Re-visiting the relationship between neighbourhood environment and BMI: an instrumental variables approach to correcting
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RESEARCH
Open Access
Re-visiting the relationship between neighbourhood environment and BMI: an instrumental variables approach to correcting for residential selection bias Cathleen D Zick1*, Heidi Hanson2,3, Jessie X Fan1, Ken R Smith1,3, Lori Kowaleski-Jones1, Barbara B Brown1 and Ikuho Yamada4
Abstract Background: A burgeoning literature links attributes of neighbourhoods’ built environments to residents’ physical activity, food and transportation choices, weight, and/or obesity risk. In cross-sectional studies, non-random residential selection impedes researchers’ ability to conclude that neighbourhood environments cause these outcomes. Methods: Cross-sectional data for the current study are based on 14,689 non-Hispanic white women living in Salt Lake County, Utah, USA. Instrumental variables techniques are used to adjust for the possibility that neighbourhoods may affect weight but heavier or lighter women may also choose to live in certain neighbourhoods. All analyses control for the average BMI of siblings and thus familial predisposition for overweight/obesity, which is often an omitted variable in past studies. Results: We find that cross-sectional analyses relating neighbourhood characteristics to BMI understate the strength of the relationship if they do not make statistical adjustments for the decision to live in a walkable neighbourhood. Standard cross-sectional estimation reveals no significant relationship between neighbourhood walkability and BMI. However, the instrumental variables estimates reveal statistically significant effects. Conclusions: We find evidence that residential selection leads to an understatement of the causal effects of neighbourhood walkability features on BMI. Although caution should be used in generalizing from research done with one demographic group in a single locale, our findings support the contention that public policies designed to alter neighbourhood walkability may moderately affect the BMI of large numbers of individuals. Keywords: Body mass index, Obesity risk, Neighbourhood walkability, Residential selection
Background A burgeoning literature links attributes of neighbourhoods’ built environments to residents’ physical activity, food choices, weight, and/or obesity risk. While these studies do not necessarily view the relationship as causal, it is sometimes implied. If the neighbourhood built environment influences residents’ physical activity, food choices, and/or weight, then changing the built environment may be an * Correspondence: [email protected] 1 Department of Family and Consumer Studies, University of Utah, 225 South 1400 East, Room 220, Salt Lake City, UT 84112, USA Full list of author information is available at the end of the article
important public policy tool that could help reduce Americans’ rising overweight and obesity risk. But what if people choose to live in neighbourhoods that support their dietary and physical activity preferences? This latter view has recently been espoused by land-use developers [1]. Different public policy implicati
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