STRESS, NEUROTRANSMITTERS, AND HORMONES Salivary Cortisol Levels in Brazilian Citizens of Distinct Socioeconomic and Cultural Levels M´ arcia C. Garcia, a Aglecio de Souza, a Geruza P. Bella, a Dora M. Grassi-Kassisse, a Artur P. Tacla, b and Regina C. Spadari-Bratﬁsch a,c a Department of Physiology and Biophysics, Institute of Biology, State University of Campinas, Campinas, SP, Brazil b Atma Desenvolvimento Humano, S ˜ ao Paulo, SP, Brazil c Department of Health Sciences, Federal University of S ˜ ao Paulo, Santos, SP, Brazil We have analyzed the perceived stress index, the basal salivary cortisol levels, and the awakening cortisol response (ACR) in 86 volunteers of low (LSES) and high socioe- conomic status (HSES). The LSES presented higher perceived stress index and basal salivary cortisol levels, nonaltered ACR, or cortisol diurnal rhythm. We have concluded that the LSES is associated with high perceived stress index and salivary cortisol levels, which could impact negatively in health, and that it is related to the daily life stress experienced by individuals in the LSES group. Because the LSES corresponds to about 30% of the total Brazilian population, this conclusion might have a great impact on public health policies and costs. Key words: stress; socioeconomic status; salivary cortisol levels Introduction Socioeconomic status (SES) is considered a well-established risk factor for poor health, the lower the SES, the worse are prospects for health outcomes. 1,2 SES gradients in disease risk are partially explained by bad health re- lated with behaviors and partially by environ- mental conditions that people at lower SES are exposed. 3 There are only a few reports on the relationship between low SES (LSES) and stress markers in people living in develop- ing countries, 4–6 including the Brazilian popu- lation, where the social differences are accentu- ated, social support is deﬁcient, and the public violence index is alarmingly high. 7 Address for correspondence: Regina C. Spadari-Bratﬁsch, Departa- mento de Ciˆ encias da Sa ´ ude, Campus da Baixada Santista, Universidade Federal de S˜ ao Paulo (UNIFESP), Rua Ana Costa, 95, 11060-001 Santos, SP, Brazil. Voice/fax: 55 (13) 3222 2048. regina.spadari@unifesp.br Stressors, whether they were physical or psy- chological, activate several neural pathways including the hypothamo-pituitary-adrenal (HPA) axis. One of the consequences is the increase in the cortisol plasma levels that su- perimpose the endogenous corticosteroid cir- cadian rhythm. The cortisol rhythm might be altered by LSES, 8 stress work, or domestic en- vironment, 9 conditions that determine chronic psychosocial stress and contribute to the preva- lence of severe illnesses. Because there is a good correlation between stress and cortisol plasma levels and between this last and salivary cortisol levels, analysis of salivary cortisol levels has been considered a good physiological indicator of the stress re- sponse relating to HPA axis activation. 10 In this paper we have analyzed the per- ceived stress index, basal salivary cortisol lev- els and rhythm, and the awakening cortisol response (ACR) in two groups of different Stress, Neurotransmitters, and Hormones: Ann. N.Y. Acad. Sci. 1148: 504–508 (2008). doi: 10.1196/annals.1410.065 C  2008 New York Academy of Sciences. 504