Study objective: To investigate the association between perceptions of neighbourhood physical and social characteristics and three health outcomes (self assessed health status, chronic conditions, and emotional distress). Design: Cross sectional survey data analysed in small neighbourhoods. Setting: Hamilton, Ontario, Canada, a medium sized industrial city, located at the western end of Lake Ontario (population at the time of the study about 380 000). Participants: Random sample of 1504 adults aged 18 years and older residing in four contrasting neighbourhoods. Main results: Significant differences across the four neighbourhoods are apparent in self assessed health status and emotional distress, but not in chronic conditions. Neighbourhoods with lower SES reported poorer health and more emotional distress. Perceptions of the physical environment dominated social concerns in all neighbourhoods. For all three health outcomes, individual risk factors followed expectations, with measures of poverty, age, and lifestyle all significantly associated with poor health outcomes. Physical environmental problems were positively and significantly associated with poor physical and emotional health. Specifically, people reporting they dislike aspects of their neighbourhood's physical environment are 1.5 times more likely to report chronic health conditions (OR 1.56, 95% CI 1.19 to 2.05), while those reporting physical likes with their neighbourhood are less likely to report fair/poor health (OR 0.50, 95% CI 0.28 to 0.90) or emotional distress (OR 0.45, 95% CI 0.26 to 0.80).Conclusions: These results demonstrate the importance of neighbourhood perceptions as a determinant of health, as well as conventional factors such as low income, lifestyle, and age. The dominance of physical environmental concerns may have arisen from the industrial nature of Hamilton, but this result merits further investigation.

This article explores the relationships between social, physical, and sociodemographic characteristics and the health status of individuals within four contrasting neighbourhoods in Hamilton, Ontario, using a cross-sectional design. Using data from a telephone survey conducted in 2001 and 2002 of a random sample of adults (1504 respondents, response rate = 60%), path analysis was used to estimate direct and indirect effects of neighbourhood location and satisfaction on health; specifically, the effect of income, coping skills, and neighbourhood satisfaction on self-rated health. Coping was found to be an important mediator between several lifestyle and neighbourhood characteristics and health outcomes. Income and other measures of wealth such as housing tenure, employment, money worries, and lack of money/food bank use were found significant in all health outcomes as well as daily coping ability. Since coping ability was found to be more important for health status than income, policy implications include a greater emphasis on social programmes to assist individuals to manage stress, as well as income support.

Background: Self-reported health status has become a conventional measure of health status at the population level. Further, the literature supports its use as a valid indicator of morbidity and mortality. However, relatively little attention has been paid to how selfreported health status changes over time or the factors affecting change. This paper explores the factors affecting health status change over time using data from a neighbourhood health survey. Methods: Two rounds (2001; 2003) of health survey data (n=671) were collected across 4 distinct neighbourhoods in Hamilton, Ontario. Logistic regression analysis is used to predict change in self-reported health status between the two time periods as well as determinants of change using a range of compositional, contextual and collective characteristics of individuals as potential explanatory variables. Results: Results reveal that approximately one third of participants experienced a change in health status between the two survey years. Interestingly, the key factors affecting change in health status are compositional characteristics of individuals (e.g., smoking, health care use) as opposed to contextual (e.g., neighbourhood of residence) or collective (e.g., marital status). Contrary to published literature, the current study does not reveal any significant links between a change in health status and either gender or age. Conclusion: These results inform our understanding of both the stability of health ratings over time and the determinants of health status change. Further research should be undertaken to enhance this understanding; in particular, studies with larger sample sizes, longer time frames and more sensitive indicators of composition, context and collective are needed. MeSH terms: Health status; health determinants; change in health status, neighbourhoods La traduction du résumé se trouve à la fin de l'article.

Abstract