Does where we live matter? Neighborhood context and implications for stress and health.

Abstract

In an attempt to mitigate health inequalities, researchers have focused on the unequal distribution of psychological and physiological stress as a potential cause of health inequalities. Black Americans experience more frequent exposure to stressors across their lifetime than White Americans, which may be related to poor physical and mental health. One context in which individuals are exposed to stressors is the neighborhood. Residents of socio-economically disadvantaged neighborhoods are more likely to be exposed to poverty, crime, violence, residential instability, and social isolation, which may harm health beyond the influence of individual socioeconomic status. Although many researchers have examined neighborhood context and health, and have studied the stress process, research connecting neighborhood context to stress is limited. In this dissertation I apply neighborhood models and the Theory of Stress and Coping, to more thoroughly examine the relationship between neighborhood stressors, individual risk and promotive factors, stress and health. I use data from a longitudinal survey of adolescents and young adults in Flint, Michigan for my primary data source. I also include neighborhood measures from the U.S. census, Flint violent crime, and a community survey of Flint residents. In the first study I find an initial association between neighborhood disadvantage and stress, which vanishes once I consider individual coping and social support. While a disadvantaged neighborhood exert detrimental influences on residents, coping and social support may mitigate these harmful neighborhood exposures to reduce psychological stress during development. The second study also suggests a connection between neighborhood disadvantage and cortisol, as well as offer support for mediating pathways that include individual risk and promotive factors. Thus, stressor exposure in disadvantaged neighborhoods may also be reflected physiologically. The last study indicates that neighborhood socio-economic disadvantage influences health via proximal pathways including neighborhood perceptions and psychological stress. Overall, my results support the hypothesis that neighborhood context influences stress beyond individual factors. They also indicate that this relationship is complex, and may be dependent on neighborhood perceptions, stress and coping, behavior and attitudes. These proximal factors in the stress pathway may be valuable points of intervention to alleviate the adverse consequences of exposure to neighborhood disadvantage.