Abstract
Associations between local-area residential features and glycosylated hemoglobin (HbA1c) may be mediated by individual-level health behaviors. Such indirect effects have rarely been tested. This study assessed whether individual-level self-reported physical activity mediated the influence of local-area descriptive norms and objectively expressed walkability on 10-year change in HbA1c. HbA1c was assessed three times for adults in a 10-year population-based biomedical cohort (n = 4056). Local-area norms specific to each participant were calculated, aggregating responses from a separate statewide surveillance survey for 1600 m road-network buffers centered on participant addresses (local prevalence of overweight/obesity (body mass index ≥25 kg/m2) and physical inactivity (<150 min/week)). Separate latent growth models estimated direct and indirect (through physical activity) effects of local-area exposures on change in HbA1c, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, marital status, employment and education, and area-level median household income). HbA1c worsened over time. Local-area norms directly and indirectly predicted worsening HbA1c trajectories. Walkability was directly and indirectly protective of worsening HbA1c. Local-area descriptive norms and walkability influence cardiometabolic risk trajectory through individual-level physical activity. Efforts to reduce population cardiometabolic risk should consider the extent of local-area unhealthful behavioral norms and walkability in tailoring strategies to improve physical activity.
Highlights
In efforts to improve population health relating to chronic disease outcomes, interventions have often targeted individual-level health-related behaviors such as physical activity
The current study was part of the Place and Metabolic Syndrome (PAMS) Project which evaluated the role of residential environment features on the evolution of cardiometabolic risk
The most novel aspect of this work reflects the test of individual-level physical activity behavior as mediating environmental influences on the evolution of cardiometabolic risk, where physical activity only partially explained the effect of the environmental exposures on change in HbA1c
Summary
In efforts to improve population health relating to chronic disease outcomes, interventions have often targeted individual-level health-related behaviors such as physical activity. It is well understood that regular participation in physical activity is protective against the development of chronic diseases, including cardiometabolic disease [1,2,3]. Res. Public Health 2017, 14, 953; doi:10.3390/ijerph14090953 www.mdpi.com/journal/ijerph
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
More From: International journal of environmental research and public health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.