Study of Neighborhood Environment for Cardiovascular Health in a Squatter Area in Nepal

Background Behavioral risk factors for cardiovascular diseases are prevalent among the urban poor in Nepal. Understanding environmental factors such as the availability of retailers selling tobacco, alcohol, and junk food, as well as neighbourhood access to and the built environment's support for physical activity is critical for addressing the rising burden of cardiovascular disease in the community. Objective To identify aspects of the community environment that contribute to behavioral risk factors, focusing on the food supply system, built environment, walkability, and the marketing, availability, and accessibility of tobacco and alcohol. Method Spatial data were collected in the Sinamangal-Minbhawan squatter area of Kathmandu using a mixed-method approach. Geographic Information System tool, direct field observations, including spot observation and transect walk, and Market Basket Surveys were done by a trained research team during the period March-May 2022. Data were analyzed using methodological triangulation, combining interviews, observations, GPS data, and Google Earth imagery in ArcMap 10.8. Thematic analysis of market basket survey interviews involved coding transcripts for cardiovascular disease-related behaviors, with codes refined into six key themes, including sociodemographic characteristics. Result We reported a few vegetable outlets and no fruit shops. There were 84 fast-food outlets and local restaurants with junk food and soft drinks available. We observed 77 tobacco outlets with a variety of tobacco products easily available to all. There were 48 alcohol outlets in the area, which, except for four outlets, were present together with tobacco and junk food outlets. Tobacco and alcohol products were largely consumed by men of all age groups. Conclusion Community-based health programs can raise awareness about the importance of healthy behavior. Advocacy efforts to promote policies that support improved access to healthy foods, smoke-free public spaces, and safe environments for physical activity are important to provide community members with healthy choices.