Chaix, Basile; Duncan, Dustin; Vallee, Julie; Vernez-moudon, Anne; Benmarhnia, Tarik; Kestens, Yan. (2017). The Residential Effect Fallacy in Neighborhood and Health Studies Formal Definition, Empirical Identification, and Correction. Epidemiology, 28(6), 789 – 797.
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Abstract
Background: Because of confounding from the urban/rural and socioeconomic organizations of territories and resulting correlation between residential and nonresidential exposures, classically estimated residential neighborhood-outcome associations capture nonresidential environment effects, overestimating residential intervention effects. Our study diagnosed and corrected this residential effect fallacy bias applicable to a large fraction of neighborhood and health studies. Methods: Our empirical application investigated the effect that hypothetical interventions raising the residential number of services would have on the probability that a trip is walked. Using global positioning systems tracking and mobility surveys over 7 days (227 participants and 7440 trips), we employed a multilevel linear probability model to estimate the trip-level association between residential number of services and walking to derive a naive intervention effect estimate and a corrected model accounting for numbers of services at the residence, trip origin, and trip destination to determine a corrected intervention effect estimate (true effect conditional on assumptions). Results: There was a strong correlation in service densities between the residential neighborhood and nonresidential places. From the naive model, hypothetical interventions raising the residential number of services to 200, 500, and 1000 were associated with an increase by 0.020, 0.055, and 0.109 of the probability of walking in the intervention groups. Corrected estimates were of 0.007, 0.019, and 0.039. Thus, naive estimates were overestimated by multiplicative factors of 3.0, 2.9, and 2.8. Conclusions: Commonly estimated residential intervention-outcome associations substantially overestimate true effects. Our somewhat paradoxical conclusion is that to estimate residential effects, investigators critically need information on nonresidential places visited.
Keywords
Self-rated Health; Record Cohort; Physical-activity; Transportation Modes; Built Environment; Activity Spaces; Research Agenda; Risk-factors; Associations; Exposure
Drewnowski, Adam; Aggarwal, Anju; Rose, Chelsea M.; Gupta, Shilpi; Delaney, Joseph A.; Hurvitz, Philip M. (2019). Activity Space Metrics Not Associated with Sociodemographic Variables, Diet or Health Outcomes in the Seattle Obesity Study II. Spatial And Spatio-temporal Epidemiology, 30.
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Abstract
Background: Activity spaces (AS), captured using GPS tracking devices, are measures of dynamic exposure to the built environment (BE). Methods: Seven days of Global Positioning Systems (GPS) tracking data were obtained for 433 adult participants in the Seattle Obesity Study (SOS II). Heights and weights were measured. Dietary intakes from a food frequency questionnaire were used to calculate Healthy Eating Index (HEI 2010) scores. Linear regression analyses examined associations between AS measures: daily route length, convex hull, and radius of gyration, and diet quality and health outcomes, adjusting for covariates. Results: AS measures did not vary by age, gender, race/ethnicity, or socioeconomic status. AS measures were not associated with diet quality or with self-reported obesity or diabetes. One AS measure, route length (in miles), was associated with being employed, living in the suburbs, and with distance and time commuting to work. Conclusion: Spatial mobility studies based on GPS tracking of environmental exposure need to demonstrate a link to relevant health outcomes. (C) 2019 The Authors. Published by Elsevier Ltd.
Keywords
Local Food Environment; Physical-activity; Gps Data; Exposure; Patterns; Quality; Women; Index; Built Environment (be); Activity Space; Route Length; Hei 2010; Bmi
Rose, Chelsea M.; Gupta, Shilpi; Buszkiewicz, James; Ko, Linda K.; Mou, Jin; Cook, Andrea; Moudon, Anne Vernez; Aggarwal, Anju; Drewnowski, Adam. (2020). Small Increments in Diet Cost Can Improve Compliance with the Dietary Guidelines for Americans. Social Science & Medicine, 266.
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Abstract
Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI-2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000 kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/ month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.
Keywords
Healthy Eating Index; Income Inequality; Quality; Obesity; Adults; Expenditure; Disparities; Strategy; Outcomes; Scores; Food Expenditures; Diet Costs; Food Shopping; Diet Quality; Hei-2015; Ses
Moudon, Anne Vernez; Drewnowski, Adam; Duncan, Glen E.; Hurvitz, Philip M.; Saelens, Brian E.; Scharnhorst, Eric. (2013). Characterizing the Food Environment: Pitfalls and Future Directions. Public Health Nutrition, 16(7), 1238 – 1243.
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Abstract
Objective: To assess a county population's exposure to different types of food sources reported to affect both diet quality and obesity rates. Design: Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups. Setting: King County, WA, USA. Subjects: Full census of food sources. Results: According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health. Conclusions: To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.
Keywords
Food Chemistry; Obesity; Health Boards; Dietary Supplements; Food Cooperatives; Restaurant Reviews; Coffee Shops; Food Consumption; Food Quality; Census Of Food Sources; Exposure; Health Value; Neighborhood Characteristics; Store Availability; Racial Composition; Physical-activity; Weight Status; Restaurants; Association; Proximity; Access; Business Enterprises; Fast Food Restaurants; Fish; Grocery Stores; Healthy Diet; Meat; Nutritional Adequacy; Supermarkets
Drewnowski, Adam; Aggarwal, Anju; Tang, Wesley; Moudon, Anne Vernez. (2015). Residential Property Values Predict Prevalent Obesity but Do Not Predict 1-year Weight Change. Obesity, 23(3), 671 – 676.
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Abstract
ObjectiveLower socio economic status (SES) has been linked with higher obesity rates but not with weight gain. This study examined whether SES can predict short-term weight change. MethodsThe Seattle Obesity Study II was based on an observational cohort of 440 adults. Weights and heights were measured at baseline and at 1 year. Self-reported education and incomes were obtained by questionnaire. Home addresses were linked to tax parcel property values from the King County, Washington, tax assessor. Associations among SES variables, prevalent obesity, and 1-year weight change were examined using multivariable linear regressions. ResultsLow residential property values at the tax parcel level predicted prevalent obesity at baseline and at 1 year. Living in the top quartile of house prices reduced obesity risk by 80% at both time points. At 1 year, about 38% of the sample lost >1 kg body weight; 32% maintained ( 1 kg); and 30% gained >1 kg. In adjusted models, none of the baseline SES measures had any impact on 1-year weight change. ConclusionsSES variables, including tax parcel property values, predicted prevalent obesity but did not predict short-term weight change. These findings, based on longitudinal cohort data, suggest other mechanisms are involved in short-term weight change.
Keywords
Body-mass-index; Socioeconomic-status; United-states; Physical-activity; King County; Association; Health; Trends; Gain; Income
Doescher, Mark P.; Lee, Chanam; Saelens, Brian E.; Lee, Chunkuen; Berke, Ethan M.; Adachi-mejia, Anna M.; Patterson, Davis G.; Moudon, Anne Vernez. (2017). Utilitarian and Recreational Walking Among Spanish- and English-Speaking Latino Adults in Micropolitan US Towns. Journal Of Immigrant & Minority Health, 19(2), 237 – 245.
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Abstract
Walking among Latinos in US Micropolitan towns may vary by language spoken. In 2011-2012, we collected telephone survey and built environment (BE) data from adults in six towns located within micropolitan counties from two states with sizable Latino populations. We performed mixed-effects logistic regression modeling to examine relationships between ethnicity-language group [Spanish-speaking Latinos (SSLs); English-speaking Latinos (ESLs); and English-speaking non-Latinos (ENLs)] and utilitarian walking and recreational walking, accounting for socio-demographic, lifestyle and BE characteristics. Low-income SSLs reported higher amounts of utilitarian walking than ENLs (p = 0.007), but utilitarian walking in this group decreased as income increased. SSLs reported lower amounts of recreational walking than ENLs (p = 0.004). ESL-ENL differences were not significant. We identified no statistically significant interactions between ethnicity-language group and BE characteristics. Approaches to increase walking in micropolitan towns with sizable SSL populations may need to account for this group's differences in walking behaviors.
Keywords
Walking; Confidence Intervals; Ecology; Ethnic Groups; Hispanic Americans; Income; Language & Languages; Metropolitan Areas; Population; Public Health; Recreation; Rural Conditions; White People; Logistic Regression Analysis; Socioeconomic Factors; Social Context; Body Mass Index; Acquisition Of Data; Physical Activity; Data Analysis Software; Odds Ratio; United States; Environment Design; Ethnicity; Rural Populations; Physical-activity; Built Environment; United-states; Postmenopausal Women; Acculturation; Risk; Transportation; Mortality; Health; Associations; Studies; Demographic Aspects; Telephone Surveys; Minority & Ethnic Groups; Physical Fitness; Low Income Groups; Urban Environments; Demographics; Language; Accounting; Statistical Analysis; Urban Areas; Towns; Populations; Adults; Lifestyles; Latin American Cultural Groups; Sociodemographics; Landscape Architecture; Population Growth; Pediatrics; Leisure; Health Care; Noncitizens; Preventive Medicine; United States--us
Duncan, Glen E.; Avery, Ally; Hurvitz, Philip M.; Moudon, Anne Vernez; Tsang, Siny; Turkheimer, Eric. (2019). Cohort Profile: Twins Study of Environment, Lifestyle Behaviours and Health. International Journal Of Epidemiology, 48(4), 1041.
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Keywords
Twin Studies; Neighborhoods; Native Americans; Normalized Difference Vegetation Index; Life Style; Twins; Body-mass Index; Physical-activity; Neighborhood Walkability; Waist Circumference; Built Environment; Causal Inference; Deprivation; Validation; Registry; Obesity
Besser, Lilah M.; Lovasi, Gina S.; Michael, Yvonne L.; Garg, Parveen; Hirsch, Jana A.; Siscovick, David; Hurvitz, Phil; Biggs, Mary L.; Galvin, James E.; Bartz, Traci M.; Longstreth, W. T. (2021). Associations between Neighborhood Greenspace and Brain Imaging Measures in Non-Demented Older Adults: The Cardiovascular Health Study. Social Psychiatry And Psychiatric Epidemiology, 56(9), 1575 – 1585.
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Abstract
Purpose Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer's disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer's disease. Methods We obtained a sample of non-demented participants 65 years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020. Results Participants were on average 79 years old [standard deviation (SD) = 4], 58% were female, and 11% were non-white race. Mean neighborhood greenspace was 38% (SD = 28%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: - 0.30; 95% confidence interval: - 0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex. Conclusion This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.
Keywords
Mild Cognitive Impairment; Ventricular Enlargement; Residential Greenness; Hippocampal Atrophy; Volume; Disease; Environment; Progression; Symptoms; Dementia; Neighborhood; Green Space; Mri; Brain Volume; Hippocampal; White Matter
Perry, Cynthia K.; Herting, Jerald R.; Berke, Ethan M.; Nguyen, Huong Q.; Moudon, Anne Vernez; Beresford, Shirley A. A.; Ockene, Judith K.; Manson, Joann E.; Lacroix, Andrea Z. (2013). Does Neighborhood Walkability Moderate the Effects of Intrapersonal Characteristics on Amount of Walking in Post-Menopausal Women? Health & Place, 21, 39 – 45.
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Abstract
This study identifies factors associated with walking among postmenopausal women and tests whether neighborhood walkability moderates the influence of intrapersonal factors on walking. We used data from the Women's Health Initiative Seattle Center and linear regression models to estimate associations and interactions. Being white and healthy, having a high school education or beyond and greater non-walking exercise were significantly associated with more walking. Neighborhood walkability was not independently associated with greater walking, nor did it moderate influence of intrapersonal factors on walking. Specifying types of walking (e.g., for transportation) can elucidate the relationships among intrapersonal factors, the built environment, and walking. (C) 2013 Elsevier Ltd. All rights reserved.
Keywords
Self-talk; Postmenopause; Walking; Women's Health; Built Environment; Social Interaction; Regression Analysis; Postmenopausal Women; Walkability; Physical-activity; Older-adults; United-states; Us Adults; Exercise; Obesity; Transportation; Association; Attributes
Huang, R.; Moudon, A. V.; Cook, A. J.; Drewnowski, A. (2015). The Spatial Clustering of Obesity: Does the Built Environment Matter? Journal Of Human Nutrition & Dietetics, 28(6), 604 – 612.
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Abstract
BackgroundObesity rates in the USA show distinct geographical patterns. The present study used spatial cluster detection methods and individual-level data to locate obesity clusters and to analyse them in relation to the neighbourhood built environment. MethodsThe 2008-2009 Seattle Obesity Study provided data on the self-reported height, weight, and sociodemographic characteristics of 1602 King County adults. Home addresses were geocoded. Clusters of high or low body mass index were identified using Anselin's Local Moran's I and a spatial scan statistic with regression models that searched for unmeasured neighbourhood-level factors from residuals, adjusting for measured individual-level covariates. Spatially continuous values of objectively measured features of the local neighbourhood built environment (SmartMaps) were constructed for seven variables obtained from tax rolls and commercial databases. ResultsBoth the Local Moran's I and a spatial scan statistic identified similar spatial concentrations of obesity. High and low obesity clusters were attenuated after adjusting for age, gender, race, education and income, and they disappeared once neighbourhood residential property values and residential density were included in the model. ConclusionsUsing individual-level data to detect obesity clusters with two cluster detection methods, the present study showed that the spatial concentration of obesity was wholly explained by neighbourhood composition and socioeconomic characteristics. These characteristics may serve to more precisely locate obesity prevention and intervention programmes.
Keywords
Real Property; Ecology; Age Distribution; Anthropometry; Black People; Cluster Analysis (statistics); Communities; Computer Software; Epidemiological Research; Geographic Information Systems; Hispanic Americans; Mathematics; Obesity; Population Geography; Probability Theory; Race; Regression Analysis; Research Funding; Restaurants; Statistical Sampling; Self-evaluation; Sex Distribution; Shopping; Surveys; Telephones; Transportation; White People; Socioeconomic Factors; Body Mass Index; Data Analysis Software; Medical Coding; Statistical Models; Descriptive Statistics; Odds Ratio; Economics; Washington (state); Built Environment; Local Moran's I; Spatial Scan Statistic; Body-mass Index; Physical-activity; United-states; Risk-factors; Neighborhood; Association; Density; Disease; Disparities; Prevalence