Social cohesion as a mediator of the association between walkable neighborhoods and self-rated health in a Midwest city

Background: Evidence suggests that built environments, specifically walkable neighborhoods, are associated with health. There are several hypotheses as to what mediates this relationship, but few studies have examined these mechanisms in the context of socioeconomic status.

Purpose: The purpose of this study was to examine whether neighborhood walking, as an indicator of physical activity, and social cohesion mediated the relationship between walkable neighborhood environments and self-rated health (SRH), and whether this relationship was moderated by income.   

Methods:  A cluster randomized sample of Kansas City, Missouri residents was taken in fall 2010.  Household surveys assessed residents’ perceptions of neighborhood walkability, social cohesion, self-reported neighborhood walking, SRH, and demographic characteristics. A multiple mediation analysis tested whether social cohesion and neighborhood walking mediated the relationship between perceived neighborhood walkability and SRH, while controlling for income and other potential confounders.

Results: A total of 811 surveys were completed. Perceptions about the walkability of the neighborhood environment were correlated with social cohesion (b=.34, p < .01), neighborhood walking (b=.13, p<.01), and SRH (b=.16, p<.01). Social cohesion mediated the relationship between neighborhood walkability and health in the uncontrolled model (b=.07, p=.02), while neighborhood walking did not (b=.02, p=.23). This effect was moderated by income, such that social cohesion was only a significant mediator of SRH in middle- to high-income respondents.

Conclusion: These data support the association between walkable environments and health, and suggest that social cohesion may play an important role in this relationship.  Yet, more research is needed in understanding the saliency of social cohesion as a health mechanism among low-income residents.