Abstract Body: Background: Cardiovascular health (CVH) among young adults in Puerto Rico (PR) is below optimal levels, underscoring the vulnerability of this understudied population. Understanding the influence of neighborhood environment on CVH is crucial for designing public health interventions that promote and sustain CVH. We assessed the association between neighborhood environment characteristics and CVH among young adults living in PR.

Methods: This study analyzed data from 2,179 adults aged 18–29 years (mean age: 22.6 y; 60.8% women) participating in the PR-OUTLOOK study. CVH was measured using the AHA's Life’s Essential 8 metric score (range 0-100), with suboptimal CVH defined as a score below 80. The neighborhood environment was evaluated using the Mujahid Neighborhood Health Questionnaire, which assesses neighborhood violence, safety, aesthetic quality, walkability, access to healthy foods, social cohesion, and interaction with neighbors. Responses were recorded on a 5-point Likert scale (1=strongly disagree to 5=strongly agree), except for the violence and neighbor interaction scales, which ranged from 1=often to 4=never. Separate logistic regression models examined the association between each neighborhood environment characteristic and suboptimal CVH, adjusting for age, sex at birth, education, and subjective social status.

Results: Mean scores (±SD) for neighborhood environment characteristics were as follows: violence (3.7±0.5), safety (3.4±1.1), aesthetic quality (2.8±0.5), walkability (3.1±0.8), availability of healthy foods (2.4±1.0), social cohesion (3.3±0.7), and activities with neighbors (1.3±0.8). Approximately 72.5% of participants had suboptimal CVH. In adjusted models, young adults who perceived their neighborhoods as having higher aesthetic quality (OR = 0.70, 95% CI: 0.57–0.85), greater walkability (OR = 0.84, 95% CI: 0.75–0.94), and better availability of healthy foods (OR = 0.89, 95% CI: 0.81–0.98) had lower odds of suboptimal CVH compared to their counterparts.

Conclusions: Young adults in PR residing in neighborhoods with better aesthetics, walkability, and access to healthy foods have lower odds of suboptimal CVH. Further research is necessary to explore the long-term effects of these neighborhood characteristics on CVH, which could inform the design of targeted interventions to improve cardiovascular outcomes in this population.