title: Physical environment may modify the association between depressive symptoms and change in waist circumference: the multi-ethnic study of atherosclerosis.
abstract: BACKGROUND
  Although the bidirectional association between depressive symptoms and adiposity has been recognized, the contribution of neighborhood factors to this relationship has not been assessed.
  
  
  OBJECTIVE
  This study evaluates whether physical and social neighborhood environments modify the bidirectional relationship between depressive symptoms and adiposity (measured by waist circumference and body mass index).
  
  
  METHODS
  Using data on 5,122 men and women (ages 45 to 84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) we investigated whether neighborhood physical (i.e., walking environment and availability of healthy food) and social (i.e., safety, aesthetics, and social coherence) environments modified the association between the following: (1) baseline elevated depressive symptoms (Center for Epidemiologic Study Depression Scale score ≥ 16) and change in adiposity (as measured by waist circumference and body mass index) and (2) baseline overweight/obesity (waist circumference > 102 cm for men and >88 cm for women, or body mass index ≥ 25 kg/m(2)) and change in depressive symptoms using multilevel models. Neighborhood-level factors were obtained from the MESA Neighborhood Study.
  
  
  RESULTS
  A greater increase in waist circumference in participants with vs without elevated depressive symptoms was observed in those living in poorly-rated physical environments but not in those living in better-rated environments (interaction p = 0.045). No associations were observed with body mass index. Baseline overweight/obesity was not associated with change in depressive symptoms and there was no modification by neighborhood-level factors.
  
  
  CONCLUSIONS
  Elevated depressive symptoms were associated with greater increase in waist circumference among individuals living in poorly-rated physical environments than in those in better-rated physical environments. No association was found between overweight/obesity and change in depressive symptoms.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Rosemay A
authors.initials: RA
authors.lastname: Remigio-Baker
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jeannie-Marie
authors.initials: JM
authors.lastname: Leoutsakos
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Manuel
authors.initials: M
authors.lastname: Franco
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schreiner
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: Department of Nutrition and Obesity, The University of Texas School of Public Health, Houston, TX.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Nettleton
authors.affiliation: Department of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, CA.
authors.forename: Mahasin S
authors.initials: MS
authors.lastname: Mujahid
authors.affiliation: Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Gary-Webb
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: sahill@jhmi.edu.
authors.forename: Sherita H
authors.initials: SH
authors.lastname: Golden
mesh_terms: D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology*; D004779:Environment Design; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000453:epidemiology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012931:Social Environment; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference