Northwest Center for Livable Communities Archives

Does the Built Environment Have Independent Obesogenic Power? Urban Form and Trajectories of Weight Gain

Buszkiewicz, James H.; Bobb, Jennifer F.; Hurvitz, Philip M.; Arterburn, David; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Cruz, Maricela; Gupta, Shilpi; Lozano, Paula; Rosenberg, Dori E.; Theis, Mary Kay; Anau, Jane; Drewnowski, Adam. (2021). Does the Built Environment Have Independent Obesogenic Power? Urban Form and Trajectories of Weight Gain. International Journal Of Obesity, 45(9), 1914 – 1924.

View Publication

Abstract

Objective To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults. Methods Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values. Results Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg. Conclusions Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Keywords

Body-mass Index; Physical-activity; Food Environment; Structural Racism; Obesity; Neighborhoods; Associations; Health; Walkability; Exposure; Environment Models; Minority & Ethnic Groups; Urban Environments; Regression Analysis; Regression Models; Residential Density; Body Mass Index; Property Values; Body Weight Gain; Government Programs; Body Weight; Electronic Medical Records; Electronic Health Records; Fast Food; Buffers; Real Estate; Body Mass; Body Size; Socioeconomics; Health Care

Differential Associations of the Built Environment on Weight Gain by Sex and Race/Ethnicity but Not Age

Buszkiewicz, James H.; Bobb, Jennifer F.; Kapos, Flavia; Hurvitz, Philip M.; Arterburn, David; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Cruz, Maricela; Gupta, Shilpi; Lozano, Paula; Rosenberg, Dori E.; Theis, Mary Kay; Anau, Jane; Drewnowski, Adam. (2021). Differential Associations of the Built Environment on Weight Gain by Sex and Race/Ethnicity but Not Age. International Journal Of Obesity, 45(12), 2648 – 2656.

View Publication

Abstract

Objective To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults. Methods Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values. Results Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures. Conclusion The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.

Keywords

Body-mass Index; Socioeconomic-status; Food Environment; Obesity; Health; Outcomes; Scale; Risk; Minority & Ethnic Groups; Urban Environments; Etiology; Demographics; Sex; Residential Density; Supermarkets; Age; Race; Ethnicity; Property Values; Body Weight Gain; Electronic Medical Records; Fast Food; Electronic Health Records; Real Estate; Subgroups; Demography; Trajectory Analysis; Weight

Advancing Research in Transportation and Public Health: A Selection of Twenty Project Ideas from a US Research Roadmap

Dannenberg, Andrew L.; Rodriguez, Daniel A.; Sandt, Laura S. (2021). Advancing Research in Transportation and Public Health: A Selection of Twenty Project Ideas from a US Research Roadmap. Journal Of Transport & Health, 21.

View Publication

Abstract

Background: Transportation policies and projects have multiple impacts on health. Research on these impacts can help promote positive and reduce adverse health consequences of decisions made by transportation agencies. Methods: In 2019 the U.S. National Cooperative Highway Research Program published a research roadmap for transportation and public health based on an extensive literature search and key informant interviews. The roadmap identified 44 research gaps and 122 research needs on a wide range of relevant topics. From this list, using pre-established criteria including specificity, equity, potential impact, and long-term usefulness, we selected 20 topics suitable for further research especially in academic settings. Results: We present the questions, context, and possible research approach for each of the 20 topics. These topics cover issues ranging from integrating equity into performance measures and developing forecasting models for active travel to incorporating health questions into routine household travel surveys and examining health impacts of autonomous vehicles. We added questions on the impacts of the COVID-19 pandemic on transportation. Discussion: This list will be useful to faculty, researchers, and students as they consider topics for research in transportation and public health. Results of research on these topics could influence transportation decisions in policy making, planning and community participation, capital programming, project design, and implementation. Future leaders of transportation agencies, transportation providers, and advocacy organizations may be more likely to consider transportation policies that incorporate a health perspective if their training includes research findings that increase their awareness of the health impacts of these policies.

Keywords

Public Health; Equity; Research; Public Transit; Metrics; Transportation Planning

Measurement of Neighborhood-Based Physical Activity Bouts

Duncan, Glen E.; Hurvitz, Philip M.; Moudon, Anne Vernez; Avery, Ally R.; Tsang, Siny. (2021). Measurement of Neighborhood-Based Physical Activity Bouts. Health & Place, 70.

View Publication

Abstract

This study examined how buffer type (shape), size, and the allocation of activity bouts inside buffers that delineate the neighborhood spatially produce different estimates of neighborhood-based physical activity. A sample of 375 adults wore a global positioning system (GPS) data logger and accelerometer over 2 weeks under free-living conditions. Analytically, the amount of neighborhood physical activity measured objectively varies substantially, not only due to buffer shape and size, but by how GPS-based activity bouts are identified with respect to containment within neighborhood buffers. To move the neighborhood-effects literature forward, it is critical to delineate the spatial extent of the neighborhood, given how different ways of measuring GPS-based activity containment will result in different levels of physical activity across different buffer types and sizes.

Keywords

Built Environment; Walking; Home; Accelerometry; Geographic Information Systems; Gps; Neighborhood; Physical Activity

Measuring the Urban Forms of Shanghai’s City Center and Its New Districts: A Neighborhood-Level Comparative Analysis

Lin, Lin; Chen, Xueming (Jimmy); Moudon, Anne Vernez. (2021). Measuring the Urban Forms of Shanghai’s City Center and Its New Districts: A Neighborhood-Level Comparative Analysis. Sustainability, 13(15).

View Publication

Abstract

Rapid urban expansion has radically transformed the city centers and the new districts of Chinese cities. Both areas have undergone unique redevelopment and development over the past decades, generating unique urban forms worthy of study. To date, few studies have investigated development patterns and land use intensities at the neighborhood level. The present study aims to fill the gap and compare the densities of different types of developments and the spatial compositions of different commercial uses at the neighborhood level. We captured the attributes of their built environment that support instrumental activities of daily living of 710 neighborhoods centered on the public elementary schools of the entire Shanghai municipality using application programming interfaces provided in Baidu Map services. The 200 m neighborhood provided the best fit to capture the variations of the built environment. Overall, city center neighborhoods had significantly higher residential densities and housed more daily routine destinations than their counterparts in the new districts. Unexpectedly, however, the total length of streets was considerably smaller in city-center neighborhoods, likely reflecting the prominence of the wide multilane vehicular roads surrounding large center city redevelopment projects. The findings point to convergence between the city center's urban forms and that of the new districts.

Keywords

Quantifying Spatiotemporal Patterns; Fast-food Restaurants; Instrumental Activities; Physical-activity; Chinese Cities; Land; Schools; Redevelopment; Expansion; Transformation; Built Environment; Planning; Neighborhood; Urban Form; Shanghai

What County-level Factors Influence Covid-19 Incidence in the United States? Findings from the First Wave of the Pandemic

Wang, Lan; Zhang, Surong; Yang, Zilin; Zhao, Ziyu; Moudon, Anne Vernez; Feng, Huasen; Liang, Junhao; Sun, Wenyao; Cao, Buyang. (2021). What County-level Factors Influence Covid-19 Incidence in the United States? Findings from the First Wave of the Pandemic. Cities, 118.

View Publication

Abstract

Effective control of the COVID-19 pandemic via appropriate management of the built environment is an urgent issue. This study develops a research framework to explore the relationship between COVID-19 incidence and influential factors related to protection of vulnerable populations, intervention in transmission pathways, and provision of healthcare resources. Relevant data for regression analysis and structural equation modeling is collected during the first wave of the pandemic in the United States, from counties with over 100 confirmed cases. In addition to confirming certain factors found in the existing literature, we uncover six new factors significantly associated with COVID-19 incidence. Furthermore, incidence during the lockdown is found to significantly affect incidence after the reopening, highlighting that timely quarantining and treating of patients is essential to avoid the snowballing transmission over time. These findings suggest ways to mitigate the negative effects of subsequent waves of the pandemic, such as special attention of infection prevention in neighborhoods with unsanitary and overcrowded housing, minimization of social activities organized by neighborhood associations, and contactless home delivery service of healthy food. Also worth noting is the need to provide support to people less capable of complying with the stay-at-home order because of their occupations or socio-economic disadvantage.

Keywords

Pandemics; Covid-19; Covid-19 Pandemic; Infection Prevention; Stay-at-home Orders; Structural Equation Modeling; United States; Communicable Disease Prevention; Influential Factors; Lockdown; Structural Equation Modeling (sem); Prevalence; Disease; Healthy Food; Social Activities; Counties; Neighborhoods; Housing; Built Environment; Prevention; Minimization; Socioeconomic Factors; Intervention; Health Care; Vulnerability; Occupations; Coronaviruses; Food Service; Disease Transmission; United States--us

Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States

Cowling, Krycia; Lindberg, Ruth; Dannenberg, Andrew L.; Neff, Roni A.; Pollack, Keshia M. (2017). Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States. Journal Of Agriculture Food Systems And Community Development, 7(3), 139 – 157.

View Publication

Abstract

Policies, programs, and projects related to agriculture, food, and nutrition can significantly affect public health. Health impact assessment (HIA) is one tool that can be used to improve awareness of the health effects of decisions outside the health sector, and increasing the use of HIA for agriculture, food, and nutrition decisions presents an opportunity to improve public health. This study identifies and reviews all HIAs completed in the United States on agriculture, food, and nutrition topics. Studies were identified from HIA databases, an Internet search, and expert consultation. Key characteristics were extracted from each study: type of decision assessed, location, level of jurisdiction, lead organization, methods of analysis, and recommendations. Twenty-five eligible HIAs that were conducted between 2007 and 2016 address topics such as regulations on land use for agriculture; food and beverage taxes; and developing grocery stores in food deserts. These HIAs have predominantly supported policy, as opposed to program or project, decisions. Four case studies are presented to illustrate in detail the HIA process and the mechanisms through which HIA findings affected policy decisions. Among other influences, these four HIAs affected the language of legislation and provided guidance for federal regulations. These examples demonstrate several findings: appropriate timing is critical for findings to have an influence; diverse stakeholder involvement generates support for recommendations; and the clear communication of feasible recommendations is highly important. There is substantial scope to increase the use of HIA in the agriculture, food, and nutrition sectors. Challenges include the paucity of monitoring and evaluation of HIAs' effects on health outcomes, and the limited funding available to conduct HIAs. Opportunities include integrating HIAs and community food assessments, and more widely sharing HIA findings to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system.

Keywords

Environments; Obesity; Health Impact Assessment; Policy; Food; Nutrition; Agriculture

Review of Education-Focused Health Impact Assessments Conducted in the United States

Gase, Lauren N.; Defosset, Amelia R.; Gakh, Maxim; Harris, Celia; Weisman, Susan R.; Dannenberg, Andrew L. (2017). Review of Education-Focused Health Impact Assessments Conducted in the United States. Journal Of School Health, 87(12), 911 – 922.

View Publication

Abstract

BACKGROUNDHealth impact assessment (HIA) provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. This study systematically reviewed HIAs conducted in the United States on prekindergarten, primary, and secondary education-focused decisions. METHODSRelevant HIA reports were identified from web sources in late 2015. Key data elements were abstracted from each report. Four case studies were selected to highlight diversity of topics, methods, and impacts of the assessment process. RESULTSTwenty HIAs completed in 2003-2015 from 8 states on issues related to prekindergarten through secondary education were identified. The types of decisions examined included school structure and funding, transportation to and from school, physical modifications to school facilities, in-school physical activity and nutrition, and school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies. CONCLUSIONSHealth impact assessment is a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities.

Keywords

Decision Making; Elementary Schools; High Schools; Medical Policy; Medline; Nutrition; Online Information Services; Research Funding; Student Health; Systematic Reviews (medical Research); Search Engines; Physical Activity; Health Impact Assessment; United States; Collaboration; Policy; Public Health; Academic-achievement; Programs

Use and Effectiveness of Health Impact Assessment in the Energy and Natural Resources Sector in the United States, 2007 – 2016

Nkyekyer, Esi W.; Dannenberg, Andrew L. (2019). Use and Effectiveness of Health Impact Assessment in the Energy and Natural Resources Sector in the United States, 2007 – 2016. Impact Assessment & Project Appraisal, 37(1), 17 – 32.

View Publication

Abstract

Decisions made in the energy and natural resources sector can affect public health. This report reviews the characteristics and assesses the effectiveness of health impact assessments (HIAs) conducted in this sector. A total of 30 HIAs conducted in 14 states in the United States were identified using a targeted literature search. Five HIAs illustrative of the different source and sub-sector categories, and with identifiable impacts on decision-making processes were selected for review. An existing conceptual framework (Wismar) was used to assess the effectiveness of the five selected HIAs on decision-making related to non-renewable energy, renewable energy, mining, and energy conservation. The 30 HIAs were performed for a variety of projects and assessed health impacts ranging from metabolic disorders to community livability. Eight of the 30 reports were incorporated into environmental impact assessments. All five selected HIAs were generally effective and raised awareness of the health effects of the projects being assessed; four were directly effective and led to changes in final project decisions. Their variable effectiveness may be related to the extent of community engagement and consideration of equity issues, differences in the details and quality of monitoring and evaluation plans devised as part of the HIA process, and whether the outcomes of monitoring and evaluation are reported.

Keywords

Health Impact Assessment; Health Equity; Natural Resources; Environmental Impact Analysis; Power Resources; U.s. States; Energy Conservation; United States; Decision-making Effectiveness; Energy And Natural Resources; Wismar Framework; Horizon Oil-spill; Wind Turbine Noise; Quality-of-life; Environmental-health; Gas Development; Mental-health; Exposure; Vicinity; Hazards; Sleep; Environmental Assessment; Public Health; Metabolic Disorders; Renewable Energy; Monitoring; Decision Making; Evaluation; Environmental Impact; Community Involvement; Environmental Impact Assessment; Renewable Resources; Decisions; Impact Analysis; Mining; United States--us

Do Home Buyers Value the New Urbanist Neighborhood? The Case of Issaquah Highlands, WA

Kim, Jinyhup; Bae, Chang-Hee Christine. (2020). Do Home Buyers Value the New Urbanist Neighborhood? The Case of Issaquah Highlands, WA. Journal Of Urbanism, 13(3), 303 – 324.

View Publication

Abstract

This study compares Issaquah Highlands‚Äô home prices with those of traditional suburban single-family homes in the city of Issaquah. Issaquah Highlands is a community that was developed using New Urbanism principles. The null hypothesis is that the sale prices of houses in Issaquah Highlands are not different from the conventional suburban neighborhood in the city of Issaquah. The principal database consists of US Census Washington State Geospatial Data Archive, and the King County Tax Assessments. The final dataset contains 1,780 single family homes over the seven-year period from 2012 to 2018 based on sale records throughout the city of Issaquah. This study uses the hedonic pricing technique to assess the impact of New Urbanism on the value of single-family residences. The findings suggest that people are willing to pay a $92,700‚Äì96,800 premium (approximately 7.1‚Äì12.0 percent of the sales prices) for houses in Issaquah Highlands.

Keywords

New Urbanism; Home Prices; Real Property; Sustainable Development; Spatial Analysis (statistics); Hedonic Pricing Model; Property Value; Smart Growth; Spatial Autocorrelation; Neighborhoods; Databases; Taxation; Spatial Data; Suburban Areas; Census; Prices; Housing Prices; Urbanism; Houses; Willingness To Pay; Residential Areas; Null Hypothesis; Cities; Buyers; Hedonism; Sales; Highlands; Tax Assessments