Neighborhood effects on health: A multilevel analysis of neighborhood environment, physical activity and public health in suburban Shanghai

With great concern over the health-promoting environment worldwide, there is a growing body of research into the neighborhood effects on health beyond the sole focus on individual socioeconomic disadvantages and lifestyle risks. Our study contributes to neighborhood health research by investigating the combined effects of multi-dimensional neighborhood environmental characteristics and recreational physical activity under different geographic contexts on residents' self-rated health. Drawing upon a health survey conducted in suburban Shanghai in 2017, we employ a series of multilevel models to examine how the multi-scale environmental and behavioral factors are related to residents' self-rated physical and mental health, respectively. The results show that the greening rate of the community, rather than accessibility to large-scale urban parks, is a significant indicator of self-rated health for suburban residents. Subjective evaluations on neighborhood safety and air pollution exposure are significantly associated with residents' physical and mental health, while neighborhood attachment matters more for mental health. Outdoor recreational exercises, especially in the environment of neighborhood green space, are conducive to better physical health, while indoor physical activity shows weaker and insignificant health benefits. These findings offer a promising way for public health policymakers and urban planners to implement place-based health interventions and develop health-supportive neighborhoods.