摘要：Objectives. We explored the relationship between boarded-up housing and rates of gonorrhea and premature mortality. Methods. In this ecological study of 107 US cities, we developed several models predicting rates of gonorrhea and premature death before age 65 from all causes and from specific causes. We controlled for race, poverty, education, population change, and health insurance coverage. Results. Boarded-up housing remained a predictor of gonorrhea rates, all-cause premature mortality, and premature mortality due to malignant neoplasms, diabetes, homicide, and suicide after control for sociodemographic factors. Conclusions. Boarded-up housing may be related to mortality risk because of its potential adverse impact on social relationships and opportunities to engage in healthful behaviors. Neighborhood physical conditions deserve further consideration as a potential global factor influencing health and well-being. We give shape to our buildings, and they in turn shape us. Winston Churchill, in a 1943 speech to the House of Commons In a substantial body of work, Wallace and colleagues have identified the deterioration of inner cities as contributing to the spread of HIV and tuberculosis, violence, and a variety of health disparities. 1– 4 These studies highlight the potential importance of the physical environment in influencing health. The physical aspects of a neighborhood create opportunities for people to interact and to informally monitor one another’s behavior. Neighborhoods are where people exercise and purchase their foodstuffs and other consumer products (including illegal substances). Local neighborhood resources are likely to be more important for persons of lower income, because more affluent people have greater mobility, allowing them to travel farther to obtain healthful products as well as social support. Causal relationships are believed to exist between crime and the appearance and design of buildings and streets. 5– 7 Physical structures apparently provide cues to potential criminals as to whether they can behave criminally without being apprehended. Cues from the physical environment that influence criminal behavior come from entire neighborhoods, city blocks, buildings, and portions of buildings. For example, high-rise housing projects experience more crime than low-rise housing projects in a linear fashion—the higher the building, the higher the crime rate. 8 When buildings have more than 50 apartments, residents often treat each other as strangers. This makes them more vulnerable to crime, as residents are less likely to challenge criminals when they enter the building. 9 Houses are more likely to be burglarized if they are in areas with higher speed limits and have fewer fences or other barriers, fewer signs of being occupied, and less visual access to neighboring homes. 8 Although no randomized controlled studies have irrefutably proven a link between crime and the condition of the environment, the possibility of such a link has spawned a movement to prevent crime through environmental controls, such as removing graffiti, trash on the street, and abandoned cars—the so-called broken windows approach to crime prevention. There is some evidence that the physical environment has other effects on health and well-being, including effects on mental health and child development. A study examining the emotional adjustment of children aged 9 to 11 years indicated that children living on commercial streets in inner-city neighborhoods were more lonely, fearful, and unhappy than their counterparts in strictly residential neighborhoods, after family composition and social class were controlled. 10 In another study, adolescents who lived in neighborhoods that were considered dangerous and were marked by graffiti, low residential stability, and low socioeconomic status had higher levels of depression, anxiety, and conduct disorders than those from more ordered neighborhoods, even after controlling for socioeconomic status. 11 Opportunities for social interaction and physical activity, as well as cues from the environment, may trigger a variety of emotional responses and either facilitate or reduce health-related behaviors such as exercising, indulging in substance use, and maintaining a healthy diet. Architectural design is also known to affect the type and number of social networks a person might have through the opportunities it affords (or fails to afford) to interact with others. One study comparing dormitory designs showed that students living in a building with a central access area developed more extensive social networks than students living in dormitories with more isolated entryways. 12 A study of residents in the Washington Heights section of New York indicated that a deteriorated neighborhood interfered with the community’s ability to organize and form relationships. 13 Maintaining social relationships (including social and support networks) and a sense of social trust is believed to significantly influence health outcomes. 14, 15 It is certainly plausible that if physical structures increase criminal behavior either directly by increasing opportunities to commit crime or indirectly by limiting informal social controls, physical structures may also influence social controls and social relationships related to health behaviors. Figure 1 ▶ illustrates how the relationship between the social and physical environments may affect health by inhibiting or facilitating risk-taking behavior, by influencing social relationships, and by exposing residents to visual cues that can arouse fear, anxiety, and depression. Open in a separate window FIGURE 1— Environmental influences on health. In an earlier study in New Orleans, we found that gonorrhea rates were associated with degree of neighborhood deterioration at the level of the census block group. 16 To further investigate the generalizability of the relationship between the physical environment and health, we conducted an ecological study of the relationship between neighborhood deterioration and health in 107 US cities.
