Adult BMI and Access to Built Environment Resources in a High-Poverty, Urban Geography


      The purpose of this study is to examine the relationship between BMI and access to built environment resources in a high-poverty, urban geography.


      Participants (aged ≥35 years) were surveyed between November 2012 and July 2013 to examine access to common health-enabling resources (grocers, outpatient providers, pharmacies, places of worship, and physical activity resources). Survey data were linked to a contemporaneous census of built resources. Associations between BMI and access to resources (potential and realized) were examined using independent t-tests and multiple linear regression. Data analysis was conducted in 2014–2015.


      Median age was 53.8 years (N=267, 62% cooperation rate). Obesity (BMI ≥30) prevalence was 54.9%. BMI was not associated with potential access to resources located nearest to home. Nearly all participants (98.1%) bypassed at least one nearby resource type; half bypassed nearby grocers (realized access >1 mile from home). Bypassing grocers was associated with a higher BMI (p=0.03). Each additional mile traveled from home to a grocer was associated with a 0.9-higher BMI (95% CI=0.4, 1.3). Quality and affordability were common reasons for bypassing resources.


      Despite potential access to grocers in a high-poverty, urban region, half of participants bypassed nearby grocers to access food. Bypassing grocers was associated with a higher BMI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Centers for Disease Control and Prevention. Addressing Obesity Disparities. 2013;

        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Chang V.W.
        Racial residential segregation and weight status among U.S. adults.
        Soc Sci Med. 2006; 63: 1289-1303
        • Kirby J.B.
        • Liang L.
        • Chen H.J.
        • Wang Y.
        Race, place, and obesity: the complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States.
        Am J Public Health. 2012; 102: 1572-1578
        • Krishnan S.
        • Cozier Y.C.
        • Rosenberg L.
        • Palmer J.R.
        Socioeconomic status and incidence of type 2 diabetes: results from the Black Women’s Health Study.
        Am J Epidemiol. 2010; 171: 564-570
        • Gary-Webb T.L.
        • Baptiste-Roberts K.
        • Pham L.
        • et al.
        Neighborhood socioeconomic status, depression, and health status in the Look AHEAD (Action for Health in Diabetes) study.
        BMC Public Health. 2011; 11: 349
        • Northridge M.E.
        • Sclar E.D.
        • Biswas P.
        Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities.
        J Urban Health. 2003; 80: 556-568
        • Morland K.
        • Diez Roux A.V.
        • Wing S.
        Supermarkets, other food stores, and obesity: the Atherosclerosis Risk in Communities Study.
        Am J Prev Med. 2006; 30: 333-339
        • Dubowitz T.
        • Ghosh-Dastidar M.
        • Eibner C.
        • et al.
        The Women’s Health Initiative: The food environment, neighborhood socioeconomic status, BMI, and blood pressure.
        Obesity (Silver Spring). 2012; 20: 862-871
        • Carroll-Scott A.
        • Gilstad-Hayden K.
        • Rosenthal L.
        • et al.
        Disentangling neighborhood contextual associations with child body mass index, diet, and physical activity: the role of built, socioeconomic, and social environments.
        Soc Sci Med. 2013; 95: 106-114
        • Cohen D.A.
        • Finch B.K.
        • Bower A.
        • Sastry N.
        Collective efficacy and obesity: the potential influence of social factors on health.
        Soc Sci Med. 2006; 62: 769-778
        • Condrasky M.D.
        • Baruth M.
        • Wilcox S.
        • Carter C.
        Predictors of change in fruit and vegetable consumption in a faith-based intervention with African American adults.
        Fam Community Health. 2013; 36: 236-247
        • Burgoine T.
        • Forouhi N.G.
        • Griffin S.J.
        • Wareham N.J.
        • Monsivais P.
        Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: population based, cross sectional study.
        BMJ. 2014; 348: g1464
        • Block J.P.
        • Christakis N.A.
        • O’Malley A.J.
        • Subramanian S.V.
        Proximity to food establishments and body mass index in the Framingham Heart Study offspring cohort over 30 years.
        Am J Epidemiol. 2011; 174: 1108-1114
        • Mejia N.
        • Lightstone A.S.
        • Basurto-Davila R.
        • Morales D.M.
        • Sturm R.
        Neighborhood food environment, diet, and obesity among Los Angeles County adults, 2011.
        Prev Chronic Dis. 2015; 12: E143
        • Ludwig J.
        • Sanbonmatsu L.
        • Gennetian L.
        • et al.
        Neighborhoods, obesity, and diabetes—a randomized social experiment.
        N Engl J Med. 2011; 365: 1509-1519
        • Lovasi G.S.
        • Hutson M.A.
        • Guerra M.
        • Neckerman K.M.
        Built environments and obesity in disadvantaged populations.
        Epidemiol Rev. 2009; 31: 7-20
        • Drewnowski A.
        • Aggarwal A.
        • Hurvitz P.M.
        • Monsivais P.
        • Moudon A.V.
        Obesity and supermarket access: proximity or price?.
        Am J Public Health. 2012; 102: e74-e80
        • Andersen R.M.
        Revisiting the behavioral model and access to medical care: does it matter?.
        J Health Soc Behav. 1995; 36: 1-10
      2. U.S. Census Bureau. American Community Survey. Published 2012. Accessed 2015.

      3. Qualtrics Survey Software. Published 2015.

        • Makelarski J.A.
        • Lindau S.T.
        • Fabbre V.D.
        • et al.
        Are your asset data as good as you think? Conducting a comprehensive census of built assets to improve urban population health.
        J Urban Health. 2013; 90: 586-601
        • Lindau S.T.
        • James R.
        • Makelarski J.A.
        • Sanders E.
        • Johnson D.
        Comments from the south side of Chicago on New Haven’s inspiring initiative.
        Am J Public Health. 2012; 102 (author reply e4–e5. e3-e4
      4. The University of Michigan. Health and retirement study. Published 2002.

      5. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, GA; 2011-2012.

        • Centers for Disease Control and Prevention
        National Health and Nutrition Examination Survey Questionnaire (or Examination Protocol, or Laboratory Protocol).
        U.S. DHHS, Hyattsville, MD20112012
        • Mattessich P.W.
        • Rausch E.J.
        Collaboration to build healthier communities: a report for the Robert Wood Johnson Foundation Commission to Build a Healthier America.
        Wilder Research, Saint Paul, MN2013 June
        • Mattessich P.W.
        • Rausch E.J.
        Cross-sector collaboration to improve community health: a view of the current landscape.
        Health Aff (Millwood). 2014; 33: 1968-1974
      6. Walgreens. Offering fresh food choices in food deserts. Published 2016.

        • U.S. Department of Agriculture
        Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences.
        Economic Research Service, Washington, DC2009: 150
        • Sallis J.F.
        • Johnson M.F.
        • Calfas K.J.
        • Caparosa S.
        • Nichols J.F.
        Assessing perceived physical environmental variables that may influence physical activity.
        Res Q Exerc Sport. 1997; 68: 345-351
        • Pebley A.R.
        • Peterson C.E.
        • Sastry N.
        • Yuhas K.
        The Los Angeles Family and Neighborhood Survey, Wave 2: Household Questionnaires. 2010;
        • Smith S.
        • Jaszczak A.
        • Graber J.
        • et al.
        Instrument development, study design implementation, and survey conduct for the national social life, health, and aging project.
        J Gerontol B Psychol Sci Soc Sci. 2009; 64: i20-i29
        • Williams S.R.
        • Pham-Kanter G.
        • Leitsch S.A.
        Measures of chronic conditions and diseases associated with aging in the national social life, health, and aging project.
        J Gerontol B Psychol Sci Soc Sci. 2009; 64: i67-i75
        • Braveman P.
        • Egerter S.
        • An J.
        • Williams D.
        Race, Socioeconomic Factors, and Health. Center of Social Disparities in Health, San Francisco, CA2011
        • Ware J.E.
        • Kosinski M.
        • Keller S.K.
        SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Health Institute, Boston, MA1994
        • Chastin S.F.
        • Egerton T.
        • Leask C.
        • Stamatakis E.
        Meta-analysis of the relationship between breaks in sedentary behavior and cardiometabolic health.
        Obesity (Silver Spring). 2015; 23: 1800-1810
        • Swanson K.C.
        • McCormack G.R.
        The relations between driving behavior, physical activity and weight status among Canadian adults.
        J Phys Act Health. 2012; 9: 352-359
        • The American Association for Public Opinion Research
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. AAPOR, Lenexa, KS2008
        • Hatzenbuehler M.L.
        • Phelan J.C.
        • Link B.G.
        Stigma as a fundamental cause of population health inequalities.
        Am J Public Health. 2013; 103: 813-821
        • Cannuscio C.C.
        • Tappe K.
        • Hillier A.
        • Buttenheim A.
        • Karpyn A.
        • Glanz K.
        Urban food environments and residents’ shopping behaviors.
        Am J Prev Med. 2013; 45: 606-614
        • DiSantis K.I.
        • Hillier A.
        • Holaday R.
        • Kumanyika S.
        Why do you shop there? A mixed methods study mapping household food shopping patterns onto weekly routines of black women.
        Int J Behav Nutr Phys Act. 2016; 13: 11
        • Sequist T.D.
        • Taveras E.M.
        Clinic-community linkages for high-value care.
        N Engl J Med. 2014; 371: 2148-2150