The Impact of Neighborhood Stress on Cardiovascular Health: The Association between Perceptions of Neighborhood Physical and Social Disorder and Cardiovascular Disease Risk in Latinas.

摘要

Attention has been paid to "objective" characteristics but not "subjective" perceptions of neighborhood environments and associations with cardiovascular disease (CVD) risk; the latter may be of particular import since one of the ways in which impoverished neighborhood environments are theorized to impact health is through their roles as daily sources of stress. Few studies have examined how neighborhood characteristics impact CVD risk within Latinos. The current study examined the relationship between perceptions of neighborhood physical and social disorder and CVD risk as assessed by body mass index (BMI), the Homeostasis Model of Assessment -- Insulin Resistance (HOMA-IR), total to high-density lipoprotein cholesterol ratio (total/HDL-c), triglycerides, and mean arterial blood pressure (MAP). Indirect effects through behavioral (dietary patterns, sedentary behavior, exercise, smoking, sleep quality/quantity) and psychological (chronic stress, perceived stress, anxiety, depression) factors were also examined. A sample of 304 healthy, Mexican-American women, aged 40-65 years, were recruited from south San Diego communities of diverse SES. Participants completed questionnaires assessing demographics, health behaviors and neighborhood disorder. Trained assessors measured blood pressure and obtained anthropometric measurements. Levels of lipids, insulin, and glucose were collected through a fasting venous blood draw. Findings showed no significant relationship between physical disorder and CVD risk factors in either age-adjusted or fully-adjusted (controlling for SES, acculturation, menopausal status, and medications relevant to CVD risk factors) models. Social disorder was significantly associated with total/HDL-c ratio, triglycerides, and MAP and were marginally associated with HOMA-IR (p=.058). No associations remained significant in fully-adjusted models. In addition, no indirect effects through behavioral or psychological pathways were significant. Sensitivity analyses revealed an interaction between social disorder and neighborhood SES on MAP that approached significance (p= .053). Simple slope analyses showed a trend for a stronger association between social disorder and MAP with increasing neighborhood SES. In sum, results provide preliminary evidence of associations between greater perceived social disorder in one's neighborhood and CVD risk through increased lipids and blood pressure in Latino women. However, these effects may be due to confounding with SES. Findings contribute to the understanding of how appraisals of macro-level influences relate to CVD risk within the Latino population.