Stress and physical health: the role of neighborhoods as mediating and moderating mechanisms

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Abstract

Using data from the 1995 Detroit Area Study (N=1106) in conjunction with tract-level data from the 1990 census, this paper evaluates the relationship between residential stability and physical health among black and white adults. Results suggest that neighborhood-level variation in health is primarily mediated by key sociodemographic characteristics of individuals (e.g., age, race, and socioeconomic status). However, a significant portion of health differentials across neighborhoods is due to disparate stress levels across neighborhoods. Further, high levels of neighborhood stability provide an important buffer to the otherwise deleterious effects of increased stress levels on adults’ overall health.

Introduction

In recent years, research emphasizing the composition and context of neighborhoods as an important mechanism contributing to population health differentials has increased dramatically (Duncan, Jones, & Moon, 1996; Robert, 1998; Robert, 1999; Pampalon, Duncan, Subramanian, & Jones, 1999; Subramania, Kawachi, & Kennedy, 2001; Macintyre, Ellaway, & Cummins, 2002; Morenoff & Lynch, 2002). This body of research denotes an important break from the theoretical and methodological individualism that until recently has defined mainstream social-scientific research into health related phenomena signaling, for some, a “new public health” (Baum, 1997). With a renewed interest in upstream social characteristics as the key determinants of health differentials (Martin & McQueen, 1989) this line of inquiry denotes a break from more traditional epidemiology and public health research because it explicitly focuses on differential access to material, social, and psychological resources, exposure to deleterious pollutants and discriminatory actions as opposed to emphasizing specific health and disease outcomes, per se (Berkman & Kawachi (2000), Berkman & Kawachi (2000a)).

A number of neighborhood characteristics are believed to impact individuals’ physical health, psychological well-being, and life chances in general (see Sampson, Morenoff, & Gannon-Rowley (2002) for a useful review of this research). This paper focuses on one particular aspect of neighborhood context that may have important consequences for adults’ physical health: residential stability. Drawing on work involving the life-stress process (Lin & Ensel, 1989) and the growing body of work linking social integration and physical health status (Berkman, Glass, Brissette, & Seeman, 2000; Kawachi & Berkman, 2000) this paper posits that the health status for residents of more stable communities will be less affected by the effects of chronic and acute stressors compared to residents of communities with high rates of residential instability. In short, the potentially salubrious nature of residential stability is tested as an important buffer to the otherwise deleterious effects associated with stress on adults’ physical health.

Section snippets

Stress, neighborhoods, and health

Stress provides an important conceptual and physiological link between an individual's social context and their physical health status (McEwen, 1998) and research involving individuals’ exposure to social stressors and their overall well-being has increased notably in recent years (e.g., Baum, Garofalo, & Yali, 1999; Brunner & Marmot, 1999; Landale, Oropesa, Llanes, & Gorman, 1999; Turner & Lloyd, 1999; Dohrenwend, 2000; Boardman, Finch, Ellison, Williams, & Jackson, 2001). The relationship

Research questions

This paper addresses the four following research questions:

  • (1)

    Do stress levels and physical health status vary across neighborhoods?

  • (2)

    To what extent does the non-random distribution of stress across neighborhoods account for neighborhood variation in health?

  • (3)

    Does the effect of stress on adults’ health vary across neighborhoods?

  • (4)

    Do social resources associated with neighborhood stability account for the neighborhood-to-neighborhood variation in the effect associated with stress?

Several related

Data

Individual-level data: Individual-level data come from the 1995 Detroit Area Study (DAS). The 1995 DAS is one of a series of studies from the Survey Research Center and the Department of Sociology at the University of Michigan. Each DAS poses a unique set of research questions and is headed by different principal investigators every year. The primary investigators of the 1995 DAS, James Jackson and David Williams, were primarily interested in identifying the social influences on individual

Analyses: multilevel modeling of health outcomes

In the introduction of an important new text, Berkman and Kawachi (2000a) provide a useful review of the development and proliferation of research associated with the field deemed “social epidemiology”. They define social epidemiology as “the branch of epidemiology that studies the social distribution and social determinants of states of health” and specifically highlight “socioenvironmental exposures that may be related to a broad range of physical and mental health outcomes” (p. 6). While

Results

Table 1 presents unadjusted multilevel residual variance estimates and the subsequent intra-class correlation coefficients for the dependent variable (health) and the primary independent variable (stress). According to these estimates, 12.4% and 9.1% of the variance in stress levels and physical health, respectively, is due to unmeasured characteristics of respondents’ neighborhoods. In short, these results provide an affirmative response to the first research questions: do stress and physical

Discussion

The findings presented in this paper identify significant variation in physical health status and stress levels across residential areas and controls for stress levels significantly reduce the observed neighborhood variation in health levels. More importantly, the impact of stress on physical health is found to be stronger among residents of relatively unstable neighborhoods. Social stressors are known risk factors for a number of adverse health outcomes and the findings presented here are

Conclusion

Echoing the comments of other researchers in this area (Sampson et al., 2002; Macintyre et al., 2002), this paper concludes with several suggestions regarding the collection of data on health and health related phenomena that will facilitate this type of research in the future. First, data should permit detailed examination of variation within and across important social contexts. Sociological theory takes the following rather obvious idea as an unmentioned point of departure: individuals are

Acknowledgements

The author would like to thank Robert A. Hummer for his comments on previous drafts of this manuscript and David R. Williams and James S. Jackson for making these data available. An earlier version of this manuscript was presented in the Medical Sociology Section (Section 1: “Social Determinants of Population Health”) of the 2002 Annual Meetings of the American Sociological Association.

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