Traffic stress, vehicular burden and well-being: A multilevel analysis

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Abstract

This study examined whether health is associated with individually perceived traffic stress and as well as ecologically measured vehicular burden using multi-level analysis.

Data from the Chinese American psychiatric epidemiologic study (N=1503) are linked to data from the 1990 Census in the United States. Hierarchical linear modeling was used to analyze the cross-sectional relationship between traffic stress, neighborhood conditions, depression and health status. Perceived traffic stress is associated with both general health status and depression in multivariate multilevel models, such that persons reporting traffic stress had lower health status and more depressive symptoms. Further, there is an interaction between vehicular burden and traffic stress for both health outcomes. Persons who lived in areas with greater vehicular burden and who reported the most traffic stress also had the lowest health status and greatest depressive symptoms. These findings suggest that traffic stress may represent an important factor that influences the well-being of urban populations, and that studies which examine factors at only one level (either individual level only or ecological level only) may underestimate the effect of the social environment.

Introduction

Urban and suburban centers rely upon their transportation infrastructure for the well-being of their populous. Roads allow for the development of populated areas, facilitating the exchange of commerce and ideas (Abu-Lughod, 1991). Automobile ownership provides mobility, potential enjoyment from the vehicle and driving experience, and may confer and reflect social status (Parsons, Tassinary, Ulrich, Hebl, & Grossman-Alexander, 1998). Transportation also aids in the accessibility of preventive health services (Lovett, Haynes, Sunnenberg, & Gale, 2002) and can be one of the rallying points from which to help develop community coalitions and social capital (World Health Organization, 2000; Brugge et al. (2002a), Brugge, Leong, & Lai (2002b)).

At the same time, transportation and one of its undesired consequences—traffic—pose potential challenges to the public's health. There are some obvious hazards, including unintentional injuries, pollution, “road rage” and drive-by-shootings (Centers for Disease Control, 2002; Krug, Sharma, & Lozano 2000; Wong et al., 1990; Bentham, 1986; Fong, Frost, & Stansfeld, 2001; Parker, Lajunen, & Summala, 2002; WHO, 2000; Winston et al., 2002; Batten, Penn, & Bloom, 2000; Koren, Arnon, & Klein, 1999; Hasselberg, Laflamme, & Weitoft, 2001). Less apparent are the indirect effects of transportation, including the displacement of city residents and racial segregation due to the construction of highways (Sugrue, 1996), the role of roads as a vector in the transmission of communicable diseases (Singhanetra-Renard, 1993), and the stresses and annoyances due to traffic noise (Babish, Fromme, Beyer, & Ising, 2001; Ouis, 2001). Finally, transportation and traffic may impede preventive actions and health care, by limiting access to health services and discouraging physical exercise (Lovett, Haynes, Sunnenberg, & Gale, 2002; Cvitkovich & Wister, 2001; Macintyre & Ellaway, 1998). The Centers for Disease Control (2002) recently reported that perceived traffic danger was the second leading barrier to children walking and biking to school in the United States. Similarly Balfour and Kaplan (2002) found that traffic was the most commonly cited neighborhood problem among elderly persons and further, that elderly persons living in neighborhoods characterized by heavy traffic and other neighborhood problems had greater functional deterioration over 1 year of followup. These observations suggest that a constellation of experiences due to transportation and traffic impact well-being (WHO, 2000).

We examine some of these issues in Los Angeles. Los Angeles is one urban center where the use of automobiles is widespread, necessitated by urban sprawl and a minimal public transportation system. Use of cars is so normative here that people sometimes ask, “need a ride to your car?” Thus, Los Angeles presents an ideal place to examine the issues of transportation and traffic. Los Angeles may be unique in several aspects of the urban experience, including its ethnically diverse community (Davis, 1992; Ong, Bonacich, & Cheng, 1994), but issues related to travel and transportation are common in many areas, urban or not. For example, in the year 2000, 88% for the US population, aged 16 or over, drove themselves or carpooled to work, compared with 86% for Los Angeles (US Census Bureau, 2002). Outside of the United States, the World Health Organization (2000) recently articulated that health concerns related to traffic and transportation have become a worldwide phenomenon and will likely become more of an issue in the future (for examples, see Lovett, Haynes, Sunnenberg, & Gale, 2002; Forjuoh & Li, 1996). Finally, others have suggested that the organization of Los Angeles may reflect the trends in other global cities, including transnational economic ties and diverse burgeoning immigration (United Nations Centre for Human Settlements, 2001).

This study is situated in a broader literature focused on understanding the relationship between places and health. Neighborhood factors, such as poverty, are discussed quite often, but several have critiqued the literature for not clearly specifying the potential mechanisms whereby places may impact health (Macintyre, Ellaway, & Cummins, 2002; Mitchell, Gleave, Bartley, Wiggins, & Joshi, 2000; Diez-Roux (1998), Diez-Roux, 1998 (2000); Pickett & Pearl, 2001; Kaplan, 1996; Yen & Syme, 1999). This study attempts to address this issue by investigating perceptions of stress due to traffic and transportation (hereafter called “traffic stress”) among residents of Los Angeles. Traffic stress may result from the hassles of driving and parking, the potential for unintentional injuries, and pecuniary hardships and inconveniences of vehicle maintenance and purchase. This stress is seen not merely an intrapsychic phenomenon, but arises from an interaction between an individual and her/his environment. When stress exceeds the ability to cope with the stress, illness occurs (Lazarus & Folkman, 1984). However, the stress literature has been criticized as being overly individualized, with inadequate attention given to environmental factors, both theoretically and analytically (Pearlin, 1989; Aneschensel, 1992).

Given this background, the present study seeks to examine both individual perceptions of traffic stress, as well as objectively measured environmental characteristics related to traffic. One of the pertinent environmental characteristics related to perceptions of traffic stress is the presence of vehicles in the neighborhood. It is suggested that the vehicular burden of the neighborhood interacts with individual perceptions to produce illness. This is because stressful objective conditions (vehicular burden) will weigh more heavily upon individual perceptions of (traffic) stress than less stressful objective conditions to produce differential patterns of illness. This reasoning is the basis for hypothesizing a statistical interaction between traffic stress and vehicular burden.

In addition to traffic stress, an individual's perceptions of their environment may be associated with illness. There is some suggestion that perceptions of neighborhood problems themselves are associated with poor health (Steptoe & Feldman, 2001; Balfour & Kaplan, 2002; Booth, Owen, Bauman, Clavisi, & Leslie, 2000; Mitchell et al., 2000). Therefore, this study also seeks to examine whether it is perceptions of the environment per se, as well as neighborhood economic conditions, that may account for any potential relationship between traffic stress and health.

Section snippets

Methods

The data come from the Chinese American Psychiatric Epidemiologic Study (CAPES). The CAPES study is only summarized as it has been described previously (Gee, 2002; Takeuchi et al., 1998). Thirty-six census tracts were selected from 1652 tracts in Los Angeles, based on income and race characteristics. This sampling design was used in order to identify persons of Chinese descent in a cost-efficient manner. In 1993, 16,916 households within 36 census tracts in Los Angeles were screened to produce

Dependent variables

Stress is associated with a variety of physical and mental health outcomes. Following Sooman and Macintyre's (1995) approach, we focus on general measures of mental health and global self-perceived health. General health status was measured with a five-item scale derived from the Medical Outcomes Study Short-Form 36 (SF-36). The range was 0–100, with higher scores indicating better health status. This scale is widely used and has been correlated with several health outcomes (Ware, 1993).

Independent variables

Traffic stress was measured with a Likert-response scale asking respondents how much they were bothered within the last month by: (a) traffic; (b) auto maintenance; (c) accidents. The reliability of this three-item scale was moderate (Cronbach's alpha=0.58). The moderate alpha may have been due to the few number of items, since alpha increases with the number of items in a scale. The range was 3–11, with higher values indicating greater concerns.

Because traffic stress could actually be due to

Analysis

Bivariate analysis and hierarchical linear modeling (HLM) were performed to examine the association between traffic stress, perceived environment, and other covariates. The data are hierarchically arranged, with individuals nesting within census tracts. HLM is a multivariate technique suited for this type of design, not only because it accounts for autocorrelation due to clustering, but also because HLM was built from a theoretical base designed to examine multilevel factors (Raudenbush & Bryk,

Results

Table 1 describes the characteristics of the 1503 CAPES respondents. Respondents are fairly healthy and well educated, but there is also a sizable low-income population. Almost a third earn less than $20,000 a year in household income. On average, respondents report a fairly low level of stress due to traffic or neighborhood conditions.

The intraclass correlation coefficients for general health status, depression, traffic stress and perceived environment are 0.03, 0.07, 0.15 and 0.16,

Discussion

This study sought to examine whether stress due to traffic and travel was associated with well-being. The data suggest that concerns over traffic, vehicle maintenance, and accidents were stressors faced by persons living in Los Angeles, and that these stressors are associated with lowered health status and greater depressive symptoms. Consistent with other studies, individual social class, acculturation, gender, age and neighborhood poverty are associated with health outcomes (e.g. Gee, 2002;

Acknowledgements

We thank Larissa Larsen, Wendy Lin and several anonymous reviewers for their helpful comments and Beth Talbot for her assistance in preparing this manuscript. This study was funded by a grant from the National Institutes of Mental Health (#47460) to David Takeuchi.

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