Identifying Stress Landscapes in Boston Neighborhoods

Abstract

Background: Chronic stress plays a role in the development of health disparities. However, the relationship between neighborhood stressors and stress-related health problems and behaviors is unknown. In the city of Boston, Massachusetts, 3 neighborhoods, while within a 3 mile radius, have widely divergent life expectancies. This work aims to investigate and compare perceived neighborhood-level stressors, stress-related negative behaviors, and stress-related health problems in these neighborhoods.

Methods: Three hundred twenty-six participants were surveyed from the neighborhoods. Participants were asked to rate (1) 27 neighborhood stressors, (2) 16 stress-related negative behaviors, and (3) 13 stress-related health problems using a 1 to 5 Likert-type scale. Differences in responses between neighborhoods were analyzed using Kruskal-Wallis and χ² tests.

Results: The highest neighborhood stressors overall were related to finance, unequal treatment, and unsafe bike/pedestrian access. The highest stress-related health problems were related to substance abuse and obesity, and the largest stress-related behaviors were related to poor diet, intolerance, and aggressive driving. There were significant differences across neighborhoods (P < .05) for 18 of the 27 neighborhood stressors, 8 of the 10 stress-related health problems, and 12 of the 15 stress-related behaviors.

Conclusions: There is marked contrast in stress landscapes between the 3 neighborhoods in Boston despite their geographical proximity. This finding potentially serves as an explanation for the drastic differences in health outcomes, even though these neighborhoods are equidistant from academic medical centers. Strategies for improving the health of individuals should incorporate the unique stressors at the neighborhood level. Further research is needed to investigate how specifically neighborhood stressors influence the health of residents, thereby informing what policy interventions might be useful.

Keywords: neighborhood health; neighborhood stressors; stress; stress-related behaviors; stress-related health problems.

Figure 1.

Map of Boston With Neighborhoods of Roxbury, Jamaica Plain, and Back Bay. Major tertiary care hospitals depicted with label.

Figure 2.

Self-reported Neighborhood-Level Stress Sources. Participants were asked to rate the neighborhood characteristics between 1 and 5—1 = “not stressful,” 5= “very strong stress source.” The mean strength of the stressor is shown on the y-axis. Standard deviations depicted. Only stressors with a mean of greater than or equal to 2 in at least one of the neighborhoods are depicted. Neighborhoods characteristics that are statistically significant across neighborhoods are depicted with an asterisk.

Figure 3.

Self-reported Stress-Related Health Problems by Neighborhood. Participants were asked to identifying which stress-related health problem they have personally and to quantify how large of a problem it is—between 1 and 3—1 = “mild problem,” 2 = “moderate problem,” 3 = “large problem.” The mean strength of the stressor is on the y-axis. Standard deviations depicted. Health problems that are statistically significant across neighborhoods are depicted with an asterisk.

Figure 4.

Self-reported Stress-Related Negative Behaviors. Participants were asked to identify which stress-related behaviors were present in their neighborhood and have the greatest impact on overall community health. The percentage of survey participants that identified each stressor is shown on the y-axis. Only stressors with at least a 20% response rate in at least one neighborhood are shown. Behaviors that are statistically significant across neighborhoods are depicted with an asterisk.