Instrumental variables in the cost of illness featuring type 2 diabetes.

Objective: To ascertain how an instrumental variables (IV) model can improve upon the estimates obtained from traditional cost-of-illness (COI) models that treat health conditions as predetermined.

Study Setting And Design: A simulation study based on observational data compares the coefficients and average marginal effects from an IV model to a traditional COI model when an unobservable confounder is introduced. The two approaches are then applied to real data, using a kinship-weighted family history as an instrument, and differences are interpreted within the context of the findings from the simulation study.

Social inequities in neighborhood health amenities over time in the Wasatch Front Region of Utah: Historical inequities, population selection, or differential investment?

Socially disadvantaged groups generally are more likely to reside in areas with less desirable conditions. We examined longitudinal relationships between neighborhood resident characteristics and amenities from 1990 to 2010 in an urban area of Utah, U.S.

Lean legacy, heavy heritage: family history of diabetes and its association with young adult body mass index.

Substantial intergenerational transmission of diabetes mellitus (DM) risk exists. However, less is known regarding whether parental DM and DM among extended family members relate to adult offspring's body mass index (BMI), and whether any of these associations vary by sex. Using data from the National Longitudinal Study of Youth 1997 cohort (NLSY97), we assess the sex-specific relationship between DM present in first-degree parents and second-degree relatives and BMI among the parents' young adult offspring.

The changing food environment and neighborhood prevalence of type 2 diabetes.

In this ecological study, we used longitudinal data to assess if changes in neighborhood food environments were associated with type 2 diabetes mellitus (T2DM) prevalence, controlling for a host of neighborhood characteristics and spatial error correlation. We found that the population-adjusted prevalence of fast-food and pizza restaurants, grocery stores, and full-service restaurants along with changes in their numbers from 1990 to 2010 were associated with 2015 T2DM prevalence. The results suggested that neighborhoods where fast-food restaurants have increased and neighborhoods where full-service restaurants have decreased over time may be especially important targets for educational campaigns or other public health-related T2DM interventions.

Walkable neighborhoods and obesity: Evaluating effects with a propensity score approach.

Background: Research investigating the connection between neighborhood walkability and obesity often overlooks the issue of nonrandom residential selection.

Methods: We use propensity score methods to adjust for the nonrandom selection into residential neighborhoods in this cross-sectional, observational study. The sample includes 103,912 women residing in Salt Lake County, Utah age 20 or older.

Rural-Urban Disparities in Obesity Prevalence Among Working Age Adults in the United States: Exploring the Mechanisms.

Purpose: Higher prevalence rates of overweight and obesity in rural America have been consistently reported, but sources of these disparities are not well known. This study presented patterns and mechanisms of these disparities among working age Americans.

Design: Cross-sectional study.

The joint effects of family risk of obesity and neighborhood environment on obesity among women.

Obesity is a significant health problem in the United States that has encouraged a search for modifiable risk factors, such as walkable neighborhood designs. Prior research has shown linkages between a family history of obesity (i.e.

Neighborhood Context and Youth Physical Activity: Differential Associations by Gender and Age.

Purpose: The goal of this research is to examine the extent to which facets of neighborhood sociodemographic contexts influence individual-level physical activity (PA) among youth.

Design: Using National Health and Nutrition Examination Survey (NHANES), geographic information systems (GIS), and census data sources, we explicitly test whether built environment factors have differential associations depending on the age and gender of the youth living in urban census tracts.

Setting: Participants are from the NHANES 2003 to 2006 waves.

Tract- and county-level income inequality and individual risk of obesity in the United States.

Objectives: We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county.

An ecological analysis of environmental correlates of active commuting in urban U.S.

We conduct a cross-sectional ecological analysis to examine environmental correlates of active commuting in 39,660 urban tracts using data from the 2010 Census, 2007-2011 American Community Survey, and other sources. The five-year average (2007-2011) prevalence is 3.05% for walking, 0.

Rural-urban differences in objective and subjective measures of physical activity: findings from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.

Introduction: Lower levels of physical activity among rural relative to urban residents have been suggested as an important contributor to rural-urban health disparity; however, empirical evidence is sparse.

Methods: We examined rural-urban differences in 4 objective physical activity measures (2 intensity thresholds by 2 bout lengths) and 4 subjective measures (total, leisure, household, and transportation) in a nationally representative sample of participants in the National Health and Nutrition Examination Survey (NHANES) 2003-2006. The sample comprised 5,056 adults aged 20 to 75 years.

Geographic scale matters in detecting the relationship between neighbourhood food environments and obesity risk: an analysis of driver license records in Salt Lake County, Utah.

Objectives: Empirical studies of the association between neighbourhood food environments and individual obesity risk have found mixed results. One possible cause of these mixed findings is the variation in neighbourhood geographic scale used. The purpose of this paper was to examine how various neighbourhood geographic scales affected the estimated relationship between food environments and obesity risk.

Sociodemographic and environmental correlates of active commuting in rural America.

Purpose: This research investigated participation rates in 3 modes of active commuting (AC) and their sociodemographic and physical environmental correlates in rural America.

Methods: The 2000 Census supplemented with other data sets were used to analyze AC rates in percentage of workers walking, biking, and taking public transportation to work in 14,209 nonmetropolitan rural tracts identified by RUCA codes, including 4,067 small rural and 10,142 town-micropolitan rural tracts. Sociodemographic and physical environmental variables were correlated with 3 AC modes simultaneously using Seemingly Unrelated Regression for nonmetro rural, and for small rural and town-micropolitan rural separately.

Ethnic-immigrant disparities in total and abdominal obesity in the US.

Objectives: To examine sex-specific disparities in total and abdominal obesity prevalence across 6 ethnic-immigrant groups and explore whether the observed differences were attributable to diet and physical activity (PA).

Methods: Data were from 4331 respondents age 18-64 from the 2003-2006 National Health and Nutrition Examination Survey. Sex-specific multiple logistic regression analyses were performed.

Walking or dancing: patterns of physical activity by cross-sectional age among U.S. women.

Objectives: To identify age differences in physical activity (PA) participation for women.

Methods: Data from 3,952 women 25+ from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) were used to analyze participation patterns for 17 PA types.

Results: The top five leisure PAs by participation rate for all ages were walking (42%), dancing (20%), treadmill (15%), biking (11%), and yoga (10%).

Harvesting more than vegetables: the potential weight control benefits of community gardening.

Objectives: We examined the association of participation in community gardening with healthy body weight.

Methods: We examined body mass index (BMI) data from 198 community gardening participants in Salt Lake City, Utah, in relationship to BMI data for 3 comparison groups: neighbors, siblings, and spouses. In comparisons, we adjusted for gender, age, and the year of the BMI measurement.

Community and child energy balance: differential associations between neighborhood environment and overweight risk by gender.

Using data from the 2003 to 2004 continuous National Health Nutrition Examination Survey merged with the 2000 census and other geographic information systems-based neighborhood data, this study conducted gender-specific analyses to examine the influence of neighborhood characteristics on child risk for overweight (defined as gender-specific body mass index which is greater than the 85 percentile). Models of neighborhood influence that include institutional factors, built environment factors, and social modeling dynamics were tested. The study sample included 1753 (915 girls and 838 boys) children aged 2-11 years.

Moderate to vigorous physical activity and weight outcomes: does every minute count?

Purpose: The purpose of this study was to test if moderate to vigorous physical activity (MVPA) in less than the recommended ≥10-minute bouts related to weight outcomes.

Design: Secondary data analysis.

Setting: Random sample from the U.

Re-visiting the relationship between neighbourhood environment and BMI: an instrumental variables approach to correcting for residential selection bias.

Background: A burgeoning literature links attributes of neighbourhoods' built environments to residents' physical activity, food and transportation choices, weight, and/or obesity risk. In cross-sectional studies, non-random residential selection impedes researchers' ability to conclude that neighbourhood environments cause these outcomes.

Methods: Cross-sectional data for the current study are based on 14,689 non-Hispanic white women living in Salt Lake County, Utah, USA.

Neighborhood design for walking and biking: physical activity and body mass index.

Background: Neighborhood designs often relate to physical activity and to BMI.

Purpose: Does neighborhood walkability/bikeability relate to BMI and obesity risk and does moderate-to-vigorous physical activity (MVPA) account for some of the relationship?

Methods: Census 2000 provided walkability/bikeability measures-block group proportions of workers who walk or bike to work, housing age, and population density-and National Health and Nutrition Examination Study (NHANES 2003-2006) provided MVPA accelerometer measures. Regression analyses (2011-2012) adjusted for geographic clustering and multiple control variables.

The built environment and risk of obesity in the United States: racial-ethnic disparities.

Using data from the 2003-2008 waves of the continuous National Health Nutrition Examination Survey merged with the 2000 census and GIS-based data, this study conducted genderspecific analyses to explore whether neighborhood built environment attributes are significant correlates of obesity risk and mediators of obesity disparities by race-ethnicity. Results indicate that the built environment is a significant correlate of obesity risk but is not much of a mediator of obesity disparities by race-ethnicity. Neighborhood walkability, density, and distance to parks are significant covariates of obesity risks net of individual and neighborhood controls.

Sex and ethnic differences in validity of self-reported adult height, weight and body mass index.

Objectives: Describe self-reported and measured height, weight, and body mass index (BMI) stratified by sex and ethnicity in the United States, explore ethnic variations in the likelihood of under-reporting BMI, and investigate pathways linking race/ethnicity to the underassessment of BMI.

Design: An observational study.

Setting: The entire United States.

Mixed land use and obesity: an empirical comparison of alternative land use measures and geographic scales.

Obesity is a growing epidemic in the United States. Walkable neighborhoods, characterized as having the 3Ds of walkability (population Density, land use Diversity, and pedestrian-friendly Design), have been identified as a potentially promising factor to prevent obesity for their residents. Past studies examining the relationship between obesity and walkability vary in geographic scales of neighborhood definitions and methods of measuring the 3Ds.

Joint physical custody and neighborhood friendships in middle childhood.

Almost half of first marriages end in divorce, which in turn may produce joint physical custody arrangements. Seen by many states to be in the best interest of the child, joint physical custody is increasingly common. Yet much is unknown about its consequences for children.

Effects of neighborhood walkability on healthy weight: assessing selection and causal influences.

Studies that examine the relationship between neighborhood characteristics and weight are limited because residents are not randomly distributed into neighborhoods. If associations are found between neighborhood characteristics and weight in observational studies, one cannot confidently draw conclusions about causality. We use data from the Utah Population Database (UPDB) that contain body mass index (BMI) information from all drivers holding a Utah driver license to undertake a cross-sectional analysis that compares the neighborhood determinants of BMI for youth and young adults.