Neighborhood Environment and Adiposity among Older Adults: the Cardiovascular Health of Seniors and the Built Environment study
Main Article Content
Abstract
Background. Individual neighborhood factors are associated with obesity-related health behaviors and rates; however, there remains a paucity of information characterizing whole environments in these relationships and limited information on the effect for older adults.
Methods. Adults, aged 60 or older living in New York City, were enrolled into the Cardiovascular Health of Seniors and the Built Environment between January 2009 and June 2011. Walking audits of all streets within 300-meter buffer zones around residential addresses were conducted resulting in the assessment of 34 different neighborhood features hypothesized to be associated with obesity through physical activity and diet. Outcomes included objective measures of body fat mass (FM), waist circumference (WC), and body mass index (BMI). Stratified linear regression models were used to calculate geographic differences in associations between neighborhood resources and adiposity by gender and age categories in areas where Black, White and Latino residents lived.
Results. For women 60-69 years of age living in black areas, neighborhood features resulted in a higher FM than the average Brooklyn neighborhood (Difference (D) =2.15, 95% CI [1.15, 3.15]). Conversely, for women of the same age living in white and Latino areas, a lower prevalence of FM was observed: white areas: (D= -2.01, 95% CI [-3.62, -0.40]); Latino areas: (D= -1.43, 95% CI [-2.72, -0.14]). The direction of the effects remained similar for other age groups, although the estimates were less precise. Estimates of FM were inconsistent across age groups for men living in each of the areas. Other measurements of adiposity showed similar results.
Conclusions. The composition of neighborhood features in white and Latino residential areas is protective of adiposity, whereas features located in black areas appear to place residents at greater risk.Article Details
How to Cite
MORLAND, Kimberly B. et al.
Neighborhood Environment and Adiposity among Older Adults: the Cardiovascular Health of Seniors and the Built Environment study.
Medical Research Archives, [S.l.], v. 5, n. 7, july 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1361>. Date accessed: 24 dec. 2024.
Keywords
older adults, built environment, adiposity, cardiovascular disease
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. U.S. Department of Health and Human Services. Healthy People 2020. Nutrition and weight status. U.S. Health and Human Services, Public Health Service, [2012]. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/HP2020objectives.pdf. Accessed February 3, 2017.
2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491-497.
3. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA.. 2002;288(14):1723-1727.
4. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523-1529.
5. Allison DB, Fontaine KR, Manson JE, Stevens J, Van Itallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530-1538.
6. Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much and who’s paying. Health Affairs. 2003;Suppl:W3 219-W3 226.
7. Rothman KJ and Greenland S. Causation and Causal Inference. Modern Epidemiology, 2nd Ed. Lippincott-Raven. 1998.
8. Fitzgibbon ML, Stolley MR. Environmental changes may be needed for prevention of overweight in minority children. Pediatrics Annals. 2004;33(1):45-49.
9. Sooman A, Macintyre S, Anderson A. Scotland’s health – a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland. Health Bulletin. 1993;51(5):276-284.
10. Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Pub Health. 2004;94(9):1549-1554.
11. Burns CM, Gibbon P, Boak R, Baudinette S, Dunbar JA. Food cost and availability in a rural setting in Australia. Rural and Remote Health 4 (online), 2004:311.Available from: http://www.rrh.org.au/publishedarticles/article_print_311.pdf. Accessed February 3, 2017.
12. Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: a novel application of spatial statistics to the study of food environments. Am J Pub Health. 2005;95(9):1575-1581.
13. Sallis JF, Nadar R. Atkins J. San Diego surveyed for heart healthy foods and exercise facilities. Public Health Reports. 1986;101(2):216-218.
14. Algert SJ, Agrawal A, Lewis DS. Disparities in access to fresh produce in low-income neighborhoods in Los Angeles. Am J Prev Med. 2006;30(5):365-370.
15. Alwitt LF, Donley TD. Retail stores in poor urban neighborhoods. J Consum Aff. 1997;31(1):139-164.
16. Ayala GX, Mueller K, Lopez-Madurga E, Campbell NR, Elder JP. Restaurant and food shopping selections among Latino women in southern California. J Am Diet Assoc. 2005;105(1):38-45.
17. Block JP, Scribner RA, DeSalvo KB. Fast food, race/ethnicity, and income: a geographic analysis. Am J Prev Med 2004;27(3):211-217.
18. Block D, Kouba J. A comparison of the availability and affordability of a market basket in two communities in the Chicago area. Public Health Nutr. 2006;9(7):837-845.
19. Chung C, Myers SLJ. Do the poor pay more for food? An analysis of grocery store availability and food price disparities. J Consum Aff. 1999;33(2):276-296.
20. Cummins S, McKay L, MacIntyre S. McDonald's restaurants and neighborhood deprivation in Scotland and England. Am J Prev Med. 2005;29(4):308-310.
21. Donkin, AJ, Dowler EA, Stevenson SJ. Mapping access to food in a deprived area: the development of price and availability indices. Public Health Nutr 2000;3(1):31-38.
22. Fisher BD, Strogatz DS. Community measures of low-fat milk consumption: comparing store shelves with households. Am J Public Health. 1999;89(2):235-237.
23. Neckerman KM, Bader MD, Richards CA, Purciel M, Quinn JW, Thomas JS, et al. Disparities in the food environments of New York City public schools. Am J Prev Med 2010;39:195-202.
24. Jetter KM, Cassady DL. The availability and cost of healthier food alternatives. Am J Prev Med 2006;30(1):96-7.
25. Latham J, Moffat T. Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada. Health Place. 2007;13(1):273-287.
26. Lewis LB, Sloane DC, Nascimento LM, et al. African Americans' access to healthy food options in south Los Angeles restaurants. Am J Public Health. 2005;95(4):668-673.
27. Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96(2):325-331.
28. Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23-29.
29. Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44(3):189-195.
30. Winkler E, Turrell G, Patterson C. Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study. Health Place. 2005;12(3):741-748.
31. Zenk SN, Schulz AJ, Israel BA, et al. Neighborhood racial composition, neighborhood poverty and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95(4):660-667.
31. Diez-Roux AV, Nieto FJ, Caulfield L, et al. Neighbourhood differences in diet: the atherosclerosis risk in communities (ARIC) study. J Epidemiol Community Health. 1999;53(1):55-63.
32. Edmonds J, Baranowski T, Baranowski J, et al. Ecological and socioeconomic correlates of fruit, juice and vegetable consumption among African-American boys. Prev Med. 2001;32(6):476-481.
33. Laraia BA, Siega-Riz AM, Kaufman JS, Jones SJ. Proximity of supermarkets is positively associated with the diet quality index for pregnancy. Prev Med. 2004;39(5):869-875.
34. Morland K, Wing S, Diez-Roux A. The contextual effect of the local food environment on residents' diet: The atherosclerosis risk in communities study. Am J Public Health. 2002;92(11):1761-1767.
35. Zenk SN, Schutz AJ, Hollis-Neely T, et al. Fruit and vegetable intake in African Americans: income and store characteristics. Am J Prev Med. 2005;29(1):1-9.
36. Johnston Y, Denniston R, Morgan M, Bordeau M. Rock on café: achieving sustainable systems changes in school lunch programs. Health Promotion Practice. 2009;10(2 Suppl):100S-108S.
37. Venditti EM, Elliot DL, Faith MS, et al. Rationale, design and methods of the HEALTHY study behavior intervention component. Int J Obes (Lond). 2009;33(Suppl 4):S44-S51.
38. French SA. Public health strategies for dietary change: schools and workplaces. J Nutr. 2005;135(4):910-913.
39. Devine CM, Farrell TJ, Blake CE, Jastran M, Wethington E, Bisogni CA. Work conditions and the food choice coping strategies of employed parents. J Nutr Educ Behav. 2009; 41(5):365-370.
40. New York City Department of Health. Summary of Proposal: Green carts will increase access to healthy foods, improving the health of an estimated 75,000 New Yorkers. Available at: http://home2.nyc.gov/html/doh/downloads/pdf/cdp/green_carts_presentation.pdf. Accessed February 3, 2017.
41. Giange T, Karpyn A, Laurison HB, Hillier A, Perry RD. Closing the grocery gap in underserved communities: the creation of the Pennsylvania fresh food financing initiative. J Public Health Manag Pract. 2008;14(3):272-279.
42. Morland K. An evaluation of a neighborhood-level intervention to a local food environment. Am J Prev Med. 2010;39(6):e31-e38.
43. McCormack GR and Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act 2011;8(1):125.
44. Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE. Neighborhood environment and physical activity among youth: a review. Am J Prev Med. 2011;41(6):442-455.
45. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: What are the contributors? Annu Rev Public Health. 2005;26:421-43.
46. Sallis JF, Slymen DJ, Conway TL, Frank LD, Saelens BE, Cain K, Chapman JE. Income disparties in perceived neighborhood built and social environment attributes. Health Place. 2011;17(6):1274-1283.
47. McNeil AM, Katz R, Girman CJ, Rosamond WD, Wagenknecht LE, Barzilay JI, Tracey RP, Savage PJ, Jackson SA. Metabolic syndrome and cardiovascular disease in older people: the cardiovascular health study. JAGS. 2006:54(9);1317-1324.
48. Klieman L, Hyde S, Berra K. Cardiovascular disease risk reduction in older adults. Journal of Cardiovascular Nursing. 2006:21(5 Suppl 1);S27-S39.
49. Michael KM, Shaughnessy M. Stroke prevention and management in older adults. Journal of Cardiovascular Nursing. 2006:21(5 Suppl 1);;S21-S26.
50. McNeil J. U.S. Bureau of the Census, Current Population Reports, Series P23-189, Population Profile of the United States: 1995. U.S. Government Printing Office, Washington D.C., 1995. “Disability”, 32-33.
51. . National Institute on Aging, National Institutes of Health. “Healthy Eating After 50”, 2010. Available from www.nia.nih.gov/health/publication/healthy-eating-after-50.
52. Administration on Aging. A profile of Older Americans: 2010. Available from www.aoa.gov/AoARoot/Aging_Statistics/Profile
53. Administration on Aging. The Elderly Nutrition Program. Available from www.aoa.gov/aoaroot/Press_Room/Products_Materials/fact/pdf/Elderly_Nutrition_Program.pdf.
54. Carlson JA, Sallis JF, Conway TL, Saelens BE, et al. Interactions between psychosocial and built environment factors in explaining older adults’ physical activity. Prev Med. 2012;54(1):68-73.
55. Gomez LF, Parra DC, Buchner D, Brownson RC, et al. Built environment attributes and walking patters among the elderly population in Bogota. Am J Prev Med. 2010;38(6):592-599.
56. Parra DC, Gomez LF, Fleischer NL, Pinzon JD. Built environment characteristics and perceived active park use among older adults: results from a multilevel study in Bogota. Health Place. 2010;16(6):1174-1181.
57. Li F, Harmer P, Cardinal BJ, Bosworth M, et al. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009;169(4):401-408.
58. Bird S, Kurowski W, Feldman S, Browning C, et al. The influence of the built environment and other fators on the physical activity of older women from different ethnic communities. Journal of Women & Aging. 2009;21(1):33-47.
59. Nagel CL, Carleson NE, Bosworth M, Michael YL. The relation between neighborhood built environment and walking activity.Am J Epidemiol. 2008;168(4):461-468.
60. Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association for the built environment with physical activity and obesity in older persons. Am J Pub Health. 2007;97(3):486-492.
61. Li F, Fisher J, Brownson RC, Bosworth M. Multilevel modeling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005;59:558-564.
62. Smith GC. Grocery shopping patterns of the ambulatory urban elderly. Environment and Behavior 1991;23(1):86-114.
63. Smith GC, Gauthier JJ. Evaluation and utilization of local service environments by residents of low rent senior citizen apartments. Canadian J Urban Res. 1995;4(2):305-323.
64. New York City Department of City Planning. Community District Profiles. Available at www. nyc.gov/html /dcp/html/lucds/cdstart.shtml. Accessed Feb 3, 2017.
65. U.S. Health and Human Service. Diagnosis of Diabetes. NIH Publication No. 09-4642, October 2008.
66. Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS. The built environment and obesity: a systematic review of the epidemiologic evidence. Health Place. 2010;16(2): 175-190.
67. Hobbs FB. U.S. Bureau of the Census, Current Population Reports, Series P23-189, Population Profile in the United States: 1995. U.S. Government Printing Office, Washington D.C. 1995. “The Elderly Population”, 52-53.
68. U.S. Health and Human Services, Insulin Resistance and Pre-diabetes. Available at : http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx#BMI. Accessed Feb 7, 2017
2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491-497.
3. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA.. 2002;288(14):1723-1727.
4. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523-1529.
5. Allison DB, Fontaine KR, Manson JE, Stevens J, Van Itallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530-1538.
6. Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much and who’s paying. Health Affairs. 2003;Suppl:W3 219-W3 226.
7. Rothman KJ and Greenland S. Causation and Causal Inference. Modern Epidemiology, 2nd Ed. Lippincott-Raven. 1998.
8. Fitzgibbon ML, Stolley MR. Environmental changes may be needed for prevention of overweight in minority children. Pediatrics Annals. 2004;33(1):45-49.
9. Sooman A, Macintyre S, Anderson A. Scotland’s health – a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland. Health Bulletin. 1993;51(5):276-284.
10. Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Pub Health. 2004;94(9):1549-1554.
11. Burns CM, Gibbon P, Boak R, Baudinette S, Dunbar JA. Food cost and availability in a rural setting in Australia. Rural and Remote Health 4 (online), 2004:311.Available from: http://www.rrh.org.au/publishedarticles/article_print_311.pdf. Accessed February 3, 2017.
12. Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: a novel application of spatial statistics to the study of food environments. Am J Pub Health. 2005;95(9):1575-1581.
13. Sallis JF, Nadar R. Atkins J. San Diego surveyed for heart healthy foods and exercise facilities. Public Health Reports. 1986;101(2):216-218.
14. Algert SJ, Agrawal A, Lewis DS. Disparities in access to fresh produce in low-income neighborhoods in Los Angeles. Am J Prev Med. 2006;30(5):365-370.
15. Alwitt LF, Donley TD. Retail stores in poor urban neighborhoods. J Consum Aff. 1997;31(1):139-164.
16. Ayala GX, Mueller K, Lopez-Madurga E, Campbell NR, Elder JP. Restaurant and food shopping selections among Latino women in southern California. J Am Diet Assoc. 2005;105(1):38-45.
17. Block JP, Scribner RA, DeSalvo KB. Fast food, race/ethnicity, and income: a geographic analysis. Am J Prev Med 2004;27(3):211-217.
18. Block D, Kouba J. A comparison of the availability and affordability of a market basket in two communities in the Chicago area. Public Health Nutr. 2006;9(7):837-845.
19. Chung C, Myers SLJ. Do the poor pay more for food? An analysis of grocery store availability and food price disparities. J Consum Aff. 1999;33(2):276-296.
20. Cummins S, McKay L, MacIntyre S. McDonald's restaurants and neighborhood deprivation in Scotland and England. Am J Prev Med. 2005;29(4):308-310.
21. Donkin, AJ, Dowler EA, Stevenson SJ. Mapping access to food in a deprived area: the development of price and availability indices. Public Health Nutr 2000;3(1):31-38.
22. Fisher BD, Strogatz DS. Community measures of low-fat milk consumption: comparing store shelves with households. Am J Public Health. 1999;89(2):235-237.
23. Neckerman KM, Bader MD, Richards CA, Purciel M, Quinn JW, Thomas JS, et al. Disparities in the food environments of New York City public schools. Am J Prev Med 2010;39:195-202.
24. Jetter KM, Cassady DL. The availability and cost of healthier food alternatives. Am J Prev Med 2006;30(1):96-7.
25. Latham J, Moffat T. Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada. Health Place. 2007;13(1):273-287.
26. Lewis LB, Sloane DC, Nascimento LM, et al. African Americans' access to healthy food options in south Los Angeles restaurants. Am J Public Health. 2005;95(4):668-673.
27. Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96(2):325-331.
28. Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23-29.
29. Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44(3):189-195.
30. Winkler E, Turrell G, Patterson C. Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study. Health Place. 2005;12(3):741-748.
31. Zenk SN, Schulz AJ, Israel BA, et al. Neighborhood racial composition, neighborhood poverty and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95(4):660-667.
31. Diez-Roux AV, Nieto FJ, Caulfield L, et al. Neighbourhood differences in diet: the atherosclerosis risk in communities (ARIC) study. J Epidemiol Community Health. 1999;53(1):55-63.
32. Edmonds J, Baranowski T, Baranowski J, et al. Ecological and socioeconomic correlates of fruit, juice and vegetable consumption among African-American boys. Prev Med. 2001;32(6):476-481.
33. Laraia BA, Siega-Riz AM, Kaufman JS, Jones SJ. Proximity of supermarkets is positively associated with the diet quality index for pregnancy. Prev Med. 2004;39(5):869-875.
34. Morland K, Wing S, Diez-Roux A. The contextual effect of the local food environment on residents' diet: The atherosclerosis risk in communities study. Am J Public Health. 2002;92(11):1761-1767.
35. Zenk SN, Schutz AJ, Hollis-Neely T, et al. Fruit and vegetable intake in African Americans: income and store characteristics. Am J Prev Med. 2005;29(1):1-9.
36. Johnston Y, Denniston R, Morgan M, Bordeau M. Rock on café: achieving sustainable systems changes in school lunch programs. Health Promotion Practice. 2009;10(2 Suppl):100S-108S.
37. Venditti EM, Elliot DL, Faith MS, et al. Rationale, design and methods of the HEALTHY study behavior intervention component. Int J Obes (Lond). 2009;33(Suppl 4):S44-S51.
38. French SA. Public health strategies for dietary change: schools and workplaces. J Nutr. 2005;135(4):910-913.
39. Devine CM, Farrell TJ, Blake CE, Jastran M, Wethington E, Bisogni CA. Work conditions and the food choice coping strategies of employed parents. J Nutr Educ Behav. 2009; 41(5):365-370.
40. New York City Department of Health. Summary of Proposal: Green carts will increase access to healthy foods, improving the health of an estimated 75,000 New Yorkers. Available at: http://home2.nyc.gov/html/doh/downloads/pdf/cdp/green_carts_presentation.pdf. Accessed February 3, 2017.
41. Giange T, Karpyn A, Laurison HB, Hillier A, Perry RD. Closing the grocery gap in underserved communities: the creation of the Pennsylvania fresh food financing initiative. J Public Health Manag Pract. 2008;14(3):272-279.
42. Morland K. An evaluation of a neighborhood-level intervention to a local food environment. Am J Prev Med. 2010;39(6):e31-e38.
43. McCormack GR and Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act 2011;8(1):125.
44. Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE. Neighborhood environment and physical activity among youth: a review. Am J Prev Med. 2011;41(6):442-455.
45. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: What are the contributors? Annu Rev Public Health. 2005;26:421-43.
46. Sallis JF, Slymen DJ, Conway TL, Frank LD, Saelens BE, Cain K, Chapman JE. Income disparties in perceived neighborhood built and social environment attributes. Health Place. 2011;17(6):1274-1283.
47. McNeil AM, Katz R, Girman CJ, Rosamond WD, Wagenknecht LE, Barzilay JI, Tracey RP, Savage PJ, Jackson SA. Metabolic syndrome and cardiovascular disease in older people: the cardiovascular health study. JAGS. 2006:54(9);1317-1324.
48. Klieman L, Hyde S, Berra K. Cardiovascular disease risk reduction in older adults. Journal of Cardiovascular Nursing. 2006:21(5 Suppl 1);S27-S39.
49. Michael KM, Shaughnessy M. Stroke prevention and management in older adults. Journal of Cardiovascular Nursing. 2006:21(5 Suppl 1);;S21-S26.
50. McNeil J. U.S. Bureau of the Census, Current Population Reports, Series P23-189, Population Profile of the United States: 1995. U.S. Government Printing Office, Washington D.C., 1995. “Disability”, 32-33.
51. . National Institute on Aging, National Institutes of Health. “Healthy Eating After 50”, 2010. Available from www.nia.nih.gov/health/publication/healthy-eating-after-50.
52. Administration on Aging. A profile of Older Americans: 2010. Available from www.aoa.gov/AoARoot/Aging_Statistics/Profile
53. Administration on Aging. The Elderly Nutrition Program. Available from www.aoa.gov/aoaroot/Press_Room/Products_Materials/fact/pdf/Elderly_Nutrition_Program.pdf.
54. Carlson JA, Sallis JF, Conway TL, Saelens BE, et al. Interactions between psychosocial and built environment factors in explaining older adults’ physical activity. Prev Med. 2012;54(1):68-73.
55. Gomez LF, Parra DC, Buchner D, Brownson RC, et al. Built environment attributes and walking patters among the elderly population in Bogota. Am J Prev Med. 2010;38(6):592-599.
56. Parra DC, Gomez LF, Fleischer NL, Pinzon JD. Built environment characteristics and perceived active park use among older adults: results from a multilevel study in Bogota. Health Place. 2010;16(6):1174-1181.
57. Li F, Harmer P, Cardinal BJ, Bosworth M, et al. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009;169(4):401-408.
58. Bird S, Kurowski W, Feldman S, Browning C, et al. The influence of the built environment and other fators on the physical activity of older women from different ethnic communities. Journal of Women & Aging. 2009;21(1):33-47.
59. Nagel CL, Carleson NE, Bosworth M, Michael YL. The relation between neighborhood built environment and walking activity.Am J Epidemiol. 2008;168(4):461-468.
60. Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association for the built environment with physical activity and obesity in older persons. Am J Pub Health. 2007;97(3):486-492.
61. Li F, Fisher J, Brownson RC, Bosworth M. Multilevel modeling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005;59:558-564.
62. Smith GC. Grocery shopping patterns of the ambulatory urban elderly. Environment and Behavior 1991;23(1):86-114.
63. Smith GC, Gauthier JJ. Evaluation and utilization of local service environments by residents of low rent senior citizen apartments. Canadian J Urban Res. 1995;4(2):305-323.
64. New York City Department of City Planning. Community District Profiles. Available at www. nyc.gov/html /dcp/html/lucds/cdstart.shtml. Accessed Feb 3, 2017.
65. U.S. Health and Human Service. Diagnosis of Diabetes. NIH Publication No. 09-4642, October 2008.
66. Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS. The built environment and obesity: a systematic review of the epidemiologic evidence. Health Place. 2010;16(2): 175-190.
67. Hobbs FB. U.S. Bureau of the Census, Current Population Reports, Series P23-189, Population Profile in the United States: 1995. U.S. Government Printing Office, Washington D.C. 1995. “The Elderly Population”, 52-53.
68. U.S. Health and Human Services, Insulin Resistance and Pre-diabetes. Available at : http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx#BMI. Accessed Feb 7, 2017