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01-02-2013

Reconsidering the Effects of Poverty and Social Support on Health: A 5-Year Longitudinal Test of the Stress-Buffering Hypothesis

Authors: David Moskowitz, Eric Vittinghoff, Laura Schmidt

Published in: Journal of Urban Health | Issue 1/2013

Abstract

Prior research in the general population has found that social support can buffer the adverse effects of stressors on health. However, both stressors and social support may be qualitatively different for those living in urban poverty. We examined the effects of social support and poverty-specific stressors on self-rated health. We used data from the Welfare Client Longitudinal Survey (WCLS), a 5-year longitudinal study of 718 public aid recipients. We measured received social support and “net social support,” defined as the difference between support received and that given to others. We used restricted cubic splines to model the stress-buffering effects of social support on self-rated health as a function of stressful life events and neighborhood disorder. Increased exposure to stressors was associated with poorer self-rated health. Evidence of stress buffering was confined to those with the heaviest exposure to stressors, and its effects decreased across increasing levels of social support. Analyses using net social support had generally more modest effects than those using received social support. Social support does not buffer the effects of stressors on health uniformly for individuals living in conditions of urban poverty. Researchers and policymakers should be cautious in overestimating the beneficial effects that social support may have on health for marginalized populations.

Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alemeda County residents. Am J Epidemiol. 1979; 109(2): 186–204.PubMed

House J, Landis K, Umberson D. Social relationships and health. Science. 1988; 241(4865): 540–545.PubMedCrossRef

Uchino BN, Cacioppo JT, Kiecolt-Glaser JK. The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996; 119(3): 488–531.PubMedCrossRef

Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98(2): 310–357.PubMedCrossRef

Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L. Stressful life events, social support, and mortality in men born in 1933. BMJ. 1993; 307(6912): 1102–1105.PubMedCrossRef

Falk A, Hanson BS, Isacsson SO, Ostergren PO. Job strain and mortality in elderly men: social network, support, and influence as buffers. Am J Public Health. 1992; 82(8): 1136–1139.PubMedCrossRef

Feldman PJ, Steptoe A. How neighborhoods and physical functioning are related: the roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors. Ann Behav Med. 2004; 27(2): 91–99.PubMedCrossRef

Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001; 42(3): 258–276.PubMedCrossRef

Wacquant L. Urban outcasts: a comparative sociology of advanced marginality. Cambridge: Polity; 2007.

10.

Currie E. Reckoning: drugs, the cities, and the American future. New York: Hill and Wang; 1993.

11.

Venkatesh SA. American project: the rise and fall of a Modern Ghetto. Cambridge: Harvard University Press; 2000.

12.

Conley D. Being black, living in the red: race, wealth, and social policy in America. London: University of California Press; 1999.

13.

Dohan D. The price of poverty: money, work and culture in the Mexican-American Barrio. Berkeley: University of California Press; 2003.

14.

Sundquist K, Theobald H, Yang M, et al. Neighborhood violent crime and unemployment increase the risk of coronary heart disease: a multilevel study in an urban setting. Soc Sci Med. 2006; 62(8): 2061–2071.PubMedCrossRef

15.

Chaix B, Lindstrom M, Rosvall M, Merlo J. Neighbourhood social interactions and risk of acute myocardial infarction. J Epidemiol Community Health. 2008; 62(1): 62–68.PubMedCrossRef

16.

Berkman L, Kawachi I. Social epidemiology. London: Oxford University Press; 2000.

17.

Tigges LM, Browne I, Green GP. Social isolation of the urban poor: race, class, and neighborhood effects on social resources. Sociol Q. 1998; 39(1): 53–77.CrossRef

18.

Cattell V. Poor people, poor places, and poor health: the mediating role of social networks and social capital. Soc Sci Med. 2001; 52(10): 1501–1516.PubMedCrossRef

19.

Edin K, Lein L. Making ends meet: how single mothers survive welfare and low-wage work. New York: Russell Sage; 1997.

20.

Stack C. All our kin: strategies for survival in a black community. New York: Harper and Row; 1974.

21.

Domínguez S, Watkins C. Creating networks for survival and mobility: social capital among African-American and Latin-American low-income mothers. Soc Probl. 2003; 50(1): 111–135.CrossRef

22.

Newman K. Chutes and ladders: navigating the low-wage labor market. New York: Russell Sage; 2006.

23.

Belle D. Poverty and women’s mental health. Am Psychol. 1990; 45(3): 385–398.CrossRef

24.

Knowlton AR, Yang C, Bohnert A, Wissow L, Chander G, Arnsten JA. Informal Care and Reciprocity of Support are Associated with HAART Adherence Among Men in Baltimore, MD, USA. AIDS Behav. 2011; 15(7): 1429–1436.

25.

Antonucci TC, Fuhrer R, Jackson JS. Social support and reciprocity—a cross-ethnic and cross national perspective. J Soc Pers Relatsh. 1990; 7: 519–530.CrossRef

26.

Ziersch AM, Baum FE, Macdougall C, Putland C. Neighbourhood life and social capital: the implications for health. Soc Sci Med. 2005; 60(1): 71–86.PubMedCrossRef

27.

Abbott S, Freeth D. Social capital and health: starting to make sense of the role of generalized trust and reciprocity. J Health Psychol. 2008; 13(7): 874–883.PubMedCrossRef

28.

Diggle PJ, Heagerty P, Liang K-Y, Zeger SL. Analysis of longitudinal data. 2nd ed. Oxford: Oxford University Press; 2002.

29.

Mulia N, Schmidt L, Bond J, Jacobs L, Korcha R. Stress, social support and problem drinking among women in poverty. Addiction. 2008; 103(8): 1283–1293.PubMedCrossRef

30.

Lown EA, Schmidt L, Wiley J. Unraveling lives: interpersonal violence among women seeking welfare. Paper presented at: Research Society on Alcohol. Santa Barbara, CA; June 2005.

31.

Schmidt LA, Weisner CM, Wiley JA. Substance abuse and the course of welfare dependency. Am J Public Health. 1998; 88(11): 1616–1622.PubMedCrossRef

32.

Schmidt LA, Wiley JA, Dohan D, et al. Changing patterns of addiction and public aid receipt: tracking the unintended consequences of welfare reform policy. J Health Polit Policy Law. 2006; 31(5): 945–980.PubMedCrossRef

33.

Schmidt L, Dohan D, Wiley J, Zabkiewicz D. Addiction and welfare dependency: interpreting the connection. Soc Probl. 2002; 49: 221–241.CrossRef

34.

Schmidt L, Zabkiewicz D, Henderson S, Wiley J, Jacobs L. On the declining health status of welfare caseloads: emerging dilemmas in serving the poor. Soc Work Publ Health. 2011; 26(2): 181–211.

35.

Schmidt L, Zabkiewicz D, Jacobs L, Wiley J. Substance abuse and employment among welfare mothers: from welfare to work and back again? Subst Use Misuse. 2007; 42(7): 1069–1087.PubMedCrossRef

36.

Zabiewicz D, Schmidt LA. The mental health benefits of work: do they apply to welfare mothers with a drinking problem? J Behav Health Serv Res. 2009; 36(1): 96–110.CrossRef

37.

McGee DL, Liao Y, Cao G, Cooper RS. Self-reported health status and mortality in a multiethnic US cohort. Am J Epidemiol. 1999; 149(1): 41–46.PubMedCrossRef

38.

Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997; 38(1): 21–37.PubMedCrossRef

39.

Stewart AL, Napoles-Springer A. Health-related quality-of-life assessments in diverse population groups in the United States. Med Care. 2000; 38(9 Suppl): 102–124.

40.

Burstrom B, Fredlund P. Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health. 2001; 55(11): 836–840.PubMedCrossRef

41.

University of Michigan Ford School of Public Policy. The women’s health study: wave 1 survey instrument. http://www.fordschool.umich.edu/research/poverty/wes/instrument/wave_1.php. Accessed 1 February 2010.

42.

Ewart CK, Suchday S. Discovering how urban poverty and violence affect health: development and validation of a Neighborhood Stress Index. Health Psychol. 2002; 21(3): 254–262.PubMedCrossRef

43.

Perkins DD, Taylor RB. Ecological assessments of community disorder: their relationship to fear of crime and theoretical implications. Am J Community Psychol. 1996; 24(1): 63–107.

44.

Mulia N, Schmidt L. Conflicts and trade-offs due to alcohol and drugs: clients’ accounts of leaving welfare. Soc Serv Rev. 2003; 77(4): 499–522.CrossRef

45.

Kawachi I, Subramanian SV, Kim D. Social capital and health. New York: Springer; 2008.CrossRef

46.

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(3): 177–185.PubMedCrossRef

47.

Knowlton AR, Curry A, Hua W, Wissow L. Depression and social context: primary supporter relationship factors associated with depressive symptoms among a disadvantaged population with HIV/AIDS. J Community Psychol. 2009; 37(4): 526–541.CrossRef

48.

Venkatesh SA. Off the books: the underground economy of the urban poor. Cambridge: Harvard University Press; 2006.

49.

Odierna DH, Schmidt LA. The effects of failing to include hard-to-reach respondents in longitudinal surveys. Am J Public Health. 2009; 99(8): 1515–1521.PubMedCrossRef

50.

Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989; 8(5): 551–561.PubMedCrossRef

51.

Oehlert G. A note on the delta method. Am Stat. 1992; 46(1): 27–29.

Title: Reconsidering the Effects of Poverty and Social Support on Health: A 5-Year Longitudinal Test of the Stress-Buffering Hypothesis
Authors: David Moskowitz
Eric Vittinghoff
Laura Schmidt
Publication date: 01-02-2013
Publisher: Springer US
Published in: Journal of Urban Health / Issue 1/2013
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI: https://doi.org/10.1007/s11524-012-9757-8

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Reconsidering the Effects of Poverty and Social Support on Health: A 5-Year Longitudinal Test of the Stress-Buffering Hypothesis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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