Innovation in the measurement of place: Using systematic social observation and GIS to illustrate neighborhood effects on health in rural settings

Neighborhoods have become a necessary lens for better understanding how environmental and social contexts impact human health. Numerous studies have revealed that a concentration of poverty and crime have a relationship to various health outcomes in urban neighborhoods. Considerably less is known about neighborhood effects on health in rural areas. Methods and approaches that work well in urban settings do not necessarily apply to rural settings. The use of inappropriate methods may mask social and environmental issues in a rural community and result is an incomplete picture of the risk factors faced by residents of these communities.

A systematic social observation (SSO) study designed to reveal physical, social, and economic characteristics of neighborhoods was recently conducted in a rural county in the southeast. Key to this study is a new approach to defining a unit of observation. In urban areas, SSO's typically rely on the block or block face as a unit of observation. This does not translate well to rural environments where blocks may be miles long. We propose a new approach focused on observations at predesignated locations that combines spatial analysis, innovative sampling techniques, and GPS. Advantages of this new approach include greater measurement reliability and the flexibility to aggregate the observations into alternative operational definitions of neighborhood. The public health implications of this research could lead to new ways to conceptualize the environment and neighborhoods in rural communities and a better illustration of risk factors present in often understudied communities.