Top

Published in:

Open Access 01-12-2018 | Research article

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

Authors: Maria Holst Algren, Ola Ekholm, Line Nielsen, Annette Kjær Ersbøll, Carsten Kronborg Bak, Pernille Tanggaard Andersen

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

Previous studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.

Methods

Four questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.

Results

Residents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.

Conclusions

Overall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

Available only for authorised users

Diderichsen F, Andersen I, Manuel C. The working Group of the Danish Review on social determinants of health, Andersen A-MN, Bach E et al. health inequality - determinants and policies. Scandinavian journal of public health. 2012;40(8 suppl):12–105. https://doi.org/10.1177/1403494812457734.CrossRefPubMed

Juel K, Sorensen J, Risk B-HH. Factors and public health in Denmark. Scandinavian journal of public health. 2008;36(Suppl 1):11–227. https://doi.org/10.1177/1403494808097590.PubMed

Marmot M. The marmot review final report: fair society, healthy lives. London: University College London; 2010.

Marmot M, Wilkinson R. Social determinants of health. Oxford: Oxford University Press; 2006.

Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Social science & medicine (1982). 1997;44(6):809–19.CrossRef

Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA : the journal of the American Medical Association. 2010;303(12):1159–66. https://doi.org/10.1001/jama.2010.297.CrossRefPubMed

Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: a cross-sectional study. Health & place. 2017;45:189–98. https://doi.org/10.1016/j.healthplace.2017.03.014.CrossRef

Algren MH, Bak CK, Berg-Beckhoff G, Andersen PT. Health-risk behaviour in deprived Neighbourhoods compared with non-deprived Neighbourhoods: a systematic literature review of quantitative observational studies. PLoS One. 2015;10(10):e0139297. https://doi.org/10.1371/journal.pone.0139297.CrossRefPubMedPubMedCentral

Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–22.CrossRefPubMedPubMedCentral

10.

Stimpson JP. Ju H, Raji MA, Eschbach K. Neighborhood deprivation and health risk behaviors in NHANES III. Am J Health Behav. 2007;31(2):215–22. https://doi.org/10.5555/ajhb.2007.31.2.215.CrossRefPubMed

11.

Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186(1):125–45. https://doi.org/10.1111/j.1749-6632.2009.05333.x.CrossRefPubMed

12.

Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med. 2002;55(1):125–39. https://doi.org/10.1016/S0277-9536(01)00214-3.CrossRefPubMed

13.

Steptoe A, Neighborhood FPJ. 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):177–85.CrossRefPubMed

14.

Elliott M. The stress process in neighborhood context. Health & place. 2000;6(4):287–99.CrossRef

15.

Matheson FI, Moineddin R, Dunn JR, Creatore MI, Gozdyra P, Glazier RH. Urban neighborhoods, chronic stress, gender and depression. Social science & medicine (1982). 2006;63(10):2604–16. https://doi.org/10.1016/j.socscimed.2006.07.001.CrossRef

16.

Senn TE, Walsh JL, Carey MP. The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health. Ann Behav Med. 2014. doi:https://doi.org/10.1007/s12160-014-9591-1.

17.

Olstad DL, Ball K, Wright C, Abbott G, Brown E, Turner AI. Hair Cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study. Stress. 2016;19(2):158–67. https://doi.org/10.3109/10253890.2016.1160282.CrossRefPubMed

18.

Bak CK, Tanggaard Andersen P, Bacher I, Draghiciu Bancila D. The association between socio-demographic characteristics and perceived stress among residents in a deprived neighbourhood in Denmark. Eur J Pub Health. 2012;22(6):787–92. https://doi.org/10.1093/eurpub/cks004.CrossRef

19.

Nielsen L, Curtis T, Kristensen TS, Nielsen NR. What characterizes persons with high levels of perceived stress in Denmark? A national representative study. Scand J Public Health. 2008;36(4):369–79. https://doi.org/10.1177/1403494807088456.CrossRefPubMed

20.

Ng DM, Jeffery RW. Relationships Between perceived stress and health behaviors in a sample of working adults. Health Psychol. 2003;22(6):638–42. https://doi.org/10.1037/0278-6133.22.6.638.CrossRefPubMed

21.

Krueger PM, Chang VW. Being poor and coping with stress: health behaviors and the risk of death. Am J Public Health. 2008;98(5):889–96. https://doi.org/10.2105/ajph.2007.114454.CrossRefPubMedPubMedCentral

22.

Mikolajczyk RT, Maxwell AE, Naydenova V, Meier S, El Ansari W. Depressive symptoms and perceived burdens related to being a student: survey in three European countries. Clin Pract Epidemol Ment Health 2008;4. doi:https://doi.org/10.1186/1745-0179-4-19.

23.

Cartwright M, Wardle J, Steggles N, Simon AE, Croker H, Jarvis MJ. Stress and Dietary practices in adolescents. Health psychology. 2003;22(4):362–9.CrossRefPubMed

24.

Moore CJ, Cunningham SA. Social position, psychological stress, and obesity: a systematic review. J Acad Nutr Diet. 2012;112(4):518–26. https://doi.org/10.1016/j.jand.2011.12.001.CrossRefPubMed

25.

Heslop P, Smith GD, Carroll D, Macleod J, Hyland F, Perceived HC. Stress and coronary heart disease risk factors: the contribution of socio-economic position. Br J Health Psychol. 2001;6(Pt 2):167–78. https://doi.org/10.1348/135910701169133.CrossRefPubMed

26.

Steptoe A, Wardle J, Pollard TM, Canaan L, Davies GJ. Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise. J Psychosom Res. 1996;41(2):171–80.CrossRefPubMed

27.

Rod NH, Gronbaek M, Schnohr P, Prescott E, Kristensen TS. Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study. J Intern Med. 2009;266(5):467–75. https://doi.org/10.1111/j.1365-2796.2009.02124.x.CrossRefPubMed

28.

Peretti-Watel P, Seror V, Constance J, Beck F. Poverty as a smoking trap. Int J Drug Policy. 2009;20(3):230–6. https://doi.org/10.1016/j.drugpo.2008.10.001.CrossRefPubMed

29.

Berkman L, Glass T. Social network epidemiology. In: Berkman L, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2014. p. 234–89.

30.

Park CL, Iacocca MO. A stress and coping perspective on health behaviors: theoretical and methodological considerations. Anxiety Stress Coping. 2014;27(2):123–37. https://doi.org/10.1080/10615806.2013.860969.CrossRefPubMed

31.

Ellen IG, Mijanovich T, Dillman K-N. Neighborhood effects on health: exploring the links and assessing the evidence. J Urban Affairs. 2001;23(3–4):391–408. https://doi.org/10.1111/0735-2166.00096.CrossRef

32.

Walsh JL, Senn TE, Carey MP. Longitudinal associations between health behaviors and mental health in low-income adults. Transl Behav Med. 2013;3(1):104–13. https://doi.org/10.1007/s13142-012-0189-5.CrossRefPubMedPubMedCentral

33.

Hajek P, Taylor T, McRobbie H. The effect of stopping smoking on perceived stress levels. Addiction. 2010;105(8):1466–71. https://doi.org/10.1111/j.1360-0443.2010.02979.x.CrossRefPubMed

34.

Mouchacca J, Abbott GR, Ball K. Associations between psychological stress, eating, physical activity, sedentary behaviours and body weight among women: a longitudinal study. BMC Public Health. 2013;13:828. https://doi.org/10.1186/1471-2458-13-828.CrossRefPubMedPubMedCentral

35.

Danish Health Authority. Forebyggelsesindsatser i Nærmiljøet [Neighborhood prevention efforts]. Danish Health Authority, https://www.sst.dk/da/puljer-og-projekter/2010/forebyggelse-i-naermiljoeet 2010. Accessed February 16 2017.

36.

Danish Health Authority. Call for proposals by the Danish Health Authority. “Forebyggelsesindsatser i nærmiljøet” [Neighborhood prevention efforts]. Danish Health Authority, https://www.sst.dk/da/puljer-og-projekter/2010/~/media/540D72C0E7EE4240A2B61E00268DA5E6.ashx 2010. Accessed February 17 2017.

37.

Christensen AI, Ekholm O, Glumer C, Andreasen AH, Hvidberg MF, Kristensen PL, et al. The Danish National Health Survey 2010. Study design and respondent characteristics. Scandinavian journal of public health. 2012;40(4):391–7. https://doi.org/10.1177/1403494812451412.CrossRefPubMed

38.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.CrossRefPubMed

39.

Gronbaek MN, Iversen L, Olsen J, Becker PU, Hardt F, Sensible STI. drinking limits. Ugeskr Laeger. 1997;159(40):5939–45.PubMed

40.

Pedersen CB. The Danish civil registration system. Scandinavian journal of public health. 2011;39(7 Suppl):22–5. https://doi.org/10.1177/1403494810387965.CrossRefPubMed

41.

Kurita GP, Sjogren P, Juel K, Hojsted J, Ekholm O. The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use. Pain. 2012;153(12):2332–8. https://doi.org/10.1016/j.pain.2012.07.023.CrossRefPubMed

42.

Bak C, Andersen P, Dokkedal U. The association between social position and self-rated health in 10 deprived neighbourhoods. BMC Public Health. 2015;15(1):14. https://doi.org/10.1186/s12889-015-1377-2.CrossRefPubMedPubMedCentral

43.

Mikolajczyk RT, El Ansari W, Food MAE. Consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J. 2009;8(1):31. https://doi.org/10.1186/1475-2891-8-31.CrossRefPubMedPubMedCentral

44.

Dallman MF, Pecoraro N, Akana SF, la Fleur SE, Gomez F, Houshyar H, et al. Chronic stress and obesity: a new view of “comfort food”. Proc Natl Acad Sci U S A. 2003;100(20):11696–701. https://doi.org/10.1073/pnas.1934666100.CrossRefPubMedPubMedCentral

45.

Kaplan SA, Madden VP, Mijanovich T, Purcaro E. The perception of stress and its impact on health in poor communities. J Community Health. 2013;38(1):142–9. https://doi.org/10.1007/s10900-012-9593-5.CrossRefPubMed

46.

Miles R. Neighborhood disorder and smoking: findings of a European urban survey. Social science & medicine (1982). 2006;63(9):2464–75. https://doi.org/10.1016/j.socscimed.2006.06.011.CrossRef

47.

Shohaimi S, Luben R, Wareham N, Day N, Bingham S, Welch A, et al. Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European investigation into cancer (EPIC-Norfolk). J Epidemiol Community Health. 2003;57(4):270–6.CrossRefPubMedPubMedCentral

48.

Steptoe A, Lipsey Z, Wardle J. Stress, hassles and variations in alcohol consumption, food choice and physical exercise: a diary study. Br J Health Psychol. 1998;3(1):51–63. https://doi.org/10.1111/j.2044-8287.1998.tb00555.x.CrossRef

49.

Bloomfield K, Grittner U, Rasmussen HB, Petersen HC. Socio-demographic correlates of alcohol consumption in the Danish general population. Scandinavian journal of public health. 2008;36(6):580–8. https://doi.org/10.1177/1403494808089648.CrossRefPubMed

50.

Danish Health Authority. Danskernes Sundhed - Den Nationale Sundhedsprofil 2013 [The Danish National Health Survey]. Copenhagen: Danish Health Authority; 2014.

51.

Järvinen M. Drinking rituals and drinking problems in a wet culture. Addict Res Theory. 2003;11(4):217–33. https://doi.org/10.1080/1606635031000135613.CrossRef

52.

Schnohr P, Kristensen TS, Prescott E, Scharling H. Stress and life dissatisfaction are inversely associated with jogging and other types of physical activity in leisure time—the Copenhagen City heart study. Scand J Med Sci Sports. 2005;15(2):107–12. https://doi.org/10.1111/j.1600-0838.2004.00394.x.CrossRefPubMed

53.

Long BC, Rv S. Effects of exercise training on anxiety: a meta-analysis. Journal of Applied Sport Psychology. 1995;7(2):167–89. https://doi.org/10.1080/10413209508406963.CrossRef

54.

Fine LJ, Philogene GS, Gramling R, Coups EJ, Prevalence SS. Of multiple chronic disease risk factors. 2001 National Health Interview Survey. Am J Prev Med. 2004;27(2 Suppl):18–24. https://doi.org/10.1016/j.amepre.2004.04.017.CrossRefPubMed

55.

Wilkinson RG. Unhealthy societies. The afflictions of inequality. London: Routledge; 1996.CrossRef

56.

Kawachi I, Income KBP. Inequality and health: pathways and mechanisms. Health Serv Res. 1999;34(1 Pt 2):215–27.PubMedPubMedCentral

57.

Stead M, MacAskill S, MacKintosh A-M, Reece J, Eadie D. "It's as if You're locked in": qualitative explanations for area effects on smoking in disadvantaged communities. Health & place. 2001;7(4):333–43.CrossRef

58.

Evers KE, Prochaska JO, Johnson JL, Mauriello LM, Padula JA, Prochaska JMA. Randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health psychology. 2006;25(4):521–9. https://doi.org/10.1037/0278-6133.25.4.521.CrossRefPubMed

59.

Lipschitz JM, Paiva AL, Redding CA, Butterworth S, Prochaska JO. Co-occurrence and coaction of stress management with other health risk behaviors. J Health Psychol. 2015;20(7):1002–12. https://doi.org/10.1177/1359105313506026.CrossRefPubMed

60.

Stranges S, Samaraweera PC, Taggart F, Kandala N-B, Stewart-Brown. major Health-related behaviours and mental well-being in the general population: the health survey for England. BMJ Open. 2014;4(9) https://doi.org/10.1136/bmjopen-2014-005878.

61.

McLeod JD, Kessler RC. Socioeconomic status differences in vulnerability to undesirable life events. J Health Soc Behav. 1990;31(2):162–72.CrossRefPubMed

62.

Elstad JI. The psycho-social perspective on social inequalities in health. Sociology of health & illness. 1998;20(5):598–618. https://doi.org/10.1111/1467-9566.00121.CrossRef

63.

Thoits PA. Stress, coping, and social support processes: where are we? What next? J Health and Soc Behav. 1995;(Extra Issue):53-79.

64.

Rasmussen M, Poulsen EK, Rytter AS, Kristiansen TM, Bak CK. Experiences with recruitment of marginalized groups in a Danish health promotion program: a document evaluation study. PLoS One. 2016;11(6):e0158079. https://doi.org/10.1371/journal.pone.0158079.CrossRefPubMedPubMedCentral

65.

Kuipers MA, Jongeneel-Grimen B, Droomers M, Wingen M, Stronks K, Kunst AE. Why residents of Dutch deprived neighbourhoods are less likely to be heavy drinkers: the role of individual and contextual characteristics. J Epidemiol Community Health. 2013;67(7):587–94. https://doi.org/10.1136/jech-2012-201242.CrossRefPubMed

66.

Andersen PT, Bak CK, Vangsgaard S, Dokkedal U, Larsen PV. Self-rated health, ethnicity and social position in a deprived neighbourhood in Denmark. Int J Equity Health. 2011;10:5. https://doi.org/10.1186/1475-9276-10-5.CrossRefPubMedPubMedCentral

67.

Bowling A. Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health. 2005;27(3):281–91. https://doi.org/10.1093/pubmed/fdi031.CrossRefPubMed

68.

Adams SA, Matthews CE, Ebbeling CB, Moore CG, Cunningham JE, Fulton J, et al. The effect of social desirability and social approval on self-reports of physical activity. Am J Epidemiol. 2005;161(4):389–98. https://doi.org/10.1093/aje/kwi054.CrossRefPubMedPubMedCentral

Title: Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study
Authors: Maria Holst Algren
Ola Ekholm
Line Nielsen
Annette Kjær Ersbøll
Carsten Kronborg Bak
Pernille Tanggaard Andersen
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5170-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway

Incidence and clinical outcomes of diabetes mellitus in HIV-infected adults in Thailand: a retrospective cohort study

Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh

Physical activity, energy expenditure and sedentary parameters in overfeeding studies - a systematic review

Use of a counsellor supported disclosure model to improve the uptake of couple HIV testing and counselling in Kenya: a quasi-experimental study

Who is in the near market for bicycle sharing? Identifying current, potential, and unlikely users of a public bicycle share program in Vancouver, Canada