Research Related To Neighborhood Cohesion

The underlying theory states that multiple levels of influence, from microlevel to macrolevel of context, jointly influence individual behaviors and health outcomes.

The hypothesis proposed by the authors is that neighborhood cohesion is associated with self-neglect and that greater cohesion corelates with lower risk of self-neglect(1). Self-neglect is associated with worse health and mortality outcome; therefore, studying the relationship between neighborhood cohesion and self-neglect can further guide the intervention to prevent self-neglect and its possible consequences(2,3). The population of interest is Chinese-American elders who dwelled in greater Chicago area for some studies have reported that self-neglect is more prevalence among minority elderly people(4).

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The primary predictor in this study is neighborhood cohesion which is a positive network of relationships that comprise of trust, connectedness and solidarity with shared values and norms among populations(1,5). Some research suggests that positive social network or neighborhood can improve health outcome, especially among older population because they tend to have more contact within their neighborhood and that older adults may receive or even provide more community services compared to younger ones(6). Moreover, neighborhood cohesion can provide an emotional form of social support by belonging and attachment(1). This study measured neighborhood cohesion by using a scale of six items, which evaluate participants’ involvement in their own society. The first three questions of the six items ask how often they see neighbors talking outside, taking care and watching out for others by answering with a 4-point scale(1).

The other three questions ask the how many neighbors’ names they know, how many neighbors they talk at least once a week and how many neighbors they can call for help by answering a number for each question. The scale generally measures the essential aspects of social cohesion, which are trust and connectedness and the results are adjusted for standardized scores due to different response scales. The measure appears to be a fair reflection of cohesion and since there are only six questions in addition to multilingual interviewers, it does not seem to be difficult for the Chinese-American participants to complete the questionnaire. However, community participation, which also contributes to and reinforces neighborhood cohesion, was not assessed in this scale and it may cause incomplete evaluation of neighborhood cohesion(7).

Furthermore, one of the items is to answer how many neighbors study participants know by their names, yet name recognition can possibly be interrupted by poor memory function or unfamiliar languages, for example, names other than Chinese or English. For reliability, the authors reported a Cronbach alpha of 0.86 for this scale evaluating neighborhood cohesion while test-retest and interobserver reliability are not addressed in this article. This article did not reveal information about the validity of this scale; however, tracing back its reference, this measure is adopted from Chicago Health and Aging Project(8). The original measure showed a positive correlation with neighborhood-level SES and a modest construct validity.

The primary outcome in this study is self-neglect which is defined as an adult’s inability to perform essential self-care because of physical or mental incapacity and therefore, it can potentially damage one’s health, especially in elders(9). In this study, self-neglect was evaluated by 27 items, which can be further group into 5 categories: hoarding, poor hygiene, need for home repair, unsanitary conditions, and inadequate utilities with a 4-point scale for each item(1). The authors revealed that this measure was derived from their previous study with a Cronbach alpha of 0.79. Although no further information about validity is shown, according to their previous study, they revealed good content and concurrent validity. According to above findings, the measure appears to be of modest quality; nevertheless, the inability to obtain nutritious foods and take medicine on time is another crucial measure of elderly self-neglect, yet left out in the questionnaires. Furthermore, this cross-sectional study is not able to address temporality and is thus susceptible to reverse causation as neighborhood cohesion can be a downstream consequence of self-neglect.

The authors also proposed several covariates that can possibly confound the association between neighborhood cohesion and self-neglect, including age, sex, education, income, marital status, living environment, number of children, years in the United States and community, country of origin, and language preference(1). One major covariate measured is socioeconomic status (SES) because elder people with lower SES may be less involved in their communities and they also tend to have higher rates of self-neglect(10). The duration ones have lived in their communities also plays a crucial role as if one just moved into a new place, the measure of her self-neglect may be higher due to new settlement while community bondage and cohesion are likely not completely formed. Statistically, some of the crude point estimate and confidence interval of the association between neighborhood cohesion and self-neglect changed after adjustment; though direct prove of confounding is not plausible.

An alternative way to measure neighborhood cohesion can be based on its core concepts: trust, connectedness, solidarity, shared values and norms. The scale asks seven questions:

1) will you be able to seek help from your neighbors, for example, when you are sick or in emergency?

2) if you have not seen or heard from your neighbors for more than 3 days, will you check on them?

3) if there a community committee in your neighborhood?

4) how likely do you trust your neighbors?

5) how likely do you think your neighbors will check on you if you have not been out for more than three days?

6) how many times in a week averagely do you talk to your neighbors,

7) how many times in a month averagely do you participate in community activities.

The first three are answered by Y/N, question 4 and 5 can be indicated on a 4-point scale (0 = definitely not, 3 = definitely) while the last two questions are asked to provide a number. This measure includes the concept of community participation and tries to avoid the requirement of good memory compared to the measure proposed in the article; nevertheless, its reliability and validity remain to be further investigated.

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