Cumulative Neighborhood Risk of Psychosocial Stress and Allostatic Load in Adolescents

The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 1220 years in the National Health and Nutrition Examination Survey (19992006). Individuals (first level, n 11,886) were nested within families/households (second level, n 6,696) and then census tracts (third level, n 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35 of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10 higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) 1.09, 95 confidence interval (CI): 1.08, 1.09), 28 higher for those living in high-risk neighborhoods (adjusted OR 1.28, 95 CI: 1.27, 1.30), and 69 higher for those living in very-high-risk neighborhoods (adjusted OR 1.69, 95 CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents.