title: Cumulative neighborhood risk of psychosocial stress and allostatic load in adolescents.
abstract: The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12-20 years in the National Health and Nutrition Examination Survey (1999-2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents.
authors.affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2301, New Orleans, LA 70112, USA. ktheall@tulane.edu
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Theall
authors.forename: Stacy S
authors.initials: SS
authors.lastname: Drury
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shirtcliff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D052636:Allostasis; D002648:Child; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D016017:Odds Ratio; D057216:Propensity Score; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult