Neighborhood and Health The Portland Neighborhood Environment & Health Study Fuzhong Li, Ph. D Oregon Research Institute Part II

Studies Conducted To Date

Study 1  Purpose To examine the relationship between neighborhood built environment factors (representing various dimensions of urban form), adiposity and physical activity in middle aged and older adults To examine the relationship between neighborhood built environment factors (representing various dimensions of urban form), adiposity and physical activity in middle aged and older adults Li et al. (2008). American Journal of Preventive Medicine

METHODOLOGY  Measures Independent Variables at the PSU Level: Geographic Information System-derived measures of land use mix, distribution of fast food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables at the Resident Level: Overweight/obesity (BMI  25), three walking activities, and levels of overall physical activity

What We’ve Found  Living in High Density of Fast-food Outlet Neighborhoods Is Associated with 1.15 Odds of Being Overweight/obese  Living in Better Land Use Mix Neighborhoods Means Lower Risk (24%) of Being Overweight/obese  Living in Better Land Use Mix Neighborhoods Means a Person is More Likely to: –Engage in neighborhood walking –Walk for transportation –Walk for errands –Meet physical activity recommendations Li et al. (2008). American Journal of Preventive Medicine

DISCUSSION The need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles

Study 2  Purpose To examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast-food outlets and residents’ behavioral, psychosocial, and sociodemographic characteristics To examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast-food outlets and residents’ behavioral, psychosocial, and sociodemographic characteristics Li et al. (2009). American Journal of Health Promotion

METHODOLOGY  Measures Independent Variables at the PSU Level: Geographic Information System-derived measures of fast-food restaurants Dependent variables at the Resident Level: Obesity (BMI  30), frequency of visits to local fast-food restaurants, fried food consumption, levels of physical activity, self- efficacy of eating fruits and vegetables

 Person and Environment –Likelihood of being obese –Depending on density of fast food outlets and how frequent visits are made to local fast food restaurants  Odds = 1.88 –If living in higher density of fast-food restaurants AND making weekly visits to local fast-food restaurants Li et al. (2008). American Journal of Health Promotion What We’ve Found

 Likelihood of being obese –Depending on density of fast food outlets and whether meeting recommended physical activity – Odds = 1.79 –If living in higher density of fast-food restaurants AND not meeting physical activity recommendations Li et al. (2008). American Journal of Health Promotion What We’ve Found So Far?

 Likelihood of being obese –Depending on density of fast food outlets and level of confidence in eating healthy food  Odds = 1.21 –If living in higher density of fast-food restaurants AND low confidence in eating healthy food Li et al. (2008). American Journal of Health Promotion What We’ve Found So Far?

Conclusion  Increased density of neighborhood fast-food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults  H ighlight the importance of considering the role of an obesogenic environment – density of fast-food outlets, and the mechanisms through which it may influence behavior and health

Study 3  Purpose To examine neighborhood built environment characteristics (fast-food restaurant density, walkability) and individual eating-out and physical activity behaviors in relation to 1-year change in body weight among adults who were years of age at baseline To examine neighborhood built environment characteristics (fast-food restaurant density, walkability) and individual eating-out and physical activity behaviors in relation to 1-year change in body weight among adults who were years of age at baseline Li et al. (2009). American Journal of Epidemiology

METHODOLOGY  Measures Independent Variables at the PSU Level: Geographic Information System-derived measures of neighborhood walkability, density of fast-food outlets Dependent variables at the Resident Level: Body weight (kg) and waist circumference (cm), visits to local fast-food restaurants, change in physical activity

RESULTS A high-density of fast food outlets was associated with an increase of 3 pounds in weight and 0.8 inches in waist circumference among neighborhood residents who frequently ate at those restaurants. In contrast, high-walkability neighborhoods were associated with a decrease of 2.7 pounds in weight and 0.6 inches in waist size among residents who increased their levels of vigorous PA during a one-year period.

Conclusion  Findings point to the negative influences of the availability of neighborhood fast-food outlets and individual unhealthy eating behaviors that jointly affect weight gain  However, better neighborhood walkability and increased levels of physical activity are likely to be associated with maintaining a healthy weight over time.

Study 4  Purpose To examine built environment characteristics and individual health behaviors as they relate to blood pressure, an important component of CVD To examine built environment characteristics and individual health behaviors as they relate to blood pressure, an important component of CVD Li et al. (2009). Preventive Medicine

METHODOLOGY  Measures Independent Variables at the PSU Level: Geographic Information System-derived measures of neighborhood walkability, distribution of fast food outlets Dependent variables at the Resident Level: Systolic and diastolic blood pressure; meeting recommended physical activity, and fruit and vegetable intake

RESULTS  low neighborhood walkability and high density of fast-food restaurants were both significantly related to increases in systolic and diastolic blood pressure over time  However, neighborhood walkability appears to play an important moderating role in that high neighborhood walkability was associated with a reduction in the negative impact of high density of fast-food outlets on blood pressure

Conclusion Neighborhoods with high walkability may ameliorate the risk of hypertension at the community level and promotion of neighborhood walkability could play a significant role in improving population health and reducing CVD risk

WHT IS NEXT?  To examine multilevel change in BMI over time  To simultaneously examine neighborhood-level and resident-level change and variation in change in BMI over a 3-year period  To examine association between the physical and built environment and change in physical activity over time

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