HOV to the MD? A Multilevel Analysis of Urban Sprawl and the Risk for Negative Health Outcomes

Urban sprawl often has a negative connotation, used as a derogatory label for certain forms and consequences of land development that are seen as environmentally and socially unpleasant. Although sprawl may be seen as offensive, there may be other, far greater and more harmful consequences of sprawl. The literature indicates that rates of negative health outcomes, such as obesity, tend to be higher in more developed areas. However, aside from a few studies, little empirical research looks specifically at the influence of sprawl when it comes to individual health. This research project focuses on sprawl and examines the relationships it has with health behaviors and health outcomes. By analyzing data from the CDC’s 2003 Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey of adults that include more than two-hundred selfreported and calculated variables, I investigate the associations between sprawl, physical activity, body weight, and health outcomes using Structural Equation Modeling (SEM). By employing SEM, my research differs from previous research in this field by adding not only additional layers to the evaluation of sprawl and health outcomes, but also allows for the evaluation of associations through various “paths” instead of looking at variables within simpler hierarchical regression models. In addition to direct effects, it also allows for the determination of indirect, or mediated, effects between variables within a path model. Even though no direct relationship between sprawl and health outcomes was revealed, sprawl did show to have a statistically significant indirect effect on health outcomes mediated by physical activity and body weight. Physical activity is also shown to mediate the relationship between sprawl and body weight. Additionally, physical activity reveals both a direct and indirect effect on health outcomes, with its indirect effect being mediated by body weight. Finally, physical activity and body weight are both shown to have statistically significant direct effects on health outcomes. In the concluding chapter I propose a new path model in light of the results of the analyses of data in order to represent the associations between sprawl, physical activity, body weight, and health outcomes more accurately. INDEX WORDS: Urban Sprawl, Health, Health behaviors, Health outcomes, Diabetes, Heart attack, Heart disease, High cholesterol, Hypertension, Stroke, Multilevel analysis HOV TO THE MD? A MULTILEVEL ANALYSIS OF URBAN SPRAWL AND THE RISK FOR NEGATIVE HEALTH OUTCOMES