Obesity Epidemiology

350 EPIDEMIOLOGIC STUDIES OF DETERMINANTS OF OBESITYof the measures. Income (in comparison to education and occupation) is unstable, yet issensitive to life circumstances. Income is also age dependent and may be less usefulamong those of retirement age. There are a number of challenges interpreting such data,as purchasing power associated with income may be noncomparable across geographicregions or sociodemographically diverse groups; for example, it is well known that fruitsand vegetables as well as dairy foods are more expensive in low-income urban neighborhoodsthan in middle-class suburban environments. All economic measures (includingincome, wealth, and poverty status) may not be sensitive to informal financial transactionsand assets (e.g., inheritances, savings, and benefits).Neighborhood CharacteristicsWhere you live is undeniably linked to health. Living in a neighborhood with accessto multiple full-service supermarkets, plentiful safe options for physical activity, andoptions for walking for transportation (rather than using an automobile) may decreaseone’s likelihood for becoming obese. While recognition of the importance of the localneighborhood context is not new, such research has surged in popularity in recent yearsas the limitations of focusing only on individual-level determinants have been increasinglyacknowledged. Particularly in industrialized nations, recent research has exploredthe myriad potential connections between obesity and aspects of the neighborhood context(including the built environment). Although epidemiological attention to these issuesis relatively new, and evidence is still accumulating, the importance of cons idering neighborhoodcharacteristics as fundamental determinants of obesity is nevertheless becomingincreasingly apparent. In this section, we review the accumulating body of empiricalevidence on selected obesogenic neighborhood characteristics. We begin with an overviewof neighborhood SEP and then discuss specific neighborhood characteristics thatprimarily act through dietary pathways (supermarkets and other food stores, fast foodrestaurants), followed by those that are primarily associated with physical activity (urbansprawl, neighborhood safety).Neighborhood Socioeconomic PositionAs has been discussed, there is abundant evidence that individual SEP is strongly associatedwith obesity risk and related behaviors across a wide range of populations. Arguably,the bulk of evidence in the neighborhood effects literature pertains to neighborhood SEP. Itgenerally shows that residing in a socioeconomically disadvantaged neighborhood is alsoassociated with poorer health in general, and increased odds of obesity more specifically(largely independent of individual SEP). Both individual-level and neighborhood SEPindependently (and perhaps differentially) affect health status, 59 with neighborhood SEPserving as a strong predictor of sociostructural determinants of obesity. For example,neighborhood deprivation may influence obesity risk by restricting access to healthyfood and opportunities for physical activity, while also impacting cultural characteristics(e.g., social norms).A number of cross-sectional investigations (conducted in the United States, UnitedKingdom, Australia, and Sweden) show that living in a more socioeconomically disadvantagedneighborhood is associated with higher odds of obesity. 52,60-65 For example,Cubbin et al. 62 linked socioeconomic indicators of neighborhood-level deprivation withindividual-level data from the Swedish Annual Level of Living Survey. They found thatliving in a neighborhood characterized by low socioeconomic deprivation was associated