title: Urban sprawl and body mass index among displaced Hurricane Katrina survivors.
abstract: OBJECTIVE
  Existing research suggests that walkable environments are protective against weight gain, while sprawling neighborhoods may pose health risks. Using prospective data on displaced Hurricane Katrina survivors, we provide the first natural experimental data on sprawl and body mass index (BMI).
  
  
  METHODS
  The analysis uses prospectively collected pre- (2003-2005) and post-hurricane (2006-2007) data from the Resilience in Survivors of Katrina (RISK) project on 280 displaced Hurricane Katrina survivors who had little control over their neighborhood placement immediately after the disaster. The county sprawl index, a standardized measure of built environment, was used to predict BMI at follow-up, adjusted for baseline BMI and sprawl; hurricane-related trauma; and demographic and economic characteristics.
  
  
  RESULTS
  Respondents from 8 New Orleans-area counties were dispersed to 76 counties post-Katrina. Sprawl increased by an average of 1.5 standard deviations (30 points) on the county sprawl index. Each one point increase in sprawl was associated with approximately .05kg/m(2) higher BMI in unadjusted models (95%CI: .01-.08), and the relationship was not attenuated after covariate adjustment.
  
  
  CONCLUSIONS
  We find a robust association between residence in a sprawling county and higher BMI unlikely to be caused by self-selection into neighborhoods, suggesting that the built environment may foster changes in weight.
authors.affiliation: Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA, USA. Electronic address: marcaya@hsph.harvard.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Arcaya
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. Electronic address: pjames@hsph.harvard.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.affiliation: Department of Psychology, University of Massachusetts, Boston, Boston, MA, USA. Electronic address: Jean.Rhodes@umb.edu.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Rhodes
authors.affiliation: Department of Sociology, Harvard University, Cambridge, MA, USA. Electronic address: mcw@wjh.harvard.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Waters
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. Electronic address: svsubram@hsph.harvard.edu.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D015992:Body Mass Index; D055867:Cyclonic Storms; D004190:Disasters; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D055361:Multilevel Analysis; D055820:New Orleans; D011446:Prospective Studies; D012036:Refugees; D012111:Residence Characteristics; D017741:Survivors; D014504:Urban Health; D015430:Weight Gain
keywords: Body mass index; Disasters; Multilevel analysis; Residence characteristics; United States
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