The importance of social context: Neighborhood stressors, stress-buffering mechanisms, and alcohol, drug, and mental health disorders
Introduction
Although a growing body of evidence indicates that neighborhood characteristics are associated with prevalence of alcohol, drug, and mental health (ADM) conditions, research identifying mechanisms through which contextual effects operate is necessary to plan and develop health care systems that integrate aspects of place with service. “Neighborhood effects” research has focused on demonstrating how neighborhood disadvantage contributes to risk for ADM problems (Aneshensel & Sucoff, 1996; Boardman, Finch, Ellison, Williams, & Jackson, 2001; Park & Nelson, 1998; Reijneveld & Schene, 1998; Ross, 2000; Weich, Twigg, Holt, Lewis, & Jones, 2003; Wheaton & Clarke, 2003). However, neighborhoods can also provide resources to support routine activity and facilitate social support, lowering risk for ADM conditions (Heaney & Israel, 2002; Robert, 1999).
Some research has shown that larger support structures may interact with individual supports to affect mental health (Lin, Ye, & Ensel, 1999); few have explored effects of neighborhood characteristics and their stress-buffering effects for ADM disorders. In this paper, we test a conceptual model that explores effects of neighborhood stressors and stress-buffering mechanisms on ADM disorders. We use neighborhood-level data from US Census and other sources to develop neighborhood measures that parallel stress-buffering functions of individual social support and stress. We have two research questions. First, net of neighborhood economic context, what role do neighborhood stressors and stress-buffering mechanisms play in prevalence of ADM disorders? Second, does the impact of individual-level stress and social support on likelihood of ADM disorders differ depending on neighborhood stressors and stress-buffering mechanisms?
Section snippets
Neighborhood context, stress, and ADM conditions
Durkheim's studies of suicide (Durkheim, 1951) began a long tradition of exploring the association between social environment and individual well-being. Faris and Dunham (1939) were the first to link “social disorganization” with schizophrenia and substance abuse at the neighborhood level, arguing that disorganized neighborhoods increased social isolation, as positive relationships were more difficult to develop and maintain. Within the life stress paradigm, the effects of social support and
Conceptual framework
Fig. 1 illustrates pathways through which neighborhood economic context may impact mental health, demonstrating hypothesized relationships among neighborhood economic context, stressors, and stress-buffering mechanisms. It acknowledges that individual demographics, stress, and social support affect likelihood of ADM disorders. Below we discuss relevant literature supporting our conceptual model. To summarize, neighborhood disadvantage operates through its effects on neighborhood stressors and
Data
We used cross-sectional data from Healthcare for Communities (HCC) wave 2 telephone survey, supplemented with cases from wave 1. HCC was designed to track effects of the changing health care system on risk for ADM disorders. Both HCC waves were drawn from participants in the Community Tracking Study (CTS), a sequence of telephone surveys that focused on health care and health insurance coverage (Kemper et al., 1996). The first HCC wave (1997–1998) sampled 14,985 individuals from the 30,375
Any alcohol, drug, or mental health disorders
Model 1 (Table 3) shows that with all individual-level variables in the model, neighborhood economic context was not significantly associated with likelihood of any ADM disorder. Non-whites, married, and individuals with more family savings had lower likelihoods of ADM disorders, while having less than high school education increased likelihood. Likelihood of ADM disorders decreased with age and higher social support. The significant interaction terms for social support by age and social
Conclusions
Building on previous research that points to physical and structural characteristics of disadvantaged neighborhoods as sources of stress (Boardman et al., 2001; Robert, 1999), we found evidence that one neighborhood stressor (high violent crime) is associated with worse mental health outcomes, above and beyond effects of neighborhood economic context. In contrast to studies suggesting that signs of public drinking and alcohol-related problems are sources of stress, alcohol availability was not
Acknowledgments
The authors would like to acknowledge and thank the following people for their contributions to the conceptualization of the analysis variables, technical assistance, and helpful comments: Ruth Klap, Roland Sturm, and Diana Liao. This research was supported by grants from the Robert Wood Johnson Foundation (038273), the National Institute of Mental Health (P30MH068639:01), and the National Institute of Environmental Health Sciences (P50ES012383).
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