**5. Discussion and Conclusions**

This study aims to test a model on the neglected, but pivotal, mediating role of human–place bond on the relationship between incivility and health. Direct and indirect relationships between incivility and health were tested. Understanding how residents create human–place bonds, which can affect health outcomes, is crucial. The conceptual framework was formed based on social disorganisation theory. Data were collected from a heterogeneous neighbourhood in Penang, Malaysia, using a sample of 265 residents. In contrast to predictions, no significant direct relationship was found between incivility and health. This is not surprising, as previous literature reported inconsistent evidence for incivilities' impact on health and risky behaviours [22]. O'Brien and colleagues [22] found a quite weak impact of incivilities on general health.

The results further sugges<sup>t</sup> that place attachment significantly mediates the relationship between incivility and health, whereas place identity does not mediate this relationship. This is an interesting finding and may refer to methodological inconsistencies undermining the study of BWT [22]. However, the relationship between incivility and health is serially mediated by place identity and place attachment. Thus, although place identity does not play a mediating role in the relationship between incivility and health, it promotes the sense of place attachment by integrating the place as part of one's self. Therefore, if residents' health and wellbeing are affected by their environment, then the effect is likely caused by promoting or decreasing the degree of human–place bonds.

As two research hypotheses were not supported, the results help to better understand the relationship between incivility and health. This result is inconsistent with previous studies, and may refer to employing a second-order factor for the incivility construct in the research model. Many neighbourhood characteristics, in particular social and physical incivilities, may not directly affect health [39]; however, these features may influence perceptions of place identity and place attachment towards the neighbourhood, and consequently health. This finding helps to better understand the cognitive and social mechanisms underlying health, and give some insight into the incivility–health relationship. Therefore, longitudinal studies would assist in cross-validating the findings and determining the generalisability of the study findings to other contexts.

In terms of theoretical implications, this study provides insight into the mechanisms that lead to the experience and perception of the environment. The study findings may improve the knowledge on how the dimensions of an urban environment (social and physical) can affect the manner in which individuals perceive and experience their living environment. On the basis of the study findings, a stronger identity and attachment to a place is attributed to individuals who experience less incivilities in their neighbourhood. The study improves the research on the human–place relationship, which remains unclear in the literature [70]. This study revealed a positive and significant relationship between place identity and place attachment. Place identity and place attachment are conjectured to

two different, but related, concepts, in which high levels of place identification indicate high levels of place attachment.

Previous research has indicated that place attachment and place identity promote health and wellbeing [14,19,22,32]. Our findings extend on such research, by revealing that individuals with high levels of identification and attachment with place also show high levels of general health. By evaluating the serial mediating roles of place identity and place attachment, the study found that the human–place bond can alleviate the negative effects of incivilities on residents' health in neighbourhoods. An ideal neighbourhood for residents is one that is safe, clean, and stable, whereas social and physical incivilities are associated with a poor quality of the neighbourhood. In agreemen<sup>t</sup> with the literature [22], the results further sugges<sup>t</sup> that incivilities can diminish place identity and place attachment, which decreases the ability of residents to improve their health and wellbeing.

The more people perceive their area of residency as being deteriorated, the less they report a place attachment to it in relation to estimating their general health. This finding is consistent with previous studies, which reported that disadvantaged neighbourhoods exacerbate the development process of social relationships [16]. By contrast, the human–place bond improves the perception of the environment as a safe place to live, where people choose to live in the same neighbourhood. People's experience of incivilities could have an even greater influence than the experience of crime, because of the higher feasibility of residents having behavioural reactions to physical or social disorders (by confronting offenders) compared with criminal offenders, who may be dangerous to confront. The findings of this study show that incivilities and place identity are the antecedents of place attachment.

The practical implication of the study is as follows. Local authorities may improve the living conditions of residents to strengthen their level of attachment and identification to their living environment, which may improve individuals' health. Local authorities have the responsibility to design and make beneficial use of public areas. Thus, they have a crucial role in improving the social and physical qualities of the environment. The result further suggests that the degree of attachment and identification considerably affects individuals' health. Residents' bonds to the neighbourhood affect their level of engagemen<sup>t</sup> in community events. Thus, by planning neighbourhood gatherings, local authorities or the neighbourhood committee can promote a sense of belonging and feelings of attachment among the residents. Therefore, effective communication between residents is crucial in order to promote the spirit of neighbourliness and the creation of human–place bonds, and consequently enhance individuals' health. This promotion can be achieved by organising (i) public meetings on neighbourhood development; (ii) community clean-up incentives; (iii) recreational, athletic, and social events; and (iv) other activities conducted in the neighbourhood aimed at persuading residents to participate and promote a sense of community.

### **6. Limitations and Directions for Future Research**

The study has some limitations that also provide directions for future research. Firstly, the study concentrated only on a heterogeneous middle-class neighbourhood. Although the study area represents a typical neighbourhood in Penang, Malaysia, the findings might not necessarily be applicable to other homogenous low- or high-class neighbourhoods. Secondly, although incivility was measured with subjective scales that have been validated in previous studies [32], results could differ if incivility was measured using quantitative methods, such as observation checklists. As such, future studies can use different samples and measure incivility objectively in order to improve the external validity of the proposed model. Thirdly, based on the basis of social disorganisation theory, neighbourhood structures, such as socioeconomic factors, are powerful determinants of the perception of safety and health, regardless of the role of neighbourhood physical attributes [97,98]. Sampson and Raudenbush [16] hypothesise that physical and social incivilities are greater in neighbourhoods marked by instability, poverty, and high ethnic transition. Future studies may consider the effect of neighbourhood structural factors, such as neighbourhood

socioeconomic status and residents' turnover, on the perception of safety, crime, and health. Lastly, a prevailing tendency among the research on place identity and place attachment is considering the neighbourhood scale as the main category of analysis [99]. However, Casakin et al. [100] have suggested a city scale as having a predominant effect on the development of human–place bonds. Thus, additional studies should be conducted in order to investigate the creation of human–place bonds at neighbourhood and city scales.

**Author Contributions:** Conceptualization, M.H.M.; methodology, M.H.M. and M.S.; software, M.H.M.; validation, M.H.M.; formal analysis, M.H.M. and A.A.; investigation, M.J.M.T. and A.A.; resources, M.H.M. and M.S.; data curation, M.H.M. and A.A.; writing—original draft preparation, M.H.M., M.S. and M.J.M.T.; writing—review and editing, M.H.M., M.S., M.J.M.T. and A.A.; visualization, M.S.; supervision, M.H.M. and M.J.M.T.; project administration, M.H.M. and A.A.; funding acquisition, M.H.M. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by the Universiti Sains Malaysia (grant number RUI 1001/PP-BGN/8016079).

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Universiti Sains Malaysia, and approved by the Human Research Ethics Committee Universiti Sains Malaysia (protocol code USM/JEPeM/19050313 on 5 August 2019).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Acknowledgments:** The authors would like to thank Universiti Sains Malaysia for providing financial supports under RUI gran<sup>t</sup> (RUI 1001/PPBGN/8016079).

**Conflicts of Interest:** The authors declare no conflict of interest.
