Elsevier

Social Science & Medicine

Volume 68, Issue 7, April 2009, Pages 1285-1293
Social Science & Medicine

Neighborhood built environment and income: Examining multiple health outcomes

https://doi.org/10.1016/j.socscimed.2009.01.017Get rights and content

Abstract

There is growing interest in the relation of built environments to physical activity, obesity, and other health outcomes. The purpose of the present study was to test associations of neighborhood built environment and median income to multiple health outcomes and examine whether associations are similar for low- and high-income groups. This was a cross-sectional study of 32 neighborhoods in Seattle, WA and Baltimore, MD regions, stratified by income and walkability, and conducted between 2001 and 2005. Participants were adults aged 20–65 years (n = 2199; 26% ethnic minority). The main outcomes were daily minutes of moderate-to-vigorous physical activity (MVPA) from accelerometer monitoring, body mass index (BMI) based on self-report, and mental and physical quality of life (QoL) assessed with the SF-12.

We found that MVPA was higher in high- vs. low-walkability neighborhoods but did not differ by neighborhood income. Overweight/obesity (BMI ≥25) was lower in high-walkability neighborhoods. Physical QoL was higher in high-income neighborhoods but unrelated to walkability. Adjustment for neighborhood self-selection produced minor changes. We concluded that living in walkable neighborhoods was associated with more physical activity and lower overweight/obesity but not with other benefits. Lower- and higher-income groups benefited similarly from living in high-walkability neighborhoods. Adults in higher-income neighborhoods had lower BMI and higher physical QoL.

Introduction

Physical inactivity and obesity are prevalent and serious health challenges, contributing to cardiovascular diseases, certain cancers, diabetes, and mental disorders (Andersen, 2003, Dishman et al., 2004). Physical activity and obesity have been linked with physical attributes of neighborhoods. Neighborhoods considered walkable have non-residential destinations (e.g., shops) close to residences and well-connected streets. Low-walkability areas separate residences from destinations and have poorly connected street networks, so walking to destinations is difficult. People walk and bicycle more for transportation in high-walkability than low-walkability neighborhoods, as indicated by multiple reviews (Gebel et al., 2007, Heath et al., 2006, Transportation Research Board and Institute of Medicine, 2005). There is a need to confirm whether more walkable neighborhoods are associated with higher total physical activity, particularly using objective measures of environment and activity (Frank, Andresen, & Schmid, 2004), because total physical activity should be most closely related to health benefits. A few studies indicate adults living in high-walkability neighborhoods or regions are less likely to be overweight or obese than those living in low-walkability areas (Papas et al., 2007), but further studies are needed.

Because disparities in health outcomes (Centers for Disease Control and Prevention, 2004) and physical activity are well documented across socioeconomic groups (Crespo, Smit, Andersen, Carter-Pokras, & Ainsworth, 2000), an important question is whether favorable built environments could reduce health disparities. Findings that walkability was related to physical activity and obesity among whites but not blacks (Frank, Andresen, & Schmid, 2004; Frank, Sallis, Chapman, & Saelens, 2005) raise the possibility that not all groups benefit from walkable built environments. Because a primary health objective of the United States is to eliminate health disparities (United States Department of Health and Human Services, 2000), it is important to determine whether walkability has similar associations with health outcomes in lower- and higher-income groups.

Advocates of walkable communities propose additional health benefits that have not been examined empirically (Duany et al., 2000, Frank et al., 2003, Frumkin et al., 2004). One hypothesis is that suburban residents who drive everywhere have fewer chances to form bonds with neighbors, negatively impacting social cohesion (Wood et al., 2008). Inadequate social networks are a risk factor for depression (Kawachi & Berkman, 2001), so residents of low-walkability neighborhoods might have more depressive symptoms. Some claim overall quality of life is higher for people living in walkable communities (Duany et al., 2000, Frumkin et al., 2004).

The present study investigated how living in high- vs. low-walkability and high- vs. low-income neighborhoods was related to adults’ biological, behavioral, social, and mental health outcomes. Because self-selection to neighborhood has been identified as a potential confounder of associations with walkability (Transportation Research Board and Institute of Medicine, 2005, Handy et al., 2006, Frank et al., 2007; Eid, Overman, Puga, & Turner, 2007), analyses were conducted with and without adjusting for participants’ reasons for moving to their current neighborhoods.

Section snippets

Study design

The neighborhood quality of life study (NQLS) is an observational epidemiologic study designed to compare multiple health outcomes among residents of neighborhoods stratified on “walkability” characteristics and median household income. Data were collected from 2001 to 2005 in two metropolitan areas in the United States that were chosen based on availability of parcel-level land use information, and variability in walkability. The King County-Seattle, WA and Baltimore-Washington DC regions met

Participant characteristics and representativeness

Data were collected from 2199 participants from 32 neighborhoods. Demographics of the study sample by quadrant are reported in Table 2. The sample was well balanced by sex, mostly well-educated, most were married, and 26% were non-white.

A total of 8504 eligible adults were contacted by phone. The study participation rate (i.e., returned survey 1/eligible contacts) was 26% overall and did not differ by quadrant (range of 23–29% by quadrant). The 6 month retention rate was 87% overall (range of

Discussion

Four major findings emerged from the present study. First, neighborhood walkability was related to higher levels of physical activity and lower risk of being overweight or obese, but not to social or psychological outcomes. Second, neighborhood income was not related to any measure of physical activity, but lower-income adults had less favorable weight status, physical QoL, neighborhood satisfaction, and social cohesion than higher-income participants. Third, there was only one significant

Acknowledgements

This study was supported by grant HL67350 from the National Heart, Lung, and Blood Institute. The funder was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We acknowledge the important contributions of the office of the County Executive in King County, WA, and multiple state and county agencies in Maryland.

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