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The current obesity epidemic has many causes, but there is an association between urban sprawl and obesity.

LOPEZ, RUSS P. Neighborhood risk factors for obesity. Obesity. 2007;15:2111-2119. Objective: The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area. Research Methods and Procedures: This was a multi-level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI Ͼ30), and independent variables assessed included individual level variables (age, education, income, smoking status, sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets). Results: After controlling for individual level factors, median household income [relative risk (RR) ϭ 0.992; 95% confidence interval (CI) ϭ 0.990, 0.994], population density (RR ϭ 0.98; 95% CI ϭ 0.972, 0.990), employment density (RR ϭ 1.004; 95% CI ϭ 1.001, 1.009), establishment density (RR ϭ 0.981 95% CI ϭ 0.964, 0.999), and the presence of a supermarket (RR ϭ 0.893; 95% CI ϭ 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk. Discussion: Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.

Environmental Justice I examined non-Hispanic Black and non-Hispanic White differences in exposure to noncriteria air pollutants in 44 U.S. Census Bureau-defined metropolitan areas with populations greater than one million, using data on air toxics concentrations prepared for the U.S. Environmental Protection Agency as part of its Cumulative Exposure Project combined with U.S. census data. I measured differences in exposure to air toxics through the calculation of a net difference score, which is a statistical measure used in income inequality analysis to measure inequality over the whole range of exposures. The scores ranged from 11.52 to 83.60. In every metropolitan area, non-Hispanic Blacks are more likely than non-Hispanic Whites to be living in tracts with higher total modeled air toxics concentrations. To assess potential reasons for such a wide variation in exposure differences, I performed a multiple regression analysis with the net difference score as the dependent variable. Independent variables initially included were as follows: the dissimilarity index (to measure segregation), Black poverty/White poverty (to control for Black/White economic differences), population density and percentage of persons traveling to work who drive to work (alone and in car pools), and percentage of workforce employed in manufacturing (factors affecting air quality). After an initial analysis I eliminated from the model the measures of density and the persons driving to work because they were statistically insignificant, they did not add to

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Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.

Although sprawl is a growing national debate, there have been few efforts to measure or monitor changes in degree of sprawl over time. By using a methodology that employs census data, this sprawl index allows computation of levels of sprawl and examination of temporal and geographic changes. The results show that sprawl has increased over the past decade in many metropolitan areas. There are important geographic variations in sprawl, implying that it is neither inevitable nor universal.