American Journal of Epidemiology Advance Access published online on March 25, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn047
Original Contribution |
Relation between Neighborhood Environments and Obesity in the Multi-Ethnic Study of Atherosclerosis
1 Robert Wood Johnson Health and Society Program, Harvard University, Boston, MA
2 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
3 Center for Social Epidemiology and Population Health, Ann Arbor, MI
4 Department of Medicine, Columbia University, New York, NY
5 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
6 Department of Epidemiology, Columbia University, New York, NY
7 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
8 Department of Nutrition, University of Oslo, Oslo, Norway
9 Northrop Grumman Contractor to the Division of Heart Disease and Stroke Prevention, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Correspondence to Dr. Mahasin Mujahid, Department of Society, Human Development, and Health, School of Public Health, Harvard University, Landmark Center, Room 445-A, 401 Park Drive, Boston, MA 02115 (e-mail: mmujahid{at}hsph.harvard.edu).
Received for publication October 25, 2007. Accepted for publication January 31, 2008.
This study investigated associations between neighborhood physical and social environments and body mass index in 2,865 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) aged 45–84 years and residing in Maryland, New York, and North Carolina. Neighborhood (census tract) environments were measured in non-MESA participants residing in MESA neighborhoods (2000–2002). The neighborhood physical environment score combined measures of a better walking environment and greater availability of healthy foods. The neighborhood social environment score combined measures of greater aesthetic quality, safety, and social cohesion and less violent crime. Marginal maximum likelihood was used to estimate associations between neighborhood environments and body mass index (kg/m2) before and after adjustment for individual-level covariates. MESA residents of neighborhoods with better physical environments had lower body mass index (mean difference per standard deviation higher neighborhood measure = –2.38 (95% confidence interval (CI): –3.38, –1.38) kg/m2 for women and –1.20 (95% CI: –1.84, –0.57) kg/m2 for men), independent of age, race/ethnicity, education, and income. Attenuation of these associations after adjustment for diet and physical activity suggests a mediating role of these behaviors. In men, the mean body mass index was higher in areas with better social environments (mean difference = 0.52 (95% CI: 0.07, 0.97) kg/m2). Improvement in the neighborhood physical environment should be considered for its contribution to reducing obesity.
atherosclerosis; body mass index; obesity; residence characteristics; social environment
Abbreviations: AHEI, Alternate Healthy Eating Index; CI, confidence interval; MESA, Multi-Ethnic Study of Atherosclerosis; MMLE, marginal maximum likelihood estimation; SD, standard deviation