Child Development and the Community Environment: Understanding Overweight across the Income Gradient

Exploring correlation between social determinants and overweight/obesity in children and youths with epilepsy

Aim

This study aimed to explore the correlation between social determinants and overweight and obesity in children and youths with epilepsy.

Methods

The study data were derived from the National Survey of Children's Health (NSCH) 2016-2017 and 2018-2019, a cross-sectional sample of young people aged 10-17. Three groups participated by weight: 423 in body mass index (BMI) 5th-84th group (normal weight), 108 in BMI 85th-94th group (overweight), and 124 in BMI ≥ 95th group (obesity). Multivariate ordinal logistic regression analyses were conducted. The three subgroups were divided to explore the correlation between social determinants and overweight and obesity.

Results

A total of 655 children were included. After adjusting for sex, age, race, use of cigarets, cigars, or pipe tobacco inside, afterschool activity, and physical activity, children in poor physical condition reported by their parents [OR = 1.573 (95% CI, 1.164-2.125)] were associated with overweight/obesity. There were negative correlations between parents with higher education and overweight/obesity, especially in children and youths with previous or current epilepsy groups. Also, overweight/obesity was correlated with the 200%-400% family poverty level (FPL) [the adjusted odds ratio (OR) = 0.156 (95% CI, 0.028-0.876)] and above 400% FPL [the adjusted OR = 0.121 (95% CI, 0.023-0.641)] in children and youths with mild symptoms of epilepsy, and above 400% FPL [the adjusted OR = 0.103 (95% CI, 0.023-0.460)] in children with moderate to severe epilepsy.

Conclusion

Poor physical conditions were correlated with obesity in childhood epilepsy. Parents with higher education and FPLs were negatively correlated to childhood obesity. Therefore, this study was intended to advocate for a greater emphasis on BMI for children and youths with epilepsy in families with lower-educated and low-income groups.

Adversity and child body mass index in Fragile Families over 15 years: Do type and timing matter?

Background

Weight status has been linked to adverse childhood experiences. Existing research, however, is limited to unidimensional assessments of cumulative risk and does not account for the complex nature of adversity experienced by children in high-risk settings. We fill existing gaps by assessing how four subtypes of adversity across two primary dimensions of threat and deprivation-based adversity are associated with changes in body mass index (BMI) across child ages 3 through 15 years.

Method

U.S. mothers and fathers (n = 2412) in the Fragile Families and Child Wellbeing Study were interviewed when children were born, and again at ages 1, 3, 5, 9, and 15 years. Independent variables include interpersonal (e.g., domestic violence), family (e.g., mental health), economic (e.g., housing insecurity), and community (e.g., witness/victim of violence) adversity from ages 1 through 9 years. Path analysis regressed changes in BMIz from ages 3 through 15 on past adversity exposures.

Results

Increased interpersonal and community adversity subtypes from ages 3 to 5 were associated with decreased BMIz from ages 5-9 years. Increased economic adversity from age 3 to 5 was associated with increased BMIz from ages 5 to 9, adjusted for mother age, race, and education.

Conclusion

Findings highlight the differential influence of past adversity type and timing on child BMI. Interpersonal and community adversity were associated with decreased BMIz, and economic adversity with increased BMIz. Differences in directionality of associations suggest research should capture multiple dimensions of adversity in early childhood and possible positive and negative trends in effects on child weight as children grow from early to mid-childhood.

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Moderating Effects of Components of Resilience on Obesity Across Income Strata in the National Survey of Children's Health

OBJECTIVE

This study examined whether components of resilience at the family or child level are associated with a decreased risk of obesity in children after accounting for community-, family-, and individual-level stressors associated with an increased risk of obesity.

METHODS

Data are from the 2016 National Survey of Children's Health, using the subset of children 10 to 17 years of age with weight data. We examined whether or not components of family- or child-level resilience were associated with weight status. Community-, family-, and individual-level risk factors for obesity were examined within each income stratum. We used multinomial logistic regression to evaluate if components of resilience are associated with lower overweight or obesity.

RESULTS

The sample included 24,405 10- to 17-year-old children. Child-level but not family-level resilience components were associated with a decreased risk of child obesity across income strata. Food security and adverse childhood experiences (ACEs) were only associated with obesity within higher income strata; bullying was consistently associated across strata. Physical activity was strongly associated with increased emotional resilience. The association between higher emotional resilience and lower obesity remained after adjusting for community-level factors (parks), family-level factors (ACEs), and individual-level factors (bullying). Better maternal health was associated with increased emotional resilience and lower risk of obesity.

CONCLUSIONS

Resilience, specifically emotional resilience, may be a protective factor against obesity in children regardless of income stratum. Physical activity of the child is associated with greater emotional resilience, and better maternal health may mediate the association between this component of resilience and weight.