BMC Public Health 2007, 7:285 http://www.biomedcentral.com/1471-2458/7/285 Table 4: Odds ratios (OR) and 95% Confidence Intervals (CI) of reporting poor health for male and female respondents. Model 1: Socio-demographics(1) Age Social class (I & II) III NM III M IV & V Other Employment status (employed) Unemployed Retired Disabled Other Household tenure (homeowner) Non-homeowner Model 2b: Adjusted for socio-demographics(2 3) Access to amenities Neighbourhood quality Neighbourhood disorder Social cohesion Deprivation OR 1.02 1.03 1.41 1.56 1.22 1.79 2.44 20.92 1.53 1.57 1.10 1.20 1.12 1.05 1.21 Male 95% CI 1.02–1.03 0.79–1.34 1.17–1.69 1.27–1.91 0.79–1.89 1.27–2.53 1.97–3.03 16.07–27.24 1.04–2.25 1.30–1.89 1.03–1.18 1.12–1.29 1.05–1.21 0.97–1.13 1.11–1.31 p <0.001 0.834 <0.001 <0.001 0.358 <0.001 <0.001 <0.001 0.032 <0.001 0.007 <0.001 0.001 0.221 <0.001 OR 1.02 1.05 1.19 1.29 1.51 1.00 2.26 17.59 1.48 1.57 1.09 1.17 1.11 1.12 1.16 Female 95% CI 1.02–1.03 0.88–1.25 0.93–1.52 1.08–1.54 1.15–1.98 0.62–1.62 1.87–2.75 13.83–22.37 1.22–1.81 1.34–1.84 1.03–1.16 1.09–1.24 1.04–1.18 1.06–1.19 1.08–1.24 p <0.001 0.610 0.159 0.005 0.003 0.984 <0.001 <0.001 <0.001 <0.001 0.003 <0.001 0.002 <0.001 <0.001 (1) Reference groups are given in brackets. (2) The neighbourhood measures were included as z-scores, with higher values representing a more negative evaluation. (3) The odds ratios are expressed for each SD increase. [1,5,13,17,19,46]. Overall, the contextual effects of the different aspects of the physical and social environment could be considered modest, in particular when simulta- neously controlling for socio-demographic differences and neighbourhood deprivation. In this context it has to be kept in mind that because of its large sample size the study has the statistical power to detect small neighbour- hood effects. However, neighbourhood health effects are generally found to be small [5,6,17,28], and therefore large sample sizes are required to detect these effects. It also has to be considered that this study may have under- estimated the size of neighbourhood effects through over- adjustment. While individual level variables are often seen as confounders, they could in some cases be concep- tualized as mediators. That is, neighbourhoods may influ- ence the life chances of individuals through their effects on achieved income and education, as well as through other residential segregation and selection processes [47]. The results of this study further suggest that the interpre- tation of the possible health effects of social and physical aspects of the environment may not be straightforward. We found that the health effects of neighbourhood qual- ity, neighbourhood disorder, and social cohesion are sub- stantially attenuated when controlling for individual and collective socio-economic status. This suggests that, instead of being aspects of the neighbourhood environ- ment that independently contribute to people's health, they may mediate or reflect differences in socio-economic status. Unfortunately, the difference between mediation and confounding can not be shown using statistical meth- ods alone, and a decision can only be made based on the- ory [48]. There is a need for more detailed analyses to determine the specific associations between neighbour- hood deprivation and the quality of the social and physi- cal environment, as well as the different possible pathways that link them to health. In either case, the results show that neighbourhood deprivation is associ- ated with worse neighbourhood disorder, poorer neigh- bourhood quality, and less social cohesion. The gender-stratified analyses show that a lack of social cohesion significantly increases the odds of women reporting poor health, but not the odds of men reporting poor health. In contrast, unemployment appeared more detrimental to men's than to women's health. These find- ings are similar to a number of recent studies, and suggest that whilst social aspects of the residential environment are more important for women, individual socio-eco- nomic status is more important for men [27-29]. It has been hypothesised that the neighbourhood environment is more important for women because they spend more time at home looking after children, doing domestic work or being primary carers [28]. Although we found that women were indeed more likely to look after the home and/or children, the contextual effects of neighbourhood Page 7 of 10 (page number not for citation purposes)