There has been much recent interest in how features of residential environments (the built environment as well as social features of neighborhoods) affect the prevalence and development of cardiovascular disease and its risk factors, including obesity, diabetes, and hypertension. Identifying modifiable features of neighborhoods that contribute to cardiovascular risk would have important implications for the development of interventions and strategies to prevent cardiovascular disease and reduce social inequalities and race/ethnic differences in cardiovascular risk. Although randomized trials and/or evaluation of quasi experiments or natural experiments will ultimately be needed to determine the effectiveness of specific neighborhood-level interventions, rigorous observational work is still needed to determine what the most promising areas for intervention may be. However, very few observational studies have the type of detailed neighborhood and individual- level data necessary for this work. This competing renewal proposal builds on prior work conducted under R01 HL071759. As part of the prior funding cycle we created a unique and rich dataset with a multiplicity of rigorous objective and survey-based measures of residential environments linked to the Multi-Ethnic Study of Atherosclerosis (MESA), a state-of-the art, longitudinal, population-based, multi-site and multi-ethnic epidemiologic study of cardiovascular disease. In this renewal we propose to enhance and update the neighborhood-level environmental measures to allow for methodologically rigorous longitudinal analyses that build on key findings of cross-sectional analyses conducted as part of the prior cycle.
The Specific Aims of the project are: (1) To examine associations of specific neighborhood characteristics (including measures of access to healthy foods, walkability and urban design, access to recreational resources, and neighborhood stressors) with changes in diet, physical activity, and body weight over time;(2) To examine associations of neighborhood characteristics with incident diabetes and hypertension as well as with changes over time in continuous measures of insulin resistance and blood pressure (3) To examine associations of neighborhood characteristics with incident fatal and non fatal cardiovascular events;and (4)To investigate the contribution of neighborhood environments to race/ethnic and socioeconomic differences in longitudinal changes in risk factors and incident disease. In addition, the creation and maintenance of a rich data set on environmental features for MESA participants over time will generate a unique resource to be used in gene-environment interaction studies as MESA genotyping proceeds.
If features of neighborhoods are shown to be important in the development of cardiovascular disease and its risk factors, strategies to prevent cardiovascular disease may need to focus on environments as well as individuals. Identifying the specific neighborhood features that are most important is key to the development and future testing of these interventions.
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