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Ana V. Diez Roux, Phd, MD

The author is with the Division of General Medicine, Columbia College of Physicians and Surgeons, and the Division of Epide-miology, Joseph T. Mailman School of Public Health, Columbia University, NewYork City.

Correspondence: Requests for reprints should be sent to Ana V. Diez Roux, MD, PhD, Division of General Medicine, Columbia Presbyterian Medical Center, Ph 9 East Room 105, 622 W 168th St, New York, NY 10032 (ad290{at}columbia.edu).

The past few years have witnessed an explosion of interest in neighborhood or area effects on health. Several types of empiric studies have been used to examine possible area or neighborhood effects, including ecologic studies relating area characteristics to morbidity and mortality rates, contextual and multilevel analyses relating area socioeconomic context to health outcomes, and studies comparing small numbers of well-defined neighborhoods.

Strengthening inferences regarding the presence and magnitude of neighborhood effects will require addressing a series of conceptual and methodological issues. Many of these issues relate to the need to develop theory and specific hypotheses on the processes through which neighborhood and individual factors may jointly influence specific health outcomes. Important challenges include defining neighborhoods or relevant geographic areas, identifying significant area or neighborhood characteristics, specifying the role of individual-level variables, incorporating life-course and longitudinal dimensions, combining a variety of research designs, and avoiding reductionism in the way in which "neighborhood" factors are incorporated into models of disease causation and quantitative analyses.analyses.

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