Socioecological models of health emphasize contextual and environmental factors that influence disease risk (McLeroy et al., 1988; Stokols, 1992). Neighborhoods vary in the availability of supermarkets or large grocery stores that tend to offer healthier foods, and in the density of fast food restaurants and corner stores that offer inexpensive but less healthy food (Larson et al., 2009). Living in neighborhoods characterized by an absence of supermarkets or a plethora of unhealthy food retailers is associated with poorer overall diet quality and higher body mass (Cooksey-et al., 2017; Walker et al., 2010). Some neighborhoods have more walkable streets or offer greater access to parks and green space (land covered by vegetation), which can support walking, sports, and other health-promoting physical activities (Prince et al., 2022). To the degree that physical activity and diet influence cardiometabolic risk, (Lloyd-Jones et al., 2022; Sun et al., 2023) it would be expected that living in a neighborhood that is not conducive to healthy eating and physical activity would lead to a worsening cardiometabolic risk profile over time.

A number of observational studies provide support for this hypothesis, but with some limitations. Residents of neighborhoods with limited supermarket access, or with a high density of unhealthy food retailers, have greater risk of type 2 diabetes, hypertension, and cardiovascular disease (Garg et al., 2023; Testa et al., 2021). Individuals who live in neighborhoods that are less walkable, or that lack access to parks or greenspace, tend to be less physically active and have poorer physical health and elevated risk for cardiometabolic disease (Nguyen et al., 2021; Makhlouf et al., 2022; Hajna et al., 2015; Chandrabose et al., 2019; Twohig-Bennett and Jones, 2018). However, the body of research examining neighborhood influences on cardiometabolic risk has been heavily reliant on cross-sectional studies, and associations are less consistent in prospective analyses (Lam et al., 2021; McCormack and Shiell, 2011).

Given the cross-sectional nature of most prior studies, we leveraged data from an ethnically/racially diverse, multisite, longitudinal cohort of midlife women to test the prospective associations between neighborhood-level exposures and changes in objectively measured cardiometabolic risk factors over 9–14 years. Consistent with socioecological models of health, analyses tested whether women who lived in neighborhoods that are less conducive to healthy eating (fewer supermarkets, more fast food restaurants and corner stores) and physical activity (less walkable streets) exhibited greater increases in cardiometabolic risk factors across follow-up. Additional analyses examining an alternative measure of supermarket access, neighborhood access to greenspace, and proximity to parks as predictors are reported for subsets of women with available data.