Health Psychology, Vol 45(10), Oct 2026, 963-974; doi:10.1037/hea0001615
Objective: Despite robust evidence linking psychological stress to cardiovascular disease (CVD), explanations for how risk is transmitted are limited by a lack of ecologically valid models. Recent conceptual advances including generalized unsafety theory of stress and social safety theory articulate persistent physiological activation driven by contextual exposure and compensatory situational vigilance as a pathway. This study provides an integrated first test of generalized unsafety theory of stress and social safety theory models on preclinical CVD. Method: A diverse community sample of 300 adults (Mage = 42.44 years; 50% women; 60% non-Hispanic (NH) Whites, 19% Hispanic/Latinos, 15% NH Blacks, 6% NH Others) completed a 2-year longitudinal study with surveys, ecological momentary assessment (EMA), and carotid artery scans measuring disease progression. Residential data were geo-coded to assess risk for crime exposure. Data collection occurred in 2012 and 2014. Results: As hypothesized, greater environmental unsafety (geo-coded crime rates; B = 0.02, p Bs = 0.09, ps B = −0.04, p