James W. Quinn

Neighborhood food environment and walkability predict obesity in New York City.

Background Differences in the neighborhood food environment may contribute to disparities in obesity. Objectives The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability. Methods This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject’s home address. Results Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km2, respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27–1.32] in the fifth quintile (10.98 stores/km2) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78–0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73–0.96) and for land-use mix was 0.91 (95% CI, 0.86–0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity. Conclusions Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity.

Children living in areas with more street trees have lower prevalence of asthma

Background: The prevalence of childhood asthma in the USA increased by 50% from 1980 to 2000, with especially high prevalence in poor urban communities. Methods: Data on the prevalence of asthma among children aged 4–5 years and on hospitalisations for asthma among children less than 15 years old were available for 42 health service catchment areas within New York City. Street tree counts were provided by the New York City Department of Parks and Recreation. The proximity to pollution sources, sociodemographic characteristics and population density for each area were also measured. Results: Controlling for potential confounders, an increase in tree density of 1 standard deviation (SD, 343 trees/km2) was associated with a lower prevalence of asthma (RR, 0.71 per SD of tree density; 95% CI, 0.64 to 0.79), but not with hospitalisations for asthma (RR, 0.89 per SD of tree density; 95% CI, 0.75 to 1.06). Conclusions: Street trees were associated with a lower prevalence of early childhood asthma. This study does not permit inference that trees are causally related to asthma at the individual level. The PlaNYC sustainability initiative, which includes a commitment to plant one million trees by the year 2017, offers an opportunity for a large prospective evaluation.

Maternal Prenatal Urinary Phthalate Metabolite Concentrations and Child Mental, Psychomotor, and Behavioral Development at 3 Years of Age

Background: Research suggests that prenatal phthalate exposures affect child executive function and behavior. Objective: We evaluated associations between phthalate metabolite concentrations in maternal prenatal urine and mental, motor, and behavioral development in children at 3 years of age. Methods: Mono-n-butyl phthalate (MnBP), monobenzyl phthalate (MBzP), monoisobutyl phthalate (MiBP), and four di-2-ethylhexyl phthalate metabolites were measured in a spot urine sample collected from 319 women during the third trimester. When children were 3 years of age, the Mental Development Index (MDI) and Psychomotor Development Index (PDI) were measured using the Bayley Scales of Infant Development II, and behavior problems were assessed by maternal report on the Child Behavior Checklist. Results: Child PDI scores decreased with increasing loge MnBP [estimated adjusted β-coefficient = –2.81; 95% confidence interval (CI): –4.63, –1.0] and loge MiBP (β = –2.28; 95% CI: –3.90, –0.67); odds of motor delay increased significantly [per loge MnBP: estimated adjusted odds ratio (OR) = 1.64; 95% CI: 1.10, 2.44; per loge MiBP: adjusted OR =1.82; 95% CI: 1.24, 2.66]. In girls, MDI scores decreased with increasing loge MnBP (β = –2.67; 95% CI: –4.70, –0.65); the child sex difference in odds of mental delay was significant (p = 0.037). The ORs for clinically withdrawn behavior were 2.23 (95% CI: 1.27, 3.92) and 1.57 (95% CI: 1.07, 2.31) per loge unit increase in MnBP and MBzP, respectively; for clinically internalizing behaviors, the OR was 1.43 (95% CI: 1.01, 1.90) per loge unit increase in MBzP. Significant child sex differences were seen in associations between MnBP and MBzP and behaviors in internalizing domains (p < 0.05). Conclusion: Certain prenatal phthalate exposures may decrease child mental and motor development and increase internalizing behaviors.

Disparities in urban neighborhood conditions: evidence from GIS measures and field observation in New York City.

Although many low-income urban areas are highly walkable by conventional measures such as population density or land use mix, chronic diseases related to lack of physical activity are more common among residents of these areas. Disparities in neighborhood conditions may make poor areas less attractive environments for walking, offsetting the advantages of density and land use mix. This study compared poor and nonpoor neighborhoods in New York City, using geographic information systems measures constructed from public data for US census tracts within New York City (N=2,172) as well as field observation of a matched-pair sample of 76 block faces on commercial streets in poor and nonpoor neighborhoods. Poor census tracts had significantly fewer street trees, landmarked buildings, clean streets, and sidewalk cafes, and higher rates of felony complaints, narcotics arrests, and vehicular crashes. The field observation showed similar results. Improving aesthetic and safety conditions in poor neighborhoods may help reduce disparities in physical activity among urban residents.

Effect of Individual or Neighborhood Disadvantage on the Association Between Neighborhood Walkability and Body Mass Index

OBJECTIVES We sought to test whether the association between walkable environments and lower body mass index (BMI) was stronger within disadvantaged groups that may be particularly sensitive to environmental constraints. METHODS We measured height and weight in a diverse sample of 13 102 adults living throughout New York City from 2000-2002. Each participants home address was geocoded and surrounded by a circular buffer with a 1-km radius. The composition and built environment characteristics of these areas were used to predict BMI through the use of generalized estimating equations. Indicators of individual or area disadvantage included low educational attainment, low household income, Black race, and Hispanic ethnicity. RESULTS Higher population density, more mixed land use, and greater transit access were most consistently associated with a lower BMI among those with more education or higher incomes and among non-Hispanic Whites. Significant interactions were observed for education, income, race, and ethnicity. CONCLUSIONS Contrary to expectations, built environment characteristics were less consistently associated with BMI among disadvantaged groups. This pattern may be explained by other barriers to maintaining a healthy weight encountered by disadvantaged groups.

Place of birth, duration of residence, neighborhood immigrant composition and body mass index in New York City

BackgroundPast research has suggested that changes in culture explain the substantial weight gain seen in many immigrant groups with length of residence in the U.S. and across generations of residence in the U.S. However, it has been theorized that those settling in immigrant and co-ethnic neighborhoods may be buffered against this acculturative process and will be more likely to maintain home country dietary and physical activity patterns. To investigate this theory we incorporated measures of neighborhood immigrant composition into analyses of individuals body mass index (BMI) and generation of immigration and duration of residence in the U.S.MethodsMultilevel analyses were performed using objectively measured height and weight and survey data on diet and physical activity from a sample of 13,011 residents of New York City. Census data were used to calculate the proportion of foreign-born residents and extent of household linguistic isolation in a ½ mile radial buffer around the subjects home.ResultsForeign birth was associated with a significantly lower BMI (-1.09 BMI units, P < 0.001). This association was weakest among Asians (-0.66 BMI units, P = 0.08) and strongest among Black-Caribbeans (-1.41 BMI units, P = 0.07). After controlling for individual level variables, neighborhood proportion foreign-born was not associated with BMI, but increasing neighborhood linguistic isolation was inversely associated with BMI among Hispanics (-2.97 BMI units, P = 0.03). Furthermore among Hispanics, the association between foreign birth and BMI was stronger in low linguistic isolation neighborhoods (-1.36 BMI units, P < 0.0001) as compared to in high linguistic isolation levels (-0.42 BMI units, P = 0.79). Increasing duration of residence in the U.S. was significantly associated with higher BMI overall and among Hispanics.ConclusionThe analyses suggest that acculturation is associated with weight gain, and that neighborhood characteristics are only associated with BMI among Hispanics. However, we suggest that changes in body size currently interpreted as post-migration effects of acculturation to U.S. norms may in fact reflect changes in norms that are taking place internationally.

Reconsidering Access: Park Facilities and Neighborhood Disamenities in New York City

With increasing concern about rising rates of obesity, public health researchers have begun to examine the availability of parks and other spaces for physical activity, particularly in cities, to assess whether access to parks reduces the risk of obesity. Much of the research in this field has shown that proximity to parks may support increased physical activity in urban environments; however, as yet, there has been limited consideration of environmental impediments or disamenities that might influence individuals’ perceptions or usage of public recreation opportunities. Prior research suggests that neighborhood disamenities, for instance crime, pedestrian safety, and noxious land uses, might dissuade people from using parks or recreational facilities and vary by neighborhood composition. Motivated by such research, this study estimates the relationship between neighborhood compositional characteristics and measures of park facilities, controlling for variation in neighborhood disamenities, using geographic information systems (GIS) data for New York City parks and employing both kernel density estimation and distance measures. The central finding is that attention to neighborhood disamenities can appreciably alter the relationship between neighborhood composition and spatial access to parks. Policy efforts to enhance the recreational opportunities in urban areas should expand beyond a focus on availability to consider also the hazards and disincentives that may influence park usage.

Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City

BACKGROUND Neighborhood safety, green space, walkability, and sociodemographics may influence physical activity and childhood obesity. METHODS Data on measured height and weight, demographic characteristics, and home ZIP code were collected from year 2004 enrollees in a means-tested preschool program in New York City. Each ZIP code was surrounded by a 400-m buffer and characterized using data from the US census, local government departments, New York Times website, and Transportation Alternatives. Linear and Poisson models were constructed using cluster robust standard errors and adjusting for childs sex, race, ethnicity, age, and neighborhood characteristics. RESULTS Analyses included 11,562 children ages 3-5 years living in 160 residential ZIP codes. A higher homicide rate (at the 75th vs 25th percentile) was associated with a 22% higher prevalence of obesity (95% CI for the prevalence ratio (PR): 1.05 to 1.41). A higher density of street trees (at the 75th vs 25th percentile) was associated with 12% lower prevalence of obesity (95% CI for the PR: 0.79 to 0.99). Other neighborhood characteristics did not have significant associations with childhood obesity. CONCLUSIONS Among preschool children from low-income families, neighborhood homicide rate was associated with more obesity and street tree density was associated with less obesity.

Domestic airborne black carbon and exhaled nitric oxide in children in NYC

Differential exposure to combustion by-products and allergens may partially explain the marked disparity in asthma prevalence (3–18%) among New York City neighborhoods. Subclinical changes in airway inflammation can be measured by fractional exhaled nitric oxide (FeNO). FeNO could be used to test independent effects of these environmental exposures on airway inflammation. Seven- and eight-year-old children from neighborhoods with lower (range 3–9%, n=119) and higher (range 11–18%, n=121) asthma prevalence participated in an asthma case–control study. During home visits, FeNO was measured, and samples of bed dust (allergens) and air (black carbon; BC) were collected. Neighborhood built-environment characteristics were assessed for the 500 m surrounding participants’ homes. Airborne BC concentrations in homes correlated with neighborhood asthma prevalence (P<0.001) and neighborhood densities of truck routes (P<0.001) and buildings burning residual oil (P<0.001). FeNO concentrations were higher among asthmatics with than in those without frequent wheeze (≥4 times/year) (P=0.002). FeNO concentrations correlated with domestic BC among children without seroatopy (P=0.012) and with dust mite allergen among children with seroatopy (P=0.020). The association between airborne BC in homes and both neighborhood asthma prevalence and FeNO suggest that further public health interventions on truck emissions standards and residual oil use are warranted.

Chlorpyrifos exposure and urban residential environment characteristics as determinants of early childhood neurodevelopment.

OBJECTIVES We evaluated whether neighborhood characteristics correlated with early neurodevelopment and whether these characteristics confounded the previously reported association between exposure to chlorpyrifos (an organophosphate insecticide) and neurodevelopment. METHODS We obtained prenatal addresses, chlorpyrifos exposure data, and 36-month Psychomotor Development Index (PDI) and Mental Development Index (MDI) scores for a birth cohort in New York City (born 1998-2002). We used data from the 2000 US Census to estimate measures of physical infrastructure, socioeconomic status, crowding, demographic composition, and linguistic isolation for 1-kilometer network areas around each childs prenatal address. Generalized estimating equations were adjusted for demographics, maternal education and IQ, prenatal exposure to tobacco smoke, caretaking environment quality, and building dilapidation. RESULTS Of 266 children included as participants, 47% were male, 59% were Dominican, and 41% were African American. For each standard deviation higher in neighborhood percent poverty, the PDI score was 2.6 points lower (95% confidence interval [CI] = -3.7, -1.5), and the MDI score was 1.7 points lower (95% CI = -2.6, -0.8). Neighborhood-level confounding of the chlorpyrifos-neurodevelopment association was not apparent. CONCLUSIONS Neighborhood context and chlorpyrifos exposure were independently associated with neurodevelopment, thus providing distinct opportunities for health promotion.