AJPM Focus · Published 2025-12-11 · DOI 10.1016/j.focus.2025.100472
Introduction: Individuals living in neighborhoods with high levels of violence are exposed to chronic stress, which can have deleterious effects on health. In addition, subjective appraisal of stress may influence health outcomes. Methods: The authors conducted structural equation modeling. The authors used data collected between May and August 2022, which included 127 older Black men who resided in Chicago, to explore the extent to which perceptions of stress and violence exposure mediate the relationship between actual neighborhood homicide rate and health outcomes. Results: Bivariate statistics showed that the upper quartiles of homicide rates were associated with higher hair cortisol concentration (p=0.01) but not with depression and post-traumatic stress disorder. Both perceived stress (p=0.01) and perceived violence exposure (p=0.001) were significantly associated with the homicide rate quartiles. Structural equation modeling results showed that with perceived stress as a mediator, there was a significant direct effect (p=0.03) and total effect (p=0.04) of homicide rate on hair cortisol. Although perceived stress was significantly associated with depression (p=0.01) and post-traumatic stress disorder (p=0.03), the direct and total effects of the homicide rate were not statistically significant. With perceived violence exposure as a mediator, there were no significant direct or indirect effects of the homicide rate on hair cortisol, depression, and post-traumatic stress disorder. Conclusions: Even when older Black men do not perceive or report stress and violence exposure, neighborhood violence still affects their physiologic stress response. The impact of stress can be more accurately assessed by considering both actual and perceived stress measures as well as incorporating stress biomarkers.
Abstract from DOAJ. Public domain (CC0 1.0).
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