The association between neighborhood quality, youth physical fitness, and modifiable cardiovascular disease risk factors

Hiwot Zewdie, Amy Y. Zhao, Hersila H. Patel, Eric Hansen, Sarah E. Messiah, Sarah C. Armstrong, Asheley C. Skinner, Cody D. Neshteruk, J. Aaron Hipp, Emily M. D'Agostino

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose: Striking disparities persist in cardiovascular disease risk factors among minority youth. We examined the association between multiple indicators of neighborhood quality and minority youth fitness. Methods: The primary exposure was the Child Opportunity Index (COI), a measure comprised of indicators that facilitate healthy child development. Outcome data were drawn from the 2018–2019 Fit2Play Study (Miami-Dade County, FL). Hotspot analysis evaluated COI spatial clustering. Generalized linear mixed models examined cross-sectional COI-fitness associations. Results: The sample included 725 youth (53% Black, 43% Hispanic; 5–17 years). Significant neighborhood quality spatial clusters were identified (Gi*z-score = −4.85 to 5.36). Adjusting for sociodemographics, walkability was associated with lower percentiles in body mass index (BMI) and diastolic blood pressure percentiles (DBP) (β = −5.25, 95% CI: −8.88, −1.62 and β = −3.95, 95% CI: −7.02, −0.89, respectively) for all, lower skinfold thickness (β = −4.83, 95% CI: −9.97, 0.31 and higher sit-ups (β = 1.67, 95% CI: −0.17, 3.50) among girls, and lower systolic blood pressure percentiles (SBP) (β = −4.75, 95% CI: −8.99, −0.52) among boys. Greenspace was associated with higher BMI (β = 6.17, 95% CI: 2.47, 9.87), SBP (β = 3.47, 95% CI: −0.05, 6.99), and DBP (β = 4.11, 95% CI: 1.08, 7.13). Conclusions: COI indicators were positively associated with youth fitness. Disparities in youth cardiovascular disease risk may be modifiable through community interventions and built environment initiatives targeting select neighborhood factors.

Original languageEnglish (US)
Pages (from-to)30-39
Number of pages10
JournalAnnals of Epidemiology
StatePublished - May 2021
Externally publishedYes


  • Cardiovascular health disparities
  • Neighborhood quality
  • Youth fitness

ASJC Scopus subject areas

  • Epidemiology


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