Title: Smoking and Obesity in a Social Context
Description: Background: Smoking and obesity are the leading causes of preventable death in the United States and known cancer risk factors, yet the patterning of these conditions within low-income and immigrant populations is not well understood. The distribution of social-environmental stressors is also poorly understood in these populations. Furthermore, the relationship between socioeconomic status (SES) and stress is understudied. Therefore, this dissertation explores the association between SES, psychosocial stress and social-environmental stressors, self-reported smoking and measured obesity.

Methods: Papers 1 and 2 used cross-sectional data from the Health in Common study of racially/ethnically diverse adults living in low-income housing in the Boston metropolitan area (n=828). Paper 1 examined associations between SES, chronic stress, and smoking while paper 2 explored the relationship between SES, chronic stress, and obesity. In papers 1 and 2, SES and chronic stress were conceptualized as latent variables where chronic stress was represented by perceived stress and physical characteristics of the neighborhood and external home environment. Analyses were conducted using structural equation modeling (SEM) adjusting for sex, age, and nativity. For paper 3, we performed a targeted and systematic review of the literature on the relationship between SES and perceived stress and then conducted a meta-analysis.

Results: The meta-analysis found a one unit standard deviation change in education resulted in a -.13 change in perceived stress. SEM results suggest residents with higher SES had significantly lower odds of being a current smoker (standardized coefficient=-0.31, p<0.05), but not of being obese (standardized coefficient=0.01, p=0.80). Furthermore, residents demonstrating higher chronic stress had significantly higher odds of being a current smoker (standardized coefficient=0.24, p<0.05) and being obese (standardized coefficient=0.13, p<0.05). SES was not associated with chronic stress in either model.

Conclusions: SES impacts stress and stress impacts health and health behavior in vulnerable populations. More research is needed to explore the complex and multifactorial relationships between SES, stress, and health, particularly among different population segments. This dissertation work is significant because identifying stress/stressors that act as structural barriers, exacerbating inequities, could result in interventions demonstrating population health impact.