The Influence of Neighborhood Environment on Risk Factors for Cardiovascular Disease in African American Women

Cardiovascular disease (CVD) is the leading cause of death for women in the US. Prevalence of risk factors for CVD such as hypertension, physical inactivity and obesity is high in African American (AA) women. Ecologic models suggest that built environments which support physical activity can reduce risk for CVD. However, questions remain about the influence of the built environment on changes or long term maintenance of physical activity, health outcomes, and overall risk for CVD. This study examined the influence of built environment characteristics on (1) changes in self-reported physical activity, body mass index (BMI), percent body fat (BF%) and blood pressure (BP) five years following an individually focused intervention, (2) cardiorespiratory fitness (CRF), lipid profile and fasting blood glucose, and (3) the likelihood of having four or more CVD risk factors at ideal levels. AA women who took part in the Health Is Power (HIP) project participated in this study (N=30). Participant’s neighborhoods were assessed for characteristics hypothesized to support physical activity. At five-year follow up, BMI (M=33.5kg/m2, SD=8.3) and diastolic BP (M=78.9mmHg, SD=10.6) were not significantly different from post intervention. BF% (M=43.7, SD=5.8) increased, and systolic BP (M=117.9, SD=13.5), walking physical activity (Median=973.0 MET-min/week) and leisure time physical activity (Median=792.2 MET-min/week) decreased from post intervention. Overall, 66.7% of participants had four or more CVD risk factor metrics at ideal levels. Linear regression models showed that built environment characteristics did not predict changes in physical activity or health outcomes from post intervention to five-year follow up. Higher crime score was associated with larger waist circumference [F(1,25)=5.39, p=.029, R2=.183], and participants who were older than 55 and lived in neighborhoods with few, low quality physical activity resources were least likely to have four or more CVD risk factors metrics at ideal levels. To support sustainability of health behaviors and outcomes following an individually focused intervention, researchers and community leaders should consider the importance of other aspects the intervention such as psycho-social factors. Qualitative aspects of the built environment such as crime and quality of physical activity resources may be most important for health and disease risk in older, AA women.