title: Associations between neighborhood effects and physical activity, obesity, and diabetes: The Jamaica Health and Lifestyle Survey 2008.
abstract: OBJECTIVE
  To examine the impact of neighborhood disorder, perceived neighborhood safety, and availability of recreational facilities on prevalence of physical activity (PA), obesity, and diabetes mellitus (DM).
  
  
  METHODS
  Multilevel analyses were conducted among 2,848 respondents from the 2007-08 Jamaica Health and Lifestyle Survey. Neighborhood effects were based on aggregated interviewer responses to systematic social observation questions. Mixed-effect logistic regression models were created to assess the relationship between neighborhood indicators and DM and the modifiable risk factors PA and overweight/obesity.
  
  
  RESULTS
  There was significant clustering in PA levels of 20 minutes at least once per week (intraclass correlation coefficient [ICC] = 10.7%), low/no PA (ICC = 7.22%), diabetes (ICC = 5.44%), and obesity (ICC = 3.33%) across neighborhoods. Greater levels of neighborhood disorder, home disorder, and counterintuitively recreational space availability were associated with higher levels of low/no PA among women. There was significant interaction by sex between neighborhood infrastructure and overweight/obesity with a significant association in men (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.05, 1.28) but not women (OR = 1.01; 95% CI = 0.95, 1.07).
  
  
  CONCLUSIONS
  Differences in PA and obesity-related outcomes among Jamaicans may be partially explained by characteristics of the neighborhood environment and differ by sex. Future studies must be conducted to determine the mechanistic pathways through which the neighborhood environment may impact such outcomes to better inform prevention efforts.
authors.affiliation: Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica; Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica. Electronic address: colette.cunninghammyrie@uwimona.edu.jm.
authors.forename: Colette Andrea
authors.initials: CA
authors.lastname: Cunningham-Myrie
authors.affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Theall
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Novie O
authors.initials: NO
authors.lastname: Younger
authors.affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Mabile
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Marshall K
authors.initials: MK
authors.lastname: Tulloch-Reid
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Damian K
authors.initials: DK
authors.lastname: Francis
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Shelly R
authors.initials: SR
authors.lastname: McFarlane
authors.affiliation: Mona Office for Research and Innovation, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Georgiana M
authors.initials: GM
authors.lastname: Gordon-Strachan
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Rainford J
authors.initials: RJ
authors.lastname: Wilks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors
keywords: Developing country; Diabetes; Multilevel modeling; Neighborhood effects; Obesity; Physical activity