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

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Abstract
Objective: Many studies have shown that poor health status and harmful health 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 contextual effects vary. It is unclear if this variation is attributable to differences in methodology. This study examines whether contextual neighbourhood differences in health outcomes really vary between cities or that differences in methodology may account for these differences. Design: Secondary analysis 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: General 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, neighbourhood differences vary in size between native and other residents. Contextual neighbourhood 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.