Abstract
Residential self-selection bias is a concern in studies of neighborhoods and health. This bias results from health behaviors predicting neighborhood choice. To quantify this bias, we examined associations between pre-move health factors (body mass index, walking, and total physical activity) and post-move neighborhood factors (County Sprawl Index, Census tract socioeconomic status (SES)) in the Nurses’ Health Study (n = 14,159 moves from 1986–2008). Individuals in the highest quartile of pre-move BMI (BMI > 28.4) compared to the lowest quartile (BMI < 22.5) moved to counties that averaged 2.57 points lower on the sprawl index (95% confidence interval −3.55, −1.59) indicating that individuals moved to less dense counties; however, no associations were observed for pre-move walking nor total physical activity. Individuals with higher pre-move BMI tended to move to Census tracts with lower median income and home values and higher levels of poverty. Analyses examining the change in neighborhood environments after a move demonstrated that healthy pre-move behaviors were associated with moves to worse socioeconomic environments. This type of self-selection would bias results downward, underestimating the true relationship between SES and physical activity. Generally, the magnitudes of associations between pre-move health factors and neighborhood measures were small and indicated that residential self-selection was not a major source of bias in analyses in this population.
Highlights
Stark health differences exist between neighborhoods, with life expectancies differing up to 25 years between zip codes only miles apart [1]
To provide more insight into the magnitude of residential self-selection bias within a longitudinal study, this study aims to examine the relationship between pre-move health factors and subsequent neighborhood features among participants of a long-term prospective cohort study of adult female nurses with a large amount of residential mobility
Participants undertook an average of 18.9 metabolic equivalents (METs) Hrs/Wk of total physical activity and about 7.5 MET Hrs/Wk of walking
Summary
Stark health differences exist between neighborhoods, with life expectancies differing up to 25 years between zip codes only miles apart [1]. Has been consistently linked to negative health outcomes, including physical inactivity and obesity [3,4,5]. Residential segregation by SES serves to distribute resources unevenly between neighborhoods, which can drive neighborhood differences in diet and health behaviors [6]. Substantial evidence demonstrates that physical inactivity and obesity are linked to areas with high levels of urban sprawl, characterized by low residential density and roads with large blocks and poor access [7,8,9,10]. Physical inactivity and obesity have been attributed to features of the neighborhood socioeconomic and built environment; the causal nature of these relationships has been questioned
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