title: Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis).
abstract: OBJECTIVE
  While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence.
  
  
  METHODS
  Data came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m(2) . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression.
  
  
  RESULTS
  Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15).
  
  
  CONCLUSIONS
  Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA. aha27@drexel.edu
authors.forename: Amy H
authors.initials: AH
authors.lastname: Auchincloss
authors.forename: Mahasin S
authors.initials: MS
authors.lastname: Mujahid
authors.forename: Mingwu
authors.initials: M
authors.lastname: Shen
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.forename: Melicia C
authors.initials: MC
authors.lastname: Whitt-Glover
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology* / Q000517:prevention & control; D005006:Ethnicity; D005260:Female; D058870:Food, Organic; D015438:Health Behavior; D006293:Health Promotion; D006295:Health Resources; D006801:Humans; D015994:Incidence; D008019:Life Style; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012931:Social Environment; D016138:Walking