Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: a Cross-Sectional Study

TL;DR

This study explores how neighborhood characteristics affect cardiovascular disease risk factors like BMI and physical activity in Native Hawaiians.

Contribution

The study is the first to examine the relationship between neighborhood-level stressors and individual-level CVD risk in Native Hawaiians.

Findings

Neighborhood availability of healthy foods was significantly associated with lower BMI.

Neighborhood characteristics improved the model's ability to explain BMI variance.

No neighborhood factors significantly predicted physical activity levels.

Abstract

Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, physical inactivity, obesity, and tobacco use) are associated with neighborhood characteristics (ie, social cohesion, walkability, availability of healthy food, and safety). This association has yet to be examined among Native Hawaiians.

We conducted a cross-sectional survey of community-dwelling Native Hawaiian people in 2020. Three multiple regression models and 1 logistic regression model were assessed. Each model included individual-level CVD risk factors, age, sex, education, income, and neighborhood characteristics.

The regression models for body mass index (BMI) and physical activity showed significant results. The BMI model (R
2 = 0.22, F = 4.81, P < .001) demonstrated that age, sex, education level, physical activity, and percentage of fat in the diet were significantly related to BMI. The availability of healthy foods had a significant, independent relationship with BMI (standardized β = −1.47, SE = 0.53, P = .01). The physical activity model (R
2 = 0.21, F = 4.46, P < .001) demonstrated that age, sex, education, and BMI were significantly related to physical activity. None of the neighborhood characteristics had significant, independent relationships to physical activity.

We found that neighborhood-level factors improved the model’s ability to explain variance in BMI. Efforts to decrease BMI would benefit from improving the availability of healthy foods in neighborhoods, a finding supported by research in other populations.