Cumulative neighborhood risk of psychosocial stress and allostatic load in adolescents

Abstract

The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12-20 years in the National Health and Nutrition Examination Survey (1999-2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents.

Figure 1.

Clustering (intraclass correlation coefficient) of allostatic load and biomarkers (on original, continuous scales; see text for units) in neighborhoods, National Health and Nutrition Examination Survey, 1999–2006. (HDL, high density lipoprotein; LDL, low density lipoprotein).

Figure 2.

Propensity score matching (propensity for living in a high-cumulative-risk neighborhood vs. a low-cumulative-risk neighborhood according to residence in a high- vs. low-cumulative-risk neighborhood), National Health and Nutrition Examination Survey, 1999–2006. “High Risk Neighborhood” = actual residence in a very-high- or high-cumulative-risk neighborhood (1) versus a medium- or low-cumulative-risk neighborhood (0). Propensity score quintiles rank the propensity for living in a high-cumulative-risk neighborhood.