title: Neighbourhood environment and its association with self rated health: evidence from Scotland and England.
abstract: OBJECTIVE
  To investigate associations between measures of neighbourhood social and material environment and self rated health.
  
  
  METHODS
  New contextual measures added to cross sectional study of a sample of people from the Health Survey for England and the Scottish Health Survey to provide multilevel data.
  
  
  METHODS
  13,899 men and women aged 16 or over for whom data on self rated health were available from the Health Survey for England (years 1994-99) and the Scottish Health Survey (years 1995 and 1998).
  
  
  RESULTS
  Fair to very bad self rated health was significantly associated with six neighbourhood attributes: poor physical quality residential environment, left wing political climate, low political engagement, high unemployment, lower access to private transport, and lower transport wealth. Associations were independent of sex, age, social class, and economic activity. Odds ratios were larger for non-employed residents than for employed residents. Self rated health was not significantly associated with five other neighbourhood measures: public recreation facilities, crime, health service provision, access to food shops, or access to banks and buildings societies.
  
  
  CONCLUSIONS
  Some, but not all, features of the neighbourhood environment are associated with self rated health and may be indicators of important causal pathways that could provide a focus for public health intervention strategies. Associations were more pronounced for non-employed residents, perhaps because of greater exposure to the local environment compared with employed people. Operationalizing specific measures of the characteristics of local areas hypothesised to be important for living a healthy life provides a more focused approach than general measures of deprivation in the search for area effects.
authors.affiliation: MRC Social and Public Health Sciences Unit, Glasgow, UK. s.c.j.cummins@qmul.ac.uk
authors.forename: Steven
authors.initials: S
authors.lastname: Cummins
authors.forename: Mai
authors.initials: M
authors.lastname: Stafford
authors.forename: Sally
authors.initials: S
authors.lastname: Macintyre
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
authors.forename: Anne
authors.initials: A
authors.lastname: Ellaway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors