The Perception of Stress and its Impact on Health in Poor Communities

With the increased understanding of the relationship between stress and disease, the role of stress in explaining persistent
disparities in health outcomes has received growing attention. One body of research has focused on allostatic load—the “wear
and tear” that results from chronic or excessive activation of the stress response. Other research has looked at the link
between stress and health behaviors. In this study, we conducted 7 focus groups with a total of 56 people to understand how
people living in Highbridge, South Bronx, New York, a low income community with poor health outcomes, perceive stress and
its relationship to health. Focus group participants described a direct causal pathway between stress and poor health as well
as an indirect pathway through health behaviors, including uncontrolled eating, sleep deprivation, substance abuse, smoking,
violence and aggression, and withdrawal and inactivity. Participants articulated a number of theories about why stress leads
to these unhealthy behaviors, including self-medication, adaptive behavior, discounting the future, depletion of willpower,
and competing priorities. Their nuanced understanding of the link between stress and health elucidates the mechanisms and
pathways by which stress may result in disparities in health outcomes and create challenges in changing health behaviors in
poor communities like the South Bronx.