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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Concincion S, van Houtum L, Verhoeff A, Dedding C. Bored, afraid, alone: What can we learn from children with paediatric obesity about the impact of the COVID-19 pandemic for future pandemics, care practices and policies? J Pediatr Nurs 2024; 77:162-171. [PMID: 38522210 DOI: 10.1016/j.pedn.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/16/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE The aim of this study was to gain insight into the perspectives of children with paediatric obesity themselves, during the pandemic and afterwards, regarding their wellbeing and health, and to solicit their advice on tailoring obesity care to match their daily realities. DESIGN AND METHODS We used a 'draw, write and tell' interview technique, conducted walk-alongs, participant observations and a group session with children with paediatric obesity from seldom-heard communities in Amsterdam, the Netherlands. Data was analysed using reflexive thematic analysis. RESULTS Children reported that during lockdowns they were confined to the house, causing them to feel bored and alone. This triggered them to fall into previous unhealthy patterns, such as an increase in sitting on the couch or lying in bed, gaming or watching TV, feeling hungry a lot and eating more. Some children experienced major events, such as mourning the death of a loved one or taking care of other family members, and thus felt they had to grow up fast. CONCLUSION Our study adds to our understanding of the mechanisms of the impact of the COVID-19 pandemic from the perspectives of children with paediatric obesity from seldom-heard communities and emphasizes the importance of considering how the pandemic (and related measures) affected the daily - as well as future - lives of children in vulnerable circumstances. PRACTICAL IMPLICATIONS The recommendations children gave could be explored as pathways for more child-centred, successful and tailored obesity care practices and policies in order to support their (mental) wellbeing and health.
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Affiliation(s)
- Siegnella Concincion
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Youth Health Care Department (JGZ) of the Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Lieke van Houtum
- Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Arnoud Verhoeff
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Sarphati Amsterdam, Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law and Humanities (ERH), Amsterdam University Medical Centers, location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
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Duh-Leong C, Messito MJ, Katzow MW, Kim CN, Mendelsohn AL, Scott MA, Gross RS. Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact. Child Obes 2024. [PMID: 38301173 DOI: 10.1089/chi.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background: Adverse social determinants of health (SDoHs), specifically psychosocial stressors and material hardships, are associated with early childhood obesity. Less is known about whether adverse SDoHs modify the efficacy of early childhood obesity prevention programs. Methods: We conducted a secondary analysis of publicly insured birthing parent-child dyads with Latino backgrounds participating in a randomized controlled trial of the Starting Early Program (StEP), a child obesity prevention program beginning in pregnancy. We measured baseline adverse SDoHs categorized as psychosocial stressors (low social support, single marital status, and maternal depressive symptoms) and material hardships (food insecurity, housing disrepair, and financial difficulties) individually and cumulatively in the third trimester. Logistic regression models tested effects of adverse SDoHs on StEP attendance. We then tested whether adverse SDoHs moderated intervention impacts on weight at age 2 years. Results: We observed heterogeneous effects of adverse SDoHs on outcomes in 358 parent-child dyads. While housing disrepair decreased odds of higher attendance [adjusted odds ratio (aOR) 0.52, 95% confidence interval (CI): 0.29-0.94], high levels of psychosocial stressors doubled odds of higher attendance (aOR 2.36, 95% CI: 1.04-5.34). Similarly, while certain adverse SDoHs diminished StEP impact on weight (e.g., housing disrepair), others (e.g., high psychosocial stress) enhanced StEP impact on weight. Conclusions: Effects of adverse SDoHs on intervention outcomes depend on the specific adverse SDoH. Highest engagement and benefit occurred in those with high psychosocial stress at baseline, suggesting that StEP components may mitigate aspects of psychosocial stressors. Findings also support integration of adverse SDoH assessment into strategies to enhance obesity prevention impacts on families with material hardships. Trial Registration: This study is registered on clinicaltrials.gov: Starting Early Obesity Prevention Program (NCT01541761); https://clinicaltrials.gov/ct2/show/NCT01541761.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Michelle W Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Christina N Kim
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Ramel M, Wilfley DE, Tabak R, Lew D, Moursi NA, Kilanowski C, Cook SR, Eneli IU, Quattrin T, Schechtman KB, Epstein LH. Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment. Pediatr Obes 2023; 18:e13062. [PMID: 37282798 PMCID: PMC11342443 DOI: 10.1111/ijpo.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Family based treatment is an effective, multipronged approach to address obesity as it plagues families. OBJECTIVE To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. METHODS Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. RESULTS A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. CONCLUSIONS Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
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Affiliation(s)
- Melissa Ramel
- Department of Family and Consumer Sciences, Fontbonne University, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nasreen A. Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Ihouma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth B. Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Willer BL, Mpody C, Nafiu OO. Racial Inequity in Pediatric Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2023; 13:108-116. [PMID: 37168831 PMCID: PMC10150147 DOI: 10.1007/s40140-023-00560-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
Purpose of Review Minority health disparities have received renewed attention in the USA following several highly publicized racial injustices in 2020. Though the focus has been largely on adults, children are not immune to these inequities. By reviewing racial disparities in pediatric perioperative care, we aim to engage the anesthesia community in the fight against systemic racism. Recent Findings Minority children have higher rates of anesthetic and surgical morbidity compared to White children, including respiratory events, length of stay, hospital costs, and even death. These inequities occur across surgical specialties and environments. Summary Racial disparities in the perioperative health and management of children are ubiquitous. Herein, we will summarize recent pediatric health disparity literature, discuss some important contributors to persistent inequities, and propose avenues for anesthesiologists to impact the pursuit of equitable healthcare outcomes.
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Affiliation(s)
- Brittany L. Willer
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Olubukola O. Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Huang Y, Sparks PJ. Longitudinal exposure to neighborhood poverty and obesity risk in emerging adulthood. SOCIAL SCIENCE RESEARCH 2023; 111:102796. [PMID: 36898786 PMCID: PMC10009773 DOI: 10.1016/j.ssresearch.2022.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/18/2023]
Abstract
This study uses data from the longitudinal Panel Study of Income Dynamics data and its Transition to Adulthood (TA) Study (2005-2017), in conjunction with decades of neighborhood-level data from the U.S. decennial census and American Community Survey, to examine the relationship between individuals' neighborhood poverty exposure trajectories in childhood and the likelihood of obesity in emerging adulthood. Latent growth mixture models reveal that exposure to neighborhood poverty differs considerably for white and nonwhite individuals over their childhood life course. Durable exposure to neighborhood poverty confers greater subsequent obesity risks in emerging adulthood than transitory experiences of neighborhood poverty. Racial differences in the changing and persistent trajectories of neighborhood poverty help explain part of the racial differences in obesity risks. Among nonwhites, and compared to consistent nonpoor neighborhood conditions, both durable and transitory neighborhood poverty exposures are significantly associated with higher obesity risks. This study suggests that a theoretical framework that integrates key elements of the life-course perspective is helpful to uncover the individual and structural pathways through which neighborhood histories in poverty shape population health in general.
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Affiliation(s)
- Ying Huang
- Department of Demography, University of Texas at San Antonio, San Antonio, TX 78207, USA.
| | - P Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, TX 78207, USA.
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Neshteruk CD, Day SE, Konty KJ, Armstrong SC, Skinner AC, D’Agostino EM. Severe obesity and fitness in New York City public school youth, 2010-2018. BMC Public Health 2023; 23:345. [PMID: 36797700 PMCID: PMC9933284 DOI: 10.1186/s12889-023-15267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Obesity is associated with poorer youth fitness. However, little research has examined the magnitude of this relationship in youth with severe obesity. Therefore, we sought to determine the relationship between increasing weight status and fitness within a sample of children and adolescents from New York City public schools. METHODS This study utilized longitudinal data from the NYC Fitnessgram dataset years 2010-2018. Height and weight along with fitness were measured annually during physical education classes. Severity of obesity was defined using body mass index relative to the 95th percentile and then categorized into classes. A composite measure of fitness was calculated based on scores for three fitness tests: aerobic capacity, muscular strength, and muscular endurance. To examine the weight status-fitness relationship, repeated measures mixed models with random-intercepts were constructed. Stratified models examined differences by demographic factors. RESULTS The sample included 917,554 youth (51.8% male, 39.3% Hispanic, 29.9% non-Hispanic Black, 14.0%, 4.6%, and 1.6% class I, II and III obesity, respectively). Compared to youth with healthy weight, increasing severity of obesity was associated with decreased fitness: overweight (β = - 0.28, 95% CI:-0.29;-0.28), class I obesity (β = - 0.60, 95% CI:-0.60; - 0.60), class II obesity (β = - 0.94, 95% CI:-0.94; - 0.93), and class III obesity (β = - 1.28; 95% CI:-1.28; - 1.27). Stratified models showed the association was stronger among male and non-Hispanic White youth. CONCLUSION Findings revealed that more severe obesity was associated with lower fitness. Future research is needed to develop targeted interventions to improve fitness in youth with obesity.
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Affiliation(s)
- Cody D. Neshteruk
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA
| | - Sophia E. Day
- grid.238477.d0000 0001 0320 6731New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY USA
| | - Kevin J. Konty
- grid.238477.d0000 0001 0320 6731New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY USA
| | - Sarah C. Armstrong
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University, Durham, North Carolina USA ,grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina USA
| | - Asheley C. Skinner
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University, Durham, North Carolina USA
| | - Emily M. D’Agostino
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina USA
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8
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Using Explainable Artificial Intelligence to Discover Interactions in an Ecological Model for Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159447. [PMID: 35954804 PMCID: PMC9367834 DOI: 10.3390/ijerph19159447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 02/05/2023]
Abstract
Ecological theories suggest that environmental, social, and individual factors interact to cause obesity. Yet, many analytic techniques, such as multilevel modeling, require manual specification of interacting factors, making them inept in their ability to search for interactions. This paper shows evidence that an explainable artificial intelligence approach, commonly employed in genomics research, can address this problem. The method entails using random intersection trees to decode interactions learned by random forest models. Here, this approach is used to extract interactions between features of a multi-level environment from random forest models of waist-to-height ratios using 11,112 participants from the Adolescent Brain Cognitive Development study. This study shows that methods used to discover interactions between genes can also discover interacting features of the environment that impact obesity. This new approach to modeling ecosystems may help shine a spotlight on combinations of environmental features that are important to obesity, as well as other health outcomes.
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Theoretical Approaches to Research on the Social Determinants of Obesity. Am J Prev Med 2022; 63:S8-S17. [PMID: 35725145 DOI: 10.1016/j.amepre.2022.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022]
Abstract
This article reviews selected theoretical approaches explaining the social determinants of obesity. The significance of this topic for medicine, public health, and other areas of obesity-related research is the growing body of evidence showing that the social environment is often key to understanding the risk of obesity. A review of relevant literature and analysis of empirical evidence linking theory to data in studies of obesity was performed. Several studies show that differences in social behavior and living conditions associated with SES, lifestyles, inequality, and other social variables have important roles in weight gain. Because the social determinants of obesity often begin in childhood, life course theory and its concepts of cumulative advantage/disadvantage and cumulative inequality are initially reviewed, followed by a discussion of how fundamental cause theory, health lifestyle theory, and cultural capital theory can be applied to obesity research. The stress process model and the concepts of social networks and neighborhood disadvantage concerning obesity are also included.
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Azevedo LB, Stephenson J, Ells L, Adu-Ntiamoah S, DeSmet A, Giles EL, Haste A, O'Malley C, Jones D, Chai LK, Burrows T, Collins CE, van Grieken A, Hudson M. The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis. Obes Rev 2022; 23:e13373. [PMID: 34747118 DOI: 10.1111/obr.13373] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 12/13/2022]
Abstract
The aim of this systematic review and meta-analysis was to examine the effectiveness of e-health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomized controlled trials where interventions were delivered via e-health (e.g., computers, tablets, and smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report body mass index (BMI) or BMI z-score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behavior change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a nonzero effect (standardized mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I2 = 74%, p < 0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits, and sustainability should be further studied.
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Affiliation(s)
- Liane B Azevedo
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | | | - Ann DeSmet
- Faculty of Psychological and Educational Sciences, Université libre de Bruxelles, Brussels, Belgium.,Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Anna Haste
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Daniel Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Li Kheng Chai
- Health and Wellbeing Queensland, Queensland Government, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, New South Wales, Australia
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle Hudson
- Middlesbrough 0-19 Service (Healthier Together), Harrogate and District NHS Foundation Trust, Harrogate, UK
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11
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Andersson MA, Garcia MA, Glass J. Work-Family Reconciliation and Children's Well-Being Disparities across OECD Countries. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2021; 100:794-820. [PMID: 34711998 PMCID: PMC8547204 DOI: 10.1093/sf/soaa132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Socioeconomic inequalities in health and well-being are large, beginning early in childhood and accumulating over the life course, but they also vary widely across rich developed nations. Despite this well-known cross-national variation, research has yet to examine why children's health disparities might be larger or smaller based on national policy contexts and macroeconomic conditions. Parental health and well-being suffer under high work-family or economic strain, which may directly impact children's health inequalities by family social class. These childhood health disadvantages, if not substantially improved, compound to even larger adult inequalities. To examine the role of national work-family reconciliation in children's health, we merge country-level policy data with 2006 and 2010 World Health Organization child-level data on mental and physical well-being and family economic disadvantage. Based on adjusted estimates, we find greatly narrowed disparities in children's self-rated health as work flexibility and vacation-sick leave mandates become more generous. However, cash transfer policies including family benefits spending and childcare costs were not associated with the size of children's health disparities. Taken together, our results suggest the distinctive value of better work-family accommodations, rather than any generic cash allowances, for lessening family-based inequalities in children's health and human capital development.
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12
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Hartono S, Cochrane T, Niyonsenga T, Kinfu Y. A longitudinal analysis of the effect of maternal region-of-birth on transitions in children's bodyweight status from early childhood to late adolescence in Australia: A population-based cohort study. Prev Med 2021; 153:106832. [PMID: 34624388 DOI: 10.1016/j.ypmed.2021.106832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/11/2021] [Accepted: 10/03/2021] [Indexed: 01/05/2023]
Abstract
Although 49% of Australian residents have at least one overseas-born parent, little is known about children's longitudinal bodyweight transitions among the migrant population. This study examines the net associations between maternal region-of-birth and children's longitudinal bodyweight transitions between underweight, normal, and overweight/obese status from ages 2 to 17 years. A sample of 8889 children was drawn from seven waves of a national population-based cohort study, the Longitudinal Study of Australian Children, conducted between 2004 and 2016. A multistate approach was used to investigate (i) the net effect of mother's region-of-birth on children's bodyweight transitions, (ii) the net estimation of cumulative transition probabilities, and (ii) the net conditional bodyweight expectancy, controlling for child-, family-, and neighbourhood-factors associated with children's bodyweight. Our results showed children of Oceania and African mothers had unfavourable outcomes (i.e., lower remission from or higher incidence of underweight or overweight/obese status) than children of non-migrants. Toddlers with suboptimal bodyweight status (especially those from disadvantaged groups) had higher net cumulative probabilities of staying in that status as a 17-year-old adolescent unless they managed to transfer to normal weight in the primary school years. The 15-year bodyweight expectancy depended on the initial bodyweight status at age two years, with some children of migrant mothers affected longer by suboptimal bodyweight status. In Australia, region-of-birth related disparities in bodyweight started early and were of significant duration throughout development until late adolescence. Culturally tailored health programs should begin at least as early as two years of age.
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Affiliation(s)
- Susan Hartono
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | - Tom Cochrane
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | - Theo Niyonsenga
- Health Research Institute, University of Canberra, Bruce, ACT, Australia; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Bruce, ACT, Australia; College of Medicine, Qatar University, Doha, Qatar; Department of Health Metrics, University of Washington, Seattle, USA; Murdoch Children's Research Institute, Melbourne, Australia.
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13
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Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. [Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]. Obes Rev 2021; 22 Suppl 5:e13350. [PMID: 34708540 PMCID: PMC9138052 DOI: 10.1111/obr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X Ayala
- School of Public Health, San Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK Center, San Diego, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica
| | - Abby C King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California, EE. UU
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, Irlanda del Norte, Belfast, Reino Unido
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Mineápolis, Minesota, EE. UU
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Ayala GX, Monge‐Rojas R, King AC, Hunter R, Berge JM. The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obes Rev 2021; 22 Suppl 3:e13246. [PMID: 33951272 PMCID: PMC8365653 DOI: 10.1111/obr.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X. Ayala
- School of Public HealthSan Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK CenterSan DiegoCaliforniaUSA
| | - Rafael Monge‐Rojas
- Health and Nutrition UnitCosta Rican Institute for Research and Education on Nutrition and Health (INCIENSA)CartagoCosta Rica
| | - Abby C. King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ruth Hunter
- Centre for Public HealthQueen's University Belfast, North IrelandBelfastUK
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
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Xiong P, Liang X, Chen H, Chen L, Zuo L, Jing C, Hao G. Association Between Childhood Neighborhood Quality and the Risk of Cognitive Dysfunction in Chinese Middle-Aged and Elderly Population: The Moderation Effect of Body Mass Index. Front Aging Neurosci 2021; 13:645189. [PMID: 34054503 PMCID: PMC8155274 DOI: 10.3389/fnagi.2021.645189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Identification of early modifiable factors is crucial to delay or prevent the development of cognitive impairment and reduce the social and economic burden. Objective: This study aimed to examine the longitudinal associations of childhood neighborhood quality (CNQ) with the risk of later-life cognitive dysfunction and the role of body mass index (BMI) in this association. Methods: A total of 8,289 community-dwelling middle-aged and elderly population from wave 2011, wave 2013, and wave 2015 of the China Health and Retirement Longitudinal Study (CHARLS) were included. Cognitive function and CNQ were measured by standardized questionnaires. Multilevel linear regression models were used to estimate the associations of CNQ and cognitive function. The interactions of BMI with CNQ in the progress of cognitive function were also estimated. Results: The participants with higher CNQ had a significantly low risk of cognitive impairment than those with lower CNQ score (β = 0.067, 95% CI: 0.031, 0.103), and the results remained similar (β = 0.039, 95% CI: 0.004, 0.075) after controlling other confounding variables. Furthermore, there was an interaction between BMI with CNQ score (P < 0.001) for the risk of cognitive impairment. In BMI-stratified analysis, we found that the association of CNQ and cognitive function was not statistically significant in overweight or obese population (β = 0.019, 95% CI: -0.032, 0.070), but was statistically significant in people with lower BMI (β = 0.059, 95% CI: 0.010, 0.107). Conclusions: Higher CNQ score is significantly associated with the lower risk of cognitive dysfunction in adulthood. BMI may moderate the associations of CNQ with the risk of cognitive function.
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Affiliation(s)
- Peng Xiong
- Division of Medical Psychology and Behavioral Sciences, Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Haiyan Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Li Chen
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Lei Zuo
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
- Guangdong Key Laboratory of Environmental Exposure and Health, Jinan University, Guangzhou, China
| | - Guang Hao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
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Miller M, Saldarriaga EM, Jones-Smith JC. Household socioeconomic status modifies the association between neighborhood SES and obesity in a nationally representative sample of first grade children in the United States. Prev Med Rep 2020; 20:101207. [PMID: 33083208 PMCID: PMC7553333 DOI: 10.1016/j.pmedr.2020.101207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
We investigate household SES, neighborhood SES and childhood obesity. Sample was nationally representative of US first graders in 2011. Both SES variables–household and neighborhood SES–were associated with obesity. No evidence of greater prevalence of obesity due to low SES on both dimensions. In low SES neighborhoods, high household SES did not mitigate obesity prevalence. In low SES households, high neighborhood SES did not mitigate obesity prevalence.
Both low family socioeconomic status (SES) and low neighborhood SES have been associated with higher levels of childhood obesity. However, little is known about how these two factors operate together. The purpose of this study was to determine if the association between neighborhood SES and obesity varies across household SES. We used the first-grade round of the Early Childhood Longitudinal Study, Kindergarten Class of 2011 (ECLS-K:2011). Household SES was defined based on income, education, and occupation. Neighborhood SES was defined by the percent of households living in poverty in the child’s school district. Log-binomial regression models estimated the association between neighborhood SES and obesity and tested whether this association varied by household SES. We found the association between neighborhood SES and obesity varied significantly by household SES (p-interaction = 0.002). For children in the lowest tertile of neighborhood SES, prevalence of obesity was not statistically significantly different comparing children with low, middle or high household SES (Predicted probability (PP)lowest 0.20 (95% CI: 0.17, 0.23), PPmiddle 0.21 (95%CI: 0.18, 0.24), PPhighest 0.16 (95%CI: 0.12, 0.20)). Conversely, within the highest and the middle tertiles of neighborhood SES, children with high household SES have significantly lower prevalence of obesity compared to children with the lowest household SES (PP: 0.09 (95%CI: 0.07, 0.11) vs 0.19 (0.16, 0.21) and (PP: 0.07 (95%CI: 0.05, 0.09) vs 0.17 (0.13, 0.21) for highest vs lowest household SES in middle and high neighborhood SES, respectively). Hence, low-SES in either variable is enough to be associated with increased prevalence of obesity.
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Affiliation(s)
- Michelle Miller
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Enrique M Saldarriaga
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, USA
| | - Jessica C Jones-Smith
- Departments of Health Services and Epidemiology, School of Public Health, University of Washington, Seattle, USA
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Vinopal K, Morrissey TW. Neighborhood disadvantage and children's cognitive skill trajectories. CHILDREN AND YOUTH SERVICES REVIEW 2020; 116:105231. [PMID: 32834271 PMCID: PMC7347335 DOI: 10.1016/j.childyouth.2020.105231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
This study examined how neighborhood poverty is associated with children's trajectories of growth in math and reading skills in early elementary school, and how these associations vary by student characteristics, using multilevel growth models with nationally representative data from the 2011 Early Childhood Longitudinal Study-Kindergarten Cohort. About one-quarter (25.6%) of children lived in communities of concentrated poverty. Findings suggest that achievement gaps by neighborhood disadvantage are large and present before Kindergarten, shrink during the Kindergarten year, but then widen the year following, and remain relatively consistent in the first years of elementary school. Growth in math skills appeared to vary more with neighborhood poverty than growth in reading skills. There was limited evidence that the relationship between neighborhood poverty and test score trajectories varied by child race, ethnicity, early education and Kindergarten experience, and parents' immigration status, but growth differences across student characteristics were small. Policy and research implications are discussed.
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Affiliation(s)
- Katie Vinopal
- The John Glenn College of Public Affairs, The Ohio State University, 1810 College Road, Columbus, OH 43210, United States
| | - Taryn W Morrissey
- Department of Public Administration and Policy, School of Public Affairs, American University, 4400 Massachusetts Ave. NW, Washington, DC 20016, United States
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18
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Graham C, Reither EN, Ciciurkaite G, Dev DA, Fargo J. Does context matter? A multilevel analysis of neighborhood disadvantage and children's sleep health. Sleep Health 2020; 6:578-586. [PMID: 32546433 DOI: 10.1016/j.sleh.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine how demographic, socioeconomic, and neighborhood characteristics are associated with bedtimes among US kindergarteners. DESIGN Parents reported bedtimes of their children as well as personal, household, and residential characteristics via interviews in the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) Class of 1998-1999. The ECLS-K links individual households to US Census tracts. SETTING A random selection of 1,280 schools and surrounding communities in the US. PARTICIPANTS A random selection of 16,936 kindergarteners and their parents. MEASUREMENTS The 2 outcomes were regular and latest weekday bedtimes of kindergarteners. Through a series of nested multilevel regression models, these outcomes were regressed on individual- and neighborhood-level variables, including race/ethnicity, sex, family type, household income, mother's educational attainment, neighborhood disorder, and several additional neighborhood characteristics. RESULTS Models showed significant (P < .05) bedtime disparities by race/ethnicity, sex, family income, and mother's educational attainment. Additionally, models tended to indicate that kindergarteners from disadvantaged neighborhoods experienced later bedtimes than children from more advantaged areas. Neighborhood characteristics accounted for a portion of racial/ethnic differences, suggesting that bedtime disparities are partly rooted in disparate environmental conditions. CONCLUSIONS Reducing disparities in childhood sleep may require programs that target not only children and their parents, but also the communities in which they reside.
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Affiliation(s)
| | - Eric N Reither
- Department of Sociology, Social Work and Anthropology, Utah State University, Logan, Utah; Utah State University, Logan, Utah.
| | | | - Dipti A Dev
- University of Nebraska-Lincoln, Lincoln, Nebraska
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19
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On the limitations of barriers: Social visibility and weight management in Cuba and Samoa. Soc Sci Med 2019; 239:112501. [DOI: 10.1016/j.socscimed.2019.112501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
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Qin W, Wang L, Xu L, Sun L, Li J, Zhang J, Shao H. An exploratory spatial analysis of overweight and obesity among children and adolescents in Shandong, China. BMJ Open 2019; 9:e028152. [PMID: 31444183 PMCID: PMC6707763 DOI: 10.1136/bmjopen-2018-028152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters. DESIGN Cross-sectional study. SETTING Shandong Province in China. PARTICIPANTS AND METHODS Data on 6 216 076 children and adolescents aged 7-18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran's I) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation. RESULTS The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or 'hot spots') of childhood OW/OB in the eastern coastal region, central region and southwestern region. CONCLUSIONS The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.
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Affiliation(s)
- Wenzhe Qin
- School of Public Health, Shandong University, Jinan, China
| | - Lu Wang
- Shandong Provincial Medical Examination Office, Shandong Province Health and Family Planning Commission, Jinan, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, China
| | - Long Sun
- School of Public Health, Shandong University, Jinan, China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, China
| | - Jiao Zhang
- School of Public Health, Shandong University, Jinan, China
| | - Hui Shao
- Department of Global Health Systems and Development School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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21
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Cunningham SA, Chandrasekar EK, Cartwright K, Yount KM. Protecting children's health in a calorie-surplus context: Household structure and child growth in the United States. PLoS One 2019; 14:e0220802. [PMID: 31393933 PMCID: PMC6687172 DOI: 10.1371/journal.pone.0220802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children's wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998-99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children's weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing.
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Affiliation(s)
- Solveig A. Cunningham
- Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, Georgia, United States of America
| | - Eeshwar K. Chandrasekar
- Department of Epidemiology and School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Kate Cartwright
- School of Public Administration, The University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Kathryn M. Yount
- Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, Georgia, United States of America
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22
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Goff SL, Garb JL, Guhn-Knight H, Priya A, Pekow PS, Lindenauer PK. Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations. J Paediatr Child Health 2019; 55:948-955. [PMID: 30548139 PMCID: PMC6555692 DOI: 10.1111/jpc.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 11/29/2022]
Abstract
AIM Publicly reported quality data theoretically enable parents to choose higher-performing paediatric practices. However, little is known about how parents decide where to seek paediatric care. We explored the relationship between geographic factors, care quality and choice of practice to see if the decision-making process could be described in terms of a 'gravity model' of spatial data. METHODS In the context of a randomised controlled trial, we used a geographic information system to calculate flow volume between practice locations and participants' homes, to locate subjects within a census tract, to determine distances between points and to perform exploratory mapping. Generalised linear modelling was then used to determine whether the data fit a gravity model, which is a spatial model that evaluates factors impacting travel from one set of locations to another. RESULTS A total of 662 women and 52 paediatric practices were included in the analysis. Proximity of a practice to home was the most important factor in choosing a practice (Z = -15.01, P < 0.001). Practice size was important to a lesser extent, with larger practices more likely to be chosen (Z = 8.96, P < 0.001). A practice's performance on quality measures was associated with choice only for women who had received an intervention to increase use of quality data (Z = 2.51, P < 0.05). CONCLUSIONS The gravity model and the concept of flow can help explain the choice of paediatric practice in a predominantly low-income, racially ethnic minority (non-White) urban population. This has important ramifications for the potential impact of publicly reported quality data.
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Affiliation(s)
- Sarah L Goff
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Medicine, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Jane L Garb
- Office of Research, Epidemiology and Biostatistics Core, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Haley Guhn-Knight
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Aruna Priya
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Penelope S Pekow
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Peter K Lindenauer
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Medicine, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
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23
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Borg A, Haughton CF, Sawyer M, Lemon SC, Kane K, Pbert L, Li W, Rosal MC. Design and methods of the Healthy Kids & Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention. BMC OBESITY 2019; 6:19. [PMID: 31171975 PMCID: PMC6545743 DOI: 10.1186/s40608-019-0240-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
Background One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
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Affiliation(s)
- Amy Borg
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Christina F Haughton
- Oak Hill Community Development Corporation, 74 Providence Street, Worcester, MA 01604 USA
| | - Mullen Sawyer
- 3Tufts University Friedman School of Nutrition and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Stephenie C Lemon
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Kevin Kane
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Lori Pbert
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Wenjun Li
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Milagros C Rosal
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
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24
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Associations of extracurricular physical activity patterns and body composition components in a multi-ethnic population of UK children (the Size and Lung Function in Children study): a multilevel modelling analysis. BMC Public Health 2019; 19:573. [PMID: 31104628 PMCID: PMC6526612 DOI: 10.1186/s12889-019-6883-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Body Mass Index (BMI) is a common outcome when assessing associations between childhood overweight and obesity and physical activity patterns. However, the fat and fat-free components of BMI, measured by the Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI), may show contrasting associations with physical activity, while ethnic groups may vary in both physical activity patterns and body composition. Body composition must therefore be evaluated when assessing the associations between childhood overweight and obesity and physical activity in multi-ethnic populations. Methods This cross-sectional study investigated associations of BMI, FMI and FFMI z-scores with extracurricular physical activity for 2171 London primary schoolchildren (aged 5–11 years) of black, South Asian and white/other ethnicity. Multilevel mixed-effects ordered logistic modelling was used, adjusting for age, sex and family and neighbourhood socioeconomic status as potential confounders. Results Controlling for ethnicity and individual, family and neighbourhood socioeconomic confounders, actively commuting children had significantly lower Odds Ratios for being in high BMI (Odds Ratio (OR) = 0.678; 95 % Confidence Interval (CI) = 0.531 − 0.865; p − value = 0.002) and FMI z-score groups (OR = 0.679; 95 % CI = 0.499 − 0.922; p = 0.013), but not FFMI z-score groups, than passive commuters. Children doing sports less than once a week had lower Odds Ratios for being in high BMI (OR = 0.435; 95 % CI = 0.236 − 0.802; p = 0.008) and FFMI (OR = 0.455; 95 % CI = 0.214 − 0.969; p = .041) z-score categories compared to daily active children. Differences in FMI between groups did not reach the significance threshold. A trend towards statistical significance was obtained whereby children’s complete inactivity was associated with higher odds for being in higher BMI (OR = 2.222 : 95 % CI = 0.977 − 5.052; p = .057) and FMI z-score groups (OR = 2.485 : 95 % CI = 0.961 − 6.429; p = .060). FFMI z-scores did not show a similar trend with complete inactivity. Conclusions Active commuting was objectively associated with lower adiposity, while more frequent extracurricular sports participation was correlated with greater fat-free mass accretion. These relationships were independent of ethnicity and individual, family or neighbourhood socioeconomic confounding factors. Electronic supplementary material The online version of this article (10.1186/s12889-019-6883-1) contains supplementary material, which is available to authorized users.
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Early exposure to neighborhood crime and child internalizing and externalizing behaviors. Health Place 2019; 57:228-237. [DOI: 10.1016/j.healthplace.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
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Estimating Childhood Obesity Prevalence in Communities Through Multi-institutional Data Sharing. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 26:E1-E10. [DOI: 10.1097/phh.0000000000000942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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27
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The weight of school entry: Weight gain among Hispanic children of immigrants during the elementary school years. DEMOGRAPHIC RESEARCH 2019. [DOI: 10.4054/demres.2019.40.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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28
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Child Obesity and the Interaction of Family and Neighborhood Socioeconomic Context. POPULATION RESEARCH AND POLICY REVIEW 2018. [DOI: 10.1007/s11113-018-9504-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Johnson KA, Showell NN, Flessa S, Janssen M, Reid N, Cheskin LJ, Thornton RL. Do Neighborhoods Matter? A Systematic Review of Modifiable Risk Factors for Obesity among Low Socio-Economic Status Black and Hispanic Children. Child Obes 2018; 15:71-86. [PMID: 30565954 PMCID: PMC6386088 DOI: 10.1089/chi.2018.0044] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Childhood obesity increases the risk of obesity and harmful comorbidities later in life. It is influenced by characteristics of a child's neighborhood, particularly among underserved groups. Our objective was to systematically review the evidence relating neighborhood environment and obesity risk among urban, low socioeconomic status (SES) Black and Hispanic children. METHODS We included studies published from 1993 through early 2017 from PubMed, SCOPUS, Web of Science, and Sociological Abstracts databases investigating relationships between empirically measured neighborhood characteristics and obesity risk factors in the populations of interest. Databases were last searched on May 8, 2018. Initial analysis took place during 2014 and was completed during 2017. We extracted data on study population, design, and associations between neighborhood characteristics and obesity risk factors. RESULTS We identified 2011 unique studies; 24 were included. Few studies demonstrated consistent patterns of association. Most neighborhood characteristics were not examined across multiple studies. BMI may be related to living in a lower-income neighborhood or convenience store access. CONCLUSIONS This review found that the body of evidence relating neighborhood exposures and obesity risk factors among urban, low SES Black (also commonly referred to in the literature as "non-Hispanic Black" or African American) and Hispanic children is limited. Given the high risk of obesity and cardiovascular disease among these populations throughout the life course, research on neighborhood determinants of obesity should specifically include these populations, ensuring adequate power and methodological rigor to detect differences.
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Affiliation(s)
- Katherine Abowd Johnson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nakiya N. Showell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarah Flessa
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Natalie Reid
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J. Cheskin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Global Obesity Prevention Center at Johns Hopkins, Baltimore, MD
| | - Rachel L.J. Thornton
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Nobari TZ, Whaley SE, Blumenberg E, Prelip ML, Wang MC. Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County. Prev Med Rep 2018; 13:139-145. [PMID: 30591855 PMCID: PMC6305808 DOI: 10.1016/j.pmedr.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022] Open
Abstract
Despite high rates of housing-cost burden in the United States, little is known regarding its impact on childhood obesity. In this article, we determine whether low-income 2–5-year-olds living in housing-cost burdened households are more likely to be obese and examine the potential moderators and behavioral and psychosocial mediators of this relationship. We used data from a triennial survey (2011, 2014) of a random sample of Los Angeles County participants of the Special Supplemental Nutrition Program for Women, Infants and Children (n = 2307). Logistic regression was used to examine the association between child's obesity status (Body Mass Index for age and sex ≥ 95th percentile) and severe housing-cost burden (finding it very difficult to pay for housing). Mother's depressive symptoms and child's diet and screen time were tested for mediation. We found that 16% of children lived in severe housing-cost burdened households. Severe housing-cost burden was associated with an increase in the odds of childhood obesity [aOR (95%CI) = 1.33 (1.00, 1.78)] and household size moderated this relationship. Child's diet and screen time and mother's depressive symptoms were not mediators. Given the high and vacillating rates of early childhood obesity and the increasing burden of housing costs in low-income populations, there is an urgency to better understand the role of housing-cost burden in epidemiologic investigations of early childhood obesity. Children in severe housing-cost burdened households had more chronic stressors. Severe housing-cost burden was associated with greater odds of childhood obesity. Child's behavior and mother's mental well-being were not mediators of the relationship.
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Affiliation(s)
- Tabashir Z Nobari
- UCLA Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.,Public Health Foundation Enterprises WIC Program, 12781 Schabarum Ave., Irwindale, CA 91706, USA
| | - Shannon E Whaley
- Public Health Foundation Enterprises WIC Program, 12781 Schabarum Ave., Irwindale, CA 91706, USA
| | - Evelyn Blumenberg
- UCLA Luskin School of Public Affairs, Department of Urban Planning, 3250 Public Affairs Buliding, Box 951656, Los Angeles, CA 90095, USA
| | - Michael L Prelip
- UCLA Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - May C Wang
- UCLA Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
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Kranjac AW, Denney JT, Kimbro RT, Moffett BS, Lopez KN. Neighborhood and Social Environmental Influences on Child Chronic Disease Prevalence. POPULATION AND ENVIRONMENT 2018; 40:93-114. [PMID: 31485093 PMCID: PMC6726389 DOI: 10.1007/s11111-018-0303-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children's chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated disadvantage and air pollution exposure associate with higher risks of having at least one chronic condition for children after also considering their individual- and family-level characteristics. Overall, our analysis serves as a comprehensive start for future researchers interested in assessing which neighborhood factors matter most for child chronic health conditions.
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Affiliation(s)
| | - Justin T. Denney
- Washington State University, Department of Sociology, Washington, United States
| | - Rachel T. Kimbro
- Rice University, Department of Sociology, Kinder Institute Urban Health Program, Houston, United States
| | - Brady S. Moffett
- Baylor College of Medicine, Pain Medicine, Houston, United States
| | - Keila N. Lopez
- Baylor College of Medicine, Texas Children’s Hospital, Heart Center, Cardiology, Houston, United States
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Kranjac AW. School-Level Body Mass Index Shapes Children's Weight Trajectories. THE JOURNAL OF SCHOOL HEALTH 2018; 88:917-927. [PMID: 30392191 DOI: 10.1111/josh.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/08/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Embedded within children's weight trajectories are complex environmental contexts that influence obesity risk. As such, the normative environment of body mass index (BMI) within schools may influence children's weight trajectories as they age from kindergarten to fifth grade. METHODS I use 5 waves of the ECLS-K-Kindergarten Class 1998-1999 data and a series of multilevel growth models to examine whether attending schools with higher overall BMI influences children's weight status over time. RESULTS Results show that, net of child, family, and school sociodemographic characteristics, children who attend schools with higher rates of obesity have increased weight compared to children who attend schools with lower rates of obesity, and this effect increases annually. CONCLUSIONS Findings indicate that the overall weight status of schools influence child obesity, and further speak to the importance of school-based intervention programs.
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Williams AD, Shenassa E, Slopen N, Rossen L. Cardiometabolic Dysfunction Among U.S. Adolescents and Area-Level Poverty: Race/Ethnicity-Specific Associations. J Adolesc Health 2018; 63:546-553. [PMID: 30348278 PMCID: PMC6318802 DOI: 10.1016/j.jadohealth.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents. METHODS Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio. RESULTS Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents. CONCLUSIONS We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
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Affiliation(s)
- Andrew D. Williams
- Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland
| | - Edmond Shenassa
- Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland; Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland; Department of Epidemiology and Biostatistics, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland Baltimore, Baltimore, Maryland.
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
| | - Lauren Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Chambers T, Pearson A, Kawachi I, Stanley J, Smith M, Barr M, Mhurchu CN, Signal L. Children's home and school neighbourhood exposure to alcohol marketing: Using wearable camera and GPS data to directly examine the link between retailer availability and visual exposure to marketing. Health Place 2018; 54:102-109. [DOI: 10.1016/j.healthplace.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
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Woodward-Lopez G, Gosliner W, Au LE, Kao J, Webb K, Sagatov RD, Strauss W, Landgraf AJ, Nagaraja J, Wilson DK, Nicastro HL, Nebeling LC, Schultz JA, Ritchie LD. Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:46-55. [PMID: 29992765 PMCID: PMC6382075 DOI: 10.1111/ijpo.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 04/17/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood. OBJECTIVE Examine the interaction of community characteristics with the relationship between community programmes and policies (CPPs) and dietary intake. METHODS An observational study of 5138 children in grades K-8 in 130 US communities was conducted in 2013-2015. Key informant interviews identified and characterized CPPs. CPP scores were generated for the number of target behaviours (CPP-Behav) and the number of behaviour change strategies (CPP-Strat) addressed by all CPPs and CPPs with nutrition goals over the prior 6 years in each community. Dietary intake was assessed by dietary screener and included intake of sugar from sugar-sweetened beverages; energy-dense foods; fruits and vegetables; whole grains; and fibre. Multivariate statistical models assessed the interactions between US region, urbanicity, community-level income, and community-level race/ethnicity and CPP scores in relation to dietary intake. RESULTS CPP-Strat was positively associated with healthier dietary intakes in the Northeast and West, and in high Hispanic communities; the reverse was true in the South, and in high African-American and low-income communities. The CPP-Behav was positively associated with healthier dietary intakes in the South and rural areas, and the reverse was true in the West. CONCLUSION The relationships between CPP index scores and dietary intake were most strongly influenced by region and urbanicity and to a lesser extent by community-level race/ethnicity and income. Findings suggest that different considerations may be needed for childhood obesity prevention efforts in communities with different characteristics.
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Affiliation(s)
- Gail Woodward-Lopez
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | - Lauren E. Au
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | - Janice Kao
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | - Karen Webb
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | | | | | | | | | - Dawn K. Wilson
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | | | | | - Jerry A. Schultz
- Workgroup for Community Health and Development, University of Kansas, Lawrence, Kansas
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
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Wong MS, Chan KS, Jones-Smith JC, Colantuoni E, Thorpe RJ, Bleich SN. The neighborhood environment and obesity: Understanding variation by race/ethnicity. Prev Med 2018; 111:371-377. [PMID: 29197530 PMCID: PMC5930051 DOI: 10.1016/j.ypmed.2017.11.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/13/2017] [Accepted: 11/26/2017] [Indexed: 01/10/2023]
Abstract
Neighborhood characteristics have been associated with obesity, but less is known whether relationships vary by race/ethnicity. This study examined the relationship between soda consumption - a behavior strongly associated with obesity - and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. We merged data on adults from the 2011-2013 California Health Interview Survey, U.S. Census data, and InfoUSA (n=62,396). Dependent variables were soda consumption and weight status outcomes (body mass index and obesity status). Main independent variables were measures of three neighborhood environments: social (social cohesion and safety), sociodemographic (neighborhood socioeconomic status, educational attainment, percent Asian, percent Hispanic, and percent black), and built environments (number of grocery stores, convenience stores, fast food restaurants, and gyms in neighborhood). We fit multi-level linear and logistic regression models, stratified by individual race/ethnicity (NH (non-Hispanic) Whites, NH African Americans, Hispanics, and NH Asians) controlling for individual-level characteristics, to estimate neighborhood contextual effects on study outcomes. Lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. We found fewer associations between study outcomes and the neighborhood, especially the built environment, among NH African Americans and NH Asians. While improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Jessica C Jones-Smith
- Department of Health Services & Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Nobari TZ, Whaley SE, Prelip ML, Crespi CM, Wang MC. Trends in Socioeconomic Disparities in Obesity Prevalence among Low-Income Children Aged 2-4 Years in Los Angeles County, 2003-2014. Child Obes 2018; 14:248-258. [PMID: 29741920 PMCID: PMC6001382 DOI: 10.1089/chi.2017.0264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity prevalence among low-income preschool-aged children in the United States decreased between 2010 and 2014. However, this decreasing trend may be varied across socioeconomic subgroups. This study examined trends in obesity prevalence among low-income children from 2003 to 2014 by child's age and household and neighborhood socioeconomic status (SES). METHODS This study used administrative data for all children, aged 2-4 years, participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County (LAC) during the years 2003-2014. Obesity was defined as having a BMI ≥95th percentile of CDC's age- and sex-specific growth charts. Household income and household educational attainment were indicators of household SES. Neighborhood median household income was an indicator of neighborhood SES. RESULTS Childhood obesity prevalence increased sharply from 15.7% in 2003 to 19.1% in 2005, and remained constant until 2010, when it started decreasing. During most years, the prevalence of obesity was higher among the lowest SES groups. Despite the recent decreasing trend, the 2014 estimates were still generally higher than the 2003 levels except among some low-income children living in less-poor and more-educated households. CONCLUSIONS The decreasing trend between 2010 and 2014 among WIC-participating children in LAC is encouraging and mirrors national trends among WIC-participating children. However, continued efforts should be made to focus obesity prevention efforts on low-income children, especially those who are the most vulnerable as they have experienced significant gains in obesity since 2003.
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Affiliation(s)
- Tabashir Z. Nobari
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA.,Public Health Foundation Enterprises WIC Program, Irwindale, CA
| | | | - Michael L. Prelip
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Catherine M. Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA
| | - May C. Wang
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
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Castle B, Wendel M, Kerr J, Brooms D, Rollins A. Public Health’s Approach to Systemic Racism: a Systematic Literature Review. J Racial Ethn Health Disparities 2018; 6:27-36. [DOI: 10.1007/s40615-018-0494-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
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Showell NN, Jennings JM, Johnson KA, Perin J, Thornton RLJ. Where Children Live: Examining Whether Neighborhood Crime and Poverty Is Associated With Overweight and Obesity Among Low-Income Preschool-Aged Primary Care Patients. Front Pediatr 2018; 6:433. [PMID: 30723710 PMCID: PMC6350678 DOI: 10.3389/fped.2018.00433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: Low-income and racial/ethnic minority preschoolers (aged 2-5 years) are disproportionately affected by obesity and its associated health consequences. Individual-level factors (e.g., diet) and environmental factors (e.g., neighborhood conditions) contribute to these disparities. However, there is limited research examining the role of neighborhood factors on obesity risk specifically among high-risk preschoolers. The objectives of this study are to describe the geographic distribution of preschool patients receiving care at two primary care pediatrics clinics affiliated with an academic medical center, and explore whether exposure to neighborhood crime and poverty is associated with obesity risk among this population. Methods: Cross-sectional multilevel study linking clinical administrative data on patient visits between 2007 and 2012 with data from the American Community Survey and the Baltimore City Police Department. Home addresses of 2-5 year-old patients were geocoded to their neighborhood (i.e., census block group) of residence. We used logistic regression to examine the cross-sectional relationship between obesity and overweight and neighborhood-level factors. All analyses were adjusted for age and gender, and stratified by race/ethnicity (Black, Hispanic, and White). Results: The majority of preschool patients lived in moderate or high crime (84%) or high poverty (54%) neighborhoods. A significantly higher proportion of Black preschoolers lived in high poverty neighborhoods compared to White preschoolers (61% vs. 38%, p < 0.001). Among this clinic-based sample of preschoolers, living in high crime or high poverty neighborhoods was not associated with a clinically significant increased odds of overweight or obesity. Conclusions: This study examines the association between neighborhood factors and obesity and overweight among a clinic-based population of low-income racial/ethnic minority preschoolers. The neighborhoods where preschoolers in this sample lived, on average had higher crime counts and poverty than the citywide average for Baltimore. Our findings also suggest that Black preschoolers are exposed to higher levels of neighborhood poverty compared to Whites. While no meaningful association between these neighborhood factors and odds of obesity or overweight was found in this cross-sectional analysis, our findings suggest avenues for future studies informative to the development of clinic-based obesity management interventions aimed at effectively addressing neighborhood contributors to early childhood obesity disparities.
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Affiliation(s)
- Nakiya N Showell
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jacky M Jennings
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Katherine A Johnson
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jamie Perin
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rachel L J Thornton
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Santos R, Huerta G, Karki M, Cantarero A. Social Determinants of Overweight and Obesity Rates by Elementary School in a Predominantly Hispanic School District. J Pediatr Nurs 2017; 37:8-12. [PMID: 28830654 DOI: 10.1016/j.pedn.2017.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study analyzes the social determinants associated with the overweight or obesity prevalence of 85 elementary schools during the 2010-11 academic year in a predominantly Hispanic school district. METHODS A binomial logistic regression is used to analyze the aggregate overweight or obesity rate of a school by the percent of Hispanic students in each school, selected school and neighborhood characteristics, and its geographical location. RESULTS The proportion of Hispanic enrollment more readily explains a school's aggregate overweight or obesity rate than social determinants or spatial location. Number of fast food establishments and the academic ranking of a school appear to slightly impact the aggregate prevalence rate. Spatial location of school is not a significant factor, controlling for other determinants. CONCLUSIONS An elementary school's overall overweight or obesity rate provides a valuable health indicator to study the social determinants of obesity among Hispanics and other students within a local neighborhood.
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Affiliation(s)
- Richard Santos
- Department of Economics, University of New Mexico, Albuquerque, NM, USA.
| | - Gabriel Huerta
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Menuka Karki
- Department of Economics, University of New Mexico, Albuquerque, NM, USA
| | - Andrea Cantarero
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
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Raphael JL, Lion KC, Bearer CF. Policy solutions to recruiting and retaining minority children in research. Pediatr Res 2017; 82:180-182. [PMID: 28590464 DOI: 10.1038/pr.2017.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, Texas
| | - K Casey Lion
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Cynthia F Bearer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Li K, Wen M, Henry KA. Ethnic density, immigrant enclaves, and Latino health risks: A propensity score matching approach. Soc Sci Med 2017; 189:44-52. [PMID: 28780439 DOI: 10.1016/j.socscimed.2017.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
Abstract
Whether minority concentration in a neighborhood exposes residents to, or protects them from, health risks has generated burgeoning scholarly interests; yet endogeneity as a result of neighborhood selection largely remains unclear in the literature. This study addresses such endogeneity and simultaneously investigates the roles of co-ethnic density and immigrant enclaves in influencing high blood pressure and high cholesterol level among Latinos, the largest minority group in the United States. Pooled cross-sectional data that included both native and foreign-born Latinos of Puerto Rican, Mexican, and other origins (N = 1563) from the 2006 and 2008 Southeastern Pennsylvania Household Health Survey were linked to census-tract profiles from the 2005-2009 American Community Survey. Results from both multilevel regression and propensity score matching analysis confirmed the deleterious effect of residential co-ethnic density on Latino adults' health risks over and above individual risk factors. We also found selection bias associated with the observed protective effect of immigrant concentration, which is likely a result of residential preference.
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Affiliation(s)
- Kelin Li
- Department of Sociology, California State University-Dominguez Hills, Carson, CA, United States.
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, United States
| | - Kevin A Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, United States; Fox Chase Cancer Center, Philadelphia, PA, United States
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Vargas CM, Stines EM, Granado HS. Health-equity issues related to childhood obesity: a scoping review. J Public Health Dent 2017; 77 Suppl 1:S32-S42. [DOI: 10.1111/jphd.12233] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022]
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Chi DL, Luu M, Chu F. A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research. J Public Health Dent 2017; 77 Suppl 1:S8-S31. [PMID: 28600842 DOI: 10.1111/jphd.12221] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/06/2017] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTIONS What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children? OBJECTIVES Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children. METHODS The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed. RESULTS Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health). CONCLUSIONS Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.
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Affiliation(s)
- Donald L Chi
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Monique Luu
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Frances Chu
- Oral Health Sciences, University of Washington, Seattle, WA, USA
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Piontak JR, Schulman MD. School Context Matters: The Impacts of Concentrated Poverty and Racial Segregation on Childhood Obesity. THE JOURNAL OF SCHOOL HEALTH 2016; 86:864-872. [PMID: 27866387 DOI: 10.1111/josh.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/15/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Schools are important sites for interventions to prevent childhood obesity. This study examines how variables measuring the socioeconomic and racial composition of schools and counties affect the likelihood of obesity among third to fifth grade children. METHODS Body mass index data were collected from third to fifth grade public school students by teachers from 317 urban and rural North Carolina schools in 38 counties. Multilevel models are used to examine county-, school-, and individual-level effects. RESULTS Low concentrations of poverty at the school level are associated with lower odds of obesity. Schools in rural counties had significantly higher rates of obesity, net the other variables in the model. Students in minority-segregated schools had higher rates of obesity than those in more racially diverse schools, but the effect was not statistically significant once school-level poverty was controlled. CONCLUSIONS Place-based inequalities are important determinants of health inequalities. The results of this study show that school-level variables related to poverty are important for understanding and confronting childhood obesity.
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Affiliation(s)
- Joy Rayanne Piontak
- Center for Child and Family Policy, Duke University, 2024 W, Main Street, Bay C # 202, Durham, NC 27705-4667
| | - Michael D Schulman
- Department of Youth, Family, and Community Sciences, North Carolina State University, 512 Brickhaven Drive 210Q, Campus Box 7606, Raleigh, NC 27695-7606
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Priesnitz MC, Celeste RK, Pereira MJ, Pires CA, Feldens CA, Kramer PF. Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study. Caries Res 2016; 50:455-461. [PMID: 27529624 DOI: 10.1159/000447307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the association between neighbourhood factors and decayed, missing, and filled teeth (dmft) index among preschool children. METHODS The sample of this cross-sectional study comprised 1,110 children (0-5 years old) clustered in 16 official neighbourhoods of Canoas city, southern Brazil. Multilevel binomial models were used to estimate the association of contextual variables at neighbourhood level (Human Development Index, average income, and public primary health care units) with two oral health outcomes: decayed teeth (dt) and missing or filled teeth (mft), after adjusting for individual variables (gender, age, maternal education, equivalent household income logarithm, household, and point of care). RESULTS Overall, 24.9% of the sample had dental caries experience (dmft >0), and 92.3% of the dmft was untreated caries. There was no statistical significant association (p > 0.05) of contextual characteristics with the decay component. The teeth of children living in richer areas had 2.87 (95% CI: 1.05-7.86) times more chances of being treated (mft component). Variance attributed to neighbourhood level was estimated as 5.9% (p < 0.01) and 4.1% (p = 0.17) for dt and mft, respectively, in adjusted models. CONCLUSIONS Intra-urban areas seem homogeneous, with small variability between neighbourhoods, having no contextual effect on untreated dental caries (dt). Contextual variables may influence treatment access (mft) through the use of dental services in preschool children.
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Affiliation(s)
- M C Priesnitz
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Hawkins SS, Gillman MW, Rifas-Shiman SL, Kleinman KP, Mariotti M, Taveras EM. The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity. BMC Pediatr 2016; 16:32. [PMID: 26961130 PMCID: PMC4784443 DOI: 10.1186/s12887-016-0567-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 01/07/2023] Open
Abstract
Background Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with birth certificates; and discuss the potential implications of combining clinical and public health data sources in examining the etiology of disparities in childhood obesity. Methods We linked the existing CENTURY Study, a database of 269,959 singleton children from birth to age 18 years with measured heights and weights, with each child’s Massachusetts birth certificate, which captures information on their mothers’ pregnancy history and detailed socio-demographic information of both mothers and fathers. Results Overall, 74.2 % were matched, resulting in 200,343 children in the Linked CENTURY Study with 1,580,597 well child visits. Among this cohort, 94.0 % (188,334) of children have some father information available on the birth certificate and 60.9 % (121,917) of children have at least one other sibling in the dataset. Using maternal race/ethnicity from the birth certificate as an indicator of children’s race/ethnicity, 75.7 % of children were white, 11.6 % black, 4.6 % Hispanic, and 5.7 % Asian. Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 5.9 % smoked during pregnancy, 76.3 % initiated breastfeeding, and 11.0 % of mothers had their delivery paid for by public health insurance. Using clinical data from the CENTURY Study, 22.7 % of children had a weight-for-length ≥ 95th percentile between 1 and 24 months and 12.0 % of children had a body mass index ≥ 95th percentile at ages 5 and 17 years. Conclusions By linking routinely-collected data sources, it is possible to address research questions that could not be answered with either source alone. Linkage between a clinical database and each child’s birth certificate has created a unique dataset with nearly complete racial/ethnic and socio-demographic information from both parents, which has the potential to examine the etiology of racial/ethnic and socioeconomic disparities in childhood obesity.
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Affiliation(s)
- Summer Sherburne Hawkins
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, USA.
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Ken P Kleinman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Megan Mariotti
- Penn Center for Health Care Innovation, Philadelphia, PA, USA.
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Van Hook J, Quiros S, Frisco ML, Fikru E. It is Hard to Swim Upstream: Dietary Acculturation Among Mexican-Origin Children. POPULATION RESEARCH AND POLICY REVIEW 2015; 35:177-196. [PMID: 27152059 DOI: 10.1007/s11113-015-9381-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Health and immigration researchers often implicate dietary acculturation in explanations of Mexican children of immigrants' weight gain after moving to the U.S., but rarely explore how diet is shaped by immigrants' structural incorporation. We used data from the 1999/00-2009/10 National Health and Nutrition Examination Survey to assess how indicators of Mexican-origin children's acculturation and structural incorporation influence two outcomes: how healthy and how "Americanized" children's diets are. Indicators of acculturation were strongly associated with more Americanized and less healthy diets. However, structural incorporation indicators were mostly unrelated to diet outcomes net of acculturation. An exception was that parental education was positively associated with consuming a healthy diet. Finally, children of natives consumed more Americanized, unhealthy diets than children of immigrants and these differences were largely explained by differences in the acculturation. Children of natives would have consumed an even less healthy diet were it not for their higher levels of parental education. Overall, the results suggest that the process of adapting to the U.S. life style is associated with the loss of cultural culinary preferences and less healthy eating behaviors despite improvements in socioeconomic status.
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Affiliation(s)
- Jennifer Van Hook
- Population Research Institute, Pennsylvania State University, 601 Oswald Tower, University Park, PA 16802, USA
| | - Susana Quiros
- Population Research Institute, Pennsylvania State University, 601 Oswald Tower, University Park, PA 16802, USA
| | - Michelle L Frisco
- Population Research Institute, Pennsylvania State University, 601 Oswald Tower, University Park, PA 16802, USA
| | - Emnet Fikru
- Population Research Institute, Pennsylvania State University, 601 Oswald Tower, University Park, PA 16802, USA
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Examining childhood obesity and the environment of a segregated, lower-income US suburb. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2015. [DOI: 10.1108/ijhrh-09-2014-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The contribution of the built environment within communities plays a significant role in the higher rates of childhood obesity, particularly among black and Hispanic youth. The purpose of this paper is to investigate neighborhood assets and barriers to nutrition and physical activity in an underserved, majority-minority suburban community in New York State, USA using Photovoice, a community-based participatory research method.
Design/methodology/approach
– Nine local youth took photographs to visually identify the community’s environmental assets and barriers. Through an extensive review and selection of photos and group discussion themes were identified. Final results of the Photovoice project were presented to local policy makers and community members for action.
Findings
– Participants provided complex and insightful perspectives of health inequalities in the suburbs, including limited access to fresh, healthy food, and safe spaces for physical activity. They also understood that improving nutrition and physical activity practices required policy changes and civic engagement.
Research limitations/implications
– This study represented one suburban area of New York, and is not meant to be representative of all suburban areas. However, the findings of environmental barriers to childhood obesity are similar to those found in urban areas, suggesting similarities in low-income communities of color.
Social implications
– This study suggests that Photovoice is an effective way of collaborating between various community stakeholders (particularly youth) in an underserved suburb that can result in community changes.
Originality/value
– Besides achieving all three Photovoice goals – recording and reflection, dialogue, and reaching policymakers – the Photovoice project identified a long-standing environmental hazard as a result of the partnerships established between the youth, academic institution, community-based organizations, and residents. This study also identified factors in the built environment that contribute to health disparities in a racially segregated suburban community.
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Carroll-Scott A, Gilstad-Hayden K, Rosenthal L, Eldahan A, McCaslin C, Peters SM, Ickovics JR. Associations of Neighborhood and School Socioeconomic and Social Contexts With Body Mass Index Among Urban Preadolescent Students. Am J Public Health 2015; 105:2496-502. [PMID: 26469652 PMCID: PMC4638273 DOI: 10.2105/ajph.2015.302882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined independent and synergistic effects of school and neighborhood environments on preadolescent body mass index (BMI) to determine why obesity rates nearly double during preadolescence. METHODS Physical measures and health surveys from fifth and sixth graders in 12 randomly selected schools in New Haven, Connecticut, in 2009 were matched to student sociodemographics and school- and residential census tract-level data, for a total of 811 urban preadolescents. Key independent variables included school connectedness, neighborhood social ties, and school and neighborhood socioeconomic status. We estimated cross-classified random-effects hierarchical linear models to examine associations between key school and neighborhood characteristics with student BMI. RESULTS Greater average connectedness felt by students to their school was significantly associated with lower BMI. This association was stronger among students living in neighborhoods with higher concentrations of affluent neighbors. CONCLUSIONS How schools engage and support students may affect obesity rates preferentially in higher-income neighborhoods. Further research should explore the associations between multiple environments to which children are exposed and obesity-related behaviors and outcomes. This understanding of the multiple social-spatial contexts that children occupy has potential to inform comprehensive and sustainable child obesity prevention efforts.
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Affiliation(s)
- Amy Carroll-Scott
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Kathryn Gilstad-Hayden
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Lisa Rosenthal
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Adam Eldahan
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Catherine McCaslin
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Susan M Peters
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Jeannette R Ickovics
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
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