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Moving Beyond Poverty: Neighborhood Structure, Social #1156—Jnl of Health and Social Behavior—Vol. 44 No. 4—44407-bro wning Moving Beyond Poverty: Neighborhood Structure,Social Processes, and Health* CHRISTOPHER R. BROWNING The Ohio State University KATHLEEN A. CAGNEY University of Chicago Delivered by Ingenta to Journal of Health and Social BehaviorWelch 2003, V Medicalol 44 (December): Library 552– (cid571 82007175), We investigate the impact of neighborhoodJohns Hopkins structural University characteristics, (cid 90000553) social organization, and culture on self-ratedIP: 127.0.0.1 health in a large, cross-sectional sample of urban adults. Findings indicateDate: that 2005..04..18..17..00..neighborhood affluence is a more pow- erful predictor of health status than poverty, above and beyond individual demographic background, socioeconomic status, health behaviors, and insur- ance coverage. Moreover, neighborhood affluence and residential stability interact in their association with health. When the prevalence of affluence is low, residential stability is negatively associated with health. Neighborhood affluence also accounts for a substantial proportion of the racial gap in health status. Finally, collective efficacy is a significant positive predictor of health but does not mediate the effects of structural factors. Research on the contribution of neighbor- these efforts, neighborhood effects research on hood characteristics to individual health has health has typically focused on only one progressed rapidly over the last decade. dimension of neighborhood structure—the Mounting empirical evidence of neighborhood prevalence of economic deprivation—and has socioeconomic structure (SES) effects on a yet to explore competing hypotheses regarding range of adult outcomes including mortality the community level mediators of structural (Haan, Kaplan, and Camacho 1987), heart dis- effects on health. ease (LeClere, Rogers, and Peters 1998), num- We draw on social disorganization and col- ber of chronic conditions (Robert 1998), and lective efficacy theory (Shaw & McKay 1969; self-rated health (Malmstrom, Sundquist, and Sampson, Raudenbush, and Earls 1997), Johansson 1999) has fueled calls for continued Wilson’s theory of neighborhood decline research on the health effects of multiple (Wilson 1987; 1996), and research exploring dimensions of community SES and the mech- the health effects of neighborhood context to anisms that may account for the community elaborate and test two sets of hypotheses. First, structure-health link (Robert 1999). Despite we extend the typical focus on the health con- sequences of neighborhood poverty to include * Paper presented in part at the 2001 meetings of the a range of other structural characteristics of Population Association of America, Washington, D.C. Support for this research was provided by the neighborhoods including the concentration of Ohio State Seed Grand Initiative. Thanks to Felicia affluence, residential stability, and ethnic het- LeClere, Lauren Krivo, Ming Wen, and participants erogeneity. Our focus on the role of affluence, in the University of Chicago Population Research in particular, builds on recent theory and Center Demography Workshop for their helpful research highlighting the potentially important comments. We wish to thank Robert Sampson, role of middle and upper-middle class resi- Felton Earls, and members of the Project on Human dents in anchoring community institutions and Development in Chicago neighborhoods for gener- ously providing access to the Community Survey providing organizational and economic data. We also thank the Metropolitan Community resources with which to promote a healthy Information Center for providing access to the environment (Cagney, Browning, and Wen Metro Survey data. 2002; Robert 1998). Wilson’s theory of social 552 #1156—Jnl of Health and Social Behavior—Vol. 44 No. 4—44407-bro wning MOVING BEYOND POVERTY 553 isolation adds the additional insight that resi- basis for this association has received compar- dential stability may interact with socioeco- atively less attention. We draw on recent exten- nomic context in influencing the well-being of sions of the longstanding tradition of theory urban residents (Wilson 1987; 1996; Ross, and research on the role of “social disorgani- Reynolds, and Geis 2000). zation” in the spread of urban social problems Second, we elaborate and test a number of (Bursik 1988; Shaw & McKay 1969; hypotheses regarding the community-level Sampson, Raudenbush, and Earls 1997). mechanisms thought to mediate the effects of Though originally developed as an explanation structural conditions at the neighborhood for varying crime rates across urban neighbor- level. The mechanisms we consider include hoods, this body of theory identifies specific neighborhood level social support and socia- dimensions of neighborhood structure that bility (Berkman 1995; Berkman,Delivered Glass, by mayIngenta be relevant to to the distribution of a wide Brissette, and Seeman 2000; Berkman and range of phenomena, including poor health. Syme 1979; Hawe and Shiell 2000)Welch, normative MedicalSocial Library disorganization (cid 82007175), theory has a lengthy transmission of health-compromisingJohns behavior Hopkinshistory University in urban (cid sociology. 90000553) In Shaw and (Fitzpatrick and Lagory 2000) , IP:and 127.0.0.1 health- McKay’s (1969) initial statements of the related collective efficacy (BrowningDate: 2005..04..18..17..00.. and approach and subsequent elaborations Cagney 2002; Sampson, Raudenbush, and (Kornhauser 1978), features of neighborhood Earls 1997). Though some studies have exam- structure—principa lly poverty, residential ined the impact of individual mechanisms, this instability, and ethnic heterogeneity—were research has either focused on relatively large hypothesized to limit resources with which to units of aggregation (e.g., the state level support local institutions, diminish community [Kawachi, Kennedy, Lochner, and Prothrow- attachments through high population turnover, Stith 1997]) or has used person level opera- and impede communication across diverse tionalizations of processes specified to operate racial/ethnic groups. In turn, these conditions at the neighborhood level (Ross and Mirowsky result in attenuated community-level social 2001). In contrast, we consider multiple control of crime. In their empirical analyses, hypotheses regarding the neighborhood level Shaw and McKay found that these structural mediators of socioeconomic structure effects factors continued to affect crime rates regard- on health simultaneously. less of ethnic and racial population succession, We investigate neighborhood effects on suggesting that macro level processes operate health using a multilevel statistical approach independently of the characteristics of individ- (Raudenbush and Bryk 2002; Snijders and uals who comprise disadvantaged neighbor- Bosker 1999). Three data sources are hoods. This insight remains critical to research employed: 1990 decennial census data, the on neighborhood effects today. For instance, 1994–95 Project on Human Development in deficits in the health of African-Americans and Chicago Neighborhoods Community Survey Latinos by comparison with whites observed at (PHDCN-CS), and the 1991–2000 Metro- the individual level may actually be capturing politan Community Information Center-Metro inequality in the social environments these Survey (MCIC-MS)—a serial cross-section of groups typically occupy. Chicago adults. The combination of these data These early efforts at describing the spatial sets offers a unique opportunity to assess the organization of social problems have seen contribution of multiple dimensions of neigh- renewed interest over the last two decades. borhood structure and social process to varia- Research examining the contextual impact of tions in the health of urban residents. economic conditions on health, for instance, has highlighted the potential relevance of social disorganization theory to health out- THEORETICAL PERSPECTIVES comes (Robert 1999). Indeed, the neighbor- hood level consequences hypothesized to fol- Neighborhood Socioeconomic Structure and low from structural deficits in the disorganiza- Health tion approach—attenuated institutional strength, limited network interaction, dimin- The contribution of neighborhood structure ished neighborhood attachment, and low levels to health has been the subject of extensive of informal social control (Kasarda and empirical investigation, but the theoretical Janowitz 1974; Kornhauser 1978; Sampson #1156—Jnl of Health and Social Behavior—Vol. 44 No. 4—44407-bro wning 554 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 1997)—can be seen as potentially important proportion of households with incomes over determinants of health as well as outcomes $50,000 was significantly associated with bet- such as victimization. We describe this process ter health independent of demographic and in more detail in our discussion of the hypoth- health background while the prevalence of esized mechanisms linking neighborhood poverty was not a significant predictor of structure with health. In particular, we empha- health. Robert (1999) found that a measure of size the role of collective efficacy—or the the proportion of residents with incomes combination of social cohesion and shared greater than $30,000 had a direct positive expectations for beneficial action on behalf of effect on the health of individuals. the community—as a critical intervening Consequently, a focus on the prevalence of social process relevant to health
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