Perceived spatial stigma, body mass index and blood pressure: a global positioning system study among low-income housing residents in New York City.

Previous research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI), and blood pressure among a sample of low-income housing residents in New York City (NYC). Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample). Global positioning systems (GPS) tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income) we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051), as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01) and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004). In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR)=1.32, 95%CI: 1.1, 1.4, P=0.02) and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007). However, we found no differences in spatial mobility (based GPS data) among participants who reported living in neighborhoods with and without spatial stigma (P>0.05). Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals in stigmatised neighborhoods to inform effective cardiovascular risk reduction interventions.