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Environmental quality modifies the relationship between county-level leisure-time physical inactivity and obesity in the U.S.
Gray, C., L. Messer, K. Rappazzo, J. Jagai, A. Patel, M. Jimenez, S. Deflorio-Barker, AND D. Lobdell. Environmental quality modifies the relationship between county-level leisure-time physical inactivity and obesity in the U.S. International Society of Environmental Epidemiology, Sydney, New South Wales, AUSTRALIA, September 24 - 28, 2017.
The purpose of this study was to examine how the environment modifies relationship between physical inactivity and obesity. This study used the Environmental Quality Index
Background/Aim More than one-third of U.S. adults are obese, making them vulnerable to multiple poor outcomes including diabetes, heart disease, cancer, and death. Physical inactivity is a well-established mechanism contributing to obesity that can be promoted or hindered by numerous environmental factors. We aim to examine how cumulative environmental quality may modify the inactivity-obesity relationship. Methods We used county-level Behavioral Risk Factor Surveillance System (BRFSS) data for our exposure (2009 leisure-time physical inactivity (LTPIA)) and outcome (2010 obesity). We linked BRFSS data to the Environmental Quality Index (EQI), a composite measure of variables from five environmental domains (air, water, land, built, and sociodemographic) across all U.S. counties from 2000-2005. We estimated the county-level association (N=3,137 counties) between LTPIA and obesity across tertiles of the EQI using multi-level linear regression models, with random intercept for state, and adjusted for county percent minority and rural-urban status. Because obesity is modified by sex, we modeled overall as well as sex-specific estimates from the BRFSS data. We report estimates as prevalence differences (PD) and 95% confidence intervals (CI). Results Before stratification, adjusted associations between LTPIA and obesity were 0.51% (0.48, 0.54) overall, 0.44% (0.42, 0.47) for males, and 0.56% (0.53, 0.60) for females. In stratified results, the PD increases substantially from the best (PD=0.34% [0.29, 0.40]) to worst (PD=0.64% [0.60, 0.69]) tertile of environmental quality in the overall population. We observed similar trends in males from best (PD=0.24% [0.19, 0.29]) to worst (PD=0.60% [0.56, 0.65]) quality environments, as well as in females from best (PD=0.45% [0.39, 0.51]) to worst (PD=0.65% [0.61, 0.70]) quality environments. Conclusions We found that poor environmental quality exacerbates the county-level association between physical inactivity and obesity. Research and programs aimed at improving obesity through physical activity may benefit from considering this relationship. This abstract does not reflect EPA policy.
Record Details:Record Type: DOCUMENT (PRESENTATION/POSTER)
Organization:U.S. ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF RESEARCH AND DEVELOPMENT
NATIONAL HEALTH AND ENVIRONMENTAL EFFECTS RESEARCH LABORATORY
ENVIRONMENTAL PUBLIC HEALTH DIVISION