Neighborhood Environment and Obesity in Pre-adolescent Girls

Institution: University of California, San Francisco
Investigator(s): Irene  Yen , Ph.D. -
Award Cycle: 2006 (Cycle 12) Grant #: 12IB-0013 Award: $162,847
Award Type: IDEA
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer



Initial Award Abstract (2006)
Non-technical introduction to the research topics: Obesity is an important predictor of breast cancer. Girls who are overweight or obese are more likely to become overweight or obese women. Childhood obesity may lead to early pubertal development and menarche, which is itself a risk factor for adult breast cancer. Obesity is generally understood to be the result of eating poorly and not exercising. However, girls’ eating and exercise habits are very much influenced by their home and school environments. These environments are in part a product of city planning policies and the types of neighborhood services and stores the girls and their families may have access to. This proposal seeks to investigate the association between city planning policies and neighborhood environment (e.g. food stores, fast food chains, parks, traffic conditions) and girls’ growth patterns and the development of obesity.

The question(s) or central hypotheses of the research in lay terms:
1.City planning policy influences neighborhood environment, diet and physical activity resources.
2.Neighborhood services and conditions are associated with girls’ diet and physical activity, and influence their growth patterns and pubertal changes.

The general methodology in lay terms: This proposed study will examine seven-year-old girls who are being followed as part of an ongoing 5-year longitudinal study of, the Community Study of Young Girls’ Nutrition, Environment, and Transitions (CYGNET). In CYGNET, 400 girls in the Northern California region of Kaiser Permanente are being recruited for a study of social, environmental, and biologic precursors to breast cancer. Our study will collect information on 200 of the girls’ neighborhoods and city policies that influence their physical environment and link it to the data already being collected for the CYGNET. We plan to visit the girls’ neighborhoods to collect information about the food resources, recreational facilities, and other conditions in the area relevant to diet and physical activity. In this way we can investigate how policies influence services and conditions and how the three together influence girls’ growth and risk for obesity.

Innovative elements of the project in lay terms: This study has four innovative elements. First, the study will utilize a systematic approach to quantifying policies such as walkability, housing, and mixed-use development into a scorecard. Second, we will be able to compare how written policy corresponds with actual on-the-ground circumstances such the services and physical conditions in neighborhoods that promote or hinder nutritious diet and physical activity. Third, this study will be able to take advantage of a large on-going investigation to link myriad data on individual precursors to breast cancer with information about neighborhood and policy factors. Finally, the multiple types of data to be analyzed (city policy, neighborhood, individual) is also an overall innovative aspect.

Advocacy involvement and human issues: Breast cancer advocates and community groups have played a key role in instigating the parent study (the BCERC) in collaboration with the National Institute of Environmental Health Sciences and the National Cancer Institute. The parent study incorporates on-going communications between scientists and community advocates in the implementation, analysis, and reporting of the research. Community advocates have a keen interest in the role of the environment in breast cancer and are actively engaged in community education, recruitment, and media communications supported by the project during their interactions with the scientific team. They help the scientists keep the relevance of the research aligned to community needs. The current study, an ancillary study to BCERC and the CYGNET, builds upon and benefits from this underlying community support and involvement and the results of this study will add to the knowledge generated by the project and transferred to the community.


Final Report (2008)
Obesity is an important predictor of breast cancer. Girls who are overweight or obese are more likely to become overweight or obese women and childhood obesity may lead to early pubertal development and menarche, which is itself a risk factor for adult breast cancer. Obesity is generally understood to be the result of eating poorly and not exercising. However, girls’ eating and exercise habits are very much influenced by their home and school environments. These environments are in part a product of city planning policies and the presence of neighborhood services and stores. This project investigated the association between city planning policies, neighborhood environment (e.g. food stores, fast food chains, parks, traffic conditions) and girls’ diet, physical activity, and growth patterns. The project observed the neighborhoods of 215 girls who were recruited into an ongoing study directed by the Kaiser Permanente Division of Research, the Community Study of Young Girls’ Nutrition, Environment, and Transitions (CYGNET). Data on girls’ diet, physical activity, and body mass index were from the CYGNET project.

The proposal had three aims and we have made progress on two of the three. The first aim was to examine the association between city planning policies and on-the-ground neighborhood circumstances. We ascertained city planning policies using the Greenbelt Alliance Smart Growth measures. We measured on-the-ground circumstances through direct observation of 215 neighborhoods. The single neighborhood measure, recreation, did correspond to the affordable housing smart growth sub score such that a 10% increase in the affordable housing sub score, there was a 1.23 odds (95% confidence interval [CI]: 1.04,1.45) of the presence of recreational facilities. The neighborhood composite scores corresponded to the Smart Growth development density sub score. For every 10% increase in the development density sub score, there was a: 1.47 odds (95% confidence interval [CI]: 1.03, 2.05) of having a higher urban disorder score; a 1.73 odds (95% CI: 1.16, 2.60) of having a higher commercial services score. A higher means higher "disorder" or higher commercial development (i.e. more of both of these types of entities observed in a girl's neighborhood). Factors considered included the presence or absence of such things as church, warehouse, litter (includes broken glass), graffiti, liquor, “walkability”, “bikeability “ public service, laundry, pharmacy, fast food, food store, restaurans, medical facility and so on.

The second aim examined the association between on-the-ground circumstances and physical activity and body mass index (diet data are not yet available). We found an association between a measure of walkability/bikeability and physical activity (measured by metabolic equivalents or MET), such that a unit increase in the walkability/bikeability score was associated with a 0.77 (95% CI: 0.62,0.96) increase in quartile units of MET equivalents (i.e. not quite 1 quartile increase) and a 1.48 (95% CI: 0.99,2.23) increase in quartile units of body mass index. The third aim involves analyzing two waves of data from the CYGNET. Year 2 CYGNET data are not yet available.

We completed street observations for 215 girls and began analysis for Specific Aims 1 and 2. We just learned that our competitive renewal proposal has been funded. For the renewal, we will be able to link the entire CYGNET sample (approximately 400 girls) to a geospatial database of restaurants, fast food outlets, grocery stores, and recreational facilities and investigate how these entities are or are not associated with girls’ diet, physical activity, and growth.

Neighborhood Influences on Girls' Obesity Risk Across the Transition to Adolescence
Periodical:Pediatrics
Index Medicus: Pediatri
Authors: Hoyt LT, Kushi LH, Leung CW, Nickleach DC, Adler N, Laraia BA, Hiatt, RA, Yes IH.
Yr: Vol: Nbr: Abs: Pg: