AS220 - Neighborhoods, women, and coronary heart disease: a prospective study

This page provides study documentation for AS220.  The AS220 datasets are also available on this site for qualified investigators (sign in and a completed Data Distribution Agreement are required; see details on the Data site).

Investigator Names and Contact Information

Chloe Bird, Ph.D., M.A. - Principal Investigator
RAND Corporation - Santa Monica Branch


To test whether aspects of the built environment predict the development of CHD in a longitudinal cohort of middle aged and elderly women after controlling for baseline sociodemographic and CHD risk factors.


Data: Individual data on CHD and associated risk factors came from the Observational Study (OS) and Clinical Trial (CT) arms of the Women’s Health Initiative (WHI). Additional data were obtained from RAND’s Center for Population Health and Health Disparities data core, which contains geocoded, census-tract level information on the sociodemographic and built environment.

Methods: We estimated multi-level models, where the built environment was used to predict CHD outcomes. All models controlled for a comprehensive set of individual and neighborhood sociodemographic characteristics, as well as health habits and baseline health status.


To date, we have found significant relationships between the development of CHD, other CHD-related outcomes (e.g. BMI) and cognition, and aspects of the built and social environment.  In particular, we have found that neighborhood socioeconomic status (SES), urban sprawl, and proximity to fast food outlets, are predictive of poor outcomes, whereas proximity to grocery stores is predictive of better outcomes.  These relationships are robust to extensive controls for individual characteristics, health behaviors, and health history. 

Some of the publications related to this ancillary study are:

Ms703 - Griffin BA, Eibner C, Bird CE, Jewell A, Margolis K, Shih R, Ellen Slaughter M, Whitsel EA, Allison M, Escarce JJ. The relationship between urban sprawl and coronary heart disease in women. Health Place. Health Place. 2012 Dec 7;20C:51-61. [Epub ahead of print]

Ms726 - Dubowitz T, Ghosh-Dastidar M, Eibner C, Slaughter ME, Fernandes M, Whitsel EA, Bird CE, Jewell A, Margolis KL, Li W, Michael YL, Shih RA, Manson JE, Escarce JJ. The Women's Health Initiative: the food environment, neighborhood socioeconomic status, BMI, and blood pressure. Obesity (Silver Spring). 2011 Jun 9. [Epub ahead of print]

Ms854 - Shih RA, Griffin BA, Salkowski N, Jewell A, Eibner C, Bird CE, Liao D, Cushman M, Margolis HG, Eaton CB, and Whitsel EA. Ambient particulate matter air pollution and venous thromboembolism in the Women’s Health Initiative Hormone Therapy Trials. Environ Health Perspect. 29 Oct 2010. [Epub ahead of print]

Ms1149 - Shih RA, Ghosh-Dastidar B, Margolis KL, Slaughter ME, Jewell A, Bird CE, Eibner C, Denburg NL, Ockene J, Messina CR, Espeland MA. Neighborhood socioeconomic status and cognitive function in women. Am J Public Health. 2011 Jul 21. [Epub ahead of print]

For a complete, up-to-date list of WHI papers related to this ancillary study, please use the searchable Bibliography section of this website. To search for papers by study number, access the Simple Search, and enter the study number in the “Related Studies” field. 


References (as of the August 2012 Progress Report)

Shih RA, Ghosh-Dastidar M, Margolis KL, Slaughter ME, Jewell A, Bird CE, Eibner C, Denburg NL, Ockene J, Messina CR, Espeland MA. “Neighborhood Socioeconomic Status and Cognitive Function in Women.”  American Journal of Public Health. 101(9):1721-8. Epub 2011 Jul 21.

Shih RA, Griffin BA, Salkowski, N, Jewell A, Eibner C, Bird CE, Cushman M, Liao D, Eaton CB, Margolis HG, Whitsel EA. 2011. Ambient particulate matter air pollution and venous thromboembolism in the Women’s Health Initiative Hormone Therapy Trials.  Environmental Health Perspectives, 119(3): 326-331.

Tamara Dubowitz, Madhumita Ghosh-Dastidar, Christine Eibner, Mary E. Slaughter, Meenakshi Fernandes, Eric A. Whitsel, Chloe E. Bird, Adria Jewell, Karen L. Margolis, Wenjun Li, Yvonne L. Michael, Regina A. Shih, JoAnn E. Manson and José J. Escarce.  2012. “The Women’s Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure.”  Obesity. 20(4):862-71: Jun 9. doi: 10.1038/oby.2011.141. [Epub ahead of print]

Griffin, BA, Andersen, G, Shih, R, Whitsel, E. Use of Alternative Time Scales in Cox Proportional Hazard Models: Implications for Time-Varying Environmental Exposures. 2012. DOI: 10.1002/sim.5347. Statistics in Medicine.​