title: Perceived and observed neighborhood indicators of obesity among urban adults.
abstract: OBJECTIVE
  The global obesity epidemic has been partially attributed to modern environments that encourage inactivity and overeating, yet few studies have examined specific features of the physical neighborhood environment that influence obesity. Using two different measurement methods, this study sought to identify and compare perceived and observed neighborhood indicators of obesity and a high-risk profile of being obese and inactive.
  
  
  METHODS
  Cross-sectional telephone surveys (perceived) and street-scale environmental audits (observed) were conducted concurrently in two diverse US cities to assess recreational facility access, land use, transportation infrastructure and aesthetics.
  
  
  METHODS
  A total of 1032 randomly selected urban residents (20% obese, 32% black, 65% female).
  
  
  METHODS
  Bivariate and multivariate logistic regression analyses were conducted to estimate the association (adjusted prevalence odds ratio (aOR)) between the primary outcome (obese vs normal weight) and perceived and observed environmental indicators, controlling for demographic variables.
  
  
  RESULTS
  Being obese was significantly associated with perceived indicators of no nearby nonresidential destinations (aOR=2.2), absence of sidewalks (aOR=2.2), unpleasant community (aOR=3.1) and lack of interesting sites (aOR=4.8) and observed indicators of poor sidewalk quality (aOR=2.1), physical disorder (aOR=4.0) and presence of garbage (aOR=3.7). Perceived and observed indicators of land use and aesthetics were the most robust neighborhood correlates of obesity in multivariate analyses.
  
  
  CONCLUSIONS
  The findings contribute substantially to the growing evidence base of community-level correlates of obesity and suggest salient environmental and policy intervention strategies that may reduce population-level obesity prevalence. Continued use of both measurement methods is recommended to clarify inconsistent associations across perceived and observed indicators within the same domain.
authors.affiliation: Prevention Research Center and Department of Community Health, School of Public Health, Saint Louis University, St Louis, MO, USA. tkboehmer@gmail.com
authors.forename: T K
authors.initials: TK
authors.lastname: Boehmer
authors.forename: C M
authors.initials: CM
authors.lastname: Hoehner
authors.forename: A D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: L K
authors.initials: LK
authors.lastname: Brennan Ramirez
authors.forename: R C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004779:Environment Design / Q000592:standards*; D004954:Esthetics; D015444:Exercise; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods; D011998:Recreation; D014186:Transportation; D014504:Urban Health