Neighborhood violence and stress: Connecting fundamental causes to population-wide health inequalities

Background Racial inequalities in health are widely documented, their causes and solutions discussed and debated, and attempts to eliminate them implemented; yet the black-white gap in health persists. Research theorizes that frequent, persistent, and severe experiences of lifetime stress may result in the higher incidence of morbidity and mortality for black versus white Americans, resulting in stress accumulation that wears down both the psychological and physical systems in the body. Allostatic load, which causes hyper-activation of the stress response is associated with cardiovascular health, cognitive dysfunction, neuronal atrophy, immunosuppressive effects, and increased risk of autoimmune disorders, yet few researchers have quantitatively examined the relationship between exposure to stressors and indicators of physiological stress. Purpose This research will examine the relationship between community crime and violence and physiological stress in a national sample of young adults. More specifically, the analysis will investigate the association between crime and average cortisol levels, blood pressure and waist-to-hip ratio, all of which are indicators of allostatic load. Differences in these associations by race will be examined, as literature on weathering suggests that African Americans are exposed to more stressors over a lifetime and have higher allostatic loads Methods The most recent wave of data from the National Longitudinal Study of Adolescent Health (Add Health) will be used for these analyses. I will examine the effects of neighborhood-level crime and violence on individual physiological outcomes related to allostatic load using multi-level models. This analysis will also consider social support and substance use as moderating and mediating variables in this pathway. Expected Outcomes I expect that young adults who grew up in neighborhoods with high rates of violent crimes will have higher allostatic load than residents from lower crime areas. Additionally, I expect that this relationship will be stronger in neighborhoods with a higher proportion of Black residents due to the structural inequalities and chronic stressors present in highly segregated communities. Finally, I hypothesize that residents living in high crime neighborhoods will use more substances and receive less social support, both of which are expected to be associated with increased allostatic load.