Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

Abstract

Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD=6.28 (95% CI 1.22, 11.35)] than for parents [RD=3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD= 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD=0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD=0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a "social pollutant" and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.

How does the social “get under the gums”? The role of socio-economic position in the oral-systemic health link

“…Previous research has highlighted the ability of social conditions to "get under the skin" to affect one's biological systems and hence the body's ability to fend off disease. 9,10,23 The effect of socio-economic position observed in this analysis supports this concept, where social and economic conditions that determine an individual's position on the social hierarchy can potentially influence immune functions -indicated here by markers of systemic inflammation -and eventually affect one's risk of periodontal inflammation. Furthermore, our findings are consistent with previous studies emphasizing the role of socio-economic position in linking oral and systemic health outcomes.…”

Economic, Legal, and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities

“…Indicators of various individual-level hardships, including social (unstable housing), economic (joblessness, poverty), and legal (incarceration) have been linked to elevated HIV risks and other poor health outcomes. [16][17][18][19][20][21] The confluence of various forms of hardships can structure circumstances that involve high risk for HIV and at the same time limit the perceived options available for risk-reduction. 22,23 For example, consider a case of a Black MSM who is poor, with limited employability due to a felony conviction, at risk of eviction from his home for nonpayment of rent, yet is on parole-which requires that he maintain a residential address.…”

The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children

“…9 Research consistently suggests a complex interplay between individual (e.g., genetic predisposition), family (e.g., parental smoking, socioeconomic status, and maternal stress), and environmental risk factors (e.g., allergen exposure), which undermine asthma management and exacerbate vulnerability to poor outcomes. [10][11][12][13][14][15][16] Community violence, which may range from perceived threats to direct victimization, is one stressor that has an especially robust connection to asthma morbidity, as it is proposed to precipitate asthma exacerbations and result in increased healthcare utilization. 17,18 In a prospective study, adults with asthma who were exposed to violence had 92 times more asthma-related ED visits and 92 times more hospitalizations compared with adults without community violence exposure.…”