Abstract Body: Background: Single-family zoning (SFZ) is an urban planning regulation that prevents neighborhoods zoned for single-family homes from developing multifamily housing units, which are often more affordable and disproportionately utilized by lower-income individuals. We evaluated whether SFZ was related to cardiovascular health.

Methods: We used 2010-2011 data from the Multi-Ethnic Study of Atherosclerosis (MESA) study and 2010-2012 zoning data of the 6 MESA study sites. SFZ was defined as the percentage of land zoned as single-family within a one-mile radius of the study participants’ homes. Cardiovascular health was defined as the American Heart Association’s Life’s Essential Eight (LE8) composite measure, comprised of diet, physical activity, smoking status, body mass index, cholesterol level, fasting blood glucose, and blood pressure. Higher scores implied better health. We also calculated a measure without sleep (LE8-no sleep) since sleep data were missing on 50% of participants. Multivariable linear mixed models, controlling for sex, education, income, and age, and accounting for clustering by census tract, were used to examine the relationship between SFZ and LE8/LE8-no sleep, overall and by MESA site.

Results: Among MESA participants (N=3,550), SFZ was greatest in buffers around those residing in Winston-Salem County, NC (median: 70%) and lowest in Upper Manhattan/Bronx, NY (0%). Overall, living in an area with 10% more SFZ was associated with higher LE8-no sleep scores (β: 0.21, 95% CI: 0.005, 0.42). In stratified analyses, a 10% increase in SFZ was associated with greater LE8-no sleep in Baltimore County (β: 1.14, 95% CI: 0.47, 1.81) and Los Angeles County (β: 0.80, 95% CI: 0.14, 1.45). In Chicago, a 10% increase in SFZ was associated with lower LE8-no sleep (β: -1.42, 95% CI: -2.14, -0.70) and LE8 (β: -1.20, 95% CI: -2.11, -0.29).

Conclusion: The relationship between SFZ and cardiovascular health may differ between locations. As cities consider creating or rescinding policies of exclusionary zoning, the implications on health should be considered.