neighborhood disadvantage, disorder, and health, catherine e. ross and john mirowsky

8/13/2019 Neighborhood Disadvantage, Disorder, and Health, Catherine E. Ross and John Mirowsky

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Neighborhood Disadvantage, Disorder, and HealthAuthor(s): Catherine E. Ross and John MirowskyReviewed work(s):Source: Journal of Health and Social Behavior, Vol. 42, No. 3 (Sep., 2001), pp. 258-276Published by: American Sociological AssociationStable URL: http://www.jstor.org/stable/3090214.

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Neighborhood Disadvantage, Disorder, and Health*CATHERINEE. ROSSJOHNMIROWSKYOhio State University

Journalof Health and Social Behavior2001, Vol42 (September):258-276We examine the question of whether living in a disadvantaged neighborhooddamages health, over and above the impact ofpersonal socioeconomic charac-teristics. Wehypothesize that (1) health correlates negatively with neighbor-hood disadvantage adjustingfor personal disadvantage, and that (2) neighbor-hood disorder mediates the association, (3)partly because disorderand the earassociated with it discourage walking and (4) partly because they directlyimpair health. Data arefrom the 1995 Community,Crime, and Health survey,a probability sample of 2,482 adults in Illinois, with linked informationaboutthe respondent's census tract. We ind that residents of disadvantaged neigh-borhoods have worse health (worse self-reported health andphysicalfunction-ing and more chronic conditions) than residents of more advantaged neighbor-hoods. The association is mediated entirely by perceived neighborhood disor-der and the resulting fear It is not mediated by limitation of outdoorphysicalactivity. The daily stress associated with living in a neighborhood where dan-ger, trouble, crime and incivility are common apparently damages health. Wecall for a bio-demography of stress that links chronic exposure to threateningconditionsfaced by disadvantaged individuals in disadvantaged neighborhoodswithphysiological responses that may impair health.

Does neighborhooddisadvantagempair he borhood disorderaccounts for the associationphysical health of residents? If so, how? of neighborhood disadvantage with poorResidentialareascharacterized y highratesof health. Signs of neighborhooddisorder takepoverty or single-mother households and by two forms: physical disorder such as aban-low ratesof college educationand home own- doned buildings, noise, graffiti, vandalism,ership add collective or environmentaldisad- filth, anddisrepair; ndsocial disordersuch asvantages to the personal ones of residents crime, loitering, public drinking or drug use,(Masseyl996; Wilson 1996). Living in a dis- conflicts, and indifference. Many individualsadvantagedneighborhoodmay damagehealth, may find life undersuch conditionsthreaten-over and above the impactof personalsocioe- ing and forbidding. Neighborhood disorderconomic characteristicsthat limit residential may discourage healthful outdoor activitiesoptions (Jones and Duncan 1995; LeClere, such as walking.Beyond that, it maystimulateRogers,and Peters 1997;Robert 1998, 1999). frequent errorandchronicforeboding,repeat-This study tests the hypothesis that neigh- edly floodingthe body with adrenalhormonesthatdirectly underminehealth.*This researchwas supported by a grant from theNational Institute of Mental Health, Community,Crime, and Health (ROI MH51558) to Catherine NEIGHBORHOOD DISADVANTAGE,E. Ross (p..) and Chester Britt (co p.i.). We thank DISORDER, AND HEALTHShana Pribesh and the JHSB reviewers and editorfor their help. Direct all correspondence toCatherineRoss, Department f Sociology, 300 NeighborhoodisadvantagendDisorderBricker Hall, The Ohio State University, 190 N.Oval Mall, Columbus, OH 43210. E-mail: The lack of economic and social [email protected]. in disadvantagedneighborhoodspredisposes

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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 259them to physical and social disorder. ple who see little chance to succeed may beDisadvantage is a condition or circumstance less likely to stayin school and more likely tounfavorable o success. To the extent that dis- engage in illegitimateactivities, thus increas-advantaged individuals are concentrated in ing the level of disorder n the neighborhood.geographically defined areas, disadvantage Disadvantagedneighborhoods may also lackbecomes characteristicof their neighborhoods the informal social ties that bind neighbors(Massey 1996). Neighborhooddisadvantages together and help maintain social orderindicated by things such as the prevalence of (Sampson and Groves 1989). Disadvantagedpoverty and of mother-only households. neighborhoodsalso have fewer resources likeMassey (1996) argues that concentrationof good schools, parks, and services, which maypoverty creates alienation of many types indicate to residentsthat mainstream societybecause it erodes public order.Wilson (1996) has abandonedthem; residents, in response,also considers neighborhoodsto be a funda- may abandonconventional, orderly behaviormental cause of many socialproblems, but he (LaGrangeet al. 1992; Taylorand Hale 1986;arguesthatfamily structure s a critical aspect Wilson 1987). In neighborhoodswith greaterof neighborhoods, too. According to him, social and economicresources, residents havepoverty itself did not demolish social order the assets, abilitiesand self-interestsconducivewhen poor families typicallyhad two parents, to orderand safetybecause two-parent amilies provideorder andstability even in the presenceof poverty.On the opposite end of the scale, neighbor- Evidence RegardingNeighborhoodhood advantagessuch as a high prevalence of Disadvantageand Healthcollege education and home ownership canfavor success. College educatedresidents in a Multilevel analyses suggest that neighbor-neighborhoodprovidecollectivehumancapital hood disadvantagemay negatively affect resi-and positive role models (Wilson 1996). They dents'health,over and above the effects of per-contribute to an environment n which many sonal disadvantages. A multilevel analysisadultshave skills, jobs, opportunities,and con- adjusts for individual socioeconomic andnections outside the neighborhood.Likewise, demographic status when correlating healthin neighborhoods with high levels of home with aggregate neighborhood conditions.ownership many residents have wealth that Multilevel research often finds poorerhealthinheres n the neighborhood.Because the value associated with indications of neighborhoodof each home depends on the quality of the disadvantage net of personal attributes,neighborhood,home-owningresidents have a although heestimatedeffects of neighborhoodsubstantialpersonalinterestin preserving and characteristics end to be small and inconsis-improving t. tent compared o those of individualattributes.Informal social control weakens in disad- Robert 1998) correlated hreehealthmeasuresvantaged neighborhoods, where many resi- with the proportionof householdsin the cen-dents are poor and poorly educated,few own sus tractreceiving public assistance, the per-homes, andsingle-parent amiliesarecommon cent of families with incomes of less than(Sampson, Raudenbush,and Earls 1997). The $30,000, and the percent of adults unem-combinationof few economic resources,little ployed.An indexof the threeaspectsof neigh-human capital, and weak control generatesa borhood economic disadvantage correlatesthreateningand disorderedenvironmentchar- significantlywith a resident'snumberof diag-acterized by incivility and crime. nosed chronic conditions, and the percentageNeighborhood disadvantage might provoke of families receiving public assistance corre-disorder because of limited opportunity lates significantly with self-reported health,(Wilson 1987, 1996),lack of social integration even with adjustmentfor personal educationandcohesion(SampsonandGroves1989),and and household income and assets. However,normative climates conducive to disorderly the correlationswithphysical functioningwerebehavior (Brewster, Billy, and Grady 1993; not statisticallysignificant after adjustingforElliot et al. 1996; Jencks and Mayer 1990). individual-levelsocioeconomic status (RobertPoorand isolatedneighborhoodsmayhavefew 1998). Two multilevel studies examine thejobs, so that residentsperceivelittle opportuni- associationof heartdiseasewithneighborhoodty for employment(Wilson 1996). Youngpeo- disadvantage. One finds that neighborhood


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 261cardiovascularproblems, colon cancer, back raise blood glucose levels by decreasingglu-pain, osteoporosis, obesity, high blood pres- cose metabolismand accelerating the conver-sure, constipation, varicoseveins, adult onset sion of fatsand proteins (including muscle) todiabetes, and it improves subjective health glucose. While cortisone and cortisol relieve(Caspersen et al. 1992; Duncan,Gordon, and some symptoms, they appear to create oth-Scott 1991; Leon et al. 1987; Magnus, ers-notably fatigue and sleep disturbanceMatroos, and Strackee 1979; Paffenbargeret (Glaser and Kiecolt-Glaser 1998; Brunneral. 1986;Ross and Wu 1995;Segovia, Bartlett, 1997). Excess cortisone and cortisol producesand Edwards 1989; U.S. PreventiveTask Force central obesity, hypertension, and hyper-1989). glycemia (Thibodeauand Patton1997).Disorder, ear, and stress. Disorder and the The hormonesreleased n both phasesof thefear it engenders may impairhealth directly, stress responsemay reduce resistanceto infec-apart from discouraging healthful outdoor tions andcancers (Glaser et al. 1999; Herbertactivity such as walking. Biomedical research and Cohen 1993; Irwin et al. 1997). Chronicshows thata threateningenvironment an pro- stress appears to inhibit innate, nonspecificduce physiological responsesthat may impair immunity, n which naturalkiller lymphocyteshealth in several ways: by creating symptoms detect anddestroycells that show signs of viralexperiencedas illness, by increasing suscepti- infection or other abnormalities. It alsobility to pathogens and pathological condi- appears o suppressthe productionof antibod-tions, and by acceleratingthe degradationof ies and T-lymphocytes keyed to detect andcritical physiological systems (Fremont and destroy specific invaders. As a result, socialBird2000; McEwen 2000; Taylor,Repetti, and and psychological stress undermines theSeeman 1997). immunesystem's ability to suppress an infec-According to current biomedical theory, tion beforeit produces unpleasantor incapaci-threats stimulate the fight or flight response, tating symptoms. Psychosocial stress corre-which has two phases (Memler, Cohen, and lates positivelywith the likelihood of develop-Wood 1996; Thibodeau and Patton 1997). In ing symptomsafter exposure to cold viruses,the initial alarm stage, sympathetic nerve and with antibody concentrations hat suggestfibers stimulatethe adrenalmedulla to release widespreadviral proliferation Cohen, Tyrrell,the hormone epinephrineand the neurotrans- and Smith 1991). It also may reactivate atentmitter norepinephrine. This increases heart viral infectionssuch as varicella zoster, herpesrate; blood pressure; and respiration rate; simplex,and Epstein Barr (Cohen et al. 1999;dilates the blood vessels of the heart, lungs, Cohen andHerbert 1996; Glaser and Kiecolt-and skeletalmuscles; constrictsthe vessels of Glaser 1998;Irwin et al. 1998). Chronicexpo-the digestive tract;and releases glucose from sure to a threateningenvironmentmay under-the liver into the blood. The activation of the mine the body's naturaldefenses.sympatheticnerves also stimulatesthe sweat Stresshormonesalso can exacerbateor evenglands and suppresses the salivary glands. instigate chronic health conditions (FremontThese physiological responsesmay be experi- and Bird 2000; McEwen 2000). Stressorscanenced as illness, particularly f the response precipitateheart problems such as irregularbecomes frequent or generalized and thus beat (arrhythmia)and platelet clotting whichseemingly detached from specific stimuli. can produceinadequatebloodflow (ischemia),Individuals exposed to chronic psychosocial perhaps resulting in death of heart tissuestrainsdevelop heightenedreactivity(Pike et (infarction).The alarmphase of the fight-or-al. 1997;Pruessneret al. 1997). Theyenterthe flight response thus may stimulate a heartstage of alarm more readily, quickly, and attack. It also can damagethe lining of coro-intensely,and takelongerto recoverfromit. nary arteries, instigating the formation ofIn the follow-up resistance stage of the plaque that eventually occludes the arteries.

fight or flight response,an endocrinegland Chronic stress increases allostatic load,in the brain calledthe anteriorpituitaryreleas- which refers to the price the body pays fores adrenocorticotropicstimulating hormone being forced to adaptto adversepsychosocial(ACTH),which stimulates he releaseof corti- or physical situations (McEwen 2000:110).sone and cortisol (hydrocortisone)from the Forexample,the cortisol releasedin the resis-adrenalcortex.These hormonessuppresspain, tancephaseapparently ccelerates heprogres-inflammation, allergy, and immunityv.They sive thickening and hardening of arteries


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262 JOURNALOF HEALTHAND SOCIAL BEHAVIORthrough the buildup of fatty plaque (athero- age, are disadvantaged hemselves;thus, it issclerosis) and perhapsalso the buildup of cal- possible that geographically-defined placescium salts and scar tissue (arteriosclerosis) have no effect independentof the demograph-throughout he body, includingarteriessupply- ic characteristics f their residents(Jencksanding the heart, brain, and other vital organs. Mayer 1990; Jones and Duncan1995; RobertAtherosclerosis interacting with high blood 1998; SloggetandJoshi 1994). Disadvantagedpressure (anotherresult of chronic stress) can individuals who lack social and economicdevelop into coronaryheart disease (McEwen resources often live in disadvantagedneigh-2000). borhoods with high levels of disorder.In sum, repeated exposure to threatening Individualswith low incomes and little educa-conditions may impairhealth. People exposed tion, those who are unemployed or employedto neighborhooddisorderseem likely to expe- in low statusjobs, minorities, and unmarriedrience more frequentand intense activationof people have worse health, on average, thanthe stress response, with possible conse- those with high incomes and education,quences for their health. employed persons, whites, and marriedpeople(Link and Phelan 1995; Mirowsky,Ross, andReynolds 2000; Ross, Mirowsky, andHypotheses Goldsteen 1990). We adjust for the personaldisadvantagesthat lead individualsto live inWe hypothesize that (1) health correlates disadvantaged neighborhoodsand that alsonegatively with neighborhood disadvantage underminehealth.adjustingfor personal disadvantage,and that We use multilevel datain which the unit of(2) neighborhooddisordermediatesthe associ- analysis is the individualandcharacteristics fation, (3) partlybecause disorderand the fear the respondent's neighborhoodare linked toassociated with it discourage walking and (4) individual surveydata.Indicatorsof objectivepartly because they directly impair health.' neighborhood disadvantageare derived fromFigure 1 shows the processes by which neigh- an exogenous data source-the Censusborhooddisadvantagemay influencehealth. SummaryTapefile 3 from the 1990CensusofPopulation and Housing-which providesindependent assessments of disadvantageinMETHODS the contextual units (Blalock 1985). We, likeothers,use the census tract as the best approx-MultilevelData andModel imation of the neighborhood (South andCrowder1997;Tienda1991).Inorder o test the hypothesisthat the neigh- About two-thirds of the respondents n theborhoodin which a person lives affects physi- statewide random sample used here reside incal well-being, we distinguish individual from the same tract as at least one other member ofneighborhood disadvantage. Disadvantaged the sample. That creates the possibility of aneighborhoods containpersons who, on aver- regression residual correlated within tracts.FIGURE1.TheoreticalModel of the Processesby whichNeighborhoodDisadvantage ffectsHealth

Sociodemographic FearCharacteristics/ R~~~+1- +Y

Disorder Health

Neighborhood WalkingDisadvantage


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 263Thus,when estimatingthe effects of neighbor- select and contacta respondent,and up to 10tohood contexton health,ordinary east squares completethe interviewonce contactwas made.techniquesmay producebiasedstandard rrors Interviewswere completed with 73.1 percent(Blalock 1985; Bryk and Raudenbush1992; of the eligible persons who were contacted.DiPrete and Forristal1994; Goldstein 1995).2 The final sample has 2,482 respondents,Weuse the multilevel statisticalmodelingpro- rangingin age from 18 to 92, with an averagegramMLn to addressthe possibility (Rasbash age of 45. The sample'sdemographicprofile iset al. 1995), by distinguishing a tract-level similar to the population (Illinois residentsresidual from the individual-level one overage 18), but, like most surveys, is some-(Goldstein1995; Brykand Raudenbush1992). what more educated, well-to-do, white, andMLnuses iterativegeneralized east squares o female.The medianfamilyincome in the sam-estimate the slopes and two components of ple is $40,000, comparedto $38,664 in theresidualvariance (u2): residualvarianceat the population;the mean education level in theindividual evel (u 2) and residualvariance hat sampleis 13.8, compared o 12.7 in the popu-is constantacross individualswithin a tractbut lation; the percentagewhite is 84.0, comparedrandomacross tracts(ou2). to 80.5; and the percentagemale is 41.0 per-Themultilevelmodel can be summarizedas cent, compared to 48.5 percent. Regressionfollows: models with income, education,race, and sexas independentvariablesinherentlyadjustfory = a + I3'xf+ V11 these differences between the sample and thepopulationit represents(Winshipand Radbillwhere t indexes tractsand i indexesindividuals 1994).3within tracts, and

Vd = Ut + sta ConceptsandMeasurementThe model assumesthat:utareconstantacross Physical health is the dependentvariable.Itindividuals within tracts but random across is measuredas an index of self-reportedhealth,tracts andnormallydistributedwith a mean of physical functioning,and lack of chronic con-0 and variance of uF ; 8dt. are random across ditions.Self-reportedhealth is therespondent'stracts and individualswithin tracts and nor- subjective assessment of his or her generalmany distributedwith a mean of 0 and van- health as very poor (coded 1), poor (2), satis-ance of rE2; nd 8td andutare not correlated. factory (3), good (4), or very good (5).Physical functioning is measured by askingrespondents how much difficulty they haveSample with (1) goingup and downstairs; 2) kneelingor stooping; (3) lifting or carryingobjects less

Community,Crime and Health (CCH) is a than 10 pounds, like a bag of groceries; (4)1995 surveyof a probabilitysample of Illinois preparing meals, cleaning house, or doinghouseholds linkedto census tractinformation. other householdwork; (5) shoppingor gettingRespondentswere interviewed by telephone. around own; (6) seeing, even with glasses;andThey were selected using a pre-screenedran- (7) hearing, even with a hearing aid (Nagidom-digit dialing method that increases the 1976; McDowell and Newell 1987). Therate of contacting eligible numbers (i.e., response categoriesare a great deal of diffi-decreases the rate of contactingbusiness and culty (coded 0), some difficulty (coded 1),non-workingnumbers)and decreases standard and nodifficulty (coded2). Exploratoryac-errors compared to the standardMitofsky- toranalysisindicatesthat the seven items formWaksbergmethod while producinga sample a single factor. Our measure of physical func-with the same demographicprofile (Lundand tioning sums these seven items. Low scoresWright 1994). The survey was limited to indicate physical impairment or disability;English-speaking adults. The adult (18 or high scores indicateunimpairedphysicalfunc-older) with the most recent birthday was tioning.To assess chronic medical conditions,selected as respondent,which is an efficient respondentswere asked abouta series of healthmethod to randomlyselect a respondent n the problems: Thenext set of questionsask abouthousehold. Up to 10 call-backswere made to conditionsthat some people have been diag-


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264 JOURNALOF HEALTHAND SOCIALBEHAVIORnosed as having. Have you ever been diag- equivalentto an average increase of ten per-nosed or told by a doctor that you have: (1) centage points across the four components.heart disease, (2) high bloodpressure,(3) lung The index ranges from advantagedneighbor-disease like emphysema or lung cancer, (4) hoods in which many adults have collegebreastcancer, (5) any othertype of cancer, (6) degrees and own their homes and few house-diabetes, (7) arthritisorrheumatism, 8) osteo- holds are poor or female-headed,on the lowporosis (brittlebones), (9) allergiesor asthma, end,to disadvantagedneighborhoods n whichor (10) ulcers,ulcerativecolitis, orotherdiges- few adults have college degrees, many renttive problems. These items represent he most rather han own theirhomes, andmanyhouse-common health problems that threaten sur- holds arepoor andfemale-headed,on the highvival, function, and quality of life (Kochanek end.andHudson 1995).The absenceof each condi- Both theoreticaland empiricalobservationstion is scored 1 and the presence of each con- warrantmeasuringneighborhooddisadvantagedition is scored 0. The resultingindex counts by reference to poor and mother-onlyhouse-the instances where chronic health problems holds andthe absence of home ownershipandare absent.Self-reportedhealth, physicalfunc- adultswith college degrees.The prevalenceoftioning, andthe absence of chronic conditions poverty is the core measure of economic dis-load on a single factor at .82, .83, and .79, advantage n neighborhoods Jargowsky1997;respectively.The final index is a result of stan- Massey 1996;Wilson 1987). Home ownershipdardizingeach measure and taking the mean is an indicatorof wealth that inheres in thescore of the three;it rangesfrompoorto good neighborhood; t indicatesneighborhoodeco-health(alpha= .75). nomic advantageand collective commitmentThe index of objective neighborhooddisad- to the neighborhood.The prevalenceof moth-vantageadds the prevalenceof povertyand of er-only households capturessocial disadvan-mother-only households and subtracts the tage which is correlatedwith economic disad-prevalence of home ownership and college vantagebut potentiallymakes an independenteducated residents in the respondent'sCensus contributiono disorderbecause single parentstract.The prevalenceof povertyis the percent- may be less able to control theirchildren andage of householdswith incomes below the fed- single-parent neighbors may be less able toeral poverty threshold. The prevalence of watch each other's children (Wilson 1996).mother-onlyhouseholds is the percentage of Mother-child amilies,moreover,are the poor-female-headed households with children. The est of any family type (McLanahanand Boothprevalence of college educated adults is the 1989), and poor households tend to be com-percentageof adults over the age of 24 with mon where mother-headed households arecollege degrees.The prevalenceof home own- common. Adults with college degrees indicateership is the percentage of housing units that collective humancapital; hey providepositiveare owner occupied. Among the tracts in the role models of adultswith skills, jobs, and con-sample, the percent of households in poverty nections outside the neighborhood, and theirranges from 0 to 83, with a mean of 10. The presence signifies to teens that opportunitiespercent of mother-only households ranges exist if one stays in school and out of jailfrom0 to 67, with a mean of 6. Thepercent of (Wilson 1996). Thus, a lack of well-educatedadults with college degrees ranges from 0 to adultsin the neighborhood, oo, may makean51, with a mean of 14. The percentof homes independent contribution to disorder. Poorthat are owned ranges from .3 to 97, with a households, mother-only households, ownermean of 64. The index of neighborhooddisad- occupied houses, and adults with collegevantage divides each of the four percentages degreesload on a single factorat .84, .89,-.55,by ten, addspoorandmother-onlyhouseholds, and-.60, respectively,andthe alphareliabilitysubtractshome ownershipand college educat- of the index is .61.ed residents, and divides by four.Thus, a unit Objective neighborhood disadvantage isincrease in the scale is equivalent to an measured using information from theincrease of tenpercentagepoints in each of the Summary Tape File 3 of the 1990 Censuscomponents: the prevalence of poor house- (Bureau of the Census 1992). We matchedholds, of mother-only households, of non- tract-level data to the geographic location ofowner occupied units, and of adultswithout a each respondent. Seven hundred and elevencollege degree. Alternatively,a unit increase is cases were missing tract level data. For the


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 265majorityof these cases (511 of 711) we were their neighborhood and independent assess-able to use dataat the zip code level insteadof ments by researchers are moderate to highthe tract-level. Zip codes are somewhat larger (Perkins and Taylor 1996). Table 1 lists theunits,butthey are the next best approximation items in the index, along with loadingson theof a neighborhood. In orderto determine the first rotated factor from an exploratoryfactoreffect of substituting zip code for tract we analysis.The perceivedneighborhooddisorderaddedto the preliminary egressions a dummy scale ranges from orderon the low end to dis-variabledistinguishingthe two. Its coefficient orderon the high end of the continuum, andwas never significant and was dropped n the has an alpha reliability of .916.subsequentanalyses presentedhere. Walking s measured as the number of daysPerceived neighborhood disorder is mea- walked per week. Respondents were asked,sured with the Ross-Mirowsky neighborhood Howoften do you take a walk? Open-endeddisorderscale (1999). Neighborhood disorder responses are coded into number of daysrefers to conditions and activities, both major walked per week.andminor,criminalandnon-criminal, hat res- Fear is measured as a mean-score index ofidentsperceive to be signs of the breakdownof the numberof days in the lastweek that some-social order. The index measures physical one (1) feared being robbed,attacked,or phys-signs of disordersuch as graffiti, vandalism, ically injured; (2) worried that their homenoise, and abandonedbuildings, and social would be broken into; and (3) felt afraid tosigns such as crime, people hanging out on the leavethe house (alpha= .69).street, and people drinking or using drugs. It Individualsociodemographic disadvantagealso includesreverse-codedsigns of neighbor- may create apparentcontextual effects thathood order, such as safety,people taking care actually are compositional,due to the disad-of theirhouses andapartments r watching out vantaged sociodemographiccharacteristicsoffor each other. the individuals who live in disadvantagedDisorder is perceivedand reportedby resi- neighborhoods Jencks andMayer 1990). Ourdents of theneighborhood. n order o describe models include the following individualhis or her neighborhood, a person must be sociodemographicattributes.Age is scored inawareof it and perceive it, and two people in number of years. Sex is a binary scored 1 forthe same neighborhood might describe it males and 0 for females. Race is a binarysomewhat differently.Nonetheless, both are scored 1 for whites and 0 for non-whites.describing a certain place, and correlations Education is scored in number of years.between respondents' reports of disorder in Household income is coded in thousands ofTABLE 1. Items in Ross-Mirowsky Perceived Neighborhood Disorder Scale (1999), TheoreticalDistinction between Social and Physical Disorder and Order and Empirical Associations

FactorLoadingsaPhysical Disorder and OrderbThereis a lot of graffiti in my neighborhood .804My neighborhood s noisy .747Vandalism s commonin my neighborhood .832Thereare lot of abandonedbuildings in my neighborhood .723My neighborhood s clean .603People in my neighborhood ake good care of their houses andapartments .558Social Disorder and OrderbThere are too many people hangingaroundon the streetsnearmy home .754Thereis a lot of crime in my neighborhood .847There is too much druguse in my neighborhood .817There is too muchalcohol use in my neighborhood .754I'm always havingtroublewith my neighbors .438

Inmy neighborhood,people watch out for each other .442My neighborhood s safe .608Alpha reliability .916Mean 1.811aFactoroadings fromstructurematrix,factor 1, obliminrotation.bAllitems are scored so that a high score indicatesdisorder.Disorder tems are scoredstronglydisagree(1), disagree(2), agree (3), and strongly agree (4). Order tems are scoredstronglyagree (1), agree (2), disagree(3), and stronglydisagree(4).


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266 JOURNALOF HEALTHAND SOCIALBEHAVIORdollars and logged in the regressionanalyses. less likelyto havehigh levels of physical func-Employment tatuscontrastspersonsemployed tioning, less likely to feel healthy,and morefull- or part-timefor pay (coded 1) with per- likely to have chronic healthproblems.4sons who are not employed (0). Occupational Individual socioeconomic disadvantageisstatus is measured by the National Opinion also associated with worse health. The wellResearch Center/General Social Survey educated report better physical functioning,Socioeconomic Index score (Nakao, Hodge, better self-reportedhealth, and fewer healthand Treas 1990). The non-employed are problems than the poorly educated. Peopleassigned the mean and employmentstatus is with higherincomes have fewerphysical limi-included in the regressions. Marital status is tations, fewer chronic conditions, and feelcoded as a series of binaries:divorced,single, healthiermore than those with lowerincomes.widowed, andmarried,withmarriedpersonsas The health returns to income diminish asthe comparison category in the regression income rises, as indicated by the fact thatanalyses. Number of children is the number logged incomewas moresignificantthanotherunderthe age of 18 in the home. specifications.Each dollarhas a largerpositive

Because urbanareas concentratedisadvan- influence on health at lower levels of incometaged neighborhoods,apparentneighborhood thanat higher.Employedpersonsscore highereffects could be due to city residence.Thus,we on the health index than those who are notalso include urban residence, measuredas a employed,butoccupational tatus s not signif-dummyvariablewhich contrastsliving in the icant. Men reportbetterphysical functioning,city of Chicago (coded 1) with residence in better perceived health, and fewer chronicsuburbs, small cities, small towns, and rural healthproblems hanwomen,peoplewith chil-areas(coded 0). dren score higher on the health index thanthose withoutchildren,divorcedpersonsscoreloweron the healthindex than do marriedper-RESULTS sons, and older persons score lower on thehealth index thanyounger persons.Table 2 shows the prediction of physical Standardized oefficients (not shown) indi-health in five steps. Model 1 shows the total cate that an individual'sown socioeconomiceffect of neighborhooddisadvantage.Model 2 statushas a largereffect on health than doesadds adjustment for individual sociodemo- the neighborhood n which one lives. The betagraphiccharacteristics.Models 3, 4, and5 add associatedwith neighborhooddisadvantage sthe series of mediators:neighborhooddisorder, -.05 comparedwith .11 forhousehold ncome,fear,andwalking. .12 foreducation,and.14 foremployment.TheResidents of disadvantagedneighborhoods health effects of one'sown education,employ-reportsignificantly worsehealththan those in ment, and household income are more thanmore advantagedplaces, as shown in model 1 doublethatof neighborhooddisadvantage.

of Table 2. However,this significant negative What are the mechanismsby which neigh-coefficient may be biased by the omission of borhood disadvantage influences health?individual disadvantagethat correlates with When neighborhood disorder is added inworse health and with living in a disadvan- model 3, the coefficient associatedwithneigh-tagedneighborhood.Withadjustment or indi- borhooddisadvantage s reducedby 57 percentvidualsociodemographicattributes n model2, from model 2 and becomes insignificant atthe coefficient associated with neighborhood conventionallevels (-.056 - (-.024) /-.056 =disadvantage s reducedby almost 57 percent .57). Neighborhood disorderhas a significant(-.129 - (-.056)/-.129 = .566). More thanhalf negative association with health. People whoof the apparentneighborhoodeffect was dueto reportthat there is a lot of crime,graffiti, van-the sociodemographiccharacteristicsof resi- dalism, trouble,drug use, dirt, and danger indents. Nonetheless, a significant contextual their neighborhoodhave more chronichealtheffect remains.Withadjustment or individual problems, worse self-reported health, andcharacteristics n model 2, living in a disad- worse physical functioning than people invantaged neighborhood is still significantly neighborhoods ypified by orderandsafety.associated with worse health. Comparedwith Some readers may wonder whether theresidents of more advantagedneighborhoods, effect of neighborhood disorder on healthresidentsof disadvantagedneighborhoodsare resultsfrom threator from squalor.The physi-


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268 JOURNALOF HEALTHAND SOCIALBEHAVIORp < .00 1). The coefficient b2represents he dif- hoods do not walk less. Instead, here is someference in the effects of the two subscales.It is evidence that they walk more. Residents ofestimatedas .165 (t= 3.016,p < .010).The sig- neighborhoodswith a lot of disorder do notnificantpositive b2coefficient implies that the walk less than those in neighborhoodswitheffect of physical disorder on health is less higher levels of order, althoughpeople whonegative (-.215 + .165 = -.050) and that the feel afraiddo walk less.effect of social disorder is more negative Health is damaged by residence in a disad-(-.215 - .165 = -.380). Social disorderappar- vantagedneighborhoodbecausedisadvantagedentlyhas a largernegativeeffect on healththan neighborhoodshavehigh levels of disorder. ndoes physical disorder.This suggests that the these neighborhoodsresidentsface a noxious,operative factor is exposure to threat, rather threatening,anddangerousenvironmentwhichthan to squalor. negatively mpactshealthdirectlyandindirect-Adding adjustment or frequencyof fear in ly because it is associated with fear.Thus, thethe past week in model 4 of Table 2 further first partof our theoreticalexplanation s sup-reduces the coefficient associatedwith neigh- ported. It appears as if the small additionalborhooddisadvantage.Comparisonof models reductionof the disadvantagecoefficient with2 and 4 shows that over sixty percent of the the introductionof fear is simply due to theimpact of neighborhood disadvantage on attenuation nherentin two levels of indirecthealth is accounted for by disorder and fear effects. On the otherhand,the hypothesisthat(-.056 - (-.021)/-.060 = .625). Peoplewho are residents of disadvantaged and disorderedafraid of being robbed,attackedor injuredand neighborhoodswalk less is not supported.Inareafraidof leavingtheir house reportsignifi- order to furtherunderstandwhy,we disaggre-cantly worse health than people who are not gate theneighborhooddisadvantagendexintoafraid.The adjustment or frequencyof fearin its componentsandpredictwalkingin Table4.thepastweek also reducesthe coefficient asso- Overall, neighborhooddisadvantagehas lit-ciated with neighborhooddisorderby about 9 tle effect on walkingbecause economic disad-percent,althoughdisorder s still significantat vantage and educational disadvantage havethe .001 level. (-.226 - (-.203)/-.226 = .899). opposite effects. The percent of college edu-Walking is significantly associated with cated residents ntheneighborhoods positive-good health, but its introduction n model 5 ly associatedwithwalking,which supportsourdoes not explain any of the effect neighbor- hypothesis.Statedthe other way, the absencehood disadvantageon health.In fact, the coef- of college educated residents in a neighbor-ficient associated with neighborhood disad- hood, which indicatesdisadvantage, s associ-vantageactually ncreases somewhat.Nor does ated with a decreased ikelihoodof walkingonwalkingexplain anyof the associationbetween the partof residents.However,bothaspectsofneighborhood disorderand health, which also economic disadvantage, poverty and theincreasesa littlewith the introductionof walk- absence of home ownership, are positivelying. associatedwithwalking, whichcontradictsourWhy do disorderand fear explain much of theory.When both areincludedin the Table4,the effect of neighborhood disadvantage on neither is significant, and home ownership ispoor health,but walkingdoes not? In orderto moresignificantthanpoverty(withadjustmentfurtherunderstand hese effects we show the for neighborhoodeducation), so we show itspredictionsof the threepotentialmediators n effect in the table.Residents of neighborhoodsTable 3. As hypothesized, in disadvantaged where most people own theirhomes walk sig-neighborhoods, residents reporthigher levels nificantly less than those in neighborhoodsof disorderthan they do in more advantaged witha highpercentageof renters.When neigh-neighborhoods.Furthermore, esidentsof dis- borhood poverty is substituted or home own-advantagedneighborhoodsreportsignificantly ership in the neighborhood,poverty has a sig-more fear,and this is due in partto the higher nificant positive effect on walking (b = .024,levels of disorderin disadvantagedneighbor- Seb = .0 12,p = .05). Residents of poor neigh-hoods. Both disadvantageand disorder influ- borhoodswherefew residentsowntheirhomesence fear, and the introduction of disorder walk more, not less, whichcontradictsour the-explains about 48 percent of the association ory.5between disadvantage and fear (.124 - Walking is typically done on neighborhood.065/.124 .476). Contrary to expectations, streets, so we emphasizedit in our theory ofthough, residents of disadvantagedneighbor- the mechanisms by which neighborhoods


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 269TABLE 3. Neighborhood Disorder, Fear, and Walking Regressed on Neighborhood Disadvantage,Adjusting for Sociodemographic Characteristics; Disorder Added in Model 2 PredictingFear, and Disorder and Fear Added in Model 2 Predicting Walking (CCH, Illinois, 1995;N = 2,252; metric coefficients with standard errors in parentheses are shown)

Disorder Fear Walking1 2 1 2Neighborhood .140*** .124*** .065** .172 .193+disadvantage (.013) (.026) (.026) (.100) (.112)Disorder - .422*** .019

(.042) (.189)Fear -.188*(.093)Education -.024*** -.012 -.002 .103** .101**(.004) (.008) (.008) (.034) (.034)Household -.049*** -.063*** -.043* .084 .072incomea (.009) (.019) (.019) (.082) (.082)Employment tatus .024 -.003 -.013 -.471** -.471**(employed= 1) (.021) (.042) (.041) (.184) (.184)Occupational -.001 .001 .002 -.005 -.005Status (.001) (.002) (.002) (.007) (.007)Divorcedb .037 .040 .023 .397+ .402+(.026) (.053) (.052) (.230) (.230)Singleb .044+ .088+ .068 -.035 -.021(.026) (.051) (.050) (.224) (.224)Widowedb .028 .036 .024 .626* .634*(.034) (.069) (.068) (.301) (.300)Numberof .011 .038** .034** -.058 -.050children (.008) (.016) (.016) (.070) (.070)Age .000 .001 .001 -.022*** -.022**(.001) (.001) (.001) (.006) (.006)

Race -.122*** -.068 -.026 .149 .135(white= 1) (.026) (.054) (.053) (.229) (.230)Sex .014 -.046 -.053 .283+ .273+(male = 1) (.018) (.035) (.035) (.154) (.154)Urban .337*** .309*** .160* 1.023*** 1.068***residence (.030) (.065) (.064) (.245) (.252)Constant 1.836 -.068 -.698 2.745 2.734R2bsP e .201 .079 .122 .034 .035IndividualLevel .151*** .595*** .574*** 11.779*** 11.759***ErrorVariance Ure2) (.005) (.020) (.019) (.384) (.383)NeighborhoodLevel .005* .048*** .039*** .157 .154ErrorVariance ru2) (.002) (.012) (.011) (.166) (.167)+p


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 271educated adults and home owners, residents live in the city of Chicago walkmore than res-generally report hat the neighborhood s safe, idents of suburbs, small cities, small towns,clean, and quiet, that there is little vandalism, and rural areasgives credenceto the idea thatgraffiti or crime,and thatpeoplemaintain heir density facilitates walking for transportation.houses andapartmentsandwatch out for each Since we haveadjusted orhousehold income,other. These perceptions of social order are it doesn't seem likely that this is simply due toassociatedwith better health for all residents, the fact that poor people cannot afford cars,whatever heirpersonal status. although t is possible (we haveno information

on car ownership).The propensityto walk inpoor neighborhoodswhere few people ownCausation and Selection their homes could also be due to a normativeclimate where people hang out on the streetCould the association between neighbor- and walk to visit others, go to thecornerstore,hood disadvantageand poor health result from or just go down the street.unhealthy individualsmoving into disadvan- People walk more in poor neighborhoodstaged neighborhoods?Whilepossible, it seems where most people rent rather han own theirunlikely. The models adjust for stable traits homes, despite the fact that living in a disad-such as race, age, and educationthat influence vantagedneighborhood s associatedwith fearhealth and constrain residential options and of being attackedand injuredand being afraidchoices. They also adjust for possible conse- to leave the house. This effect of dangerousquences of poorhealth thatmight conceivably streetsdoes not overcomeothereffects of poor,limit housing optionsto disadvantagedneigh- rental neighborhoods.We had expected thatborhoods: income, employment, and marital residents of poor neighborhoodswould walkstatus. There seems little reason to think that less than the residents of affluent neighbor-unhealthypersonswould move into disordered hoods because they would be more afraid ofneighborhoodsmore frequently han healthier being victimized. Residents of disadvantagedindividuals with similar demographic andsocieconmicprofles.Howverit m be neighborhoodsdo have higher levels of fear:tha some ofites. so eteen poo they are more afraid of being assaulted andthat and fearefctsvnetfelt by injured,more afraidto go out on the streets,thoeah ar imeared oulerasiclith we and more afraidof having their home brokenmay have overestimatedear'sdamagingeffect into.In partthis fear reflectshigh levels of dis-on healthsomewhat, t is preciselythis associ- order in disadvantaged neighborhoods.ation for which the best biological evidence Residents of economically disadvantagedexists. Fear stimulates the release of epineph- neighborhoodswalk more than residents ofrineand norepinephrine,ollowedby releaseof more affluent neighborhoods, despite theircortisone and cortisol, which, when chronic, fear.increases blood pressure, serum cholesterol, Residents of neighborhoods n which a highserum glucose, atherosclerosis, and conse- proportionof adults have college degrees alsoquentlythe risk of diabetes, stroke,heart dis- walk more. Thus, two aspects of neighborhoodease, and so on (McEwen2000). socioeconomic status-economic status andeducation-have opposite effects. Possiblyneighborhoodswhere the college-educated iveWalkings Not theLink have a cultureof walking in which people walkfor exercise, pleasure, and transportation.

Neighborhood economic disadvantage is People may see otherswalking and adopttheassociatedwith the likelihood of walking,but lifestyle themselves-a contagion effectnot in the expected way. People who live in (Crane 1991)-and residents of advantagedpoor neighborhoodswhere few people own neighborhoods are generally not afraid oftheir homes aremore likely to walk thanthose being victimized on the streets.in more economicallyadvantagedplaces. This Because neighborhood disadvantage doescouldbe due to the structureof neighborhoods not decreasewalking,one partof ourexplana-where most people rent,where higherdensity tion for the associationbetweenneighborhoodencourageswalking.The fact thatpeople who disadvantageandhealthis not supported.


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272 JOURNALOF HEALTHAND SOCIALBEHAVIORStress Physiologyand Bio-Demography

The endocrinologists'concept of a physio-logical fight or flight response has beenaroundfor over half a century (Selye 1956).During that same period demographers, ocialepidemiologists,and sociologists have repeat-edly documentedthe concentrationof healthproblems in disadvantagedpopulations. Theidea of stress, and the word, has diffused andgeneralized throughoutpopularand scientificculture.Whilemuchwas gainedin theprocess,perhapssomethingwas also lost: the centralityof imminent danger. Generalization of thestress response to life's undesirablechanges,highly supervised obs, maritalconflict,andsoon should not blind us to its unconditionedoperationon dangerousstreets.The correlation of neighborhooddisorderwith poor health points to a new directionforpopulation research on health. It provides apreviously unobserved clue to the explanationof persistentandwidening socioeconomicdis-paritiesin health(Elo andPreston1996). Poorand poorly educated individuals often live indisadvantagedneighborhoodswith high levelsof disorder.It also underscores the need tomove psychoendocrinologybeyond laboratoryanimals and clinical populations into largescale social and demographic surveys(Umberson, Williams, and Sharp 2000).Psychologists have done much to advanceknowledgeof thephysiologicalresponseslink-ing stress to poor health. As a practicalmatter,theirsamples typicallyconsist of subjects suchas students taking important examinations,married couples in conflict or under strain,family members caring for impaired elders,and the like. Their researchprovides valuableinformation on likely physiological mecha-nisms linking stressto poor health. We need acomplimentary bio-demography that mapspopulationdistributions of bioassays indicat-ing stress, that correlates the bioassays withsocial ones suchas neighborhooddisadvantageanddisorder,andthattests the hypothesis thatchronicrelease of endogenouscatecholaminesand corticosteroidslinks threateningenviron-ments to poor health.Despite practical difficulties, advances inbiomedical technology increasingly provideassays that use saliva, hair, urine, or bloodsamples feasible for use in representativehousehold surveys (see Booth, Johnson, andGranger 1999). The association between

neighborhooddisorderandpoor health under-scores the need to move psychoendocrinologyfrom laboratoriesand clinics into the worldinwhich some individuals ive, wherethreatanddangercharacterizeplaces.

ConclusionLiving in a disadvantagedneighborhood sassociatedwith worse health,net of the healthconsequences of individual disadvantage.Residents of disadvantaged neighborhoodstend to feel less healthy andhavemorephysi-cal impairmentsand chronic health problems

such as high blood pressure, asthma, andarthritis.The impact of living in a disadvan-taged neighborhoodon physical well-being ismediatedentirelyby disorder n the neighbor-hood, which influences health both directlyand indirectly,by way of fear.Theseneighbor-hoods presentresidentswith observablesignsthat social controlhasbrokendown:the streetsare dirty and dangerous;buildings are run-down and abandoned;graffiti and vandalismare common; and people hang out on thestreets, drinking,using drugs, and creatingasense of danger.Residents in these neighbor-hoods face a threateningandnoxious environ-ment characterizedby crime, incivility, andharassment,all of which are stressful. Thechronic stress of exposureto disorderappearsto impairhealth.

NOTES1. Our theory focuses on neighborhooddisor-deras a chronicstressor hatdirectly mpairshealth, and its consequences for fear andoutdoor physical activity that indirectlyaffect health, but theremaybe othermecha-nisms by which neighborhooddisadvantageaffects health,some of which we address nthe discussion.2. Since approximatelywo-thirdsof the tracts(766 of 1,169) containonly one respondent,few residentsare nestedin tracts.Thus,clus-

tering is not a problem,and in fact the OLSresults aresubstantively he same.3. Our sample is limited to residents of onestate, Illinois.However,Illinois is fairlyrep-resentativeof the nation as a whole becauseit is one of the states that has ruralareas,small towns, small cities, and a majormet-


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NEIGHBORHOODISADVANTAGE,ISORDER,NDHEALTH 273ropolitan area: Chicago. Large cities every-wherein the United States have moredisad-vantaged neighborhoodswith higher levelsof disorder than do non-urbanareas, but,while largecities have many thingsin com-mon, they have many differences. Cities inthe Midwest and Northeast may have moredisadvantaged neighborhoods than thosestudied by Fischer (1982) in NorthernCalifornia; or example, half of thetotal risein concentratedpoverty during he seventieswas accountedfor by just two cities: NewYorkand Chicago (Wilson 1991).4. Dichotomizingneighborhoods nto very dis-advantaged (one standard deviationabovethe mean andhigher) versus others ndicatesthere is not a cut-off abovewhich neighbor-hood disadvantage affects health. Thedummyvariable'scoefficient is smaller andless significant than the continuous form.5. The percent of female-headedhouseholdshas no significant effect on walking evenwhen enteredalone, so we pruned it fromthe model. The case of walking is the onlyone in which differentcomponentsof disad-vantage have opposite effects on an out-come; all four aspects of disadvantagecor-relate negativelywith health and positivelywith disorderand fear. Because of this, andbecausethe fourcomponentsarehighlycor-related with each other, when they areenteredseparately n the models predictinghealth, disorder,and fear, multicolinearityresults.

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Catherine E. Ross is a Professorin the Departmentof Sociology at the Ohio StateUniversity.She studiesthe effects of socioeconomic status, work,familyandcommunityon men's andwomen'sphysicaland men-tal health, and their sense of control versus powerlessness. Recent publicationsinclude Does MedicalInsuranceContribute to Socioeconomic Differentials in Health? Milbank Quarterly,2000 (with JohnMirowsky); and The ContingentMeaning of NeighborhoodStability for Residents'PsychologicalWell-being AmericanSociological Review,2000 (with John Reynolds andKarlynGeis). She is writing a book,Education and Health, with JohnMirowsky.John Mirowsky is Professor of Sociology at Ohio State. He is principal nvestigatoron a projectfiuded bythe NationalInstituteon Aging to study Aging,Statusand the Sense of Control and a projectfunded bythe National Institute of Mental Health to study Children,Child-Careand Psychological Well-Being(Catherine E. Ross is co-principal investigator on both). His recent publications include EconomicHardshipAcross the Life Course, withCatherineE. Ross,AmericanSociologicalReview,1999),and Age,Depression and Attrition in the National Survey of Families and Households (with John R. Reynolds,Sociological Methodsand Research,2000). With CatherineRoss, he is workingon the second edition ofSocial Causes of Psychological Distress,Aldine de Gruyter.

neighborhood disadvantage, disorder, and health, catherine e. ross and john mirowsky

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