Resilience to urban poverty: theoretical and empirical considerations for population health.
OBJECTIVE
To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level.


METHODS
Health resilience is the capacity to maintain good health in the face of significant adversity. With higher levels of tooth retention as a marker of health resilience, we used a social-epidemiological framework to define capacity for health resilience through a chain of determinants starting in the built environment (housing quality) and community context (social support) to familial influences (religiosity) and individual mental health and health behavior.


RESULTS
Odds of retaining 20 or more teeth were 3 times as likely among adults with resilience versus more-vulnerable adults (odds ratio=3.1; 95% confidence interval [CI]=1.3, 7.4). Children of caregivers with resilience had a lower incident rate of noncavitated tooth decay at 18- to 24-month follow-up (incidence risk ratio=0.8; 95% CI=0.7, 0.9) compared with other children.


CONCLUSIONS
Health resilience to poverty was supported by protective factors in the built and social environments. When poverty itself cannot be eliminated, improving the quality of the built and social environments will foster resilience to its harmful health effects.
Sanders
Anne E
AE
School of Dentistry, University of Michigan, 1011 N University, Ann Arbor, MI 48109-1078, USA. aesand@umich.edu
Lim
Sungwoo
S
Sohn
Woosung
W
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009059:Mouth Diseases / Q000453:epidemiology; D016017:Odds Ratio; D016012:Poisson Distribution; D011203:Poverty; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014505:Urban Population; D001741:Black or African American