摘要：Popular magazines often rank cities in terms of various aspects of quality of life. Such ranking studies can motivate people to visit or relocate to a particular city or increase the frequency with which they engage in healthy behaviors. With careful consideration of study design and data limitations, these efforts also can assist policymakers in identifying local public health issues. We discuss considerations in interpreting ranking studies that use environmental measures of a city population’s public health related to physical activity, nutrition, and obesity. Ranking studies such as those commonly publicized are constrained by statistical methodology issues and a lack of a scientific basis in regard to design. FOR CENTURIES, PLACES TO live have been ranked on the basis of factors that contribute to quality of life, such as friendliness, wealth, crime, and health; in a 17th-century ranking, for example, areas with more plentiful game, heavier livestock, and lower mortality from Indian attacks were promoted as more “livable.” 1 Further, recent examples are numerous, such as the Places Rated Almanac , a book that rates and ranks 354 metropolitan areas in terms of cost of living, job outlooks, transportation, education, health care, crime, the arts, recreation, and climate. 1 Popular magazines often publish rankings as well. For instance, Natural Health magazine ranked “America’s Healthiest Cities” in 2001 (in terms of 37 criteria in the areas of amenities, physical health, environment, and happiness), 2 and Men’s Fitness magazine has ranked “America’s Fattest Cities” annually since 1999 (in terms of 16 categories including number of fitness centers and fast-food restaurants, measures of the natural environment and climate, and number of parks and recreational areas). 3 “Best places” are also proclaimed on the Internet, examples being Money Magazine ’s “Best Places to Live” (factors considered are climate, crime, housing, education, economy, health, arts and leisure, and transportation) 4 and Fast Forward ’s “Sperling’s Best Places” (criteria are housing, cost of living, crime, education, economy, health, and climate). 5 Ranking studies can garner considerable press coverage, can influence local public health and environmental policies, and motivate populations to work toward healthier lifestyles. In Philadelphia, after the release of “America’s Fattest Cities 2000,” the mayor implemented a new public health program in which he challenged the city’s population to lose 76 tons of weight in 76 days. 6 In such ways, rankings of cities can effectively raise awareness of the factors influencing quality of life. In addition, local governments may use the findings to attract new residents, businesses, or tourists. For example, the Web site of the Visitors Association of Portland, Ore, touts the city as a great place to visit and live, 7 in part as a result of the high ranking it achieved in the “America’s Fattest Cities 2001” article. Nevertheless, controversies exist about whether ratings accurately reflect the “livability” of cities and the extent to which such reports can be misleading. A city’s ranking varies depending on the quality of life criteria used in a particular study. Furthermore, these criteria typically include public health prevalence data and environmental measures with multiple sources of variability that are ignored when ranking studies are done. To date, there has not, to our knowledge, been a systematic analysis of ranking studies attempting to determine the extent to which their findings are methodologically sound. Editors of studies published in popular magazines and on the Internet are not bound by criteria imposed by peer-reviewed journals such as requirements regarding complete source citations and discussion of study limitations. We provide an analysis designed to help policymakers interpret ranking studies that appear in the popular press. We discuss considerations in developing ranking studies that use environmental measures of a city population’s public health related to physical activity, nutrition, and obesity in the hopes of stimulating greater interaction between policymakers and those who publish such studies.
