The role of the physical environment in adolescent mental health

The existing literature suggests an association between the physical environment and mental health but also complex relationships between the social and the physical environment as well as between objective and subjective measures of the environment. In this study, we attempted to explore the role of the residential neighbourhood's physical environment in adolescent mental health, taking this complexity into account. Using data on 3683 ten- to 15-year-olds from England and Wales who participated in Understanding Society, we investigated the role of neighbourhood greenspace and air pollution in adolescent mental health (measured with the Strengths and Difficulties Questionnaire) while controlling for measures of neighbourhood and family socio-economic disadvantage as well as subjective perceptions of social cohesion, crime, safety, and noise in the neighbourhood. In linear regression models, greenspace and air pollution could not predict mental health. However, fear of being a victim of crime was a consistent predictor of mental health and behaviour, indicating the essential role of young people's subjective experience of their neighbourhoods for their mental health and well-being.     

Associations between physical activity and the neighbourhood social environment: baseline results from the HABITAT multilevel study

Limitations have arisen when measuring associations between the neighbourhood social environment and physical activity, including same-source bias, and the reliability of aggregated neighbourhood-level social environment measures. This study examines cross-sectional associations between the neighbourhood social environment (perceptions of incivilities, crime, and social cohesion) and self-reported physical activity, while accounting for same-source bias and reliability of neighbourhood-level exposure measures, using data from a large population-based clustered sample. This investigation included 11,035 residents aged 40–65 years from 200 neighbourhoods in Brisbane, Australia, in 2007. Respondents self-reported their physical activity and perceptions of the social environment (neighbourhood incivilities, crime and safety, and social cohesion). Models were adjusted for individual-level education, occupation, and household income, and neighbourhood disadvantage. Exposure measures were generated via split clusters and an empirical Bayes estimation procedure. Data were analysed in 2016 using multilevel multinomial logistic regression. Residents of neighbourhoods with the highest incivilities and crime, and lowest social cohesion were reference categories. Individuals were more likely to be in the higher physical activity categories if they were in neighbourhoods with the lowest incivilities and the lowest crime. No associations were found between social cohesion and physical activity. This study provides a basis from which to gain a clearer understanding of the relationship between the neighbourhood social environment and individual physical activity. Further work is required to explore the pathways between perceptions of the neighbourhood social environment and physical activity.     

What you see is what you get? Questioning the relationship between objective and subjective appraisals of neighbourhood resources in relation to health

BACKGROUND: Some research concerned with place and health has used the study of opportunity structures in neighbourhoods to understand how place might get under the skin. It has become somewhat common to assume that objective indicators of opportunity structures are in some way equivalent to people's access to them. The general objective of this study, therefore, was to evaluate the level of convergence between objective and subjective evaluations of neighbourhood resources in Winnipeg, Canada. METHODS: Winnipeg residents (n = 1,102) were sampled from 59 neighbourhood units to permit hierarchical linear modelling and to enable the testing of Winnipeg residents' individual-level subjective appraisals within neighbourhood-level objective characteristics. Several databases provided objective neighbourhood data on premature mortality rates, crime, housing, recreation programs, education, and household income. To evaluate subjective appraisals of these resources, data were gathered from the Winnipeg Quality of Life Survey (WQLS). RESULTS: We found that, when controlling for individual- and neighbourhood-level confounders, the objective data at hand match relatively well with participants' subjective perceptions of housing and crime, while neighbourhood-level premature mortality rates and the objective numbers of recreation programs across neighbourhood are not significant predictors of their subjective counterparts. CONCLUSION: It may be that objective measures of some opportunity structures should be accompanied by subjective measures to ensure a more complete understanding of the impact of these resources on population health.     

Neighbourhood quality and self-rated health: a survey of eight suburban neighbourhoods in the Vancouver Census Metropolitan Area

We investigated the relationship between perceptions of neighbourhood quality and self-rated health for residents of eight suburban neighbourhoods with modestly contrasting income profiles in the Vancouver Census Metropolitan Area. Survey respondents from lower income neighbourhoods more often rated their health as fair/poor, and perceived their neighbourhood to be of poor quality. The strongest predictors for fair/poor health status were employment status, body mass index, neighbourhood satisfaction, and age, while modest predictors were annual household income, neighbourhood median income profile, and perceptions of neighbourhood safety. The unique contribution of this study is its demonstration that social gradients in self-rated health are observable between neighbourhoods of even modestly contrasting income profiles.     

Association between perceived security of the neighbourhood and small-for-gestational-age birth

Evidence points to an association between a mother's place of residence and her newborn's health, independent of individual characteristics. Neighbourhood constructs such as immigrant density, deprivation and crime have all been separately associated with birth outcomes. Little research has considered the joint influence of variables representing a spectrum of neighbourhood constructs. Subjective vs. objective measures of neighbourhood constructs (e.g. reported vs. perceived crime) are often not considered. We sought to evaluate the relationship between neighbourhood measures of reported crime, neighbourhood perceived security, immigrant density, material/social deprivation, residential stability and the odds of small-for-gestational-age (SGA) birth in an urban setting in Canada. Neighbourhood was defined as police districts ( n  = 49). We linked Montreal livebirths 1997–2001 ( n  = 98 330) to police district crime measures, survey data on perceived security, and 2001 census data. We used multi-level analysis to calculate odds ratios (OR) for neighbourhood effects on SGA birth accounting for individual characteristics.
Mothers residing in neighbourhoods with the most favourable perception had a lower odds of SGA birth than neighbourhoods with the least favourable perception [OR 0.87, 95% CI 0.77, 0.97]. Mothers in neighbourhoods with lower proportions of immigrants had lower odds of SGA birth relative to neighbourhoods with the highest proportion of immigrants. Reported crime, residential stability and material/social deprivation (accounting for neighbourhood perception) were not associated with SGA birth. Immigrant density and subjective perceptions of neighbourhood security are associated with SGA birth. Public health strategies to improve fetal growth should target neighbourhoods with low perceived security and high immigrant density.     

Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics

PurposeThis study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage.MethodsThis cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models.ResultsSmoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect.ConclusionsSome neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.     

“Safe Going”: The influence of crime rates and perceived crime and safety on walking in deprived neighbourhoods

Few studies have simultaneously examined the relationship of levels of recorded crime, perceptions of crime and disorder, and safety from crime with rates of physical activity. We developed a series of multilevel ordinal regression models to examine these aspects in relation to self-reported neighbourhood walking frequency in a cross-sectional sample of 3824 British adults from 29 deprived neighbourhoods in Glasgow, UK. Perceptions of several serious local antisocial behaviours (drunkenness and burglary) and feelings of personal safety (feeling safe in the home and if walking alone in the local area at night) were consistently associated, respectively, with less and more frequent walking. Conversely, perceiving drug dealing or drug use as a serious problem was associated with walking more frequently. There was a small but significant association between walking frequency in neighbourhoods with higher recorded person crime (but not property crime) rates when considered in conjunction with other aspects of disorder and crime safety, although not when additionally controlling for sociodemographic, neighbourhood and community aspects. The magnitude of these objective and perceived crime-related effects is modest and features of the psychosocial environment and social cohesion (having a sense of progress from living in the neighbourhood, group participation and positively rating social venues), as well as health and personal income deprivation, may more strongly determine levels of neighbourhood walking. Nevertheless, physical activity benefits may accrue at the population level through provision of environments that are safer from crime. Our study also shows the importance to local walking of neighbourhood management, which reduces problems of disorder, and of social regeneration, which helps strengthen sense of community.     

Neighbourhood deprivation and self-rated health: the role of perceptions of the neighbourhood and of housing problems

It has been known for a long time that people living in socially and economically deprived neighbourhoods generally experience poorer health. However, it is often not clear what processes underlie the relationship between neighbourhood deprivation and individual health. In this study we explore the association between neighbourhood socio-economic status and self-rated health using the Caerphilly Health and Social Needs Survey (n=10,892). We found that the association between neighbourhood deprivation and self-rated health was substantially reduced after adjusting for individual socio-economic status, but remained statistically significant. This suggests that the health effects of neighbourhood deprivation are partly contextual. We also found that the association between neighbourhood deprivation and self-rated health was further attenuated when controlling for perceptions of the neighbourhood and of housing problems, suggesting that these variables may play a role in mediating the health effects of neighbourhood deprivation. The implications of the results are that health policy should target 'places' as well as 'people'; and that policies aimed at improving the quality of housing, access to amenities, neighbourhood safety, and social cohesion may help to reduce health inequalities.     

Qualitative evaluation of a community‐based intervention to reduce social isolation among older people in disadvantaged urban areas of Barcelona

This study analyses participants' and coordinators' perceptions of the implementation process and perceived benefits of a community‐based intervention to reduce social isolation among older adults. The ‘School of Health for Older People’ is a weekly community intervention that promotes resources among individuals and communities in order to enhance their ability to identify problems and activate solutions, encouraging participation in the community. A qualitative approach was employed, based on semi‐structured interviews and focus groups (FGs). This study was carried out in Barcelona. Two coordinators (community nurses) and 26 community‐dwelling people aged 65 and over who attended the School of Health for Older People in the neighbourhoods of Besòs and Guineueta, participated in in‐depth interviews and FGs between January and February 2016. Views and experiences about the intervention were explored. The main perceived effects of the intervention were expanding knowledge of health issues and of community activities, encouraging participants to go out, giving them a feeling of being heard, and peer relationships, increasing participants' contacts and knowledge while the main negative features were related to repetition of certain contents. The benefits identified included learning something about health and their own neighbourhood and breaking the habit of staying at home. Social isolation might be prevented by increasing the number of contacts with peers and sharing a common interest, since it could help to give them a sense of belonging to a community .     

Older UK sheltered housing tenants' perceptions of well‐being and their usage of hospital services

The aim of this study was to examine sheltered housing tenants' views of health and well‐being, the strategies they adopted to support their well‐being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service‐integrated housing for people, predominantly over 60. The study used a parallel, three‐strand mixed method approach to encompass the tenants' perceptions of health and well‐being (n = 96 participants), analysis of the service's health and well‐being database, and analysis of emergency and elective hospital admissions (n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well‐being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self‐reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi‐professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.     

The health of immigrant children who live in areas with high immigrant concentration

Objectives. Our objective is to contribute to the literature regarding the association between immigrant children's health, their ethnicity and their living in neighbourhoods with a high ethnic concentration of one's own ethnicity. Using data from families from five ethnic groups who all immigrated to Vancouver metropolitan region in Canada, our research question asks: How ethnicity, ethnic concentration and living in a neighbourhood with others of the same ethnic background contribute to the health of immigrant children?

Design. Two data sets are integrated in our study. The first is the New Canadian Children and Youth Study, which collected original data from five ethnic groups who immigrated to metropolitan Vancouver. The second data set, from which we derived neighbourhood data, is the Canadian census. The dependent variable is health status as reported by the parent. Independent variables are at both the individual and neighbourhood levels, including ethnicity, sex and the percentage of people living in the neighbourhood of the same ethnic background. Analysis was completed using hierarchical linear modelling.

Results. Children (n?=?759) from 24 neighbourhoods were included in the analyses. Health status varied by ethnicity and ethnic concentration, indicating the heterogeneity of immigrant populations.

Conclusion. With the lack of research on the health of immigrant children and youth living in ethnic concentrations, our findings make an important contribution to understanding the influences on the well-being of immigrant populations.     

Modifiable neighbourhood units, zone design and residents' perceptions

Neighbourhood effects on health are partly determined by the way the neighbourhoods are defined (the modifiable areal unit problem), but few studies of place effects have incorporated alternative sets of areal units. This study compared computer-generated zones with areal units identified subjectively by local government officers as communities in the city of Bristol, UK. Automated zone design came close to replicating the subjective communities when the balance of objectives and boundary constraints was adjusted. The set of subjective community areas was compared with automated zone designs, which maximized the homogeneity of a social factor (deprivation) and an environmental factor (housing type), at three different geographical scales, with average populations of 2500, 3700 and 7500. All sets of areas were then matched against the neighbourhood perceptions and social behaviour reported by residents, measured as part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Neighbourhood perceptions and social behaviour varied mostly between individuals, but there were significant small differences between all sets of areas. The neighbourhood perceptions of residents were found to match the areas identified by automated zone design as well as they matched the subjectively defined communities, suggesting that the neighbourhoods identified by experts were not more real to residents than synthetic areas. Differences in perceptions could be explained by variations in social and housing conditions at the very local scale of enumeration districts, with populations of about 500. The neighbourhoods with meaning for residents therefore appeared to be much smaller areas than those typically investigated in geographical studies of health.     

Perception of place and health: Differences between neighbourhoods in the Québec City region

This paper addresses two questions: (1) Can people's perceptions of problems and social cohesion in the neighbourhood be considered as contextual variables; and (2) are these perceptions related to people's health? Data come from a general health survey carried out in 2004 among 1634 individuals living in three localities of the region of Québec City, namely a downtown, a suburban and a rural area, which were further subdivided into 34 smaller spatial units, hereafter called neighbourhoods. The survey included questions on individuals’ perception of problems (social and environmental) and social cohesion (attraction to neighbourhood, neighbouring and psychological sense of community) in the neighbourhood, as well as questions on self-rated health, long-term disability and self-mastery. A first set of logistic multilevel models was performed to ascertain the existence of neighbourhood variations in the perception of problems and social cohesion, after accounting for individual attributes. A second set of multilevel models was carried out to examine the association between perceived problems and social cohesion in the neighbourhood and people's health. Results show that, after accounting for individual attributes, the perception of problems and social cohesion varies significantly by neighbourhood and/or localities and can be considered as contextual variables. Furthermore, these perceptions of place appear to be significant predictors of people's health.     

The effect of kin, social network and neighbourhood support on individual well-being

This paper explores the effects of kin, social network and the neighbourhood on an individual's well-being. The material is drawn from a community-based qualitative study that explored the attitudes and experiences of African-Caribbean adolescents and their families in the north of England towards healthy lifestyles. A convenience sample of 10 African-Caribbean households units comprising 24 adolescents (12-18 years of age) and 18 adults (22-60 years of age) participated in the study with interviews conducted in their homes. The paper focuses on the adult participants' perception of the role of social support networks and neighbourhood effects on well-being. An in-depth interview schedule was used to explore participants' perceptions on barriers to health and healthy lifestyles; and factors facilitating and inhibiting good health and healthy lifestyles. Data were subjected to thematic analysis with the aid of a Qualitative Data Analysis software package. Emerging categories were discussed with participants by conducting post interview visits and at community events. Findings indicated that participants believed that being a member of a kin network enhanced one's well-being, with such networks described as capable of providing protective support for one's health and well-being. In addition, they preferred to live in neighbourhoods with a high concentration of people of the same ethnicity, despite the effects of neighbourhood deprivation such as poor housing and lack of services. However, participants believed that ethnic segregation leads to marginalisation and further deprivation. These findings suggest that there is a need to explore further the influence of social networks and neighbourhoods on the full spectrum of an individual's well-being. The study concludes by suggesting that in considering new paradigms for the promotion of well-being, health and social care practitioners need to incorporate ways to promote social support and consider relevant psychosocial and neighbourhood factors in designing models of community well-being.     

Linking perceptions of neighbourhood to health in Hamilton, Canada

STUDY OBJECTIVE: To investigate the association between perceptions of neighbourhood physical and social characteristics and three health outcomes (self assessed health status, chronic conditions, and emotional distress). DESIGN: Cross sectional survey data analysed in small neighbourhoods. SETTING: Hamilton, Ontario, Canada, a medium sized industrial city, located at the western end of Lake Ontario (population at the time of the study about 380 000). PARTICIPANTS: Random sample of 1504 adults aged 18 years and older residing in four contrasting neighbourhoods. MAIN RESULTS: Significant differences across the four neighbourhoods are apparent in self assessed health status and emotional distress, but not in chronic conditions. Neighbourhoods with lower SES reported poorer health and more emotional distress. Perceptions of the physical environment dominated social concerns in all neighbourhoods. For all three health outcomes, individual risk factors followed expectations, with measures of poverty, age, and lifestyle all significantly associated with poor health outcomes. Physical environmental problems were positively and significantly associated with poor physical and emotional health. Specifically, people reporting they dislike aspects of their neighbourhood's physical environment are 1.5 times more likely to report chronic health conditions (OR 1.56, 95% CI 1.19 to 2.05), while those reporting physical likes with their neighbourhood are less likely to report fair/poor health (OR 0.50, 95% CI 0.28 to 0.90) or emotional distress (OR 0.45, 95% CI 0.26 to 0.80). CONCLUSIONS: These results demonstrate the importance of neighbourhood perceptions as a determinant of health, as well as conventional factors such as low income, lifestyle, and age. The dominance of physical environmental concerns may have arisen from the industrial nature of Hamilton, but this result merits further investigation.     

NEIGHBOURHOOD SOCIAL CAPITAL AND INDIVIDUAL SELF‐RATED HEALTH IN WALES

Although neighbourhood social capital can be beneficial for individual health, supporting evidence in the UK is scant. We aim to find the net effect of neighbourhood social capital and deprivation on individual health beyond sociodemographic composition of neighbourhood. We propose a multilevel path analytic model of health to delineate complex pathways involving neighbourhoods (measured as local super output area) and individuals. Analysis of the most recent data containing independent measures of neighbourhood social capital shows that neighbourhood social capital appears to be associated with benefits in some aspects of individual health in the Welsh setting. The improvement stands beyond individual determinants and neighbourhood deprivation. Social scientists and public health officials have reason to continue focusing on the neighbourhoods as well as the individuals to improve the health of the population. Copyright © 2011 John Wiley & Sons, Ltd.     

Block observations of neighbourhood physical disorder are associated with neighbourhood crime, firearm injuries and deaths, and teen births

STUDY OBJECTIVE: To provide reliability information for a brief observational measure of physical disorder and determine its relation with neighbourhood level crime and health variables after controlling for census based measures of concentrated poverty and minority concentration. DESIGN: Psychometric analysis of block observation data comprising a brief measure of neighbourhood physical disorder, and cross sectional analysis of neighbourhood physical disorder, neighbourhood crime and birth statistics, and neighbourhood level poverty and minority concentration. SETTING: Pittsburgh, Pennsylvania, US (2000 population=334 563). PARTICIPANTS: Pittsburgh neighbourhoods (n=82) and their residents (as reflected in neighbourhood level statistics). MAIN RESULTS: The physical disorder index showed adequate reliability and validity and was associated significantly with rates of crime, firearm injuries and homicides, and teen births, while controlling for concentrated poverty and minority population. CONCLUSIONS: This brief measure of neighbourhood physical disorder may help increase our understanding of how community level factors reflect health and crime outcomes.     

Residents' perceptions of walkability attributes in objectively different neighbourhoods: a pilot study

Physical attributes of local environments may influence walking. We used a modified version of the Neighbourhood Environment Walkability Scale to compare residents' perceptions of the attributes of two neighbourhoods that differed on measures derived from Geographic Information System databases. Residents of the high-walkable neighbourhood rated relevant attributes of residential density, land-use mix (access and diversity) and street connectivity, consistently higher than did residents of the low-walkable neighbourhood. Traffic safety and safety from crime attributes did not differ. Perceived neighbourhood environment characteristics had moderate to high test-retest reliabilities. Neighbourhood environment attribute ratings may be used in population surveys and other studies.     

Are residents of downtown Toronto influenced by their urban neighbourhoods? Using concept mapping to examine neighbourhood characteristics and their perceived impact on self-rated mental well-being

ABSTRACT: BACKGROUND: There is ample evidence that residential neighbourhoods can influence mental well-being (MWB), with most studies relying on census or similar data to characterize communities. Few studies have actively investigated local residents' perceptions. METHODS: Concept mapping was conducted with residents from five Toronto neighbourhoods representing low income and non-low income socio-economic groups. These residents participated in small groups and attended two sessions per neighbourhood. The first session (brainstorming) generated neighbourhood characteristics that residents felt influenced their MWB. A few weeks later, participants returned to sort these neighbourhood characteristics and rate their relative importance in affecting residents' 'good' and 'poor' MWB. The data from the sorting and rating groups were analyzed to generate conceptual maps of neighbourhood characteristics that influence MWB. RESULTS: While agreement existed on factors influencing poor MWB (regardless of neighbourhood, income, gender and age), perceptions related to factors affecting good MWB were more varied. For example, women were more likely to rank physical beauty of their neighbourhood and range of services available as more important to good MWB, while men were more likely to cite free access to computers/internet and neighbourhood reputation as important. Low-income residents emphasized aesthetic attributes and public transportation as important to good MWB, while non-low-income residents rated crime, negative neighbourhood environment and social concerns as more important contributors to good MWB. CONCLUSION: These findings contribute to the emerging literature on neighbourhoods and MWB, and inform urban planning in a Canadian context.     

Examining how contexts shape young children's perspectives of health

BACKGROUND: We know that the social conditions in which children live exert a strong influence on their health; yet, we do not know how children's experience of these conditions of daily life shape their perspectives of health. METHODS: Through ethnographic research methods, the first author spent 1 year with the 14 6-year-old children involved in this research and examined how the contexts of daily life influenced the children's perspectives of health. The children involved in this study all lived in a neighbourhood characterized as having a complex of mid to high range of neighbourhood factors associated with vulnerability. RESULTS: The findings demonstrate that the children were able to articulate the health requirements of physical activity and healthy eating that supports their health. However, there was a disparity between the children's health knowledge, their perceptions and their contextual realities in relation to health. Children spoke of concerns for their physical safety within their schools and neighbourhoods; their lack of free range of play, and that they had few opportunities to play with or get to know neighbourhood friends. CONCLUSION: Professionals in contact with children and families who live in challenging social conditions need to be aware of how these contexts shape children's understanding of their own health potential.