Neighborhood effects on body mass: Temporal and spatial dimensions

The health implications of neighborhood networks based on daily mobility in US cities

A large body of research has been dedicated to understanding the neighborhood conditions that impact health, which outcomes are affected, and how these associations vary by demographic and socioeconomic neighborhood and individual characteristics. This literature has focused mostly on the neighborhoods in which individuals reside, thus failing to recognize that residents across race/ethnicity and class spend a non-trivial amount of their time in neighborhoods far from their residential settings. To address this gap, we use mobile phone data from the company SafeGraph to compare racial inequality in neighborhood socioeconomic advantage exposure across three scales: the neighborhoods that residents live in, their adjacent neighborhoods, and the neighborhoods that they regularly visit. We found that the socioeconomic advantage levels in neighborhood networks differ from the levels at the residential and adjacent scales across all ethnoracial neighborhoods. Furthermore, socioeconomic advantage at the network level is associated with diabetes and hypertension prevalence above and beyond its impact at the residential and adjacent levels. We also find ethnoracial differences in these associations, with greater beneficial consequences of network socioeconomic advantage exposure on hypertension and diabetes for white neighborhoods. Future social determinants of health research needs to reconceptualize exposure to include the larger neighborhood network that a community is embedded in based on where their residents travel to and from.

Association between neighborhood health behaviors and body mass index in Northern Norway: evidence from the Tromsø Study

AIM

The prevalence of overweight and obesity has risen rapidly worldwide, and the ongoing obesity pandemic is one of the most severe public health concerns in modern society. The average body mass index (BMI) of people living in Northern Norway has also steadily increased since the late 1970s. This study aimed to understand how individuals' health behavior is associated with the general health behavior of the people in their neighborhood.

METHODS

Using the population-based Tromsø Study, we examined the life course association between average leisure time physical activity at the neighborhood level and the BMI of individuals living in the same neighborhood. We used a longitudinal dataset following 25,604 individuals living in 33 neighborhoods and performed a linear mixed-effects analysis.

RESULTS

The results showed that participants living in neighborhoods whose residents were more physically active during their leisure time, were likely to have a significantly lower BMI (-0.9 kg/m², 95% CI -1.5 to -0.4). Also, individuals living in neighborhoods whose residents were doing mainly manual work, had significantly higher BMIs (0.7 kg/m², 95% CI 0.4-1.0).

CONCLUSIONS

Our results showed a strong association between the average leisure time physical activity level of neighborhood residents and the higher BMI levels of residents of the same neighborhood.

Differences in liver and mortality outcomes of non-alcoholic fatty liver disease by race and ethnicity: A longitudinal real-world study

BACKGROUND/AIMS

Understanding of nonalcoholic fatty liver disease (NAFLD) continues to expand, but the relationship between race and ethnicity and NAFLD outside the use of cross-sectional data is lacking. Using longitudinal data, we investigated the role of race and ethnicity in adverse outcomes in NAFLD patients.

METHODS

Patients with NAFLD confirmed by imaging via manual chart review from any clinics at Stanford University Medical Center (1995-2021) were included. Primary study outcomes were incidence of liver events and mortality (overall and non-liver related).

RESULTS

The study included 9,340 NAFLD patients: White (44.1%), Black (2.29%), Hispanic (27.9%), and Asian (25.7%) patients. For liver events, the cumulative 5-year incidence was highest among White (19.1%) patients, lowest among Black (7.9%) patients, and similar among Asian and Hispanic patients (~15%). The 5-year and 10-year cumulative overall mortality was highest for Black patients (9.2% and 15.0%, respectively, vs. 2.5-3.5% and 4.3-7.3% in other groups) as well as for non-liver mortality. On multivariable regression analysis, compared to White patients, only Asian group was associated with lower liver-related outcomes (aHR: 0.83, P=0.027), while Black patients were at more than two times higher risk of both non-liver related (aHR: 2.35, P=0.010) and overall mortality (aHR: 2.13, P=0.022) as well as Hispanic patients (overall mortality: aHR: 1.44, P=0.022).

CONCLUSION

Compared to White patients, Black patients with NAFLD were at the highest risk for overall and non-liver-related mortality, followed by Hispanic patients with Asian patients at the lowest risk for all adverse outcomes. Culturally sensitive and appropriate programs may be needed for more successful interventions.

Longitudinal exposure to neighborhood poverty and obesity risk in emerging adulthood

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.

Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents

BACKGROUND

In China, the threat of obesity and overweight in children and adolescents is developing quickly. It may be possible to lower the risk of obesity and overweight in children and adolescents by understanding the factors that drive these conditions. Therefore, this study aimed to investigate the association between SES and risk of obesity and overweight among children and adolesecnts in China's provinces of Jiangsu, Anhui, Zhejiang, and Shanghai.

METHODS

Chinese children and adolescents (n = 2,746; 46.3% boys) were recruited using multistage sampling. SES was measured using self-reported questionnaires, the specific indicators were parental education, perceived family wealth, and Family Affluence Scale II. Height and weight were measured and used to calculate body mass index (BMI, categorized into obesity or overweight). The definition of obesity or overweight was based on the Chinese standard "Screening for obesity and overweight among school-age children and adolescents". Descriptive statistics, independent sample t-tests, and a Chi-square test were used to report the sample characteristics and analyse BMI differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with BMI in children and adolescents.

RESULTS

Overall, 22.5% of children and adolescents were obese or overweight. Participants with medium and high maternal education levels were 1.48 [95% CI 1.15-1.91] and 1.47 [95% CI 1.03-2.11] times more likely to be obese/overweight. Girls with medium maternal education levels were 1.70[95% CI 1.21-2.40] times more likely to be obese/overweight. For boys, no association was observed. Junior middle school students with medium maternal education levels were 1.51[95% CI 1.10-2.07] times more likely to be obese/overweight. Participants with medium or high FAS, perceived family wealth, or paternal education levels were not associated with obesity/overweight.

CONCLUSIONS

The findings of this study indicated a positive association between SES and risk of overweight/obesity in girls, suggesting that maternal education level may have a substantial impact on future prevention efforts for these conditions in girls. To increase the effectiveness of interventions, longitudinal studies are necessary to better understand the causal association between SES and obesity/overweight.

The Longitudinal Effect of Area Socioeconomic Changes on Obesity: a Longitudinal Cohort Study in the USA from 2003 to 2017

Despite several dimensions of area socioeconomic status (SES), past literature has been dominated by the use of area socioeconomic position. We examined the longitudinal effect of three area SES measures (i.e., socioeconomic position, inequality, and segregation) on obesity. Using longitudinal data from the Fragile Families & Child Wellbeing Study (N = 1493), we estimated a linear mixed model to examine the effect of three time-varying area SES measures on time-varying measures of objectively measured body mass index z-score (BMIz) from ages 5 years to 15 years. Findings showed that BMIz increased steadily over time (B = 0.02, 95% CI = 0.02, 0.03). A significant interaction between time and area socioeconomic position indicates that children in areas with higher socioeconomic position had a smaller increase in BMIz than those in low socioeconomic areas (B =  - 0.02, 95% CI =  - 0.02, - 0.01). A non-linear relationship of area income inequality with BMIz such that BMIz was higher as area income inequality was greater, but the effect diminishes in magnitude with a higher level of area income inequality (linear term: B = 0.07; quadratic term: B =  - 0.03). Area income segregation was associated with greater BMIz (B = 0.08, 95% CI = 0.03, 0.12). No time interaction effect was found for area income inequality and segregation. Results highlight a need for community health policy efforts and evidence-based interventions to address childhood obesity issues in low-SES areas.

Changes in neighborhood environments and the increasing socioeconomic gap in child obesity risks: Evidence from Singapore

Most empirical research studying the link between neighborhood environments and child obesity risks are conducted in contexts such as the U.S., with pronounced patterns of residential segregation, making it difficult to extrapolate how far built environment characteristics contribute to socioeconomic disparities in obesity risks in less segregated contexts. Using a large national dataset of almost 625,000 students' height and weight data collected at ages 7, 11 and 14, between 2004 and 2015, this paper explores whether differences in eight neighborhood characteristics measuring access to different type of food outlets, parks and other active spaces, and public transport infrastructure might be responsible for socioeconomic differences in child obesity risks in Singapore, a city-state with relatively low levels of residential segregation. Through descriptive analyses we find that socioeconomic disparities in child BMIz in Singapore widened from 2004 onwards. However, while longitudinal regression models with individual and time fixed effects suggest that family socioeconomic status modified the relationship between environmental exposures and BMIz, there does not seem to be a clear, unequivocal relationship between built environment changes and the observed widening of the socioeconomic obesity gap.

The Effect of Neighborhood-level Resources on Children's Physical Development: Trajectories of Body Mass Index and Pubertal Development and the Influence of Child Biological Sex

Growing research substantiates the role of neighborhood disadvantage in contributing to early pubertal maturation and higher body mass index; however, previous studies in this area have design limitations. Specifically, many studies have been cross-sectional, have used singular indicators of neighborhood disadvantage (e.g., poverty), and have provided mixed findings about the role of biological sex. The present study addresses these gaps by examining how neighborhood resources (spanning educational, health/environmental, and social/economic domains) predict trajectories of pubertal maturation and body mass index using longitudinal multi-wave data. Furthermore, multigroup analyses assessed how these associations may differ by child biological sex. Participants in this study (n = 505; 54% male) were assessed every 3 years at age 9 (M = 9.17, SD = 0.39), age 12 (M = 12.63, SD = 0.43), and age 15 (M = 15.23, SD = 0.37). Approximately 12% of the sample identified as Hispanic, and 11% as non-White. Using multigroup latent growth analyses, the study examined how neighborhood resources predicted trajectories of pubertal maturation and body mass index using multi-wave data across middle childhood through mid-adolescence. The findings suggested that greater neighborhood resources were cross-sectionally associated with lower pubertal development and predicted slower trajectories across time. Although all girls in the study eventually progressed through pubertal development, girls in lower resourced neighborhoods experienced a much earlier onset of puberty. Additionally, greater neighborhood resources predicted lower BMI both cross sectionally and longitudinally. Specifically, higher resourced neighborhoods were protective against obesity risk for both boys and girls across mid-childhood through mid-adolescence. In sum, the study highlights the role of broader neighborhood factors on early maturity risk for female children, and obesity risk for children regardless of biological sex.

Do intersecting identities structure social contexts to influence life course health? The case of school peer economic disadvantage and obesity

Scholarship linking social contextual measures to health outcomes has grown in recent decades, but the role of individuals' intersecting identities in structuring social contexts to influence health remains unclear. Building on an existing intersectionality framework, we conceptualize how this may occur through social relationships. Then, we apply this framework to analyze whether adolescent peer social contextual disadvantage influences life-course obesity heterogeneously by individual gender, race, and early-life income. We take a life course approach as adolescence is a sensitive period for both social development and adult obesity development. In our analysis, we use cohort data from the National Longitudinal Study of Adolescent to Adult Health and leverage quasi-experimental variation in adolescent peers to addresses common sources of bias in prior observational studies. We find that among Black men from lower-income households in adolescence, there is a strong negative relationship between adolescent peer economic disadvantage and adult obesity that strengthens over time. By contrast, among Black women across adolescent household income levels, we find a strong positive relationship between adolescent peer economic disadvantage and obesity that emerges as women leave high school and endures into mid-adulthood. Among non-Black women, a more modest positive relationship appears between peer disadvantage and obesity. Among non-Black men, we find no relationship. These diverging patterns suggest that the pathways through which adolescent peer economic disadvantage influences health may differ or produce differential effects based on intersecting race, gender, and socioeconomic identities. Such heterogenous effects offer new insights, and future directions, for better understanding social life-course determinants of adult health and addressing inequities.

Socioeconomic Status, Institutional Power, and Body Mass Index among Chinese Adults

Despite the vast literature on the socioeconomic status (SES) gradient of obesity among adult people, no study has investigated the relationship between institutional power and body mass index. Using national survey data from the “China Labor-force Dynamics Survey 2016” (CLDS 2016), multistage cluster-stratified probability proportional to size (PPS) sampling was employed to select cases from 29 provinces, cities, and autonomous regions in China. This study adopts an institutional approach to explore the influences of SES and institutional power on the state of being overweight or severely overweight (obese) among Chinese adults. It is shown that SES has a non-linear influence on being overweight or obese, higher education has a negative effect on being overweight or obese, income has an inverted U-shaped effect on being overweight or obese, and having a managerial or administrative job has a positive effect on being overweight but less so on obesity. These findings reveal that disparities in health outcome and risks are due to inequality in SES. The work unit is a stronger predictor of adults being overweight or obese than occupation. Working in the public sector has a positive effect on being overweight relative to working in the private sector, and only state institutions and government departments have a positive association with obesity. Our results indicate that institutional structure still has effects on individuals’ life chances in the era of China’s market transition.

Life Course Neighbourhood Deprivation and Self-Rated Health: Does It Matter Where You Lived in Adolescence and Do Neighbourhood Effects Build Up over Life?

There is an overreliance on concurrent neighbourhood deprivation as a determinant of health. Only a small section of the literature focuses on the cumulative exposure of neighbourhood deprivation over the life course. This paper uses data from the 1958 National Child Development Study, a British birth cohort study, linked to 1971–2011 Census data at the neighbourhood level to longitudinally model self-rated health between ages 23 and 55 by Townsend deprivation score between ages 16 and 55. Change in self-rated health is analysed using ordinal multilevel models to test the strength of association with neighbourhood deprivation at age 16, concurrently and cumulatively. The results show that greater neighbourhood deprivation at age 16 predicts worsening self-rated health between ages 33 and 50. The association with concurrent neighbourhood deprivation is shown to be stronger compared with the measurement at age 16 when both are adjusted in the model. The concurrent association with change in self-rated health is explained by cumulative neighbourhood deprivation. These findings suggest that neglecting exposure to neighbourhood deprivation over the life course will underestimate the neighbourhood effect. They also have potential implications for public policy suggesting that neighbourhood socioeconomic equality may bring about better population health.

The impact of life course exposures to neighbourhood deprivation on health and well-being: a review of the long-term neighbourhood effects literature

Background

In this review article, we detail a small but growing literature in the field of health geography that uses longitudinal data to determine a life course component to the neighbourhood effects thesis. For too long, there has been reliance on cross-sectional data to test the hypothesis that where you live has an effect on your health and well-being over and above your individual circumstances.

Methods

We identified 53 articles that demonstrate how neighbourhood deprivation measured at least 15 years prior affects health and well-being later in life using the databases Scopus and Web of Science.

Results

We find a bias towards US studies, the most common being the Panel Study of Income Dynamics. Definition of neighbourhood and operationalization of neighbourhood deprivation across most of the included articles relied on data availability rather than a priori hypothesis.

Conclusions

To further progress neighbourhood effects research, we suggest that more data linkage to longitudinal datasets is required beyond the narrow list identified in this review. The limited literature published to date suggests an accumulation of exposure to neighbourhood deprivation over the life course is damaging to later life health, which indicates improving neighbourhoods as early in life as possible would have the greatest public health improvement.

A life course perspective on BMI in rural America

Rural Americans are substantially more likely to be obese than their urban counterparts. A life course perspective offers insights into how growing up in rural areas may affect weight in young adulthood. Using data from the Panel Survey of Income Dynamics, this study follows the residential trajectories of 3157 respondents since birth. Living in a rural area during the critical period of early childhood (before age two) is predictive of higher BMI, while residence in later childhood and adolescence is not. Improving the health and wellbeing of rural mothers and infants could potentially help address the roots of rural obesity.

Longitudinal exposure assessments of neighbourhood effects in health research: What can be learned from people's residential histories?

Health research into neighbourhood effects has generally examined neighbourhoods cross-sectionally, ignoring the fact that neighbourhood exposures might accumulate over people's lives and affect health outcomes later in life. Using longitudinal Dutch register data with complete 15-year residential address histories, we examined whether health effects of neighbourhood socioeconomic characteristics differ between cumulative and current exposures. We illustrated these differences between exposure assessments using suicide mortality among middle-aged adults. All suicides aged 40-64 years between 2012 and 2016 were matched with 10 random controls in a nested case-control design. We measured neighbourhood exposures longitudinally for circular buffers around residential addresses at the current address and through three accumulative measures, each incorporating the residential address history with increasing detail. Covariate-adjusted conditional logistic regressions were used to assess associations between suicide and neighbourhood social fragmentation, population density and unemployment rate. Our results showed that total and male suicide mortality was significantly lower in highly fragmented neighbourhoods when using accumulative exposures, but not when using the current residential address. However, we observed few differences in coefficients between exposures assessments for neighbourhood urbanicity and unemployment rate. None of the neighbourhood characteristics showed evidence that detailed cumulative exposures were a stronger predictor of suicide compared to more crude measures. Our findings provide little evidence that socioeconomic neighbourhood characteristics measured cumulatively along people's residential histories are stronger predictors of suicide mortality than cross-sectional exposures.

Neighborhood Poverty and Physical Health at Midlife: The Role of Life-Course Exposure

Studies of the effect of neighborhood poverty on health are dominated by research designs that measure neighborhood poverty at a single point in time, ignoring the potential influence of exposure to neighborhood poverty over the life course. Applying latent class analysis to restricted residential history data from the National Longitudinal Survey of Youth, 1979 Cohort, we identify four trajectories of life-course exposure to high-poverty neighborhoods between adolescence and midlife and then examine how these groups differ in their physical health conditions (SF-12 score) and self-rated health at around age 40. Linear and logistic regression analyses show that life-course exposure to high-poverty neighborhoods is a stronger predictor of midlife physical health than are point-in-time measures of neighborhood poverty observed during either adolescence or midlife. Our findings suggest that a life-course approach can enhance our understanding of how neighborhood poverty affects physical health.

Using Electronic Medical Record Data to Better Understand Obesity in Hispanic Neighborhoods in El Paso, Texas

The prevalence of obesity has been persistent amongst Hispanics over the last 20 years. Socioeconomic inequities have led to delayed diagnosis and treatment of chronic medical conditions related to obesity. Factors contributing include lack of insurance and insufficient health education. It is well-documented that obesity amongst Hispanics is higher in comparison to non-Hispanics, but it is not well-understood how the socioeconomic context along with Hispanic ethnic concentration impact the prevalence of obesity within a community. Specifically studying obesity within Hispanic dominant regions of the United States, along the Texas–Mexico border will aid in understanding this relationship. El Paso, Texas is predominantly Mexican-origin Hispanic, making up 83% of the county’s total population. Through the use of electronic medical records, BMI averages along with obesity prevalence were analyzed for 161 census tracts in the El Paso County. Geographic weighted regression and Hot Spot technology were used to analyze the data. This study did identify a positive association between Hispanic ethnic concentration and obesity prevalence within the El Paso County. Median income did have a direct effect on obesity prevalence while evidence demonstrates that higher education is protective for health.

Ethnic Disparities in Adiposity: Focus on Non-alcoholic Fatty Liver Disease, Visceral, and Generalized Obesity

PURPOSE OF REVIEW

Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD).

RECENT FINDINGS

Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk. Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.

The indelible weight of place: Childhood neighborhood disadvantage, timing of exposure, and obesity across adulthood

I use 28 (1986-2014) years of restricted geocoded NLSY tract-level data and find positive associations between exposure to childhood neighborhood disadvantage and adult obesity and BMI among individuals growing up and entering adulthood during the rise of obesity in the United States. Sibling fixed effects and cousin fixed effects models partially address unobserved confounding nested in the nuclear as well as extended family. Furthermore, exposure to neighborhood disadvantage in adolescence is most salient, providing insight into when policy intervention may be most effective. Results are robust to alternative specifications for neighborhood disadvantage, ages of exposure, and to alternative sampling strategies.