Childhood obesity in New York City elementary school students

A Review of the Role of the School Spatial Environment in Promoting the Visual Health of Minors

Rising childhood myopia rate has detrimental health consequences that pose a considerable challenge to health systems. The school spatial environment, which is where students are for the longest period of time, has a high health value for myopia systematic intervention. While research has demonstrated associations between physical daylight environments, medical gene and visual health, the literature currently lacks a synthesis of evidence that will act as a spatially-organized resource for school designers. This study is based on literature from the period 2000-2022 and has been taken from the Web of Science, scopus, Medline and CNKI core collection database. Collaboration, literature co-citation and quantitative and qualitative analysis, in addition to keyword co-occurrence are adopted to conduct a visual health research review. The results indicate that intensive near work activity (as a risk factor) and longer time spent outdoors (as a protective factor), are involved in visual health factors. Two main research themes are obtained and relate to: (1) The environment of visual work behavior (especially the near work learning environment) and adaptable multimedia learning environment; and (2) the environment of outdoor exposure behavior. Furthermore, with the variation of educational demands, models and concepts, there are different demands for near work behavior, and this study makes an important contribution by pointing to two future research directions, including the accurate and controllable environment of near work behavior, which operate in accordance with various educational mode requirements and the active design of the environment of outdoor exposure behavior. In referring to differences between regions and countries, as well as the development of the educational environment, it provides insight into how these demands can be controlled.

Quantile Regression of Childhood Growth Trajectories: Obesity Disparities and Evaluation of Public Policy Interventions at the Local Level

Quantile regression applied to child growth trajectories has been proposed in the methodological literature but has only seen limited applications even though it is a promising framework for the evaluation of school-based policy interventions designed to address childhood obesity. Data that could be used to support such assessments, school-based collection of height and weight, has become increasingly common. Three states currently mandate annual collection and several other jurisdictions including California and New York City (NYC) collect BMI as part of physical fitness assessments. This has resulted in the establishment of extremely large databases that share important characteristics including the ability to define longitudinal growth curves by student with high coverage rates. In NYC public schools, starting in 2006, student records have been linked to registry, academic, and attendance data and across years resulting in a longitudinal dataset containing 9 cohorts with 2 million unique children. A high level of demographic and geographic detail allow for analysis of public policy at the local scale. We demonstrate the utility of quantile regression longitudinal growth curve models applied to BMI trajectories as a means of assessing policy interventions. Models consisting solely of age terms yield empirical curves similar to CDC growth charts; covariates modify these curves. Incorporating lag terms yields a distribution of possible growth trajectories and the effect of interventions can be explicitly quantified. We evaluate area-based and individual poverty measures, known strong correlates of child obesity, as a baseline assessment of the modeling framework. We then evaluate the impact of a real intervention (water jet installations). Our results indicate that students with access to water jets have a statistically significant leftward shift in the right tail of the BMI distribution relative to students without access to water jets. The absolute magnitude of the shift is comparable to the difference in BMI associated with student residential exposure to low versus extreme poverty.

Social vulnerabilities as determinants of overweight in 2-, 4- and 6-year-old Spanish children

Background

Differences in obesity prevalence among vulnerable groups exist in childhood but it remains unclear whether these differences may be partly determined by socioeconomic status (SES), parental body mass index (BMI) and early life risk factors. We aimed to explore (i) longitudinal associations between belonging to a minority group and being overweight/obese at age 2, 4 and 6 and (ii) associations between accumulation of social vulnerabilities and being overweight/obese at age 6.

Methods

In total, 1031 children (53.8% boys) were evaluated at birth and re-examined during a 6-year follow-up in a representative cohort of Aragon (Spain). Children from minority (vulnerable) groups included Spanish Roma/gypsies, Eastern Europeans, Latin Americans and Africans. Two more vulnerable groups were defined at baseline as children whose parents reported low occupation and education. Ethnicity, SES and parental BMI were collected via interviews. We used logistic mixed-effects models and adjusted for parental BMI, SES, mother's tobacco use, maternal weight gain, birth weight, infant weight gain and breastfeeding practices.

Results

Regardless of confounders, Roma/gypsy children (OR = 4.63;[1.69-12.70]95%CI) and with Latin American background (OR = 3.04;[1.59-5.82]95%CI) were more likely to be overweight/obese at age 6 compared with non-gypsy Spanish group. Children with three vulnerabilities (OR = 2.18;[1.31-3.64]95%CI) were more likely to be overweight/obese at age 6 compared with children with no vulnerabilities. No associations were found between belonging to a minority group and overweight/obesity in children under 6.

Conclusion

Interventions should target Roma/gypsy children, Latin American children and those who accumulate more vulnerabilities as they are at higher risk of being overweight/obese at age 6.

A Reexamination of the Accuracy of the Broselow Tape as an Instrument for Weight Estimation

BACKGROUND

Accurate weight estimation is important for calculating appropriate medication dosages, determining rates of fluid replacement, and selecting correct equipment sizes in critically ill children requiring resuscitation. The actual measurement of the weight of a critically ill or injured child is often not possible. The Broselow Pediatric Emergency Tape (BT) is an important tool for predicting a child's weight based on his/her height. Although BT has previously been validated, given the increasing prevalence of obesity in today's society, it behooves clinicians relying on this resuscitation aid to revisit the issue.

OBJECTIVE

The aim of this study was to evaluate the accuracy of the color-coded BT in weight estimation and the influence of obesity on its accuracy.

METHODS

This is a retrospective study conducted in a pediatric clinic of urban hospital. This study reviewed the medical records of children up to 96 months of age, who presented during 2008-2010. We recorded the child's age (in months), actual (measured) weight (in kilograms), and height (in centimeters). Based on the height, weight estimation was obtained using the color-coded BT. The actual weight was compared with the predicted weight obtained by the height-based BT. Patients presenting with any medical condition that would substantially affect growth of the child were excluded. A univariate logistic regression model was utilized to predict any underestimation based on age, sex, and body mass index (BMI) percentile.

RESULTS

The medical records of 538 children were reviewed. There was a discrepancy in 226 children (42%). Broselow Pediatric Emergency Tape underestimated weight (measured weight was higher than predicted weight) in 158 children (29.4%) and overestimated (measured weight was lower than predicted weight) in 68 children (12.6%). Of the 158 underestimated children, 138 were off by 1 color zone, 16 by 2 color zones, and 4 by more than 2 color zones. When characterized by BMI, 46 children (13.6%) had normal BMI, 27 (45.8%) were overweight, and 84 (80.8%) were obese, whereas one child (2.8%) was underweight.

CONCLUSIONS

In our population, BT was inaccurate in predicting weight in 42% of children (underestimation in 158 children [29.4%] and overestimation weight in 68 children [12.6%]). However, the majority of discrepancies involved only 1 BT color zone. Emergency physicians should be aware of this discrepancy until more accurate methods become available.

Why and How Schools Make Nutrition Education Programs "Work"

BACKGROUND

There are many potential health benefits to having nutrition education programs offered by expert outside sources in schools. However, little is known about why and how schools initiate, implement, and institutionalize them. Gaining this understanding may allow the impact and reach of nutrition and other health education programs in schools to be extended.

METHODS

A total of 22 school community members from 21 purposefully selected New York City public elementary schools were interviewed using a semistructured interview protocol about their schools' experiences initiating, implementing, and institutionalizing nutrition education programs. Interviews were audiotaped and transcribed. Chronological narratives were written detailing each school's experience and passages highlighting key aspects of each school's experience were identified. These passages (N = 266) were sorted into domains and themes which were regrouped, resorted, and adjusted until all researchers agreed the domains and themes represented the collective experiences of the schools.

RESULTS

The interviews elicited 4 broad domains of action: building motivation, choosing programs, developing capacity, and legitimizing nutrition education. Within each domain, themes reflecting specific actions and thoughts emerged.

CONCLUSIONS

The identified domains of action and their themes highlight specific, practical actions that school health advocates can use to initiate, implement, and institutionalize nutrition education programs in schools.

Potential return on investment of a family-centered early childhood intervention: a cost-effectiveness analysis

Background

ParentCorps is a family-centered enhancement to pre-kindergarten programming in elementary schools and early education centers. When implemented in high-poverty, urban elementary schools serving primarily Black and Latino children, it has been found to yield benefits in childhood across domains of academic achievement, behavior problems, and obesity. However, its long-term cost-effectiveness is unknown.

Methods

We determined the cost-effectiveness of ParentCorps in high-poverty, urban schools using a Markov Model projecting the long-term impact of ParentCorps compared to standard pre-kindergarten programming. We measured costs and quality adjusted life years (QALYs) resulting from the development of three disease states (i.e., drug abuse, obesity, and diabetes); from the health sequelae of these disease states; from graduation from high school; from interaction with the judiciary system; and opportunity costs of unemployment with a lifetime time horizon. The model was built, and analyses were performed in 2015–2016.

Results

ParentCorps was estimated to save $4387 per individual and increase each individual’s quality adjusted life expectancy by 0.27 QALYs. These benefits were primarily due to the impact of ParentCorps on childhood obesity and the subsequent predicted prevention of diabetes, and ParentCorps’ impact on childhood behavior problems and the subsequent predicted prevention of interaction with the judiciary system and unemployment. Results were robust on sensitivity analyses, with ParentCorps remaining cost saving and health generating under nearly all assumptions, except when schools had very small pre-kindergarten programs.

Conclusions

Effective family-centered interventions early in life such as ParentCorps that impact academic, behavioral and health outcomes among children attending high-poverty, urban schools have the potential to result in longer-term health benefits and substantial cost savings.

Symptomatic Gallstones in the Young: Changing Trends of the Gallstone Disease-Related Hospitalization in the State of New York: 1996 - 2010

Background

The aim of the study was to evaluate if the gallstone-related hospitalizations in the young (< 20 years of age) have increased over time in both the Bronx County and New York State as a whole.

Methods

We retrospectively reviewed 15 years (1996 - 2010) of Statewide Planning and Research Cooperative System (SPARCS) data of New York State Department of Health. Patients with ICD-9 code diagnosis of 574 (cholelithiasis) among the first three discharge diagnoses were reviewed.

Results

Total number of all cause admissions to hospitals had increased from 2.44 million to 2.77 million (1996 - 2010). However, gallstone-related hospitalizations had decreased from 1.7% to 1.2%. It was noted that there was a 30% increment in the proportion of those below 20 years of age with gallstone disease requiring hospitalization over the same period. This young patient population contributed only 2.04% to all gallstone-related hospitalizations in 1996, whereas it had increased to 2.96% in 2010. This trend was more pronounced in women, Hispanics and in those who were residing in the Bronx County as compared to all other New York counties combined.

Conclusion

The gallstone-related hospitalizations in the young (< 20 years of age) have increased over time in both the Bronx County and New York State as a whole. This could be due to increasing prevalence of risk factors such as obesity, physical inactivity, diabetes and early pregnancy.

Associations among measures of energy balance related behaviors and psychosocial determinants in urban upper elementary school children

BACKGROUND

Childhood obesity prevention is a pressing issue. Understanding the relationships among eating and physical activity behaviors and potential psychosocial determinants of behavior will help us design more effective interventions. This study aimed to examine such relationships in a large sample of urban elementary school children.

METHODS

Fifth grade students in 20 recruited New York City public schools completed a validated questionnaire on six "do more" (fruits and vegetables and physical activity) and "do less" (sweetened beverages, processed packaged snacks, fast food and sedentary behavior) energy balance related behaviors (EBRBs) and psychosocial determinants of behavior from social cognitive and self-determination theories. Correlations among behaviors and hierarchical linear model analyses of the relationship between psychosocial determinants and behaviors were conducted for those with complete data (n = 952).

RESULTS

The "do more" and the "do less" behaviors were significantly correlated within categories (p < 0.01). "Do more" food-related behaviors were correlated with physical activity but so were sports drinks, while the "do less" food-related behaviors tended to be correlated to sedentary behavior (p < 0.01). "Do more" behaviors were associated with self-efficacy and habit strength, and "do less" behaviors with outcome expectations, self-efficacy, habit strength, and behavioral intention.

CONCLUSIONS

Interventions can address the healthy and less healthy clusters of behaviors together, focusing on strategies to enhance their self-efficacy and habit strength for the "do more" behaviors and outcome expectations to motivate intention to choose fewer "do less" behaviors, along with enhancing self-efficacy and habit. Research can examine these determinants as potential mediators of change in intervention.

Neighborhoods, Schools and Obesity: The Potential for Place-Based Approaches to Reduce Childhood Obesity

A common policy approach to reducing childhood obesity aims to shape the environment in which children spend most of their time: neighborhoods and schools. This paper uses richly detailed data on the body mass index (BMI) of all New York City public school students in grades K-8 to assess the potential for place-based approaches to reduce child obesity. We document variation in the prevalence of obesity across NYC public schools and census tracts, and then estimate the extent to which this variation can be explained by differences in individual-level predictors (such as race and household income). Both unadjusted and adjusted variability across neighborhoods and schools suggest place-based policies have the potential to meaningfully reduce child obesity, but under most realistic scenarios the improvement would be modest.

Timed Up and Go: Reference Data for Children Who Are School Age

PURPOSE

To collect normative data for the Timed Up and Go (TUG) on a large, diverse sample of urban school children who are typically developing, accounting for age, sex, and body mass index.

METHODS

Physical therapists administered the TUG with natural walking speeds on 1481 children (M = 635, F = 846), ages 5 to 13 years representing 29.60% whites, 24.2% Asian/Pacific Islanders, 19.7% Latino/Hispanics, 16.3% African Americans, 1.40% Native American/Alaskans, and 8.80% other.

RESULTS

Average TUG speeds ranged from 6.20 to 7.12 seconds across all ages, with speeds decreasing from 5 to 9 years and increasing from 9 to 13 years. Differences between 8-, 9-, and 11-year-old males and females and across age groups did not exceed a clinically important threshold. Body mass index was not consistently correlated with TUG speed.

CONCLUSION

This study provides reference data on the TUG. These data should complement clinical observations and additional tests and measures to determine whether a student is functioning slower than age-matched peers.

Childhood Obesity Prevention in Childcare Settings: the Potential of Policy and Environmental Change Interventions

Current obesity rates in young children are a serious public health concern; developing and implementing obesity prevention interventions in childcare settings is a promising avenue to address this issue. In recent years, there has been increasing focus on environmental and policy change interventions for this setting. Improving access to and quality of outdoor play spaces and implementing the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) are two promising environmental change strategies in this setting. Laws at the local, state, and federal level have also been implemented; New York City and Delaware are two jurisdictions that have passed policies and provided preliminary evidence of the potential of policy interventions to change child outcomes. A combination of programmatic, environmental, and policy change strategies will likely be most effective in maximizing the potential of childcare settings to promote healthy weight in children.

[The racialization of public health in the United States : the possibility that the concept be allowed to die out]

Résumé

Aux États-Unis, une intensification de l’usage de la race en santé publique a récemment été notée ; une idée qui est pourtant controversée dans les sciences. La race a été vue dans ce contexte comme un objet de discours entre pouvoirs et savoirs, un objet qui se réfère au corps devenu au cours des derniers siècles un site discursif pour représenter la différence. Cet article s’appuie sur une analyse de documents de la santé publique parus aux États-Unis et issus de bureaux fédéraux et d’une importante revue spécialisée dans le domaine sanitaire, qui ont été publiés entre 2001 et 2009. Cette étude a analysé la manière dont la race est représentée, produite comme objet de connaissance et régulée par les pratiques discursives dans ces documents. Les résultats décrivent deux processus enchevêtrés, la racialisation et la sanitarisation, qui concourent à reformuler l’idée de race. Le premier est un ensemble d’opérations qui visent à identifier, à situer et à opposer les sujets et les groupes à partir de labels standardisés. La sanitarisation assure la traduction des groupes racialisés en termes de maladies, de comportements, de vie ou de mort. Ces pratiques aboutissent à la caractérisation et à la formation d’objets racialisés et sanitarisés et à des stéréotypes ; un ensemble d’opérations qui a tendance à naturaliser la différence. La racialisation apparaît également tiraillée entre un pouvoir sur la vie et un droit de laisser mourir. Enfin, cette étude propose aux acteurs de la santé publique de sortir des frontières imposées par le discours racialisant.

Growth comparison in children with and without food allergies in 2 different demographic populations

OBJECTIVE

To examine the effects of food avoidance on the growth of children with food allergies.

STUDY DESIGN

A retrospective chart review was performed for children with and without food allergies followed at 2 New York City general pediatric practices. Charts were selected based on codes from the International Classification of Diseases, 9th Revision, for well child visit, food allergy, anaphylaxis, and/or epinephrine autoinjector prescriptions. Heights and weights were obtained to calculate body mass index, height, and weight z-scores.

RESULTS

Of the 9938 children seen, 439 (4.4%) were avoiding one or more foods. Of those with commercial insurance, children with food allergies were significantly shorter (mean height z-score = 0.06; P = .01) and weighed less (mean weight z-score -0.1; P = .006) than children without food allergies (mean height z-score = 0.42; mean weight z-score = 0.07). In contrast, children with food allergies and state insurance were not smaller in height or weight compared with children without food allergies. Among white subjects, there was a significant effect of food allergies on height and weight (ANOVA for height P = .012, for weight P = .0036) that was not observed for Hispanic/Latino, black, or Asian subjects. Children with allergies to milk weighed significantly less than children without milk allergies (P = .0006).

CONCLUSIONS

Children with food allergies and commercial insurance have significant impairment in growth compared with those without food allergies. Additionally, children avoiding all forms of milk are shorter and weigh less than matched counterparts. Therefore, height and weight measurements should be assessed routinely in children with food allergies because there is risk for growth impairment in this population.

The cost-effectiveness of New York City's Safe Routes to School Program

OBJECTIVE

We evaluated the cost-effectiveness of a package of roadway modifications in New York City funded under the Safe Routes to School (SRTS) program.

METHODS

We used a Markov model to estimate long-term impacts of SRTS on injury reduction and the associated savings in medical costs, lifelong disability, and death. Model inputs included societal costs (in 2013 US dollars) and observed spatiotemporal changes in injury rates associated with New York City's implementation of SRTS relative to control intersections. Structural changes to roadways were assumed to last 50 years before further investment is required. Therefore, costs were discounted over 50 consecutive cohorts of modified roadway users under SRTS.

RESULTS

SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City.

CONCLUSIONS

SRTS reduces injuries and saves money over the long run.

Hispanic Youth With Excess Weight Display Psychological Distress

Adolescent overweight/obesity (OW/O) has reached epidemic proportions. The Youth Self-Report (YSR) was administered to 514 primarily Hispanic urban high school students to examine the relationship between weight and psychological distress. YSR and study population-specific norms were used to assess risk on Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, and Social Problems scales. OW/O status increased Social Problems regardless of norms. OW/O students endorsed greater Withdrawn/Depressed symptoms with YSR norms; greater Anxious/Depressed and Somatic Complaints were endorsed with population-specific norms. Females drive results. Findings suggest norms need to incorporate minority and economically disadvantaged groups.

Polycyclic aromatic hydrocarbon exposure, obesity and childhood asthma in an urban cohort

BACKGROUND

Exposure to traffic-related air pollutants, including polycyclic aromatic hydrocarbons (PAHs) from traffic emissions and other combustion sources, and childhood obesity, have been implicated as risk factors for developing asthma. However, the interaction between these two on asthma among young urban children has not been studied previously.

METHODS

Exposure to early childhood PAHs was measured by two week residential indoor monitoring at age 5-6 years in the Columbia Center for Children's Environmental Health birth cohort (n=311). Semivolatile [e.g., methylphenanthrenes] and nonvolatile [e.g., benzo(a)pyrene] PAHs were monitored. Obesity at age 5 was defined as a body mass index (BMI) greater than or equal to the 95th percentile of the year 2000 age- and sex-specific growth charts (Center for Disease Control). Current asthma and recent wheeze at ages 5 and 7 were determined by validated questionnaires. Data were analyzed using a modified Poisson regression in generalized estimating equations (GEE) to estimate relative risks (RR), after adjusting for potential covariates.

RESULTS

Neither PAH concentrations or obesity had a main effect on asthma or recent wheeze. In models stratified by presence/absence of obesity, a significant positive association was observed between an interquartile range (IQR) increase in natural log-transformed 1-methylphenanthrene (RR [95% CI]: 2.62 [1.17-5.88] with IQRln=0.76), and 9-methylphenanthrene (2.92 [1.09-7.82] with IQRln=0.73) concentrations and asthma in obese children (n=63). No association in non-obese (n=248) children was observed at age 5 (Pinteraction<0.03). Similar associations were observed for 3-methylphenanthrene, 9-methylphenanthrene, and 3,6-dimethylphenanthrene at age 7.

CONCLUSIONS

Obese young children may be more likely to develop asthma in association with greater exposure to PAHs, and methylphenanthrenes in particular, than non-obese children.

Prevalence and risk factors of being overweight or obese among children and adolescents in northeast China

BACKGROUND

We determined the prevalence and risk profiles of being overweight or obese among children and adolescents in rural northeast China.

METHODS

We conducted a cross-sectional study consisting of 4,094 children and adolescents aged 5-18 y. Anthropometric measurements and information on health-related variables were collected by well-trained personnel. Odds ratios (ORs) are presented with 95% confidence intervals (CIs).

RESULTS

The overall prevalence of subjects who were overweight or obese was 21.8% (15.4% overweight and 6.4% obese). Among boys, getting more sleep was found to be a protective factor against being overweight or obese, and a higher monthly family income (2,000-5,000 Chinese yuan (CNY); 1 CNY = 0.163 US dollar) was associated with an increased risk as compared with lower incomes. For girls, not having breakfast every day conferred higher odds of being overweight or obese (OR, 1.45 (95% confidence interval (CI), 1.11-1.91)). When both parents were overweight, this increased the risk of a child being overweight or obese in both boy (overweight father: OR, 1.54 (95% CI, 1.26-1.89); overweight mother: OR, 1.73 (95% CI, 1.35-2.22)) and girl participants (overweight father: OR, 2.01 (95% CI, 1.57-2.57); overweight mother: OR, 1.45 (95% CI, 1.07-1.96)).

CONCLUSION

The prevalence of pediatric obesity in rural China was relatively high. Risk profiles should be fully considered when planning prevention and treatment programs for pediatric obesity.

Long term effects of a health promotion intervention in low socioeconomic Arab- Israeli kindergartens

Background

Obesity is the most common chronic pediatric disease in westernized, especially low socioeconomic societies. We previously demonstrated the beneficial effects of a randomized prospective school-based health education program for low socioeconomic status Arab-Israeli kindergarten children.

Methods

To examine whether the effects of our program on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness persisted one year after the end of intervention.

We were able to perform the one year follow-up in 203 kindergarten children (59% of our 342 original cohort; 85 control, 118 intervention).

Results

At one year following the intervention BMI and BMI percentiles approached baseline level in both the intervention (16.4±0.2 kg/m² and 61.5±2.4%, respectively) and control group participants (16.5±0.2 kg/m² and 58.5±3.3%, respectively). Yet, a year after the end of the intervention, the decrease in BMI%ile from baseline was significantly greater in the intervention group (-7.8±1.5 vs. -1.9±1.9, p<0.012). Nutritional and physical activity knowledge and preferences, and physical fitness remained significantly elevated in the intervention compared to the control group participants.

Conclusions

The beneficial effects of a kindergarten dietary-physical activity intervention applied by the kindergarten teachers, on nutrition and physical activity knowledge and preferences, fitness, and BMI percentile were evident one year after the end of intervention. This promising program may play a role in health promotion, prevention and treatment of childhood obesity.

Perinatal outcomes of Southeast Asians with pregnancies complicated by gestational diabetes mellitus or preeclampsia

To examine risks for adverse perinatal outcomes among Southeast Asian women with pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia. Perinatal outcomes of singleton births of Cambodian (3,489), Laotian (2,038), Vietnamese (11,605), Japanese (3,083) and non-Hispanic White women (33,088) were analyzed using Washington state linked birth certificate and hospitalization discharge records (1993-2006). Both Cambodian (aOR = 1.68) and Laotian (aOR = 1.71) women with GDM had increased odds of macrosomia when compared with Japanese women with GDM. Southeast Asian women with GDM had reduced odds of macrosomia when compared with White women. Southeast Asian women with preeclampsia had increased odds for preterm delivery when compared with Japanese and White women with preeclampsia. Research is needed to understand why Southeast Asian women with GDM are more likely to have better perinatal outcomes when compared with White women. Vigilant monitoring and culturally sensitive care for Southeast Asian women with preeclampsia is needed.

Associations of physical activity and dietary behaviors with children's health and academic problems

BACKGROUND

We examined the associations of physical activities and dietary behaviors with children's health and academic-behavioral problems.

METHODS

We employed a Community-wide Children's Health Assessment and Planning Survey to examine physical activity, healthy meals, health status, and academic-behavioral problems in 3708 children 7 to 14 years of age. Statistical associations were examined with chi-square test and logistic regression analysis; we calculated odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among these children, 30.2% were overweight-obese, 11.0% had academic problems, and 7.9% had behavioral problems. Children classified as healthy eaters were more likely to exercise ≥4 days/week (79.1% vs 64.6%, OR: 2.08, 95% CI: 1.14 to 2.49), less likely to be overweight-obese (27.7% vs 44.6%, OR: 0.48, CI: 0.31 to 0.73), less likely to have academic problems (9.1% vs 16.1%, OR: 0.57, 95% CI: 0.41 to 0.79) and behavioral problems (6.9% vs 13.9%, OR: 0.46, 95% CI: 0.32 to 0.66) compared with their less healthy eating peers. Physical activity and healthy meals were associated with an improved health status (p < .001). However, the proportions of children taking unhealthy meals or choosing sedentary lifestyle increased as the cohorts progressed (p < .05) from childhood (7 to 8 years) to adolescence (13 to 14 years).

CONCLUSIONS

Healthy (or unhealthy) lifestyle behaviors are significantly interrelated. Children who take healthy meals and exercise often are associated with better health and fewer academic and behavioral problems. Unfortunately, taking unhealthy meals and sedentary lifestyle characterize a growing proportion of young adolescents. Thus, curbing unhealthy lifestyle behaviors should start in early childhood.

Individual- and school-level sociodemographic predictors of obesity among New York City public school children

To identify student- and school-level sociodemographic characteristics associated with overweight and obesity, the authors conducted cross-sectional analyses of data from 624,204 public school children (kindergarten through 12th grade) who took part in the 2007-2008 New York City Fitnessgram Program. The overall prevalence of obesity was 20.3%, and the prevalence of overweight was 17.6%. In multivariate models, the odds of being obese as compared with normal weight were higher for boys versus girls (odds ratio (OR) = 1.39, 95% confidence interval (CI): 1.36, 1.42), for black (OR = 1.11, 95% CI: 1.07, 1.15) and Hispanic (OR = 1.48, 95% CI: 1.43, 1.53) children as compared with white children, for children receiving reduced-price (OR = 1.17, 95% CI: 1.13, 1.21) or free (OR = 1.12, 95% CI: 1.09, 1.15) school lunches as compared with those paying full price, and for US-born students (OR = 1.54, 95% CI: 1.50, 1.58) as compared with foreign-born students. After adjustment for individual-level factors, obesity was associated with the percentage of students who were US-born (across interquartile range (75th percentile vs. 25th), OR = 1.10, 95% CI: 1.07, 1.14) and the percentage of students who received free or reduced-price lunches (across interquartile range, OR = 1.13, 95% CI: 1.10, 1.18). The authors conclude that individual sociodemographic characteristics and school-level sociodemographic composition are associated with obesity among New York City public school students.

Diet, physical activity, weight status, and culture in a sample of children from the developing world

Objective. Barbados, a small developing state at the end of the nutrition transition, faces an obesity epidemic. Although there is hope of stemming the epidemic in childhood, no descriptions of children's dietary and physical activity (PA) patterns are available for planning purposes. We describe the food and activity preferences and adult encouragement of active and sedentary behaviors for children 9–11 years in relation to weight status and the cultural context. Design. We used data from a pilot study preceding a large-scale ongoing study on the local drivers of the obesity epidemic among preadolescent children. PA, sedentary activity, and dietary intakes were assessed from recalls. Weight and height were measured. Setting. Barbados. Subjects. Sixty-two (62), 9–11-year-old school children. Results. Sugar-sweetened beverages provided 21% of energy consumed. Energy intake significantly explained BMI. Parents selected significantly more of children's sedentary activities and encouraged mostly homework and chores (59%). Children's self-selected school-based activity was significantly related to BMI. Conclusions. Childhood obesity prevention recommendations and research should focus on culture-specific practices that promote acquired taste for excess sugar and parent-child interactions regarding PA. Child influenced by school-based activity intervention may an important area for preventive intervention research.

A ballroom dance classroom program promotes moderate to vigorous physical activity in elementary school children

PURPOSE

To determine if an existing ballroom dance classroom program meets national recommendations to engage children in moderate to vigorous physical activity (MVPA) for ≥50% of class time and to determine class effects on body mass index (BMI).

DESIGN

Prospective descriptive study. Setting . Two New York City public schools.

PARTICIPANTS

Seventy-nine fourth and fifth grade students.

MEASUREMENTS

The System for Observing Fitness Instruction Time (SOFIT) and direct heart rate monitoring were used to determine participants' MVPA levels during class time. Weight and height were measured to calculate BMI.

ANALYSIS

Means were calculated for continuous variables; frequency counts and percentages were calculated for categorical variables. Change in BMI percentiles was assessed by using Bhapkar's χ(2) test of overall marginal homogeneity.

RESULTS

Data from SOFIT observations showed that a mean of 50.0% and 67.0% of class time in the first and second halves of the program, respectively, were spent in MVPA. Data from the heart rate monitoring revealed that 71.1% of students were at ≥25% heart rate reserve, which indicated MVPA for ≥50% of class time. Improvement was seen in BMI percentile (p= .051).

CONCLUSION

Ballroom dance provides MVPA in elementary school children for ≥50% of class time and has a positive impact on BMI percentiles.

Relation of growth rate from birth to three months and four to six months to body mass index at ages four to six years

Background. While rapid early weight gain are common in children who become obese later in life, so is growth faltering in the first 3 months of life. Objective. We seek to determine what relationship weight gain in the first six months of age, separated into two 3-month periods, have with the BMI of children ages 4 to 6 years in an inner-city community. Subjects. A convenience sample cohort of 154 children attending an inner-city clinic. Methods. Consecutive charts were reviewed retrospectively. Age, gender, birth weight and weight change in the first and second 3 months of life were introduced as fixed factors using mixed linear models with BMI in years 4 to 6 as the dependent variable. Results. Weight change quartile in the first 3 months of life did not predict of BMI in years 4 to 6; however, weight changes quartiles during months 4 to 6 were significant predictors for subsequent overweight. Conclusion. The data presented herein suggest that, for this specific population, weight gain can be promoted when it is most essential. It is necessary, however, to identify intermediary variables that could affect outcomes in this and other communities.

Pilot Study of an Active Screen Time Game Correlates with Improved Physical Fitness in Minority Elementary School Youth

OBJECTIVE

The aim of our feasibility study was to examine the acceptability and utility of "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA)) to increase physical fitness in 8-11-year-old black and Hispanic youth.

SUBJECTS AND METHODS

Twenty-eight 4(th) and 5(th) grade children attending an afterschool program participated. Outcomes included physical activity, physical fitness, use of home DDR, survey of safety and acceptability, anthropometrics, and fasting metabolic profile measured at baseline, 12 weeks, and 30 weeks.

RESULTS

At 12 weeks, physical fitness (maximum O2 uptake [VO2max]) increased by 4.9±9.9 percent and was sustained through 30 weeks, when the VO2max was 105.0±9.9 percent (range, 93.0-133.9 percent) of baseline values. Absolute VO2max increased by 2.97±4.99 mL/kg/minute (95% confidence interval 0.75-5.19, P=0.013). Participants maintained an average of 1.12 hours/day of increased movement to music. Trends suggested increased total moderate-vigorous physical activity, decreased light activity, and a modest increase in sedentary screen time. There were no significant changes in body mass index, fasting lipids, or glucose. Participants and parents approved of the activity.

CONCLUSION

DDR appears feasible and acceptable to minority youth. DDR may increase moderate-vigorous physical activity and improve physical fitness in at-risk populations.

Health-related knowledge and preferences in low socio-economic kindergarteners

OBJECTIVE

The aim of the present study was to determine physical activity (PA) and nutrition knowledge and preferences in low socio-economic status kindergarten children.

METHODS

Following height and weight measurement, 795 low socio-economic status kindergarten children (age 3.8-6.8 y.o) completed a photo-pair knowledge and preferences food and exercise questionnaire.

RESULTS

No difference was found between nutrition and PA knowledge scores (52.3 ± 0.9 versus 52.6 ± 0.8%, respectively). There was no difference between the nutrition knowledge and preference score (52.3 ± 0.9 versus 50.9 ± 0.9%, respectively). PA preference was significantly higher than knowledge (56.9 ± 1.5 versus 52.6 ± 0.8%, respectively; p < 0.0001). Significant correlations were found between nutrition knowledge and preferences (r = 0.55, p < 0.0001), physical activity knowledge and preferences (r = 0.46, p < 0.0001), and nutrition and PA preferences (r = 0.46, p < 0.001). Nutrition preference scores were significantly lower in overweight compared to normal weight kindergartners 48.1 ± 1.7 versus 52.0 ± 1.0%; p < 0.05). PA knowledge and preference scores were significantly higher among male compared to the female kindergartners (p < 0.001 for both).

CONCLUSION

Our data demonstrate diversities in physical activity and nutrition knowledge and preferences among low socio-economic status kindergarten children. These findings may be important for the development of health promotion programs in low socioeconomic kindergarten children.

An after-school dance and lifestyle education program reduces risk factors for heart disease and diabetes in elementary school children

BACKGROUND

Forty-three percent of New York City's (NYC) school-age children are overweight or obese, placing them at risk for heart disease and type 2 diabetes mellitus (T2DM).

OBJECTIVE

The objective of this study was to determine if an intensive after-school dance and lifestyle education program would reduce risk factors for heart disease, T2DM, and improve lifestyle choices.

SUBJECTS

Subject include 64 fourth- and fifth-grade students at an elementary school in NYC.

METHODS

Students received freestyle dance and lifestyle classes for 16 weeks and were evaluated for changes in body composition, endurance, biochemical measurements, and lifestyle choices.

RESULTS

Significant improvements in BMI percentiles were found among children in the overweight and obese categories as well as in endurance and biochemical measurements that reflect heart disease and diabetes risk. Improvement was also reported in lifestyle choices.

CONCLUSION

An intensive after-school dance and lifestyle education program can reduce risk factors for heart disease and T2DM and improve lifestyle choices among elementary school children.

Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials

Objective. To assess the effectiveness of interventions that focus on reducing sedentary behavior (SB) among school-age youth and to identify elements associated with interventions' potential for translation into practice settings. Methods. A comprehensive literature search was conducted using 4 databases for peer-reviewed studies published between 1980 and April 2011. Randomized trials, which lasted at least 12 weeks, aimed at decreasing SB among children aged 6 to 19 years were identified. Results. Twelve studies were included; 3 focused only on SB, 1 focused on physical activity (PA), 6 were combined SB and PA interventions, and 2 studies targeted SB, PA, and diet. The majority of the studies were conducted in a school setting, while others were conducted in such settings as clinics, community centers, and libraries. Conclusions. Overall, interventions that focused on decreasing SB were associated with reduction in time spent on SB and/or improvements in anthropometric measurements related to childhood obesity. Several of the studies did consider elements related to the intervention's potential for translation into practice settings.

Family-based factors associated with overweight and obesity among Pakistani primary school children

BACKGROUND

Childhood obesity epidemic is now penetrating the developing countries including Pakistan, especially in the affluent urban population. There is no data on association of family-based factors with overweight and obesity among school-aged children in Pakistan. The study aimed to explore the family-based factors associated with overweight and obesity among Pakistani primary school children.

METHODS

A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Overweight (> +1SD BMI-for-age z-score) and obesity (> +2SD BMI-for-age z-score) were defined using the World Health Organization reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors of overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05.

RESULTS

Significant family-based correlates of overweight and obesity included higher parental education (P < 0.001), both parents working (P = 0.002), fewer siblings (P < 0.001), fewer persons in child's living room (P < 0.001) and residence in high-income neighborhoods (P < 0.001). Smoking in living place was not associated with overweight and obesity. Higher parental education (P < 0.001) and living in high-income neighborhoods (P < 0.001) showed a significant independent positive association with BMI while greater number of siblings (P = 0.001) and persons in child's living room (P = 0.022) showed a significant independent inverse association. College-level or higher parental education as compared to high school-level or lower parental education (aOR 2.54, 95% CI 1.76-3.67), living in high-income neighborhoods as compared to low-income neighborhoods (aOR 2.13, 95% CI 1.31-3.46) and three or less siblings as compared to more than three siblings (aOR 1.75, 95% CI 1.26-2.42) were significant independent predictors of overweight.

CONCLUSION

Family-based factors were significantly associated with overweight and obesity among school-aged children in Pakistan. Higher parental education, living in high-income neighborhoods and fewer siblings were independent predictors of overweight. These findings support the need to design evidence-based child health policy and implement targeted interventions, considering the impact of family-based factors and involving communities.

OBESITY, ACADEMIC PERFORMANCE AND REASONING ABILITY IN PORTUGUESE STUDENTS BETWEEN 6 AND 12 YEARS OLD

Obesity has been linked to several physiological and psycho-social diseases, decreases in cognitive function, poor levels of scholastic achievement, low socioeconomic status and delayed onset of maturity. This study investigates the association between obesity and both academic performance and reasoning ability in 394 male and 398 females students between the ages of 6 and 12 from Lisbon, Portugal. It also assesses how this relationship may be influenced by chronological age, maturity and socioeconomic status. The results suggest that: 1) reasoning ability is independent of socioeconomic status and level of maturity; 2) no differences in reasoning ability exist between groups of different BMI; 3) academic performance is moderated by chronological age in boys, and by maturity in both genders; 4) obesity is not associated with academic performance. It is concluded that reasoning ability and academic performance are not associated with obesity, and that inter-individual differences in academic performance in boys may be explained by differences in their level of maturity.

Prevalence, demographics, and health outcomes of comorbid asthma and overweight in urban children

BACKGROUND

Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity.

OBJECTIVE

To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence.

METHOD

Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes.

RESULTS

Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%).

CONCLUSIONS

The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma-obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.

Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children

Background

Childhood obesity is becoming an equally challenging, yet under-recognized, problem in developing countries including Pakistan. Children and adolescents are worst affected with an estimated 10% of the world's school-going children being overweight and one quarter of these being obese. The study aimed to assess prevalence and socioeconomic correlates of overweight and obesity, and trend in prevalence statistics, among Pakistani primary school children.

Methods

A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged 5-12 years in Lahore, Pakistan. Overweight (> + 1SD) and obesity (> + 2SD) were defined using the World Health Organization child growth reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors for overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05.

Results

Seventeen percent (95% CI 15.4-18.8) children were overweight and 7.5% (95% CI 6.5-8.7) were obese. Higher prevalence of obesity was observed among boys than girls (P = 0.028), however, there was no gender disparity in overweight prevalence. Prevalence of overweight showed a significantly increasing trend with grade (P < 0.001). Children living in the urban area with high socioeconomic status (SES) were significantly at risk for being overweight and obese (both P < 0.001) as compared to children living in the urban area with lower SES and rural children. Being in higher grade (aOR 2.39, 95% CI 1.17-4.90) and living in the urban area with higher SES (aOR 18.10, 95% CI 10.24-32.00) independently predicted the risk of being overweight.

Conclusion

Alarmingly rapid rise in overweight and obesity among Pakistani primary school children was observed, especially among the affluent urban population. The findings support the urgent need for National preventive strategy for childhood obesity and targeted interventions tailored to local circumstances with meaningful involvement of communities.

Health promotion intervention in low socioeconomic kindergarten children

OBJECTIVE

To prospectively examine the effects of a randomized school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness in low socioeconomic kindergarten children.

STUDY DESIGN

A total of 376 children completed a school-year combined dietary-behavioral-physical activity intervention and were compared with 349 control subjects (age 3.8 to 6.8 years).

RESULTS

The prevalence of overweight and obesity among the kindergarten children was 27.7%. Even though the intervention was not associated with between group differences in body mass index changes, it was associated with significantly (P < .05) greater increase in nutrition knowledge and preferences, physical activity knowledge and preferences, and improvement in fitness. There was a greater (P < .05) decrease in the number of overweight children in the intervention group (-31.9%) compared with the controls (-17.5%).

CONCLUSIONS

A kindergarten dietary-physical activity intervention applied by the kindergarten teachers, had no effect on body mass index changes between the groups, but improved nutrition and physical activity knowledge and preferences, improved fitness, and decreased the percent of overweight children. This intervention may play an important role in health promotion, prevention and treatment of childhood obesity.

Obesity prevention, screening, and treatment: practices of pediatric providers since the 2007 expert committee recommendations

This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P < .05). Although most providers felt comfortable counseling patients and families about the prevention of overweight and obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.

Latino parents' perceptions of their ability to prevent obesity in their children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.

Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation

BACKGROUND

The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts.

OBJECTIVE

To examine the impact of a curriculum intervention, Choice, Control & Change, on the adoption of the energy balance-related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors.

DESIGN

Ten middle schools were randomly assigned within matched pairs to either intervention or comparison/delayed control conditions during the 2006-2007 school year.

SUBJECTS/SETTING

Students were from low-income New York City neighborhoods; 562 were in the intervention condition, and 574 in the comparison condition.

INTERVENTION

Students received the 24 Choice, Control & Change lessons that used science inquiry investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action.

MAIN OUTCOME MEASURES

Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors.

STATISTICAL ANALYSES

Analysis of covariance with group (intervention/control) as a fixed factor and pretest as covariate.

RESULTS

Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen time, but showed no increases in their intakes of water, fruits, and vegetables. They showed substantial increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy.

CONCLUSIONS

The Choice, Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.

Evaluating a bilingual video to improve infant feeding knowledge and behavior among immigrant Latina mothers

Childhood obesity is recognized as a major health problem in the United States and is occurring at ever younger ages. While most prevention efforts are aimed at school-age children, this project focuses on the caregivers of children from 0 to 24 months of age. This study is an evaluation of an educational English/Spanish infant feeding video, distributed for home viewing at one New York City Special Supplemental Food Program for Women, Infants and Children (WIC) center (video group) but not at three others (comparison group). Baseline, 3 and 6 month infant feeding knowledge and behavior surveys were conducted. For this report, analyses are restricted to Latina immigrant mothers. The video and comparison group mothers were similar in age, education, and parity. The video group was more likely to speak Spanish at home, and had lower knowledge scores at baseline. At the 6 month follow-up, knowledge increased for both groups, but the video group showed a greater increase in knowledge between baseline and 6 months: in ordered logistic regression analyses the video group had a 1.7 times greater score increase at each outcome level. The video group also showed positive changes in behavior-later age at first solid feeding was observed in the video group. We found that an inexpensive, low-intensity video intervention can positively impact maternal knowledge and behavior related to infant feeding among immigrant Latinas. Attention should be given to intervening early with high-risk populations.

Obesity, food selectivity, and physical activity in individuals with fragile X syndrome

National survey data from 884 families were used to examine the overall health of children and adults with fragile X syndrome. Results indicate the rate of obesity in adults with fragile X syndrome is similar to the general population (∼30%). Male children with fragile X syndrome, however, had higher rates of obesity (31%) when compared with typically developing same-aged peers (18%). Both males and females displayed food selectivity, especially with regard to texture. Physical activity levels for children were higher than for adults, but neither group met recommended levels. Several cognitive and behavioral characteristics, food selectivity, and physical activity were related to overall health and body mass index. Continued monitoring of the health status of individuals with fragile X syndrome is recommended.

A tale of two obesCities: the role of municipal governance in reducing childhood obesity in New York City and London

As rates of childhood obesity and overweight rise around the world, researchers and policy makers seek new ways to reverse these trends. Given the concentration of the world's population, income inequalities, unhealthy diets, and patterns of physical activity in cities, urban areas bear a disproportionate burden of obesity. To address these issues, in 2008, researchers from the City University of New York and London Metropolitan University created the Municipal Responses to Childhood Obesity Collaborative. The Collaborative examined three questions: What role has city government played in responding to childhood obesity in each jurisdiction? How have municipal governance structures in each city influenced its capacity to respond effectively? How can policy and programmatic interventions to reduce childhood obesity also reduce the growing socioeconomic and racial/ethnic inequities in its prevalence? Based on a review of existing initiatives in London and New York City, the Collaborative recommended 11 broad strategies by which each city could reduce childhood obesity. These recommendations were selected because they can be enacted at the municipal level; will reduce socioeconomic and racial/ethnic inequalities in obesity; are either well supported by research or are already being implemented in one city, demonstrating their feasibility; build on existing city assets; and are both green and healthy.

Disparities in the food environments of New York City public schools

BACKGROUND

Studies of the food environment near schools have focused on fast food. Research is needed that describes patterns of exposure to a broader range of food outlet types and that examines the influence of neighborhood built environments.

PURPOSE

Using data for New York City, this paper describes the prevalence of five different food outlet types near schools, examines disparities by economic status and race/ethnicity in access to these food outlets, and evaluates the extent to which these disparities are explained by the built environment surrounding the school.

METHODS

National chain and local fast-food restaurants, pizzerias, small grocery stores ("bodegas"), and convenience stores within 400 m of public schools in New York City were identified by matching 2005 Dun & Bradstreet data to 2006-2007 school locations. Associations of student poverty and race/ethnicity with food outlet density, adjusted for school level, population density, commercial zoning, and public transit access, were evaluated in 2009 using negative binomial regression.

RESULTS

New York City's public school students have high levels of access to unhealthy food near their schools: 92.9% of students had a bodega within 400 m, and pizzerias (70.6%); convenience stores (48.9%); national chain restaurants (43.2%); and local fast-food restaurants (33.9%) were also prevalent within 400 m. Racial/ethnic minority and low-income students were more likely to attend schools with unhealthy food outlets nearby. Bodegas were the most common source of unhealthy food, with an average of nearly ten bodegas within 400 m, and were more prevalent near schools attended by low-income and racial/ethnic minority students; this was the only association that remained significant after adjustment for school and built-environment characteristics.

CONCLUSIONS

Nearly all New York City public school students have access to inexpensive, energy-dense foods within a 5-minute walk of school. Low-income and Hispanic students had the highest level of exposure to the food outlets studied here.

A meta-analysis of obesity interventions among U.S. minority children

PURPOSE

To quantitatively evaluate the efficacy of interventions designed to prevent or treat obesity among U.S. minority children using meta-analytic techniques.

METHODS

A total of 40 intervention trials involving 10,725 children aged 6-19 years were examined.

RESULTS

Interventions with more components showed a higher mean effect size than those with fewer components: among 32 controlled trials, d = .07 for one-component (n = 6); d = .08 for two-component (n = 15); d = .33 for three-component (n = 10); and d = .71 for four-component (n = 1) interventions. Interventions with parental involvement (n = 22, d = .21) and lifestyle interventions (n = 14, d = .34) showed a greater mean effect size than those without parental involvement (n = 10, d = .05) or lifestyle interventions (n = 18, d = .04), despite the fact that their 90% confidence intervals overlapped. Among uncontrolled trials (n = 8), two-component interventions (n = 5) yielded d = .86 and three-component interventions (n = 3) yielded d = .96.

CONCLUSIONS

Evidence indicates that, among U.S. minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs seem to show promise in the reduction of obese minority children.

Noninvasive Screening for Risk Factors of Type 2 Diabetes in Young, Rural, Caucasian Children

School nurses play an important role in identifying students who are at risk for Type 2 diabetes mellitus (T2DM). Few studies have screened Caucasian students, and none have targeted rural, low-income, elementary children. The five noninvasive risk factors used for this study were family history, high body mass index (BMI) for age/sex, racial/ethnic background, hypertension, and acanthosis nigricans. Two thirds of those screened ( n = 299) had at least one of the five risk factors for T2DM. Seventeen students (5.6% of those screened) had three or more of the five risk factors and were considered at risk for T2DM. Fifteen percent ( n = 43) had hypertension or prehypertension, and 18% (n = 53) were morbidly obese. Hypertension and acanthosis nigricans were significantly associated with being at risk in morbidly obese students. School nurses play an important role as frontline health professionals who are aware that risk factors for T2DM exist in all schools, regardless of students' age, size of community, or ethnic background.

Trends in prevalence of obesity and overweight among children enrolled in the New York State WIC program, 2002-2007

OBJECTIVES

We examined recent overweight and obesity trends in a multiethnic population of low-income preschool children.

METHODS

We defined overweight as sex-specific body mass index (BMI)-forage > or = 85th and < 95th percentile and obesity as sex-specific BMI-for-age > or = 95th percentile, and calculated them using demographic data and randomly selected height and weight measurements that were recorded while 2- to < 5-year-old children were enrolled in the New York State (NYS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2002-2007.

RESULTS

Obesity prevalence peaked at 16.7% in 2003, declined from 2003 through 2005, and stabilized at 14.7% through 2007. Among both boys and girls, the downward trend in annual prevalence of obesity was evident only among Hispanic children (22.8% boys and 20.9% girls in 2002 vs. 19.3% boys and 17.5% girls in 2007) and non-Hispanic black children (15.6% boys and 14.2% girls in 2002 vs. 13.6% boys and 12.4% girls in 2007). In contrast, the annual prevalence estimate for overweight showed an increasing trend from 2002 through 2007.

CONCLUSIONS

These results showed a slight decline in prevalence of childhood obesity and a continuing rise in prevalence of childhood overweight among children enrolled in the NYS WIC program during 2002-2007. Future research should investigate the extent to which the slight decline in childhood obesity prevalence may be attributable to population-based and high-risk obesity prevention efforts in NYS.

Environmental justice and the health of children

Environmental injustice is the inequitable and disproportionately heavy exposure of poor, minority, and disenfranchised populations to toxic chemicals and other environmental hazards. Environmental injustice contributes to disparities in health status across populations of differing ethnicity, race, and socioeconomic status. Infants and children, because of their unique biological vulnerabilities and age-related patterns of exposure, are especially vulnerable to the health impacts of environmental injustice. These impacts are illustrated by sharp disparities across children of different racial and ethnic backgrounds in the prevalence of 3 common diseases caused in part by environmental factors: asthma, lead poisoning, and obesity. Documentation of linkages between health disparities and environmental injustice is an important step toward achieving environmental justice.

Obesity in the transition to adulthood: predictions across race/ethnicity, immigrant generation, and sex

OBJECTIVE

To trace how racial/ethnic and immigrant disparities in body mass index (BMI) change over time as adolescents (age, 11-19 years) transition to young adulthood (age, 20-28 years).

DESIGN

We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood.

SETTING

All participants in the study were residents of the United States enrolled in junior high school or high school during the 1994-1995 school year.

PARTICIPANTS

More than 20 000 adolescents from nationally representative data interviewed at wave I (1994-1995) and followed up in wave II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health when the sample was in early adulthood.

MAIN EXPOSURES

Race/ethnicity, immigrant generation, and sex.

OUTCOME MEASURE

Body mass index.

RESULTS

Findings indicate significant differences in both the level and change in BMI across age by sex, race/ethnicity, and immigrant generation. Females, second- and third-generation immigrants, and Hispanic and black individuals experience more rapidly increasing BMIs from adolescence into young adulthood. Increases in BMI are relatively lower for males, first-generation immigrants, and white and Asian individuals.

CONCLUSION

Disparities in BMI and prevalence of overweight and obesity widen with age as adolescents leave home and begin independent lives as young adults in their 20s.