Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk?
Introduction
The substantial literature demonstrating relationships between neighborhood socioeconomic status (SES) and a wide range of health outcomes (Borrell et al., 2004, Cox et al., 2007, Diez-Roux and Mair, 2010, Diez-Roux et al., 2001, Mair et al., 2008, Pickett and Pearl, 2001, Winkleby et al., 2007) has led to the suggestion that these effects occur through a broad range of behavioral and physiological mechanisms (House, 2002, Link et al., 2008, Phelan et al., 2010). Potential pathways linking neighborhood SES to health include effects of local environmental conditions (e.g., access to food, safe places for physical activity) on health-related behaviors (e.g., dietary practices, physical activity) (Izumi et al., 2011, Laraia et al., 2004, Larson and Story, 2009, Morland et al., 2002, Zenk et al., 2009, Zenk et al., 2013) as well as biological indicators of health (e.g., percent body fat, systolic blood pressure) (Dengel et al., 2009, Li et al., 2009). Neighborhood SES may also be associated with environmental conditions that are conducive to stress, and thus are linked to health outcomes through physiologic responses to stress (Lazarus and Folkman, 1984, Selye, 1982). A small body of recent research has examined the hypothesis that neighborhood socioeconomic conditions may “get under the skin” (Bird et al., 2010), affecting health through wear and tear on the body associated with cumulative exposure to stressful life conditions. Reported findings are generally consistent with this hypothesis (King et al., 2011, Merkin et al., 2009, Stimpson et al., 2007), and one study reported evidence that associations between neighborhood poverty and allostatic load (as an indicator of cumulative biological risk) were mediated by self-reported stress (Schulz et al., 2012). To date, no studies of which we are aware have examined the role of observed neighborhood environmental conditions as pathways linking neighborhood SES and cumulative biological indicators of risk. Our aim in this paper is to begin to fill this gap in the literature by explicitly examining the plausibility of observed as well as perceived neighborhood conditions as mediators of associations between neighborhood poverty and indicators of cumulative biological risk (CBR).
Section snippets
Conceptual model
This analysis builds on conceptual models and empirical research that suggest that associations between SES and health involve multiple dynamic processes and pathways (Fig. 1) (House, 2002, Link et al., 2008, Phelan et al., 2010, Schulz et al., 2005). Among these pathways are environmental conditions that may be considered conducive to stress if they are perceived as harmful, threatening or bothersome (Lazarus and Folkman, 1984) or that place a demand on individuals that results in
Sample
Data for this study were drawn from three sources: individual level data from the Healthy Environments Partnership (HEP) 2002 Community Survey, observational data from the HEP Neighborhood Observational Checklist (Zenk et al., 2005, Zenk et al., 2007) and 2000 Census data. The HEP Community Survey and Neighborhood Observational Checklist data were collected as a part of a community-based participatory research study involving academic, health care, and community-based organizations in Detroit,
Results
Table 1 shows descriptive statistics for the individual, block and block group neighborhood-level variables. About half of the participants were female; about one-fifth were Latino and NHW, with the majority NHB. At the block group level, on an average about one-third of households had incomes below the federal poverty level, and about two-thirds of households were NHB.
Table 2 shows results from multilevel regression analyses testing relationships between neighborhood poverty, observed
Discussion
There were three main findings from the analyses reported here. First, observed and perceived indicators of the neighborhood environment were associated with CBR, after accounting for neighborhood poverty, racial and ethnic composition of neighborhoods, and individual level demographic characteristics and behavior indicators. We found no evidence that these associations were modified by age, gender or household income. Second, formal tests for mediation support the hypothesis that observed and
Contributors statement
A. Schulz conceptualized and oversaw all aspects of the study; G. Mentz conducted the analyses, contributed to the interpretation, and assisted with drafting the paper; L. Lachance and J. Johnson provided consultation regarding analyses and interpretation of findings, and edited the paper; C. Stokes assisted with the acquisition of data, contributed to the interpretation and review of the article; S. Zenk provided conceptual guidance, assisted with the collection of data, and edited the paper.
Human participant protection
The University of Michigan Institutional Review Board for Protection of Human Subjects approved the study in January 2001 and survey participants provided informed consent. Data collection was conducted in accordance with ethical standards for the conduct of research with human subjects, and with the Helsinki Declaration of 1975, as revised in 2000.
Acknowledgments
The Healthy Environments Partnership (HEP) (www.hepdetroit.org) is a community-based participatory research partnership affiliated with the Detroit Community-Academic Urban Research Center (www.detroiturc.org). We thank the members of the HEP Steering Committee for their contributions to the work presented here, including representatives from Brightmoor Community Center, Detroit Department of Health and Wellness Promotion, Detroit Hispanic Development Corporation, Friends of Parkside, Henry
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