Development and Psychopathology, 13 (2001), 653–676

Copyright  2001 Cambridge University Press

Printed in the United States of America

Can poverty get under your skin?

Basal cortisol levels and cognitive
function in children from low and high
socioeconomic status

S. J. LUPIEN,a,b S. KING,a M. J. MEANEY,a AND B. S. MCEWENc

a b
Douglas Hospital/McGill University; Montreal Geriatric Institute; and
c
Rockefeller University

Abstract
It is well known that individuals from more advantaged social classes enjoy better mental and physical health than
do individuals within lower classes. Various mechanisms have been evoked to explain the association between
socioeconomic status (SES) and health. One mechanism that has received particular attention in recent years is
stress. It has been shown that individuals lower in SES report greater exposure to stressful life events and a greater
impact of these events on their life than individuals higher in SES. In order to measure whether the development of
the relationship between SES and mental health is sustained by exposure to high levels of glucocorticoids, we
measured morning salivary cortisol levels as well as cognitive function (memory, attention, and language) in 307
children (from 6 to 16 years of age) from low versus high SES in the Montreal area in Canada. The results revealed
that low SES children from 6 to 10 years old present significantly higher salivary cortisol levels when compared to
children from high SES. This difference disappears at the time of school transition, and no SES differences are
observed in salivary cortisol levels during high school. However, children from low and high SES do not differ with
regard to memory or to attentional and linguistic functions. Also, mothers of low SES children reported higher
feelings of depression and more unhealthy behaviors, while mothers of high SES children reported higher stress
related to work or family transitions. Altogether, these results show that low SES in young children is related to
increased cortisol secretion, although the impact of SES on cortisol secretion is absent after transition to high
school. These data are interpreted within the context of the equalization process of class patterning. Four social
explanatory factors are suggested to explain the disappearance of SES differences in basal cortisol levels after
school transition, taking into account the influence of family environment on the child’s secretion of stress
hormones.

It is well known that individuals from more
advantaged backgrounds enjoy better health
This study was supported by a grant from the John D.
and Catherine T. MacArthur Foundation. S.J.L.’s work
was supported by a scientist award from the Fonds de la
recherche en santé du Québec (FRSQ) and by a Young
Investigator Award from the National Alliance for Re-
search on Schizophrenia and Depression (NARSAD).
Address correspondence and reprint requests to:
Sonia Lupien, PhD, Director, Laboratory of Human Psy-
choneuroendocrine Research, Douglas Hospital/McGill
University, 6875 Boulevard Lasalle, Montréal PQ H4H
1R3 Canada; E-mail: Lupson@douglas.mcgill.ca.
than do individuals from disadvantaged envi-
ronments (Anderson & Armstead, 1995; An-
tonovsky, 1967). In the health literature, the
terms “social class” and “socioeconomic sta-
tus (SES)” are often used interchangeably.
However, in disciplines such as sociology,
they bear different meanings. “Social class” is
a term widely used in theories of social order-
ing and class categories, such as Marx’s the-
ory (Wright & Perrone, 1977) and others.
“SES,” as used in the sociological literature,
is function of education, income, or occupa-
tion (Dutton & Levine, 1989). Epidemiologic
studies and census data have provided the

653
654
most well known associations between SES
and health. It has been shown that the risk of
mortality, the prevalence and course of dis-
ease (Pincus, Callahan, & Burkhauser, 1987),
and blood pressure (Dyer, Stamler, & Shek-
elle, 1976) increase significantly as employ-
ment grade (Marmot, Shipley, & Rose, 1984),
occupational status (Adelstein, 1980), income
(Pappas, Queen, Hadden, & Fisher, 1993),
and years of education (Adelstein, 1980) de-
crease. A link has also been observed between
SES and the prevalence and course of disease
(Pincus et al., 1987). Finally, it has been
shown that blood pressure is higher in indi-
viduals lower on the SES hierarchy (Dyer et
al., 1976; Keil, Tyroler, & Sanfider, 1977;
Matthews, Kelsey, & Meilahn, 1989; Syme,
Oakes, & Friedman, 1974) and that this asso-
ciation is closely related to race, which in it-
self is closely associated with SES (Bureau of
Labor Statistics, 1967; Kahn, Williamson, &
Stevens, 1991; Keil et al., 1977; Susser, Wat-
son, & Hopper, 1985). Although most of the
literature on the association between SES and
health has concentrated on systemic disease,
other studies have shown a significant rela-
tionship between SES and mental health. In-
verse associations have been reported be-
tween SES and prevalence of schizophrenia
(Dohrenwend, 1990), as well as between SES
and depression (Hirschfeld & Cross, 1982).
The relationship between SES and health
begins at the earliest stages of life (Ander-
son & Armstead, 1995). According to Star-
field (1982), who reviewed the literature on
SES and child health, a SES–health linkage
has been found with the following health
problems: lead poisoning, vision problems,
otitis media and hearing loss, cytomegalic in-
clusion disease, and iron deficiency anemia.
Langford, Watson, and Douglas (1968) have
reported results on 1,765 high school girls and
showed that the lower the SES of the parents,
the higher the blood pressure of the girls. In
addition, mental retardation, learning disor-
ders, and emotional and behavioral problems
occur at greater frequency among children of
lower SES (Anderson & Armstead, 1995).
Another study by Ardila and Rosselli (1995)
in Columbia reported significant develop-
mental differences between children from
S. J. Lupien et al.
high versus low SES: children from low SES
showed deficits in language, memory, and at-
tentional capacities when compared with chil-
dren from high SES.
Mechanisms Underlying the Association
Between SES and Health
Various mechanisms have been evoked to ex-
plain the association between SES and health.
Three of them have received particular atten-
tion in recent years (for a review, see Adler,
Boyce, Chesney, Folkman, & Syme, 1993;
Boyce, Chesney, Cohen, Folkman, Kahn, &
Syme, 1994). First, it has been proposed that
the empirical link between SES and health is
due to underlying genetic factors. Genetically
based physical or mental factors might lead
to lower social position and poorer health. As
noted by many researchers (see Adler et al.,
1994; Anderson & Armstead, 1995), this ex-
planation is plausible but improbable because
the association between SES and health per-
sists even after adjusting for factors such as
height, body mass index, and cognitive flexi-
bility. Second, it is suggested that the associa-
tion between SES and health is due to the in-
fluence of illness on SES, rather than of SES
on illness. It has been reported that, although
there is evidence that mental and physical dis-
turbances may lead to lower SES, available
data on this association does not explain it in
its totality (see Anderson & Armstead, 1995).
The third explanation for the association be-
tween SES and health is that SES may lead to
behaviors that, in turn, will influence health
status. Income, education, and occupation,
which are all components of SES, may shape
an individual’s life course and determine his
or her health outcome. The physical environ-
ment in which one lives, the social environ-
ment and associated vulnerability to interper-
sonal aggression and violence, and the health
behaviors related to a particular lifestyle, as
well as socialization and experiences, may all
be candidate variables that may contribute to
the association between SES and health (see
McLeod & Kessler, 1990). For example, ciga-
rette smoking (Winkleby, Fortmann, & Bar-
rett, 1990) and lack of physical activity
(Cauley, Donfield, Laporte, & Warhaftig,
Basal cortisol levels in low and high SES children
1991) are inversely related to SES and are
positively associated with poor health out-
comes (Winkleby et al., 1990). Moreover,
psychological characteristics such as anger
and hostility, emotional suppression, depres-
sion, and pessimism or fatalism (for a review,
see Scheier & Bridges, 1995) relate to both
SES and disease risk (Barefoot, Dodge, & Pe-
terson, 1989; Murphy, Olivier, Monson, &
Sobol, 1991).
Although behavioral or personality traits
may shed some light on the association be-
tween SES and health, they do not explain the
significant relationships observed between
SES and health in children (Langford et al.,
1968), in whom such risk behaviors or per-
sonality traits may not yet be developed. Most
of the research performed on the association
between SES and health suggest that we
should see the largest socioeconomic differ-
ences in health during middle and early old
age because these age groups are most likely
to be characterized by sizable socioeconomic
differentials in exposure to risk factors (see
House, Kepkowski, Kinney, Mero, Kessler, &
Herzog, 1994; West, 1997).
Stress as the Missing Link?
So, health behaviors and personality traits
represent two pathways by which SES may
influence health, but they do not account for
all of the association. Other potential path-
ways by which SES may influence health are
through differential exposure of the individu-
als to physical and social contexts that may
be damaging for their health. A factor that has
received a great deal of attention in recent
years is stress (for recent reviews, see Mar-
mot & Feeney, 2000; Steptoe, 2000). Stress is
generally defined as previous or actual expo-
sure to life events that require adaptation from
the individual (Selye, 1950), or else as a state
occurring when an individual perceives that
the demands of the environment exceeds his
or her ability to cope (see Adler et al., 1994).
The association between SES and health may
result in part from differential exposure to
stress. It has been shown that individuals from
lower SES report greater exposure to stressful
life events and a greater impact of these
655
events on their life than individuals from
higher SES (Dohrenwend, 1973). This sug-
gests that individuals from lower SES may
have greater vulnerability to stress and, subse-
quently, to disease.
The association between SES and stress
may stem from environmental and social–
psychological factors. With regard to environ-
mental factors, it is known that, as one moves
down the SES ladder, residential choices be-
come more limited and many of the environ-
ments in which individuals lower on the SES
hierarchy live are associated with increased
mortality rate and crime (Haan, Kaplan, &
Syme, 1989). It has been suggested that these
differences in environments vary objectively
in chronic exposures to stressor events (Har-
burg, Erfurt, Chape, Hauenstein, Schull, &
Schork, 1973). With regard to sociological–
psychological factors, it has been shown that
higher SES decreases the likelihood of expo-
sure to negative events such as social aggres-
sion and risk behaviors (Dohrenwend & Doh-
renwend, 1970). Individuals of lower SES are
exposed to a higher rate of change or instabil-
ity in their lives, and this instability has been
found to produce a higher level of individual
distress in lower SES individuals (Broadhead,
Kaplan, & James, 1983; Dohrenwend & Doh-
renwend, 1970).
This association between SES and stress
has led researchers to look for the effects of
stress on health as the possible missing link
in the global association between SES and
health. It has been shown that prior life stress
is related to cardiovascular disease (Bros-
schot, Benschop, Godaert, De Smet, Olff,
Heijnen, & Ballieux, 1994), sudden cardiac
death (Rahe & Lind, 1971), birth complica-
tions (Gorsuch & Key, 1974), seriousness of
chronic illness (Wyler, Masuda, & Holmes,
1971), and the exacerbation of symptoms
among persons with chronic illness (Bedell,
Giordani, Amour, Tavormina, & Boll, 1977).
Prior stressful life events, as well as perceived
stress, have also been shown to alter immune
function (Calabrese, Kling, & Gold, 1987;
Jemmott & Locke, 1984; Kennedy, Kiecolt–
Glaser, & Glaser, 1988; Kiecolt–Glaser &
Glaser, 1991, 1995; McKinnon, Weisse, &
Reynolds, 1989; Naliboff, Benton, Solomon,
656 S. J. Lupien et al.

Morley, Fahey, Bloom, Makinodan, & Gil- also been reported on mood or cognitive pro-
more, 1991; Schleiffer, Keller, & Camerino, cessing. Breier, Albus, Pickar, Zahn, Wol-
1983; Ursin, Mykletun, & Tonder, 1984), and kowitz, and Paul (1987) have exposed healthy
stress has been reported to affect mood or human volunteers to the stress of loud noise
cognitive processing (for a review, see Lu- under controllable and uncontrollable condi-
pien & McEwen, 1997). Direct effects of tions. Subjects submitted to the uncontrollable
stress on the immune function have been re- stress conditions reported higher self-ratings
ported by Brosschot, Benschop, Godaert, De of helplessness, lack of control, tension, un-
Smet, Olff, Heijnen, and Ballieux (1992), happiness, anxiety, and depression than sub-
who submitted young male subjects to a mild jects submitted to the controllable stress con-
and potentially uncontrollable interpersonal dition.
stress situation. They showed that, in contrast
to control subjects, experimental subjects
SES, Stress, and Health in Children
showed a significant increase in numbers of
natural killer cells after the stress period. In children, it has been hypothesized that the
There is some other direct evidence that psy- child’s response to stress experienced in the
chological stress also increases the risk of ver- early years may have long-term effects upon
ified acute infectious respiratory diseases future development of psychosomatic diseases
(Boyce, Jensen, Cassel, Collior, Smith, & Ra- (Tennes & Kreye, 1985). However, immediate
mey, 1977; Graham, Douglas, & Ryan, 1986). effects of stress on children’s health have also
Cohen, Tyrell, and Smith (1991) have studied been reported (Gunnar, Gonzales, Goodlin, &
the relationship between psychological stress Levine, 1981; Gunner, Connors, & Isensee,
and the frequency of documented clinical 1989, 1992; Knight, Atkins, Eagle, Evans, Fin-
colds among subjects intentionally exposed to kelstein, Fukushima, Katz, & Weiner, 1979).
respiratory virus. They showed that the rates Cohen, Evans, Krantz, and Stokols (1980) mea-
of both respiratory infection and clinical colds sured the blood pressure of children in ele-
increased in a dose–response manner with in- mentary schools that differed in terms of
creases in the degree of previously reported amount of noise in the environment. They
psychological stress. compared children from schools that were be-
Stress has also been shown to affect mood or neath the flight path of the Los Angeles Inter-
cognitive processing (for reviews, see Lupien, national Airport with children from schools of
Lecours, Schwartz, Sharma, Meaney, & Nair, quieter areas. They showed that children from
1995; Lupien, Gandreau, Tchiteya, Mahue, the noisy school areas presented a higher blood
Sharma, Nair, Hauger, McEwen, & Meaney, pressure than children from the quieter school
1997; Lupien & McEwen, 1997; Lupien et al., areas. Moreover, they reported that children
1994). Life stress has been found to be corre- from the noisy areas were more distractable
lated with psychiatric symptomatology (Dek- and had more difficulty with problem-solving
ker & Webb, 1974), and several researchers tasks than the other children. More impor-
have found life stress scores to correlate with tantly, children from the noisy areas presented
measures of anxiety and depression (Vino- trouble learning how to discriminate between
kur & Selzer, 1975), as well as with indices irrelevant noise and the relevant task, which
of academic (Harris, 1972) and work perfor- supposes that stress may affect selective atten-
mance (Carranza, 1972). A variety of other tion (i.e., the ability to discriminate between
studies have suggested that high levels of anx- relevant and irrelevant information).
iety and arousal as induced by stress are nega- Similar findings have been reported by Co-
tively related to performance on complex hen, Glass, and Singer (1973). Although
tasks (Eysenck, 1976), to the ability to utilize adults can adapt to stressful events, stress in
semantic cues in recall (Mueller, 1976), and itself may have the most detrimental effects
to a lesser degree of cue utilization in atten- on children. They studied the effects of living
tional tasks (Bacon, 1974; Easterbrook, 1959). in apartments built directly over congested
More direct and acute effects of stress have highways in New York City. They showed
Basal cortisol levels in low and high SES children
that, despite the relatively higher noise levels
on lower floors of the buildings, residents of
lower floors did not differ from neighbors on
upper floors in ratings of noise level or annoy-
ance. However, the ability of children living
on lower floors to discriminate between simi-
lar sounds was lower than that displayed by
children living on upper floors. Thus, children
on the lower floor adapted to the noise by
“tuning out” sounds which resulted in a lower
responsiveness to differences in spoken words.
This further affected their reading ability and
this latter fact was apparent in long-term read-
ing impairments.
These results suggest that stress in early
age may affect health (blood pressure), as
well as cognitive processing. Moreover, stress
in school has widely been perceived as having
an impact on the developing socioemotional
life of children (Bower, 1964; Phillips, 1978;
Rutter, 1980). Given that urban socioecologi-
cal areas vary in rates of stressor conditions
(see Harburg et al., 1973), it is possible that
schools in low SES areas lead to more stress-
ful conditions in children than schools in
higher SES areas. The long-term effects of
these differences may have an impact on the
SES–health relationship.
Impact of Stress Hormones on
Physical Health
So, stress is one major factor that has been
proposed in order to explain the association
between SES and health. Individuals from
lower SES areas may be subjected to more
stressful events and have less ability and re-
sources to cope with them, which will eventu-
ally lead to disease. Although this proposal
may help one understand part of the associa-
tion between SES and health, it does not offer
an explanation as to the physiological mecha-
nisms by which differences in stress environ-
ments may alter physical and mental function.
For this reason, a second-order class of mech-
anisms is now evoked in order to explain the
SES–stress–health relationship, namely the
potentiation of disease as a result of behavior-
ally stress-evoked perturbations of the body’s
principal axes of neuroendocrine response
(see Manuck, Marshland, Kaplan, & Wil-
657
liams, 1995). In this regard, the hypothala-
mic–pituitary–adrenal (HPA) system plays a
key role in coordinating an organism’s physi-
ologic reactions to environmental challenges
and has received a great deal of attention in
recent years. The adrenal glucocorticoid hor-
mone cortisol is the principal effector in this
system and is thought to be responsible for
both adaptational and maladaptational pro-
cesses in response to perturbing situations
(Munck, Guyre, Holbrook, 1984).
The secretion of glucocorticoids from the
adrenal cortex is under the control of the adre-
nocorticotrophin hormone (ACTH), which in
turn is released from the anterior lobe of the
pituitary. Adrenocorticotrophin secretion is
regulated by corticotropin releasing factor
(CRF) and other secretagogues from the hy-
pothalamus (Keller–Wood & Dallman, 1984).
Several closed feedback mechanisms regulate
the secretion of glucocorticoids. Circulating
glucocorticoids act on the pituitary directly to
inhibit ACTH secretion, and on the hypothal-
amus to suppress secretion of CRF (Keller–
Wood & Dallman, 1984). These feedback
loops enable the organism to maintain a stable
blood level of glucocorticoids at all times,
while simultaneously providing an emergency
override, via the central nervous system, to re-
spond to stressors.
When the HPA system is functioning un-
der basal conditions, cortisol levels generally
follow a circadian rhythm with elevations of
cortisol levels in the morning and decreases
in cortisol over the day. Following the onset
of a stressor, however, cortisol levels raise
rapidly (in a range of 10–15 min), initiating
the peripheral catabolic processes required for
mobilizing energy reserves to meet the meta-
bolic demands imposed by the stressor (Bax-
ter & Tyrrell, 1987). Although it is well docu-
mented that other steroid hormones are also
affected by stress, cortisol is still considered
one of the best markers of altered physiologi-
cal states in response to stressful stimulation
(for reviews, see Kirschbaum & Hellhammer,
1989, 1994). As early as 1943, it was shown
that flight in test pilots and instructor pilots
leads to an elevation in urinary cortisol excre-
tion (Pincus & Hoagland, 1943). Further stud-
ies showed increases in cortisol excretion in
658
race-car drivers (Frost, Dryer, & Kohlstaedt,
1951), parachute jumpers (Basowitz, Persky,
Korchin, & Grinker, 1955), and subjects tak-
ing final college examinations (Markkanen,
Pekkarinen, Pulkkinen, & Simola, 1956). Bliss,
Migeon, Branch, and Samuels (1956) sur-
veyed the literature on cortisol excretion in
studies measuring the relatives of emergency-
room patients, medical students taking final
examinations, and normal subjects in day-to-
day events, as well as through a number of
laboratory techniques of eliciting emotional
disturbances, and concluded that the emotional
disturbances associated with most of these situ-
ations caused modest but consistent increases
in plasma and urinary cortisol levels.
Cortisol can now be measured easily and
noninvasively in small samples of saliva. The
measurement of steroid concentrations in sa-
liva has a number of potential advantages
over the more conventionally used total serum
concentrations. These advantages include a
stress-free and noninvasive collection proce-
dure and the measurement of a parameter
which is believed to reflect the biologically
active, serum-unbound steroid concentration
(Mendel, 1989; Robbins & Rall, 1957). High
correlation coefficients have been reported
between plasma and salivary cortisol in el-
derly, in adults (Harris, Watkins, Cook,
Walker, Read, & Riad–Fahmy, 1990; Mc-
Cracken & Poland, 1989; Woodside, Win-
ter, & Fisman, 1991), and in children (Bober,
Weller, Weller, Tait, Fristad, & Preskorn,
1988; Gunnar, Hertsgaard, Larson, & Riga-
tuso, 1992). A wide variety of studies have
shown significant increases in saliva cortisol
in the same stress conditions as those showing
increases in plasma cortisol levels (for a re-
view, see Kirschbaum & Hellhammer, 1994).
Due to the noninvasive nature of samplings,
several studies have recently emerged on sali-
vary cortisol stress responses among new-
borns and infants. Increases in saliva cortisol
in newborns have been observed during dis-
charge examinations (Gunnar et al., 1989), in-
oculation of infants by a pediatrician (Lewis
& Thomas, 1990), a brief maternal separation
(Larson, Gunnar, & Hertsgaard, 1991). These
results indicate that the human HPA system is
highly responsive from a very early postnatal
period.
S. J. Lupien et al.
Although short-term glucocorticoid re-
sponse to stress serves an adaptative function,
chronic exposure to elevated glucocorticoid
concentrations contributes to the onset of pa-
thology, ranging from an increased resistance
to insulin, hypertension, hypercholesterol-
emia, arteriosclerosis, and immunosuppres-
sion (Munck et al., 1984). Glucocorticoids ex-
ert multiple and complex effects on the
immunologic apparatus. At plasma levels gen-
erally achieved during stress, glucocorticoids
exert immunosuppressive and antiinflamma-
tory effects (Bateman, Singh, Kral, & Solo-
mon, 1989; Calabrese et al., 1987; Munck et
al., 1984). It is known that natural killer cells
and cytotoxic T cells play a pivotal role in
defending the organism against viral infection
(Sheridan, Feng, Bonneau, Allen, Huney-
cutt, & Glaser, 1991). Stress has been shown
to influence the development of viral infec-
tion (for a review, see Cohen, 1988; Cohen &
Wills, 1985; Cohen et al., 1991), and it has
been suggested that adrenal steroids are in-
volved in the stress effects on immunity
(Rabin, Cunnick, & Lysle, 1990).
Even if glucocorticoids act primarily at a
peripheral level to maintain homeostasis, the
brain represents one of the principal targets
for these steroid hormones. Circulating gluco-
corticoids easily cross the blood–brain barrier
and exert their actions in the central nervous
system at steroids receptor sites. In the brain,
glucocorticoids exert their actions primarily
on the hippocampus, which is the brain area
richest in glucocorticoids receptors (McEwen,
Weiss, & Schwartz, 1968). Two types of re-
ceptors have been described, according to
their affinity for different glucocorticoids
(Reul & deKloet, 1985). Type I receptors (or
mineralocorticoid receptors) show a high af-
finity for glucocorticoids and appear to serve
as the major receptor that, when occupied,
regulates normal basal activity in the HPA
axis. Type II receptors (or glucocorticoid re-
ceptor) show a low affinity for glucocorti-
coids and is occupied during the diurnal peak
of cortisol or in response to stress (Reul &
deKloet, 1985).
Prolonged exposure to elevated glucocorti-
coid levels under endogenous or exogenous
conditions has been shown to lead to hippo-
campal neuronal dysfunction or neuron loss
Basal cortisol levels in low and high SES children
(Landfield, Baskin, & Pitler, 1981). Sapolsky,
Krey, and McEwen (1986) exposed young
rats to stresslike levels of glucocorticoids for
3 months and compared these animals to old,
untreated controls. They showed that the two
groups exhibited similar anatomical sequelae,
including a significant loss of neurons in the
hippocampal regions and increases in the den-
sity of microglia. Thus, exposure to high lev-
els of glucocorticoids appeared to accelerate
the brain aging process in young rats. In order
to see if endogenous elevations of glucocorti-
coids induced by stress may have the same
effects upon hippocampal cells, Kerr, Camp-
bell, Applegate, Brodish, and Landfield (1991)
applied stress to young, middle-aged, and old
rats for 6 months and measured hippocampal
changes. The results showed that the younger
groups under stress exhibited increased evi-
dence of aginglike neurophysiological changes.
So, the possibility that stress-induced long-
term elevations of endogenous corticosteroids
levels might accelerate or induce brain aging-
like neuropathology may have considerable
implications for human health.
The Model of Allostatic Load
This suggestion goes along with a recent
model of stress and health developed by
McEwen and Stellar (1993). Their model,
called the “allostatic load” model, is based on
the concept of allostasis—the ability of the
body to increase or decrease vital functions to
a new steady state following a challenge—
proposed by Sterling and Eyer (1988). In or-
der to define allostatic load, McEwen and
Stellar (1993) give the analogy of two heavy
versus two light weights on a seesaw. Al-
though both heavy and light weights are well
balanced on the seesaw, the see-saw itself ex-
periences more strain with the two heavy
weights than with the two light weights. Allo-
static load refers to the strain put on an other-
wise balanced system. Thus, the strain pro-
duced by repeated assaults to physiologic
response, as well as that produced by elevated
activity of physiologic systems under chal-
lenge, will, by increasing the allostatic load,
predispose an organism to disease. The first
factor in McEwen and Stellar’s model is the
reaction of the individual to physical and psy-
659
chological stimuli. This reaction is in part de-
termined by social context and the social sta-
tus of the individual. Second, the stimulus
will have an effect on the individual’s infor-
mation processing system (the “processor”),
and the response of the processor will be de-
termined by genetic makeup, stage of biologi-
cal development, gender, past learning, and
social history. If, at this point, the stimulus is
perceived as a threat, and the source of the
threat is unknown, the individual will become
highly vigilant and try to determine the real
nature (threat vs. nonthreat) of the stimuli. If,
on the contrary, the stimulus is perceived as a
threat and the source of it is known, the indi-
vidual will try to find a coping response to the
threat. If no response is available, helpless-
ness or hopelessness may appear, with its al-
tered physiologic responses. If a response is
available, the outcome of it will depend on the
cost of that response. If a low-cost response is
appropriate, no stress response will be initi-
ated. If a high-cost response is needed, it may
necessitate the appearance of aggression or
thrill-seeking or risk-taking behaviors. How-
ever, the available response can also be
thwarted, which will eventually lead to dis-
placed frustration or aggression. So, percep-
tions of threat and choice of response are cen-
tral aspects of the assessment of risk and
making choices leading to health-damaging or
health-promoting behaviors. The biological
side of the allostatic load model can be di-
vided into mediators, effectors, and disease
outcomes. The mediators of the stressful stim-
uli are the brain, the autonomic nervous sys-
tem, and the neuroendocrine system. We
know that all three are affected by chronic
stress leading to allostatic load (for a review,
see McEwen, 1998). The effectors are the
main organ systems, the immune and cardio-
vascular systems, adipose tissue, and muscle,
responding to the mediators.
This model can be used to explain part of
the association between SES and health. Indi-
viduals from lower SES areas may be submit-
ted to a greater amount of environmental, so-
ciological, and psychological challenges, and
these events will increase the probability that
the individual will process more incoming in-
formation as being threatening (real or fic-
tive). Individuals from lower SES areas are
660
also known to have fewer coping resources
for stressful events, which will also increase
the probability that the individual will come
to the conclusion that he or she has no re-
source to cope with the stressor and that a
costly response will have to be taken. This
latter path may lead to more frequent and
larger increases in cortisol levels or to a
greater probability of establishing risk behav-
ior or personality traits that will, eventually,
lead to disease.
Goal of the Study
The main goal of the present descriptive study
was to measure salivary cortisol levels in chil-
dren of low and high SES and from different
age groups in order to measure whether SES
differences in salivary cortisol exist and if
these differences vary according to age. The
second goal of the study was to measure the
relationship between salivary cortisol levels
and cognitive function in this population, as
well as possible changes in this relation as a
function of age. Finally, the third goal of this
study was to measure whether scores of chil-
dren’s parents on various stress questionnaires
differed with regard to SES.
Material and Method
Population
A cross-sectional experimental design was
used, with six age groups (ranging from 6 to
16 years old) and two categories of SES (low,
high1). The age groups were determined ac-
cording to grade—that is, elementary school
(Grades 1 [mean age: 6 years], 3 [mean age:
8 years], and 5 [mean age: 10 years]) and high
school (Grades 1 [mean age: 12 years], 3
(mean age: 14 years], and 5 [mean age: 16
years]). The entire population of children and
1. Note that the high SES group was defined as families
with an income higher than $50,000. In Quebec, Can-
ada, the average family income is between $30,000 and
$35,000. Children from higher SES (higher than
$100,000) were not tested given that the majority of
these children are placed in private schools, which
were not part of the CECM School Board of Montreal
(see below).
S. J. Lupien et al.
adolescents was gathered using the school
system, within only one school board com-
mission (Commission des Ecoles Catholiques
de Montreal: [CECM]). This was done in or-
der to ensure a similar schooling procedure
for all subjects. The CECM governs the ma-
jority of French-speaking schools in the Mon-
treal urban community. With the help of cen-
sus data, and in conjunction with the CECM,
we chose schools for the study according to
the SES levels of the neighborhoods in which
the schools are located (low and high SES)
and according to grade level (elementary: 1,
3, 5; high school: 1, 3, 5). The CECM uses a
criterion for SES using parents’ income and
education level, and this criterion has been
shown to be a reliable one for description of
the socioeconomic background of these chil-
dren. Within each of these schools, students
were sampled randomly within grade levels
from a list provided by the school. A total of
307 children of low and high SES were stud-
ied, and there were no significant differences
between ages of children from same grades
but of different SES. Every child was in good
general health as reported in school records.
The only exclusion criteria for the present
study was the presence of asthma or the use
of corticosteroids as treatment.
Written consent was obtained from the
mothers. Consenting mothers were also asked
if they would be interested in participating in
a 40-min phone interview in which they
would be asked to answer two questionnaires
measuring environmental and family stres-
sors, as well as to answer questions relative
to income, education, and so forth. Mothers
had the choice of participating in the study
in conjunction with their child or refusing to
participate although they consented their child
to participate. The demographic questions re-
lated to both mothers and fathers were put to
the mothers in order to verify SES as obtained
from the CECM. The sample of children and
parents from low and high SES who were
tested is presented in Table 1. Fifty-three per-
cent of low SES parents and 61% of high SES
parents consented to the 40-min phone inter-
view, which allowed us to measure various
stressors in the parents using a representative
sample.
Basal cortisol levels in low and high SES children
Table 1. Sample of children and parents from low and high socioeconomic status (SES)
Low SES
Number of Number of Participation Number of Number of Participation
Children Parents
Children’s grade level
Elementary 1 36 22
Elementary 3 25 11
Elementary 5 35 22
High school 1 20 11
High school 3 27 13
High school 5 24 10
Total 167 89
Children’s assessment
Cortisol levels. Saliva samples for cortisol
levels determination were taken in the morn-
ing, at 8:00 a.m., at the beginning of the neu-
ropsychological session (see section below),
and 60 min later (9:00 a.m.), at the end of the
session. Rectangular filter papers (3.5 × 5 cm)
were used for salivettes. One centimeter of the
salivette was used for handling while the
other 4 cm were used for saliva sampling.
This method has proven to yield reliable cor-
tisol measurements in adult and elderly sub-
jects (Lupien et al., 1997; Lupien, DeLeon,
DeSanti, Convit, Tarshish, Nair, McEwen,
Hauger, & Meaney, 1998). The subjects were
asked to put the filter paper in their mouth
until it was saturated with saliva. Saliva sam-
plings have proven to be an easy and reliable
method in children (Stansbury & Gunnar,
1994). Coding of saliva samples was made
during saliva sampling. Once saliva was sam-
pled, the examiners wrote the name, date, and
hour of the sample on the handling part of the
salivette, and the filter paper was then clipped
on a drying device. Cortisol levels were mea-
sured using radioimmunoassay with tritiated
cortisol and a highly specific antibody (B-63;
Endocrine Science Tarzana, CA) that cross-
reacts with corticosterone has 4% and has less
than 1% cross-reactivity with deoxycorticos-
terone and deoxycortisol and less than 0.5%
cross-reactivity with any other adrenal steroid.
Intra- and interassay variability is 3.5 and 5%.
Child’s cognitive processing. Children were
submitted to a neuropsychological assessment
661
High SES
(%) Children Parents (%)
61.1 12 10 83.3
44 18 12 66.7
62.8 15 12 80
55 26 19 73.1
48.1 35 21 60
41.6 34 12 35.3
53.2 140 86 61.4
session that measured memory, attention, and
linguistic functions. The neuropsychological
session lasted for about 1 hr and was per-
formed in the classroom, using a group-test-
ing method. Presentation of stimuli to the
children was performed using a computer and
a LCD projector. This device permitted for
presentation of stimuli to all students, with
possibilities of computer-controlled presenta-
tion time of the stimuli.
Declarative memory test. The distinction be-
tween declarative and nondeclarative memory
revolves mainly around whether conscious
recollection of previously learned information
is necessary for performance. Thus, tests of
declarative memory depend on conscious rec-
ollection of previously learned information,
while tests of nondeclarative memory refer
subjects to a processing task and measure the
extent to which previous exposure to the ma-
terial changes the speed or the accuracy of
performance on the processing task. In this
study, declarative memory was measured by
an immediate and 30-min delayed free recall
test, and nondeclarative memory was mea-
sured by an implicit recall test. Fifteen line
drawings of animals were presented, one at a
time, on the screen, and the task of the child
was to say whether the gender of the animal
was “feminine” or “masculine” (which is a
normative form of language in French). Im-
mediately after and 30 min later, children
were asked to freely recall all the animals of
the list, in any given order. Given the absence
of writing–reading capacity in 6-year-old
662
children, they were tested using a recognition
task in which they were presented with the
line drawing of two animals and asked to cir-
cle the animal they had seen previously. For
children 8 or more years old, declarative
memory was tested using a free recall task in
which they were asked to write down the
name of the animals they had seen previously,
in any given order. Given this important dif-
ference in the methods for testing memory
performance, data from 6-year-old children
were not analyzed in the same analysis of
variance as data from older children.
Nondeclarative memory. Nondeclarative mem-
ory was tested by asking children to write
down all the animal names they knew in a
45-s period. Nondeclarative memory was cal-
culated as the number of animal names from
the previously studied list that were given by
the child. In order to prevent children from
making a link between the declarative and
nondeclarative memory tasks, the nondeclara-
tive memory test was given 15 min after the
declarative memory task and was embedded
within a larger verbal fluency task for which
children had to provide names for vegetables,
jobs, and animals (nondeclarative memory
task). Given the absence of writing–reading
capacity in 6-year-old children, they were not
tested for nondeclarative memory function.
Selective attention. Selective attention refers
to the ability to discriminate relevant from ir-
relevant information (Rabbitt, 1964). This
was measured by a visual detection task with
stimuli presented for 50 ms. In this task, the
target was the digit “2,” and this target was
inserted in simple visual displays comprised
of letters (easy detection; e.g., R J 2 X) or
digits (difficult detection; e.g., 3 9 2 1). There
were 60 stimuli presented to the children; 30
of them were absent-target trials (target was
absent from the display), and 30 others were
present-target trials (target was present in the
display). Half of each set was comprised of
15 easy and 15 difficult detection stimuli. The
number of targets correctly detected consti-
tuted the dependent variable.
S. J. Lupien et al.
Parents’ assessment
Environmental stressors. Environmental stres-
sors were measured using the Derogatis Stress
Profile (DSP; Derogatis & DellaPietra, 1994)
questionnaire. The DSP is a multidimensional
psychological self-report scale designed to
measure various subcomponents of stress. It
reflects the three principal components of
stress and their interaction: environmental
events, personality mediators, and emotional
responses. Collectively, these measures pro-
vide a comprehensive screening assessment of
current stress levels. The DSP consists of 77
items that are divided into 11 subscales, or
domains, that measure the salient aspects of
each of the three principal stress domains (en-
vironmental events’ subscale: vocational/
work, family, health; personality mediators’
subscale: time pressure, driven behavior, atti-
tude posture, relaxation potential, role defini-
tion; emotional response’s subscale: hostility,
anxiety, depression). The DSP has been eval-
uated on two measures of reliability, homoge-
neity and repeated measures, and has demon-
strated very acceptable reliability coefficients.
Test–retest coefficients range from .92 to .72,
and internal consistency for the three princi-
pal domain scores ranged from .88 to .83.
Family stressors. Family stressors were mea-
sured using the Family Inventory Life Experi-
ence (FILE; McCubbin, Patterson, & Wilson,
1980) survey. The FILE questionnaire is an
objective measure that assesses the buildup of
life events experienced by a family, and is an
index of family stress. The FILE is a 72-item
self-report instrument designed to record the
normative and nonnormative life events and
changes experienced by a family unit. Since
it is a family life change inventory, all events
experienced by any member of the family are
recorded. Each item is worded to reflect a
change of sufficient magnitude to require
some adjustments in the regular pattern of in-
teraction of family members. The emphasis is
on change, which may be either positive or
negative. The FILE comprises nine subscales
(intrafamily strains; marital strains; pregnancy
or childbearing strains; finance and business
Basal cortisol levels in low and high SES children
strains; work–family transitions and strains;
illness and family care strains, losses, and
transition; and legal strains). The reliability
coefficient ranges from .73 to .30, and test–
retest reliability ranges from .77 to .72.
Procedure
Four examiners tested groups on each occa-
sion. Such a high number of examiners was
used in order to ensure an adequate cortisol
sampling for the group of children, as well as
to ensure a valid environment (e.g., absence
of noise) for the neuropsychological testing.
The four examiners used for the study were
the same for each class tested.
A particular session was as follows: when
the examiners arrived, the consented children
had already been gathered in a room by the
school director. The principal investigator of
the project (S.J.L.) served as the “presentator”
of the study and introduced the procedure of
testing to the children, while the other exam-
iners prepared the material for testing and
placed the answer sheets (response booklet)
on the desk of each student. Any questions
were answered at that time. The presentator
then showed how to take a saliva sample and
took one in front of the children in order to
ensure that everyone understood. Afterward,
a first sample of saliva was taken. Saliva sam-
pling in the classroom using four examines
lasted an average of 10 min. The neuropsy-
chological testing was then introduced to the
children, and task order was counterbalanced
across classrooms.
For the declarative memory task, children
were presented with words or images on the
screen and then asked to recall as many of
them as possible on a specific page of the re-
sponse booklet. For the selective attention
task, stimuli were presented on the wall
screen for 50 ms and children were asked to
write on a specific page of the booklet
whether the target was present or not in the
display they saw. For the verbal fluency task
and nondeclarative memory task, children
were given a specific category and then asked
to write as many items as possible that related
to the criterion in a 45-s session.
663
As a compensation for the children’s par-
ticipation in the study, each school received
$350.00, which was deposited in the school’s
foundation for children’s social activities.
Analyses of results
Data were first examined for normal distribu-
tions and means, and standard errors were cal-
culated (descriptive study). Data were then
analyzed using a univariate or multivariate
analysis of variance (ANOVA or MANOVA),
with SES (low vs. high) and age (6–16 years)
as the between-subject factors and with the
specific dependent variable of each test as the
within-subject factor. Given the number of
dependent variables used for neuropsycholog-
ical assessment, we used a Bonferroni correc-
tion with an alpha set to p < 0.01. For the
memory (declarative vs. nondeclarative), the
performance of 6-year-old was not compared
to that of other children, so these data were
compared using a t test. For salivary cortisol
data, the average of the two morning cortisol
samples was used as a measure of basal morn-
ing cortisol levels, because this procedure
takes into account intra- and intersubjects
variability in salivary cortisol samplings (Lu-
pien et al., 1998) and has been shown to be
highly correlated with personality variables
(Bossert et al., 1988; Bridges, 1974; Steptoe,
2000). Preliminary analyses were performed
in order to test the existence of gender differ-
ences on the biological and cognitive factors.
No differences between boys and girls were
observed for any variables tested, so data
were collapsed across subsequent analyses.
Results
Representativity of the sample of
children and parents
Annual salary, education level, and employ-
ment type and time (full-time vs. part-time)
were assessed during the semistructured
phone interview with mothers in order to ver-
ify the accuracy of SES (defined by the
CECM) as a grouping factor for the analysis
of cortisol levels in children. Table 2 gives
664 S. J. Lupien et al.

Table 2. Demographic data on parents of children from low and high socioeconomic status
(SES) in Montreal (data obtained on 175 families)

Low SES High SES

N Data N Data Difference

Family
Salary 91 $24.000 ± 11 82 $56.000 ± 12 p < 0.001
Family type 94 47.8% (45) single mom 88 22.7% (20) single mom χ2 = 12.51
52.2% (49) both parents 77.3% (68) both parents p < .001
Number of children 94 2.48 ± 0.10 88 2.36 ± 0.08 ns
Rank of tested child 94 1.67 ± 0.09 88 1.58 ± 0.08 ns
Mothers
Education 92 12.56 ± 0.68 86 18.89 ± 1.07 p < 0.001
Employment type 92 51.1% (47) occasional/ 86 24.4% (21) occasional/ χ2 = 27.01
unemployed unemployed p < .0001
44.6% (41) clerical/ 44.2% (38) clerical/
technical technical
4.2% (4) professional/ 31.4% (27) professional/
career career
Employment time 92 52.2% (48) unemployed 86 26.7% (23) unemployed χ2 = 12.9
22.8% (21) part-time 19.8% (17) part-time p < .01
25% (23) full-time 53.5% (46) full-time
Alcohol consumption 92 0.025 ± 0.01 87 0.10 ± 0.04 p < 0.07
Cigarette consumption 92 0.45 ± 0.05 87 0.19 ± 0.04 p < 0.001
Fathers
Education 63 13.03 ± 0.8 79 19.56 ± 1.13 p < 0.001
Employment type 63 20.6% (13) occasional/ 79 9.5% (6) occasional/ χ2 = 20.9
unemployed unemployed p < .0001
73.1% (46) clerical/ 70.8% (43) clerical/
technical technical
6.3% (4) professional/ 19.7% (30) professional/
career career
Employment time 63 20.6% (13) unemployed 79 0% (0) unemployed χ2 = 17.78
7.9% (5) part-time 6.3% (5) part-time p < .001
71.5% (45) full-time 93.7% (72) full-time
Alcohol consumption 59 0.05 ± 0.03 77 0.18 ± 0.06 p < 0.08
Cigarette consumption 60 0.56 ± 0.08 77 0.17 ± 0.04 p < 0.001

the information gathered in CECM criterion
for low- and high-SES parents. There were
significant differences between the annual sal-
ary of low- and high-SES parents, t (171) =
−7.41; p < .0001, as well as a higher educa-
tion level for both mothers, t (176) = −5.03;
p < .0001, and fathers, t (140) = −4.14; p <
.0001, of high SES, when compared to low-
SES parents. Parents of high SES had a sig-
nificantly higher employment type than low-
SES parents (mothers: χ2 = 27.01, p < .0001;
fathers: χ2 = 20.0, p < .0001), and were signif-
icantly more employed full time, when com-
pared to low-SES parents (mothers: χ2 = 12.9,
p < .01; fathers: χ2 = 17.78, p < .001). There
was a tendency for both mothers and fathers
of high SES to report a higher intake of alco-
hol (mothers: t (176) = −1.82, p = .07; fathers:
t (137) = −1.73, p = .086). Finally, both moth-
ers and fathers of low SES reported a higher
intake of nicotine (mothers: t (176) = 4.03,
p < .0001; fathers: t (135) = 4.42, p < .0001).
Children’s cortisol levels
Figure 1 presents the mean morning saliva
cortisol levels for low- and high-SES children
from 6 to 16 years of age. The ANOVA per-
formed on salivary cortisol data revealed sig-
nificant main effects of SES, F (1, 307) =
Basal cortisol levels in low and high SES children
Figure 1. Mean morning salivary cortisol levels (±SE) in children from low and high SES
ranging from 6 to 16 years of age.
6.62, p < .01, and age, F (5, 307) = 21.23,
p < .001, as well as a significant interaction
between SES and age, F (5, 307) = 4.78, p <
.0001. We then broke down the interaction by
age. An a posteriori comparison of means re-
vealed significant SES differences in children
6, 8, and 10 years old (p < .0001), with chil-
dren of low SES showing significantly higher
salivary cortisol levels than children of high
SES. There were no significant SES differ-
ences in salivary cortisol levels for children
from high school (12–16 years of age; p > .1).
Interestingly, the SES differences in cortisol
levels disappeared at the time of school transi-
tion, with SES differences in cortisol levels in
elementary school and a disappearance of
these differences during high school.
Cognitive function
Table 3 presents the cognitive performance of
low- and high-SES children for each cogni-
tive task performed.
Memory. The ANOVA performed on immedi-
ate declarative memory performance (children
8–16 years old) revealed a significant age dif-
ference, F (4, 259) = 40.97, p < .0001, with
no main effect of SES (p > .2) or interaction
between SES and age (p < .1). The same re-
665
sults were observed for the effect of age per-
formance on the delayed memory task, F (4,
259) = 26.8, p < .0001. Children from the 6-
year-old group were tested using an immedi-
ate and delayed picture recognition task, due
to the lack of writing skills in these children.
Again, no SES differences were observed on
immediate (p > .2) or delayed (p > .1) mem-
ory performance in 6-year-old children. The
ANOVA performed on nondeclarative mem-
ory performance revealed a significant main
effect of age, F (4, 259) = 23.11, p < .0001,
with no main effect of SES, F (1, 259) = 3.1,
p > .08, or interaction between SES and age
(p > .2). Thus, declarative and nondeclarative
memory performance increased with age, but
SES did not have any effect on this change
across age in children.
Verbal fluency. The ANOVA performed on
this data set revealed a significant main effect
of age, F (4, 259) = 66.7, p < .0001, as well
as a tendency toward a significant interaction
between SES and age, F (4, 259) = 2.4, p =
.051. However, due to the use of a Bonferroni
correction set at p < 0.01, this interaction was
not further decomposed.
Selective attention. The ANOVA performed
on the number of correctly detected targets
Table 3. Cognitive performance of low and high SES children as a function of age

Elementary 1 Elementary 3 Elementary 5 High School 1 High School 3 High School 5

Low High Low High Low High Low High Low High Low High

Declarative memory (no. words

recalled)
Immediate 9.1 9.4 4.7 4.8 6.1 5.3 7.7 8.2 7.6 8.3 7.7 7.6
(0.19) (0.26) (0.27) (0.28) (0.27) (0.37) (0.51) (0.39) (0.24) (0.23) (0.32) (0.24)
Delayed 9.1 9.6 4.4 4.0 5.3 5.3 6.7 7.2 6.7 6.8 7.6 7.4
(0.16) (0.26) (0.23) (0.35) (0.26) (0.35) (0.44) (0.46) (0.28) (0.31) (0.43) (0.32)
Nondeclarative memory (no. words — — 1.6 2.4 2.7 2.7 3.7 4.5 3.9 4.1 4.3 4.1
recalled) (0.22) (0.27) (0.23) (0.32) (0.31) (0.29) (0.28) (0.22) (0.34) (0.26)
Verbal fluency (no. words given — — 3.9 4.6 6.1 6.9 8.1 7.4 8.6 9.7 9.9 9.5
in 45 s) (0.32) (0.51) (0.28) (0.44) (0.30) (0.31) (0.42) (0.34) (0.51) (0.24)
Selective attention (no. of targets 8.0 10.6* 13.4 14.0 18.2 17.1 20.2 21.2 22.9 24.2 28.2 22.9*
detected in 45 s) (0.30) (1.08) (0.65) (0.80) (0.65) (0.80) (0.92) (0.68) (0.86) (0.59) (1.24) (0.72)
*Significant difference (p < .05) between low and high SES children.
Basal cortisol levels in low and high SES children 667

Figure 2. Scores (calculated as t scores ± SE) of low and high SES children on the 11 stress
subscales of the Derogatis Stress Profile: 1, anxiety; 2, hostility; 3, time pressure; 4, depres-
sion; 5, attitude; 6, relaxation; 7, role definition; 8, driven behavior; 9, vocational status; 10,
domestic; 11, health attitude. **Significant group difference at p < .05.

revealed a main effect of age, F (5, 306) =
46.23, p < .0001, as well as a significant inter-
action between SES and age, F (5, 306) = 3.8,
p < .003. An a posteriori comparison of means
revealed significant SES differences on the
selective attention task for 6-year-old and 16-
year-old subjects. Among 6-year-olds, high-
SES children performed significantly better
than low-SES children (p < .05), while low-
SES 16-year-olds performed significantly bet-
ter than high-SES 16-year-olds (p < .05). No
other age groups showed significant SES dif-
ferences with regard to selective attention per-
formance.
Environmental and family stressors
higher feelings of depression and higher un-
healthy behaviors when compared to high-
SES parents.
FILE. Figure 3 presents the scores of chil-
dren’s parents on the nine subscales of the
FILE questionnaire. The MANOVA performed
on the FILE scores of the parents revealed
significant SES differences on the subscales
of family transitions, F (1, 173) = 4.52, p <
.03, and work-related stressors, F (1, 173) =
3.8, p < .04. These differences revealed that
high-SES parents scored higher for stress re-
lated to work and family transition (e.g., child
leaving the house) when compared to low-
SES parents.

DSP. Figure 2 presents the scores of low- and Discussion

high-SES parents on the subscales of the DSP
questionnaires. The MANOVA performed on
the DSP scores of the parents revealed signifi-
cant SES differences on the subscales of de-
pression, F (1, 170) = 3.92, p < .05, and
health, F (1, 170) = 17.8, p < .0001. An a pos-
teriori comparison of means showed that low-
SES parents scored significantly higher on
these subscales when compared to high-SES
parents, showing that low-SES parents report
The results obtained in this study revealed
significant developmental SES differences in
cortisol levels during childhood, which tended
to equalize during youth. Children from ele-
mentary schools (ages 6–10 years) presented
significantly higher basal salivary cortisol lev-
els when compared to children from high
SES. However, after school transition, when
children are 12–16 years of age, there are no
668
Figure 3. Scores (±SE) of low and high SES children on the nine stress subscales of the
Derogatis Stress Profile: 1, marital; 2, intrafamily; 3, pregnancy; 4, finance; 5, work;
6, illness; 7, losses; 8, transitions; 9, legal. **Significant group difference at p < .05.
significant differences in basal cortisol levels
in children of low and high SES. These results
raise some interesting questions as to the im-
pact of school transition on stress reactivity in
low- and high-SES children.
We also report a significant increase of
cortisol levels with age, with the largest
change occurring between 10 and 12 years of
age, which corresponds to the onset of pu-
berty. Similar findings of increased cortisol
levels at the time of puberty have been re-
ported previously (see Weinstein, Diforio,
Schiffman, Walker, & Borsall, 1999). This in-
creased cortisol secretion at the time of pu-
berty corresponds to the significant increase
in gonadal hormone secretion (estrogen and
testosterone). Since gonadal hormones are se-
creted by the adrenal glands, interaction be-
tween puberty-induced gonadal hormone
changes and cortisol secretion is highly proba-
ble. Also, melatonin (which is coregulated
with cortisol levels) is involved in regulation
of puberty onset (see Reiter, 1973), which
could also be a significant factor in the occur-
rence of the significant increase of cortisol
around the age of 10–12 years.
We have further shown that SES differ-
S. J. Lupien et al.
ences in basal cortisol levels do not impact on
cognitive performance on tests of memory
and linguistic abilities in this population. The
only SES difference to emerge with regard to
cognitive function was observed on the test of
selective attention. At 6 years of age, high-
SES children performed better than low-SES
children, while this tendency reversed at 16
years of age, with low-SES children outper-
forming children of high SES. Such an effect
of SES at different ages was also observed
by Ardila and Rosselli (1995), who reported
significant developmental differences in cog-
nitive processing between children of high
versus low SES. However, these results have
to be taken with caution, given the limited
sample size of children tested at these age
ranges. Also, selective attrition of subjects
may have influenced the results. Indeed, it
might be possible that low-SES children with
cognitive deficits are more likely to drop out
of school or to refuse to participate in the re-
search. This possibility would have the poten-
tial to mask the existence of SES-related se-
lective attention throughout the age ranges
tested.
With regard to the children’s mothers, we
Basal cortisol levels in low and high SES children
have found that low SES in the family is gen-
erally related to high levels of environmental
stressors, while high SES is significantly
more related to familial stressors. Indeed,
low-SES mothers showed a higher score on
the depressive subscale of the DSP and a
lower score on healthy behaviors of the same
questionnaire. With regard to family stressors,
high-SES mothers scored higher on the
FILE’s subscale of family stress related to
work and family transitions. These results
give us a very interesting view of the familial
environment of the low- and high-SES chil-
dren tested. The mothers of low-SES children
tend to complain more about depression and
unhealthy behaviors, while the mothers of
high-SES children tend to complain more
about stress related to work and to transitions
in the family, such as their children leaving
home.
Altogether, these results go along with data
showing that school transition in low- and
high-SES children may act as an equalization
process for SES impact on health (West,
1997). This “equalization process” refers to
the observed changes in class patterning be-
tween childhood and youth, with SES differ-
ences tending to disappear during youth and
reemerge during adulthood (for a complete re-
view, see West, 1997). Four major explana-
tory factors have been suggested in the litera-
ture to explain the equalization of SES
difference in health during youth (see West,
1997). What is very interesting is that all
these factors have been shown to be signifi-
cant variables in activating the HPA axis. We
will discuss each of these variables in turn
and relate them to HPA activation data.
Educational system
The first explanatory factor for the equaliza-
tion of SES differences during youth is related
to the educational system itself, with impor-
tant differences relating to the school environ-
ments. In our study, we have found that basal
cortisol levels are significantly higher in low-
SES children of elementary grades but that
differences tend to disappear at the time of
669
school transition, with no SES differences ob-
served during high school. This difference in
basal cortisol levels as a function of SES and
age could be due to the school environments
in which children are exposed as a function of
SES. A study performed by Tennes and Kreye
(1985) on children’s adrenocortical responses
to classroom activities reported that in second
graders cortisol levels are influenced by social
interactions with peers and teachers at school.
It might thus be possible that the school envi-
ronment in low-SES areas differ from those
in high-SES areas in such a way that they act
on the basal secretion of stress hormones in
the children attending these schools. How-
ever, we have previously reported data from
another subset of this study (Lupien, King,
Meaney, & McEwen, 2000) in which we were
able to obtain salivary cortisol levels in ele-
mentary school children of medium SES. In
this data set, children 6–10 years of age were
tested in the same school of a low-, medium-,
or high-SES area, and significant SES differ-
ences still emerged as a function of age in
medium-SES children. These data suggest
that if the school environment plays a signifi-
cant role in cortisol differences as a function
of SES, its impact is concomitant with other
environmental variables associated with age.
The second explanatory factor within the
educational system relates to the importance
of school transition itself. Transition to high
school marks the first major change in status
for a child. The child then moves from a rela-
tively small, community-based school to a
larger impersonal unit, and also moves from
being the oldest of the school (elementary
school, Grade 5) to being the youngest (high
school, Grade 1). The work of Sapolsky, Al-
berts, and Altmann (1997) on primates re-
vealed the importance of the hierarchical sta-
tus in determining basal cortisol levels. In his
studies, Sapolsky has shown that in a stable
social hierarchy, basal cortisol levels are sig-
nificantly higher in subordinates than in
leader baboons. These results have been con-
firmed in human army recruits (Hellhammer,
Buchtal, Gutberlet, & Kirschbaum, 1997; see
also Kessler, 1979). These data could be used
to interpret the school transition effect on
670
basal salivary cortisol levels. Indeed, it is pos-
sible that the change of SES differences in
cortisol levels observed at the time of school
transition may be due to the change of status
of the children and to the advantage of this
changing status for low-SES children when
compared to high-SES children.
Influence of peers
The second influencing factor that could ex-
plain the equalization of cortisol levels at the
time of school transition is related to the influ-
ence of the peer system (for a review, see
West, 1997). It is known that during youth,
peer-based relationships have a more impor-
tant influence than family-based relationships
(see West, 1997). It has further been shown
that the significance of the peer group in-
creases markedly around 12–13 years of age
(Claes, 1992), which is the age at which we
report the disappearance of the SES difference
in cortisol levels. Based on this assumption, it
could be suggested that the absence of SES
differences observed during youth are due to
the decrease of the family influence on the
low-SES teen’s life and the increase in the in-
fluence of peers in these children. Given that
low-SES mothers tended to be more de-
pressed than high-SES mothers, we can postu-
late that the high levels of cortisol in low-SES
children during elementary school might be
related to the family environment in which
they live. In our previous report of a subset of
these data in low-, medium-, and high-SES
elementary school children (Lupien et al.,
2000), we reported the presence of a signifi-
cant positive relationship between the moth-
er’s score on the depressive subscale of the
DSP and her own child’s cortisol levels. We
interpreted this data as suggesting that chil-
dren may be reactive, in terms of adrenocorti-
cal activation, to the family environment in
which they live. The frequent presence of dis-
cord and disorganization in families with a
depressed parent (Brown & Harris, 1978) or
in low-SES families (see Adler et al., 1994)
is well known. It is thus be possible that the
family setting in which a child is raised (other
than pure environmental factors like low sal-
S. J. Lupien et al.
ary) gives rise to higher cortisol levels in low-
SES children when compared to high-SES
children. However, at the time of school tran-
sition, when peer relationships become more-
important than family relationship, this transi-
tion might have a more significant impact on
basal cortisol levels in low-SES children
when compared to high-SES children.
Youth culture
The third influence that could explain the
equalization of basal cortisol levels during
youth is closely related to the second one and
concerns the influence of the youth culture it-
self (for a review, see West, 1997). It is
known that the youth culture permeates both
school-based and peer group experiences and
gives meaning to a particular membership to
the social culture of youth. This influence will
go beyond that of the school and the peer
group and may explain the equalization of
SES differences during youth. The youth cul-
ture has a potential influence on identity and
the behavior of the teen, and this youth cul-
ture may assume greater significance for
young people than family or peer-based rela-
tionships. Now, it may also be possible that
the feeling of membership to the youth culture
has advantageous effects for low-SES young
people, while it has more disadvantageous ef-
fects for high-SES young people. Going along
with this hypothesis is the significant SES dif-
ference observed between low- and high-SES
parents on the family transition subscale of
the FILE questionnaire. High-SES parents
scored higher on stress related to family tran-
sitions (e.g., child leaving the house) than
low-SES parents, and it may thus be possible
that young people of high SES place more
weight on parents’ expectations than young
people of low SES, giving rise to higher cor-
tisol levels in high-SES teenagers than
low-SES teenagers. If this is the case, then it
must be suggested that the absence of SES
differences in terms of cortisol levels during
youth may be due to the increase of cortisol
levels in high-SES teenagers, rather than the
decrease of cortisol levels in low-SES teen-
agers.
Basal cortisol levels in low and high SES children
Resilience
Finally, there is a fourth influencing factor
that could explain the equalization of SES dif-
ferences in terms of basal cortisol levels dur-
ing youth, and this last factor relates to resil-
ience. It is known that low-SES teenagers
tend to quit school at a lower ages than high-
SES teenagers. It may thus be possible that
the absence of SES differences in terms of
cortisol levels observed during youth may be
due to the fact that the teenagers studied in
our experiment were the “resilient” ones (i.e.,
those who have decided to stay in school).
Many vulnerability factors (e.g., personality
traits) have been shown to be related to basal
cortisol levels (Mason, 1968), so it may be
suggested that the absence of SES differences
observed during youth are due to a population
bias, which means that the low cortisol levels
of the resilient low-SES teenagers who stayed
in school—thus being “available” for our
study—created an artificial absence of SES
differences in terms of cortisol levels.
Conclusion
At the present time, all these influencing fac-
tors carry equal weight in explaining the
equalization of SES differences during youth.
However, this descriptive study has shed
some light on the physiological differences
existing between low- and high-SES children
and teenagers.
The susceptibility of an individual to
stress-related disorders is likely to reflect de-
velopmental influences as well as genetic risk
factors. In this perspective, creators of models
such as the allostatic load model (for a re-
view, see McEwen, 1998) are to be congratu-
lated on their attempt at providing a multisys-
temic view about the cumulative impact of
wear and tear on physical and mental health.
Indeed, a major advance in behavioral neuro-
science during the past decade has been the
establishment of a lifelong perspective for en-
vironmental influences on stress reactivity
during development that persist for a lifetime
(for a review, see McEwen & Lupien, in
press). In this line of work, we can cite animal
671
studies that have shown that prenatal stress
increases emotionality and stress hormone re-
activity for the life of the individual. Con-
versely, postnatal “handling” of neonates leads
to reduced emotionality and reduced stress hor-
mone reactivity for the lifetime of the individ-
ual (Anisman, Zaharia, Meaney, & Merali,
1998; Caldji, Tannenbaum, Sharma, Francis,
Plotsky, & Meaney, 1998; DeNelsky & De-
nenberg, 1967; Denenberg & Zarrow, 1971;
Francis, Champagne, Liu, & Meaney, 1999;
Francis, Diorio, Liu, & Meaney, 1999; Le-
vine, Haltmeyer, Karas, & Denenberg, 1967;
Meaney, Aitken, Sharma, Viau, & Sarrieau,
1989; Meaney, Aitken, Van Berkel, Bhatna-
gar, & Sapolsky, 1989). In animal models,
brain aging is increased by elevated stress re-
activity and reduced by lowered stress reactiv-
ity (Dellu, Mayo, Vallee, LeMoal, & Simon,
1994; Escorihuela, Tobena, & Fernandez–
Teruel, 1995; Liu, Diorio, Tannenbaum, Caldji,
Francis, Freedman, Sharma, Pearson, Plot-
sky, & Meaney, 1997). There are also data
from an animal model that increased stress re-
activity increases propensity for substance
abuse (Dellu et al., 1994), and this finding
needs to be studied for its implications and
relevance to human drug abuse. In addition,
studies in infrahuman primates have shown
that early maternal deprivation reduces brain
serotonin levels and increases alcohol prefer-
ence and aggressive behavior and decreases
affiliative behaviors (Higley, King, Hasert,
Champoux, Suomi, & Linnoila, 1996; Higley,
Mehlman, Higley, Fernald, Vickers, Lindell,
Taub, Suomi, & Linnoila, 1996). This data is
to be put in line with recent human evidence
showing that low SES in adult men and
women is significantly related with a blunted
serotoninergic responsitivity similar to what is
observed in endogenous depression (Mat-
thews, Flory, Muldoon, & Manuck, 2000).
From all these animal and human studies,
it becomes clear that future longitudinal stud-
ies of children of low and high SES are ur-
gently needed, as well as others measuring
basal cortisol levels in the mothers of low-
and high-SES children and teenagers. Such
studies should yield very valuable data as to
the possible origin of SES differences in
physical and mental health.
672
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