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标题：Examining Differential Resilience Mechanisms by Comparing ‘Tipping Points’ of the Effects of Neighborhood Conditions on Anxiety by Race/Ethnicity
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作者：Emil Nicolae Coman ; Helen Zhao Wu
期刊名称：Healthcare
电子版ISSN：2227-9032
出版年度：2018
卷号：6
期号：1
页码：18-27
DOI：10.3390/healthcare6010018
出版社：MDPI Publishing
摘要：Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the “tipping points,” where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women’s anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points.
关键词：health disparities; resilience; stress; heterogeneity of effects health disparities ; resilience ; stress ; heterogeneity of effects