BMC Public Health Research article Perceptions of the neighbourhood environment and self rated health: a multilevel analysis of the Caerphilly Health and Social Needs Study Wouter Poortinga*1, Frank D Dunstan2 and David L Fone2 BioMed Central Open Access Address: 1Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK and 2Department of Primary Care and Public Health, Centre for Health Sciences Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK Email: Wouter Poortinga* - poortingaw@cardiff.ac.uk; Frank D Dunstan - dunstanfd@cardiff.ac.uk; David L Fone - foned@Cardiff.ac.uk * Corresponding author Published: 9 October 2007 BMC Public Health 2007, 7:285 doi:10.1186/1471-2458-7-285 This article is available from: http://www.biomedcentral.com/1471-2458/7/285 Received: 27 October 2006 Accepted: 9 October 2007 © 2007 Poortinga et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: In this study we examined whether (1) the neighbourhood aspects of access to amenities, neighbourhood quality, neighbourhood disorder, and neighbourhood social cohesion are associated with people's self rated health, (2) these health effects reflect differences in socio- demographic composition and/or neighbourhood deprivation, and (3) the associations with the different aspects of the neighbourhood environment vary between men and women. Methods: Data from the cross-sectional Caerphilly Health and Social Needs Survey were analysed using multilevel modelling, with individuals nested within enumeration districts. In this study we used the responses of people under 75 years of age (n = 10,892). The response rate of this subgroup was 62.3%. All individual responses were geo-referenced to the 325 census enumeration districts of Caerphilly county borough. Results: The neighbourhood attributes of poor access to amenities, poor neighbourhood quality, neighbourhood disorder, lack of social cohesion, and neighbourhood deprivation were associated with the reporting of poor health. These effects were attenuated when controlling for individual and collective socio-economic status. Lack of social cohesion significantly increased the odds of women reporting poor health, but did not increase the odds of men reporting poor health. In contrast, unemployment significantly affected men's health, but not women's health. Conclusion: This study shows that different aspects of the neighbourhood environment are associated with people's self rated health, which may partly reflect the health impacts of neighbourhood socio-economic status. The findings further suggest that the social environment is more important for women's health, but that individual socio-economic status is more important for men's health. Background There is growing awareness among health researchers and policy makers that the local environment is important for people's health. This has resulted in a large number of research initiatives examining the health effects associated with different social and physical aspects of the neigh- Page 1 of 10 (page number not for citation purposes)