Neighborhood disorder and smoking: findings of a European urban survey.

Using the Large Analysis and Review of European housing and health Status (LARES) survey, this paper investigates the influence of neighborhood physical disorder on smoking behaviors, and the extent to which it is mediated by perceptions of safety. Indicators of physical disorder: litter, graffiti, and the absence of vegetation on facades, balconies or windows, were directly observed by surveyors. The paper also considers whether the place effects on smoking are similar across the 7 European cities in the study. Results indicate that the odds of smoking are 64% higher for those living in an area rated high on neighborhood disorder compared to low. The effect is substantially greater for men than for women with men in areas rated high on disorder showing odds of smoking that are twice as high as those living in areas rated low. The association does not vary by city of residence. Only a small part of the effect of neighborhood disorder is mediated by perceptions of safety. The finding of a substantial neighborhood physical disorder effect on smoking across a range of cities in Europe adds to the evidence suggesting that environmental interventions are worth pursuing in conjunction with other approaches to smoking prevention.