Environmental Predictors of Elderly Obesity

描述(由申请人提供) 在美国，肥胖症的流行和发病率是对公共健康的严重威胁，并已达到流行病的程度。其他令人担忧的问题是超重和肥胖与心血管疾病、糖尿病、癌症和其他令人衰弱的疾病的关联。这一拟议的项目响应了人们的呼吁，即努力确定和衡量建筑环境与肥胖以及相关共病之间的潜在因果关系。这项调查提出了一个纵向、多层次的项目，以检查物理和建筑环境如何影响老年居民社区的超重和肥胖、身体活动不足和血压水平。主要目标是：(A)在三年的时间里同时检查社区和居民层面的体重指数、体力活动和血压的变化，以及(B)确定社区层面的物理和建筑环境与拟议结果变化的相关性，同时控制居民层面的协变量。 这项研究采用多阶段抽样设计，将从俄勒冈州波利诺米尔县的120个人口普查区组(定义为社区的代理--主要抽样单位)中随机抽取1800名年龄在60岁及以上的社区居民。要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、体力活动和血压的相关结果测量。主要的物理和建筑环境措施将包括丘陵地带、城市形态和快餐店密度。由此产生的环境和个人因素数据将被整合到一个涉及时间测量的三级统计模型中(第一级)，这些测量嵌套在居民内部(第二级)，而居民本身也嵌套在社区内(第三级)。将通过多层次建模方法进行分析的分层结构数据将检查拟议结果变化的邻里间和居民间变异性，以及邻里水平建立的环境变量与随时间变化的结果变化的关系程度。 这项拟议的研究将当前的以个人为导向的范式扩展到一个生态的、多水平的范式，以评估建成环境因素随着时间的推移对肥胖和老年人社区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地影响社区水平的老年人超重和肥胖，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速度。

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.