title: Quantifying neighbourhood socioeconomic effects in clustering of behaviour-related risk factors: a multilevel analysis.
abstract: BACKGROUND
  The extent to which neighbourhood characteristics explain accumulation of health behaviours is poorly understood. We examined whether neighbourhood disadvantage was associated with co-occurrence of behaviour-related risk factors, and how much of the neighbourhood differences in the co-occurrence can be explained by individual and neighbourhood level covariates.
  
  
  METHODS
  The study population consisted of 60 694 Finnish Public Sector Study participants in 2004 and 2008. Neighbourhood disadvantage was determined using small-area level information on household income, education attainment, and unemployment rate, and linked with individual data using Global Positioning System-coordinates. Associations between neighbourhood disadvantage and co-occurrence of three behaviour-related risk factors (smoking, heavy alcohol use, and physical inactivity), and the extent to which individual and neighbourhood level covariates explain neighbourhood differences in co-occurrence of risk factors were determined with multilevel cumulative logistic regression.
  
  
  RESULTS
  After adjusting for age, sex, marital status, and population density we found a dose-response relationship between neighbourhood disadvantage and co-occurrence of risk factors within each level of individual socioeconomic status. The cumulative odds ratios for the sum of health risks comparing the most to the least disadvantaged neighbourhoods ranged between 1.13 (95% confidence interval (CI): 1.03-1.24) and 1.75 (95% CI, 1.54-1.98). Individual socioeconomic characteristics explained 35%, and neighbourhood disadvantage and population density 17% of the neighbourhood differences in the co-occurrence of risk factors.
  
  
  CONCLUSIONS
  Co-occurrence of poor health behaviours associated with neighbourhood disadvantage over and above individual's own socioeconomic status. Neighbourhood differences cannot be captured using individual socioeconomic factors alone, but neighbourhood level characteristics should also be considered.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland. jaana.halonen@ttl.fi
authors.forename: Jaana I
authors.initials: JI
authors.lastname: Halonen
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000428:Alcohol Drinking; D004522:Educational Status; D005387:Finland; D015438:Health Behavior; D006801:Humans; D055361:Multilevel Analysis; D016017:Odds Ratio; D010809:Physical Fitness; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors