About

Dr. Stephanie Cook is an Associate Professor of Social and Behavioral Sciences and Biostatistics at NYU School of Global Public Health. Her research focuses on understanding the complex relationship between stress, health, and social determinants of health across the lifespan. She examines how structural and individual-level stressors contribute to mental and physical health outcomes, especially in vulnerable populations. Dr. Cook is particularly interested in how features of close relationships, such as attachment patterns, can either exacerbate or buffer the negative effects of stress on overall well-being. Her current research explores how daily and momentary experiences of stress are linked to physical health markers like cortisol and C-reactive protein, as well as health behaviors such as substance use and sexual risk behaviors. She employs advanced longitudinal study designs, including intensive longitudinal methods, to track how changes in stress exposure influence health risk behaviors and physical health outcomes over time. As the Director of the Attachment and Health Disparities Research Lab (AHDL), Dr. Cook leads a team of students and postdoctoral fellows in exploring innovative ways to mitigate the impact of stress on health. She has developed an integrated model combining adult attachment theory and stress research to better understand how relational factors influence health outcomes for individuals facing social disadvantage. Her long-term goal is to develop and implement sustainable interventions aimed at reducing the harmful effects of stress on health, with a focus on improving health equity. Her research projects include geospatial studies on intersectionality, discrimination, and cardiometabolic health behaviors among young sexual and gender minorities, as well as investigations into physiological and behavioral mechanisms linking discrimination to cardiovascular risk among racial and sexual minority groups.

Research topics

• Medicine
• Psychiatry
• Emergency medicine
• Computer Science
• Artificial Intelligence
• Medical emergency
• Psychology
• Internal medicine
• Environmental health
• Machine Learning
• Surgery
• Clinical psychology
• Social psychology
• Gerontology
• Anesthesia
• Pediatrics
• Intensive care medicine
• Virology

Selected publications

• Digital Weathering: How Social Media Platforms Organize Chronic Stress Exposure During Adolescence

  2026-04-07

  articleOpen access1st authorCorresponding

  Research on social media and adolescent mental health has focused largely on individual use patterns, asking how much young people use platforms rather than examining how platform design organizes what they are exposed to. We introduce digital weathering, a theoretical framework that extends the weathering hypothesis to algorithmically curated social media environments. The weathering hypothesis shows that chronic exposure to structural disadvantage becomes biologically embedded through cumulative physiological wear. We propose that social media platforms function as structural environments that organize exposure to chronic stress during adolescence through three mechanisms. Algorithmic sorting classifies users and distributes content unequally across populations. Persistent connectivity compresses recovery between stress exposures. Engagement amplification prioritizes emotionally arousing content, increasing exposure intensity. These mechanisms interact with the heightened biological sensitivity of adolescence to produce differential accumulation of physiological wear across populations. We predict that adolescents with equivalent platform usage will show systematically different patterns of biological stress accumulation, reflecting algorithmically organized exposure rather than individual behavior. We discuss implications for measurement, intervention, and platform design.

  PublisherDOI

• Mapping Power Through Space: The Spatial Intersectionality Health Framework and Intersectional Geographically-Explicit Ecological Momentary Assessment

  medRxiv · 2026-04-10

  articleOpen access1st authorCorresponding

  Background Young sexual and gender minorities of color face compound health risks shaped by interlocking systems of racism, cisgenderism, and class inequality. Spatial health research documents that place shapes health, but existing methods cannot specify the mechanisms through which spatial configurations produce different health outcomes for differently positioned people. This gap prevents targeted intervention. Objective To develop and pilot test the Spatial Intersectionality Health Framework (SIHF), which specifies three mechanisms through which space produces intersectional health inequities: Layered (multiple oppressive systems activating simultaneously), Positional (the same space producing different health pathways by intersectional position), and Conditional (nominally protective spaces carrying hidden costs for specific positions). We also introduce and validate Intersectional Geographically-Explicit Ecological Momentary Assessment (IGEMA) as the methodology operationalizing SIHF across three data levels. Methods The GeoSense study enrolled 32 young sexual and gender minorities of color (ages 18-29) in New York City. IGEMA was implemented across three integrated levels: (1) GPS mobility tracking via participants’ personal smartphones, linked to census tract structural exposure indices across n=19 participants; (2) ecological momentary assessment of intersectional discrimination with multilevel modeling of mood, stress, and sleep outcomes; and (3) map-guided qualitative interviews with SIHF mechanism coding and intercoder reliability assessment across 92 coded records from 18 participants. This study was conducted as the pilot for NIH R01HL169503. Results All three SIHF mechanisms were empirically detectable. A compound structural gendered racism index outperformed every single-axis alternative in predicting daily mood (b=-0.048, p=.001) and stress (b=0.121, p<.001). The Positional mechanism accounted for 71% of coded harm experiences. Intercoder reliability for mechanism assignment reached kappa=0.824 at Stage 2 reconciliation. Daily intersectional discrimination predicted greater sleep disturbance (b=1.308, p=.004). Conclusions SIHF and IGEMA together provide an empirically testable framework for specifying how space produces intersectional health inequities. Mechanism specification, not spatial location alone, is the condition for designing research and intervention that reaches the source of harm for multiply marginalized populations.

  PublisherDOI

• Digital Weathering: How Social Media Platforms Organize Chronic Stress Exposure During Adolescence

  PsyArXiv (OSF Preprints) · 2026-04-06

  preprintOpen accessSenior author

  Research on social media and adolescent mental health has focused largely on individual use patterns, asking how much young people use platforms rather than examining how platform design organizes what they are exposed to. We introduce digital weathering, a theoretical framework that extends the weathering hypothesis to algorithmically curated social media environments. The weathering hypothesis shows that chronic exposure to structural disadvantage becomes biologically embedded through cumulative physiological wear. We propose that social media platforms function as structural environments that organize exposure to chronic stress during adolescence through three mechanisms. Algorithmic sorting classifies users and distributes content unequally across populations. Persistent connectivity compresses recovery between stress exposures. Engagement amplification prioritizes emotionally arousing content, increasing exposure intensity. These mechanisms interact with the heightened biological sensitivity of adolescence to produce differential accumulation of physiological wear across populations. We predict that adolescents with equivalent platform usage will show systematically different patterns of biological stress accumulation, reflecting algorithmically organized exposure rather than individual behavior. We discuss implications for measurement, intervention, and platform design.

  Publisher

• Integrating a Strengths‐Based Intersectional Approach to the Study of Suicide Risk Among Black Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth

  Mental Health Science · 2025-06-29

  articleOpen access

  Suicide among Black lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ + ) youth constitutes a significant public health concern (Congressional Black Caucus 2019). Research shows 44% of Black LGBTQ+ youth seriously considered suicide and 16% attempted suicide during the previous 12 months, compared to 37% and 11%, respectively, of White LGBTQ+ youth (The Trevor Project 2023). Black LGBTQ+ youth are 5.8 times more likely than Black cisgender heterosexual youth to report suicidal ideation and behavior (henceforth suicidality) (Mereish et al. 2019). Further, Black youth may underreport suicidality due to a lack of culturally valid suicide risk assessment tools (Francois et al. 2025), thus, rates may be higher than they appear using existing tools. Given this population's heightened risk for suicide, researchers must identify risk and protective factors associated with increasing and decreasing suicidality among Black LGBTQ+ youth using an intersectional lens (Price-Feeney et al. 2020). Intersectionality represents a conceptual framework introduced by Black feminist scholars to understand and examine interlocking, structural-level systems of power and oppression (e.g., systems of heterosexism, cisgenderism, racism) as they collectively shape individuals’ lived experiences and patterns of health inequities (Abrams et al. 2020; Collins and Bilge 2020; Combahee River Collective 1977; Crenshaw 1989). Within an intersectionality framework, an intersectional methodological research approach considers distinct ways marginalized social positions work together relationally in connection with systems of power for different groups to understand and address health inequities among specific populations (Bowleg and Bauer 2016; Gardner et al. 2025; McCall 2005). For example, Black LGBTQ+ youth may experience multiple intersectional systems of oppression (e.g., racism and heterosexism/cisgenderism) and forms of discrimination (e.g., racist bigotry and homophobia/transphobia) that elevate their risk for suicide (Balsam et al. 2011; Opara et al. 2020). An intersectional approach also can demonstrate Black LGBTQ+ youth's capacity to become empowered by holding multiple minoritized social positions, feel strengthened to advocate for themselves and their communities, and experience identity harmony, self-acceptance, and empathy (Bowleg 2013; Ghabrial 2017, 2019; Ghabrial and Andersen 2023). Strengths-based intersectional research with Black LGBTQ+ youth can show how holding multiple minoritized positions may serve an adaptive role by allowing youth to shift identities and glean diverse external supports to better address their current needs (Pittinsky et al. 1999), mitigating suicide risk. Thus, to understand the complex nature of suicide among Black LGBTQ+ youth, researchers must utilize an intersectional methodological approach informed by an intersectionality framework that considers intracategorical (within group) and intercategorical (between group) complexity within sampling designs (McCall 2005), measurement of intersectional risk and protective factors (e.g., intersectional survey/interview questions, state-level equality indices), intersectional data analytic approaches, and interpretation of study findings within an intersectionality framework. We propose an integrated causal model of suicide risk that incorporates an intersectional methodological approach into established suicide risk theories (see Figure 1). Projects integrating the Minority Stress Theory (Brooks 1981; Meyer 2003) and suicide-related theories utilizing an intersectional approach could advance research and understanding of suicidality among Black LGBTQ+ youth. Studying effects of intersectional minority stressors is new to suicide research, where most studies examine single-position minority stressors or additive models of risk (Mallory and Russell 2021). For Black LGBTQ+ youth, holding multiple minoritized social positions may intensify the minority-based stressors experienced (Bowleg 2008; Bruce et al. 2011; Collier et al. 2013), elevating risk for suicide. A better understanding of how intersectional minority stressors affect suicide risk among Black LGBTQ+ youth would inform the development of tailored prevention interventions. Minority stress may come from multiple stressors, including structural oppressions (e.g., discriminatory state policies/laws) (Alvarez et al. 2022; Sheftall et al. 2022) and negative interactions within schools, families, and communities (stigmatization, victimization, discrimination) that lead to intrapersonal stressors (internalized homophobia/transphobia/racism, expectations of rejection, identity concealment) (Hatchel et al. 2021; Holloway and Varner 2021; McMahon et al. 2011; Mustanski and Espelage 2020), each of which can increase suicide risk (Opara et al. 2020; Toomey et al. 2017). While minority stressors alone may increase risk, current suicide theories, such as the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV; O'Connor and Kirtley 2018), suggest additional psychological mediators (e.g., entrapment) and moderators (e.g., protective factors) of that pathway (Baams et al. 2015; Joiner and Silva 2012; O'Connor and Kirtley 2018). Specifically, the IMV model suggests individual-level processes, such as positive perceptions of oneself (e.g., identity affirmation/pride) and coping abilities (e.g., civic engagement), represent moderators influencing whether negative experiences, such as external and internalized minority stressors, develop into feelings of entrapment, which precede the onset of suicidality. The IMV model also proposes positive social relationships and community engagement that foster feelings of connection, belonging, and support as moderators of the transition from entrapment to suicide ideation and intent. While a robust body of research supports the IMV model in understanding suicide risk (Souza et al. 2024), very few studies have tested these ideas within Black and/or LGBTQ+ populations, and all fail to account for structural factors impacting these processes. Integrating minority stress and suicide theories within an intersectional approach to better account for structural, community, interpersonal, and individual influences on suicide risk and protection would expand upon current theories to account for external factors impacting suicide (Alvarez et al. 2022; Hjelmeland and Knizek 2016; Opara et al. 2020; Standley 2020). Further, existing research and theory on suicide among Black LGBTQ+ youth remains limited by risk-based, deficit-focused models (Haas and Rohlfsen 2010; Hatchel et al. 2021). To advance the science on suicidality, we need to examine theoretically-relevant, Black LGBTQ + -specific protective factors across socioecological levels that may diminish adverse effects of intersectional minority stressors and structural oppressions on suicidality (Busby et al. 2020; Hatchel et al. 2021). Black LGBTQ+ identity affirmation/authenticity/regard, activism/social justice engagement, and religiosity represent individual-level protective factors that may moderate the risk relationship between intersectional minority stressors and psychological distress among Black LGBTQ+ youth. Researchers demonstrated positive, protective effects of identity affirmation/regard on mental health problems, empowerment, and psychological resilience among Black LGBTQ+ populations (Ghabrial and Andersen 2021, 2023). However, we need research examining protective effects of a positive intersectional Black LGBTQ+ identity on pathways of risk for suicide. Further, Black LGBTQ+ youth may draw on their intersectional social positions to make sense of their own experiences, identify discrimination, find commonalities across social movements, and engage in action to promote justice for all (Hope et al. 2019; Pender et al. 2019; Rivas-Drake et al. 2022; Terriquez et al. 2018). Efforts of resisting oppression through activism or social justice movements may moderate effects of intersectional minority stressors on psychological vulnerabilities associated with suicidality among this population (Hope et al. 2018), yet more research is needed to examine these associations. Finally, much research has demonstrated protective effects of religiosity/religious coping on suicidality among Black youth (Bonelli and Koenig 2013; Kleiman and Liu 2014; Koenig 2016), yet protective effects are less clear for Black LGBTQ+ youth, suggesting a need for further inquiry regarding the influence of religiosity on suicidality for this population. While little research examines interpersonal factors that buffer adverse effects of intersectional minority stressors on suicidality among Black LGBTQ+ youth, researchers highlight the importance of social safety (connection, inclusion, protection) and accessible, supportive LGBTQ+ peers and adult role models for racially/ethnically diverse LGBTQ+ youth's positive identity, life purpose, and mental health (Diamond and Alley 2022; The Trevor Project 2024; Singh 2013). Still, more research is needed specifically with Black LGBTQ+ youth. A health equity perspective recognizes that LGBTQ+ youth may need additional interpersonal supports than their cisgender heterosexual peers. Social support and acceptance of one's LGBTQ+ identity, especially from family/parental figures, is associated with lower levels of suicidality among LGBTQ+ youth and can buffer against negative effects of minority stressors (Green et al. 2021). However, more research is needed examining beneficial effects of different forms of social supports on suicide risk specifically among Black LGBTQ+ youth. Engagement with and support from Black LGBTQ+ communities may mitigate suicide risk among Black LGBTQ+ youth by increasing satisfaction with life and decreasing mental health problems (Arango et al. 2018; Jackson et al. 2020; Stone et al. 2015). Researchers must further explore benefits of engagement in and support from Black LGBTQ+ communities on suicidality among Black LGBTQ+ youth. Supportive and inclusive school climates that create access to Black- and/or LGBTQ + -specific supportive organizations are associated with lower psychological distress, reduced risk of suicide attempts, and more favorable school experiences among diverse LGBTQ+ youth (Heck et al. 2011; Poteat et al. 2013; Truong et al. 2020). Therefore, researchers much examine effects of access to and engagement in inclusive Gender and Sexualities Alliances and ethnic/cultural student organizations (GLSEN n.d.) as protective factors that can moderate the risk relationship between psychological distress (e.g., feelings of entrapment) and suicidality among Black LGBTQ+ youth. Finally, researchers must examine religious community engagement as a potential protective factor, given the importance of religious communities in shaping religious and cultural norms for many Black youth (Molock et al. 2008; Watkins et al. 2016), and the association between involvement with a religious community and reduced risk of suicide among this population (Molock et al. 2006). Still, LGBTQ+ youth may experience internalized homophobia/transphobia from religious messages (Barnes and Meyer 2012), and Black LGBTQ+ youth may feel further challenged by the multiple intersections of their race, LGBTQ+ identity, and religious community engagement. Thus, researchers must explore these intersectional experiences in the context of understanding suicide risk and protection. Suicide prevention research with Black LGBTQ+ youth lacks a focus on intersectional structural factors or underlying power structures that inform well-being and health inequities (Bowleg 2017). Evidence shows deleterious mental health effects of single-axis structural oppression (e.g., racism alone, heterosexism alone) (English et al. 2021), as well as protective effects of state-level inclusive policies and antidiscrimination laws, separately, on suicide risk among LGBTQ+ (Aivadyan et al. 2023; Krantz et al. 2024) and Black (Polanco-Roman et al. 2024) youth. However, researchers have not examined effects of conjoined structural oppressions or supports on suicidality among Black LGBTQ+ youth. We need more strengths-based, intersectionality-grounded research examining how structural oppressions and supports (e.g., State Racial Equality Index, Lynch et al. 2021; Mesic et al. 2018; and State [LGBTQ + ] Equality Index, Warbelow and Diaz 2016) are jointly associated with suicide inequities and moderate pathways from intersectional minority stressors to suicidality among Black LGBTQ+ youth (Standley 2020). Advancing suicide prevention efforts with Black LGBTQ+ youth requires proactive research, practice, and policy/advocacy action steps. Researchers must examine effects of Black LGBTQ+ specific protective factors across socioecological levels over time on theoretical pathways of suicide risk utilizing an intersectional approach. Suicidologists must apply innovative methods of ecological momentary assessments, daily diary, continuous physiological monitoring, and longitudinal designs to expand current understanding of the complex influences of daily risk and protective experiences on concurrent, next day, and longer subsequent suicidality (Kleiman et al. 2023). Integrating lived experiences through inductive, qualitative methods remains essential for decolonizing the study of suicide (White et al. 2016), understanding nuanced and unique experiences influencing suicide risk and protection, designing effective measures (e.g., intersectional and culturally-relevant suicide risk assessment tools), and developing culturally-appropriate suicide prevention interventions for Black LGBTQ+ youth. Researchers also must appreciate historical experiences and justifiable mistrust of research efforts within Black and LGBTQ+ communities and ensure Black LGBTQ+ youth advisory boards provide stewardship for research projects. In practice, we must increase access to training programs and mentorship for students to eliminate barriers for Black LGBTQ+ individuals pursuing careers in research. Suicide prevention efforts must intentionally focus on ameliorating suicide among Black LGBTQ+ youth by developing and implementing tailored multi-faceted and multi-sectoral interventions that aim to eliminate the overlapping systems of oppression contributing to suicide risk (Bowleg 2023; Zubizarreta and Beccia 2025), while strengthening protective factors across socioecological levels that may reduce risk among this population. Social justice represents a core construct of intersectionality (Collins 2019), and policy/advocacy efforts must address social injustices that characterize social inequities and mental health disparities among Black LGBTQ+ youth by addressing political determinants of health (Kline et al. 2023; Paceley et al. 2023) and structural-level racism, heterosexism, and cisgenderism (Alvarez et al. 2022; Hatzenbuehler 2016; Zubizarreta and Beccia 2025). Efforts also must involve advocating to enhance modifiable Black LGBTQ + -specific protective factors, including structural-level factors, to ensure Black LGBTQ+ youth have equal opportunities to thrive. Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH134051. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. The authors have nothing to report. The authors declare no conflicts of interest. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1002/mhs2.70025. The authors have nothing to report.

  PublisherOA PDFDOI

• Exploring intersectionality in psychoneuroendocrinology research: A systematic review

  Psychoneuroendocrinology · 2025-07-30 · 3 citations

  reviewSenior author
  PublisherDOI

• Author response for "Integrating a Strengths‐Based Intersectional Approach to the Study of Suicide Risk Among Black Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth"

  2025-04-29

  peer-review
  PublisherDOI

• Associations between pre-pandemic housing insecurity and reports of anxiety and depression in the early months of the COVID-19 pandemic: an analysis of the All of Us Research Program cohort

  BMC Public Health · 2025-10-01

  articleOpen accessSenior author

  BACKGROUND: Housing insecurity is an important social determinant of health that has been linked to poor mental health. The beginning of the COVID-19 pandemic marked a time of major upheaval and has been linked to worsening experiences with anxiety and depression. It is not well understood how pre-pandemic housing insecurity may be associated with trajectories of anxiety and depression in the early months of the COVID-19 pandemic. METHODS: Using data from the NIH All of Us Research Program, we estimated the correlation between pre-pandemic housing insecurity and repeated measures of anxiety and depression symptoms between May and July 2020. We combined data from baseline surveys and the COVID-19 Participant Experience Survey (COPE) and used generalized linear models with a logit link to estimate results. RESULTS: Our sample included 37,535 participants. Those who reported housing insecurity prior to the start of the pandemic were significantly more likely to report moderate-to-severe symptoms of anxiety (AOR 1.630, p < .001) and depression (AOR 1.877, p < .001) across all months. Trajectories of anxiety and depression symptoms did not differ between May and July 2020 for those who reported housing insecurity versus those who did not. CONCLUSIONS: This study examined how experiences and trajectories of anxiety and depression symptoms differed by housing insecurity status among a novel large national sample. Experiencing housing insecurity prior to the start of the COVID-19 pandemic was associated with a greater likelihood of moderate-to-severe anxiety and depression from May to July 2020, and this difference was consistent over time.

  PublisherOA PDFDOI

• Sexual identity differences in ideal cardiovascular health among cisgender adults in the All of Us Research Program

  Annals of Behavioral Medicine · 2025-01-01 · 2 citations

  articleOpen accessSenior author

  BACKGROUND: Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association's composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk. METHODS: Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups. RESULTS: The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = -8.95 [-14.50, -3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups. CONCLUSIONS: Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.

  PublisherOA PDFDOI

• Daily racial discrimination is associated with daily alcohol use among young sexual minority men

  Journal of Gay & Lesbian Mental Health · 2025-08-26

  articleOpen accessSenior authorCorresponding
  PublisherOA PDFDOI

• Intersectionality, social stress, and biological embedding: Toward intersectional psychoneuroendocrinology

  Psychoneuroendocrinology · 2025-12-30

  article1st authorCorresponding
  PublisherDOI

Recent grants

• NIH Grant F31MH087125

  NIH · $83k · 2013

Frequent coauthors

• Erica P. Wood

  New York University

  38 shared

• Perry N. Halkitis

  Rutgers, The State University of New Jersey

  16 shared

• Farzana Kapadia

  New York University

  15 shared

• Nicholas Fallon

  University of Liverpool

  14 shared

• Andrej Stančák

  University of Liverpool

  14 shared

• Rumi Chunara

  13 shared

• Pamela Valera

  Rutgers, The State University of New Jersey

  13 shared

• Katerina Kokmotou

  University of Liverpool

  11 shared

Labs

• Attachment and Health Disparities Research Lab (AHDL)PI

Awards & honors

• NIH Summer Institute Fellowship on Randomized Behavioral Cli…
• New York University Faculty Fellow in Residence, New York Un…
• New York University James Weldon Johnson Professor (2023)
• NIH Loan Repayment Program Award, National Heart, Lung, and…
• Outstanding Research Mentor, The Undergraduate Research Oppo…