Investigating neighborhood and area effects on health.

The past few years have witnessed an explosion of interest in neighborhood or area effects on health. Several types of empiric studies have been used to examine possible area or neighborhood effects, including ecologic studies relating area characteristics to morbidity and mortality rates, contextual and multilevel analyses relating area socioeconomic context to health outcomes, and studies comparing small numbers of well-defined neighborhoods. Strengthening inferences regarding the presence and magnitude of neighborhood effects will require addressing a series of conceptual and methodological issues. Many of these issues relate to the need to develop theory and specific hypotheses on the processes through which neighborhood and individual factors may jointly influence specific health outcomes. Important challenges include defining neighborhoods or relevant geographic areas, identifying significant area or neighborhood characteristics, specifying the role of individual-level variables, incorporating life-course and longitudinal dimensions, combining a variety of research designs, and avoiding reductionism in the way in which "neighborhood" factors are incorporated into models of disease causation and quantitative analyses.analyses.

[1]  J N Morris,et al.  Levels of mortality, education, and social conditions in the 107 local education authority areas of England. , 1996, Journal of epidemiology and community health.

[2]  F A Barrett,et al.  Finke's 1792 map of human diseases: the first world disease map? , 2000, Social science & medicine.

[3]  G. Kaplan,et al.  Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. , 1999, American journal of epidemiology.

[4]  D. Black HEALTH AND DEPRIVATION: Inequality and the north , 1988 .

[5]  Thomas A. DiPrete,et al.  Multilevel Models: Methods and Substance , 1994 .

[6]  D. Kleinbaum,et al.  Socioecologic stress and hypertension related mortality rates in North Carolina. , 1976, American journal of public health.

[7]  Mei-Cheng Wang,et al.  Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. , 1997, American journal of public health.

[8]  M Susser,et al.  The logic in ecological: I. The logic of analysis. , 1994, American journal of public health.

[9]  S. Kasl,et al.  Mental health and the urban environment: some doubts and second thoughts. , 1975, Journal of health and social behavior.

[10]  M. Haan,et al.  Poverty and health: Prospective evidence for the Alameda County Study , 1987 .

[11]  W. Schull,et al.  Socioecological stressor areas and black-white blood pressure: Detroit. , 1973, Journal of chronic diseases.

[12]  V. Kiri,et al.  Life expectancy in England: variations and trends by gender, health authority, and level of deprivation. , 1997, Journal of epidemiology and community health.

[13]  N. Krieger Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[14]  B. Psaty,et al.  Do communities differ in health behaviors? , 1993, Journal of clinical epidemiology.