An individual's neighborhood provides important context for cardiovascular disease risk, and neighborhood characteristics as defined by census-level socioeconomic measures or the social and physical environment in which an individual lives have been associated with cardiovascular disease and prevalent cardiovascular risk factors. Obesity as a cardiovascular risk factor appears to be particularly influenced by an individual's neighborhood environment. The exponential rise in obesity prevalence over only three decades, with more than one-third of the U.S. population now having a body mass index (BMI) 30 kg/m2, is largely consistent with behavioral and environmental rather than biological causal factors. Prior work on environmental factors has also demonstrated an association between prevalent obesity and objectively measured neighborhood resources, where food environment may influence an individual's ability to engage in healthy dietary patterns and built environment may impact physical activity. Although psychosocial stress can result in adverse health outcomes, little is known about how perceptions of neighborhood conditions, a measure of environment-derived stress, may impact obesity. We examined the association between perceptions of neighborhood environment and obesity defined as body mass index (BMI) 30 kg/m2 among 5907 participants in the Dallas Heart Study, a multi-ethnic, probability-based sample of Dallas County residents. Participants were asked to respond to 18 questions about perceptions of their neighborhood. Using factor analysis, we identified three factors associated with neighborhood perceptions: neighborhood violence, physical environment, and social cohesion. Logistic regression analyses were performed to determine the relationship between each factor (higher quintile = more unfavorable perceptions) and the odds of obesity. Decreasing age, income, and education associated with unfavorable overall neighborhood perceptions and unfavorable perceptions about specific neighborhood factors (p trend <0.05 for all). Increasing BMI was associated with unfavorable perceptions about physical environment (p trend <0.05), but not violence or social cohesion. After adjustment for race, age, sex, income, education, and length of residence, physical environment perception score in the highest quintile remained associated with a 25% greater odds of obesity OR 1.25,(95% CI 1.03-1.50). Predictors of obesity related to environmental perceptions included heavy traffic OR 1.39,(1.17-1.64), trash/litter in neighborhood OR 1.27,(1.01-1.46), lack of recreational areas OR 1.21,(1.01-1.46), and lack of sidewalks OR 1.25,(95% CI 1.04-1.51). Thus, unfavorable perceptions of environmental physical conditions are related to increased obesity. Efforts to improve the physical characteristics of neighborhoods, or the perceptions of those characteristics, may assist in the prevention of obesity in this community. Additionally, uderstanding individual's perceptions of their neighborhood environment may be essential in the development of community-based interventions targeting prevalent obesity. Cardiovascular risk factors, including hypertension, hyperlipidemia, diabetes, and obesity disproportionately affect African-American populations, contributing to a higher burden of CVD. Physical activity and dietary changes can significantly improve cardiovascular risk factors and serve as cardiovascular disease prevention targets, with community-based interventions that leverage social determinants of health like social support having greater sustainability. Community-based interventions in faith-based organizations of African-American communities build on established social networks to promote lifestyle changes, and may be effective at improving cardiovascular risk factors. While recent studies have focused on design and implementation of community-based interventions for treatment of cardiovascular risk factors, little is known about how the individuals recruited for community-based participatory research programs reflect the community at large. Thus, we sought to compare demographics, anthropometrics, and cardiovascular risk factor prevalence, awareness, treatment, and control between participants in the Genes, Nutrition, Exercise, Wellness, and Spiritual Growth (GoodNEWS) Trial, an intervention promoting lifestyle changes in predominantly African-American churches in Dallas, Texas with age- and sex-matched African Americans in Dallas County using data from the Dallas Heart Study (DHS), a multi-ethnic, population-based sample of Dallas County residents. As a secondary aim, we evaluated the association between frequency of church attendance and cardiovascular risk factors within the DHS population to provide further insight into the association between church attendance and cardiovascular risk factors given the focus on avid church participants in GoodNEWS. Despite having more education (college education 75% vs. 51%, p<0.0001), GoodNEWS participants were more obese (mean body mass index 34 vs. 31 kg/m2,p<0.001) and had more diabetes (23% vs. 12%,p<0.001) and hyperlipidemia (53% vs. 14%,p<0.001) compared to African Americans in Dallas County. GoodNEWS participants had higher rates of treatment and control of most CV risk factors (treated hyperlipidemia 95% vs. 64%,p<0.001;controlled diabetes 95% vs. 21%,p <0.001;controlled hypertension 70% vs. 52%,p=0.003), were more physically active (233 vs. 177 METS*hrs/week,p<0.0001) and less likely to smoke (10% vs. 30%,p<0.001). These findings about GoodNEWS participants, a population of frequent churchgoers, were supported by analyses within DHS, where more frequent church attendance was associated with obesity and a lower probability of smoking. Compared to African-Americans in Dallas County, community-based participatory research participants in church congregations were more educated, physically active and had more treatment and control of most cardiovascular risk factors. Surprisingly, this motivated population in church congregations had a greater obesity burden, identifying the faith-based organization as a prime target for community-based participatory research-focused obesity treatment. Therefore, current efforts are underway in our research group to work with the faith-based community in areas at highest risk of obesity and cardiovascular disease in Washington D.C. and develop a behavioral weight loss intervention using a community-based participatory research approach.
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