AJPH20112387_James 369..375 (nih.gov)

We found an inverse relationship between the county sprawl index and BMI and positive associations between the county sprawl index and physical activity, indicating that women who lived in denser counties with more accessible street designs had lower BMIs and were more active. Our findings add to the literature because they were derived from a large, geographically diverse sample and focus on a broad age range of adult women, who are at the highest risk of inactivity.4 We also examined multiple effect modifiers and potential confounders. We analyzed data from a cohort of mostly White nurses, giving us fewer concerns about confounding by SES or race.
Our findings are consistent with other studies that examined associations between urban sprawl, BMI, and physical activity. A study of Behavioral Risk Factor Surveillance System data on 206 992 adults from 448 counties in the United States found that the county sprawl index was positively associated with minutes walked and negatively associated with obesity, BMI, and hypertension.