Original Contribution The Link between Neighborhood Poverty and Health: Context or Composition?

Cross-sectional studies of neighborhood context and health are subject to upward bias due to unobserved hetero-geneity and to downward bias due to overadjustment for potential mediators in the pathway between neighborhood context and health. In this study, the authors employed two strategies that addressed these two sources of bias. First, to mitigate overadjustment of mediators, they adjusted for baseline characteristics observed just prior to themeasurement of neighborhood context, using a combined propensity score and regression strategy. Second, to mitigate underadjust-ment of unmeasured confounders, they employed a fixed-effects modeling strategy to account for unobserved non-time-varying heterogeneity. Analyses were based on a nationally representative sample of the nonimmigrant US population from the Panel Study of Income Dynamics (1980–1997) in which respondent-rated health was regressed on neighborhood poverty. The samples consisted of approximately 6,000 respondents for the propensity score/ regression models and 45,000 person-years for the fixed-effects models. Both modeling strategies yielded significant estimates of neighborhood poverty and supported a causal link between neighborhood context and health. causality; health status disparities; poverty; residence characteristics; social class Abbreviations: CI, confidence interval; MTO, Moving to Opportunity; OR, odds ratio; PSID, Panel Study of Income Dynamics. Place and health are intimately linked, given that goods and services, exposure to hazards, and the availability o