# Contextual Effects on Cardiometabolic Health: Evidence from a Natural Experiment

> **NIH NIH R01** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2022 · $560,103

## Abstract

Project Summary
 There is growing consensus that place affects health. A wide range of community-level contextual factors
including poverty, walkability, food environment, social cohesion, social networks, and crime, among others,
have been conceptualized as drivers of a broad range of individual health outcomes. However, the extent to
which these physical and social contextual influences are causal and contribute to geographic disparities in
health remains an open question. That is because individuals can self-select into communities based on
observed (e.g. socioeconomic background) and unobserved (e.g. tastes, preferences) characteristics that can
also influence health, making it difficult to isolate causal effects from correlations using observational data. The
extent to which causal pathways versus self-selection contribute to the link between county contextual
environment and individuals' health is a critical question in the development of effective public health policies.
 This study proposes to investigate the causal mechanisms and pathways through which contextual factors
influence cardiometabolic (CM) outcomes in adults, including BMI/obesity, diabetes, and hypertension. To
disentangle causal pathways from self-selection, we will leverage a unique natural experiment created by the
periodic relocation of military service-members to different counties, thereby exposing them to geographic
areas with varying burdens of CM risk for reasons and durations outside the individuals' control. This offers a
unique opportunity to provide evidence on causality with respect to three main research questions. First,
whether exposure to counties with higher CM risk (proxied by a higher obesity rate) increases individuals' risk
for these health conditions. Second, which specific county- and neighborhood-level physical and social
contextual factors mediate the relationship between individuals' CM outcomes and the county's obesity rate.
And third, whether contextual effects on individuals' CM outcomes are moderated by sex and race-ethnicity. To
address these aims, we will link individual-level longitudinal data from the Millennium Cohort Study to
county- and neighborhood-level contextual data on the physical and social environment and estimate multi-
level longitudinal models. We will use structural equation modeling to assess the role of a rich set of county and
neighborhood level contextual factors as mediators. Also, the demographically diverse sample will allow us to
examine how these relationships vary across sex and race/ethnicity – a critical contribution given the
substantial disparities in CM conditions. Concerns about generalizability are limited given the large and diverse
sample, their substantial exposure to civilian communities, and similarities between their health behaviors and
outcomes and those among civilians.
 The study is likely to have a high impact given that the combination of a natural experiment design with
longitudinal data methods...

## Key facts

- **NIH application ID:** 10359119
- **Project number:** 5R01HL141870-04
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** ASHLESHA DATAR
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $560,103
- **Award type:** 5
- **Project period:** 2019-03-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10359119

## Citation

> US National Institutes of Health, RePORTER application 10359119, Contextual Effects on Cardiometabolic Health: Evidence from a Natural Experiment (5R01HL141870-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10359119. Licensed CC0.

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