Integrative Health and the Underserved
Secondary Topic: Patient-Centered Outcomes Research
Improving Boston's Health Network: Identifying Neighborhood-Level Stress Sources, Stress-related Behaviors and Health Problems
Frank Conyers, B.S., Osher Center, Brigham and Women's Hospital, Norwood, MA, United States; Darshan Mehta, MD; Gary Badger, MS; Helene Langevin, MD, , Boston, MA, United States
Late Breaker: No
The role chronic stress plays in the development of health disparities was demonstrated in recent studies that established the relationship between neighborhood characteristics and idealized health measures. However, the relationship between neighborhood-stressors and their effect on stress-related health problems and behaviors is unknown. In Boston MA, the neighborhoods of Roxbury, Jamaica Plains and Back Bay, while within a 3 mile radius, have widely divergent life expectancies (59, 78 and 89 respectively). This work aims to map the distribution of perceived neighborhood-level stressors, stress-related negative behaviors and stress-related health problems in these three neighborhoods.
326 participants were surveyed from the neighborhoods based on focus groups. Participants were asked to rate 1) 27 neighborhood-stressors, 2) 16 stress-related negative behaviors and 3) 13 stress-related health problems using a 1-5 likard scale. Differences in responses between neighborhoods were analyzed using an ANOVA.
Mean age was 58.1 years, with 52% women. There were statistically significant differences in stressors across neighborhoods for 19 of the 27 questions (ANOVA p values <0.02). The largest neighborhood-stressors were: 1) Roxbury– cost of living, addiction and discrimination were the largest stressors (mean score: 4.1, 3.8, 3.0, respectively); 2) Jamaica Plain– housing costs, addiction, and unsafe pedestrian/bike access (mean: 3.1, 2.8, 2.0, respectively); 3) Back Bay– unsafe pedestrian/bike access, lack of affordable fitness-facilities and noise pollution (mean: 3.2, 2.9, 2.4, respectively). The highest reported stress-related health problems were – 1) Roxbury– addiction, obesity, lack of exercise; 2) Jamaica Plain– addiction, insomnia, chronic pain; 3) Back Bay– anxiety, chronic pain, insomnia. The largest stress-related behaviors were – 1) Roxbury– addiction, physical violence, child abuse; 2) Jamaica Plain– poor diet, addiction, lack of exercise; 3) Back Bay– aggressive driving, lack of exercise, intolerance.
The marked contrasts between the three neighborhoods could guide strategies for improving the health of neighborhoods and individuals. Further research is needed to investigate how stressors are embedded into specific neighborhood environments and which interventions would best target these barriers.