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Neighborhood Problems and Health Among Older Adults: Received and Donated Social Support and the Sense of Mastery as Effect Modifiers

Department of Sociology, University of Maryland, College Park.

Address correspondence to Scott Schieman, Department of Sociology, University of Maryland, 2112 Art-Sociology Bldg., College Park, MD 21742-1315. E-mail: sschieman{at}socy.umd.edu

	Abstract

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Objectives. This study examines the associations between perceived neighborhood problems and mental and physical health, exploring the extent to which received social support, donated social support, and the sense of mastery moderate those associations.

Methods. In 2001–2002, face-to-face interviews were conducted with a sample of 1,167 adults over age 65 in several counties in Maryland and the District of Columbia.

Results. For men, received support and perceived mastery buffer against the detrimental effects of neighborhood problems on anger. In contrast, donated support exacerbates the negative physical health effects of neighborhood problems. For women, donated support amplifies the effects of neighborhood problems on anger. However, with anger and depression, the buffering effects of received support become evident only after accounting for the interaction between neighborhood problems and donated support.

Discussion. The findings have implications for the stress process model, the theoretical perspectives on different forms of social support, and the "buffering" and "cost of caring" predictions for women and men.

NEIGHBORHOODS represent an important context in which to examine common, persistent problems and their effects on stress processes (Aneshensel & Sucoff, 1996; Pearlin, 1999). Some of these conditions pertain to personal safety and security; others involve the structural or physical environment. Specific indicators include problems like trash, vandalism, run-down buildings, and crime (Ross & Mirowsky, 1999). Individuals' descriptions of those problems reflect observed realities in the community (Geis & Ross, 1998). Research documents the positive links between neighborhood problems and depression (Ross, 2000), physical health problems and impairments (Ross & Mirowsky, 2001), feelings of powerlessness (Geis & Ross, 1998), and the sense of mistrust (Ross, Mirowsky, & Pribesh, 2001).

Neighborhood problems are potential stressors for individuals of any age. Yet, we know little about their effect on elders; it is plausible that neighborhood stressors are especially problematic for adults in late life for several reasons. Higher levels of functional limitations and health problems can diminish a sense of mastery (Mirowsky, 1995; Schieman, 2001) and potentially increase feelings of vulnerability and social isolation. Likewise, visible cues of social disorder may further compound feelings of threat for older residents (Lee, 1981; Skogan, 1990). Dangerous or unpleasant residential conditions may exacerbate that seclusion by further diminishing social integration (Sampson & Groves, 1989). In turn, these factors may discourage older adults from venturing out of their homes and compound the reduction of out-of-doors physical activities such as walks or visiting neighbors (Liska, Sanchirico, & Reed, 1988; Ross & Mirowsky, 2001).

As proximate and persistent signs of inequality, neighborhood problems often coexist alongside other indicators of social disadvantage in the community, such as inferior or scarce shopping, medical, transportation, and leisure services (LeClere, Rogers, & Peters, 1997; Lee, 1981). Older residents for whom such resources can be accessed only at a distance are more likely to be penalized, feeling an additional sense of abandonment from society (LaGrange, Ferraro, & Supancic, 1992; Ross, 2000). These conditions may also create the impression of declining quality of life in one's area, leaving elders who have fewer resources feeling abandoned or trapped in a "vulnerable neighborhood" (Wilson, 1996), ultimately yielding anger and distress.

It is clear that neighborhood problems are potentially stressful. However, the stress process model posits that social support and mastery may moderate those effects (Pearlin, 1999). To our knowledge, no studies have assessed their simultaneous moderating effects and examined different forms of support. Although mastery and received support should buffer the effects of neighborhood stress (Cohen & Wills, 1985), donated support may also moderate the effects but in a different way. Drawing on the "cost of caring" idea (Kessler & McLeod, 1984), we contend that donated support exacerbates the effects of neighborhood problems, mainly among women.

	SOCIAL SUPPORT: BUFFERING VERSUS COST OF CARING

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Received support, or the sense of "being loved, valued, and able to count on others should the need arise" (Turner & Turner, 1999, p. 303), usually involves instrumental, informational, or emotional actions from significant others (House, 1987). The stress process underscores support's main and buffering effects. However, perceived support may have a stronger buffering effect than the actual receipt of support (Thoits, 1995). Research shows that support from neighbors moderates the effects of neighborhood disorder on fear and mistrust (Ross & Jang, 2000). We assess general sources of received support and contrast them with donated support. Although most prior studies examined received support (House, 1987), that overlooks the fact that many individuals also provide support to others. Support donors are available when others need help, advice, or are feeling down; they listen to and understand others' difficulties. However, empathic elements of donated support often entail obligation. Although empathy may extend to understanding others' joy and pain, support providers can also share in their troubles. Research has begun to examine the psychological costs of support provision (Rook, 1984). The "cost of caring" thesis contends that emotional bonds expose one to negative interactions that can undermine health (Kessler & McLeod, 1984).

In his review of social support research, House (1987) encouraged attention to the effects of community life on support processes. Responding to that appeal, we examine if neighborhood problems amplify the costs of donating support by depleting one's own limited resources, thereby leaving individuals vulnerable to distress. The more deeply "caught up" in others' hardships, the greater risk for emotional transference—especially in concert with structural strains. Donated support may moderate the effects of neighborhood problems, although it is likely to differ from received support. Moreover, House (1987) also called for inquiry into the ways that social statuses such as gender influence support processes. Women tend to surpass men in the provision of social support—especially emotional support (Belle, 1982). Role arrangements and societal expectations for women have contributed to their greater tendency to exceed men in socioemotional support provision (Gilligan, 1982). Women have traditionally been overrepresented in occupations that require nurturing interpersonal skills (i.e., nursing and teaching) and more responsible for caring for dependents such as children (Kessler & McLeod, 1984). In addition, relationships with women may be more health enhancing because women provide more intimate and self-disclosing support (Wheeler, Reis, & Nezlek, 1983).

Relative to the positive aspects of relationships, negative facets have a greater impact on well-being (Rook, 1984). Women tend to be exposed to greater emotional burdens than men when providing emotional support to friends and family (Turner, 1994). Moreover, Kessler and McLeod (1984) contended that "providing support leads to distress only when the provider is already overloaded with so many demands for nurturance that his or her capacities for keeping emotional distance break down" (p. 628). Applying the "overload" idea, we propose that the combination of donated support and neighborhood stress is particularly detrimental for health among women. That contention, however, adds another layer of complexity: The interaction between donated support and neighborhood problems may suppress the buffering effect of received support. The aspects of relationships that foster greater received support for women may also present stressful elements. Donating support when under stress may take an emotional toll on women and offset the buffering effect of receiving support—especially in the context of neighborhood stress. Statistically speaking, a negative Received Support x Neighborhood Stress coefficient is suppressed by a positive Donated Support x Neighborhood Stress interaction.

	THE OTHER PSYCHOSOCIAL RESOURCE: THE SENSE OF MASTERY

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In the stress process model, the hypothesized moderating role of mastery is much more straightforward. The sense of mastery involves the extent to which one perceives events and outcomes as within one's control (Pearlin & Schooler, 1978). According to Geis and Ross (1998), "as a belief, perceived powerlessness forms the mental bridge between external conditions and emotional and behavioral responses" (p. 233). Like received support, mastery is a critical resource upon which individuals can draw to avoid or cope with the deleterious effects of stressors (Pearlin, 1999). Exposure to chronic problems in the neighborhood may increase the sense of powerlessness (Ross et al., 2001). However, to the individual with higher mastery, neighborhood problems may feel less threatening or ominous (Pearlin, 1999). Given the centrality of mastery in the stress process model, we believe it is important to examine its impact alongside social support. There are additional reasons, however, to examine support and mastery simultaneously in the context of neighborhood problems. According to Ross and colleagues (2001), "structural amplification exists when conditions undermine personal attributes that otherwise would moderate the undesirable consequences of those conditions" (p. 599). We apply that idea by asserting that neighborhood problems are associated negatively with received emotional support and mastery, thus undermining resources that buffer against such stress.

To sum, we expect that neighborhood problems are associated positively with physical symptoms and distress. In addition, the buffering hypothesis predicts that received support and mastery protect against the detrimental effects of neighborhood problems. However, we also predict that the positive Received Support x Neighborhood Problems coefficient is suppressed by the patterns predicted by the "cost of caring" hypothesis, which states that donated support exacerbates the detrimental impact of neighborhood problems—but only among women.

	METHODS

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Sample
The data in this study derive from face-to-face interviews in 2001–2002 with 1,167 people age 65 and older residing in the District of Columbia and two adjoining Maryland counties, Prince Georges and Montgomery. Sample selection and recruitment began with the Medicare beneficiary files for the three areas. In addition to the names of all people age 65 and older who are entitled to Medicare, the files provided information about the race and gender of each beneficiary as well as residential address. We randomly selected a total of 4,800 names equally divided among the three locales, African Americans and Whites, and women and men. The result of this division was the creation of 12 groups, each containing 400 names. Our goal was to obtain a final sample of about 1,200 people living independently and able to complete the interview, with approximately 100 in each of the 12 groups. However, it was necessary to match names and addresses with telephone numbers, for which we used a firm specializing in such tasks. Matches were made with almost 56% of the names—an amount, according to that firm, that is above average for this age group. The matching process eliminates people with private lines, those who exclusively use cell phones, those living in homes where the listing is in the name of another person, people whose move from the area had not yet been registered in the Medicare files, and people living in institutional settings without a personal telephone listing. The 2,679 names and numbers for which matches were made were then targeted for screening interviews that in part were designed to identify people with cognitive problems that would intrude on the validity of interviews with them. Approximately 65% of all eligible respondents (1,741) who were contacted agreed to participate, yielding 1,167 cases. Table 1 compares the age, gender, and race distributions of the sample and the Census 2000 data in the three locales. It appears that the age, gender, and racial composition of the sample roughly mirrors that of the older population in these areas.

Depression
Seven items ask about depressive symptoms in the past week: "lack enthusiasm for doing anything," "feel bored or have little interest in things," "cry easily or feel like crying," "feel downhearted or blue," "feel slowed down or low in energy," "blame yourself for everything that goes wrong," and "have your feelings hurt easily." Response choices are the same as anger. We averaged the items; higher scores indicate greater depression ( =.787).

Anxiety
Anxiety items ask the frequency of feeling: "tense or keyed up," "afraid or fearful," "worry," "nervous or shaky inside," and "have trouble getting to sleep or staying asleep." Response choices are the same as anger. We averaged the items ( =.727).

Physical health symptoms
We also asked respondents how often in the past month they had experienced: "headaches," "cold, chills, or sore throat that lasted 2 or 3 days," "indigestion, heartburn, or upset stomach," "constipation or diarrhea," "sudden feelings of weakness or faintness," "back pain," "shortness of breath," "incontinence (trouble controlling urine or bowels)," "muscle aches or soreness," and "heart palpitations (rapid or hard heartbeat)." The response categories are "never" (1), "1 time" (2), "2–3 times" (3), "4–5 times" (4), and "more than 5 times" (5). We averaged the items; higher scores indicate greater symptoms ( =.717).

Neighborhood problems
To assess neighborhood problems, we use a modified version of the Ross and Mirowsky (1999) "neighborhood disorder" scale. Respondents were asked the degree to which the statements shown in Table 2 describe what they see and experience in their neighborhood ("the area around where you live"). We averaged the items to create the perceived neighborhood problems index; higher scores indicate a greater extent of neighborhood problems.

Donated social support
Four items ask respondents the extent to which they agree or disagree with the following: "There are people you know who depend on you when they need help or advice," "People count on you when they are down or blue," "People seem to tell you things about themselves that they don't tell other people," and "Other people count on you to understand what they are going through." Response choices are the same as received support. We reversed the codes; higher scores indicate greater donated support ( =.880).

The sense of mastery
Respondents were asked the extent of agreement or disagreement with the following: "You have little control over the things that happen to you," "There is really no way you can solve some of the problems you have," "You often feel helpless in dealing with the problems of life," "Sometimes you feel that you are being pushed around in life," and "You can do just about anything you really set your mind to" (reversed). Response choices are the same as social support. We averaged the items; higher scores indicate greater mastery ( =.730).

Table 3 reports the correlation coefficients and summary statistics for the main variables among women and men.

Analytic Strategy
Prior evidence about social support encouraged separate analytical models for women and men. Using ordinary least-squares regression, we regressed each outcome on neighborhood problems, received support, donated support, mastery, and controls. Next, we multiplied neighborhood problems by received support, donated support, and mastery to create interactions. Beforehand, we centered those variables by subtracting each score on a variable from the overall mean to reduce multicollinearity between interaction coefficients and lower-order terms and to increase the efficiency of lower-order estimates (see Mirowsky, 1999, p. 120). Then, we included these interactions to test the hypotheses. In separate analyses, we tested each interaction term alone and then together in the models to assess suppression effects of donated support.

	RESULTS

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Main Findings for Men
Neighborhood problems are associated positively with anger (see the first column of Table 4). In addition, received support and mastery are associated negatively with anger, but donated support is unrelated to anger. The negative Neighborhood Problems x Received Support and Neighborhood Problems x Mastery interaction coefficients in the second column indicate that received support and mastery buffer against the effects of neighborhood problems on anger. That is, received support and mastery diminish the positive association between neighborhood problems and anger. In contrast, the impact of neighborhood problems on anger is similar across all levels of donated support.

Several other peripheral findings among our control variables deserve mention. Black men tend to report less anger, anxiety, and fewer physical symptoms than White men. However, both White and Black men who are taking care of grandchildren report more anger, depression, and physical symptoms relative to those who do not provide care to grandchildren. In addition, adjustment for mastery reveals a suppressed positive association between education and depression. A separate analysis (not shown) that excludes mastery indicates that the coefficient associated with education is not significant (b =.017, p =.167); then, adjustment for mastery increases the education coefficient to significance in the third column of Table 4. That is, were it not for their higher mastery, men with more education would report higher levels of depression.

Main Findings for Women
The first column in Table 5 shows that neighborhood problems are associated positively with anger among women, although the effect is only marginally significant (p =.069). Received support and mastery are associated negatively with anger, but donated support is not. However, in the second column, the Neighborhood Problems x Donated Support coefficient indicates that donated support exacerbates the effect of neighborhood problems on anger. Moreover, we hypothesized that inclusion of that interaction would suppress the positive interaction between received support and neighborhood problems. In a separate model (not shown) that excludes the donated support interaction term, the Neighborhood Problems x Received Support coefficient is not significant (b = -.060, p =.555). The inclusion of Neighborhood Problems x Donated Support increases the size of the negative interaction between received support and neighborhood problems (b = -.293, p =.015). Thus, adjusting for the "cost of caring" aspects of donated support allows clearer detection of the buffering qualities of received support. In sum, the association between neighborhood problems and anger is more positive for women who report higher levels of donated support. Adjustment for that pattern increases the buffering effects of received support. Therefore, the negative aspects of donated support conceal the buffering effects of received support, especially when considered in combination with neighborhood problems.

The fifth column of Table 5 shows that neighborhood problems are unrelated to anxiety. Although mastery is associated negatively with anxiety, neither received nor donated support affects anxiety. In the sixth column, none of the interactions are significant. In addition, the final two columns indicate that neighborhood problems are associated positively with physical symptoms. Mastery is associated negatively with physical symptoms. However, neither form of social support is associated with symptoms and none of the neighborhood interaction terms are significant.

As an aside, we tested the possibility that being in the caregiver role or taking care of grandchildren, in the context of neighborhood problems, might be more strongly associated with health, net of our measure of donated support. Therefore, we tested interactions between neighborhood problems and those caregiver roles in a separate analysis (not shown). Neither of those interactions was significant for either men or women.

In addition, as we observed among men, several other peripheral findings among our control variables merit attention. For example, Black women tend to report less anxiety and fewer physical symptoms than White women in our sample. However, among both White and Black women, age is associated negatively (and quite strongly) with anger—a finding that is consistent with other research (Schieman, 1999). However, age is unrelated to the other dependent variables. In addition, it is noteworthy that although the number of people in the household increases feelings of anger among women, it also decreases feelings of depression. Similar to men, caring for grandchildren appears to have negative effects. Among women, it is associated positively with anxiety and physical symptoms—net of donated social support. Last, education is associated negatively with physical symptoms but none of the other outcome variables.

	DISCUSSION

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Neighborhood problems represent visible signs of inequality near one's home. The stress process proposes that neighborhood problems can have detrimental effects on health. Among a sample of older adults, our findings partially reinforce and elaborate that proposition. For example, neighborhood problems and different forms of support combine in their effect on health. These results address House's (1987) call for more evidence about "the role of social structure in understanding the nature, sources, and generally positive effects of social relationships and supports" (p. 137). However, we also tested two hypotheses about support as associated with buffering and the cost of caring. Depending on gender and the health outcome considered, our findings partially confirm both views.

Among men, neighborhood problems are associated positively with anger, depression, anxiety, and physical symptoms—patterns in accord with prior studies of adults of all ages (Ross & Mirowsky, 2001). In addition, consistent with the buffering hypothesis and related prior research, we found that higher levels of received support decrease the positive association between neighborhood problems and anger. In contrast, we observed the effects of neighborhood problems on depression, anxiety, and physical symptoms irrespective of levels of received support. The lack of uniform buffering effects across outcomes may be inconsistent with the stress process predictions, suggesting that some problems may be impervious to the traditional psychosocial "moderators" in the stress process model (Pearlin, 1999). Why is anger unique in this regard? Data limitations allow us only to offer speculation. Anger involves feeling critical of others, arguing with or yelling at someone, and feeling annoyed or irritated; it is emotionality that can be interpersonally alienating or estranging in nature. Neighborhoods with many problems may contain incivilities or structural obstacles that thwart goals and elevate feelings of inequity. However, receiving support from others may help individuals manage or overcome adversities of neighborhood life and repair damaged relationships, especially those linked to anger. In contrast, some neighborhood problems that are more persistent or chronic are not easily modified. That may help explain why neighborhood problems are associated with depression, anxiety, and physical symptoms regardless of received support. In many respects, those outcomes are more generalized, whereas angry emotions are more social—so anger may also be more responsive to socioemotional support. Being listened to and comforted by others may enhance feelings of trust and counteract feelings of threat and vulnerability associated with neighborhood problems.

Among men, we found only partial support for the "cost of caring" thesis: The positive association between neighborhood problems and physical symptoms is stronger at higher levels of donated support. It is interesting that providing support and neighborhood problems combine in their effects only when physical symptoms are considered. Perhaps men who provide support to others are involved in more instrumental forms of support that is less emotional and more physical in nature. Helping others when you have your own problems can be hazardous to your health. Neighborhood problems may increase the need for instrumental forms of support from men and simultaneously present obstacles to the implementation of that support. Future research should identify the aspects of support provision that vary across types of neighborhood stressors and the reasons why they might combine to have a greater impact only on physical well-being.

The story is more complex for older women. First, as for men, received support seems to buffer the effects of neighborhood problems on anger. However, that buffering effect occurs only after we adjust for donated support as an effect modifier. That suppresses the buffering effect of received social support, especially when anger is the outcome, but also in the case of depression. At higher levels of donated support, neighborhood problems are associated more positively with anger (consistent with "cost of caring"). There is a potential negative side to social involvement, particularly in the context of ambient stress, because it provides opportunities for getting tangled in "disputes, embarrassment, envy, invasion of privacy, or other negative outcomes" (Rook, 1984, p. 1097). When women get involved in the feelings of others, they may have less time and energy to focus on their own needs, especially if they overload limited psychosocial resources by piling on additional challenges (Rook, 2003). The provision of support could drain their resources, leaving women feeling more frustrated, irritable, and resentful. Yet, it remains unclear whether or not these patterns are unique to older adults or if we would observe them among adult women of all ages. Drawing upon the "convoy" metaphor of social relationships (Kahn & Antonucci, 1980), Pearlin and Skaff (1996) contended that "as people age they stand an increasing chance of seeing the fleet shrink" (p. 243). Therefore, the effects we observed might be weaker or nonexistent among younger adults. The age range of our data constricts the resolution of this issue. Future research might examine whether or not these findings are unique to older women. Moreover, it should examine the aspects of support provision that present new stressors or exacerbate existing ambient stressors and offset the benefits of received support.

Collectively, these interrelationships reveal patterns that are consistent with previous theory and research on gender, support provision, and distress-related outcomes. Future analyses might explore the content of support requests in the context of high versus low neighborhood stress conditions—and the ways these requests vary for (and by) women and men. Some problems may be more likely to evoke requests for support. Under some conditions, the quality of other people's troubles may be more severe, so the requests for support may be more intense. In a discussion about status homology, Pearlin (1999) argued that individuals in the same social contexts, with similar social statuses, "experience similar hardships and, furthermore, they will respond to these hardships in similar ways, with similar resources" (p. 399). In turn, there may be similar types and degrees of adversity among neighbors. There is a deficit in the literature regarding whether or not social processes in a neighborhood context diminish or exacerbate the stress process. Our findings take a step toward clarifying these issues by showing that some forms of social relations in the context of stress may be differentially associated with well-being.

As expected, mastery has a negative association with all four of our health outcomes among both women and men. However, mastery does not have consistent moderating effects on the relationship between neighborhood problems and the health outcomes. Among men, mastery decreases the positive association between neighborhood problems and anger only. Perhaps mastery minimizes the anger associated with neighborhood problems by bolstering men's problem-solving capacity and reducing associated frustrations. In contrast, among women, mastery does not have a modifying effect across all outcomes. These patterns contradict the stress process proposition about the buffering effects of mastery. In general, mastery tends to protect or buffer against the negative health effects of stress. However, neighborhood problems may represent enduring structural forms of inequality that not only erode mastery but also outweigh the psychosocial benefits of mastery.

Our findings elaborate on the stress process by specifying the buffering effect of received support under similar types of stressful conditions and in conjunction with donated support. Additional research is needed to determine gender variations in the association between neighborhood problems and support. Some neighborhood problems may increase the need for support provision. Simultaneously, some problems might also restrict opportunities for supportive exchange. Future research should assess changes in structural disadvantage to assess the impact of problems on individual functioning. Those factors can undermine social ties and reduce supportive exchanges. Moreover, the effects may vary by aggregate indicators of structural disadvantage, such as the percentage of families below poverty and the percentage of mother-only single-parent families in the area. New inquiries might draw from the two most recent census reports to establish the effects of change in structural disadvantage.

Several limitations deserve mention. Although we obtained a sample that reflects the gender, age, and racial distribution of older adults in the three locales, our sample is not necessarily representative of the population of older adults. That does not, however, discredit the internal validity of the focal relationships. The direction and magnitude of the relationships that we discovered are valid. Our sample may be healthier and wealthier than the population of older adults; therefore, some of the patterns may underestimate those in the general population. In addition, cross-sectional analyses restrict statements about causal direction. Although a number of the discovered patterns are theoretically consistent, we caution against claims about causality. The stress process model predicts that stressors like neighborhood problems diminish well-being. Our findings and others support that proposition. However, it is plausible that people who are angrier, for example, may notice neighborhood problems more than others or may have a more generally negative outlook that causes greater reporting of problems. Findings about effect modifiers undermine that argument. If mood influences assessments of neighborhood problems, then that pattern should hold, irrespective of support or mastery. Our results suggest otherwise.

Future research is needed that documents the ways in which neighborhood context, at the aggregate level, matters for health and social relationships by gender and race. Neighborhood effects may vary by the quality and function of social ties among older Blacks and Whites. The gender, race, age, and social class composition of their social networks may influence the receipt and donation of support (Felton & Shinn, 1992). Research might also consider the degree to which community-level disadvantages interact with individual-level support to affect health. As the "cost of caring" thesis suggests, support provision in the context of structural disadvantage may have a greater effect on functioning. Moreover, variations by race and gender are worthy of further investigation: The provision of social support may be more strongly associated with distress for individuals in neighborhoods with greater disadvantage—perhaps more so for Black women with fewer socioeconomic resources. Such inquiry would further extend the response to House's (1987) call for study of structural determinants of support and their potential status contingent effects.

In conclusion, neighborhood stressors tend to affect well-being. Yet, a question remains: What psychosocial conditions moderate that association? We show that it depends on gender, the outcome, and the modifier. Anger is unique among the outcomes considered—and the protective effects of received support and mastery are not as uniform as the stress process posits.

	Acknowledgments

 
A National Institute on Aging grant award (AG17461; Leonard I. Pearlin, principal investigator) supports this work. The authors thank Dr. Pearlin for his feedback on an earlier version of this manuscript. However, the authors are solely responsible for the content of this article.

	Footnotes

 
Stephen C. Meersman is now at The Center for Gerontology and Health Care Research, Brown University.

Decision Editor: Charles F. Longino, Jr., PhD

Received for publication December 12, 2002. Accepted for publication September 25, 2003.

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