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APHA Scientific Session and Event Listing

Corinne E. Joshu, MA¹, Tegan K. Boehmer, PhD, MPH¹, Reid Ewing, PhD², and Ross C. Brownson, PhD¹. (1) Department of Community Health and Prevention Research Center, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, 314-977-8122, joshuce@slu.edu, (2) National Center for Smart Growth, University of Maryland, 1112J Preinkert Field House, College Park, MD 20742

Introduction: Growing evidence suggests the built environment impacts obesity within urban areas, however little research has investigated these relationships across degrees of urbanization or considered multiple levels of influence simultaneously in a diverse U.S. population. This study aimed to determine 1) whether personal and neighborhood barriers differ by level of urbanization and 2) the relative importance of personal barriers, neighborhood barriers, and area development patterns measured by county-level sprawl index.

Methods: Cross-sectional survey data (1999-2000) of 1,818 U.S. adults of diverse ethnicity and income-level was utilized. Primary analyses were stratified by county urbanization level (large metropolitan, small metropolitan, non-metropolitan, rural). Logistic regression was used to estimate associations between obesity and perceived personal and neighborhood barriers, controlling for sociodemographic variables. Within metropolitan areas, hierarchical linear modeling was used to estimate the independent effect of county-level sprawl and individual-level personal and neighborhood barriers.

Results: Prevalence of neighborhood barriers, not personal barriers, differed widely across urbanization level. Specific neighborhood (e.g., activity locations, traffic, unattended dogs) and personal (e.g., time, motivation, injury) barriers differentially correlated with obesity across strata. Generally, personal barriers correlated more strongly with obesity than neighborhood barriers in all strata except rural areas. The impact of county sprawl index (larger values=less sprawl) on BMI (b=-.004) was consistent with previous findings; standardized coefficients indicate personal (β=.089) and neighborhood (β=.064) barriers had stronger associations than sprawl (β=-.036).

Conclusions: Future intervention planning and policy development for urban design should consider personal barriers and built environment characteristics may influence obesity differently across levels of urbanization.

Learning Objectives:

• 1.Identify the neighborhood and personal barriers that differ in their association with obesity across levels of urbanization
• 2.Articulate the relative importance of county-level sprawl as compared with individual-level neighborhood and personal barriers
• 3.Apply hierarchical linear modeling to examine built environment characteristics at multiple levels of analysis.

Keywords: Obesity, Environment

Presenting author's disclosure statement:

Not Answered