Assessing impacts of redeveloping public housing communities on obesity in low-income minority residents: Rationale, study design, and baseline data from the Watts Neighborhood Health Study

Abstract

Introduction Obesogenic built- and social-environments in low-income and minority communities are often blamed for the higher rates of obesity in this population, but existing evidence is based largely on observational studies. This study leverages a natural experiment created by the redevelopment of a public housing community to examine the impact of major improvements to the housing, built, and social environments on obesity among residents. Methods/design The study design is a natural experiment where residents from the redeveloped community (treatment group) will be compared to those from a similar community (control group) in terms of their pre/post changes in primary outcomes using annual longitudinal data on a cohort of residents. Quasi-experimental variation in the timing of exposure to various redevelopment components within the treated community will be further leveraged within a stepped-wedge research design to assess the impact of the redevelopment components. Primary outcome measures include body mass index, overweight, and obese status. Results A cohort of 868 adults and 704 children (ages 2–17 years) was recruited during 2018–2019 with up to two waves of baseline data. At baseline, the prevalence of obesity (overweight or obesity) was 57.2% (81.3%) in adults and 33.1% (52.4%) among children, with no significant differences by treatment status. No differential trends in primary outcomes were observed by treatment status during the two years of baseline. Discussion This natural experiment study offers a unique opportunity to assess whether improvements to housing, built, and social environment in low-income minority communities can lead to reductions in obesity.

Public Rental Housing and Obesogenic Behaviors among Adults in Hong Kong: Mediator Role of Food and Physical Activity Environment

“…Residing in PRH was not directly associated prolonged sitting. Our results also partly explain the mixed results of previous literature on the association between PRH residence and obesity [ 9 , 12 ]. They were possibly caused by the competition of the two forces, including eating and physical activity behaviors.…”

“…If PRH residence leads to poor health outcomes, the pathways could be related with poor housing and neighborhood environment in PRH. However, a related study, which leveraged a natural experiment created by PRH redevelopment in Los Angeles, found that there was no significant change in weight-related outcomes during the two years of baseline after the improvements to housing and the built and social environments in PRH communities [ 9 ]. Yet, weight-related outcomes, such as body mass index, are relatively long-term health consequences and need to be observed over time.…”

Real-world Associations of US Cystic Fibrosis Newborn Screening Programs With Nutritional and Pulmonary Outcomes

“…The staggered implementation of NBS for CF across 44 US states between 2004 and 2009 mimics an observational (nonexperimental) stepped-wedge design. 9 A stepped-wedge design is essentially a 1-way crossover study in which all clusters (in this case, the states) begin observation in a period of nonintervention, followed by a rollout period during which the number of clusters exposed to the intervention increases, and then ends with all clusters exposed to the intervention. In our study, the period 2000 to 2003 was the nonintervention period, 2004 to 2011 was the rollout period, and 2012 to 2018 was the period in which all states were exposed to the intervention.…”

Heterogeneity in grocery shopping patterns among low-income minority women in public housing

“…The study recruited adult and child residents from Jordan Downs, and two other public housing communities not undergoing redevelopment (Imperial Courts, Nickerson Gardens) in Watts during 2018–2019. The majority of participants were recruited from Jordan Downs due to study design consideration described elsewhere [ 44 ]. Participants were recruited through a multi-pronged approach collaborating with resident leaders at each site, including distribution of flyers and letters to homes, promotion at onsite events, and door-to-door visits.…”

“…Participants also completed body composition measurements conducted by trained study staff. Additional details on the methods of the overall study are presented in another paper [ 44 ].…”