Title: Examining Educational Attainment and Allostatic Load in Non-Hispanic Black Women
Version: 2 Date: 13 Oct 2021
Reviewer's report:
Thank you for giving me the opportunity to review your study. You investigated whether higher
education is associated with higher allostatic load among a sample of Black women. Overall, I
believe this to be an important, relevant, and scientifically sound study.
I have few comments I would like to share with the authors.
1. The Introduction/discussion part needs corrections. I suggest taking this into account. I
would also suggest providing more information about the study problem - to present in more
detail the latest research on ‘education attainment among Black women and its effect on
health’ and ‘relationship between education and allostatic load among Black women and other
ethnicity women’. Please add more explanation about ‘disaggregate Black women as a distinct
demographic category’ in the introduction part. Most likely, the specified object of research
would help to better orient and reject unnecessary parts. Comparison of the obtained results with
the researches of other authors would strengthen the part of the discussion.
2. Some part of the discussion will be included in the introduction (example – those sentences:
educational attainment is rarely isolated from other indicators of socioeconomic status (SES),
making studies that specifically examine connections among Black women’s educational
attainment and allostatic load sparse. Of those available, their findings suggest that both Black
women and those with lower educational attainment have higher AL, but these factors were
studied independently of each other (17). A cross-sectional study that included individuals
from NHANES and US Census data found that lower education level and being either Black
and women were associated with a higher AL, but the intersection of the three variables was
not studied (18). In our study, we used NHANES data over a 19-year time span to study the
effect of educational attainment as a moderating variable on NH-Black women specifically)
(other sentences: Since compounding stress manifests biologically as alarm, resistance, and
exhaustion--or Hans Selye’s General Adaptation Syndrome, this physiological process leads to
higher allostatic load (21). In scenarios where Black women experience these stress spikes and
then go on to do so for sustained time periods, the increased hormones eventually lower the
body’s resistance to maintain our baseline allostasis. When the stress exposure is chronic, the
body can no longer maintain a proper balance (21). The negative feedback loop to shut these
systems down is dysregulated resulting in the final stage known as exhaustion that leads to an
increased AL. The chronic loss of balance in the body has correlated to higher cardiovascular
disease and cognitive loss (2). One study indicated that racial discrimination as a major stressor
that has led to dysregulation in these axes (22).)
3. AL marker components differ from study to study. Please add the reasons for those variables
added in this study. In addition, it is necessary to add a reference related to the potential
confounding factors which you included in the model.