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Using a novel environmental quality measure to understand population-level physical inactivity
Citation:
Gray, C., S. Grabich, L. Messer, K. Rappazzo, J. Jagai, AND D. Lobdell. Using a novel environmental quality measure to understand population-level physical inactivity. Presented at Society for Epidemiologic Research, Seattle, WA, June 24 - 27, 2014.
Impact/Purpose:
This abstract demonstrates the utility of the Environmental Quality Index in assessing environmental exposures related to physical inactivity.
Description:
Physical inactivity has been associated with numerous adverse health outcomes including obesity, heart disease, and depression, and is considered a major contributor to all-cause mortality worldwide. Understanding the role of the overall ambient environment in population inactivity levels is essential. A novel county-level environmental quality index (EQI) was developed for all US counties from 2000-2005 representing 5 environmental domains: air, water, land, built, and sociodemographic. We linked the EQI to 2006 Behavioral Risk Factor Surveillance System county-level prevalence of age-adjusted physical inactivity in US counties (N=3,141). We used random intercept multi-level linear regression with clustering by state to estimate fixed effects of quintiles of the EQI on physical inactivity prevalence. Models were stratified by 4 rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). Results are reported as prevalence difference (PD) (95% confidence interval) comparing highest quintile/worst quality to lowest/best. Using the overall EQI, we observed negative associations across strata (RUCC1: -5.07(-5.65, -4.49); RUCC2: -3.36(-4.70, -2.01), RUCC3: -3.35(-4.00, -2.71), RUCC4: -2.55(-3.18, -1.92). We then examined domain-specific EQI quintiles. Key associations were: in RUCC1, the sociodemographic domain (4.56(4.04, 5.08)); for RUCC2, the air (1.96(0.78, 3.13)) and land domains (0.33(-0.89, 1.55); in RUCC3, the air domain (1.24(0.64, 1.84); and for RUCC4, the sociodemographic (-3.00(-3.64, -2.37) and air domains (1.86(0.98, 2.75)). Physical inactivity was influenced by different domains of environmental quality depending on the extent of urbanization. These results provide useful information for targeting environmental research questions and programs aimed at reducing county-level physical inactivity. This abstract does not necessarily reflect EPA policy.