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UNLABELLED: The importance of neighbourhoods for health and wellbeing may vary according to an individual's reliance on their local resources, but this assertion is rarely tested. We investigate whether greater neighbourhood 'exposure' through reliance on or engagement with the residential setting magnifies neighbourhood-health associations. METHODS: Three built environment characteristics (destination density, streetscape (attractiveness of built environment) and street connectivity) and two physical activity components (weekday and weekend accelerometer counts) were measured for 2033 residents living in 48 neighbourhoods within four New Zealand cities in 2009-2010, giving six different built environment-physical activity associations. Interactions for each built environment-physical activity association with four individual-level characteristics (acting as proxies for exposure: gender, working status, car access, and income) were assessed with multi-level regression models; a total of 24 'tests'. RESULTS: Of the 12 weekday built environment-physical activity tests, 5 interaction terms were significant (p < 0.05) in the expected direction (e.g. stronger streetscape-physical activity among those with restricted car access). For weekend tests, one association was statistically significant. No significant tests were contradictory. Pooled across the 12 weekday physical activity 'tests', a 1 standard deviation increase in the walkability of the built environment was associated with an overall 3.8% (95% CI: 3.6%-4.1%) greater increase in weekday physical activity across all the types of people we hypothesised to spend more time in their residential neighbourhood, and for weekend physical activity it was 4.2% (95% CI 3.9%-4.5%). CONCLUSIONS: Using multiple evaluation methods, interactions were in line with our hypothesis, with a stronger association seen for proxy exposure indicators (for example, restricted car access). Added to the wider evidence base, our study strengthens causal evidence of an effect of the built environment on physical activity, and highlights that health gains from improvements of the residential neighbourhood may be greater for some people.

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Health behavior takes place within social contexts. In this study, we investigated whether changes in exposure to neighborhood deprivation and smoking prevalence and to household smoking were associated with change in personal smoking behavior. Three waves of biannual data collection (2004-2009) in a New Zealand longitudinal study, the Survey of Family, Income and Employment (SoFIE)-Health, were used, with 13,815 adults (persons aged ≥15 years) contributing to the analyses. Smoking status was dichotomized as current smoking versus never/ex-smoking. Fixed-effects regression analyses removed time-invariant confounding and adjusted for time-varying covariates (neighborhood smoking prevalence and deprivation, household smoking, labor force status, income, household tenure, and family status). A between-wave decile increase in neighborhood deprivation was significantly associated with increased odds of smoking (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.02, 1.14), but a between-wave increase in neighborhood smoking prevalence was not (OR = 1.04, 95% CI: 0.98, 1.10). Changing household exposures between waves to live with another smoker (compared with a nonsmoker (referent)) increased the odds of smoking (OR = 2.48, 95% CI: 1.84, 3.34), as did changing to living in a sole-adult household (OR = 1.52, 95% CI: 1.07, 2.14). Tobacco control policies and programs should address the broader household and neighborhood circumstances within which individual smoking takes place.

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Being physically active has demonstrated health benefits, and more walkable neighbourhoods can potentially increase physical activity. Yet not all neighbourhoods provide opportunities for active lifestyles. This paper examines the social context of being active in local and non-local places. We use a social practice theoretical framework to examine how residents talk about and make sense of physical activity and places, contrasting individual and neighbourhood factors. In 2010, fourteen focus groups were held in four neighbourhoods varying by walkability and area-level deprivation (two Auckland and two Wellington, New Zealand), and with participants grouped by gender, ethnicity, and employment. Focus groups elicited discussion on where local residents go for physical activity, and the opportunities and barriers to physical activity in their local area and beyond. Thematic analyses compared across all groups for contrasts and similarities in the issues discussed. Neighbourhood walkability factors appeared to shape where residents engage with public places, with residents seeking out good places. Individual factors (e.g. employment status) also influenced how residents engage with their local neighbourhoods. All groups referred to being active in places both close by and further afield, but residents in less walkable neighbourhoods with fewer local destinations drew attention to the need to go elsewhere, notably for exercise, being social, and to be in pleasant, restorative environments. Being physically active in public settings was valued for social connection and mental restoration, over and above specifically 'health' reasons. Residents talk about being active in local and non-local places revealed agency in how they managed the limitations and opportunities within their immediate residential setting. That is, factors of place and people contributed to the 'shape' of everyday residential environments, at least with regard to physical activity.

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Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study.

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