EFFECTS OF BUFFER SIZE AND SHAPE ON ASSOCIATIONS BETWEEN THE BUILT ENVIRONMENT AND ENERGY BALANCE

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EFFECTS OF BUFFER SIZE AND SHAPE ON ASSOCIATIONS BETWEEN THE BUILT ENVIRONMENT AND ENERGY BALANCE PETER JAMES (HARVARD SCHOOL OF PUBLIC HEALTH) DAVID BERRIGAN (NATIONAL CANCER INSTITUTE) JAIME E HART (HARVARD SCHOOL OF PUBLIC HEALTH) CHRISTINE M HOEHNER (WASHINGTON UNIVERSITY ST. LOUIS) JACQUELINE KERR (UNIVERSITY OF CALIFORNIA SAN DIEGO) JACQUELINE M MAJOR (UNIVERSITY OF PENNSYLVANIA) MASAYOSHI OKA (WASHINGTON UNIVERSITY ST. LOUIS) FRANCINE LADEN (HARVARD SCHOOL OF PUBLIC HEALTH) ACTIVE LIVING RESEARCH 2013

Uncertain Geographic Context Problem Inconsistent findings in built environment and energy balance research Uncertain Geographic Context Problem The spatial uncertainty in the actual areas that exert the contextual influences under study and the temporal uncertainty in the timing and duration in which individuals experienced these contextual influences * * Kwan M. Annals of the Association of American Geographers, 102(5) 2012, pp. 958 968.

Inconsistent Findings in Built Environment Literature Previous research has relied mainly on pre-defined areas, or buffers, around a geocoded home address Buffer definitions are based primarily on the transportation literature describing the upper limit of the distance that individuals will walk However, there is no uniform buffer type used across studies

Aims We examined how defining the built environment with different buffer sizes and buffer shapes could influence associations with physical activity and BMI We hypothesized that Measures of intersections (count and density) and businesses (count and density) would be positively associated with physical activity and negatively associated with BMI There would be an optimal buffer shape and size to isolate these associations

Population Participants were selected from two large states in the nationwide the Nurses Health Study II, a large ongoing prospective cohort study All female Predominantly white Pennsylvania (n=11,178) Texas (n=6,255) Had a geocoded home address at the street level in Pennsylvania or Texas and data on BMI in the year 2009

Exposure Geocoded questionnaire mailing addresses Street network data from TIGER 2010-based road network (Streetmap USA, ESRI) Business data from the commercially available InfoUSA 2009 database

Methods: Exposure Geographic information systems (GIS) created Line-based network and radial buffers 400m, 800m, 1200m, and 1600m Estimated business and intersection counts and densities within each buffer

8

Methods: Outcome Two self-reported energy balance-related variables: Body mass index (BMI) (kg/m 2 ) Walking in metabolic equivalent hours per week (MET hrs/wk) Questionnaires included recreational physical activity during the past year, with questions on the average time per week spent walking or hiking outdoors Multiplied the reported time spent weekly at each activity by its typical energy expenditure requirements expressed in MET hours per week score

Methods: Statistical Analysis Cross-sectional linear regression Log-transformed built environment variables Adjusted for Age (in years) Census tract median income (in $) and household value (in $) Smoking status (never, past, current <15/day, current 15/day) Husband's education (<HS, HS, College, Grad School, Missing or Not Married)

Results: N=17,433 Variable Mean Std Dev BMI 28.2 6.7 Walking METs (hrs/wk)* 6.4 8.9 Census Tract Median Income $ 63,571 $ 23,532 Census Tract Median Household Value $ 129,349 $ 66,884 Census Tract Percent White 89.9 12.8 Census Tract Population Density 2378.2 3368.1 Census Tract Percent Urban 79.2 32.8 Census Tract Percent No High School Ed 13.3 8.6 *N=13,666 for walking analyses

Results: N=17,433 Business Intersection Count Density Count Density Line Based 400m Line Based 1600m Radial 400m Radial 1600m Line Based 400m Line Based 1600m Radial 400m Radial 1600m Line Based 400m Line Based 1600m Radial 400m Radial 1600m Line Based 400m Line Based 1600m Radial 400m Radial 1600m 0 1 2 3 4 5 6 7 8 9 10 Logtransformed Values

0.6 0.5 Line-Based Intersection Density and Walking Radial Coefficient for Walking MET hrs/wk (95% CIs) 0.4 0.3 0.2 0.1 0 400m 800m 1200m 1600m 400m 800m 1200m 1600m -0.1-0.2 Coefficients are presented as the effect on each outcome of a one unit increase in the lognormal value of each built environment measure All analyses adjusted for age, Census tract median income and household value, smoking status, and husband's education 18

0.3 0.25 Line-Based Business Density and Walking Radial Coefficients for Walking MET hrs/wk (95% CIs) 0.2 0.15 0.1 0.05 0 400m 800m 1200m 1600m 400m 800m 1200m 1600m -0.05-0.1 Coefficients are presented as the effect on each outcome of a one unit increase in the lognormal value of each built environment measure All analyses adjusted for age, Census tract median income and household value, smoking status, and husband's education 19

0.35 0.3 Line-Based Intersection Count and BMI Radial 0.25 Coefficient for BMI (95% CIs) 0.2 0.15 0.1 0.05 0 400m 800m 1200m 1600m 400m 800m 1200m 1600m -0.05 Coefficients are presented as the effect on each outcome of a one unit increase in the lognormal value of each built environment measure All analyses adjusted for age, Census tract median income and household value, smoking status, and husband's education 20

Conclusions Results indicate that the scale and type of built environment measures can have an impact on study results and may partly explain inconsistent findings from past studies of the built environment and energy balance These findings underscore the issue of the Uncertain Geographic Context Problem, an emerging key concern for studies of associations between environment and behavior

Acknowledgements Thanks to all my co-authors in the Transdisciplinary Research in Energetics and Cancer (TREC) Spatial and Contextual Measures and Modeling Working Group who contributed greatly to this analysis and presentation TREC Grant U54 CA155626 CVD Epi Training Grant T32 HL 098048

Thank you Any questions or comments, please contact me Peter James, MHS, ScD Postdoctoral Fellow Department of Epidemiology Department of Environmental Health Harvard School of Public Health pjames@hsph.harvard.edu

Built Environment Measures Positively Associated with Walking Walking Intersection Business Buffer Size Buffer Shape Count Density (count per km 2) Count Density (count per km 2) 400m Line Based 0.10 (-0.06, 0.27) 0.03 (-0.12, 0.18) 0.10 (-0.02, 0.22) 0.02 (-0.07, 0.11) Radial 0.09 (-0.06, 0.24) 0.08 (-0.05, 0.21) 0.10 (-0.01, 0.22) 0.08 (-0.02, 0.19) 800m Line Based 0.14 (-0.01, 0.28) 0.16 (-0.04, 0.37) 0.12 (0.02, 0.21) 0.11 (0.01, 0.21) Radial 0.12 (-0.02, 0.25) 0.12 (-0.03, 0.27) 0.08 (-0.02, 0.18) 0.08 (-0.02, 0.19) 1200m Line Based 0.16 (0.02, 0.29) 0.25 (0.03, 0.48) 0.10 (0.01, 0.19) 0.12 (0.02, 0.23) Radial 0.13 (0.02, 0.24) 0.15 (0.02, 0.28) 0.08 (-0.02, 0.17) 0.09 (-0.02, 0.20) 1600m Line Based 0.12 (-0.01, 0.25) 0.17 (-0.06, 0.40) 0.10 (0.02, 0.19) 0.14 (0.03, 0.25) Radial 0.09 (-0.05, 0.23) 0.09 (-0.07, 0.25) 0.07 (-0.02, 0.17) 0.09 (-0.02, 0.20) All analyses adjusted for age, Census tract median income and household value, smoking status, and husband's education Coefficients are presented as the effect on each outcome of a one unit increase in the lognormal value of each built environment measure 25 Bolded coefficients indicate p < 0.05

BMI Positively Associated with Built Environment Measures BMI Intersection Business Buffer Size Buffer Shape Count Density (count per km 2) Count Density (count per km 2) 400m Line Based 0.20 (0.09, 0.31) 0.16 (0.06, 0.26) 0.10 (0.02, 0.19) 0.08 (0.02, 0.14) Radial 0.15 (0.05, 0.25) 0.13 (0.04, 0.22) 0.11 (0.03, 0.19) 0.11 (0.04, 0.18) 800m Line Based 0.14 (0.05, 0.24) 0.15 (0.01, 0.28) 0.09 (0.03, 0.16) 0.09 (0.03, 0.16) Radial 0.12 (0.02, 0.21) 0.13 (0.03, 0.22) 0.09 (0.03, 0.16) 0.10 (0.02, 0.17) 1200m Line Based 0.13 (0.04, 0.22) 0.17 (0.02, 0.32) 0.09 (0.03, 0.14) 0.09 (0.02, 0.16) Radial 0.07 (0.00, 0.14) 0.09 (0.00, 0.18) 0.07 (0.01, 0.13) 0.08 (0.00, 0.15) 1600m Line Based 0.11 (0.03, 0.20) 0.15 (-0.01, 0.30) 0.08 (0.02, 0.14) 0.09 (0.02, 0.17) Radial 0.11 (0.02, 0.21) 0.13 (0.02, 0.23) 0.07 (0.01, 0.13) 0.07 (0.00, 0.15) All analyses adjusted for age, Census tract median income and household value, smoking status, and husband's education Coefficients are presented as the effect on each outcome of a one unit increase in the lognormal value of each built environment measure 26 Bolded coefficients indicate p < 0.05