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The interplay between neighbourhood characteristics: the health impact of changes in social cohesion, disorder and unsafety feelings.

Ruijsbroek, A., Droomers, M., Hardyns, W., Groenewegen, P.P., Stronks, K. The interplay between neighbourhood characteristics: the health impact of changes in social cohesion, disorder and unsafety feelings. Health & Place: 2016, 39(1), 1-8
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Background
Area crime and perceived safety are two components of social safety that are presumed to affect individual health and health related behaviour. So far, most studies have used cross-sectional data to study this relation. We have investigated changes in social safety in relation to self-rated general health and physical activity (PA), in order to provide support for a causal relationship between social safety and health. Additionally, we investigated whether social cohesion modifies this relation.

Methods
The Dutch Housing Survey 2012 provided information on selfreported health and physical activity of 47,926 respondents living in 3,469 4-digit postal code areas. Area crime, area-level perceived safety feelings and social cohesion were obtained from the Dutch Safety Monitors 2009 and 2012, and aggregated to the area level using ecometrics. Multilevel logistic regression analyses were used to study whether social safety in 2009 and changes in social safety between 2009 and 2011 were associated with individual general health and PA in 2012. Furthermore, we examined whether social cohesion modifies the latter relation. All analyses were adjusted for age, sex, educational level, income, household composition, ethnicity, and urbanity of the municipality. The analyses with changes in crime and unsafety feelings were corrected additionally for crime and unsafety feelings, and health / PA at baseline.

Results
An increase in unsafety feelings between 2009 and 2011 resulted in more people reporting poor general health in 2012 in that area, but was not related to physical inactivity. An increase in area crime levels was unrelated to both poor general health and physical inactivity. The social cohesion in the area did not modify the effect of changes in social safety on health and PA.

Conclusion
This study provides some support for a causal relationship between area-level safety feelings and general health. We found no evidence for a causal relation between area level social safety and PA or between area crime and general health. Social cohesion did not protect against the negative health effects of neighbourhood unsafety. The results reported here provide indications to suggest that tackling feelings of unsafety in an area might contribute to a better general health of the residents.