Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1068–1077 | Cite as

Neighborhood Environment and Health of Injured Urban Black Men

  • Aimee J. Palumbo
  • Douglas J. Wiebe
  • Nancy Kassam-Adams
  • Therese S. RichmondEmail author



Urban black males are at disproportionately high risk of poor health outcomes; thus, we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics.


In 2017–2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30 days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants.


Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants’ neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings, and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors.


We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.


Neighborhood environment Neighborhood perception Mental health Physical health Black men Injury 



The authors acknowledge Jessica Webster, Andrew Robinson, and Vicky Tam for their assistance in data collection and management.

Authors Contributions

Dr. Palumbo conceived of the study and led the analysis and write-up. Dr. Wiebe provided statistical analysis support; Dr. Kassam-Adams and Dr. Richmond provided subject matter expertise and guidance based on knowledge of study population. All authors provided substantial input into analysis and final write-up of results and have approved this manuscript.

Funding Information

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR013503 (PI: Richmond). Dr. Palumbo was supported in part by the Penn Injury Science Center and the Centers for Disease Control (grant no. R49CE002474).

Compliance with Ethical Standards

The study was approved by the Institutional Review Board at the University of Pennsylvania (IRB Protocol #814745).

Conflict of Interest

The authors declare that they have no conflict of interest.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Centers for Disease Control.

Supplementary material

40615_2019_609_MOESM1_ESM.docx (1 mb)
Supplementary Figure 1 (DOCX 1053 kb)
40615_2019_609_MOESM2_ESM.docx (23 kb)
Supplementary Table 1 (DOCX 22 kb)
40615_2019_609_MOESM3_ESM.docx (19 kb)
Supplementary Table 2 (DOCX 19 kb)
40615_2019_609_MOESM4_ESM.docx (17 kb)
Supplementary Table 3 (DOCX 16 kb)
40615_2019_609_MOESM5_ESM.docx (16 kb)
Supplementary Table 4 (DOCX 15 kb)


  1. 1.
    Cassel J. The contribution of the social environment to host resistance: the fourth Wade Hampton Frost lecture. Am J Epidemiol. 1976;104:107–23.CrossRefGoogle Scholar
  2. 2.
    Krieger N. Got theory? On the 21st c. CE rise of explicit use of epidemiologic theories of disease distribution: a review and ecosocial analysis. Curr Epidemiol Rep. 2014;1:45–56. Scholar
  3. 3.
    Taylor SE, Repetti RL, Seeman T. Health psychology: what is an unhealthy environment and how does it get under the skin? Annu Rev Psychol. 1997;48:411–47. Scholar
  4. 4.
    Yen George AIHK. Neighborhood social environment and risk of death: multilevel evidence from the Alameda County study. Am J Epidemiol. 1999;149:898–907.CrossRefGoogle Scholar
  5. 5.
    Stafford M, Marmot M. Neighbourhood deprivation and health: does it affect us all equally? Int J Epidemiol. 2003;32:357–66. Scholar
  6. 6.
    LeClere FB, Rogers RG, Peters KD. Ethnicity and mortality in the United States: individual and community correlates. Soc Forces. 1997;76:169–98.CrossRefGoogle Scholar
  7. 7.
    Izumi BT, Zenk SN, Schulz AJ, Mentz GB, Wilson C. Associations between neighborhood availability and individual consumption of dark-green and orange vegetables among ethnically diverse adults in Detroit. J Am Diet Assoc. 2011;111:274–9. Scholar
  8. 8.
    McGinn AP, Evenson KR, Herring AH, Huston SL, Rodriguez DA. Exploring associations between physical activity and perceived and objective measures of the built environment. J Urban Health. 2007;84:162–84. Scholar
  9. 9.
    Bird CE, Seeman TE, Escarce JJ, Basurto-Davila R, Finch BK, Dubowitz T, et al. Neighbourhood socioeconomic status and biological “wear and tear” in a nationally representative sample of US adults. J Epidemiol Community Health. 2010;64:860–5. Scholar
  10. 10.
    Yen IH, Syme SL. The social environment and health: a discussion of the epidemiologic literature. Annu Rev Public Health. 1999;20:287–308. Scholar
  11. 11.
    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: social processes and new directions in research. Annu Rev Sociol. 2002;28:443–78. Scholar
  12. 12.
    Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125–45. Scholar
  13. 13.
    Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35:80–94.CrossRefGoogle Scholar
  14. 14.
    Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51:S28–40.CrossRefGoogle Scholar
  15. 15.
    Massey DS, Rothwell J, Domina T. The changing bases of segregation in the United States. Ann Am Acad Pol Soc Sci. 2009;626:74–90. Scholar
  16. 16.
    Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts. Am J Public Health. 2005;95:260–5. Scholar
  17. 17.
    Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandorio TJ, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3:e260. Scholar
  18. 18.
    Adler NE, Rehkopf DH. U.S. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235–52. Scholar
  19. 19.
    Williams DR, González HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites. Arch Gen Psychiatry. 2007;64:305–15.CrossRefGoogle Scholar
  20. 20.
    Gong Y, Palmer S, Gallacher J, Marsden T, Fone D. A systematic review of the relationship between objective measurements of the urban environment and psychological distress. Environ Int. 2016;96:48–57. Scholar
  21. 21.
    Chow JC, Jaffee K, Snowden L. Racial/ethnic disparities in the use of mental health services in poverty areas. Am J Public Health. 2003;93:792–7. Scholar
  22. 22.
    Kim D. Blues from the neighborhood? Neighborhood characteristics and depression. Epidemiol Rev. 2008;30:101–17. Scholar
  23. 23.
    Sampson RJ, Raudenbush SW. Seeing disorder : neighborhood stigma and the social construction of “Broken Windows” Author ( s ): Robert J . Sampson and Stephen W . Raudenbush Published by : American Sociological Association Stable URL : Soc Psychol Q. 2004;67:319–42.CrossRefGoogle Scholar
  24. 24.
    Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91:1783–9.CrossRefGoogle Scholar
  25. 25.
    Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001;42:258–76. Scholar
  26. 26.
    Feldman PJ, Steptoe A. How neighborhoods and physical functioning are related: the roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors. Ann Behav Med Publ Soc Behav Med. 2004;27:91–9. Scholar
  27. 27.
    Franzini L, Caughy M, Spears W, Fernandez Esquer ME. Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: a multilevel latent variables model. Soc Sci Med. 2005;61:1135–50. Scholar
  28. 28.
    Schulz AJ, Mentz G, Lachance L, Zenk SN, Johnson J, Stokes C, et al. Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk? Health Place. 2013;24:147–56. Scholar
  29. 29.
    Wen M, Hawkley LC, Cacioppo JT. Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: an analysis of older adults in Cook County, Illinois. Soc Sci Med. 2006;63:2575–90. Scholar
  30. 30.
    Wilson-Genderson M, Pruchno R. Effects of neighborhood violence and perceptions of neighborhood safety on depressive symptoms of older adults. Soc Sci Med. 2013;85:43–9. Scholar
  31. 31.
    Weden MM, Carpiano RM, Robert SA. Subjective and objective neighborhood characteristics and adult health. Soc Sci Med. 2008;66:1256–70. Scholar
  32. 32.
    Orstad SL, McDonough MH, Stapleton S, Altincekic C, Troped PJ. A systematic review of agreement between perceived and objective neighborhood environment measures and associations with physical activity outcomes. Environ Behav. 2017;49:904–32. Scholar
  33. 33.
    Rich JA, Grey CM. Pathways to recurrent trauma among young black men: traumatic stress , substance use, and the “code of the street.”. Am J Public Health. 2005;95:816–24.CrossRefGoogle Scholar
  34. 34.
    Jiang T, Webster JL, Robinson A, Kassam-Adams N, Richmond TS. Emotional responses to unintentional and intentional traumatic injuries among urban black men: a qualitative study. Injury. 2018;49:983–9. Scholar
  35. 35.
    U.S. Census Bureau. American Community Survey 2015: B02001 - race. Am. FactFinder. Available from:
  36. 36.
    U.S. Census Bureau. American Community Survey 2011–2015: B17001 - Poverty status in the past 12 months by sex and age. Am. FactFinder. Available from:
  37. 37.
    National Center for Health Statistics. Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin: United States, selected years 1900–2014. Available from:
  38. 38.
    Crum RM, Lillie-Blanton M, Anthony JC. Neighborhood enviroment and opportunity to use cocaine and other drugs in late childhood and early adolescence. Drug Alcohol Depend. 1996;43:155–61.CrossRefGoogle Scholar
  39. 39.
    Sharkey P, Faber JW. Where, when, why, and for whom do residential contexts matter? Moving away from the dichotomous understanding of neighborhood effects. Annu Rev Sociol. 2014;40:559–79. Scholar
  40. 40.
    Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep. 1994;109:665–72.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey questionnaire. Atlanta, GA;Google Scholar
  42. 42.
    Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR. Obesity and quality of life: mediating effects of pain and comorbidities. Obes Res. 2003;11:209–16. Scholar
  43. 43.
    Dube SR, Rishi S. Utilizing the salutogenic paradigm to investigate well-being among adult survivors of childhood sexual abuse and other adversities. Child Abuse Negl. 2017;66:130–41. Scholar
  44. 44.
    Muthén LK, Muthén BO. MPlus User’s guide. 7th ed. Muthén & Muthén; 2012.Google Scholar
  45. 45.
    Bewick V, Cheek L, Ball J. Statistics review 14: logistic regression. Crit Care. 2005;9:112–8. Scholar
  46. 46.
    Chaskin RJ, Joseph ML. Social interaction in mixed-income developments: relational expectations and emerging reality. J Urban Aff. 2011;33:209–37. Scholar
  47. 47.
    Gibbons J, Barton MS. The Association of minority self-rated health with black versus white gentrification. J Urban Health. 2016;93:909–22. Scholar
  48. 48.
    Richardson J, Mitchell B, Franco J. Shifting neighborhoods: gentrification and cultural displacement in American cities. Washington, D.C.; 2019.Google Scholar
  49. 49.
    Ding L, Hwang J, Divringi E. Gentrification and residential mobility in Philadelphia Lei Ding Federal Reserve Bank of Philadelphia. Philadelphia, PA.Google Scholar
  50. 50.
    Franzini L, Caughy MOB, Nettles SM, O’Campo P. Perceptions of disorder: contributions of neighborhood characteristics to subjective perceptions of disorder. J Environ Psychol. 2008;28:83–93. Scholar
  51. 51.
    Basta LA, Richmond TS, Wiebe DJ. Neighborhoods, daily activities, and measuring health risks experienced in urban environments. Soc Sci Med. 2010;71:1943–50. Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Penn Injury Science CenterUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.College of Public HealthTemple UniversityPhiladelphiaUSA
  3. 3.Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Center for Injury Research and PreventionChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.School of NursingUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations