BMC Public Health 2009, 9:221 http://www.biomedcentral.com/1471-2458/9/221 tive impact on well-being and indirectly on health [50]. The two composite dimension; 'structural indicators of social disorder' and 'contact with disorderly behaviour' both reflect the construct collective efficacy introduced by Sampson [51], and defined as the linkage of social control and cohesion that reproduces the norms for behaviour in neighbourhood environments. Several studies demon- strate that where the rules of behaviour are unclear, resi- dents will experience mistrust and safety-related concerns. Poor social and economic resources and residential insta- bility in a neighbourhood have been found to be strongly associated with violence mediated by low collective effi- cacy [52-54]. This pattern could be applicable to the present study; in the areas with comparatively high vio- lence-related crime rates (blocks of flats), the levels of education and income were lower, and the density of the residents and the mobility rate were higher than for areas with low violence rates (small-scale housing areas). The occurrence of violence in the immediate environment may generate a situation where it is harder for residents to build trustworthy bonds with their neighbours [54]. If social disturbances are reported and communicated regu- larly from particular areas in the local media, this negative information will accumulate over time and have a nega- tive impact on the image of a specific area and partly mould its identity among its residents. In accordance with previous studies, we found that female gender was strongly associated with the composite dimen- sion 'existential insecurity' (to feel unsafe during the day or in the evening or at night and fear of crime). It is possi- ble that this dimension reflects an individual vulnerabil- ity, in contrast to the other concepts, which is derived from determinants in physical space and the built envi- ronment to a higher extent [55]. It is also known that per- sons who are the object of violence or threats are often closely related to the criminal [18]. Arguments have been made on the need for local safety promotion programs to take different perceptions of males and females into account [35]. To spend time outdoors in the evening and at night has been found to be correlated with an increased risk of being robbed or mugged [56]. Theft and robbery were the most prevalent types of crime in all areas in our study. Thus, area-level crime was associated with the exis- tential insecurity dimension of safety-related concerns, but having been a victim of crime and type of housing were not. These findings could be interpreted to mean that existential insecurity is a more complex issue than area of residence, type of housing and victimization. On the other hand, in this context it is also interesting to observe that country of birth, level of education and living alone were not important for perceived 'existential insecu- rity'. We found that area-level crime rate and individual-level variables were associated with the composite dimensions 'structural indicators of social disorder' and 'existential insecurity', but only individual-level variables were associ- ated with the dimension 'contact with disorderly behav- iour'. We investigated whether there was an association between the residents' self-estimated area reputation and safety- related concerns. Our data show that all three derived safety-related dimensions of safety-related concerns ('structural indicators of social order', 'contact with disor- derly behaviour' and 'existential insecurity ') were strongly influenced by whether the residents perceived themselves to live in a residential environment with a less favourable reputation. This study indicates that self-assessed area rep- utation is an invisible factor that strongly influences the sense of insecurity among residents. Why area reputation is a mechanism that has strong consequences for per- ceived safety among residents is not investigated here but it is possible that reputation is related to social dimen- sions in the residents' immediate environment. In this regard, clues can be found in studies suggesting that the occurrence of crime and incivilities is associated with the development of perceptions that one's neighbourhood is a 'bad place' [57,58]. Another plausible clue is that if the estimated reputation is an essential part of the lives of res- idents, mental images of the area could either strengthen the attachment to the neighbourhood if you live in a 'good place' or weaken the attachment if you live in a 'bad place'. The mental images the residents have of their neighbourhood are likely to have serious consequences on the community spirit of their neighbourhood, leading to either a positive or negative situation in which residents increase or reduce their willingness to come together. A less favourable reputation develops a process of stigmati- zation as a 'bad area', leading to an ongoing migration process in which residents who are able, move away from the area. Consequently the people with lesser ability and resources remain. In contrast, the reputation of a desirable 'good area' is attractive and implies a safe and secure place in which to live. Living alone was found to be positively associated with 'contact with disorderly behaviour' when compared with residents living in families. This may be in line with earlier studies that suggested that living alone could lead to social isolation and thereby a more vulnerable situation [20], which likely also generates anxiety. The three small-scale areas in this study had implemented Neighbourhood Watch programs. The lowest crime rates were recorded from these areas and the residents in detached houses reported the highest perceived safety. The rationale behind Neighbourhood Watch programs is to contribute to lower crime rates and to a perception of safety in a neighbourhood through increased reciprocity, e.g. looking after strangers and property and improved Page 9 of 11 (page number not for citation purposes)