Journal of Urban Health

, Volume 83, Issue 3, pp 523–539 | Cite as

Engaging Urban Residents in Assessing Neighborhood Environments and Their Implications for Health

  • Barbara A. Israel
  • Amy J. Schulz
  • Lorena Estrada-Martinez
  • Shannon N. Zenk
  • Edna Viruell-Fuentes
  • Antonia M. Villarruel
  • Carmen Stokes


Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.


Community-based participatory research Neighborhood assessment Qualitative and quantitative methods Stress process model 



The Healthy Environments Partnership ( is a project of the Detroit Community-Academic Urban Research Center ( We thank the members of the HEP Steering Committee for their contributions to the work presented here, including representatives from Boulevard Harambee, Brightmoor Community Center, Detroit Department of Health and Wellness Promotion, Detroit Hispanic Development Corporation, Friends of Parkside, Henry Ford Health System, Southwest Detroit Environmental Vision, Southwest Solutions, University of Detroit Mercy, and the University of Michigan Schools of Public Health, Nursing and Social Work and Survey Research Center. HEP is funded by the National Institute of Environmental Health Sciences (NIEHS), #R01 ES10936. The results presented here are solely the responsibility of the authors and do not necessarily represent the views of NIEHS. Finally, we thank Sue Andersen for her assistance with the preparation of this manuscript.


  1. 1.
    Galea S, Vlahov D. Urban health: evidence, challenges, and directions. Annu Rev Public Health. 2005;26:341–365.PubMedCrossRefGoogle Scholar
  2. 2.
    Galea S, Freudenberg N, Vlahov D. Cities and population health. Soc Sci Med. 2005;60:1017–1033.PubMedCrossRefGoogle Scholar
  3. 3.
    Stanwell Smith R. The making of an epidemiologist: John Snow before the episode of the Broad Street pump. Commun Dis Public Health. 2002;5(4):269–270.PubMedGoogle Scholar
  4. 4.
    Zenk S, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and supermarket accessibility in metropolitan Detroit. Am J Public Health. 2005;95(4):660–667.PubMedCrossRefGoogle Scholar
  5. 5.
    Schulz AJ, Northridge ME. Social determinants of health and environmental health promotion. Health Educ Behav. 2004;31(4):455–471.PubMedCrossRefGoogle Scholar
  6. 6.
    Schulz AJ, Zenk S, Kannan S, Israel BA, Koch MA, Stokes C. Community-based participatory approach to survey design and implementation: the Healthy Environments Partnership Survey. In: Israel BA, Eng E, Schulz AJ, Parker E, eds. Methods for Conducting Community-Based Participatory Research for Health. San Francisco, California: Jossey-Bass; 2005:107–127.Google Scholar
  7. 7.
    Israel BA, Schurman SJ. Social support, control and the stress process. In: Glanz K, Lewis FM, Rimer BK, eds. Health Behavior and Health Education: Theory, Research and Practice. San Francisco, California: Jossey-Bass; 1990:187–215.Google Scholar
  8. 8.
    Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001;78(3):458–467.PubMedGoogle Scholar
  9. 9.
    Schulz AJ, Kannan S, Dvonch JT, et al. Social and physical environments and disparities in risk for cardiovascular disease: the Healthy Environments Partnership conceptual model. Environ Health Perspec. 2005;113:1817–1825.CrossRefGoogle Scholar
  10. 10.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404–416.PubMedGoogle Scholar
  11. 11.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. New Engl J Med. 2002;347(20):1585–1592.PubMedCrossRefGoogle Scholar
  12. 12.
    Williams DR. Race, socioeconomic status and health. Ann N Y Acad Sci. 1999;896:173–188.PubMedCrossRefGoogle Scholar
  13. 13.
    Cooper R, Cutler JA, Desvigne-Nickens P, et al. Trends and disparities in coronary heart disease, stroke and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000;102(25):3137–3147.PubMedGoogle Scholar
  14. 14.
    Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP, Hazuda HP. All-cause and cardiovascular mortality among Mexican American and non-Hispanic white older participants in the San Antonio heart study—evidence against the “Hispanic paradox.” Am J Epidemiol. 2003;158(11):1048–1057.PubMedCrossRefGoogle Scholar
  15. 15.
    Luepker RV. Cardiovascular disease among Mexican Americans [editorial]. Am J Med. 2001;110(2):147–148.PubMedCrossRefGoogle Scholar
  16. 16.
    Pandey DK, Labarthe DR, Goff Jr. DC, Chan W, Nichaman MZ. Community-wide coronary heart disease mortality in Mexican Americans equals or exceeds that in non-Hispanic whites: the Corpus Christi Heart Project. Am J Med. 2001;110:81–87.PubMedCrossRefGoogle Scholar
  17. 17.
    Sorlie PD, Backlund E, Johnson NJ, Rogot E. Mortality by Hispanic status in the United States. JAMA. 1993;270(20):2464–2468.PubMedCrossRefGoogle Scholar
  18. 18.
    Sundquist J, Winkleby MA. Country of birth, acculturation status and abdominal obesity in a national sample of Mexican American women and men. Int J Epidemiol. 2000;29(3):470–477.PubMedCrossRefGoogle Scholar
  19. 19.
    Winkleby MA, Robinson TN, Sundquist J, Kraemer HC. Ethnic variation in cardiovascular disease risk factors among children and young adults: findings from the Third National Health and Nutrition Examination Survey. JAMA. 1999;281(11):1006–1113.PubMedCrossRefGoogle Scholar
  20. 20.
    Israel BA, Schurman SJ, House JS. Action research on occupational stress: involving workers as researchers. Int J Health Serv. 1989;19(1):135–155.PubMedGoogle Scholar
  21. 21.
    Hugentobler MK, Israel BA, Schurman SJ. An action research approach to workplace health: integrating methods. Health Educ Q. 1992;19(1):55–76.PubMedGoogle Scholar
  22. 22.
    Galea S, Schulz AJ. Methodologies for the study of urban health: how do we best assess how cities affect health? In Freudenberg N, Vlahov D, Galea S, eds. Cities and the Health of the Public. Nashville: Vanderbilt University Press; 2006; (in press).Google Scholar
  23. 23.
    Zenk S, Schulz AJ, House JS, Benjamin A, Kannan S. Application of community-based participatory research in the design of an observational tool: the neighborhood observational checklist. In: Israel BA, Eng E, Schulz AJ, Parker E, eds. Methods in Community-Based Participatory Research for Health. San Francisco, California: Jossey-Bass; 2005:167–187.Google Scholar
  24. 24.
    Israel BA, Lichtenstein R, Lantz P, et al. The Detroit Community–Academic Urban Research Center: development, implementation and evaluation. J Public Health Manag Pract. 2001;7(5):1–19.PubMedGoogle Scholar
  25. 25.
    Israel BA, Schulz AJ, Parker EA, Becker AB. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health. 2001;14(2):182–197.CrossRefGoogle Scholar
  26. 26.
    Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.PubMedCrossRefGoogle Scholar
  27. 27.
    O'Fallon LR, Dearry A. Community-based participatory research as a tool to advance environmental health sciences. Environ Health Perspect. 2002;110(2):155–159.PubMedGoogle Scholar
  28. 28.
    Farley R, Danziger S, Holzer HJ. Detroit Divided. New York: Russell Sage Foundation; 2000.Google Scholar
  29. 29.
    Sugrue TJ. The Origins of the Urban Crisis: Race and Inequality in Postwar Detroit. Princeton, New Jersey: Princeton University Press; 1996.Google Scholar
  30. 30.
    Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q. 2002;80(4):677–707.PubMedCrossRefGoogle Scholar
  31. 31.
    Glaeser EL, Vigdor JL. Racial Segregation in the 2000 Census: Promising News. Washington, District of Columbia: The Brookings Institution; 2001.Google Scholar
  32. 32.
    U.S. Census Bureau. U.S. Census 2000. 2000. Available at: Accessed June 2000.Google Scholar
  33. 33.
    City of Detroit. Planning Report: The East Sector. Preliminary Draft 1984. Detroit: Planning Department; 1984.Google Scholar
  34. 34.
    City of Detroit. Cluster 5 Demographic Profile Based on 2000 Census. Detroit: Planning and Development Department; 2000.Google Scholar
  35. 35.
    Gerald R Ford School of Public Policy. Regional Solutions to Urban Revitalization: A Policy Forum on Alternative Locations for a Detroit Metro Park. 2004. Available at: Accessed October 7, 2005.Google Scholar
  36. 36.
    Detroit News. Ambassador Bridge to Widen, Toll Roads. June 4, 2004. Available at: Accessed October 7, 2005.Google Scholar
  37. 37.
    LeClere FB, Rogers RG, Peters K. Neighborhood social context and racial differences in women's disease mortality. J Health Soc Behav. 1998;39(2):91–107.PubMedCrossRefGoogle Scholar
  38. 38.
    Ellen IG, Mijanovich T, Dillman K-N. Neighborhood effects on health: exploring the links and assessing the evidence. J Urban Aff. 2001;23(3–4):391–408.CrossRefGoogle Scholar
  39. 39.
    Pickett KE, Pearl M. Multilevel analyses of neighborhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–122.PubMedCrossRefGoogle Scholar
  40. 40.
    Waitzman NJ, Smith KR. Separate but lethal: the effects of economic segregation on mortality in metropolitan America. Milbank Q. 1998;76(3):341–373, 304.PubMedCrossRefGoogle Scholar
  41. 41.
    Anderson RT, Sorlie PD, Backlund E, Johnson NJ, Kaplan GA. Mortality effects of community socioeconomic status. Epidemiology. 1997;8(1):42–47.PubMedCrossRefGoogle Scholar
  42. 42.
    Diez-Roux AV, Nieto FJ. Epidemiology, clinical science and beyond. Epidemiology. 1997;8(4):459–461.PubMedGoogle Scholar
  43. 43.
    Morland K, Wing S, Diez-Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23–29.PubMedCrossRefGoogle Scholar
  44. 44.
    Raudenbush SW. The quantitative assessment of neighborhood social environments. In: Kawachi I, Berkman L, eds. Neighborhoods and Health. Oxford University Press; 2003:112–131.Google Scholar
  45. 45.
    Caughy MO, O'Campo PJ, Patterson J. A brief observational measure for urban neighborhoods. Health and Place. 2001;7(3):225–236.PubMedCrossRefGoogle Scholar
  46. 46.
    McEwen BS. The End of Stress as We Know It. Washington, District of Columbia: Joseph Henry; 2002.Google Scholar
  47. 47.
    Karasek RT, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands and cardiovascular disease: a prospective study of Swedish men. Am J Public Health. 1981;71(7):694–705.PubMedCrossRefGoogle Scholar
  48. 48.
    Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS. Price of adaptation-allostatic load and its health consequences: MacArthur studies of successful aging. Arch Intern Med. 1997;157(19):2259–2268.PubMedCrossRefGoogle Scholar
  49. 49.
    Selye H. The Stress of Life. New York: McGraw-Hill; 1956.Google Scholar
  50. 50.
    French JRP, Kahn R. A programmatic approach to studying the industrial environment and mental health. J Soc Issues. 1962;18:1–48.CrossRefGoogle Scholar
  51. 51.
    House JS. Work Stress and Social Support. Reading, Massachusetts: Addison-Wesley; 1981.Google Scholar
  52. 52.
    Katz D, Kahn R. The Social Psychology of Organizations. 2nd ed. New York: Wiley; 1978.Google Scholar
  53. 53.
    Baker EA, Israel BA, Schurman SJ. The integrated model: implications for worksite health promotion and occupational health and safety practice. Health Educ Q. 1996;23(2):175–190.PubMedGoogle Scholar
  54. 54.
    Israel BA, Checkoway BN, Schulz AJ, Zimmerman MA. Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control. Health Educ Q. 1994;21(2):149–170.PubMedGoogle Scholar
  55. 55.
    Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 2nd ed. Thousand Oaks, California: Sage; 1998.Google Scholar
  56. 56.
    Williams DR, Yu Y, Jackson J, Anderson NB. Racial differences in physical and mental health: socioeconomic status, stress and discrimination. J Health Psychol. 1997;2(3):335–351.CrossRefGoogle Scholar
  57. 57.
    Morgan DL, Krueger RA. The Focus Group Kit. Thousand Oaks, California: Sage; 1997.Google Scholar
  58. 58.
    Denzin NK, Lincoln YS, (eds.). Handbook of Qualitative Research. 2nd ed. Thousand Oaks, California: Sage; 2000.Google Scholar
  59. 59.
    Schulz AJ, Parker EA, Israel BA, Becker AB, Maciak BJ, Hollis R. Conducting a participatory community-based survey: collecting and interpreting data for a community health intervention on Detroit's east side. J Public Health Manag Pract. 1998;4(2):10–24.PubMedGoogle Scholar
  60. 60.
    Israel BA, Farquhar SA, Schulz AJ, James SA, Parker EA. The relationship between social support, stress and health among women on Detroit's east side. Health Educ Behav. 2002;29(3):342–360.PubMedGoogle Scholar
  61. 61.
    Schulz AJ, Parker EA, Israel BA, DeCarlo M, Lockett M. Addressing social determinants of health through community-based participatory research: the East Side Village Health Worker Partnership. Health Educ Behav. 2002;29(3):326–341.PubMedCrossRefGoogle Scholar
  62. 62.
    Schulz AJ, Israel BA, Parker EA, Lockett M, Hill Y, Wills R. The East Side Village Health Worker Partnership: integrating research with action to reduce health disparities. Public Health Rep. 2001;116(6):548–557.PubMedGoogle Scholar
  63. 63.
    Kieffer EC, Salabarría-Peña Y, Odoms-Young A, Willis S, Baber K, Guzman JR. The application of focus group methodologies to community-based participatory research. In: Israel BA, Eng E, Schulz AJ, Parker E, eds. Methods in Community-Based Participatory Research for Health. San Francisco, California: Jossey-Bass; 2005:146–166.Google Scholar
  64. 64.
    Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine; 1967.Google Scholar
  65. 65.
    Caldwell CH, Zimmerman MA, Bernat DH, Sellers RM, Notaro PC. Racial identity, maternal support, and psychological distress among African American adolescents. Child Dev. 2002;73(4):1322–1336.PubMedCrossRefGoogle Scholar
  66. 66.
    Sellers RM, Caldwell CH, Schmelke-Cone KH, Zimmerman MA. Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Social Behav. 2003;44(3):302–317.CrossRefGoogle Scholar
  67. 67.
    Pardo MS. Mexican American Women as Activists: Identity and Resistance in Two Los Angeles Communities. Philadelphia: Temple University Press; 1998.Google Scholar
  68. 68.
    Farquhar S. Effects of the perceptions and observations of environmental stressors on health and well-being in residents of eastside and southwest Detroit, Michigan [Doctoral Dissertation]. Ann Arbor, Michigan: School of Public Health, University of Michigan; 2000.Google Scholar
  69. 69.
    Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277(5328):918–924.PubMedCrossRefGoogle Scholar
  70. 70.
    Strogatz DS, James SA. Social support and hypertension among blacks and whites in a rural, southern community. Am J Epidemiol. 1986;124(6):949–956.PubMedGoogle Scholar
  71. 71.
    Pargament KI, Koenig HG, Perez L. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56(4):519–543.PubMedCrossRefGoogle Scholar
  72. 72.
    Parker EA, Lichtenstein RL, Schulz AJ, et al. Disentangling measures of individual perceptions of community social dynamics: results of a community survey. Health Educ Behav. 2001;28(4):462–486.PubMedCrossRefGoogle Scholar
  73. 73.
    Centers for Disease Control. Behavioral risk factor surveillance system survey questionnaire. 1994. Available at: http://www.cdc.gpv/brfss/questionnaires/english.htm.Google Scholar
  74. 74.
    Centers for Disease Control and Prevention. The National Health and Nutrition Examination Survey Questionnaire. 1999. Available at: Accessed June 8, 2004.Google Scholar
  75. 75.
    Wittchen H-U. Reliability and validity studies of the WHO composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res. 1994;28(1):57–84.PubMedCrossRefGoogle Scholar
  76. 76.
    World Health Organization. International Classification of Diseases (ICD-10). Geneva: WHO; 1991.Google Scholar

Copyright information

© The New York Academy of Medicine 2006

Authors and Affiliations

  • Barbara A. Israel
    • 1
  • Amy J. Schulz
  • Lorena Estrada-Martinez
  • Shannon N. Zenk
  • Edna Viruell-Fuentes
  • Antonia M. Villarruel
  • Carmen Stokes
  1. 1.University of Michigan School of Public HealthAnn ArborUSA

Personalised recommendations