3 - (OP3) Neighborhood Disadvantage and Stress in Black Americans: A Multilevel Analysis of Objective and Perceived Neighborhood Factors

Background: Black Americans continue to experience disproportionately high levels of stress, contributing to persistent health disparities. Prior research has linked stress-related inequalities to differences between predominantly Black and White neighborhoods. To date, studies have not adequately examined the joint influence of objective and subjective measures of neighborhood factors, limiting our understanding of the unique contribution of person-level relative to neighborhood-level conditions. Therefore, we examined the direct associations between an objective measure of neighborhood disadvantage and subjective measures of neighborhood disorder and cohesion, as well as the indirect associations between neighborhood disadvantage and stress through these subjective factors (neighborhood disorder and cohesion) among Black Americans.

Method: The sample consisted of 20,725 Black Americans nested within 455 ZIP codes (first three digits) who completed surveys that assessed subjective participant-level neighborhood cohesion, neighborhood disorder, and stress levels for the All of Us Research Program between May 2018 to October 2023. Neighborhood-level disadvantage was assessed using the composite index of socioeconomic deprivation (iSDI). Multilevel modeling was used to examine the relationships among neighborhood-level disadvantage, neighborhood cohesion, neighborhood disorder, and stress.

Results: Neighborhood-level disadvantage was negatively associated with participant-level neighborhood cohesion (β = -0.43, p = .011, 95% CI [-0.76, -0.10]) and positively associated with participant-level neighborhood disorder (β = 1.26, p < .001, 95% CI [0.92, 1.60]). Both neighborhood-level (β = -0.25, p < .001, 95% CI [-0.35, -0.15]) and participant-level neighborhood cohesion (β = -0.17, p < .001, 95% CI [-0.19, -0.16]) were negatively associated with stress. Similarly, both neighborhood-level (β = 0.13, p = .005, 95% CI [0.03, 0.22]) and participant-level neighborhood disorder (β = 0.27, p = .009, 95% CI [0.24, 0.29]) were positively associated with stress. The interaction effect of neighborhood level disadvantage and within-ZIP code effects of neighborhood cohesion was significant, such that the effect of neighborhood-level disadvantage on stress was strongest among those who reported higher levels of neighborhood cohesion than average within their ZIP code (β = 0.37, p = .005, 95% CI [0.11, 0.62]). Importantly, the intermediary role of participant-level neighborhood cohesion in the relationship between neighborhood-level disadvantage and stress was significant (β = 0.11, p = .026, 95% CI [0.02, 0.21]). Neighborhood-level disadvantage was associated with stress through participant-level neighborhood disorder (β = 0.16, p = .014, 95% CI [0.04, 0.30]).

Conclusion: The current research highlights the contribution of neighborhood-level disadvantage and individuals’ perceptions of neighborhood cohesion and disorder in stress among Black Americans. These findings emphasize the importance of multilevel interventions that address both structural neighborhood conditions in addition to one’s perceptions regarding their neighborhood to reduce stress burden in Black Americans.