An examination of processes linking perceived neighborhood disorder and obesity

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Abstract

In this paper, we use data collected from a statewide probability sample of Texas, USA adults to test whether perceptions of neighborhood disorder are associated with increased risk of obesity. Building on prior research, we also test whether the association between neighborhood disorder and obesity is mediated by psychological, physiological, and behavioral mechanisms. We propose and test a theoretical model which suggests that psychological distress is a lynchpin mechanism that links neighborhood disorder with obesity risk through chronic activation of the physiological stress response, poor self-rated overall diet quality, and irregular exercise. The results of our analyses are generally consistent with this theoretical model. We find that neighborhood disorder is associated with increased risk of obesity, and this association is entirely mediated by psychological distress. We also observe that the positive association between psychological distress and obesity is fully mediated by physiological distress and poor self-rated overall diet quality and only partially mediated by irregular exercise.

Introduction

Studies consistently show that residents of neighborhoods characterized by socioeconomic disadvantage, social disorganization, and disorder tend to exhibit higher rates of obesity than residents of other neighborhoods (Boardman et al., 2005, Burdette et al., 2006, Cohen et al., 2006, Glass et al., 2006, Inagami et al., 2006, Mujahid et al., 2005, Poortinga, 2006, Robert and Reither, 2004, Ross et al., 2007). If neighborhood conditions actually increase the risk of obesity, how do they? Researchers explain that residents of disadvantaged neighborhoods live within systems of obesity that are defined by a constellation of factors that encourage risky eating habits and discourage regular physical activity, including high fast-food outlet density and related marketing, restricted access to grocery stores, supermarkets, recreational amenities, exercise facilities, health centers and health-related information, widespread structural disrepair, fear of crime, and other psychosocial stressors (Chang, 2006, Cohen et al., 2006, Cummins and Macintyre, 2006, Diez Roux, 2003, French et al., 2001, Glass et al., 2006, Hill and Peters, 1998, Inagami et al., 2006, Papas et al., 2007, Poortinga, 2006, Reidpath et al., 2002, Robert and Reither, 2004, Ross et al., 2007, Stimpson et al., 2007).

Although researchers often speculate as to how adverse neighborhood conditions might increase the risk of obesity, only a few studies have attempted to explain this association empirically (e.g., Cohen et al., 2006, Glass et al., 2006, Inagami et al., 2006, Poortinga, 2006). Surprisingly, this small body of research has shown very little support for structural characteristics of the neighborhood (e.g., access to grocery stores) and individual health behaviors (e.g., diet and exercise) as potential mediators. For example, Glass et al. (2006) use data collected from a large probability sample of older adults living in the Baltimore area to test whether the association between perceived neighborhood hazards and obesity is mediated by poor dietary behavior (percent calories from fat and total dietary intake) and reduced physical activity (vigorous activity and leisure-time walking), but show no support for these mechanisms. Although these results appear to exclude diet and physical activity as viable explanations, additional research is needed to confirm these patterns and to establish new processes, including psychological and physiological pathways (Cohen et al., 2006, Glass et al., 2006, Poortinga, 2006).

In this paper, we use data collected from a statewide probability sample of Texas adults to test whether perceptions of neighborhood disorder are associated with increased risk of obesity. In the state of Texas, obesity affects over one quarter of the adult population and accounts for more than $5 billion in medical expenditures each year (Finkelstein et al., 2004, Wang and Beydoun, 2007). Building on prior research, we also test whether the association between neighborhood disorder and obesity is mediated by psychological, physiological, and behavioral mechanisms. We propose that living in a neighborhood that is perceived as noisy, unclean, and crime-ridden can be psychologically distressing, which increases the risk of obesity through chronic activation of the physiological stress response, poor self-rated overall diet quality, and irregular exercise.

The remainder of the paper consists of four parts. We begin by formally introducing and developing the theoretical model upon which subsequent analyses are based (see Fig. 1). We then describe the data source, measures, and statistical procedures. After summarizing the results of our analyses, we conclude with a discussion of our findings and the potential implications of our study.

Section snippets

Neighborhood disorder and psychological distress

Neighborhoods with high levels of disorder present residents with observable signs that social control is weak (Ross and Mirowsky, 2001, Skogan, 1986, Skogan, 1990, Skogan and Maxfield, 1981, Taylor and Hale, 1986). In these neighborhoods, residents report problems with crime, vandalism, graffiti, people hanging out on the streets, drug use, public intoxication, run-down and abandoned buildings, trouble with neighbors, and other incivilities associated with the breakdown of social control (Geis

Sample

Subsequent analyses employ data from the 2004 Survey of Texas Adults, a statewide probability sample of 1504 community-dwelling adults residing in Texas and aged 18 years and over (Musick, 2004). Sampling was conducted using a modified random digit dialing design. The data collection process yielded a household-level cooperation rate of 37% and a respondent-level cooperation rate of 89%. Each computer-assisted telephone interview lasted approximately 30–35 min. The survey instrument was

Measures

Obesity is our focal outcome variable. Consistent with prior research (e.g., Cohen et al., 2006, Glass et al., 2006, Ross et al., 2007), we assess body mass using self-reports of height and weight. Studies show that obesity (as determined by self-reports) is associated with a wide range of adverse physical health conditions, including sleep apnea, osteoarthritis, type-2 diabetes, hypertension, heart disease, stroke, and premature death (Fabricatore & Wadden, 2006). We first calculated body mass

Statistical procedures

Table 2 provides descriptive statistics for all of the variables used in our analyses. Table 3 provides bivariate correlations among the following variables: obesity, neighborhood disorder, psychological and physiological distress, self-rated overall diet quality, exercise, employment status, education, and income. Table 4 presents the results from a series of ordinary least-squares and binary logistic regression models predicting the mediators from our theoretical model. Models 1–3 examine the

Sample characteristics

According to Table 2, 24% of the sample is obese. The average respondent reports fairly low levels of neighborhood disorder, psychological distress and physiological distress. The typical respondent describes their daily overall diet as good. Approximately 41% of the sample reports irregular exercise habits. The sample consists of non-Hispanic Whites (64%), Blacks (7%), Mexicans (19%), other Hispanics (5%), and other races/ethnicities (5%). The average respondent is approximately 46 years of

Discussion

In this paper, we use data collected from a statewide probability sample of Texas adults to test whether perceptions of neighborhood disorder are associated with increased risk of obesity. Building on prior research, we also test whether the association between neighborhood disorder and obesity is mediated by psychological, physiological, and behavioral mechanisms. We propose and test a theoretical model which suggests that psychological distress is a lynchpin mechanism that links neighborhood

References (64)

  • B.S. McEwen

    Mood disorders and allostatic load

    Biological Psychiatry

    (2003)
  • R. Miles

    Neighborhood disorder and smoking: findings of a European urban survey

    Social Science & Medicine

    (2006)
  • W. Poortinga

    Perceptions of the environment, physical activity, and obesity

    Social Science & Medicine

    (2006)
  • D.D. Reidpath et al.

    An ecological study of the relationship between social and environmental determinants of obesity

    Health and Place

    (2002)
  • S.A. Robert et al.

    A multilevel analysis of race, community disadvantage, and body mass index among adults in the US

    Social Science & Medicine

    (2004)
  • C.E. Ross

    Walking, exercising and smoking: does neighborhood matter?

    Social Science & Medicine

    (2000)
  • C.S. Aneshensel et al.

    The neighborhood context of adolescent mental health

    Journal of Health and Social Behavior

    (1996)
  • S.D. Anton et al.

    Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults?

    Behavior Modification

    (2005)
  • J.D. Boardman et al.

    Race differentials in obesity: the impact of place

    Journal of Health and Social Behavior

    (2005)
  • H.L. Burdette et al.

    Neighborhood safety, collective efficacy, and obesity in women with young children

    Obesity

    (2006)
  • K.E. Campbell et al.

    Sources of personal neighbor networks: social integration

    Social Forces

    (1992)
  • A. Christie-Mizell et al.

    Seeing their surroundings: the effects of neighborhood setting and race on maternal distress

    Social Science Research

    (2003)
  • S. Cummins et al.

    Food environments and obesity—neighbourhood or nation?

    International Journal of Epidemiology

    (2006)
  • A.V. Diez Roux

    Residential environments and cardiovascular risk

    Journal of Urban Health

    (2003)
  • A.N. Fabricatore et al.

    Obesity

    Annual Review of Clinical Pscyhology

    (2006)
  • E.A. Finkelstein et al.

    State-level estimates of annual medical expenditures attributable to obesity

    Obesity Research

    (2004)
  • S.A. French et al.

    Environmental influences on eating and physical activity

    Annual Review of Public Health

    (2001)
  • K. Geis et al.

    A new look at urban alienation: the effect of neighborhood disorder on perceived powerlessness

    Social Psychology Quarterly

    (1998)
  • J.O. Hill

    Understanding and addressing the epidemic of obesity: an energy balance perspective

    Endocrine Reviews

    (2006)
  • J.O. Hill et al.

    Environmental contributions to the obesity epidemic

    Science

    (1998)
  • T.D. Hill et al.

    Neighborhood disorder, psychophysiological distress, and health

    Journal of Health & Social Behavior

    (2005)
  • R.C. Kessler et al.

    Short screening scales to monitor population prevalences and trends in non-specific psychological distress

    Psychological Medicine

    (2002)
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      Other studies likewise show that neighborhoods with higher levels of poverty have higher levels of obesity.61 In addition, Burdette and Hill58 suggest a theoretical model of the process by which perceptions of neighborhood disorder increase the risk of obesity by causing psychological distress resulting in the chronic activation of physiologic stress, poor diet quality, and irregular exercise. Race is also significant because neighborhoods with higher proportions of Black residents are associated with a greater risk of obesity than those in which the majority are White.58,63

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    The authors thank Catherine Ross for helpful suggestions. However, we are solely responsible for any errors of fact or interpretation that remain.

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