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 Casagrande SS, Whitt-Glover MC, Lancaster KJ, Odoms-Young AM, Gary TL. Built environment and health behaviors among African Americans: a systematic review. Am J Prev Med. 2009 Feb;36(2):174-81.

PubMed ID: 19135908
Study Design:
Systemic Review
M - Click here for explanation of classification scheme.
POSITIVE: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

This article presents a summarization of the literature on the built environment and its association with physical activity, diet and obesity among African Americans.

Inclusion Criteria:

Eligible articles

  • evaluated the objective or perceived physical built environment
  • and the association with physical activity, dietary behaviors, and obesity or BMI
  • study populations of ≥90% African Americans (or studies that included a subgroup analysis of African Americans).
  • observational studies, including population and community surveys, cohort and corss-sectional studies
  • published in English through July 2007
  • studied African American adults ≥18 years.
Exclusion Criteria:

Articles were excluded that

  • evaluated neighborhood socioeconomic status or racial segregation as environmental measures,
  • evaluated only health status or mortality as outcomes,
  • provided no subgroup analyses for Aftican Americans,
  • or included <90% African Americans in populations where analyses for race/ethnic groups were combined.
  •  were intervention studies, design manuscripts and qualitative studies
Description of Study Protocol:

Search Strategy:

Published studies were identified by searching the PubMed databased from inception through July 21, 2007 using study key words.

Additional strategies included searching the bibliographies of eligible studies and searching the authors' personal databases for relevant articles on the built environment among African Americans.


Data Abstraction

Using a standard review form, full articles were independently serially reviewed by tow investigators. Data abstraction occurred between October 2007 and February 2008.


Statistical Analysis

 Results of the review are summarized qualitatively in evidence tables that include major findings and conclusions. Odds ratios in the evidence tables were extracted directly from the tables of reviewed articles.

A meta-analysis was not performed since there were a small number of articles and a variety of methods were used in eligible articles.

Data Collection Summary:

Information abstracted from articles

  • Built environments features related to physical activity and obesity
  • Environmental features related to dietary intake
  • Description of health behaviors, weight status and measures
  • Associations between the built environment and physical activity
  • Associations between the built environment and dietary intake
  • Association between the built environment and obesity


Data Synthesis

Results of the review are summarized qualitatively in evidence tables that include major findings and conclusions. Odds ratios shown in the evidence tables were extracted direclty from the tables or reviewed articles. For comparison purposes, odds ratios were presented for similar exposures across studies. Any significant findings were also presented.





Description of Actual Data Sample:


Number of articles included: 10

Number of articles identified: 2797 titles were identified from the initial search; 90 were deemed eligible for abstract review. Of these, 17 articles were eligible for full review and ten met all eligibility requirements.

Characteristics of articles on the built environment and health behaviors/obesity among African Americans

Study Sample size Age (years) % female % African American Setting Location Recruitment and methods
Ainsworth (2003) 917 20-59 (range) 100.0 100.0 Metropolitan Sumter, Orangeburg counties, South Carolina


Face-to-face interview

Eyler (2003) 4,122 34.5 (M) 100.00 51.4 MIxed Multi-site: Universities: AL, SC, IL, MD, NC


Face-to-face interview

Rohm Young (2003) 234 20-50 (range) 100.0 100.0 Urban Baltimore, MD

Recruitment: community organization

Face-to-face interview

Sanderson (2003) 567 20-50 (range 100.0 100.0 Rural Green, Lowndes, Wilcox counties, AL

Recruitment: RDD

Wilbur (2003) 399 20-50 (range) 100.0 100.0 Urban Chicago, IL

Recruitment through community

Face-to-face interview

Hooker (2005) 1,165 18-96 (range) 56.5 40.9 Rural One county SC

Recruitment: RDD


King (2000) 2,912 ≥40 100.0 25.6 Mixed National sample Telephone survey by ZIP code
Morland (2002) 10,623 59.7 (M) 55.9 225 Mixed Multi-site: Washington county MD; Forsyth county NC; Jackson city MS; Minneapolis MN

Existing study

Objective environmental factors

Wanko (2004) 605 50 (M) 56.0 89.9 Urban Atlanta GA

Consecutive patients for first visit at diabetes clinic

Self-administered questionnaire

Zenk 266 48.6 100.0 100.0 Urban Detroit MI Community survey




Summary of Results:


Key Findings

  • Light traffic, the presence of sidewalks, and safety from crime were more often positively associated with physical activity, although associations were not consistent (OR range = 0.53-2.43).
  • Perceived barriers to physical activity were associated with obesity.
  • The presences of supermarkets and specialty stores was consistently positively associated with meeting fruit and vegetable guidelines.

Measures and outcomes of articles on built environment and health behaviors/obesity among African Americans (AA)

Built environment features Measure
Behavior/weight status Measure Variable of interest Point est (95% CI) Conclusions
Ainsworth (2003)


Presence of sidewalks

Street lighting at night

Unattended dogs

Women and PA Survey Physical activity BRFSS Traffic, light, Sidewalks OR=1.53(1.00,2.34) Lighter traffice and the presence of sidewalks were associated with meeting PA recommendations; social factors also associated
Eyler (2003)

Safety from crime

Places within walking distance

Places to exercise


Urban: safety from crime

Mixed: Sidewalks

Urban OR=1.27(0.51,3.15)

Mixed OR=1.07(0.70,1.65)

Physical environmental factors were not consistently related to PA
Rohm Young (2003)        

Traffic, light


Safety from crime

Traffic OR=0.59(0.20,1.78)

Sidewalks OR=0.82(0.22,3.09)

Safety OR=0.93(0.41,2.11)

For any active vs inactive, physical environment factors not associated with PA level; social factors associated with PA
Sanderson (2003)        

Traffic, light


Safety from crime

Traffic OR=0.53(0.22,1.32)

Sidewalks OR=0.95(0.52,1.76)

Safety OR=0.66(0.36,1.21)

For any active vs inactive, physical environment factors not associated with PA level; social facotrs associated with PA
Wilbur (2003)        

Traffic, light

Safety from crime

Traffic OR=1.05(0.34,3.27)

Safety OR=2.43(1.19,4.99)

Safety from crime was associated with any PA vs no activity
Hooker (2005)


Street light quality

Unattended dogs

Public facilities are safe

Adapted from Brownson and focus groups Physical activity BRFSS, 2001

Traffic, light

Safe from crime

Traffic OR=0.75(0.36,1.55)

Safe OR=1.32(0.73,2.38)

Among AA, no association between perceived neighborhood environment supports and PA
King (2000)

Feel safe walking/jogging


Heavy traffic


Street lights

Unattended dogs

Enjoyable scenery

HIgh crime

Women's determinants study Physical Activity BRFSS & NHIS

Unattended dogs


High crime

Unattended dogs OR=1.51(1.06,2.15)

Sidewalks OR=1.51(0.98,2.32)

High crime OR=0.91(0.58,1.42)

Among AA, unattended dogs was the only attribute associated with any PA vs no activity
Morland (2002) Food stores and food service places Geocoded addresses from local health and state departments Fruit and vegetable, total and saturated fat intake FFQ

Fruits and vegetables

Total fat guideline

Saturated fat guideline

Fruits and vegetables OR=1.54(1.11,2.12)

Total fat OR=1.22(1.03,1.44)

Saturated fat OR=1.30(1.07,1.56)

The presence of supermarkets and the local food environment increased the likelihood of meeting dietary recommendations
Wanko (2004) Perceived barriers to PA Survey Obesity Objective height & weight BMI OR=1.04(1.01,1.06) A higher BMI increased patients likelihood of reporting an exercise barrier
Zenk (2005) Food stores Self-report Fruit and vegetable intake BRFSS, 2001


Specialty stores

Supermarket beta=1.22(0.33)

Specialty stores beta=2.37(1.06)

Shopping at supermarket or specialty store increased likelihood to meet fruit and vegetable recommendations





Author Conclusion:

With relatively few studies in the literature focused on African Americans, the findings for features of the built environment that are associated with physical activity, diet , and obesity are inconclusive.

Reviewer Comments:

Research Design and Implementation Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients?
  2. Is the outcome or topic something that patients/clients/population groups would care about?
  3. Is the problem addressed in the review one that is relevant to nutrition or dietetics practice?
  4. Will the information, if true, require a change in practice?
Validity Questions
  1. Was the question for the review clearly focused and appropriate?
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search terms used described?
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified and appropriate? Were selection methods unbiased?
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methods specified, appropriate, and reproducible?
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently across studies and groups? Was there appropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels of significance and/or confidence intervals included?
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations of the review identified and discussed?
  10. Was bias due to the review’s funding or sponsorship unlikely?

Copyright American Dietetic Association (ADA).