Environmental Predictors of Elderly Obesity

描述（由申请人提供） 肥胖症的流行和发病率是对美国公共健康的严重威胁，并且已经达到流行病的比例。 另外的关注是超重和肥胖与心血管疾病、糖尿病、癌症和其他使人衰弱的疾病的关联。 这个拟议的项目响应了努力识别和测量建筑环境与肥胖之间的潜在因果关系以及相关合并症的呼吁。 这项调查提出了一个纵向的，多层次的项目，以研究如何的物理和建筑环境可能会影响超重和肥胖，身体活动不足，血压在老年居民的社区水平。 主要目标是：（a）同时检查三年期间的身体质量指数、身体活动和血压的社区和居民水平的变化，以及（B）在控制居民水平的协变量的同时，识别提议结果的变化的社区水平的物理和建筑环境相关性。 该研究采用多阶段抽样设计，将从俄勒冈州多项县的120个人口普查区组（定义为社区的代理-主要抽样单位）的随机样本中招募1,800名60岁及以上的社区居民。 收集的数据包括调查、评估、人口普查和地理信息系统数据，以及体重指数、身体活动和血压的相关结果指标。 主要的物理和建筑环境措施将包括丘陵地形，城市形态和快餐店的密度。 由此产生的环境和个人因素数据将被整合到一个三级统计模型，涉及时间措施（1级），这是嵌套在居民（2级），谁是自己嵌套在社区（3级）。 分层结构的数据，通过多层次建模方法进行分析，将检查两个邻里和居民间的变化，在拟议的结果，以及在何种程度上邻里级建成环境变量与变化的结果随着时间的推移。 这项研究将目前以个人为导向的范式扩展到一个生态的、多层次的范式，以评估建筑环境因素对老年人社区肥胖和肥胖相关结果的影响程度。 这项研究的结果可能会增加对物理和建筑环境因素的独特影响的理解，这些因素直接和间接影响老年人的邻里水平超重和肥胖，并将提供信息，指导未来的公共卫生调查，以减缓这种日益增长的流行病的步伐。

DESCRIPTION (provided by applicant) The prevalence and incidence of obesity is a serious threat to public health in the United States, and has reached epidemic proportions. Additional concerns are the associations of overweight and obesity with cardiovascular disease, diabetes, cancer, and other debilitating conditions. This proposed project responds to the call for efforts to identify and measure potential causal associations between the built environment and obesity, and related comorbidities. This investigation proposes a longitudinal, multilevel project to examine how the physical and built environment may influence levels of overweight and obesity, physical inactivity, and blood pressure in neighborhoods of older residents. The primary aims are to: (a) simultaneously examine neighborhood- and resident-level change in body mass index, physical activity, and blood pressure over a three-year period, and (b) identify neighborhood-level physical and built environment correlates of change in the proposed outcomes while controlling for covariates at the resident-level. Using a multistage sampling design, the study will recruit 1,800 community residents aged 60 years and older from a random sample of 120 census-block groups (defined as a proxy for neighborhoods - the primary sampling unit) in Multinomial County, Oregon. Data to be gathered include surveys, assessments, census and Geographic Information Systems data, and dependent outcome measures of body mass index, physical activity, and blood pressure. Key physical and built environment measures will include hilly terrain, urban form, and density of fast-food restaurants. The resulting environmental and personal factors data will be integrated into a three-level statistical model involving temporal measures (Level 1), that are nested within residents (Level 2), who are themselves nested within neighborhoods (Level 3). The hierarchically structured data, to be analyzed through multilevel modeling methodologies, will examine both inter-neighborhood and inter-resident variability in change in the proposed outcomes, as well as the degree to which neighborhood-level built environment variables are related to variation in change in the outcomes over time. This proposed investigation extends the current individual oriented paradigm to an ecological, multilevel paradigm for assessing the extent to which built environment factors influence obesity and obesity-related outcomes over time in the neighborhoods of older adults. The results of this study are likely to increase understanding of the unique influences of physical and built environment factors which directly and indirectly affect neighborhood-level overweight and obesity in older adults, and will provide information to guide future pubic health investigations to slow the pace of this growing epidemic.