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Does Physical Activity Mediate the Associations Between Local-Area Descriptive Norms, Built Environment Walkability, and Glycosylated Hemoglobin?

Does Physical Activity Mediate the Associations Between Local-Area Descriptive Norms, Built Environment Walkability, and Glycosylated Hemoglobin?
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Carroll SJ, Niyonsenga T, Coffee NT, Taylor AW, Daniel M,


Carroll SJ, Niyonsenga T, Coffee NT, Taylor AW, Daniel M, (click to view)

Carroll SJ, Niyonsenga T, Coffee NT, Taylor AW, Daniel M,

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International journal of environmental research and public health 2017 08 2314(9) pii E953
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.

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