents, but nativity and time spent in the U.S. were the only acculturation proxies used to reach this conclusion and offer very little insight into the actual cultural orientation of the individual [
48]. The other study found that Latinx adolescents who were recent immigrants were actually more likely to be obese than their U.S.-born counterparts, but no other measurement than status as an immigrant or a native was used to reach this conclusion [
28]. These studies are more recent than all but two of the studies that found greater acculturation to be associated with a greater risk or presence of obesity and overweight [
49,
50], and so may reflect a recent change in trends. Despite this possibility, these two recent studies may provide greater insight into the relationship between culture and overweight or obesity because they evaluated acculturation levels using several more culturally relevant factors than time spent in the U.S. and nativity.
Most studies that consider the relationship between the acculturation of Latinx adolescents and the adiposity or BMI of the same population conclude that an increase in orientation toward the mainstream U.S. culture is associated with an increase in the risk or presence of obesity and overweight [
30,
31,
33,
49,
51]. Obesity risk was associated with acculturation through a number of factors, including the location to which one immigrates and one′s age at immigration [
50]. This possible relationship can be understood by considering that younger immigrants are more likely to adopt the mainstream U.S. culture than older immigrants [
9,
44,
47] and that some neighborhoods will be more oriented toward the mainstream U.S. culture than others [
32,
52]. The obesity side of the relationship is generally attributed to the mainstream U.S. diet being more obesogenic than the typical diet of Latin American countries [
32,
48,
51], meaning that as Latinx youth orient themselves more toward mainstream U.S. culture, they are also orienting themselves towards a diet that is more likely to cause overweight and obesity.
It has been found that integrated youth, or youth that still have contact with their heritage, have healthier eating habits. Those who have assimilated and no longer accept their heritage culture tend to have worse eating habits [
52]. These bad eating habits are a result of many things, including a low socioeconomic status, marketing messages, and parenting. Oftentimes, advertisements made for the Latinx population are filled with calorically dense foods and drinks [
45]. With a lack of accessibility to healthy foods due to their socioeconomic status and advertisements that celebrate foods with little nutritional value, the Latinx community suffers great health detriments.
As was previously mentioned, diet has been identified as a possible explanation for the relationship between acculturation and physical health outcomes. This suggestion is due, at least in part, to the way acculturation impacts diet itself. Some studies have found that less acculturated Latinx individuals have healthier diets than those who are more acculturated [
53,
54]. Other studies make the relationship more apparent by pointing to higher intake of fruits and vegetables in communities that are oriented more towards Latinx cultures of origin rather than the U.S. mainstream culture [
51] and lower intake of sodium and empty calories by Latinx youth who were considered integrated in terms of acculturation [
52]. These healthier diets are more likely to protect against being overweight and obese. The relationship between culture and obesity or overweight in Latinx individuals is not as clear as it might seem. In addition to the studies that challenge the conclusion that greater orientation to mainstream U.S. culture is related to greater obesity and overweight risks, other studies have found possible contradictions within the theory that the stated relationship is due to differences in diet.
It was also found that Latinx youth who were considered as separated (completely oriented toward their culture of origin) or marginalized (not oriented toward either mainstream U.S. culture or their culture of origin) had diets that were higher in empty calories and lower in whole grains than integrated and even assimilated (completely oriented toward mainstream U.S. culture) Latinx youth [
52]. This finding suggests that an orientation toward the culture of origin is not entirely responsible for the better dietary practices of Latinx youth.
One additional study found that there was no dietary advantage for U.S. immigrants from Mexico, pointing to the Mexican diet becoming more obesogenic [
48]. An older study also points to changes in nutrition being associated with increasing obesity prevalence in Latin American countries [
55]. Some researchers suggest that, due to the Mexican diet becoming more like the U.S. diet in recent years, in terms of increasing the risk of obesity, Mexican immigrants would have the same obesity risk whether they oriented themselves toward the diet promoted by mainstream U.S. culture or toward the diet promoted by their culture of origin [
48].
1.6. The Role of Culture as a Moderator
Not only can culture and stress individually play roles in affecting one′s health, but Latinx culture in general can act as a moderator in the relationship between stress and health. This relationship appears to be particularly salient among youth, as they are in a period of identity exploration and formation [
56]. However, there does appear to be some variation in how Latinx culture moderates the relationship. For example, when Latinx individuals were more acculturated to the United States′ culture, they self-reported better mental health outcomes [
47]. This directly contradicts other findings that a stronger ethnic identity protects against poor mental health from acculturative stress [
25]. This discrepancy may be because of one′s stage of identity exploration, seeing as discrimination has more negative impacts on an individual who is exploring their ethnic identity whereas a commitment to one′s ethnic identity can instead be protective against discrimination′s negative effects [
57]. All these pieces of evidence highlight that culture can play both a positive and negative role in moderating the relationship between stress and mental health.
As previously established, stress is connected to depression [
2,
5,
7,
8,
9], but different aspects of culture may weaken this relationship. For example, both ethnic pride [
58] and positive ethnic identity [
40] are correlated with lower depression. Further, bicultural ethnic identity appears to show a similar correlation with less depressive symptoms [
9] while also mediating the relationship between discrimination and depression [
41]. In addition to how differing forms of ethnic identity can influence the relationship, cultural values such as familism may also moderate the relationship, even to the point of nullifying the negative impacts of acculturative conflict [
7,
37]. Altogether, these findings illustrate some of the many ways in which culture can positively impact the connection between stress and depression.
Aside from how culture may moderate the relationship between stress and mental health, culture may also influence the behaviors that impact this same relationship. Ethnic pride can also protect against poor health behaviors such as smoking or risky sexual behavior among adolescents [
59]. High ethnic pride also may reduce the amount of alcohol consumed by those receiving cognitive behavioral therapy for substance abuse, thus improving the effectiveness of treatment [
60]. Strong ethnic identity has also been linked to the ability to recover from serious mental illness [
45]. These impacts would indicate that recovery and behaviors can be influenced by cultural factors, which in turn can help alleviate mental illnesses or protect against future potential health complications.
While these findings highlight the many positive moderating impacts of culture on the relationship between stress and health, there are also many negatively moderating impacts to consider. Researchers found that bicultural ethnic identity was associated with higher self-esteem [
9], but others reported that when a low bicultural ethnic identity was present, acculturation conflict predicted lower self-esteem [
26]. Similarly, differences in cultural values between parents and children may also be associated with lower self-esteem [
38].
In addition to impacting self-esteem, strong ethnic identity can exacerbate the negative impacts of stressors on health. As previously established, discrimination may be linked to depression [
9,
39,
40,
41], but an interesting interaction appears when ethnic identity is considered within the context of this relationship. A strong ethnic identity can worsen discrimination′s relationship with depression [
39,
40] and minority stress [
42]. This may be because a stronger ethnic identity influences individuals to identify more with their culture and become more sensitive to discrimination [
40,
42]. A similar theory posits that those with lower levels of bicultural identity are associated with increased discrimination [
41], which could in turn lead to correlated mental health issues.
1.7. Acculturation Varies
Typically, an individual′s level of acculturation is considered as belonging within a spectrum as opposed to within a binary system of individuals being either acculturated or not [
26,
27,
52]. The spectrum exists because of the assumption that individuals progressively adopt some aspects of the host culture while also retaining or jettisoning aspects of their culture of origin. This process of acculturation is distinct for every individual in terms of initial levels of acculturation, the pace at which it occurs, and the extent to which it occurs. It is this variety within the process that gives rise to the spectrum of acculturation.
Various studies have found that the extent to which a Latinx immigrant acculturates to the U.S. culture is influenced by factors such as an individual′s age at the time of immigration and the community into which they enter [
26,
32,
38,
50,
51,
52]. Additional studies have discussed how the rate at which a Latinx individual acculturates in the U.S. is impacted by similar factors as those just mentioned [
27,
46,
47]. Therefore, as circumstances vary, so does acculturation. Studies have also found that a Latinx individual′s original nationality impacts acculturation, altering the ways in which acculturation serves as a moderator between measured variables [
32,
61,
62]. These findings can be understood to point out that even within levels of acculturation there are differences with regard to how acculturation impacts the individual. These considerations suggest that differences in acculturation can exist within not only communities but also families, with differences such as nationality, age, neighborhood, peers, etc., all impacting the level and rate of acculturation for each individual. These differences in acculturation are meaningful because a Latinx individual′s level of acculturation has been found to impact his or her mental and physical health outcomes [
9,
29,
32,
47,
49,
53,
63,
64,
65].
Guided by the previous literature, the current study examined the links between stress and risks that may be prevalent in the homes and lives of Latinx youth in the Midwest and several health outcomes, including internalizing (depression) and externalizing (aggression and frustration) behaviors and self-esteem, as well as physical health (obesity). In addition to assessing these main effects, this study also assessed the potential role of culture by testing whether ethnic pride would moderate the connections between stressors and health outcomes. Based on previous research, the authors made the following hypotheses: H1—stressful life events would be related to all five of the health outcomes; H2—parent and home stressors would be directly related to all five of the health outcomes; H3—Ethnic pride would moderate the links between stressful life events and health outcomes; and H4—Ethnic pride would moderate the links between parent and home stressors and all five of the health outcomes in Latinx youth in the Midwest.