1 Département de médecine sociale et préventive, École de santé publique (ESPUM), Université de Montréal. 7101, avenue du Parc 3(e) étage, Montréal, Quebec H3N 1X9, Canada; Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), 7101, avenue du Parc 3(e) étage, Montréal, Quebec H3N 1X9, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM). 900, rue Saint Denis, Montreal, Quebec H2X 0A9, Canada. Electronic address: ae.ghenadenik@umontreal.ca.
2 Department of Mathematics and Statistics, Concordia University. 1455, boulevard de Maisonneuve O., Montreal, Quebec H3G 1M8, Canada; PERFORM Centre, Concordia University. 7141, rue Sherbrooke O., Montreal, Quebec H4B 1R6, Canada. Electronic address: lisa.kakinami@concordia.ca.
3 Research Centre of the Sainte-Justine University Hospital, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020, avenue des Pins O., Montreal, Quebec H3A 1A2, Canada.
4 Research Centre of the Sainte-Justine University Hospital, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Pediatrics, Université de Montréal, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
5 Department of Pediatrics, Université de Montréal, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Institut National de la Recherche Scientifique (INRS) - Institut Armand Frappier, 531, boulevard des Prairies, Laval, Québec H7V 1B7, Canada. Electronic address: tracie.barnett@iaf.inrs.ca.

This paper examined prospective associations between built environment features assessed at baseline using direct audits and adiposity outcomes two years later in Montreal, Canada. Data stem from the Quebec Adipose and Lifestyle Investigation in Youth study of 630 children aged 8-10 years with a parental history of obesity. Baseline measurements took place between 2005 and 2008. Follow-up took place between 2008 and 2011. Built environment features were assessed at baseline in up to 10 contiguous street segments around participants' residential addresses using on-site audits. Analyses were restricted to participants who reported the same address both at baseline and follow-up. Prospective associations between adiposity outcomes at follow-up (BMI z-score and waist-height ratio) and built environment features at baseline (traffic-calming features, pedestrian aids, disorder, physical activity facilities, convenience stores, and fast-food restaurants) were examined using multivariable regression models. 391 children were included in the analyses. In fully-adjusted models, children living in residential areas with presence of pedestrian aids had lower BMI z-score, and lower waist-height ratio. Also, children residing in residential areas with at least one convenience store had lower BMI z-score, and lower waist-height ratio at follow-up. Findings provide evidence of the potential role of street-level urban design features in shaping childhood adiposity. To better inform policy and intervention, future research should explore the possibility of reducing obesogenic neighbourhoods by enhancing street-level design features.