Research article
Body Mass Index, Safety Hazards, and Neighborhood Attractiveness

https://doi.org/10.1016/j.amepre.2012.06.018Get rights and content

Background

Neighborhood attractiveness and safety may encourage physical activity and help individuals maintain a healthy weight. However, these neighborhood characteristics may not be equally relevant to health across all settings and population subgroups.

Purpose

To evaluate whether potentially attractive neighborhood features are associated with lower BMI, whether safety hazards are associated with higher BMI, and whether environment–environment interactions are present such that associations for a particular characteristic are stronger in an otherwise supportive environment.

Methods

Survey data and measured height and weight were collected from a convenience sample of 13,102 adult New York City (NYC) residents in 2000–2002; data analyses were completed 2008–2012. Built-environment measures based on municipal GIS data sources were constructed within 1-km network buffers to assess walkable urban form (density, land-use mix, transit access); attractiveness (sidewalk cafés, landmark buildings, street trees, street cleanliness); and safety (homicide rate, pedestrian–auto collision and fatality rate). Generalized linear models with cluster-robust SEs controlled for individual and area-based sociodemographic characteristics.

Results

The presence of sidewalk cafés, density of landmark buildings, and density of street trees were associated with lower BMI, whereas the proportion of streets rated as clean was associated with higher BMI. Interactions were observed for sidewalk cafés with neighborhood poverty, for street-tree density with walkability, and for street cleanliness with safety. Safety hazard indicators were not independently associated with BMI.

Conclusions

Potentially attractive community and natural features were associated with lower BMI among adults in NYC, and there was some evidence of effect modification.

Introduction

The current high prevalence of obesity1, 2, 3 represents a dramatic increase during recent decades that cannot be explained by genetics or other stable characteristics. One promising strategy is to promote physical activity and prevent obesity through modifications to the built environment.4, 5, 6

Most built-environment and health studies focus on walkable urban form,4, 7, 8 including features such as residential density, land-use mix, and street design. Safety and attractiveness also may encourage walking and promote healthy weight outcomes,9, 10 yet point-level objective (audit-based or GIS) measures of safety or attractiveness are not widely investigated as predictors of obesity.7, 11, 12

Neighborhood characteristics are often viewed simply as independent influences but may instead exhibit meaningful environment–environment interactions. Such interactions could take the form of an ordered hierarchy,13 such that the presence of barriers at the most basic level would eliminate other associations. Once walkable urban form makes pedestrian transportation feasible, safety concerns may become salient for those residents who have a viable alternative to walking. Finally, attractiveness may become salient among people living in safe, walkable environments.

Alternatively, socially disadvantaged populations may experience multiple barriers to maintaining a healthy weight,14 such that removing any one barrier has little effect; that is, an investment focused on any one built-environment characteristic may be ineffective if other barriers remain. This could make residents' lifestyles and ensuing obesity resistant to environmental intervention strategies until some threshold of cumulative opportunity has been reached. Both the hierarchy and the cumulative opportunity threshold models would suggest that an attractive built environment will be more influential in the absence of other barriers.

The current paper has two main objectives. The first is to examine the associations between neighborhood attractiveness and safety based on municipal GIS data sources and BMI using data from 13,102 adults in NYC. Potentially attractive features (landmark buildings, sidewalk cafés, street trees, and clean sidewalks) are hypothesized to predict lower BMI, and safety hazards (homicide or pedestrian–auto fatality rate) are hypothesized to predict higher BMI. The second objective is to examine interactions among neighborhood characteristics.

Section snippets

Subjects and Setting

The current analyses use an extensive geographic database and individual-level data from a previously described study.15, 16 Briefly, data were collected during baseline enrollment of subjects for the New York Cancer Project (NYCP) between January 2000 and December 2002. Research staff carried out extensive publicity and recruitment efforts throughout the five boroughs of NYC to recruit an ethnically and socioeconomically diverse convenience sample of 18,187 volunteers. Qualifications for

Results

The study population included 13,102 adults, with a mean age of 46 years, of whom 65% were women, 37% were overweight, and 28% were obese. High-poverty or high-walkability neighborhood buffers (categorized based on a median split) were estimated to have more sidewalk cafés, landmark buildings, homicides, and pedestrian–auto fatalities (Table 1). Each potentially attractive built-environment feature was associated with BMI when added to a model with potential individual and neighborhood

Discussion

After adjustment for individual and neighborhood sociodemographic characteristics, potentially attractive community and natural features were associated with lower BMI in this population of adult NYC residents. Contrary to expectation, street cleanliness ratings were associated with higher BMI, perhaps reflecting the role of pedestrians in generating litter. Safety-hazard indicators were not associated with BMI. Environment–environment interactions were observed.

Although no evidence was found

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