title: Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways.
abstract: OBJECTIVE
  We examined relationships between neighborhood poverty and allostatic load in a low- to moderate-income multiracial urban community. We tested the hypothesis that neighborhood poverty is associated with allostatic load, controlling for household poverty. We also examined the hypotheses that this association was mediated by psychosocial stress and health-related behaviors.
  
  
  METHODS
  We conducted multilevel analyses using cross-sectional data from a probability sample survey in Detroit, Michigan (n = 919) and the 2000 US Census. The outcome measure was allostatic load. Independent variables included neighborhood and household poverty, psychosocial stress, and health-related behaviors. Covariates included neighborhood and individual demographic characteristics.
  
  
  RESULTS
  Neighborhood poverty was positively associated with allostatic load (P < .05), independent of household poverty and controlling for potential confounders. Relationships between neighborhood poverty were mediated by self-reported neighborhood environment stress but not by health-related behaviors.
  
  
  CONCLUSIONS
  Neighborhood poverty is associated with wear and tear on physiological systems, and this relationship is mediated through psychosocial stress. These relationships are evident after accounting for household poverty levels. Efforts to promote health equity should focus on neighborhood poverty, associated stressful environmental conditions, and household poverty.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA. ajschulz@umich.edu
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Schulz
authors.forename: Graciela
authors.initials: G
authors.lastname: Mentz
authors.forename: Laurie
authors.initials: L
authors.lastname: Lachance
authors.forename: Jonetta
authors.initials: J
authors.lastname: Johnson
authors.forename: Causandra
authors.initials: C
authors.lastname: Gaines
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Israel
mesh_terms: D000328:Adult; D052636:Allostasis / Q000502:physiology*; D044383:Black People; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology; D014505:Urban Population; D044465:White People; D001741:Black or African American