title: Neighborhood Self-Selection: The Role of Pre-Move Health Factors on the Built and Socioeconomic Environment.
abstract: Residential self-selection bias is a concern in studies of neighborhoods and health. This bias results from health behaviors predicting neighborhood choice. To quantify this bias, we examined associations between pre-move health factors (body mass index, walking, and total physical activity) and post-move neighborhood factors (County Sprawl Index, Census tract socioeconomic status (SES)) in the Nurses' Health Study (n = 14,159 moves from 1986-2008). Individuals in the highest quartile of pre-move BMI (BMI > 28.4) compared to the lowest quartile (BMI < 22.5) moved to counties that averaged 2.57 points lower on the sprawl index (95% confidence interval -3.55, -1.59) indicating that individuals moved to less dense counties; however, no associations were observed for pre-move walking nor total physical activity. Individuals with higher pre-move BMI tended to move to Census tracts with lower median income and home values and higher levels of poverty. Analyses examining the change in neighborhood environments after a move demonstrated that healthy pre-move behaviors were associated with moves to worse socioeconomic environments. This type of self-selection would bias results downward, underestimating the true relationship between SES and physical activity. Generally, the magnitudes of associations between pre-move health factors and neighborhood measures were small and indicated that residential self-selection was not a major source of bias in analyses in this population.
authors.affiliation: Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA. pjames@hsph.harvard.edu.|Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. pjames@hsph.harvard.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.affiliation: Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. jaime.hart@channing.harvard.edu.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jaime.hart@channing.harvard.edu.
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Hart
authors.affiliation: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. marcaya@hsph.harvard.edu.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Arcaya
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. hpdif@channing.harvard.edu.
authors.forename: Diane
authors.initials: D
authors.lastname: Feskanich
authors.affiliation: Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA. francine.laden@channing.harvard.edu.|Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. francine.laden@channing.harvard.edu.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. francine.laden@channing.harvard.edu.
authors.forename: Francine
authors.initials: F
authors.lastname: Laden
authors.affiliation: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA. svsubram@hsph.harvard.edu.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D004777:Environment; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies; D012111:Residence Characteristics; D012923:Social Class; D014481:United States; D016138:Walking
keywords: body mass index; built environment; physical activity; residential self-selection; socioeconomic status