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Journal Article

Citation

Carroll SJ, Niyonsenga T, Coffee NT, Taylor AW, Daniel M. Int. J. Environ. Res. Public Health 2017; 14(9): e14090953.

Affiliation

Department of Medicine, University of Melbourne, St Vincent's Hospital, Parkville, Melbourne 3010, Australia. anne.taylor@adelaide.edu.au.

Copyright

(Copyright © 2017, MDPI: Multidisciplinary Digital Publishing Institute)

DOI

10.3390/ijerph14090953

PMID

28832552

PMCID

PMC5615490

Abstract

Associations between local-area residential features and glycosylated hemoglobin (HbA1c) may be mediated by individual-level health behaviors. Such indirect effects have rarely been tested. This study assessed whether individual-level self-reported physical activity mediated the influence of local-area descriptive norms and objectively expressed walkability on 10-year change in HbA1c. HbA1c was assessed three times for adults in a 10-year population-based biomedical cohort (n = 4056). Local-area norms specific to each participant were calculated, aggregating responses from a separate statewide surveillance survey for 1600 m road-network buffers centered on participant addresses (local prevalence of overweight/obesity (body mass index ≥25 kg/m²) and physical inactivity (<150 min/week)). Separate latent growth models estimated direct and indirect (through physical activity) effects of local-area exposures on change in HbA1c, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, marital status, employment and education, and area-level median household income). HbA1c worsened over time. Local-area norms directly and indirectly predicted worsening HbA1c trajectories. Walkability was directly and indirectly protective of worsening HbA1c. Local-area descriptive norms and walkability influence cardiometabolic risk trajectory through individual-level physical activity. Efforts to reduce population cardiometabolic risk should consider the extent of local-area unhealthful behavioral norms and walkability in tailoring strategies to improve physical activity.


Language: en

Keywords

built environment; cardiometabolic disease; descriptive norms; glycosylated hemoglobin; mediation; physical activity; residential environments; walkability

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