title: The association between physical environment and health: indicating the direction of effects using German panel data.
abstract: A growing body of research has identified an association between health and physical residential environmental characteristics. However, the direction of effects remains unclear, and further research is needed to determine whether the residential environment influences health.
  
  
  
  To specify the direction of the association between environmental disadvantage and self-reported health.
  
  
  
  Longitudinal data were obtained from the German Socioeconomic Panel and were examined at two points in time. Participants were grouped by relocation status assessed across a five-year period. Structural equation modeling was used to examine the effect of baseline environmental disadvantage on baseline health and on health five years later.
  
  
  
  In both groups, environmental disadvantage was cross-sectionally correlated with poor health. Only among people who did not relocate was baseline environmental disadvantage significantly related to health five years later in bivariate analyses. Results from the structural equation model found that environmental disadvantage was no longer significantly related to poor health five years later within the group of non-movers (β = -.02, p = .052). In addition, there was no effect in this direction within the group of movers (β = .02, p = .277).
  
  
  
  Our results suggest the existence of a weak contextual effect as group differences in longitudinal associations indicated the direction of ecological effects.
authors.affiliation: a Institute of Medical Psychology and Medical Sociology , University of Leipzig , Leipzig , Germany.|b Faculty of Applied Social Sciences , Leipzig University of Applied Sciences , Leipzig , Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Baar
authors.affiliation: c Department 2: Prevention and Health Promotion , Institute for Public Health and Nursing Research, University of Bremen , Bremen , Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Romppel
authors.affiliation: a Institute of Medical Psychology and Medical Sociology , University of Leipzig , Leipzig , Germany.|b Faculty of Applied Social Sciences , Leipzig University of Applied Sciences , Leipzig , Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Igel
authors.affiliation: a Institute of Medical Psychology and Medical Sociology , University of Leipzig , Leipzig , Germany.|d Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Mainz , Mainz , Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Brähler
authors.affiliation: c Department 2: Prevention and Health Promotion , Institute for Public Health and Nursing Research, University of Bremen , Bremen , Germany.
authors.forename: Gesine
authors.initials: G
authors.lastname: Grande
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004777:Environment; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012111:Residence Characteristics; D057566:Self Report; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Environmental disadvantage; Longitudinal study; Perceived neighborhood; Relocation; Self-rated health