Adult BMI and Access to Built Environment Resources in a High-Poverty, Urban Geography

Abstract

Introduction The purpose of this study is to examine the relationship between BMI and access to built environment resources in a high-poverty, urban geography. Methods Participants (aged ≥35 years) were surveyed between November 2012 and July 2013 to examine access to common health-enabling resources (grocers, outpatient providers, pharmacies, places of worship, and physical activity resources). Survey data were linked to a contemporaneous census of built resources. Associations between BMI and access to resources (potential and realized) were examined using independent t-tests and multiple linear regression. Data analysis was conducted in 2014–2015. Results Median age was 53.8 years (N=267, 62% cooperation rate). Obesity (BMI ≥30 kg/m2) prevalence was 54.9%. BMI was not associated with potential access to resources located nearest to home. Nearly all participants (98.1%) bypassed at least one nearby resource type; half bypassed nearby grocers (realized access >1 mile from home). Bypassing grocers was associated with a higher BMI (p=0.03). Each additional mile traveled from home to a grocer was associated with a 0.9 kg/m2–higher BMI (95% CI=0.4, 1.3). Quality and affordability were common reasons for bypassing resources. Conclusions Despite potential access to grocers in a high-poverty, urban region, half of participants bypassed nearby grocers to access food. Bypassing grocers was associated with a higher BMI.

Neighborhood crime and access to health-enabling resources in Chicago

“…Hour-long in-person interviews were conducted in participants' homes. A detailed methodology of this study has been previously described ( Tung et al, 2016 ).…”

“…First, we used data from the 2012 MAPSCorps asset census, a comprehensive, directly-observed census of every open and operating, public-facing business and organization in the region ( Lindau et al, 2016 ) to identify community-based resources near each resident's home. Second, we used survey items to query residents about the community-based resources they most commonly used ( Pebley et al, 2010 ; Tung et al, 2016 ). Due to practical constraints on survey length, we included the two most common resource types, specifically, grocers and pharmacies.…”

“…Poor realized access was defined as bypassing resources within 1 mile to use resources >1 mile from a resident's home. A fuller description of the methodology has been previously published ( Tung et al, 2016 ). As a secondary analysis, we also explored the relationship between prior experience of neighborhood crime (independent variable) and BMI and BP status, hypothesizing positive associations between neighborhood crime and these biological indicators of stress-related chronic disease.…”

“…Andersen's enduring Behavioral Model defines access in two ways ( Andersen, 1995 ): potential access indicates the availability of resources in a neighborhood, and realized access indicates the actual use of those resources ( Andersen, 1995 ). In a recent study, we found that people often bypassed nearby resources for more distant resources, and bypassing was associated with higher BMI; poor safety was identified as an important reason for bypassing ( Tung et al, 2016 ). Zenk and colleagues, in prior qualitative work, also identified crime-related safety as a barrier to accessing healthy and nutritious foods ( Zenk et al, 2011 ).…”

“…We used cross-sectional data from an address-based probability sample, collected on Chicago's South Side, to examine relationships between neighborhood crime and access to health-enabling resources. Based on previously published work ( Tung et al, 2016 ; Zenk et al, 2011 ), we hypothesized that neighborhood crime is inversely associated with both potential and realized access to health-enabling resources.…”