Neighborhoods and health: exploring the effects of physical, social, and cultural stressors in an environmental justice community

Abstract

Neighborhoods are composed of physical, social, and cultural environmental factors that influence health and health behaviors. These factors include chronic stressors that are associated with premature mortality. Determining the role of neighborhoods on health is challenging due to individual exposure to multiple types of stressors, and discerning effects of individual stressors from co-occurring neighborhood stressors. This dissertation investigates the role of neighborhood and individual stressors on physical activity, self-rated health, and depressive symptoms in the environmental justice community of Chelsea, Massachusetts. We interview 354 Chelsea residents aged 18 years and older using open- and closed-ended questions that address health-related topics and perceptions of the environment. We use GIS-based methods to map resident-defined neighborhoods and their relation to attributes of the physical environment, and regression models to quantify relationships between neighborhood factors and individual stressors with health outcomes. We also incorporate responses to open-ended interview questions to develop physical activity outcomes. We report positive associations between exposure to neighborhood factors and adverse outcomes. Noise, feeling unsafe, and low social cohesion display positive correlations with poor self-rated health and depressive symptoms. Proximity to resident-preferred parks is positively correlated with physical activity, while knowledge of rape or sexual assault is inversely associated with physical activity. Individual stressors, such as health conditions and disability, are positively associated with all adverse outcomes. Including neighborhood factors and individual stressors in the same model does not change any associations. We conclude that neighborhood factors are independent sources of chronic stress that influence health and health behaviors. In the literature, the outcomes we study are associated with premature mortality. This fact, coupled with the associations we see between our outcomes and neighborhood factors, suggest that aspects of neighborhoods can increase risk for premature mortality. Health could also be improved on an individual level by providing resources to buffer against the negative effects of disability and reported financial problems, such as a sudden loss of income or food insecurity. Environmental policies related to neighborhood conditions should consider the effects of neighborhoods factors on health as a systematic method of improving health.