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Neighbourhood socioeconomic context and self reported health and smoking: A secondary analysis of data on seven cities

Author: Reijneveld, S.A.
Type:article
Date:2002
Institution: TNO Kwaliteit van Leven
Source:Journal of Epidemiology and Community Health, 12, 56, 935-942
Identifier: 236863
doi: DOI:10.1136/jech.56.12.935
Keywords: Health · Lifestyle · Medical geography · Self assessment · Smoking · Socioeconomic status · Urban population · Age · Cigarette smoking · Controlled study · Data analysis · Ethnic difference · Health behavior · Interview · Self report · Sex difference · Social aspect · Socioeconomics · Statistical model · Adolescent · Adult · Age Factors · Aged · Female · Health Status · Health Surveys · Humans · Logistic Models · Male · Middle Aged · Odds Ratio · Poverty Areas · Smoking · Socioeconomic Factors · Urban Health · Netherlands

Abstract

Objective: Many studies have shown that poor health status and harmful heolth behaviour occur more frequently in deprived neighbourhoods. Most studies show modest associations between area level socioeconomic factors, the neighbourhood context, and health outcomes. However, estimates for the contextuol effects vary. It is unclear if this variation is attributable to differences in methodology. This study examines whether contextual neighbourhood differences in heolth outcomes really vary between cities or that differences in methodology may account for these differences. Design: Secondary onalysis of data from health interview surveys in seven large Dutch cities in the 1990s comprising 23 269 residents of 484 neighbourhoods, using multilevel logistic models. Setting: Generol population aged 16 and over. Main outcome measures: Self reported health, smoking of cigarettes. Main results: The socioeconomic context of neighbourhoods is associated with health outcomes in all large Dutch cities. The strength of the association varies between cities, but variation is much smaller in the age group 25-64. Furthermore, neighbourhoad differences vary in size between native and other residents. Contextual neighbourhaod differences are about two times larger for self reported health than for the smoking of cigarettes, but for native Dutch people they are of similar size. Conclusions: A comparatively large improvement in health may be gained in deprived neighbourhoods, because of the poorer health status to which the context of these neighbourhoods also contributes. Health promoting interventions should be aimed at the residents and at the context of deprived neighbourhoods, taking differences between ethnic groups and age groups into account.