Obesity and Neighborhood Collective Efficacy: A Site Comparison between San Juan, Puerto Rico and the South Bronx, New York Open Access

Lee, Yi Ting (Hana) (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/kk91fm721?locale=en



Among the Hispanic/Latino population, Puerto Rican adults have the highest prevalence of obesity and smoking rates, which increase the risks of cardiovascular diseases. Individual- and neighborhood-level factors can both influence health outcomes of individuals and populations. Compared to the built environment, there is less understanding about how the social environment can influence the development of obesity. Collective efficacy, an aspect of the social environment, is defined by informal social control and social cohesion. Our study aims to understand the association between neighborhood collective efficacy and obesity among Puerto Ricans and to examine whether the association differs between Puerto Rico and New York.


We analyzed data from the Boricua Youth Study—Healthy Heart Assessment, which included a subsample of wave 4 of the longitudinal Boricua Youth Study. The participants were identified as having a Puerto Rican background by a family member at baseline and were in their 20s. The outcome measures were obesity (BMI≥30) and high waist circumference (>40 inches for male, >35inches for female). We used log binomial regression models in the stratified analyses to estimate the prevalence ratio of obesity and high waist circumference across sites with collective efficacy as a continuous and categorical exposure. The models were adjusted for age, gender, maternal education, receipt of public assistance in the last year, current residency, neighborhood hazards, neighborhood walkability and neighborhood safety.


The association between neighborhood collective efficacy and obesity outcomes were different between the sites. In Puerto Rico, neighborhood collective efficacy was found to be positively associated with obesity and high waist circumference. In New York, as neighborhood collective efficacy increased, the prevalence of obesity and high waist circumference decreased.


The findings suggest that how neighborhood environment impacts obesity prevalence may depend on the location and context. The differential associations indicate that there are various pathways through which collective efficacy may affect obesity. To effectively prevent obesity, we need to understand the mechanisms and address the environment in interventions.

Table of Contents

Introduction 1

Disparities in Obesity Among Hispanic/Latino Population 1

Neighborhood Context 2

Boricua Youth Study Healthy Heart Assessment 6

Methods 8

Figure 1. 11

Results 13

Discussion 17

Cultural and Social Norms and Obesity 18

Socioeconomic Inequities 19

Collective Efficacy and Built Environment 20

Strengths and Limitations 20

Conclusions 22

References 23

Tables 26

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