Open Access Research article

Rating neighborhoods for older adult health: results from the African American Health study

Elena M Andresen1*, Theodore K Malmstrom2, Fredric D Wolinsky34, Mario Schootman5, J Philip Miller6 and Douglas K Miller78

Author Affiliations

1 Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida Health Sciences Center, PO Box 100231 Gainesville, FL 32610, USA

2 Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, 1438 South Grand Boulevard, St. Louis, MO 63104, USA

3 Iowa City Veterans Affairs Medical Center, Highway 6 West, Iowa City, Iowa 52246, USA

4 Department of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 General Hospital, Iowa City, Iowa 52242, USA

5 Departments of Medicine and Pediatrics, School of Medicine, Washington University, Campus Box 8504, 660 South Euclid Avenue, St. Louis, MO 63110, USA

6 Division of Biostatistics, School of Medicine, Washington University, Campus Box 8067, 660 South Euclid Avenue, St. Louis, MO 63110, USA

7 Indiana University Center for Aging Research, School of Medicine, Indiana University, IN, USA

8 Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA

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BMC Public Health 2008, 8:35  doi:10.1186/1471-2458-8-35

Published: 25 January 2008



Social theories suggest that neighborhood quality affects health. Observer ratings of neighborhoods should be subjected to psychometric tests.


African American Health (AAH) study subjects were selected from two diverse St. Louis metropolitan catchment areas. Interviewers rated streets and block faces for 816 households. Items and a summary scale were compared across catchment areas and to the resident respondents' global neighborhood assessments.


Individual items and the scale were strongly associated with both the catchment area and respondent assessments. Ratings based on both block faces did not improve those based on a single block face. Substantial interviewer effects were observed despite strong discriminant and concurrent validity.


Observer ratings show promise in understanding the effect of neighborhood on health outcomes. The AAH Neighborhood Assessment Scale and other rating systems should be tested further in diverse settings.