Annals of Behavioral Medicine

, Volume 39, Issue 2, pp 170–183 | Cite as

Exploring the Role of the Built and Social Neighborhood Environment in Moderating Stress and Health

Original Article



Health researchers have explored how different aspects of neighborhood characteristics contribute to health and well-being, but current understanding of built environment factors is limited.


This study explores whether the association between stress and health varies by residential neighborhood, and if yes, whether built and social neighborhood environment characteristics act as moderators.


This study uses multilevel modeling and variables derived from geospatial data to explore the role of neighborhood environment in moderating the association of stress with health. Individual-level data (N = 4,093) were drawn from residents of 45 neighborhoods within Philadelphia County, PA, collected as part of the 2006 Philadelphia Health Management Corporation's Household Health Survey.


We find that the negative influence of high stress varied by neighborhood, that residential stability and affluence (social characteristics) attenuated the association of high stress with health, and that the presence of hazardous waste facilities (built environment characteristics) moderated health by enhancing the association with stress.


Our findings suggest that neighborhood environment has both direct and moderating associations with health, after adjusting for individual characteristics. The use of geospatial data could broaden the scope of stress–health research and advance knowledge by untangling the intertwined relationship between built and social environments, stress, and health. In particular, future studies should integrate built environment characteristics in health-related research; these characteristics are modifiable and can facilitate health promotion policies.


Stress Health Neighborhood environment Philadelphia 


  1. 1.
    Diez Roux AV. Invited commentary: Places, people, and health. Am J Epidemiol. 2002; 155: 516-519.CrossRefPubMedGoogle Scholar
  2. 2.
    Kawachi I, Berkman LF. Neighborhoods and health. New York: Oxford University Press; 2003.CrossRefGoogle Scholar
  3. 3.
    Taylor SE, Repetti RL, Seeman T. Health psychology: What is an unhealthy environment and how does it get under the skin? Annu Rev Psychol. 1997; 48: 411-447.CrossRefPubMedGoogle Scholar
  4. 4.
    Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding and representing ‘place’ in health research: A relational approach. Soc Sci Med. 2007; 65: 1825-1838.CrossRefPubMedGoogle Scholar
  5. 5.
    Morenoff JD, Lynch JW. What makes a place healthy? Neighborhood influences on racial/ethnic disparities in health over the life course. In: Anderson NB, Rodolfo AB, Cohen B, eds. Critical perspectives on racial and ethnic difference in health in late life. Washington: National Academies; 2004: 406-449.Google Scholar
  6. 6.
    Kristensen TS. Job stress and cardiovascular disease: A theoretic critical review. J Occup Health Psychol. 1996; 1: 246-260.CrossRefPubMedGoogle Scholar
  7. 7.
    Sklar LS, Anisman H. Stress and cancer. Psychol Bull. 1981; 89: 369-406.CrossRefPubMedGoogle Scholar
  8. 8.
    Wills TA, Sandy JM, Yaeger AM. Stress and smoking in adolescence: A test of directional hypotheses. Health Psychol. 2002; 21: 122-130.CrossRefPubMedGoogle Scholar
  9. 9.
    Ader R. Psychosomatic and psychoimmunologic research. Psychosom Med. 1980; 42: 307-321.PubMedGoogle Scholar
  10. 10.
    Kasl SV. Stress and health. Annu Rev Public Health. 1984; 5: 319-341.CrossRefPubMedGoogle Scholar
  11. 11.
    Stafford M, Marmot M. Neighbourhood deprivation and health: Does it affect us all equally? Int J Epidemiol. 2003; 32: 357-366.CrossRefPubMedGoogle Scholar
  12. 12.
    Brown AF, Ang A, Pebley AR. The relationship between neighborhood characteristics and self-rated health for adults with chronic conditions. Am J Public Health. 2007; 97: 926-932.CrossRefPubMedGoogle Scholar
  13. 13.
    Entwisle B. Putting people into place. Demography. 2007; 44: 687-703.CrossRefPubMedGoogle Scholar
  14. 14.
    Diez Roux AV. The examination of neighborhood effects on health: Conceptual and methodological issues related to the presence of multiple levels of organization. In: Kawachi I, Berkman LF, eds. Neighborhoods and health. New York: Oxford University Press; 2003: 45-64.CrossRefGoogle Scholar
  15. 15.
    Manski CF. Identification problems in the social sciences. Cambridge: Harvard University Press; 1995.Google Scholar
  16. 16.
    Oakes JM. The (mis)estimation of neighborhood effects: Causal inference for a practicable social epidemiology. Soc Sci Med. 2004; 58: 1929-1952.CrossRefPubMedGoogle Scholar
  17. 17.
    Vanderweele TJ. Ignorability and stability assumptions in neighborhood effects research. Stat Med. 2007; 27: 1934-1943.CrossRefGoogle Scholar
  18. 18.
    Muller D, Judd CM, Yzerbyt VY. When moderation is mediated and mediation is moderated. J Pers Soc Psychol. 2005; 89: 852-863.CrossRefPubMedGoogle Scholar
  19. 19.
    Kennedy BP, Kawachi I, Glass R, Prothrow-Stith D. Income distribution, socioeconomic status, and self rated health in the United States: Multilevel analysis. BMJ. 1998; 317: 917-921.PubMedGoogle Scholar
  20. 20.
    Rogers RG, Hummer RA, Nam CB. Living and dying in the USA: Behavioral, health, and social differentials of adult mortality. San Diego: Academic; 2000.Google Scholar
  21. 21.
    Joung IMA, Stronks K, van de Mheen H, van Poppel FWA, van der Meer JBW, Mackenbach JP. The contribution of intermediary factors to marital status differences in self-reported health. J Marriage Fam. 1997; 59: 476-490.CrossRefGoogle Scholar
  22. 22.
    Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res. 2003; 38: 809-829.CrossRefPubMedGoogle Scholar
  23. 23.
    Carlisle DM, Leake BD, Shapiro MF. Racial and ethnic disparities in the use of cardiovascular procedures: Associations with type of health insurance. Am J Public Health. 1997; 87: 263-267.CrossRefPubMedGoogle Scholar
  24. 24.
    Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A. Neighbourhood environment and its association with self rated health: Evidence from Scotland and England. J Epidemiol Community Health. 2005; 59: 207-213.CrossRefPubMedGoogle Scholar
  25. 25.
    Steptoe A, Feldman PJ. Neighborhood problems as sources of chronic stress: Development of a measure of neighborhood problems, and associations with socioeconomic status and health. Ann Behav Med. 2001; 23: 177-185.CrossRefPubMedGoogle Scholar
  26. 26.
    Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: A contextual analysis. Am J Public Health. 1999; 89: 1187-1193.CrossRefPubMedGoogle Scholar
  27. 27.
    Daniels G, Friedman S. Spatial inequality and the distribution of industrial toxic releases: Evidence from the 1990 TRI. Soc Sci Q. 1999; 80: 244-262.Google Scholar
  28. 28.
    Anderton DL, Anderson AB, Oakes JM, Fraser MR. Environmental equity: The demographics of dumping. Demography. 1994; 31: 229-248.CrossRefPubMedGoogle Scholar
  29. 29.
    Robert SA. Community-level socioeconomic status effects on adult health. J Health Soc Behav. 1998; 39: 18-37.CrossRefPubMedGoogle Scholar
  30. 30.
    Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005; 95: 660-667.CrossRefPubMedGoogle Scholar
  31. 31.
    Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington: National Academy; 2002.Google Scholar
  32. 32.
    Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: A multilevel study of collective efficacy. Science. 1997; 277: 918-924.CrossRefPubMedGoogle Scholar
  33. 33.
    Boardman JD. Stress and physical health: The role of neighborhoods as mediating and moderating mechanisms. Soc Sci Med. 2004; 58: 2473-2483.CrossRefPubMedGoogle Scholar
  34. 34.
    Lawrence RJ. Healthy residential environments. In: Bechtel RB, Churchman A, eds. Handbook of environmental psychology. New York: Wiley; 2002: 394-412.Google Scholar
  35. 35.
    Evans GW, Wells NM, Moch A. Housing and mental health: A review of the evidence and a methodological and conceptual critique. J Soc Issues. 2003; 59: 475-500.CrossRefGoogle Scholar
  36. 36.
    Campbell JL. Patients' perceptions of medical urgency: Does deprivation matter? Fam Pract. 1999; 16: 28-32.CrossRefPubMedGoogle Scholar
  37. 37.
    Gee GC, Takeuchi DT. Traffic stress, vehicular burden and well-being: A multilevel analysis. Soc Sci Med. 2004; 59: 405-414.CrossRefPubMedGoogle Scholar
  38. 38.
    Houston D, Wu J, Ong P, Winer A. Structural disparities of urban traffic in Southern California: Implications for vehicle-related air pollution exposure in minority and high-poverty neighborhoods. J Urban Aff. 2004; 26: 565-592.CrossRefGoogle Scholar
  39. 39.
    Song Y, Gee GC, Fan Y, Takeuchi DT. Do physical neighborhood characteristics matter in predicting traffic stress and health outcomes? Transp Res, Part F Traffic Psychol Behav. 2007; 10: 164-176.CrossRefGoogle Scholar
  40. 40.
    Edelstein MR. Contaminated communities. Boulder: Westview; 1988.Google Scholar
  41. 41.
    Neutra R, Lipscomb J, Satin K, Shusterman D. Hypotheses to explain the higher symptom rates observed around hazardous waste sites. Environ Health Perspect. 1991; 94: 31-38.CrossRefPubMedGoogle Scholar
  42. 42.
    Elliott SJ, Taylor SM, Walter S, Stieb D, Frank J, Eyles J. Modelling psychosocial effects of exposure to solid waste facilities. Soc Sci Med. 1993; 37: 791-804.CrossRefPubMedGoogle Scholar
  43. 43.
    Luginaah IN, Taylor SM, Elliott SJ, Eyles JD. Community reappraisal of the perceived health effects of a petroleum refinery. Soc Sci Med. 2002; 55: 47-61.CrossRefPubMedGoogle Scholar
  44. 44.
    Task Force on Clinical Ecology. Clinical ecology—a critical appraisal. West J Med. 1986; 144: 239-245.Google Scholar
  45. 45.
    Osofsky JD. The effects of exposure to violence on young children. Am Psychol. 1995; 50: 782-788.CrossRefPubMedGoogle Scholar
  46. 46.
    Berman SL, Kurtines WM, Silverman WK, Serafini LT. The impact of exposure to crime and violence on urban youth. Am J Orthopsychiatry. 1996; 66: 329-336.CrossRefPubMedGoogle Scholar
  47. 47.
    Green DL, Pomeroy EC. Crime victims: What is the role of social support? J Aggress Maltreat Trauma. 2007; 15: 97-113.CrossRefGoogle Scholar
  48. 48.
    James SA, Schulz AJ, Van Olphen J. Social capital, poverty, and community health: An exploration of linkages. In: Saegert S, Thompson JP, Warren MR, eds. Social capital and poor communities. New York: Russell Sage Foundation; 2001: 165-188.Google Scholar
  49. 49.
    Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000; 51: 843-857.CrossRefPubMedGoogle Scholar
  50. 50.
    Krivo LJ, Peterson RD. Extremely disadvantaged neighborhoods and urban crime. Soc Forces. 1996; 75: 619-648.CrossRefGoogle Scholar
  51. 51.
    Fang J, Madhavan S, Bosworth W, Alderman MH. Residential segregation and mortality in New York City. Soc Sci Med. 1998; 47: 469-476.CrossRefPubMedGoogle Scholar
  52. 52.
    Schulz A, Williams D, Israel B, et al. Unfair treatment, neighborhood effects, and mental health in the Detroit metropolitan area. J Health Soc Behav. 2000; 41: 314-332.CrossRefPubMedGoogle Scholar
  53. 53.
    Dalgard OS, Tambs K. Urban environment and mental health. A longitudinal study. Br J Psychiatry. 1997; 171: 530-536.CrossRefPubMedGoogle Scholar
  54. 54.
    Philadelphia Health Management Corporation. The 2006 household health survey. Philadelphia: Philadelphia Health Management Corporation; 2006.Google Scholar
  55. 55.
    U.S. Census Bureau. (2006–2008). American Community Survey 2006–2008. U.S. Census Bureau.Google Scholar
  56. 56.
    Keeter S, Kennedy C, Dimock M, Best J, Craighill P. Gauging the impact of growing nonresponse on estimates from a national RDD telephone survey. Public Opin Q. 2006; 70: 759-779.CrossRefGoogle Scholar
  57. 57.
    Holbrook AL, Krosnick JA, Pfent A. Response rates in surveys by the news media and government contractor survey research firms. In: Lepkowski J, Harris-Kojetin B, Lavrakas PJ, et al., eds. Advances in telephone survey methodology. New York: Wiley; 2007: 499-528.CrossRefGoogle Scholar
  58. 58.
    Benyamini Y, Idler EL. Community studies reporting association between self-rated health and mortality: Additional studies, 1995 to 1998. Res Aging. 1999; 21: 392-401.CrossRefGoogle Scholar
  59. 59.
    Lazarus RS. Theory-based stress measurement. Psychol Inq. 1990; 1: 3-13.CrossRefGoogle Scholar
  60. 60.
    ESRI. ArcGIS Desktop 9.3. Redlands: Environmental Systems Research Institute; 2008.Google Scholar
  61. 61.
    Pennsylvania Dept of Transportation. PennDOT—Pennsylvania traffic counts 2008. Harrisburg: Bureau of Planning and Research, Geographic Information Division; 2008.Google Scholar
  62. 62.
    Environmental Protection Agency. Toxic chemical release inventory TRI data for sites in Pennsylvania. Available at Accessibility verified May 20, 2008.
  63. 63.
    EnviroCentre. Residual waste research. UK: Glasgow; 2007.Google Scholar
  64. 64.
    Pennsylvania Department of Environmental Protection. Commercial hazardous waste operations. Available at Accessibility verified May 20, 2008.
  65. 65.
    Rosenberry S. Hospital. Available at Accessibility verified May 20, 2008.
  66. 66.
    Sampson RJ, Morenoff JD, Earls F. Beyond social capital: Spatial dynamics of collective efficacy for children. Am Sociol Rev. 1999; 64: 633-660.CrossRefGoogle Scholar
  67. 67.
    Morenoff JD, Sampson RJ. Violent crime and the spatial dynamics of neighborhood transition: Chicago, 1970–1990. Soc Forces. 1997; 76: 31-64.CrossRefGoogle Scholar
  68. 68.
    Scientific Software Inc. Hierarchical linear and nonlinear modeling HML 6. Lincolnwood: Scientific Software Inc.; 2008.Google Scholar
  69. 69.
    Menard SW. Applied Logistic Regression Analysis. London: Sage; 2002.Google Scholar
  70. 70.
    Waite LJ, Gallagher M. The case for marriage: Why married people are happier, healthier, and better off financially. New York: Doubleday; 2000.Google Scholar
  71. 71.
    Hummer RA, Rogers RG, Nam CB, Ellison CG. Religious involvement and U.S. adult mortality. Demography. 1999; 36: 273-285.CrossRefPubMedGoogle Scholar
  72. 72.
    Ellison CG, Hummer RA, Cormier S, Rogers RG. Religious involvement and mortality risk among African American adults. Res Aging. 2000; 22: 630-667.CrossRefGoogle Scholar
  73. 73.
    Raudenbush SW, Bryk AS. Hierarchical linear models: Applications and data analysis methods. 2nd ed. Thousand Oaks: Sage; 2002.Google Scholar
  74. 74.
    Macintyre S, Ellaway A, Cummins S. Place effects on health: How can we conceptualise, operationalise and measure them? Soc Sci Med. 2002; 55: 125-139.CrossRefPubMedGoogle Scholar
  75. 75.
    Babisch W, Fromme H, Beyer A, Ising H. Increased catecholamine levels in urine in subjects exposed to road traffic noise: The role of stress hormones in noise research. Environ Int. 2001; 26: 475-481.CrossRefPubMedGoogle Scholar
  76. 76.
    Bowen W. An analytical review of environmental justice research: What do we really know? Environ Manage. 2002; 29: 3-15.CrossRefPubMedGoogle Scholar
  77. 77.
    Lee C. Environmental justice: Building a unified vision of health and the environment. Environ Health Perspect. 2002; 110(Suppl 2): 141-144.PubMedGoogle Scholar
  78. 78.
    Thomas D, Stram D, Dwyer J. Exposure measurement error: Influence on exposure-disease. Relationships and methods of correction. Annu Rev Public Health. 1993; 14: 69-93.CrossRefPubMedGoogle Scholar
  79. 79.
    Kan H, Heiss G, Rose KM, Whitsel EA, Lurmann F, London SJ. Prospective analysis of traffic exposure as a risk factor for incident coronary heart disease: The Atherosclerosis Risk in Communities (ARIC) study. Environ Health Perspect. 2008; 116: 1463-1468.CrossRefPubMedGoogle Scholar
  80. 80.
    Galster G. On the nature of neighbourhood. Urban Stud. 2001; 38: 2111-2124.CrossRefGoogle Scholar
  81. 81.
    Openshaw S. The modifiable areal unit problem Vol. 38 of concepts and techniques in modern geography: CATMOG series. Norwich: GeoBooks; 1983.Google Scholar
  82. 82.
    Soobader MJ, LeClere FB. Aggregation and the measurement of income inequality: Effects on morbidity. Soc Sci Med. 1999; 48: 733-744.CrossRefPubMedGoogle Scholar
  83. 83.
    Matthews SA. The salience of neighborhood: Some lessons from sociology. Am J Prev Med. 2008; 34: 257-259.CrossRefPubMedGoogle Scholar
  84. 84.
    Mair CF, Diez Roux AV, Galea S. Are neighborhood characteristics associated with depressive symptoms? A critical review. J Epidemiol Community Health. 2008; 62: 940-946.PubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2010

Authors and Affiliations

  1. 1.Population Research InstituteThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Social Science Research InstituteThe Pennsylvania State UniversityUniversity ParkUSA

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