Childhood Obesity and the Food Environment: A Population-Based Sample of Public School Children in New York City

Applying the Family Stress Model to responsive feeding and early obesity prevention

Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.

Gentrification and childhood obesity: Evidence from New York City public school students in public housing

OBJECTIVE

The study objective was to determine the effect of gentrification on the weight outcomes of New York City public school students living in public housing.

METHODS

In a prospective cohort of 19,022 New York City public school students in public housing followed during 2009-2017, weight outcomes of students living in public housing buildings in gentrified neighborhoods were compared to those living in consistently low-socioeconomic-status neighborhoods; assignment was quasi-random in each borough.

RESULTS

Among the 42,182 student-year observations, gentrification did not increase weight outcomes significantly, for BMI z scores (0.037; 95% CI: -0.012 to 0.086), obesity (0.6 percentage points [pp]; 95% CI: -0.9 to 2.1), or overweight (1.3 pp; 95% CI: -0.7 to 3.2). However, heterogeneous effects by borough were found, where the gentrification in Manhattan increased students' BMI z scores by 0.19 (95% CI: 0.09-0.29), obesity by 3.4 pp (95% CI: 0.03-6.5), and overweight by 9.2 pp (95% CI: 6.3-12.1). No heterogeneity by race and ethnicity, gender, or age was found.

CONCLUSIONS

With strong internal validity, this study shows that neighborhood gentrification differentially influenced children's health through obesity, based on borough of residence. Such findings could inform policies or interventions focused on subpopulations and geographies.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

[Hygiene and health diffusion and the prevention of obesity in Spain: the work of Jesús Noguer Moré (1903-1983)]

Introduction

Introduction: among the epidemiological challenges facing Spanish society in the first half of the 20th century, the problem of malnutrition stood out. Although hunger and malnutrition were the most prevalent forms, overweight and obesity were beginning to emerge, particularly among the wealthier classes. In all cases, and especially in the overnutrition situation, the issue was not so much economic as one of lack of knowledge. For this reason, for the hygienists, dissemination and education in food and nutrition was fundamental. In this field, the contribution of the Catalan endocrinologist Jesús Noguer Moré (1903-1983) stands out. The aim is to analyze the work he devoted to obesity. Material and methods: bibliographic analysis of the works of Jesús Noguer Moré. Results and conclusion: he considered obesity as a pathology of multifactorial etiology with serious consequences for morbidity and mortality. It would involve everything from genetics to previous pathologies, as well as inadequate dietary and lifestyle habits. Its therapeutic approach should be based on calorie restriction and physical activity. He underlined the role of certain types of family or professional activities in promoting overweight and obesity. In terms of prevention, he emphasized the importance of culinary and gastronomic practices, while at the same time placing the responsibility for these practices on housewives. A gender discourse that led Noguer to place women as the target group for his dissemination activities and where the ideal of feminine beauty in force in the inter-war period was very much present.

COVID-19 vaccines for children: Racial and ethnic disparities in New York City

Vaccination is an indispensable tool to reduce negative outcomes due to COVID-19. Although COVID-19 disproportionately affected lower income and Black and Hispanic communities, these groups have had lower population-level uptake of vaccines. Using detailed cross-sectional data, we examined racial and ethnic group differences in New York City schoolchildren becoming fully vaccinated (two doses) within 6 months of vaccine eligibility. We matched school enrollment data to vaccination data in the Citywide Immunization Registry, a census of all vaccinations delivered in New York City. We used ordinary least squares regression models to predict fully vaccinated status, with key predictors of race and ethnicity using a variety of different control variables, including residential neighborhood or school fixed effects. We also stratified by borough and by age. The sample included all New York City public school students enrolled during the 2021-2022 school year. Asian students were most likely to be vaccinated and Black and White students least likely. Controlling for student characteristics, particularly residential neighborhood or school attended, diminished some of the race and ethnicity differences. Key differences were also present by borough, both overall and by racial and ethnic groups. In sum, racial and ethnic disparities in children's COVID-19 vaccination were present. Vaccination rates varied by the geographic unit of borough; controlling for neighborhood characteristics diminished some disparities by race and ethnicity. Neighborhood demographics and resources, and the attributes, culture and preferences of those who live there may affect vaccination decisions and could be targets of future efforts to increase vaccination rates.

Association of fast-food restaurants with overweight and obesity in school-aged children and adolescents: A systematic review and meta-analysis

We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.

Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

OBJECTIVE

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program.

DESIGN

Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Food (n = 426) and PA (n = 552) Outlets.

MAIN OUTCOME MEASURES

Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively.

ANALYSIS

Descriptive statistics are presented as means ± SD or percentages.

RESULTS

High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions.

CONCLUSIONS AND IMPLICATIONS

The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

Retail Food Environment around Schools in Barcelona by Neighborhood Socioeconomic Status: Implications for Local Food Policy

Childhood obesity is a relevant public health problem. The school food environment has been identified as an important factor for promoting healthy eating behaviors. This study assessed the availability of and proximity to unhealthy food stores around schools (n = 22) in the city of Barcelona and its association with neighborhood socioeconomic status (NSES). We conducted this cross-sectional study between 2019 and 2020. First, we identified all food retailers (n = 153) within a 400-m buffer around each school and identified those selling unhealthy food products. Then, we used Poison regression models to measure the association between NSES and the healthy food availability index (HFAI), adjusting for population density and distance. A total of 95% of the food establishments studied were classified as unhealthy (n = 146). In all, 90% of schools that had, at least, two unhealthy retailers in their proximity. There were significant differences in the mean distance to unhealthy establishments according to neighborhood SES and population density (p < 0.05). We found a positive association between schools located in higher SES neighborhoods and a higher availability and affordability of healthy food products (IIR = 1.67, 95% CI = 1.45−1.91 p = 0.000). We found strong social inequalities in the supply of healthy foods in Barcelona. Local food policy interventions addressing retail food environment around schools should consider socioeconomic inequalities.

The link between gentrification, children's egocentric food environment, and obesity

While advocates argue that gentrification changes the neighborhood food environment critical to children's diet and health, we have little evidence documenting such changes or the consequences for their health outcomes. Using rich longitudinal, individual-level data on nearly 115,000 New York City children, including egocentric measures of their food environment and BMI, we examine the link between neighborhood demographic change ("gentrification"), children's access to restaurants and supermarkets, and their weight outcomes. We find that children in rapidly gentrifying neighborhoods see increased access to fast food and wait-service restaurants and reduced access to corner stores and supermarkets compared to those in non-gentrifying areas. Boys and girls have higher BMI following gentrification, but only boys are more likely to be obese or overweight. We find public housing moderates the relationship between gentrification and weight, as children living in public housing are less likely to be obese or overweight.

Mapping the Way to Good Health: The Interdisciplinary Challenges of Geographers in Medical Research

Geography has an important role to play in shaping the direction of medical research. In particular, its tools and theory provide essential understanding to the impacts of place on health behaviors and outcomes. Understanding some of its evolution-particularly into the subfield of medical geography-is therefore useful both for geographers and medical researchers. In this paper, we present some of the debates that geographers have grappled with, the growth of GIS (particularly in the context of medical research), some important methodological considerations that geographers help center, and some recommendations for future work at this nexus. Throughout, we speak from the perspective of geographers who have worked nearly exclusively in the health sciences since obtaining our PhDs.

The Prenatal Neighborhood Environment and Geographic Hotspots of Infants with At-risk Birthweights in New York City

Infants born with low or high ("at-risk") birthweights are at greater risk of adverse health outcomes across the life course. Our objective was to examine whether geographic hotspots of low and high birthweight prevalence in New York City had different patterns of neighborhood risk factors. We performed census tract-level geospatial clustering analyses using (1) birthweight prevalence and maternal residential address from an all-payer claims database and (2) domains of neighborhood risk factors (socioeconomic and food environment) from national and local datasets. We then used logistic regression analysis to identify specific neighborhood risk factors associated with low and high birthweight hotspots. This study examined 2088 census tracts representing 419,025 infants. We found almost no overlap (1.5%) between low and high birthweight hotspots. The majority of low birthweight hotspots (87.2%) overlapped with a socioeconomic risk factor and 95.7% overlapped with a food environment risk factor. Half of high birthweight hotspots (50.0%) overlapped with a socioeconomic risk factor and 48.8% overlapped with a food environment risk factor. Low birthweight hotspots were associated with high prevalence of excessive housing cost, unemployment, and poor food environment. High birthweight hotspots were associated with high prevalence of uninsured persons and convenience stores. Programs and policies that aim to prevent disparities in infant birthweight should examine the broader context by which hotspots of at-risk birthweight overlap with neighborhood risk factors. Multi-level strategies that include the neighborhood context are needed to address prenatal pathways leading to low and high birthweight outcomes.

Qualities of the Restaurant Food Environment: A Direct Observation Pilot Study of Restaurants Located Near High Schools

Objective: This study aimed to identify and describe healthful and youth-oriented qualities of the restaurant food environment around high schools. Methods: Using direct observation data from 58 restaurants located within a half-mile (804.5 meters) of all high schools in a single district, two index measures of the restaurant food environment were created: healthfulness index and youth-oriented index. Wilcoxon signed-rank order was used to examine differences in restaurant features according to index scores. Results: Mean healthfulness score was 8.9 (range = 2-14, max = 19) and mean youth-oriented score was 5.5 (range = 0-11, max = 12). Differences were found in signed-rank order of healthfulness and youth-oriented index restaurant scores (p = 0.02). Conclusion: Results suggest that restaurants have room for improvement in offering customers a healthful environment, some restaurants are more likely to appeal to youth, and that youth-oriented restaurants were different than restaurants with high healthfulness scores. Further qualitative exploration of food environment features will help contextualize the influence of restaurants on youth eating behaviors.

Social Determinants of Cardiovascular Disease

Social determinants of health (SDoH), which encompass the economic, social, environmental, and psychosocial factors that influence health, play a significant role in the development of cardiovascular disease (CVD) risk factors as well as CVD morbidity and mortality. The COVID-19 pandemic and the current social justice movement sparked by the death of George Floyd have laid bare long-existing health inequities in our society driven by SDoH. Despite a recent focus on these structural drivers of health disparities, the impact of SDoH on cardiovascular health and CVD outcomes remains understudied and incompletely understood. To further investigate the mechanisms connecting SDoH and CVD, and ultimately design targeted and effective interventions, it is important to foster interdisciplinary efforts that incorporate translational, epidemiological, and clinical research in examining SDoH-CVD relationships. This review aims to facilitate research coordination and intervention development by providing an evidence-based framework for SDoH rooted in the lived experiences of marginalized populations. Our framework highlights critical structural/socioeconomic, environmental, and psychosocial factors most strongly associated with CVD and explores several of the underlying biologic mechanisms connecting SDoH to CVD pathogenesis, including excess stress hormones, inflammation, immune cell function, and cellular aging. We present landmark studies and recent findings about SDoH in our framework, with careful consideration of the constructs and measures utilized. Finally, we provide a roadmap for future SDoH research focused on individual, clinical, and policy approaches directed towards developing multilevel community-engaged interventions to promote cardiovascular health.

Improving spatial data in health geographics: a practical approach for testing data to measure children's physical activity and food environments using Google Street View

Background

Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children’s health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity. Data is usually provided ‘as is’, and therefore may be unsuitable for retrospective or longitudinal studies of health outcomes. In this paper we outline a practical approach to both fill gaps in geospatial datasets, and to test their temporal validity. This approach is applied to both district council and open-source datasets in the Taranaki region of Aotearoa New Zealand.

Methods

We used the ‘streetview’ python script to download historic Google Street View (GSV) images taken between 2012 and 2016 across specific locations in the Taranaki region. Images were reviewed and relevant features were incorporated into GIS datasets.

Results

A total of 5166 coordinates with environmental features missing from council datasets were identified. The temporal validity of 402 (49%) environmental features was able to be confirmed from council dataset considered to be ‘complete’. A total of 664 (55%) food outlets were identified and temporally validated.

Conclusions

Our research indicates that geospatial datasets are not always complete or temporally valid. We have outlined an approach to test the sensitivity and specificity of GIS datasets using GSV images. A substantial number of features were identified, highlighting the limitations of many GIS datasets.

A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida

A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.

Neighborhoods matter; but for whom? Heterogeneity of neighborhood disadvantage on child obesity by sex

Although evidence suggests that neighborhood context, particularly socioeconomic context, influences child obesity, little is known about how these neighborhood factors may be heterogeneous rather than monolithic. Using a novel dataset comprised of the electronic medical records for over 250,000 children aged 2-17 nested within 992 neighborhoods in the greater Houston area, we assessed whether neighborhoods influenced the obesity of children differently based on sex. Results indicated that neighborhood disadvantage, assessed using a comprehensive, multidimensional, latent profile analysis-generated measure, had a strong, positive association with the odds of obesity for both boys and girls. Interactions revealed that the relationship between disadvantage and obesity was stronger for girls, relative to boys. Our findings demonstrated the complex dynamics underlying the influence of residential neighborhood context on obesity for specific subgroups of children.

Does Proximity to Fast Food Cause Childhood Obesity? Evidence from Public Housing

We examine the causal link between proximity to fast food and the incidence of childhood obesity among low-income households in New York City. Using individual-level longitudinal data on students living in public housing linked to restaurant location data, we exploit the naturally occurring within-development variation in distance to fast food restaurants to estimate the impact of proximity on obesity. Since the assignment of households to specific buildings is based upon availability at the time of assignment to public housing, the distance between student residence and retail outlets-including fast food restaurants, wait-service restaurants, supermarkets, and corner stores-is plausibly random. Our credibly causal estimates suggest that childhood obesity increases with proximity to fast food, with larger effects for younger children who attend neighborhood schools.