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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.

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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

Access to Supermarkets and Fruit and Vegetable Consumption

Aggarwal, Anju; Cook, Andrea J.; Jiao, Junfeng; Seguin, Rebecca A.; Moudon, Anne Vernez; Hurvitz, Philip M.; Drewnowski, Adam. (2014). Access to Supermarkets and Fruit and Vegetable Consumption. American Journal Of Public Health, 104(5), 917 – 923.

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Abstract

Objectives. We examined whether supermarket choice, conceptualized as a proxy for underlying personal factors, would better predict access to supermarkets and fruit and vegetable consumption than mere physical proximity. Methods. The Seattle Obesity Study geocoded respondents' home addresses and locations of their primary supermarkets. Primary supermarkets were stratified into low, medium, and high cost according to the market basket cost of 100 foods. Data on fruit and vegetable consumption were obtained during telephone surveys. Linear regressions examined associations between physical proximity to primary supermarkets, supermarket choice, and fruit and vegetable consumption. Descriptive analyses examined whether supermarket choice outweighed physical proximity among lower-income and vulnerable groups. Results. Only one third of the respondents shopped at their nearest supermarket for their primary food supply. Those who shopped at low-cost supermarkets were more likely to travel beyond their nearest supermarket. Fruit and vegetable consumption was not associated with physical distance but, with supermarket choice, after adjusting for covariates. Conclusions. Mere physical distance may not be the most salient variable to reflect access to supermarkets, particularly among those who shop by car. Studies on food environments need to focus beyond neighborhood geographic boundaries to capture actual food shopping behaviors.

Keywords

Confidence Intervals; Correlation (statistics); Fruit; Geographic Information Systems; Ingestion; Multivariate Analysis; Population Geography; Questionnaires; Regression Analysis; Research Funding; Sales Personnel; Shopping; Travel; Vegetables; Predictive Validity; Cross-sectional Method; Statistical Models; Descriptive Statistics; Null Hypothesis; Washington (state); Local Food Environment; Diet Quality; Socioeconomic Position; Atherosclerosis Risk; Stores; Associations; Obesity; Adults; Availability; Communities

Health Implications of Adults’ Eating at and Living Near Fast Food or Quick Service Restaurants

Jiao, J.; Moudon, A. V.; Kim, S. Y.; Hurvitz, P. M.; Drewnowski, A. (2015). Health Implications of Adults’ Eating at and Living Near Fast Food or Quick Service Restaurants. Nutrition & Diabetes, 5.

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Abstract

BACKGROUND: This paper examined whether the reported health impacts of frequent eating at a fast food or quick service restaurant on health were related to having such a restaurant near home. METHODS: Logistic regressions estimated associations between frequent fast food or quick service restaurant use and health status, being overweight or obese, having a cardiovascular disease or diabetes, as binary health outcomes. In all, 2001 participants in the 2008-2009 Seattle Obesity Study survey were included in the analyses. RESULTS: Results showed eating >= 2 times a week at a fast food or quick service restaurant was associated with perceived poor health status, overweight and obese. However, living close to such restaurants was not related to negative health outcomes. CONCLUSIONS: Frequent eating at a fast food or quick service restaurant was associated with perceived poor health status and higher body mass index, but living close to such facilities was not.

Keywords

Body-mass Index; Socioeconomic-status; Built Environment; Obesity; Association; Consumption; Weight; Proximity; Outlets; Establishments

GPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity

James, Peter; Hart, Jaime E.; Hipp, J. Aaron; Mitchell, Jonathan A.; Kerr, Jacqueline; Hurvitz, Philip M.; Glanz, Karen; Laden, Francine. (2017). GPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity. Cancer Epidemiology Biomarkers & Prevention, 26(4), 525 – 532.

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Abstract

Background: Physical inactivity is a risk factor for cancer that may be influenced by environmental factors. Indeed, dense and well-connected built environments and environments with natural vegetation may create opportunities for higher routine physical activity. However, studies have focused primarily on residential environments to define exposure and self-reported methods to estimate physical activity. This study explores the momentary association between minute-level global positioning systems (GPS)-based greenness exposure and time-matched objectively measured physical activity. Methods: Adult women were recruited from sites across the United States. Participants wore a GPS device and accelerometer on the hip for 7 days to assess location and physical activity at minutelevel epochs. GPS records were linked to 250mresolution satellitebased vegetation data and Census Block Group-level U.S. Environmental Protection Agency (EPA) Smart Location Database walkability data. Minute-level generalized additive mixed models were conducted to test for associations between GPS measures and accelerometer count data, accounting for repeated measures within participant and allowing for deviations fromlinearity using splines. Results: Among 360 adult women (mean age of 55.3 +/- 10.2 years), we observed positive nonlinear relationships between physical activity and both greenness and walkability. In exploratory analyses, the relationships between environmental factors and physical activity were strongest among those who were white, had higher incomes, and who were middle-aged. Conclusions: Our results indicate that higher levels of physical activity occurred in areas with higher greenness and higher walkability. Impact: Findings suggest that planning and design policies should focus on these environments to optimize opportunities for physical activity. (C) 2017 AACR.

Keywords

Built Environments; Health Research; Breast-cancer; Obesity; Neighborhood; Validation; Validity; Walking; Risk; Energetics

Higher Residential and Employment Densities Are Associated with More Objectively Measured Walking in the Home Neighborhood

Huang, Ruizhu; Moudon, Anne, V; Zhou, Chuan; Saelens, Brian E. (2019). Higher Residential and Employment Densities Are Associated with More Objectively Measured Walking in the Home Neighborhood. Journal Of Transport & Health, 12, 142 – 151.

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Abstract

Introduction: Understanding where people walk and how the built environment influences walking is a priority in active living research. Most previous studies were limited by self-reported data on walking. In the present study, walking bouts were determined by integrating one week of accelerometry, GPS, and a travel log data among 675 adult participants in the baseline sample of the Travel Assessment and Community study at Seattle, Washington in the United State. Methods: Home neighborhood was defined as being within 0.5 mile of each participants' residence (a 10-min walk), with home neighborhood walking defined as walking bout lines with at least one GPS point within the home neighborhood. Home neighborhood walkability was constructed with seven built environment variables derived from spatially continuous objective values (SmartMaps). Collinearity among neighborhood environment variables was analyzed and variables that were strongly correlated with residential density were excluded in the regression analysis to avoid erroneous estimates. A Zero Inflated Negative Binomial (ZINB) served to estimate associations between home neighborhood environment characteristics and home neighborhood walking frequency. Results: The study found that more than half of participants' walking bouts occurred in their own home neighborhood. Higher residential density and job density were the two neighborhood walkability measures related to higher likelihood and more time walking in the home neighborhood, highest tertile residential density (22.4-62.6 unit/ha) (coefficient= 1.43; 95% CI 1.00-2.05) and highest tertile job density (12.4-272.3 jobs/acre) (coefficient= 1.62; 1.10-2.37). Conclusions: The large proportion of walking that takes place in the home neighborhood highlights the importance of continuing to examine the impact of the home neighborhood environment on walking. Potential interventions to increase walking behavior may benefit from increasing residential and employment density within residential areas.

Keywords

Body-mass Index; Built Environment; Physical-activity; Land Uses; Epidemiology; Selection; Location; Obesity; Travel Assessment And Community; Smartmaps; Neighborhood Environment; Physical Activity; Walking

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.

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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

Built Environment Change: A Framework To Support Health-enhancing Behaviour Through Environmental Policy And Health ResearchBuilt Environment Change: A Framework to Support Health-Enhancing Behaviour through Environmental Policy and Health Research

Berke, Ethan M.; Vernez-Moudon, Anne. (2014). Built Environment Change: A Framework to Support Health-Enhancing Behaviour through Environmental Policy and Health Research. Journal Of Epidemiology And Community Health, 68(6), 586 – 590.

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Abstract

As research examining the effect of the built environment on health accelerates, it is critical for health and planning researchers to conduct studies and make recommendations in the context of a robust theoretical framework. We propose a framework for built environment change (BEC) related to improving health. BEC consists of elements of the built environment, how people are exposed to and interact with them perceptually and functionally, and how this exposure may affect health-related behaviours. Integrated into this framework are the legal and regulatory mechanisms and instruments that are commonly used to effect change in the built environment. This framework would be applicable to medical research as well as to issues of policy and community planning.

Keywords

Geographic Information-systems; Physical-activity; Obesity; Place; Associations; Walkability; Risk; Care

Split-Match-Aggregate (SMA) Algorithm: Integrating Sidewalk Data with Transportation Network Data in GIS

Kang, Bumjoon; Scully, Jason Y.; Stewart, Orion; Hurvitz, Philip M.; Moudon, Anne V. (2015). Split-Match-Aggregate (SMA) Algorithm: Integrating Sidewalk Data with Transportation Network Data in GIS. International Journal Of Geographical Information Science, 29(3), 440 – 453.

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Abstract

Sidewalk geodata are essential to understand walking behavior. However, such geodata are scarce, only available at the local jurisdiction and not at the regional level. If they exist, the data are stored in geometric representational formats without network characteristics such as sidewalk connectivity and completeness. This article presents the Split-Match-Aggregate (SMA) algorithm, which automatically conflates sidewalk information from secondary geometric sidewalk data to existing street network data. The algorithm uses three parameters to determine geometric relationships between sidewalk and street segments: the distance between streets and sidewalk segments; the angle between sidewalk and street segments; and the difference between the lengths of matched sidewalk and street segments. The SMA algorithm was applied in urban King County, WA, to 13 jurisdictions' secondary sidewalk geodata. Parameter values were determined based on agreement rates between results obtained from 72 pre-specified parameter combinations and those of a trained geographic information systems (GIS) analyst using a randomly selected 5% of the 79,928 street segments as a parameter-development sample. The algorithm performed best when the distances between sidewalk and street segments were 12m or less, their angles were 25 degrees or less, and the tolerance was set to 18m, showing an excellent agreement rate of 96.5%. The SMA algorithm was applied to classify sidewalks in the entire study area and it successfully updated sidewalk coverage information on the existing regional-level street network data. The algorithm can be applied for conflating attributes between associated, but geometrically misaligned line data sets in GIS.

Keywords

Geodatabases; Sidewalks; Algorithms; Pedestrians; Digital Mapping; Algorithm; Gis; Pedestrian Network Data; Polyline Conflation; Sidewalk; Built Environment; Physical-activity; Mode Choice; Urban Form; Land-use; Travel; Generation; Walking

Differences in Behavior, Time, Location, and Built Environment between Objectively Measured Utilitarian and Recreational Walking

Kang, Bumjoon; Moudon, Anne V.; Hurvitz, Philip M.; Saelens, Brian E. (2017). Differences in Behavior, Time, Location, and Built Environment between Objectively Measured Utilitarian and Recreational Walking. Transportation Research: Part D, 57, 185 – 194.

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Abstract

Objectives: Utilitarian and recreational walking both contribute to physical activity. Yet walking for these two purposes may be different behaviors. We sought to provide operational definitions of utilitarian and recreational walking and to objectively measure their behavioral, spatial, and temporal differences in order to inform transportation and public health policies and interventions. Methods: Data were collected 2008-2009 from 651 Seattle-King County residents, wearing an accelerometer and a GPS unit, and filling-in a travel diary for 7 days. Walking activity bouts were classified as utilitarian or recreational based on whether walking had a destination or not. Differences between the two walking purposes were analyzed, adjusting for the nested structure of walking activity within participants. Results: Of the 4905 observed walking bouts, 87.4% were utilitarian and 12.6% recreational walking. Utilitarian walking bouts were 45% shorter in duration (-12.1 min) and 9% faster in speed (+0.3 km/h) than recreational walking bouts. Recreational walking occurred more frequently in the home neighborhood and was not associated with recreational land uses. Utilitarian walking occurred in areas having higher residential, employment, and street density, lower residential property value, higher area percentage of mixed-use neighborhood destinations, lower percentage of parks/trails, and lower average topographic slope than recreational walking. Conclusion: Utilitarian and recreational walking are substantially different in terms of frequency, speed, duration, location, and related built environment. Policies that promote walking should adopt type-specific strategies. The high occurrence of recreational walking near home highlights the importance of the home neighborhood for this activity.

Keywords

Walking; Utilitarianism; Recreation; Behavioral Assessment; Built Environment; Physical Activity Measurement; Accelerometer; Active Transportation; Gps; Home And Non-home Based Walking; Pedestrian; Physical-activity; Us Adults; Accelerometer Data; Trip Purpose; Urban Form; Travel; Neighborhood; Distance; System

Intersections and Non-Intersections: A Protocol for Identifying Pedestrian Crash Risk Locations in GIS

Kang, Mingyu; Moudon, Anne Vernez; Kim, Haena; Boyle, Linda Ng. (2019). Intersections and Non-Intersections: A Protocol for Identifying Pedestrian Crash Risk Locations in GIS. International Journal Of Environmental Research And Public Health, 16(19).

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Abstract

Intersection and non-intersection locations are commonly used as spatial units of analysis for modeling pedestrian crashes. While both location types have been previously studied, comparing results is difficult given the different data and methods used to identify crash-risk locations. In this study, a systematic and replicable protocol was developed in GIS (Geographic Information System) to create a consistent spatial unit of analysis for use in pedestrian crash modelling. Four publicly accessible datasets were used to identify unique intersection and non-intersection locations: Roadway intersection points, roadway lanes, legal speed limits, and pedestrian crash records. Two algorithms were developed and tested using five search radii (ranging from 20 to 100 m) to assess the protocol reliability. The algorithms, which were designed to identify crash-risk locations at intersection and non-intersection areas detected 87.2% of the pedestrian crash locations (r: 20 m). Agreement rates between algorithm results and the crash data were 94.1% for intersection and 98.0% for non-intersection locations, respectively. The buffer size of 20 m generally showed the highest performance in the analyses. The present protocol offered an efficient and reliable method to create spatial analysis units for pedestrian crash modeling. It provided researchers a cost-effective method to identify unique intersection and non-intersection locations. Additional search radii should be tested in future studies to refine the capture of crash-risk locations.

Keywords

Traffic Crash; Walking; Collisions; Accidents; Models; Pedestrian Safety; Spatial Autocorrelation; Algorithm