Transit-Oriented Development: Implications for Childhood Obesity and Asthma

Project Summary / Abstract The US is in the midst of a housing affordability crisis, which fuels health inequities for children in low-income families including high rates of obesity and asthma exacerbations. To combat housing crisis, cities across the United States have turned to transit-oriented development, a type of urban planning that incentivizes developers to build dense, affordable housing in urban cores, near jobs and public transit. Transit-oriented development could improve obesity and asthma outcomes for low-income children by expanding access to affordable housing, transit, and healthy neighborhoods. Despite this promise, few studies have rigorously evaluated the impact of transit-oriented development on children's health outcomes. Los Angeles, California's Transit-Oriented Communities (TOC) program, which has led to the production of nearly 10,000 affordable housing units, offers an opportunity to study health implications of transit-oriented development. Our project will leverage TOC as a natural experiment, comparing change in obesity and asthma over time among children in neighborhoods eligible vs. ineligible for TOC (Aim 1). Secondary outcomes for Aim 1 include caregiver mental health and child physical activity. Second, we will explore potential mechanisms underlying Aim 1 associations, by measuring TOC's impact on more proximal outcomes, including housing affordability, transit use, and neighborhood environments (Aim 2). Finally, we will conduct qualitative interviews with caregivers living in TOCs as well as TOC developers and policymakers to contextualize quantitative findings and better understand peoples' lived experience with the program (Aim 3). Together, these aims will allow us to retrospectively measure TOC's impact on wellbeing, while also identifying opportunities to change the program to better promote health going forward. Results will be relevant to decisionmakers in Los Angeles and peer cities pursuing transit-oriented development. Research proposed under this K01 award will support Dr. Leifheit's mentored career development by providing opportunities for practical application of her training goals. Specifically, she will receive training in: (1) child obesity and asthma epidemiology, (2) geospatial analysis, (3) qualitative research, and (4) policy translation. A team of expert mentors will oversee Dr. Leifheit's training in these methods, content areas, and overall career development. This award will launch Dr. Leifheit's career as an independent investigator, providing her with the skills to collect mixed-methods data on child health implications of urban planning decisions. The project will also yield valuable preliminary data for future, R01-funded research measuring TOC's impact on children's longitudinal health trajectories.