摘要：Objectives. To investigate the association between walkability and obesity, we studied adults residing in Baltimore City, Maryland, in neighborhoods of varying racial and socioeconomic composition. Methods. We conducted a cross-sectional study of 3493 participants from the study Healthy Aging in Neighborhoods of Diversity across the Life Span. We used the Pedestrian Environment Data Scan to measure neighborhood walkability in 34 neighborhoods of diverse racial and socioeconomic composition in which the study participants lived. Confirmatory factor analysis was used to determine walkability scores. Multilevel modeling was used to determine prevalence ratios for the association between walkability and obesity. Results. Among individuals living in predominately White and high-socioeconomic status (SES) neighborhoods, residing in highly walkable neighborhoods was associated with a lower prevalence of obesity when compared with individuals living in poorly walkable neighborhoods, after adjusting for individual-level demographic variables (prevalence ratio–[PR] = 0.58; P = <.001 vs PR = 0.80; P = .004). Prevalence ratios were similar after controlling for the perception of crime, physical activity, and main mode of transportation. The association between walkability and obesity for individuals living in low-SES neighborhoods was not significant after accounting for main mode of transportation (PR = 0.85; P = .060). Conclusions. Future research is needed to determine how differences in associations by neighborhood characteristics may contribute to racial disparities in obesity. In the United States roughly 34% of adults are obese. 1 Obesity increases the risk of many chronic diseases including cardiovascular disease, diabetes, and some cancers. 1 – 3 Furthermore, non-Hispanic Black people and less-educated individuals are more likely to be obese compared with non-Hispanic White people and more educated individuals. 4 , 5 Given the high prevalence of obesity, recent research has focused on the role the built environment plays in influencing individual physical activity, modes of transportation, and health outcomes. Few studies have examined the association between the built environment and obesity across neighborhoods of varying racial and socioeconomic composition. Rather, associations have been documented among varying populations and geographic locations without regard for contextual neighborhood factors. Numerous features of the built environment have been associated with physical activity (which can prevent and reduce obesity), including residential density, land-use mix, urban sprawl, intersection density, walkability, park availability, and accessibility to physical activity-related resources. 6 – 13 One study found that neighborhoods with higher socioeconomic status (SES) had an increased likelihood of having 1 or more physical activity facilities; more facilities were also associated with an increased likelihood of achieving moderate to vigorous physical activity. 14 Land-use mix, nearby destinations, and the presence of sidewalks have been associated with less obesity 14 – 18 but little research has investigated differences stratified by neighborhood characteristics. Furthermore, few studies have developed measurement models for walkability. The use of a composite neighborhood walkability score would reduce the likelihood of finding associations by chance alone (i.e., type I error). 19 , 20 To investigate the association between neighborhood walkability and obesity, we implemented an environmental audit in several Baltimore neighborhoods that measures the microscale features of the pedestrian environment. 21 We hypothesized that individuals living in neighborhoods with higher walkability would have a lower prevalence of obesity than individuals living in neighborhoods with lower walkability. Our secondary hypothesis was that the association between neighborhood walkability and obesity would differ by neighborhood race and socioeconomic composition.
