Moving Neighborhoods and Health Research Forward: Using Geographic Methods to Examine the Role of Spatial Scale in Neighborhood Effects on Health.

A rich history of research documents the effects of neighborhood-level socioeconomic status (SES) conditions on health outcomes. Recent criticism of the neighborhoods and health literature, however, has stressed several conceptual and methodological challenges not adequately addressed in previous research. Critics suggest that early work on neighborhoods and health gave little thought to the spatial scale at which SES factors influence a specific health outcome. This article discusses the concept of neighborhoods and health, reviews recent criticisms of existing work, and provides a case study that exemplifies how geographic methods can address one such criticism. Using data on birth defects in North Carolina, the case study examines the relation of SES to orofacial clefts (cleft lip and cleft palate) at different spatial scales. The Brown-Forsythe test is used to select optimal neighborhood size. Results are evaluated using logistic regression models to examine the relationship between SES measures and orofacial clefts, controlling for individual-level risk factors. Results indicate modest associations between neighborhood-level measures of poverty and cleft palate but no associations with cleft lip with or without cleft palate.