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Cakmak S, Lukina A, Dales R. The association between neighbourhood walkability and blood lipids: a Canadian population study. Lipids Health Dis 2024; 23:298. [PMID: 39267049 DOI: 10.1186/s12944-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
We examined the association between walkability and blood lipids in a nationally representative sample of 29,649 participants aged 3-79 years who participated in the Canadian Health Measures Survey (CHMS) cycles 1 to 6. We focused on seven lipid biomarkers: apolipoprotein A (Apo A), apolipoprotein B (Apo B), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), and TC/HDL. Cross-sectional associations were analyzed using generalized linear mixed models incorporating survey-specific sampling weights. An increase in the Canadian Active Living Environments Index, a measure of neighborhood walkability, equivalent to the magnitude of its interquartile range (IQR) was associated with the following percentage (95% confidence intervals (CI)) changes in lipids: decreased TG, -2.85 (-4.77, -0.93) and TC/HDL, -1.68 (-2.80, -0.56), and increased HDL, 1.68 (0.93, 2.42). Significant effects were largely restricted to adults (aged 17 to 79). In the younger age group there were no significant associations between walkability and lipids in the fully adjusted model. Significant associations were more frequently seen in females than males. For females, fully adjusted significant inverse associations were observed for TG, LDL, and TC/HDL, and there were positive associations with HDL and Apo A. Canadians living in more walkable neighborhoods have more favorable lipid profiles, suggesting that the built environment has the potential to influence the risk profile for cardiovascular health, especially among adults and females.
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Affiliation(s)
- Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Anna Lukina
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada.
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
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Dugandzic R, Konstantelos N, Yu Y, Lavigne E, Srugo S, Lang JJ, Larsen K, Pollock T, Villeneuve P, Thomson EM, MacPherson M, Dales R, Cakmak S. Associations between paediatric obesity, chemical mixtures and environmental factors, in a national cross-sectional study of Canadian children. Pediatr Obes 2024; 19:e13117. [PMID: 38872449 DOI: 10.1111/ijpo.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/19/2023] [Accepted: 02/19/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Whilst single chemical exposures are suspected to be obesogenic, the combined role of chemical mixtures in paediatric obesity is not well understood. OBJECTIVES We aimed to evaluate the potential associations between chemical mixtures and obesity in a population-based sample of Canadian children. METHODS We ascertained biomonitoring and health data for children aged 3-11 from the cross-sectional Canadian Health Measures Survey from 2007 to 2019. Several chemicals of interest were measured in blood or urine and paediatric obesity was defined based on measured anthropometrics. Using quantile-based G computational analysis, we quantified the effects of three chemical mixtures selected a priori. Models were adjusted for sociodemographic and environmental factors identified through a directed acyclic graph. Results are presented through adjusted relative risks (RR) with 95% confidence intervals (95% CI). RESULTS We included 9147 children. Of these, 24.1% were overweight or obese. Exposure to the mixture of bisphenol A, acrylamide, glycidamide, metals, parabens and arsenic increased the risk of childhood overweight or obesity by 45% (95% CI 1.09, 1.93), obesity by 109% (95% CI 1.27, 3.42) and central obesity by 82% (95% CI 1.30, 2.56). CONCLUSIONS Our findings support the role of early childhood chemical exposures in paediatric obesity and the potential combined effects of chemicals.
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Affiliation(s)
- Rose Dugandzic
- Office of Environmental Health, Health Canada, Ottawa, Ontario, Canada
| | - Natalia Konstantelos
- Office of Environmental Health, Health Canada, Ottawa, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Yamei Yu
- Office of Environmental Health, Health Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Sebastian Srugo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Justin J Lang
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kristian Larsen
- Office of Environmental Health, Health Canada, Ottawa, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Geography and Planning, University of Toronto, Toronto, Ontario, Canada
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tyler Pollock
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Paul Villeneuve
- School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
| | - Errol M Thomson
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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D'Agostino EM, Zhao AY, Zewdie HY, Ogletree SS, Messiah SE, Armstrong SC, Skinner AC, Hipp JA, Day SE, Konty KJ, Neshteruk CD. Associations Between Neighborhood Opportunity and Indicators of Physical Fitness for New York City Public School Youth. Child Obes 2024; 20:328-335. [PMID: 37831961 DOI: 10.1089/chi.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Background: Fewer than 1/4th of US children and adolescents meet physical activity (PA) guidelines, leading to health disparities that track into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to improve fitness attainment and reduce these disparities. We drew data from the Child Opportunity Index to examine associations between neighborhood indicators of opportunity for PA and multiple fitness indicators among New York City public school youth. Methods: Multilevel generalized linear mixed models were used to estimate the overall and sex-stratified associations between neighborhood indicators (green space, healthy food, walkability, commute time) and indicators for physical fitness [curl-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER), sit-and-reach] using the New York City FITNESSGRAM data set. Results: The analytic sample [n = 299,839; median (interquartile range) age = 16 (12-17)] was 50.1% female, 37.5% Hispanic, 26.2% non-Hispanic Black, and most (69.5%) qualified for free/reduced price school meals. Neighborhood indicators were positively associated with higher values of indicators for physical fitness. The strongest associations were observed between walkability and both BMI and PACER, and commute time with BMI, push-ups, and PACER. For example, walkability had the greatest magnitude of effects for BMI and muscular strength and endurance (BMI: β: -0.75, 95% confidence interval, CI: -1.01 to -0.49; PACER: β: 1.98, 95% CI: 1.59 to 2.37), and particularly for girls compared with boys (BMI, girls: β: -0.91, 95% CI: -1.22 to -0.66); BMI, boys: β: -0.56, 95% CI: -0.86 to -0.25); PACER, girls: β: 2.11, 95% CI: 1.68 to 2.54; push-ups, boys: β: 1.71, 95% CI: 1.31 to 2.12). Conclusion: Neighborhood indicators were associated with multiple measures of youth fitness. Continued research on neighborhood opportunity and youth fitness may better inform place-based public health interventions to reduce disparities.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Amy Y Zhao
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Hiwot Y Zewdie
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - S Scott Ogletree
- Center for Geospatial Analytics, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Sarah C Armstrong
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - J Aaron Hipp
- Center for Geospatial Analytics, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA
| | - Sophia E Day
- NYC Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Kevin J Konty
- NYC Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Scheller DA, Bachner J. Subjective walkability perceived by children and adolescents living in urban environments: A study protocol for participatory methods and scale development in the WALKI-MUC project. PLoS One 2024; 19:e0299208. [PMID: 38437205 PMCID: PMC10911598 DOI: 10.1371/journal.pone.0299208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Youth's perceptions of a city or neighbourhood's walkability are important for determining the physical activity (PA) friendliness of their environment. Traditional objective measures of walkability fail to incorporate children and youth's (CY) subjective perceptions of places that they perceive as supportive for play and exercise. Internationally, the most promising subjective measure is the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) questionnaire. Yet, the NEWS-Y is not available for German-speaking adolescents. In the WALKI-MUC project, a combination of participatory research methods is used to identify CY's perceptions of PA-friendly places in Munich, Germany. Based on the findings, a German version of the NEWS-Y (NEWS-Y-G) for subjective walkability measurement is developed. METHODS AND DESIGN CY aged six to 17 years from neighbourhoods with different objectively-measured walkability, take part in photovoice, walking interviews and mapping to gather their perceptions of PA-friendly places. The participatory study begins with an introductory workshop and concludes with a follow-up workshop, where characteristics of PA-friendly places are discussed in focus groups. In between these workshops, participants complete a photo mission with a walking interview, allowing for individual significance of PA-related places to be shared in a one-on-one setting with the researcher. The findings are used to adapt and translate the NEWS-Y for the German context. The newly developed NEWS-Y-G is then used to measure the subjective walkability perceived by a representative sample of adolescents in Munich. DISCUSSION The WALKI-MUC project introduces a participatory methodology for researchers and urban planners to assess subjective walkability with CY. The combination of qualitative and quantitative walkability measurements is described in this study protocol. Findings on PA-friendly places contribute to environmental psychology and the development of the NEWS-Y-G adds a German-language instrument for subjective walkability measurement.
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Affiliation(s)
- Daniel Alexander Scheller
- TUM School of Medicine and Health, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Munich, Germany
| | - Joachim Bachner
- TUM School of Medicine and Health, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Munich, Germany
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Neshteruk CD, Chandrashekaran S, Armstrong SC, Skinner AC, Delarosa J, D’Agostino EM. The longitudinal association between neighbourhood quality and cardiovascular risk factors among youth receiving obesity treatment. Pediatr Obes 2023; 18:e13080. [PMID: 37905354 PMCID: PMC10697697 DOI: 10.1111/ijpo.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/11/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Neighbourhood factors are associated with cardiovascular health in adults, but these relationships are under-explored in youth. OBJECTIVES To characterize the associations between neighbourhood factors and child and adolescent health among youth with obesity. METHODS Data were drawn from patient health records at a pediatric weight management clinic (n = 2838) and the Child Opportunity Index (COI). Exposures were area-level neighbourhood factors (commute duration, walkability, greenspace and industrial pollutants). Outcomes included BMI relative to the 95th percentile (BMIp95) and blood pressure (continuous variables). Longitudinal models examined associations between COI indicators and outcomes. RESULTS Shorter commute duration (β = -4.31, 95% CI: -5.92, -2.71) and greater walkability (β = -4.40, 95% CI: -5.98, -2.82) were negatively associated with BMIp95. Increased greenspace availability was positively associated with BMIp95 (β = 1.93, 95% CI: 0.19, 3.67). None of the COI indicators were associated with cardiovascular outcomes in the full sample. Analyses stratified by sex and race/ethnicity showed similar patterns for BMIp95. For commute duration, there was a negative association with blood pressure for female, non-Hispanic White and other race/ethnicity youth. CONCLUSIONS Neighbourhood factors should be considered as contextual factors when treating youth with obesity. Additional research is needed to understand the relationship between neighbourhood factors and cardiovascular outcomes.
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Affiliation(s)
- Cody D. Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | | | - Sarah C. Armstrong
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Jesse Delarosa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Emily M. D’Agostino
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, Duke University, Durham, NC USA
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Filgueiras MDS, Pessoa MC, Bressan J, do Carmo AS, Fogal Vegi AS, de Albuquerque FM, de Novaes JF. Obesogenic neighborhood environment is associated with body fat and low-grade inflammation in Brazilian children: could the mother's BMI be a mediating factor? Public Health Nutr 2023; 27:e14. [PMID: 38031476 PMCID: PMC10830377 DOI: 10.1017/s1368980023002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate the direct and indirect associations of obesogenic and leptogenic neighborhood environments with body fat, and pro- and anti-inflammatory adipokines in Brazilian children. DESIGN Cross-sectional study. The body fat distribution was assessed using dual-energy X-ray absorptiometry (DXA). Concentrations of leptin and adiponectin were measured. Four hundred meters (0·25 miles) road network buffer was the neighborhood unit used to assess the environmental characteristics around households. Obesogenic and leptogenic environments were the latent variables obtained from the observed characteristics. The mother's BMI, ultra-processed food consumption, and physical activity before and after school, were tested as mediating variables. A hybrid model of structural equations was used to test the direct and indirect associations of obesogenic and leptogenic environments with body fat, leptin and adiponectin concentrations. SETTING Urban area of Viçosa, Minas Gerais, Brazil. PARTICIPANTS Children aged 8- and 9-years (n 367). RESULTS Obesogenic environment was directly associated with the mother's BMI (β: 0·24, P = 0·02) and the child's body fat (β: 0·19, P = 0·02). The mother's BMI and body fat mediated the association of the obesogenic environment with leptin concentrations (β: 0·05, P = 0·02). CONCLUSIONS Obesogenic neighborhood environment was directly associated with body fat and mother's BMI, and indirectly associated with leptin concentrations in Brazilian children, mediated by the mother's BMI and body fat.
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Affiliation(s)
- Mariana De Santis Filgueiras
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa, Minas Gerais36570-900, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais30130-100, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa, Minas Gerais36570-900, Brazil
| | - Ariene Silva do Carmo
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais30130-100, Brazil
| | - Aline Siqueira Fogal Vegi
- Nutrition School, Universidade Federal de Ouro Preto, Rua Dois, Campus Morro do Cruzeiro, Ouro Preto, Minas Gerais35400-000, Brazil
| | - Fernanda Martins de Albuquerque
- Nutrition Institute, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, 12th floor, Maracanã, Rio de Janeiro20550-900, Brazil
| | - Juliana Farias de Novaes
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa, Minas Gerais36570-900, Brazil
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Filgueiras MDS, Pessoa MC, Bressan J, Fogal Vegi AS, do Carmo AS, Albuquerque FMD, Gardone DS, Novaes JFD. Characteristics of the obesogenic environment around schools are associated with body fat and low-grade inflammation in Brazilian children. Public Health Nutr 2023; 26:2407-2417. [PMID: 37559196 DOI: 10.1017/s1368980023001696] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To assess the association of obesogenic environmental characteristics around schools with body adiposity and adipokine concentrations in Brazilian children. DESIGN Cross-sectional study. Body adiposity was assessed using the dual-energy X-ray absorptiometry. Concentrations of leptin, adiponectin, retinol-binding protein 4 (RBP4) and chemerin were measured. Predominantly ultra-processed food (UPF) stores, public physical activity (PA) facilities, green spaces, walkability, traffic accidents and crime were evaluated. The neighbourhood unit was the 400 m (0·25 miles) road network buffer around schools. The association of environmental characteristics with body adiposity and adipokine concentrations was assessed by linear regression models using generalised estimating equations. SETTING Urban schools (n 24), Viçosa, Minas Gerais, Brazil. PARTICIPANTS Children aged 8 and 9 years (n 378). RESULTS A higher density of predominantly UPF stores and a lower percentage of green space were associated with higher total (β: 0·12; 95 % CI 0·06, 0·18 and β: -0·10; 95 % CI -0·16, -0·04, respectively) and android body fat (β: 0·28; 95 % CI 0·13, 0·43 and β: -0·18; 95 % CI -0·32, -0·04, respectively). In addition, the densities of PA facilities and crime were inversely associated with leptin concentrations. Traffic accidents density and percentage of green spaces around schools had, respectively, a positive and an inverse association with concentrations of adiponectin and RBP4. CONCLUSIONS Obesogenic environmental characteristics around schools were associated with total and android body fat, as well as with pro-inflammatory adipokine concentrations in Brazilian children from a medium-sized city.
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Affiliation(s)
- Mariana De Santis Filgueiras
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa36570-900, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte30130-100, Minas Gerais, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa36570-900, Minas Gerais, Brazil
| | - Aline Siqueira Fogal Vegi
- Nutrition School, Universidade Federal de Ouro Preto, Rua Dois, Campus Morro do Cruzeiro, Ouro Preto35400-000, Minas Gerais, Brazil
| | - Ariene Silva do Carmo
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte30130-100, Minas Gerais, Brazil
| | - Fernanda Martins de Albuquerque
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa36570-900, Minas Gerais, Brazil
| | - Danielle Soares Gardone
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte30130-100, Minas Gerais, Brazil
| | - Juliana Farias de Novaes
- Department of Nutrition and Health, Universidade Federal de Viçosa, Av. P.H. Rolfs s/n, Centro de Ciências Biológicas II, Campus Universitário, Viçosa36570-900, Minas Gerais, Brazil
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Spoer BR, Conderino SE, Lampe TM, Ofrane RH, De Leon E, Thorpe LE, Chang VW, Elbel B. Association between racial residential segregation and walkability in 745 U.S. cities. Health Place 2023; 84:103114. [PMID: 37774640 PMCID: PMC10842472 DOI: 10.1016/j.healthplace.2023.103114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 10/01/2023]
Abstract
Despite higher chronic disease prevalence, minoritized populations live in highly walkable neighborhoods in US cities more frequently than non-minoritized populations. We investigated whether city-level racial residential segregation (RRS) was associated with city-level walkability, stratified by population density, possibly explaining this counterintuitive association. RRS for Black-White and Latino-White segregation in large US cities was calculated using the Index of Dissimilarity (ID), and walkability was measured using WalkScore. Median walkability increased across increasing quartiles of population density, as expected. Higher ID was associated with higher walkability; associations varied in strength across strata of population density. RRS undergirds the observed association between walkability and minoritized populations, especially in higher population density cities.
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Affiliation(s)
- Ben R Spoer
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Sarah E Conderino
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Taylor M Lampe
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Rebecca H Ofrane
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Elaine De Leon
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Lorna E Thorpe
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Virginia W Chang
- New York University College of Global Public Health, Department of Social and Behavioral Sciences, New York, NY, USA
| | - Brian Elbel
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA; NYU Wagner Graduate School of Public Service, New York, NY, USA
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India-Aldana S, Rundle AG, Quinn JW, Clendenen TV, Afanasyeva Y, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Zeleniuch-Jacquotte A, Chen Y. Long-Term Exposure to Walkable Residential Neighborhoods and Risk of Obesity-Related Cancer in the New York University Women's Health Study (NYUWHS). ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:107001. [PMID: 37791759 PMCID: PMC10548871 DOI: 10.1289/ehp11538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Living in neighborhoods with higher levels of walkability has been associated with a reduced risk of obesity and higher levels of physical activity. Obesity has been linked to increased risk of 13 cancers in women. However, long-term prospective studies of neighborhood walkability and risk for obesity-related cancer are scarce. OBJECTIVES We evaluated the association between long-term average neighborhood walkability and obesity-related cancer risk in women. METHODS The New York University Women's Health Study (NYUWHS) is a prospective cohort with 14,274 women recruited between 1985 and 1991 in New York City and followed over nearly three decades. We geocoded residential addresses for each participant throughout follow-up and calculated an average annual measure of neighborhood walkability across years of follow-up using data on population density and accessibility to destinations associated with geocoded residential addresses. We used ICD-9 codes to characterize first primary obesity-related cancers and employed Cox proportional hazards models to assess the association between average neighborhood walkability and risk of overall and site-specific obesity-related cancers. RESULTS Residing in neighborhoods with a higher walkability level was associated with a reduced risk of overall and site-specific obesity-related cancers. The hazards ratios associated with a 1-standard deviation increase in average annual neighborhood walkability were 0.88 (95% CI: 0.85, 0.93) for overall obesity-related cancer, 0.89 (95% CI: 0.84, 0.95) for postmenopausal breast cancer, 0.82 (95% CI: 0.68, 0.99) for ovarian cancer, 0.87 (95% CI: 0.76, 0.99) for endometrial cancer, and 0.68 (95% CI: 0.49, 0.94) for multiple myeloma, adjusting for potential confounders at both the individual and neighborhood level. The association between neighborhood walkability and risk of overall obesity-related cancer was stronger among women living in neighborhoods with higher levels of poverty compared with women living in areas with lower poverty levels (p Interaction = 0.006 ). DISCUSSION Our study highlights a potential protective role of neighborhood walkability in preventing obesity-related cancers in women. https://doi.org/10.1289/EHP11538.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - James W. Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tess V. Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Karen L. Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Mengling Liu
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, USA
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Kathryn M. Neckerman
- Columbia Population Research Center, Columbia University, New York, New York, USA
| | - Lorna E. Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, USA
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10
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Warkentin S, de Bont J, Abellan A, Pistillo A, Saucy A, Cirach M, Nieuwenhuijsen M, Khalid S, Basagaña X, Duarte-Salles T, Vrijheid M. Changes in air pollution exposure after residential relocation and body mass index in children and adolescents: A natural experiment study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 334:122217. [PMID: 37467916 DOI: 10.1016/j.envpol.2023.122217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023]
Abstract
Air pollution exposure may affect child weight gain, but observational studies provide inconsistent evidence. Residential relocation can be leveraged as a natural experiment by studying changes in health outcomes after a sudden change in exposure within an individual. We aimed to evaluate whether changes in air pollution exposure due to residential relocation are associated with changes in body mass index (BMI) in children and adolescents in a natural experiment study. This population-based study included children and adolescents, between 2 and 17 years, who moved during 2011-2018 and were registered in the primary healthcare in Catalonia, Spain (N = 46,644). Outdoor air pollutants (nitrogen dioxides (NO2), particulate matter <10 μm (PM10) and <2.5 μm (PM2.5)) were estimated at residential census tract level before and after relocation; tertile cut-offs were used to define changes in exposure. Routinely measured weight and height were used to calculate age-sex-specific BMI z-scores. A minimum of 180 days after moving was considered to observe zBMI changes according to changes in exposure using linear fixed effects regression. The majority of participants (60-67% depending on the pollutant) moved to areas with similar levels of air pollution, 15-49% to less polluted, and 14-31% to more polluted areas. Moving to areas with more air pollution was associated with zBMI increases for all air pollutants (β NO2 = 0.10(95%CI 0.09; 0.12), β PM2.5 0.06(0.04; 0.07), β PM10 0.08(0.06; 0.10)). Moving to similar air pollution areas was associated with decreases in zBMI for all pollutants. No associations were found for those moving to less polluted areas. Associations with moving to more polluted areas were stronger in preschool- and primary school-ages. Associations did not differ by area deprivation strata. This large, natural experiment study suggests that increases in outdoor air pollution may be associated with child weight gain, supporting ongoing efforts to lower air pollution levels.
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Affiliation(s)
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Alicia Abellan
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marta Cirach
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sara Khalid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK; Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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11
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Jiang Q, Forseth B, Fitzpatrick L, Laroche HH, Hampl S, Davis AM, Steel C, Carlson J. Prospective associations of neighborhood healthy food access and walkability with weight status in a regional pediatric health system. Int J Behav Nutr Phys Act 2023; 20:113. [PMID: 37730611 PMCID: PMC10510160 DOI: 10.1186/s12966-023-01514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Most neighborhood food and activity related environment research in children has been cross-sectional. A better understanding of prospective associations between these neighborhood environment factors and children's weight status can provide stronger evidence for informing interventions and policy. This study examined associations of baseline and changes in neighborhood healthy food access and walkability with changes in children's weight status over 5 years. METHODS Height, weight, and home address were obtained for 4,493 children (> 75% were Black or Latinx) from primary care visits within a large pediatric health system. Eligible participants were those who had measures collected during two time periods (2012-2014 [Time 1] and 2017-2019 [Time 2]). Data were integrated with census tract-level healthy food access and walkability data. Children who moved residences between the time periods were considered 'movers' (N = 1052; 23.4%). Mixed-effects models, accounting for nesting of children within census tracts, were conducted to model associations of baseline and changes in the neighborhood environment variables with Time 2 weight status (BMIz and overweight or obese vs. healthy weight). Models adjusted for weight status and child and neighborhood sociodemographics at baseline. RESULTS Children living in a neighborhood with [ample] healthy food access at Time 1 had a lower BMIz at Time 2, regardless of mover status. A decrease in healthy food access was not significantly associated with children's weight status at Time 2. Baseline walkability and improvements in walkability were associated with a lower BMIz at Time 2, regardless of mover status. CONCLUSIONS Findings provide evidence that residing in a neighborhood with healthy food access and walkability may support a healthy weight trajectory in children. Findings on changes in the neighborhood environment suggested that improved walkability in the neighborhood may support children's healthy weight. The greater and more consistent findings among movers may be due to movers experiencing greater changes in neighborhood features than the changes that typically occur within a neighborhood over a short period of time. Future research is needed to investigate more robust environmental changes to neighborhoods.
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Affiliation(s)
- Qianxia Jiang
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA.
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Bethany Forseth
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Lauren Fitzpatrick
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Helena H Laroche
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Sarah Hampl
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Chelsea Steel
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jordan Carlson
- Center for Children's Healthy Lifestyles & Nutrition, 610 E. 22Nd Street, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
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12
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Zewdie HY, Zhao AY, Ogletree SS, Messiah SE, Armstrong SC, Skinner AC, Neshteruk CD, Hipp JA, Day SE, Konty KJ, D'Agostino EM. Longitudinal Associations Between Neighborhood Child Opportunity and Physical Fitness for New York City Public School Youth. Am J Epidemiol 2023; 192:1278-1287. [PMID: 37083846 DOI: 10.1093/aje/kwad101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023] Open
Abstract
Neighborhood environments can support fitness-promoting behavior, yet little is known about their influence on youth physical fitness outcomes over time. We examined longitudinal associations between neighborhood opportunity and youth physical fitness among New York City (NYC) public school youth. The Child Opportunity Index (COI), a composite index of 29 indicators measuring neighborhood opportunity at the census-tract level, along with scores on 4 selected COI indicators were linked to NYC FITNESSGRAM youth data at baseline. Fitness outcomes (measured annually, 2011-2018) included body mass index, curl-ups, push-ups, and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps. Unstratified and age-stratified, adjusted, 3-level generalized linear mixed models, nested by census tract and time, estimated the association between COI and fitness outcomes. The analytical sample (n = 204,939) lived in very low (41%) or low (30%) opportunity neighborhoods. Unstratified models indicated that overall COI is modestly associated with improved youth physical fitness outcomes. The strongest opportunity-fitness associations were observed for PACER. Stratified models show differences in associations across younger vs. older youth. We find that neighborhood factors are associated with youth fitness outcomes over time, with the strength of the associations dependent on age. Future implications include better informed place-based interventions tailored to specific life stages to promote youth health.
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13
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Koohsari MJ, Oka K, Nakaya T, Vena J, Williamson T, Quan H, McCormack GR. Urban design and cardio-metabolic risk factors. Prev Med 2023; 173:107552. [PMID: 37211251 DOI: 10.1016/j.ypmed.2023.107552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
Accumulating evidence suggests that the built environment may be associated with cardiovascular disease via its influence on health behaviours. The aim of this study was to estimate the associations between traditional and novel neighbourhood built environment metrics and clinically assessed cardio-metabolic risk factors among a sample of adults in Canada. A total of 7171 participants from Albertas Tomorrow Project living in Alberta, Canada, were included. Cardio-metabolic risk factors were clinically measured. Two composite built environment metrics of traditional walkability and space syntax walkability were calculated. Among men, space syntax walkability was negatively associated with systolic and diastolic blood pressure (b = -0.87, 95% CI -1.43, -0.31 and b = -0.45, 95% CI -0.86, -0.04, respectively). Space syntax walkability was also associated with lower odds of overweight/obese among women and men (OR = 0.93, 95% CI 0.87, 0.99 and OR = 0.88, 95% CI 0.79, 0.97, respectively). No significant associations were observed between traditional walkability and cardio-metabolic outcomes. This study showed that the novel built environment metric based on the space syntax theory was associated with some cardio-metabolic risk factors.
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Affiliation(s)
- Mohammad Javad Koohsari
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Japan; Faculty of Sport Sciences, Waseda University, Japan; School of Exercise and Nutrition Sciences, Deakin University, Australia.
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Japan.
| | - Jennifer Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Tyler Williamson
- Centre for Health Informatics and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Hude Quan
- Centre for Health Informatics and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Gavin R McCormack
- Faculty of Sport Sciences, Waseda University, Japan; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Faculty of Kinesiology, University of Calgary, Canada; School of Architecture, Planning and Landscape, University of Calgary, Canada.
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14
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Kowalski K, Auerbach J, Martenies SE, Starling AP, Moore B, Dabelea D, Magzamen S. Neighborhood Walkability, Historical Redlining, and Childhood Obesity in Denver, Colorado. J Urban Health 2023; 100:103-117. [PMID: 36622547 PMCID: PMC9918655 DOI: 10.1007/s11524-022-00703-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/10/2023]
Abstract
Childhood obesity is a precursor to future health complications. In adults, neighborhood walkability is inversely associated with obesity prevalence. Recently, it has been shown that current urban walkability has been influenced by historical discriminatory neighborhood disinvestment. However, the relationship between this systemic racism and obesity has not been extensively studied. The objective of this study was to evaluate the association of neighborhood walkability and redlining, a historical practice of denying home loans to communities of color, with childhood obesity. We evaluated neighborhood walkability and walkable destinations for 250 participants of the Healthy Start cohort, based in the Denver metropolitan region. Eligible participants attended an examination between ages 4 and 8. Walkable destinations and redlining geolocations were determined based on residential addresses, and a weighting system for destination types was developed. Sidewalks and trails in Denver were included in the network analyst tool in ArcMap to calculate the precise walkable environment for each child. We implemented linear regression models to estimate associations between neighborhood characteristics and child body mass index (BMI) z-scores and fat mass percent. There was a significant association between child BMI and redlining (β: 1.36, 95% CI: 0.106, 2.620). We did not find an association between walkability measures and childhood obesity outcomes. We propose that cities such as Denver pursue built environment policies, such as inclusionary zoning and direct investments in neighborhoods that have been historically neglected, to reduce the childhood health impacts of segregated poverty, and suggest further studies on the influences that redlining and urban built environment factors have on childhood obesity.
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Affiliation(s)
- Katharina Kowalski
- Department of Environmental and Radiological Health Sciences, Colorado State University, CO, Fort Collins, USA
| | - Jeremy Auerbach
- Department of Environmental and Radiological Health Sciences, Colorado State University, CO, Fort Collins, USA
| | - Sheena E Martenies
- Department of Environmental and Radiological Health Sciences, Colorado State University, CO, Fort Collins, USA
- Department of Community Health and Kinesiology, University of Illinois Urbana-Champaign, IL, Champaign, USA
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Brianna Moore
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, CO, Fort Collins, USA.
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15
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Lam TM, Wagtendonk AJ, den Braver NR, Karssenberg D, Vaartjes I, Timmermans EJ, Beulens JWJ, Lakerveld J. Development of a neighborhood obesogenic built environment characteristics index for the Netherlands. Obesity (Silver Spring) 2023; 31:214-224. [PMID: 36541154 PMCID: PMC10108038 DOI: 10.1002/oby.23610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/26/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Environmental factors that drive obesity are often studied individually, whereas obesogenic environments are likely to consist of multiple factors from food and physical activity (PA) environments. This study aimed to compose and describe a comprehensive, theory-based, expert-informed index to quantify obesogenicity for all neighborhoods in the Netherlands. METHODS The Obesogenic Built Environment CharacterisTics (OBCT) index consists of 17 components. The index was calculated as an average of componential scores across both food and PA environments and was scaled from 0 to 100. The index was visualized and summarized with sensitivity analysis for weighting methods. RESULTS The OBCT index for all 12,821 neighborhoods was right-skewed, with a median of 44.6 (IQR = 10.1). Obesogenicity was lower in more urbanized neighborhoods except for the extremely urbanized neighborhoods (>2500 addresses/km2 ), where obesogenicity was highest. The overall OBCT index score was moderately correlated with the food environment (Spearman ρ = 0.55, p <0.05) and with the PA environment (ρ = 0.38, p <0.05). Hierarchical weighting increased index correlations with the PA environment but decreased correlations with the food environment. CONCLUSIONS The novel OBCT index and its comprehensive environmental scores are potentially useful tools to quantify obesogenicity of neighborhoods.
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Affiliation(s)
- Thao Minh Lam
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Upstream Team, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alfred J Wagtendonk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Upstream Team, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Upstream Team, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Derek Karssenberg
- Department of Physical Geography, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Upstream Team, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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16
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Zhu Z, Yang Z, Zhang X, Yu L, Yang D, Guo F, Meng L, Xu L, Wu Y, Li T, Lin Y, Shen P, Lin H, Shui L, Tang M, Jin M, Wang J, Chen K. Association of walkability and NO 2 with metabolic syndrome: A cohort study in China. ENVIRONMENT INTERNATIONAL 2023; 171:107731. [PMID: 36610356 DOI: 10.1016/j.envint.2023.107731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Epidemiological studies have reported an association between traffic-related pollution with risk of metabolic syndrome (MetS). However, evidence from prospective studies on the association of walkability and nitrogen dioxide (NO2) with MetS is still scarce. We, therefore, aimed to evaluate the association of long-term exposure to NO2 and walkability with hazards of incident MetS. METHODS A total of 17,965 participants without MetS diagnosed within one year at baseline were included in our study from a population-based prospective cohort in Yinzhou District, Ningbo, Zhejiang Province, China. Participants were followed up by the regional Health Information System (HIS) until December 15, 2021. MetS was defined based on the criteria of Chinese Diabetes Society (CDS2004). We used walkscore tools, calculating with amenity categories and decay functions, and spatial-temporal land-use regression (LUR) models to estimate walkability and NO2 concentrations. We used Cox proportional hazards regression models to examine the association of walkability and NO2 with hazards of MetS incidence reporting with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, we followed up 77,303 person-years and identified 4040 incident cases of MetS in the entire cohort. Higher walkability was inversely associated with incident MetS (HR = 0.94, 95 % CI: 0.91-0.99), whereas NO2 was positively associated with MetS incidence (HR = 1.07, 95 %CI: 1.00-1.15) per interquartile range increment in two-exposure models. Furthermore, we found a significant multiplicative interaction between walkability and NO2. Stronger associations were observed for NO2 and incident MetS among men, smokers, drinkers and participants who aged < 60 years and had higher levels of income. CONCLUSION In summary, we found living in areas with lower walkability and higher concentrations of NO2 were associated with increased incidence of MetS. The beneficial effect of higher walkability may be attenuated by exposure to NO2.
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Affiliation(s)
- Zhanghang Zhu
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zongming Yang
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xinhan Zhang
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Luhua Yu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Dandan Yang
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Fanjia Guo
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Lin Meng
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Lisha Xu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yonghao Wu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Tiezheng Li
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yaoyao Lin
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Peng Shen
- Yinzhou District Health Bureau of Ningbo, Ningbo 315040, China
| | - Hongbo Lin
- Yinzhou District Health Bureau of Ningbo, Ningbo 315040, China
| | - Liming Shui
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo 315040, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jianbing Wang
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
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17
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TETSUKA JUMPEI, MATSUKAWA TAKEHISA, YOKOYAMA KAZUHITO, YAMASAKI SYUDO, ANDO SHUNTARO, NISHIDA ATSUSHI, HIRAIWA-HASEGAWA MARIKO, KASAI KIYOTO. Effects of Trace Elements on Anthropometric Characteristics of Children: Cobalt and Childhood Body Mass Index. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:251-260. [PMID: 39021719 PMCID: PMC11250014 DOI: 10.14789/jmj.jmj21-0043-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 07/20/2024]
Abstract
Objectives There are many reports on the effects of trace elements on human anthropometric characteristics. Among these elements, cobalt has consistently shown an inverse relationship with obesity risk. In the present study, we aimed to investigate the relationship between urinary levels of trace elements, focusing on cobalt, and childhood obesity, as indicated by the body mass index (BMI) in early adolescents, focusing on the participants' gender. Design A cross-sectional study was conducted in the Tokyo Teen Cohort study. Based on urinary samples, we obtained the anthropometric characteristics (weight and height) and potential covariates associated with childhood BMI for 1542 children (mean age=12 years; 860 boys and 682 girls). Methods Concentrations of urinary cobalt and 17 other trace elements were measured using inductively coupled plasma-mass spectrometry or inductively coupled plasma-atomic emission spectrometry. Results Pearson's correlation coefficient revealed an inverse relationship between the log of cobalt concentrations in the urine and the BMI for the boys (r=-0.125, p<0.001) and girls (r=-0.082, p=0.033). Multivariate analysis, adjusted for various covariates, reconfirmed the correlation between urine cobalt and the childhood BMI, only in the boys (beta=-0.14, p<0.001). Conclusions Among the 18 elements measured in the children's urine, cobalt may exhibit sufficient potency to decrease the risk of childhood obesity, particularly in boys. Future studies are required to clearly determine the magnitude of the effect and the underlying mechanism(s).
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Affiliation(s)
| | | | - KAZUHITO YOKOYAMA
- Corresponding author: Kazuhito Yokoyama, Department of Epidemiology and Environmental Health, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan, TEL: +81-3-5802-1047 FAX: +81-3-3812-1026 E-mail:
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Deonarine A, Lyons G, Lakhani C, De Brouwer W. Identifying Communities at Risk for COVID-19-Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators. JMIR Public Health Surveill 2021; 7:e26604. [PMID: 34280122 DOI: 10.1101/2020.12.17.20248360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Although it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. OBJECTIVE This study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. METHODS We developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19-related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. RESULTS Using 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19-related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P<.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (r2=0.87). CONCLUSIONS The COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19-related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery.
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Deonarine A, Lyons G, Lakhani C, De Brouwer W. Identifying Communities at Risk for COVID-19-Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators. JMIR Public Health Surveill 2021; 7:e26604. [PMID: 34280122 PMCID: PMC8396545 DOI: 10.2196/26604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. OBJECTIVE This study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. METHODS We developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19-related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. RESULTS Using 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19-related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P<.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (r2=0.87). CONCLUSIONS The COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19-related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery.
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The Modified Normalized Urban Area Composite Index: A Satelliate-Derived High-Resolution Index for Extracting Urban Areas. REMOTE SENSING 2021. [DOI: 10.3390/rs13122350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The accurate and efficient extraction of urban areas is of great significance for better understanding of urban sprawl, built environment, economic activities, and population distribution. Night-Time Light (NTL) data have been widely used to extract urban areas. However, most of the existing NTL indexes are incapable of identifying non-luminous built-up areas. The high-resolution NTL imagery derived from the Luojia 1-01 satellite, with low saturation and the blooming effect, can be used to map urban areas at a finer scale. A new urban spectral index, named the Modified Normalized Urban Areas Composite Index (MNUACI), improved upon the existing Normalized Urban Areas Composite Index (NUACI), was proposed in this study, which integrated the Human Settlement Index (HSI) generated from Luojia 1-01 NTL data, the Normalized Difference Vegetation Index (NDVI) from Landsat 8 imagery, and the Modified Normalized Difference Water Index (MNDWI). Our results indicated that MNUACI improved the spatial variability and differentiation of urban components by eliminating the NTL blooming effect and increasing the variation of the nighttime luminosity. Compared to urban area classification from Landsat 8 data, the MNUACI yielded better accuracy than NTL, NUACI, HSI, and the EVI-Adjusted NTL Index (EANTLI) alone. Furthermore, the quadratic polynomial regression analysis showed the model based on MNUACI had the best R2 and Root-Mean Square Error (RMSE) compared with NTL, NUACI, HSI, and EANTLI in terms of estimation of impervious surface area. It is concluded that MNUACI could improve the identification of urban areas and non-luminous built-up areas with better accuracy.
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21
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Zewdie H, Zhao AY, Patel HH, Hansen E, Messiah SE, Armstrong SC, Skinner AC, Neshteruk CD, Hipp JA, D'Agostino EM. The association between neighborhood quality, youth physical fitness, and modifiable cardiovascular disease risk factors. Ann Epidemiol 2021; 57:30-39. [PMID: 33596444 DOI: 10.1016/j.annepidem.2021.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Striking disparities persist in cardiovascular disease risk factors among minority youth. We examined the association between multiple indicators of neighborhood quality and minority youth fitness. METHODS The primary exposure was the Child Opportunity Index (COI), a measure comprised of indicators that facilitate healthy child development. Outcome data were drawn from the 2018-2019 Fit2Play Study (Miami-Dade County, FL). Hotspot analysis evaluated COI spatial clustering. Generalized linear mixed models examined cross-sectional COI-fitness associations. RESULTS The sample included 725 youth (53% Black, 43% Hispanic; 5-17 years). Significant neighborhood quality spatial clusters were identified (Gi*z-score = -4.85 to 5.36). Adjusting for sociodemographics, walkability was associated with lower percentiles in body mass index (BMI) and diastolic blood pressure percentiles (DBP) (β = -5.25, 95% CI: -8.88, -1.62 and β = -3.95, 95% CI: -7.02, -0.89, respectively) for all, lower skinfold thickness (β = -4.83, 95% CI: -9.97, 0.31 and higher sit-ups (β = 1.67, 95% CI: -0.17, 3.50) among girls, and lower systolic blood pressure percentiles (SBP) (β = -4.75, 95% CI: -8.99, -0.52) among boys. Greenspace was associated with higher BMI (β = 6.17, 95% CI: 2.47, 9.87), SBP (β = 3.47, 95% CI: -0.05, 6.99), and DBP (β = 4.11, 95% CI: 1.08, 7.13). CONCLUSIONS COI indicators were positively associated with youth fitness. Disparities in youth cardiovascular disease risk may be modifiable through community interventions and built environment initiatives targeting select neighborhood factors.
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Affiliation(s)
- Hiwot Zewdie
- Duke Global Health Institute, Duke University, Durham, NC
| | - Amy Y Zhao
- Trinity College of Arts & Sciences, Duke University, Durham, NC
| | - Hersila H Patel
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL
| | - Eric Hansen
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center School of Public Health, Houston, TX
| | - Sarah C Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - J Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC; Center for Geospatial Analytics, NC State University, Raleigh, NC
| | - Emily M D'Agostino
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, NC.
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22
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Yang S, Chen X, Wang L, Wu T, Fei T, Xiao Q, Zhang G, Ning Y, Jia P. Walkability indices and childhood obesity: A review of epidemiologic evidence. Obes Rev 2021; 22 Suppl 1:e13096. [PMID: 33185012 PMCID: PMC7988583 DOI: 10.1111/obr.13096] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
The lack of an active neighbourhood living environment can impact community health to a great extent. One such impact manifests in walkability, a measure of urban design in connecting places and facilitating physical activity. Although a low level of walkability is generally considered to be a risk factor for childhood obesity, this association has not been established in obesity research. To further examine this association, we conducted a literature search on PubMed, Web of Science and Scopus for articles published until 31 December 2018. The included literature examined the association between measures of walkability (e.g., walkability score and walkability index) and weight-related behaviours and/or outcomes among children aged under 18 years. A total of 13 studies conducted in seven countries were identified, including 12 cross-sectional studies and one longitudinal study. The sample size ranged from 98 to 37 460, with a mean of 4971 ± 10 618, and the age of samples ranged from 2 to 18. Eight studies reported that a higher level of walkability was associated with active lifestyles and healthy weight status, which was not supported by five studies. In addition to reviewing the state-of-the-art of applications of walkability indices in childhood obesity studies, this study also provides guidance on when and how to use walkability indices in future obesity-related research.
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Affiliation(s)
- Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xiang Chen
- Department of Geography, University of Connecticut, Storrs, Connecticut, USA
| | - Lei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tong Wu
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Teng Fei
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,School of Resources and Environmental Science, Wuhan University, Wuhan, China
| | - Qian Xiao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Yi Ning
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Peking University Health Science Center Meinian Public Health Research Institute, Beijing, China.,Meinian Institute of Health, Beijing, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
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