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Neighborhood Safety & Cohesion

Perceptions of one’s neighborhood, such as feeling unsafe in one`s neighborhood or lack of neighborhood cohesion, have been linked to poorer physical health (Robinette, Charles, & Gruenewald, 2016; Murayama, Fujiwara, & Kawachi, 2012; Robinette, Charles, Mogle, & Almeida, 2013). Objective aspects of neighborhoods, such as crime statistics and income, are also often assessed and associated with health (Weden, Carpiano, & Robert, 2008). However, here we focus on measures to assess subjective reports of neighborhood qualities, given evidence that neighborhood perceptions may show particularly strong links with health outcomes compared to objective assessments (Weden, Carpiano, & Robert, 2008).

Several aspects of neighborhood environment have been proposed as relevant for health outcomes. For example, lack of neighborhood social cohesion has been associated with self-rated physical health and physical symptoms (Murayama, Fujiwara, & Kawachi, 2012; Robinette, Charles, Mogle, & Almeida, 2013). However, reliable and valid measures have been scarce. The most frequently used measure, developed by Sampson, Raudenbush, and Earls (1997), consists of 5 items rated on a five-point scale (“people around here are willing to help their neighbors,” “this is a close-knit neighborhood,” “people in this neighborhood can be trusted,” “people in this neighborhood generally don’t get along with each other,” and “people in this neighborhood do not share the same values”). Variations of a subset of these items have also been used in some large-scale samples (e.g., the Midlife in the United States (MIDUS) study: “I could call on a neighbor for help if I needed it; People in my neighborhood trust each other”).


Another important feature of neighborhood environment is perceived neighborhood safety. Feeling unsafe in one’s neighborhood has been associated with later chronic health conditions (Robinette, Charles, & Gruenewald, 2016). No state-of-the art measures exist, but previously tested items assessed global perceptions of neighborhood safety, such as “…how safe do you feel walking alone in your neighborhood?”, which is rated by participants for both daytime and night-time (De Jesus, Puleo, Shelton, & Emmons, 2010). Slight variations have also been used in some large-scale studies. For example, the Midlife in the United States (MIDUS) study assessed participants` ratings of “I feel safe being out alone in my neighborhood during the daytime” and “I feel safe being out alone in my neighborhood at night” (based on Keyes, 1998).

A closely related concept is perceived neighborhood disorder – the degree to which there is a lack of safety, peace, social control, and observance of the law in the neighborhood. Ross and Mirowsky (1999) developed the 15-item Neighborhood Disorder Scale, which assesses aspects of physical order/disorder (e.g., graffiti, vandalism, cleanliness) as well as social order/disorder (e.g., drug use in neighborhood, police protection), which includes perceptions of safety (e.g., “My neighborhood is safe”). Perceived neighborhood safety and neighborhood disorder have been associated with physiological risk factors such as flatter diurnal cortisol slopes (Do et al., 2011; Karb, Elliott, Dowd, & Morenoff, 2012) and telomere shortness, even after adjusting for demographic and socioeconomic characteristics (Park, Verhoeven, Cuijpers, Reynolds Iii, & Penninx, 2015).

Other self-reported neighborhood characteristics have also been examined. For example, Mujahid and colleagues (2007) have developed psychometrically and econometrically valid subscales for social cohesion (4 items) and safety (3 items), aspects of aesthetic quality (6 items), walking environment (10 items), availability of healthy foods (4 items), violence (4 items), and activities with neighbors (5 items), and similar scales have been developed for other countries, as well as for urban vs rural regions.

Author(s) and Reviewer(s):

Prepared by Stefanie Mayer, PhD. Reviewed by Ana Diex-Roux, MD, PHD, MPH, Mahasin Mujahid, PhD, MS, FAHA, Belinda Needham, PhD, MA and Barbara Laraia, PhD, MPH, RD. If you have any comments on these measures, email Version date: February 2018


De Jesus, M., Puleo, E., Shelton, R. C., & Emmons, K. M. (2010). Associations between perceived social environment and neighborhood safety: Health implications. Health & Place, 16(5), 1007-1013.

Do, D. P., Diez Roux, A. V., Hajat, A., Auchincloss, A. H., Merkin, S. S., Ranjit, N., … Seeman, T. (2011). Circadian rhythm of cortisol and neighborhood characteristics in a population-based sample: The Multi-Ethnic Study of Atherosclerosis. Health & Place, 17(2), 625–632.

Karb, R. A., Elliott, M. R., Dowd, J. B., & Morenoff, J. D. (2012). Neighborhood-level stressors, social support, and diurnal patterns of cortisol: The Chicago Community Adult Health Study. Social Science & Medicine, 75(6), 1038–1047.

Keyes, C.L.M., 1998. Social well-being. Soc. Psychol. Q. 61, 121–137, retrieved from (

Mujahid, M. S., Diez Roux, A. V., Morenoff, J. D., & Raghunathan, T. (2007). Assessing the measurement properties of neighborhood scales: from psychometrics to ecometrics. American journal of epidemiology, 165(8), 858-867.

Murayama, H., Fujiwara, Y., Kawachi, I. (2012). Social capital and health: A review of prospective multilevel studies. J Epidemiol, 22(3), 179-187.

Park, M., Verhoeven, J. E., Cuijpers, P., Reynolds Iii, C. F., & Penninx, B. W. J. H. (2015). Where You Live May Make You Old: The Association between Perceived Poor Neighborhood Quality and Leukocyte Telomere Length. PloS One, 10(6), e0128460.

Robinette, J. W., Charles, S. T., Almeida, D. M., & Gruenewald, T. L. (2016). Neighborhood features and physiological risk: An examination of allostatic load. Health & Place, 41, 110-118.

Robinette, J. W., Charles, S. T., Mogle, J. A., & Almeida, D. M. (2013). Neighborhood cohesion and daily well-being: Results from a diary study. Social Science & Medicine, 96, 174-182.

Ross, C. E., & Mirowsky, J. (1999). Disorder and decay: The concept and measurement of perceived neighborhood disorder. Urban Affairs Review, 34(3), 412-432.

Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277(5328), 918-924.

Weden, M. M., Carpiano, R. M., & Robert, S. A. (2008). Subjective and objective neighborhood characteristics and adult health. Social science & medicine, 66(6), 1256-1270.

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