The Women's Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure

Abstract

Using data (n=60,775 women) from the Women’s Health Initiative Clinical Trial (WHI CT)— a national study of postmenopausal women aged 50 to 79 years — we analyzed cross-sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a woman’s residence, census tract neighborhood socioeconomic status (NSES), body mass index (BMI) and blood pressure (BP). We simultaneously modeled NSES and food outlets using linear and logistic regression models, adjusting for multiple socio-demographic factors, population density and random effects at the tract and metropolitan statistical area (MSA) level. We found significant associations between NSES, availability of food outlets and individual-level measurements of BMI and BP. As grocery store/supermarket availability increased from the 10th to the 90th percentile of its distribution, controlling for confounders, BMI was lower by 0.30 kg/m2. Conversely, as fast-food outlet availability increased from the 10th to the 90th percentile, BMI was higher by 0.28 kg/m2. When NSES increased from the 10th to the 90th percentile of its distribution, BMI was lower by 1.26 kg/m2. As NSES increased from the 10th to the 90th percentile, systolic and diastolic BP were lower by 1.11 mm and 0.40 mm Hg, respectively. As grocery store/supermarket outlet availability increased from the 10th and 90th percentiles diastolic BP was lower by 0.31 mm Hg. In this national sample of post-menopausal women, we found important independent associations between the food and socioeconomic environments and BMI and BP. These findings suggest that changes in the neighborhood environment may contribute to efforts to control obesity and hypertension.

Association between Perceived Built Environment and Prevalent Hypertension among South African Adults

“…Other studies have reported similar results concerning odds for hypertension with proximity to major roadway [15] and street foods [48]. One possible explanation apart from physical activity is that the availability of facilities within walkable distance provides access, for example, to retail fruits and vegetables.…”

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

“…As examples, better access to grocery stores or recreational facilities has been associated with lower average blood pressure levels in large studies. [4][5][6][7] High levels of neighborhood problems, such as crime, have been associated with higher blood pressure levels. 4,7,8 Conversely, neighborhood social cohesion, which is a sense of solidarity, has been associated with lower risk of hypertension.…”

Home and work neighbourhood environments in relation to body mass index: the Multi-Ethnic Study of Atherosclerosis (MESA)

“…Availability of healthy food outlets and supermarkets have been inversely associated with BMI and obesity in some,5–8 but not all, studies 9 10. Access to fast food and all types of restaurants have been found to be associated with higher levels of BMI in some studies,5 11 but null and even inverse associations have also been reported 6 12 13. In general, neighbourhoods that are more unsafe or have lower levels of aesthetic quality have been linked to higher levels of BMI and obesity,14 15 whereas findings for other features of neighbourhood social environments, such as social cohesion and psychosocial hazards, have been more mixed 16 17…”