Maternal and child health and neighborhood context: The selection and construction of area-level variables

 Background: Increasingly, maternal and child health researchers are employing the statistical approach of multilevel modeling analysis to simultaneously examine the relationship between contextual and individual determinants and maternal and child health outcomes. This review addresses the following questions: (1) What categories of neighborhood characteristics have been addressed? (2) How were those neighborhood characteristics operationalized? Methods: A literature review identified 31 relevant articles published between January 1999 and March 2004. The articles were read with special attention toward the measurement of neighborhood characteristics. Results: Twelve categories of neighborhood characteristics represented in the articles include income/wealth, employment, family structure, population composition, housing, mobility, education, occupation, social resources, violence and crime, deviant behavior and physical conditions. A wide diversity of approaches was used to measure these characteristics. The most widely utilized source of data was that of administrative records from the census or local government authorities. Although most authors provided theoretical explanations of their choice to examine broad neighborhood constructs, few were explicit about why certain indicators were selected to measure these constructs. Conclusions: There are theoretical, methodological and practical barriers in the measurement of the neighborhood context which must be addressed for the field to move forward. These barriers are discussed and recommendations are made for addressing them in future research.