The concept of neighborhood in health and mortality research

The focus of health and mortality research is changing from individual-leve l frameworks and analyses of disease causation to multilevel frameworks and analyses that incorporate both individual and environmental or contextual explanations. This research explores the meaning of neighborhood-the contex tual-level variable used most often in health and mortality research-and di scusses how neighborhood effects are related to health and mortality outcom es. A conceptual model that proposes the pathways through which neighborhoo d effects operate to influence health and mortality differentials is develo ped. Neighborhoods have a social as well as a spatial dimension, and geogra phically smaller neighborhoods often provide a more accurate measurement of neighborhood effects. Neighborhoods affect health and mortality outcomes p rimarily in an indirect fashion through proximate determinants such as smok ing, diet, exercise, stress, and access to health insurance and medical pro viders.