Perceived and observed neighborhood indicators of obesity among urban adults

Ready-to-Eat Food Environments and Risk of Incident Heart Failure: A Prospective Cohort Study

BACKGROUND

Food environments have been linked to cardiovascular diseases; however, few studies have assessed the relationship between food environments and the risk of heart failure (HF). We aimed to evaluate the association between ready-to-eat food environments and incident HF at an individual level in a large prospective cohort.

METHODS

Exposure to ready-to-eat food environments, comprising pubs or bars, restaurants or cafeterias, and fast-food outlets, were individually measured as both proximity and density metrics. We also developed a composite ready-to-eat food environment density score by summing the densities of 3 types of food environments. Cox proportional analyses were applied to assess the associations of each single type and the composite food environments with HF risk.

RESULTS

Closer proximity to and greater density of ready-to-eat food environments, particularly for pubs and bars and fast-food outlets (P<0.05 for both proximity and density metric) were associated with an elevated risk of incident HF. Compared with those with no exposure to composite ready-to-eat food environments, participants in the highest density score category had a 16% (8%-25%; P<0.0001) higher risk of HF. In addition, we found significant interactions of food environments with education, urbanicity, and density of physical activity facilities on HF risk (all Pinteraction<0.05); the ready-to-eat food environments-associated risk of HF was stronger among participants who were poorly educated, living in urban areas, and without physical activity facilities.

CONCLUSIONS

Exposure to ready-to-eat food environments is associated with a higher risk of incident HF, suggesting the potential importance of minimizing unfavorable food environments in the prevention of HF.

Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth

Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.

Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months

PURPOSE

Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months.

MATERIALS AND METHODS

Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits.

RESULTS

There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)].

CONCLUSIONS

Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.

Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months

PURPOSE

Explorations into the neighborhood food environment have not adequately extended to adults with obesity who undergo bariatric surgery. The objective of this study is to determine how diversity of food selection at food retail stores within proximities of 5- and 10-min walks associate with patient postoperative weight loss over 24 months.

MATERIALS AND METHODS

Eight hundred eleven patients (82.1% female; 60.0% White) who had primary bariatric surgery (48.6% gastric bypass) from 2015 to 2019 at The Ohio State University were included. EHR variables included race, insurance, procedure, and percent total weight loss (%TWL) at 2, 3, 6, 12, and 24 months. Proximity from patients' home addresses to food stores within a 5- (0.25 mile)- and 10-min (0.50 mile) walk were totaled for low (LD) and moderate/high (M/HD) diversity food selections. Bivariate analyses were conducted with %TWL at all visits and LD and M/HD selections within 5- (0, ≥ 1) and 10-min (0, 1, ≥ 2) walk proximities. Four mixed multilevel models were conducted with dependent variable %TWL over 24 months with visits as the between subjects factor and covariates: race, insurance, procedure, and interaction between proximity to type of food store selections with visits to determine association with %TWL over 24 months.

RESULTS

There were no significant differences for patients living within a 5- (p = 0.523) and 10-min (p = 0.580) walk in proximity to M/HD food selection stores and weight loss through 24 months. However, patients living in proximity to at least 1 LD selection store within a 5- (p = 0.027) and 1 or 2 LD stores within a 10-min (p = 0.015) walk had less weight loss through 24 months.

CONCLUSION

Overall, living in proximity to LD selection stores was a better predictor of postoperative weight loss over 24 months than living within proximity of M/HD selection stores.

Nonlinear relationship between nonresidential destinations and body mass index across a wide range of development

BACKGROUND

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In higher density settings, an inverse association has been consistently found, but in lower density settings, findings are limited. We previously found a positive relationship between the density of nonresidential destinations (NRD) and BMI in a low-density state. We sought to test the generalizability of this unexpected finding using data from six other states that include a broader range of settlement densities.

METHODS

We obtained the address, height, and weight of 16.9 million residents with a driver's license or state identification cards, as well as the location of 3.8 million NRDs in Washington, Oregon, Texas, Illinois, Michigan, and Maine from Dun & Bradstreet. We tested the association between NRDs∙ha^-1 within 1 km of the home address, and self-reported BMI (kg∙m^-2). Visualization by locally-weighted smoothing curves (LOWESS) revealed an inverted U-shape. A multivariable piecewise regression with a random intercept for state was used to assess the relationship.

RESULTS

After accounting for age, sex, year of issue, and census tract social and economic variables, BMI correlated positively with NRDs in the low-to-mid density stratum (β = +0.005 kg∙m^-2/nonresidential building∙ha^-1; 95% CI: +0.004,+0.006) and negatively in the mid-to-high density stratum (β = -0.002; 95% CI: -0.004,-0.0003); a significant difference in slopes (P < 0.001).

CONCLUSIONS

BMI peaked in the middle density, with lower values in both the low and high-density extremes. These results suggest that the mechanisms by which NRDs are associated with obesity may differ by density level.

Social Determinants of Health: Considerations for Athletic Health Care

Health disparities are prevalent issues in the United States and a frequent topic of conversation in the public health realm. Causes of health disparities include social inequities and social determinants of health. Although social determinants of health have been suggested to contribute more to individual and population health than the health care provided, this concept in athletic health care has received little attention. Therefore, the purpose of this article is to describe social determinants of health, present examples of social determinants, and discuss awareness of actionable steps for the athletic training profession to be more culturally proficient. By increasing awareness of and acknowledging social determinants of health, athletic trainers will be positioned to improve patient outcomes more readily and contribute to ongoing conversations at the policy level of health care.

Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

INTRODUCTION

Individuals living in low-income neighborhoods have disproportionately high rates of obesity, Type-2 diabetes, and cardiometabolic conditions. Perceived safety in one's neighborhood may influence stress and physical activity, with cascading effects on cardiometabolic health.

METHODS

In this study, we examined relationships among feelings of safety while walking during the day and mental health [perceived stress (PSS), depression score], moderate-to-vigorous physical activity (PA), Body Mass Index (BMI), and hemoglobin A1C (A1C) in low-income, high-vacancy neighborhoods in Detroit, Michigan. We recruited 69 adults who wore accelerometers for one week and completed a survey on demographics, mental health, and neighborhood perceptions. Anthropometrics were collected and A1C was measured using A1CNow test strips. We compiled spatial data on vacant buildings and lots across the city. We fitted conventional and multilevel regression models to predict each outcome, using perceived safety during daytime walking as the independent variable of interest and individual or both individual and neighborhood-level covariates (e.g., number of vacant lots). Last, we examined trends in neighborhood features according to perceived safety.

RESULTS

In this predominantly African American sample (91%), 47% felt unsafe during daytime walking. Feelings of perceived safety significantly predicted PSS (β = - 2.34, p = 0.017), depression scores (β = - 4.22, p = 0.006), and BMI (β = - 2.87, p = 0.01), after full adjustment. For PA, we detected a significant association for sex only. For A1C we detected significant associations with blighted lots near the home. Those feeling unsafe lived in neighborhoods with higher park area and number of blighted lots.

CONCLUSION

Future research is needed to assess a critical pathway through which neighborhood features, including vacant or poor-quality green spaces, may affect obesity-via stress reduction and concomitant effects on cardiometabolic health.

Psychological and Biological Pathways Linking Perceived Neighborhood Characteristics and Body Mass Index

BACKGROUND

Perceived neighborhood characteristics are linked to obesity, however, the mechanisms linking these two factors remain unknown.

PURPOSE

This study aimed to examine associations between perceived neighborhood characteristics and body mass index (BMI), establish whether indirect pathways through psychological distress and inflammation are important, and determine whether these associations vary by race/ethnicity.

METHODS

Participants were 1,112 adults enrolled in the Texas City Stress and Health Study. Perceived neighborhood characteristics were measured using the Perceived Neighborhood Scale. Psychological distress was measured with the Center for Epidemiological Studies Depression Scale, Perceived Stress Scale and mental health subscale of the Short Form Health Survey-36. Markers of inflammation included C-reactive protein, interleukin-6, and tumor necrosis factor receptor-1. Associations were examined with Structural Equation Modeling.

RESULTS

A model linking neighborhood characteristics with BMI through direct and indirect (i.e., psychological distress and inflammation) paths demonstrated good fit with the data. Less favorable perceived neighborhood characteristics were associated with greater psychological distress (B = -0.87, β = -0.31, p < .001) and inflammation (B = -0.02, β = -0.10, p = .035). Psychological distress and inflammation were also significantly associated with BMI (Bdistress = 0.06, β = 0.08, p = .006; Binflammation = 4.65, β = 0.41, p < .001). Indirect paths from neighborhood characteristics to BMI via psychological distress (B = -0.05, β = -0.03, p = .004) and inflammation (B = -0.08, β = -0.04, p = .045) were significant. In multiple group analysis, a model with parameters constrained equal across race/ethnicity showed adequate fit suggesting associations were comparable across groups.

CONCLUSION

Our study extends the literature by demonstrating the importance of neighborhood perceptions as correlates of BMI across race/ethnicity, and highlights the role of psychological and physiological pathways.

The Association between Green Space and Adolescents' Mental Well-Being: A Systematic Review

This systematic review summarised and evaluated the evidence for associations between green space and adolescents’ mental well-being. The PRISMA statement guidelines were followed for reporting systematic reviews. Fourteen articles met the inclusion criteria for this review. Synthesis suggests beneficial associations between green space exposure and reduced stress, positive mood, less depressive symptoms, better emotional well-being, improved mental health and behaviour, and decreased psychological distress in adolescents. Several studies found the relationship varied by demographic and socio-economic factors. The limited number of studies and the risk of bias were the main limitations, together with heterogeneity regarding green space and mental well-being assessments. Overall, this review highlights the potential contribution of green space in schoolyards. Improving the availability, accessibility and quality of green space is likely to generate positive impacts on adolescents’ mental well-being. More consistent evidence on the use of different types of green space and perceptions of features are needed in the future.

Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women

The high prevalence of obesity among Black Americans warrants additional investigation into its relationship with socioeconomic position (SEP), sex, and ethnicity. This cross-sectional study utilizes 2001–2003 data from the National Survey of American Life, a nationally representative sample of 3570 African-Americans and 1621 Caribbean-Blacks aged 18 years and older. Multivariate logistic regression models stratified by ethnicity and sex describe the independent associations between obesity and multilevel socioeconomic factors after adjustment for age, other SEP measures at the individual, family and neighborhood levels, and health behaviors such as physical activity, alcohol intake, and smoking. A positive relationship was observed between obesity and family income among African-American and Caribbean-Black men. Receipt of public assistance was a strongly associated factor for obesity in Caribbean-Black men and women. Among African-American women, inverse relationships were observed between obesity and education, occupation, and family income; residence within a neighborhood with a supermarket also decreased their odds of obesity. Residence in a neighborhood with a park decreased the odds of obesity only among African-American men, whereas residence in a neighborhood with a supermarket decreased the odds of obesity among Caribbean-Black men. The social patterning of obesity by individual, household, and neighborhood socioeconomic resources differs for African-American and Caribbean-Black men and women within these cross-sectional analyses; an appreciation of these differences may be a prerequisite for developing effective weight control interventions and policies for these two populations.

Study of active neighborhoods in Detroit (StAND): study protocol for a natural experiment evaluating the health benefits of ecological restoration of parks

BACKGROUND

Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes.

METHODS

The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models.

DISCUSSION

Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods.

STUDY REGISTRATION

Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.

Neighborhood Walkability and Overweight/Obese Weight Status Among Latino Adults

PURPOSE

To examine whether aerobic physical activity mediates the association between neighborhood walkability and overweight/obesity weight status among Latino adults and whether the relative contribution of this pathway linking neighborhood walkability and aerobic activity varies by level of neighborhood social cohesion.

DESIGN

Cross-sectional.

SETTING

National Health Interview Survey (NHIS) 2015.

SAMPLE

NHIS adult Latino participants ≥18 years of age (n = 4303).

MEASURES

Neighborhood walkability, neighborhood social cohesion, body mass index, and aerobic physical activity.

ANALYSIS

To determine whether physical activity mediates the relationship of walkability with overweight/obese weight status, a simple mediation analysis was conducted. Additionally, a moderated mediation analysis was conducted to test whether neighborhood social cohesion had a moderating effect on this relationship.

RESULTS

On average, the sample was 41 years old, 51% were male, 34% had less than a high school education, and 57% were foreign-born. Neighborhood walkability was statistically significantly related to overweight/obese weight status (standardized effect= -0.05, standard error [SE] = 0.02, P = .01). The interaction between walkability and neighborhood social cohesion on physical activity was not significant (standardized effect = 0.06, SE = 0.03, P = .09). Thus, the indirect effect of walkability on overweight/obesity weight status through physical activity was not shown to be modified by neighborhood social cohesion.

CONCLUSION

Other neighborhood environment factors may play a role in the contribution of neighborhood walkability to overweight/obese weight status among Latinos.

Linkage between Neighborhood Social Cohesion and BMI of South Asians in the Masala Study

Introduction. South Asians in the United States have a high prevalence of obesity and an elevated risk for cardiometabolic diseases. Yet, little is known about how aspects of neighborhood environment influence cardiometabolic risk factors such as body mass index (BMI) in this rapidly growing population. We aimed to investigate the association between perceived neighborhood social cohesion and BMI among South Asians.

METHODS

We utilized cross-sectional data from the MASALA study, a prospective community-based cohort of 906 South Asian men and women from the San Francisco Bay area and the greater Chicago area. Multivariable linear regression models, stratified by sex, were used to examine the association between perceived level of neighborhood social cohesion and individual BMI after adjusting for sociodemographics.

RESULTS

Participants were 54% male, with an average age of 55 years, 88% had at least a bachelor's degree, and the average BMI was 26.0 kg/m². South Asian women living in neighborhoods with the lowest social cohesion had a significantly higher BMI than women living in neighborhoods with the highest cohesion (β coefficient = 1.48, 95% CI 0.46-2.51, p=0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (β coefficient = 1.48, 95% CI 0.46-2.51, p=0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (.

CONCLUSION

Perceived neighborhood social cohesion was not significantly associated with BMI among South Asians in our study sample. Further research is recommended to explore whether other neighborhood characteristics may be associated with BMI and other health outcomes in South Asians and the mechanisms through which neighborhood may influence health.

The Role of Built Environment on Health of Older Adults in Korea: Obesity and Gender Differences

This study examines the effect of the built environment on obesity in older adults, taking into consideration gender difference. In this regard, we ask two questions: (1) How does the built environment affect obesity in older adults? (2) Is there a gender difference in the effect of the built environment? To examine the research questions, this study uses the 2015 Korean National Health and Nutrition Survey and geographically weighted regression (GWR) analysis. The empirical analyses show that environmental factors have stronger effects on local obesity rates for older men than for older women, which indicates a gender difference in obesity. Based on these findings, we suggest that public health policies for obesity should consider the built environment as well as gender difference.

Residential self-selection, perceived built environment and type 2 diabetes incidence: A longitudinal analysis of 36,224 middle to older age adults

Much of the existing studies on the built environment and type 2 diabetes are cross-sectional and prone to residential self-selection bias. Using multilevel logistic regression analysis of 36,224 participants from a longitudinal study, we examined whether perceived built environment characteristics are associated with type 2 diabetes. We found that the odds of diabetes incidence varied geographically. Those who reported that there were no local amenities and reported day- and night-time crime rates made walking unsafe in the neighbourhood had higher odds of developing incident type 2 diabetes. These associations persisted after accounting for some predictors of residential self-selection. More longitudinal studies are needed to corroborate the findings. Changing the features of the residential built environment may be an important point of intervention for type 2 diabetes prevention.

What Determines the Psychological Well-Being during Commute in Xi’an: The Role of Built Environment, Travel Attitude, and Travel Characteristics

The commute well-being (CWB) has been associated with the mental health and depends on the positive or negative emotions that occur during the daily commute. This paper analyzes the influencing factors and discusses the structural relationship between CWB and influencing factors, based on our evaluation of the results for daily CWB between different travel modes. We based our analyses on a CWB survey conducted in the central city proper of Xi’an. In contrast to previous studies, this paper investigates two commuting phases, in the morning and evening, to better analyze daily CWB. To conduct a more comprehensive analysis, in addition to considering multi-stage combined travel, the subjective and objective aspects of factors influencing CWB were deepened and expanded. The measurement was based on the Satisfaction with Travel Scale, which was developed based on a method for measuring subjective well-being. The average CWB level of each model was compared by analyzing the variances. The influencing factors were determined by stepwise regression, and the influence mechanism was analyzed using a structural equation model (SEM). The results indicate that CWB in Xi’an was highest for walking, which was followed, in order, by motorcycle, electric bicycle, staff shuttle bus, bicycle, metro, car, taxi, and bus. The result reflects that commuting by bus is associated with more negative emotions in Xi’an. The results of SEM indicate that the built environment does not directly affect CWB, but it will act on CWB by affecting other factors. The travel attitude, commute mode choice, and other travel characteristics affect each other and affect CWB directly and indirectly. Other travel characteristics has the largest total effect on CWB, and the travel attitudes have the largest direct effect. Without considering the travel attitude, reducing traffic congestion, commuting time, and transfer times can significantly improve CWB and reduce negative emotions in the future in Xi’an.

The Moderating Role of Social Neighbourhood Factors in the Association between Features of the Physical Neighbourhood Environment and Weight Status

BACKGROUND

This paper investigated the independent and joint associations between aspects of the physical neighbourhood environment and social neighbourhood factors with BMI and overweight status in European adults.

METHODS

Data from 5,199 participants in the SPOTLIGHT survey were analysed. Participants reported on their height, weight and perceptions of the neighbourhood. Objectively measured aspects of the physical neighbourhood environment included: presence of recreational facilities, features of the active transportation environment, neighbourhood aesthetics and presence of different types of food outlets. Social factors included the self-reported variables social network, social cohesion, social trust and perceived crime and the census variable neighbourhood socioeconomic status. Outcome measures were BMI and overweight status. Main associations between physical and social factors and BMI/overweight status were analysed using multilevel regression analyses adjusted for confounders. Moderation analysis was conducted by adding the interaction terms between physical and social neighbourhood factors one by one to the multivariable models. Significant interaction terms were then stratified.

RESULTS

Significant associations with BMI/overweight status were found for features of the active transportation environment and all social factors, except perceived crime. Several significant interaction terms were detected, but no significant associations between the physical neighbourhood environment and BMI/overweight status were found after stratification.

CONCLUSION

We did not find consistent interactions between physical and social neighbourhood factors to explain BMI and overweight status.

The Relationships between Park Quality, Park Usage, and Levels of Physical Activity in Low-Income, African American Neighborhoods

Parks can be an important, low-cost neighborhood resource to increase physical activity and reduce overweight and obesity. The quality of parks, however, may impact use. This study used observational data to examine the relationships between park quality, park usage and levels of physical activity among users in 31 parks within low-income, African American neighborhoods. Relationships between park use and park characteristics (signs of disorder, attractiveness, and number of activity settings) varied by gender and user activity level. No variables of interest were significant for overall number of male users; whereas, disorder and attractiveness were significant for overall number of female users. Parks with signs of disorder were associated with 49% fewer female users (IRR = 0.51, 95% CI = (0.34–0.77)) and attractive parks with 146% more female users (IRR = 2.46, 95% CI = (1.39–4.33)). Similar significant relationships were found among active but not sedentary female users. Communities may consider increasing park maintenance and addressing attractiveness in existing parks as a relatively low-cost environmental strategy to encourage park use, increase physical activity, and reduce the burden of obesity, especially among women in low-income, African-American communities.

Associations between lifestyle, physical and social environments and frailty among Chinese older people: a multilevel analysis

BACKGROUND

Frailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people.

METHODS

The data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty.

RESULTS

The prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60-64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47-0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19-0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54-0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59-0.97), 0.59 (0.45-0.77) and 0.59 (0.45-0.77), respectively.

CONCLUSIONS

Frailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.

Soda, salad, and socioeconomic status: Findings from the Seattle Obesity Study (SOS)

Background

Documenting geographic disparities in dietary behaviors can help inform public health interventions at the local level.

Objective

To study and visualize socioeconomic gradient in soda and salad consumption using a geo-localized measure of socioeconomic status in contrast to more traditional measures.

Methods

Geo-localized dietary intake data came from the Seattle Obesity Study I, a population-based sample of King County adults (n=1099). Socio-demographic data and soda and salad consumption frequencies (times/week) were obtained by 20-min telephone survey. Food frequency questionnaire (FFQ) data were used to construct Healthy Eating Index (HEI) scores. Individual residential property values obtained from the King County tax assessor. Multivariable linear regressions examined socioeconomic gradient in the frequency of soda and salad consumption by residential property values, the primary independent variable, in comparison to annual household incomes and educational attainment, with adjustment for age, gender, and race/ethnicity. Geographic disparities in soda and salad consumption by property value metric were illustrated at the census block level using modeled predicted marginal means.

Results

Among all three socioeconomic indicators (income, education and residential property values), residential property values captured strongest gradient in soda and salad consumption. Higher quintiles of residential property values were associated with lower soda and higher salad consumption. Respondents living in the highest quintile of property values −1.04 fewer sodas per week (95% CI= −1.87, −0.21) and 0.89 more salads per week (95% CI= 0.36, 1.42), adjusting for sociodemographic covariates. Residential property values illustrated geographic disparities in soda and salad consumption at the census-block level.

Conclusion

Geo-localized disparities in food consumption patterns by neighborhood can inform current discourse on the socioeconomic determinants of health, while providing a useful tool for targeted interventions at the local level.

•

Soda (inverse) and salad (positive) consumption show gradients with socioeconomic status (SES).

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Place-based measures of SES and property values, allow for high resolution mapping of diet measures.

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Provides new tools for spatial, nutritional epidemiology analyses.

Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors

The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting for methodological inconsistencies across studies. A search identified 198 studies (152 with sufficient data for meta-analysis) testing any of the three pathways or downstream, general health outcomes. The meta-analysis found that perceived disorder was consistently associated with mental health outcomes, as well as substance abuse, and measures of overall health. This supported the psychosocial model of disadvantage, in which stressful contexts impact mental health and related sequelae. There was no consistent evidence for disorder's impact on physical health or risky behavior. Further examination revealed that support for BWT-related hypotheses has been overstated owing to data censoring and the failure to consistently include critical covariates, like socioeconomic status and collective efficacy. Even where there is evidence that BWT impacts outcomes, it is driven by studies that measured disorder as the perceptions of the focal individual, potentially conflating pessimism about the neighborhood with mental health.

Neighborhood Environment Measurements and Anthropometric Indicators of Obesity: Results from the Women and Their Children's Health (WaTCH) Study

We compared geographic information system (GIS)- and Census-based approaches for measuring the physical and social neighborhood environment at the census tract-level versus and audit approach on associations with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Data were used from the 2012-2014 Women and Their Children's Health (WaTCH) Study (n=940). Generalized linear models were used to obtain odds ratios (ORs) for BMI (≥30 kg/m²), WC (>88 cm), and WHR (>0.85). Using an audit approach, more adverse neighborhood characteristics were associated with a higher odds of WC (OR: 1.10; 95% CI: 1.05, 1.15) and WHR (OR: 1.09; 95% CI: 1.05, 1.14) after adjustment for age, race/ethnicity, income, and oil spill exposure. There were no significant associations between GIS- and Census- based measures with obesity in adjusted models. Quality aspects of the neighborhood environment captured by audits at the individual-level may be more relevant to obesity than physical or social aspects at the census-tract level.

Gender-specific associations between perceived and objective neighbourhood crime and metabolic syndrome

Much research has considered the relationship between neighbourhood crime and physical activity, but few studies have assessed clinical outcomes consequent to behaviour, such as cardiometabolic risk. Fewer still have simultaneously assessed perceived and objective measures of crime. Perceptions of crime and actual victimisation vary according to gender; thus, this study sought to assess: 1) correspondence between perceived and objective neighbourhood crime; and 2) gender-specific associations between perceived and reported crime and metabolic syndrome, representing cardiometabolic risk. The indirect effect of neighbourhood crime on metabolic syndrome via walking was additionally evaluated. An Australian population-based biomedical cohort study (2004–2007) collected biomedical, socio-demographic, and neighbourhood perceptions data from n = 1,172 urban-dwelling, adults. Area-level reported crime rates were standardised and linked to individual data based on participants' residential location. Correspondence between actual and perceived crime measures was assessed using Pearson correlation coefficients. Cross-sectional associations between crime and metabolic syndrome were analysed using generalised estimating equations regression models accounting for socio-demographic factors and area-level income. Correspondence between perceived and objective crime was small to medium among men and women (r = 0.17 to 0.33). Among men, metabolic syndrome was related to rates of violent (OR = 1.21, 95% CI 1.08–1.35) and total crime (OR = 1.17, 95% CI 1.04–1.32), after accounting for perceived crime. Among women, metabolic syndrome was related to perceived crime (OR = 1.35, 95% CI 1.14–1.60) after accounting for total reported crime. Among women, there were indirect effects of perceived crime and property crime on metabolic syndrome through walking. Results indicate that crime, an adverse social exposure, is linked to clinical health status. Crime rates, and perceptions of crime and safety, differentially impact upon cardiometabolic health according to gender. Social policy and public health strategies targeting crime reduction, as well as strategies to increase perceptions of safety, have potential to contribute to improved cardiometabolic outcomes.

Relations between Objective and Perceived Built Environments and the Modifying Role of Individual Socioeconomic Position. A Cross-Sectional Study on Traffic Noise and Urban Green Space in a Large German City

Perceived annoyance due to traffic noise and lack of urban green space is mostly determined using data from self-administered questionnaires. However, there is still no clear evidence to what extent such perceived measures are related to objectively assessed environmental data and whether socioeconomic dimensions modify such relationships. In a cross-sectional study in Dortmund, Germany, georeferenced home addresses from parents with preschool aged children were used to analyse relations between exposures to objectively measured green space and traffic noise and subjective annoyance due to noise and lack of green space with the additional consideration of socioeconomic characteristics as effect modifiers. Higher perceived annoyance correlated with higher objectively measured traffic noise and lower objectively measured green, respectively. Stratified logistic regression models indicated a modifying role of socioeconomic characteristics. The strengths of associations between objectively measured environmental exposures and perceived annoyance differed by socioeconomic strata. Especially for noise, odds ratios were higher in low socioeconomic strata than in high socioeconomic strata. Therefore, using objective measures of the built environment as a proxy for individual perception should be made with caution as negative relations between objectively assessed built environments and health could be underestimated when considering individual socioeconomic position only as a confounder.

Perceived neighborhood disorder, racial-ethnic discrimination and leading risk factors for chronic disease among women: California Behavioral Risk Factor Surveillance System, 2013

Social environmental factors are theoretically identified as influential drivers of health behaviors – tobacco smoking, alcohol consumption, and physical activity – related to chronic disease disparities. Empirical studies investigating relationships involving social environmental factors have found that either greater interpersonal racial-ethnic discrimination or perceived neighborhood disorder were associated with adverse health behaviors, with potentially larger effects among women. We simultaneously tested whether measures of perceived racial-ethnic discrimination and perceived neighborhood disorder were associated with physical activity, alcohol consumption and tobacco smoking; lifestyle risk factors of major chronic disease among women. Data were from the 2013 California Behavioral Risk Factor Surveillance System. In addition to demographic and socioeconomic factors, women self-reported experiences with racial-ethnic discrimination and perception of neighborhood disorder (i.e., crime safety, traffic safety, and aesthetics/physical disorder). Survey-, and inverse probability of censoring-weighted regression models of each chronic disease risk factor were used to investigate associations involving racial-ethnic discrimination and neighborhood disorder, controlling for potential confounders. Perceiving racial-ethnic discrimination and greater neighborhood disorder were associated with a greater tobacco smoking prevalence. Experiences of racial-ethnic discrimination were associated with greater alcohol consumption among African American and Latino women, but not White women. Similarly, African American women reporting experiences with racial-ethnic discrimination report engaging in physical activity about half as much time as women reporting no racial-ethnic discrimination. Increases in perceived neighborhood disorder were associated with increases in alcohol consumption. All associations with social environmental factors were adjusted for potential confounders and each other. Neighborhood disorder and racial-ethnic discrimination may be important, independent contributors to chronic disease risk through relationships with tobacco smoking, alcohol consumption, and physical activity.

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Neighborhood disorder was associated with tobacco smoking and alcohol consumption.

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Racial ethnic discrimination was associated with tobacco smoking.

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Race/ethnicity and discrimination interaction affecting alcohol, physical activity.

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Limited to women, associations independent of each other and additional confounders.

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Neighborhood disorder, discrimination independent pathways to adverse health.

The relationship between objectively-measured attributes of the built environment and selected cardiovascular risk factors in a South African urban setting

BACKGROUND

Evidence concerning the relationship between objectively-measured attributes of the built environment with cardio-metabolic risk in populations from lower- and middle-income countries is lacking. In this paper, we describe the association between the objectively-measured built environment with body mass index, blood pressure and physical activity in adult South Africans.

METHODS

This cross-sectional study included 341 adults aged ≥35 years drawn from the Cape Town arm of the Prospective Urban Rural Epidemiology (PURE) cohort study. All Cape Town PURE participants were invited to take part in the study. Actigraph GT3X accelerometer and Geographic Information Systems were used to measure physical activity and built environment attributes (community center, shopping center and taxi rank).

RESULTS

In age and sex adjusted models (reference 500 m), access to community centers (1000 m) was positively related to body mass index [beta 4.70 (95%CI: 2.06 to 7.34)] and diastolic blood pressure [4.97 (0.00 to 9.95)]. Distance from a community center (1600 m) was positively related to diastolic blood pressure [6.58 (1.57 to 11.58)] and inversely with moderate-to-vigorous physical activity [- 69.30 (- 134.92 to - 3.70)]. Distance to a shopping center (1600 m) was positively related to body mass index [4.78 (1.11 to 8.45)] and shopping center (1000 m) was positively related to systolic blood pressure respectively [76.99 (0.03 to 83.95)].

CONCLUSION

Distance to community and shopping centers were significantly associated with BMI, systolic, diastolic blood pressure and moderate-to-vigorous physical activity. Future research should include multiple aspects of built environment variables in order to provide for a broader understanding of their effect on cardiovascular risk profile of African populations.

Resident Perceptions of Neighborhood Conditions, Food Access, Transportation Usage, and Obesity in a Rapidly Changing Central City

There is a lack of research on obesity that uses primary data and fine-grained information on neighborhoods. I use primary data for 367 participants in Detroit to examine neighborhood predictors of obesity. These data were supplemented with public data. I considered multilevel and spatial modeling, but the data lent itself best to ordinary least squares (OLS) regressions. I find that socioeconomic factors, the built environment, transportation usage, and perceptions of neighborhoods are important predictors of obesity. Importantly, litter is associated with higher levels of obesity. Planners can take measures to reduce litter and collaborate with other policy-makers to encourage less driving, though drawing direct lines of causality is complicated.

How Segregation Makes Us Fat: Food Behaviors and Food Environment as Mediators of the Relationship Between Residential Segregation and Individual Body Mass Index

OBJECTIVES

Racial residential segregation affects food landscapes that dictate residents' food environments and is associated with obesity risk factors, including individual dietary patterns and behaviors. We examine if food behaviors and environments mediate the association between segregation and body mass index (BMI).

METHODS

Non-Hispanic Whites and Blacks living in the St. Louis and Kansas City metro regions from 2012 to 2013 were surveyed on dietary behaviors, food environment, and BMI (n = 1,412). These data were combined with the CDC's modified retail food environment index and 2012 American Community Survey data to calculate racial segregation using various evenness and exposure indices. Multi-level mediation analyses were conducted to determine if dietary behavior and food environment mediate the association between racial residential segregation and individual BMI.

RESULTS

The positive association between racial segregation and individual BMI is partially mediated by dietary behaviors and fully mediated by food environments.

CONCLUSION

Racial segregation (evenness and exposure) is associated with BMI, mediated by dietary behaviors and food environment. Elements of the food environment, which form the context for dietary behaviors, are potential targets for interventions to reduce obesity in residentially segregated areas.

Are Perceived and Objective Distances to Fresh Food and Physical Activity Resources Associated with Cardiometabolic Risk?

Perceived and objective measures of neighbourhood features have shown limited correspondence. Few studies have examined whether discordance between objective measures and individual perceptions of neighbourhood environments relates to individual health. Individuals with mismatched perceptions may benefit from initiatives to improve understandings of resource availability. This study utilised data from n = 1491 adult participants in a biomedical cohort to evaluate cross-sectional associations between measures of access (perceived, objective, and perceived-objective mismatch) to fruit and vegetable retailers (FVR) and public open space (POS), and clinically-measured metabolic syndrome and its component risk factors: central obesity, dyslipidaemia, hypertension and pre-diabetes/diabetes. Access measures included perceived distances from home to the nearest FVR and POS, corresponding objectively-assessed road network distances, and the discordance between perceived and objective distances (overestimated (i.e., mismatched) distances versus matched perceived-objective distances). Individual and neighbourhood measures were spatially joined using a geographic information system. Associations were evaluated using multilevel logistic regression, accounting for individual and area-level covariates. Hypertension was positively associated with perceived distances to FVR (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.02, 1.28) and POS (OR = 1.19, 95% CI = 1.05, 1.34), after accounting for covariates and objective distances. Hypertension was positively associated with overestimating distances to FVR (OR = 1.36, 95% CI = 1.02, 1.80). Overestimating distances to POS was positively associated with both hypertension (OR = 1.42, 95% CI = 1.11, 1.83) and dyslipidaemia (OR = 1.25, 95% CI = 1.00, 1.57). Results provide new evidence for specific associations between perceived and overestimated distances from home to nearby resources and cardiometabolic risk factors.

Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also provides a reasonable basis for further investigation with better quality data and longitudinal studies with policy-relevant environmental measures. This pursuit of better evidence is critical to support health-orientated urban design and city planning.

Does Physical Activity Mediate the Association Between Perceived Neighborhood Aesthetics and Overweight/Obesity Among South African Adults Living in Selected Urban and Rural Communities?

Background: To investigate the mediation effects of physical activity (PA) on the relationship between the perceived neighborhood aesthetic environment and overweight/obesity in free-living South Africans. Methods: A cross-sectional study of 671 adults aged ≥ 35 years was analyzed. PA was assessed using the validated International Physical Activity Questionnaire. Perceived neighborhood aesthetics was assessed using the Neighborhood Environment Walkability Scale Questionnaire. Results: Of 671 participants, 76.0% were women, 34.1% aged 45–54 years, and 69.2% were overweight or obese. In adjusted logistic regression models, overweight/obesity was significantly associated with neighborhood aesthetics [odds ratio (OR) = 0.68; 95% confidence interval (CI), 0.50–0.93] and PA (OR = 0.65; 95% CI, 0.65–0.90). In expanded multivariable models, overweight/obesity was associated with age 45–55 years (OR = 1.59; 95% CI, 1.05–2.40), female gender (OR = 6.24; 95% CI, 3.95–9.86), tertiary education (OR = 4.05; 95% CI, 1.19–13.86), and urban residence (OR = 2.46; 95% CI, 1.66–3.65). Conclusion: Aesthetics was positively associated with PA; both aesthetics and PA were negatively associated with overweight and obesity. There was no evidence to support a significant mediating effect of PA on the relationship between aesthetics and overweight/obesity. Future studies should consider objective assessment of aesthetics and PA. In addition, future studies should consider using longitudinal design to evaluate food-related environments, which are related to overweight or obesity.

Independent Effects of Neighborhood Poverty and Psychosocial Stress on Obesity Over Time

The objective of the study was to examine the independent effects of neighborhood poverty and psychosocial stress on increases in central adiposity over time. Data are from a community sample of 157 Non-Hispanic Black, Non-Hispanic White, and Hispanic adults collected in 2002-2003 and 2007-2008, and from the 2000 Decennial Census. The dependent variable was waist circumference. Independent variables included neighborhood poverty, perceived neighborhood physical environment, family stress, safety stress, everyday unfair treatment, and a cumulative stress index. Weighted 3-level hierarchical linear regression models for a continuous outcome were used to assess the effects of neighborhood poverty and psychosocial stress on central adiposity over time. We also assessed whether psychosocial stress mediated the association between neighborhood poverty and central adiposity. Neighborhood poverty and everyday unfair treatment at baseline were independently associated with increases in central adiposity over time, accounting for the other indicators of stress. Perceptions of the neighborhood physical environment and cumulative stress mediated associations between neighborhood poverty and central adiposity. Results suggest that residing in neighborhoods with higher concentrations of poverty and exposure to everyday unfair treatment independently heighten risk of increased central adiposity over time. Associations between neighborhood poverty and central adiposity were mediated by perceptions of the neighborhood physical environment and by the cumulative stress index. Public health strategies to reduce obesity should consider neighborhood poverty and exposure to multiple sources of psychosocial stress, including everyday unfair treatment.

Reducing the Global Burden of Cardiovascular Disease, Part 1: The Epidemiology and Risk Factors

Current global health policy goals include a 25% reduction in premature mortality from noncommunicable diseases by 2025. In this 2-part review, we provide an overview of the current epidemiological data on cardiovascular diseases (CVD), its risk factors, and describe strategies aimed at reducing its burden. In part 1, we examine the global epidemiology of cardiac conditions that have the greatest impact on CVD mortality; the predominant risk factors; and the impact of upstream, societal health determinants (eg, environmental factors, health policy, and health systems) on CVD. Although age-standardized mortality from CVD has decreased in many regions of the world, the absolute number of deaths continues to increase, with the majority now occurring in middle- and low-income countries. It is evident that multiple factors are causally related to CVD, including traditional individual level risk factors (mainly tobacco use, lipids, and elevated blood pressure) and societal level health determinants (eg, health systems, health policies, and barriers to CVD prevention and care). Both individual and societal risk factors vary considerably between different regions of the world and economic settings. However, reliable data to estimate CVD burden are lacking in many regions of the world, which hampers the establishment of nationwide prevention and management strategies. A 25% reduction in premature CVD mortality globally is feasible but will require better implementation of evidence-based policies (particularly tobacco control) and integrated health systems strategies that improve CVD prevention and management. In addition, there is a need for better health information to monitor progress and guide health policy decisions.

Obesity Pathogenesis: An Endocrine Society Scientific Statement

Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this "upward setting" or "resetting" of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.

Local descriptive norms for overweight/obesity and physical inactivity, features of the built environment, and 10-year change in glycosylated haemoglobin in an Australian population-based biomedical cohort

Descriptive norms vary between places. Spatial variation in health-related descriptive norms may predict individual-level health outcomes. Such relationships have rarely been investigated. This study assessed 10-year change in glycosylated haemoglobin (HbA1c) in relation to local descriptive norms for overweight/obesity (n = 1890) and physical inactivity (n = 1906) in models accounting for features of the built environment. HbA1c was measured three times over 10 years for a population-based biomedical cohort of adults in Adelaide, South Australia. Environmental exposures were expressed for cohort participants using 1600 m road-network buffers centred on participants' residential address. Local descriptive norms (prevalence of overweight/obesity [body mass index ≥25 kg/m(2)] and of physical inactivity [<150 min/week]) were aggregated from responses to a separate geocoded population survey. Built environment measures were public open space (POS) availability (proportion of buffer area) and walkability. Separate sets of multilevel models analysed different predictors of 10-year change in HbA1c. Each model featured one local descriptive norm and one built environment variable with area-level education and individual-level covariates (age, sex, employment status, education, marital status, and smoking status). Interactions between local descriptive norms and built environment measures were assessed. HbA1c increased over time. POS availability and local descriptive norms for overweight/obesity and physical inactivity were each associated with greater rates of HbA1c increase. Greater walkability was associated with a reduced rate of HbA1c increase, and reduced the influence of the overweight/obesity norm on the rate of increase in HbA1c. Local descriptive health-related norms and features of the built environment predict 10-year change in HbA1c. The impact of local descriptive norms can vary according to built environment features. Little researched thus far, local descriptive norms may play an important role in the evolution of HbA1c and thus cardiometabolic risk, over time. Further empirical research on local descriptive norms is necessary to understand how residential environments shape chronic disease risk.

Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up

Background

Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources.

Methods

A nationwide sample of 2 040 826 men and 2 153 426 women aged 35–80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS).

Results

We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15–1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05–1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income.

Conclusions

This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3293-5) contains supplementary material, which is available to authorized users.

General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment

BACKGROUND

Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents.

OBJECTIVES

To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran.

PATIENTS AND METHODS

In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model.

RESULTS

Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant.

CONCLUSIONS

The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity.

Assessing the Environment for Support of Youth Physical Activity in Rural Communities

OBJECTIVE

Assess environmental support of physical activity (PA) in rural areas and determine whether there is a correlation between the measured environment for PA and participant perceptions of the environment for PA.

DESIGN

The PA environment was assessed using the Active Neighborhood Checklist (ANC) and the Physical Activity Resource Assessment (PARA). Youth behavior and perceptions related to PA and the local environment were assessed using 5 questions from previously validated tools.

SETTING

Four rural low-income communities in South Dakota and Kansas.

PARTICIPANTS

Sixth- through eighth-grade youth.

VARIABLES MEASURED

Physical Activity Resource Assessment, ANC, behavior, and perception.

ANALYSIS

The authors used ANOVA to determine whether there were differences in ANC, PARA, and Perception of the Environment scores among communities. Pearson correlations were used to assess associations between ANC and student perception of the environment and PARA and student perception of the environment.

RESULTS

There were no differences in total ANC or total PARA among communities. Perception was weakly correlated with total ANC (multivariate coefficient, 0.016; P = .026; n = 308) but not total PARA.

CONCLUSIONS AND IMPLICATIONS

Perception of PA in rural communities may not match objective measures. Future research should work toward refining and improving existing environmental audit tools and developing new, comprehensive, location-specific tools.

Neighborhood Environment is Associated with Overweight and Obesity, Particularly in Older Residents: Results from Cross-Sectional Study in Dutch Municipality

We explored whether overweight and obesity were associated with the physical and social environment at neighborhood level. Data from Maastricht municipality survey (The Netherlands) were used (n = 9771 adults). Multinomial regression models were computed (outcome being normal weight, overweight, or obese). We found inconsistent associations between neighborhood social and physical environment characteristics and overweight and obesity in the total sample. The effects were more consistent and stronger for older residents (>65) and obesity as an outcome. Better scores on traffic nuisance, green space, social cohesion, nuisance, and safety were associated with lower odds of obesity among elderly (OR ranged between 0.71 [95% CI 0.44 to 0.93] to 0.85 [95% CI 0.74 to 0.96] for each point of improvement in neighborhood social and physical environment (scale 0-10)). We showed that there are neighborhood-level factors that are associated with obesity, particularly in elderly residents. These could be targeted in preventive strategies outside health care settings.

Heterogeneity in barriers regarding the motivation, the opportunity and the ability to choose low-calorie snack foods and beverages: associations with real-life choices

Objective

Employing Rothschild’s Motivation–Opportunity–Ability framework, the present study examines the extent to which heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. Furthermore, the study investigates which dominant barrier profiles can be discerned.

Design

Data were obtained from a survey about participants’ motivation, opportunity and ability to choose low-calorie over high-calorie snacks and an FFQ that measured habitual consumption of snack foods and beverages. Data were analysed using R packages lavaan and NbClust, and IBM SPSS Statistics.

Setting

A representative sample (n 1318) of the Dutch population based on gender (686 women), age and education level.

Results

For both snack foods and beverages, motivation to choose low-calorie over high-calorie snacks was associated strongest with proportions of low-calorie choices. The perceived ability and perceived opportunity were also associated with proportions of low-calorie choices, albeit to a lesser extent. Furthermore, three dominant profiles of barriers were identified: the no-barrier profile, the lack-of-opportunity profile and the lack-of-motivation profile. These profiles differed significantly on proportions of low-calorie snack choices, daily meal consumption and sociodemographic characteristics.

Conclusions

Heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. By identifying and appreciating heterogeneity in barriers, the present study provides further incentives for the tailoring of intervention strategies.

Influence of urban neighbourhood environment on physical activity and obesity-related diseases

OBJECTIVES

The impact of characteristics of neighbourhood environment on physical activity and obesity-related diseases is still the subject of debate. This study aimed to explore the impact of urban neighbourhood environment on physical activity and obesity-related diseases.

STUDY DESIGN

Cross-sectional study.

METHODS

Individuals who participated in the 2009 national health-screening programme, submitted all necessary information, and had lived in Community 1 (Haengdang) or Community 2 (Ilsan) for at least 2 years (n = 16,178) were selected for inclusion in this study. Anthropometric measures were taken and physical activity was assessed using a short questionnaire.

RESULTS

No significant difference in the trigger factors for walking, including the amount of neighbourhood park space, number of shopping malls, and distance between the community and shopping malls, was found between the two communities. However, Community 2 had a better street environment than Community 1. Participants who lived in Community 2 were more physically active [adjusted odds ratio (OR) 1.31, 95% confidence interval (CI) 1.16-1.48] and walked more regularly (adjusted OR 1.09, 95% CI 1.02-1.17) than participants who lived in Community 1, and were less likely to have abdominal obesity (adjusted OR 0.83, 95% CI 0.77-0.91), hypertension (adjusted OR 0.88, 95% CI 0.80-0.97) and diabetes (adjusted OR 0.86, 95% CI 0.75-0.99). However, the risk of dyslipidaemia, especially in terms of low-density lipoprotein cholesterol, was higher in Community 2.

CONCLUSIONS

These results suggest that a walkable environment has a positive influence on hypertension and diabetes, and physical activity is the possible mechanism for this association. A walkable environment may function as an important tool for health promotion in urban areas.

The Wisconsin Assessment of the Social and Built Environment (WASABE): a multi-dimensional objective audit instrument for examining neighborhood effects on health

BACKGROUND

Growing evidence suggests that mixed methods approaches to measuring neighborhood effects on health are needed. The Wisconsin Assessment of the Social and Built Environment (WASABE) is an objective audit tool designed as an addition to a statewide household-based health examination survey, the Survey of the Health of Wisconsin (SHOW), to objectively measure participant's neighborhoods.

METHODS

This paper describes the development and implementation of the WASABE and examines the instrument's ability to capture a range of social and built environment features in urban and rural communities. A systematic literature review and formative research were used to create the tool. Inter-rater reliability parameters across items were calculated. Prevalence and density of features were estimated for strata formed according to several sociodemographic and urbanicity factors.

RESULTS

The tool is highly reliable with over 81% of 115 derived items having percent agreement above 95%. It captured variance in neighborhood features in for a diverse sample of SHOW participants. Sidewalk density in neighborhoods surrounding households of participants living at less than 100% of the poverty level was 67% (95% confidence interval, 55-80%) compared to 34% (25-44%) for those living at greater than 400% of the poverty level. Walking and biking trails were present in 29% (19-39%) of participant buffer in urban areas compared to only 7% (2-12%) in rural communities. Significant environmental differences were also observed for white versus non-white, high versus low income, and college graduates versus individuals with lower level of education.

CONCLUSIONS

The WASABE has strong inter-rater reliability and validity properties. It builds on previous work to provide a rigorous and standardized method for systematically gathering objective built and social environmental data in a number of geographic settings. Findings illustrate the complex milieu of built environment features found in participants neighborhoods and have relevance for future research, policy, and community engagement purposes.