TBM TBM page 595 of 600 BRIEF REPORT Implications Practice: In partnership with local community organizations and policy makers, public health practitioners can advocate for zoning codes that promote physical activity. Policy: While this study did not find associations between zoning strength and cardiometabolic risk, prior research suggests changing zoning codes to promote active living may promote phys- ical activity, a health behavior significantly im- plicated in the development of cardiometabolic diseases. Research: Future research is needed to identify the health impacts of zoning codes and whether alterations to zoning would improve population health over the long term. 1 National Institute of Nursing Research, Bethesda, MD, USA 2 Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA 3 Methodology Research Core, Institute of Health Research and Policy, University of Illinois Chicago (UIC), Chicago, IL, USA 4 Health Policy and Administration Division, UIC, Chicago, IL, USA 5 School of Public and Environmental Affairs at Indiana University, Bloomington, IN, USA 6 athenahealth, Inc., Watertown, MA, USA 7 Department of Health Population Nursing Science, College of Nursing, UIC, Chicago, IL, USA 8 Department of Pharmaceutical and Administrative Sciences, School of Pharmacy at Concordia University in Mequon, Mequon, WI, USA Abstract Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5–19), adults (aged 20–59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term. Keywords Policy, Zoning, Active living, Obesity, Hypertension, Hyperlipidemia BACKGROUND Many cardiometabolic conditions, such as obesity and hypertension, share a common risk factor: in- sufficient physical activity [1]. Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce the high prevalence of these conditions. Research shows that mixed land use, presence of sidewalks and cross- walks, availability of walking and biking paths, and greater connectivity of streets and paths are correl- ated with greater walking or biking to work, school, shopping, and other destinations [2, 3]. While a number of policy and planning tools are available to communities seeking to create a more activity- friendly environment, local zoning codes carry the force of law and provide the overarching framework for local land use. A small number of studies have documented asso- ciations between active living-oriented zoning codes and adult physical activity behaviors. For example, one study found that municipal-level active living- oriented zoning provisions (e.g., sidewalks, mixed- use developments) were associated with increased rates of active travel to work (e.g., walking, taking public transit) [4]. Other studies found that activity- friendly zoning provisions were associated with the likelihood of walking, biking, and other physical ac- tivity behaviors [5] and lower rates of adult seden- tary behavior [6]. No study has examined whether active living-oriented zoning codes are related to cardiometabolic conditions (e.g., diabetes) that are improved by physical activity. PURPOSE This study estimated relationships between ac- tive living-oriented zoning environments and cardiometabolic conditions among U.S. youth, Active living-oriented zoning codes and cardiometabolic conditions across the lifespan Shannon N. Zenk, 1,2 Oksana Pugach, 3 Jamie F. Chriqui, 3,4 Coady Wing, 5 Dorrie Raymond, 6 Elizabeth Tarlov, 7 Bethany Sheridan, 6 Kelly K. Jones, 2, Sandy J. Slater 8 This research was supported in part by the Intramural Research Program of the NIH, National Institute on Minority Health and Health Disparities and National Institute of Nursing Research. Correspondence to: SN Zenk, shannon.zenk@nih.gov Cite this as: TBM 2022;12:595–600 https://doi.org/10.1093/tbm/ibab157 Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US. Downloaded from https://academic.oup.com/tbm/article/12/4/595/6534451 by guest on 25 March 2023