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Neighborhood Environment and Urban Schoolchildren's Risk for Being Overweight
Abstract
Purpose:
Child and adolescent obesity is increasingly prevalent and predisposes risk for poor physical and psychosocial health. Physical and social factors in the environment, such as neighborhood disorder, may be associated with childhood obesity. This study examines the association between living in a disordered neighborhood and being overweight among a sample of urban schoolchildren.
Design:
Baseline interview data, including height, weight, and hip circumference, were obtained from 313 elementary school-aged participants in a community-based epidemiologic study.
Setting:
The setting was Baltimore, Maryland, a large metropolitan city.
Subjects:
Subjects were elementary school students ages 8 to 12 years.
Measures:
To assess neighborhood characteristics, independent evaluators conducted objective environmental assessments using the Neighborhood Inventory for Environmental Typology instrument on the block faces (defined as one side of a city block between two intersections) where the children resided.
Analysis:
Logistic regression models with generalized estimating equations were used to examine the association between neighborhood disorder and children being overweight.
Results:
Neighborhood disorder showed a trend toward a statistically significant association with being overweight during childhood (odds ratio [OR], 1.03; confidence interval [CI], .99-1.07; p = .07) in the unadjusted model. Gender was significantly associated with being overweight, with female gender increasing the odds of being overweight by 50% in the sample (OR, 1.50; CI, 1.18-1.92; p < .01). After controlling for race, age, and comparative time spent on a sport, multivariable analyses revealed that gender (adjusted odds ratio [AOR], 2.42; CI, 1.63-3.59; p < .01) and neighborhood disorder (AOR, 1.09; CI, 1.03-1.15; p < .01) were associated with being overweight. Further, an examination of interactions revealed girls (AOR, 2.40; CI, 1.65-3.49; p < .01) were more likely to be overweight compared with boys (AOR, 2.20; CI, 1.57-3.11; p < .01) living in neighborhoods with the same level of neighborhood disorder.
Conclusion:
Results suggest neighborhood hazards warrant additional consideration for their potential as obesogenic elements affecting gender-based disparities in weight among urban schoolchildren. Future studies in this area should include longitudinal examinations.
... Among all United States (U.S.) populations, Native Americans report the highest ACE scores [1,22,23] At a population level, ACEs have a strong dose-response impact, with more ACEs contributing to worse lifetime health outcomes, including increased risk for alcoholism, drug abuse, depression, and suicide attempts [19]. This relationship has also been documented in the participating Fort Peck community. ...
Background
Trauma within Native American communities compromises parents’ parenting capacity; thus, increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children.
Methods
A randomized controlled trial with an embedded single-case experimental design will be used to determine effectiveness of the modular prevention intervention on parent-child outcomes and the added impact of unique cultural lesson-components. Participants include 1) Fort Peck Assiniboine and Sioux parents who have had adverse childhood experiences, and 2) their children (3–5 years). Parent-child dyads are randomized (1:1) to Little Holy One or a control group that consists of 12 lessons taught by Indigenous community health workers. Lessons were developed from elements of 1) the Common Elements Treatment Approach and Family Spirit, both evidence-based interventions, and 2) newly created cultural (intervention) and nutrition (control group only) lessons. Primary outcomes are parent (primary caregiver) trauma symptoms and stress. Secondary outcomes include: Parent depression symptoms, parenting practices, parental control, family routines, substance use, historical loss, communal mastery, tribal identity, historical trauma. Child outcomes include, externalizing and internalizing behavior and school attendance. Primary analysis will follow an intent-to-treat approach, and secondary analysis will include examination of change trajectories to determine impact of cultural lessons and exploration of overall effect moderation by age and gender of child and type of caregiver (e.g., parent, grandparent).
Discussion
Many Native American parents have endured adverse childhood experiences and traumas that can negatively impact capacity for positive parenting. Study results will provide insights about the potential of a culturally-based intervention to reduce parental distress – an upstream approach to reducing risk for childrens’ later substance misuse and suicidality. Intervention design features, including use of community health workers, cultural grounding, and administration in Head Start settings lend potential for feasibility, acceptability, sustainability, and scalability.
Trial registration
ClinicalTrials.gov: NCT04201184 . Registered 11 December 2019.
... Moreover, our findings build upon the nascent literature on the impact of crime on the food environment in particular. Previous work has explored the influence of neighborhood crime on body mass index [40,41] and physical activity [42][43][44][45], yet very few studies have evaluated the consequences of neighborhood crime on the neighborhood food environment. Specifically, we found that an increase in neighborhood crime was significantly associated with an increase in the percent of BMI-unhealthy or BMI-intermediate outlets. ...
Few studies have examined how neighborhood contextual features may influence the food outlet mix. We evaluated the relationship between changes in neighborhood crime and changes in the food environment, namely the relative density of unhealthy (or intermediate) food outlets out of total food outlets, or food swamp score, in Baltimore City from 2000 to 2012, using neighborhood fixed-effects linear regression models. Comparing neighborhoods to themselves over time, each unit increase in crime rate was associated with an increase in the food swamp score (b = 0.13; 95% CI, -0.00017 to 0.25). The association with food swamp score was in the same direction for violent crime and in the inverse direction for arrests related to juvenile crimes (proxy of reduced crime), but did not reach statistical significance when examined separately. Unfavorable conditions, such as crime, may deter a critical consumer base, diminishing the capacity of a community to attract businesses that are perceived to be neighborhood enhancing. Addressing these more distal drivers may be important for policies and programs to improve these food environments.
... Social factors such as poverty, built environment, accessibility of healthy foods, safety, and school physical education and sports team availability and policies may lead to decreased opportunities for routine exercise in urban youth. [38][39][40][41] Previous studies document an association between weight status and emotional disorders, especially depression. 18,20 Of the students endorsing depressive symptoms in the current study, the majority were females (67.7%). ...
Importance:
While urban African American adolescents face significant health disparities associated with overweight and obesity that follow them into adulthood; there is limited data on body image, emotional well-being, and weight control behaviors in this population to design effective public health interventions.
Objective:
This study was designed to understand the association of weight status to adolescent weight control, body image, and emotional well-being responses, in African American high school students.
Design/setting/participants:
The study cohort consisted of 776 students, mean age 15.8 years (±1.2). Data from Guidelines for Adolescent Preventive Services (GAPS) student surveys and anthropometric studies were collected at School-Based Health Centers.
Main outcome measures:
Associations between adolescent responses on the GAPS and body mass index (BMI) status (healthy weight: 5th to less than 85th percentile, overweight: 85th to less than 95th percentile, obese: 95th percentile or greater) were estimated using logistic regression and dose- response plots.
Results:
There were statistically significant associations between BMI category and weight control (ranging from a mean 5.18 to 7.68 odds of obesity) and body image (3.40 to 13.26 odds of obesity) responses. Responses to weight control and body image questions exhibited a dose-response for odds of overweight and obesity. Feelings of depressed mood were associated with obesity (1.47 times the odds of obesity compared to students who did not endorse depressed mood; 95% CI, 1.01 to 2.13) but not overweight status.
Conclusion and relevance:
Overweight and obese urban African American adolescents are more likely to screen positively on weight control risk behaviors and negative body image questions than their normal weight peers. The weight control and body image measures on the GAPS may provide information to identify youth in need of services and those motivated for brief school-based weight control interventions.
... The establishment and maintenance of Indian reservations, which undermine tribal subsistence and thus tribal economies, created areas of concentrated poverty and increased morbidity and mortality. Where one lives is a critical variable in mediating access to quality health care, economic opportunities, social connections, and social capital, all of which determine health status (Diez Roux 2003;Diez Roux et al. 2002;O'Campo et al. 1997;Whitaker et al. 2013). When communities are characterized by persistently low economic status and segregation, higher rates of morbidity and mortality are typical (Chaix et al. 2011;Lawman and Wilson 2012). ...
Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation-based Native Americans. In 2011, data were collected from Native American (N = 288; 15-24 years of age) tribal members from a remote plains reservation using an anonymous web-based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post-traumatic stress disorder (PTSD) symptoms, depression symptoms, poly-drug use, and suicide attempt. Seventy-eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly-drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation-based populations must be developed, tested and evaluated longitudinally.
... The establishment and maintenance of Indian reservations, which undermine tribal subsistence and thus tribal economies, created areas of concentrated poverty and increased morbidity and mortality. Where one lives is a critical variable in mediating access to quality health care, economic opportunities, social connections, and social capital, all of which determine health status (Diez Roux 2003;Diez Roux et al. 2002;O'Campo et al. 1997;Whitaker et al. 2013). When communities are characterized by persistently low economic status and segregation, higher rates of morbidity and mortality are typical (Chaix et al. 2011;Lawman and Wilson 2012). ...
Background: Suicide has been the second leading cause of death for Native American youth 15-24 years of age for 30 years. Rates vary widely within and between the 12 Indian Health Service Areas. Methods: To determine the risk and protective factors for lifetime suicide ideation and attempt among a sample of high-risk reservation-based youth an all Native American team used an anonymous web-based questionnaire to collect data from 288 youth 15-24 years of age. Multinomial logistic regression analysis was used to compare three mutually exclusive levels of suicide severity; ideation only, attempt, and no ideation/attempt (reference group). Results: The lifetime prevalence of suicide ideation only, suicide attempt, and no suicide ideation or attempt among this sample was 15%, 35%, and 50%, respectively. Physical neglect, emotional abuse, domestic violence exposure, witnessing violence, victim of violence, or learning of violence, bullying, PTSD symptoms, depression symptoms, prescription drug misuse, inhalant use, and poly-drug use were factors common to both suicide ideation and attempt. After adjusting for age, sex, and tribal affiliation, PTSD symptoms (RRR=3.3, 95% CI: 1.2, 9.4) and poly-drug use (RRR=2.5, 95% CI: 1.0, 6.0) were associated with suicide ideation whereas, PTSD symptoms (RRR=4.4, 95% CI: 1.9, 10.5), depression symptoms (RRR=4.0, 95% CI: 1.8, 8.9), and poly-drug use (RRR=2.1, 95% CI: 1.0-4.3) were associated with suicide attempt. Conclusions: These findings demonstrate PTSD symptoms and poly-drug use as predictors of both suicide ideation and attempt. Development of interventions to prevent suicide and its multiple associated risk factors in high-risk reservation communities is imperative.
... A neighborhood's safety and access to quality health care, economic opportunities, social connections, and social capital are all key determinants of the health of its residents over time [9][10][11][12]. Reservations are often characterized by low economic status and segregation, both of which limit access and are risk factors for higher rates of morbidity and mortality [13,14]. ...
Background. Native Americans disproportionately experience adverse childhood experiences (ACEs) as well as health disparities, including high rates of posttraumatic stress, depression, and substance abuse. Many ACEs have been linked to methylation changes in genes that regulate the stress response, suggesting that these molecular changes may underlie the risk for psychiatric disorders related to ACEs. Methods. We reviewed published studies to provide evidence that ACE-related methylation changes contribute to health disparities in Native Americans. This framework may be adapted to understand how ACEs may result in health disparities in other racial/ethnic groups. Findings. Here we provide evidence that links ACEs to methylation differences in genes that regulate the stress response. Psychiatric disorders are also associated with methylation differences in endocrine, immune, and neurotransmitter genes that serve to regulate the stress response and are linked to psychiatric symptoms and medical morbidity. We provide evidence linking ACEs to these epigenetic modifications, suggesting that ACEs contribute to the vulnerability for developing psychiatric disorders in Native Americans. Conclusion. Additional studies are needed to better understand how ACEs contribute to health and well-being. These studies may inform future interventions to address these serious risks and promote the health and well-being of Native Americans.
... neighborhood context with obesity among children [29,44], the associations observed during adolescence may suggest that the obesogenic effects of neighborhood disorder emerge over time. For the current study, adolescents who live in disordered neighborhoods are more obese and because obesity tracks into adulthood, they may have increased risks for adverse health outcomes later in life. ...
Background
According to recent research studies, the built and socioeconomic contexts of neighborhoods are associated with African American adolescents’ participation in physical activity and obesity status. However, few research efforts have been devoted to understand how African American adolescents’ perceptions of their neighborhood environments may affect physical activity behaviors and obesity status. The objective of the current study was to use a perceived neighborhood disorder conceptual framework to examine whether physical activity mediated the relationship between perceived neighborhood disorder and obesity status among African American adolescents.
Methods
The data were obtained from a cross-sectional study that examined social and cultural barriers and facilitators of physical activity among African American adolescents. The study included a sample of 101 African American adolescents age 12 to 16 years and their parents who were recruited from the Birmingham, Alabama metropolitan area. The primary outcome measure was obesity status which was classified using the International Obesity Task Force cut off points. Moderate-to-vigorous physical activity was assessed via accelerometry. Perceived neighborhood disorder was assessed using the Perceived Neighborhood Disorder Scale. Mediation models were used to examine whether the relationship between neighborhood disorder and obesity status was mediated by physical activity.
Results
Perceived neighborhood disorder was significantly and positively related to obesity status and moderate-to-vigorous physical activity was inversely associated with obesity status. However, there was no evidence to support a significant mediating effect of moderate-to-vigorous physical activity on the relationship between neighborhood disorder and obesity status.
Conclusion
Future studies should longitudinally assess perceived neighborhood disorder characteristics and childhood adiposity to examine the timing, extent, and the mechanisms by which perceived neighborhood disorder characteristics increase the risk of obesity.
Small‐area ecological research is critical to inform place‐based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3 years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block‐face level from a single observation. Observations from the 172‐item inventory were collected from a random sample of block faces (n = 793) in Baltimore City annually over a three‐year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood‐level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place‐based interventions designed to improve the neighborhood environment and population health outcomes.
It is rare for research on augmented-reality games to examine equity and access as grounded in features of the actual neighborhoods where game play takes place, and in the affordances of communities and their built environments for gamified ambulatory physical activity in the real world. This chapter studies two diverse groups of middle-school youth, situated in urban and suburban areas, who wore activity monitors as they went through daily activities and played an online game that synced with their monitors. The game drew data from the wearable devices so that the more youth engaged in step-countable physical activity in the real world, the more game-world energy they earned. This chapter analyzes the actual communities where our participants' activity and game play was situated. The chapter lays out the multi-modal data sources in that analysis and provides some potential models that can be employed by others in related work. Finally, the chapter closes by articulating some directions and concerns for future research in a gamified physical world.
Objective
We hypothesize that physical features of the urban environment might enhance or prevent childhood obesity. Thus, this study's main goal was to verify if there is an association between the neighborhood urban design and childhood obesity—independent of well‐known childhood obesity determinants, such as, father's level of schooling (as a proxy for socioeconomic status), and parent's weight status.
Methods
This study classifies neighborhoods according to land use and building features using hierarchical clusters analysis and examines their association with childhood obesity through logistic regression models.
Results
Four clusters resulted from the analysis: Cluster 1 represents areas with older buildings and mixed land use, cluster 2 is an area with small rented buildings and urban areas, cluster 3 comprises newer buildings with parking and urban green space, and cluster 4 is a forest area. Living in cluster 3 protects from childhood obesity, even when adjusting for father's level of schooling or parent's weight status.
Conclusions
There are distinct urban configurations in Lisbon's municipality and children who live in Cluster 3 (more recent and greener neighborhoods) seem to be protected from obesity. Therefore, public policy should focus on healthy urban planning at the neighborhood level, to promote positive impacts on peoples' health.
This article describes field experiences while implementing nutrition and physical activity education in a public junior high school in Puerto Rico (PR). Participants were classified as overweight or at risk based on body mass index (BMI). Dietary intake and weight were collected. Changes in dietary intake assessed from baseline to end of school year did not show statistical significance. The reduction in BMI Z-scores was modest at 4 months and was not observed at the end of the program. Future studies are warranted to integrate parents and behavioral theories and to evaluate food in the environment to successfully address childhood obesity.
In studies of mediated representations of obesity to date, the overwhelming majority have found predominant a personal responsibility frame, specifically as drawn against environmental frames, which are nonetheless gaining ground in recent years. In this essay, I review that extant literature and seek to trouble the binary by isolating national news coverage of obesity in two historically and culturally specific regions of the United States that are regularly referenced in relation to the issue: the South and the Midwest. I evaluate the key characterizations of obesity and obese individuals in these regions in mainstream national news coverage between January 2009 and December 2012 in order to assess whether, how, and to what extent personal responsibility or environmental frames are invoked in this coverage. I argue that 'culture' appears to be gaining traction as an emergent discourse for obesity, which may appear to offer a more complex or nuanced explanation of the issue; however, this analysis suggests that it can be taken up in ways that feature troubling implications and consequences.
Assessed a community empowerment model of grassroots organizing and an ecological framework of physical, economic, and social environmental predictors of participation (PN) in grassroots community organizations. Individual and block-level observational data and 2,500 interviews of residents and follow-up interviews with organization leaders from 3 cities were used to predict PN cross-sectionally and after a 1-yr lag. Longitudinal data from 1 city were used to predict the viability of block associations 7 yrs later. Defensible space and incivilities were sometimes negatively and sometimes positively related to PN. Income, home ownership, minority status, and residential stability were positively but inconsistently related to PN. Community-focused social cognitions and behaviors consistently positively predicted individual and block-level PN. The model explained up to 28% and 52% of the variance in individual and block-level PN, respectively.
Walking to school is an important source of physical activity among children. There is a paucity of research exploring environmental determinants of walking to school among children in urban areas.
A cross-sectional secondary analysis of baseline data (2007) from 365 children in the "Multiple Opportunities to Reach Excellence" (MORE) Study (8 to 13 years; Mean 9.60 years, SD 1.04). Children and caregivers were asked about walking to school and perceived safety. Objective measures of the environment were obtained using a validated environmental neighborhood assessment.
Over half (55.83%) of children reported walking to school most of the time. High levels of neighborhood incivilities were associated with lower levels of perceived safety (OR: 0.39, 95% CI: 0.21 to 0.72). Living on a block above the median in incivilities was associated with a 353% increase in odds of walking to school (OR: 3.53; 95% CI: 1.68 to 7.39).
Children residing in neighborhoods high in incivilities are more likely to walk to school, in spite of lower levels of perceived safety. As a high proportion of children residing in disadvantaged neighborhoods walk to school, efforts should be directed at minimizing exposure to neighborhood hazards by ensuring safe routes to and from school.
This study examines gender differences in the association between environment and internalizing problems in a sample of predominately African American schoolchildren. Internalizing problems was assessed using the Youth Self Report. Violence and alcohol and other drug (AOD) exposure subscales were created using observational assessments of neighborhood blocks. Logistic regression models were used to assess the relationship between neighborhood environment and internalizing problems. For each AOD item present on the block the odds of internalizing problems among girls increased by 17% (OR = 1.17, CI: 1.01, 1.35, P = 0.039). The relationship was not significant among boys. Violence exposure did not predict internalizing problems in boys or girls. These preliminary findings suggest that primary school-aged girls' emotional well-being is more negatively impacted by deleterious environments. Future investigations will examine the relationship between deleterious neighborhood environments and internalizing problems as the children age into adolescence.
Establish metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy).
A total of 919 residential block faces were assessed by paired raters using the NIfETy. Reliability was evaluated via interrater and internal consistency reliability; validity by comparing NIfETy data with youth self-reported violence, alcohol, and other drug exposure and crime statistics.
Validity and reliability metrics were moderate to exemplary for the total scale and subscales. NIfETy data correlated strongly with crime data and youth self-reported exposure.
The NIfETy is valid and reliable. Future investigations will explore its use in other urban centers and association to other health outcomes.
The prevalence of high body mass index (BMI) among children and adolescents in the United States appeared to plateau between 1999 and 2006.
To provide the most recent estimates of high BMI among children and adolescents and high weight for recumbent length among infants and toddlers and to analyze trends in prevalence between 1999 and 2008.
The National Health and Nutrition Examination Survey 2007-2008, a representative sample of the US population with measured heights and weights on 3281 children and adolescents (2 through 19 years of age) and 719 infants and toddlers (birth to 2 years of age).
Prevalence of high weight for recumbent length (> or = 95th percentile of the Centers for Disease Control and Prevention growth charts) among infants and toddlers. Prevalence of high BMI among children and adolescents defined at 3 levels: BMI for age at or above the 97th percentile, at or above the 95th percentile, and at or above the 85th percentile of the BMI-for-age growth charts. Analyses of trends by age, sex, and race/ethnicity from 1999-2000 to 2007-2008.
In 2007-2008, 9.5% of infants and toddlers (95% confidence interval [CI], 7.3%-11.7%) were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% (95% CI, 9.8%-13.9%) were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% (95% CI, 14.1%-19.6%) were at or above the 95th percentile; and 31.7% (95% CI, 29.2%-34.1%) were at or above the 85th percentile of BMI for age. Prevalence estimates differed by age and by race/ethnic group. Trend analyses indicate no significant trend between 1999-2000 and 2007-2008 except at the highest BMI cut point (BMI for age > or = 97th percentile) among all 6- through 19-year-old boys (odds ratio [OR], 1.52; 95% CI, 1.17-2.01) and among non-Hispanic white boys of the same age (OR, 1.87; 95% CI, 1.22-2.94).
No statistically significant linear trends in high weight for recumbent length or high BMI were found over the time periods 1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008 among girls and boys except among the very heaviest 6- through 19-year-old boys.
Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might moderate this association. We linked the 2000 US Census data and information on locations of fast food and other restaurants with the Los Angeles Family and Neighborhood Study database, which consists of 2,156 adults sampled from 63 neighborhoods in Los Angeles County. Multilevel modeling was used to estimate associations between body mass index (BMI), fast food and restaurant concentration, and car ownership after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. A high concentration of local restaurants is associated with BMI. Car owners have higher BMIs than non-car owners; however, individuals who do not own cars and reside in areas with a high concentration of fast food outlets have higher BMIs than non-car owners who live in areas with no fast food outlets, approximately 12 lb more (p = 0.02) for an individual with a height of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among local residents. The local fast food environment has a stronger association with BMI for local residents who do not have access to cars.
Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,
2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.
Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics.
Cross-sectional and multilevel design.
Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon.
A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate).
A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity.
Multilevel logistic regression analyses.
Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI > or = 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705-38.086) for non-Hispanic black residents.
Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.
There are limited validated quantitative assessment methods to measure features of the built and social environment that might form the basis for environmental preventive interventions. This study describes a model approach for epidemiologic assessment of suspected environmental determinants of violence, alcohol and other drug (VAOD) exposure and fills this gap in current research. The investigation sought to test the feasibility of a systematic and longitudinal assessment of residential block characteristics related to physical and social disorder and indicators of VAOD exposure. Planometric data were used to establish a stratified random sample of street segments within defined neighborhoods of an urban metropolitan area. Field rater assessments of these neighborhood street segments were conducted using the Neighborhood Inventory for Environmental Typology (NIfETy). This report provides a detailed description of the NIfETy Method, including metric properties of the NIfETy Instrument and outcomes of training procedures and quality control measures. Also presented are block-level characteristics and estimates of observable signs of VAOD activity. This work is a first step toward developing future community-level environmental preventive interventions geared to reduce community VAOD exposure among youthful urban populations and may prove to be useful to other public health research groups as well.
The increasing prevalence of childhood obesity and its concomitant health risks justify widespread efforts toward prevention. Although both diet and physical activity have been emphasized as appropriate interventions, the current paper focuses on the role of physical activity in obesity prevention. Children's levels of physical activity are highly variable, and may be influenced by a multitude of factors including physiological, psychological, sociocultural and environmental determinants. Although the relationship between physical activity and obesity is controversial and the protective mechanism unclear, physical activity is hypothesized to protect individuals from the development of obesity by increasing energy expenditure and resting metabolic rate (RMR) and leading to a favourable fuel utilization. The beneficial effect of physical activity in children is supported by controlled exercise intervention programs. Several broad-based public health interventions designed to increase children's levels of physical activity have been implemented in schools, families and communities, with results suggesting promising strategies for the prevention of childhood obesity. It is likely that successful prevention of childhood obesity through physical activity promotion will involve theory-based, culturally appropriate school, family and community interventions. Through policy changes, environmental planning and educational efforts in schools and communities, increased opportunities and encouragement for physical activity can be provided.
To examine associations between environmental and lifestyle factors and overweight or obesity.
A cross-sectional survey and an environmental scan of recreational facilities.
Metropolitan Perth, Western Australia.
Healthy sedentary workers and homemakers aged 18 to 59 years (n = 1803) living in areas within the top and bottom quintiles of social disadvantage.
Four lifestyle factors, one social environmental factor, and five physical environment factors (three objectively measured).
After adjustment for demographic factors and other variables in the model, overweight was associated with living on a highway (odds ratio [OR], 4.24; 95% confidence interval [CI], 1.62-11.09) or streets with no sidewalks or sidewalks on one side only (OR, 1.35; 95% CI, 1.03-1.78) and perceiving no paths within walking distance (OR, 1.42; 95% CI, 1.08-1.86). Poor access to four or more recreational facilities (OR, 1.68; 95% CI, 1.11-2.55) and sidewalks (OR, 1.62; 95% CI, .98-2.68) and perceiving no shop within walking distance (OR, 1.84; 95% CI, 1.01-3.36) were associated with obesity. Conversely, access to a motor vehicle all the time was negatively associated with obesity (OR, .56; 95% CI, .32-.99). Watching 3 or more hours of television daily (ORs, 1.92 and 1.85, respectively) and rating oneself as less active than others (ORs, 1.66 and 4.05, respectively) were associated with both overweight and obesity. After adjustment for individual demographic factors and all other variables in the model, socioeconomic status of area of residence and leisure-time physical activity were not associated with overweight or obesity.
Factors that influence overweight and obesity appear to differ, but aspects of the physical environment may be important. Objectively measured neighborhood environment factors warrant further investigation.
This paper reviews existing environmental audit instruments used to capture the walkability and bikability of environments. The review inventories and evaluates individual measures of environmental factors used in these instruments. It synthesizes the current state of knowledge in quantifying the built environment. The paper provides health promotion professionals an understanding of the essential aspects of environments influencing walking and bicycling for both recreational and transportation purposes. It serves as a basis to develop valid and efficient tools to create activity-friendly communities.
Keyword searches identified journal articles from the computer-based Academic Citation Databases, including the National Transportation Library, the Web of Science Citation Database, and MEDLINE. Governmental publications and conference proceedings were also searched.
All instruments to audit physical environments have been included in this review, considering both recreation- and transportation related walking and bicycling. Excluded are general methods devised to estimate walking and cycling trips, those used in empirical studies on land use and transportation, and research on walking inside buildings.
Data have been extracted from each instrument using a template of key items developed for this review. The data were examined for quality assurance among three experienced researchers.
A behavioral model of the built environment guides the synthesis according to three components: the origin and destination of the walk or bike trip, the characteristics of the road traveled, and the characteristics of the areas surrounding the trip's origin and destination. These components, combined with the characteristics of the instruments themselves, lead to a classification of the instruments into the four categories of inventory, route quality assessment, area quality assessment, and approaches to estimating latent demand for walking and bicycling. Furthermore, individual variables used in each instrument to measure the environment are grouped into four classes: spatiophysical, spatiobehavioral, spatiopsychosocial, and policy-based.
Individually, existing instruments rely on selective classes of variables and therefore assess only parts of built environments that affect walking and bicycling. Most of the instruments and individual measures have not been rigorously tested because of a lack of available data on walking and bicycling and because of limited research budgets. Future instrument development will depend on the acquisition of empirical data on walking and bicycling, on inclusion of all three components of the behavioral model, and on consideration of all classes of variables identified.
Lack of physical activity is associated with increased risk of overweight and cardiovascular disease, conditions associated with lower socioeconomic status (SES). Associations between activity levels of urban youth and limited access to safe recreation areas in their neighborhoods of residence were investigated.
Analyses of data from the Project on Human Development in Chicago Neighborhoods, a multilevel longitudinal study of families and communities, are reported.
Chicago, Illinois.
Individual-level data were obtained from 1378 youth 11 to 16 years old and caregivers living in 80 neighborhood clusters. Neighborhood-level data were collected from 8782 community residents and videotapes of 15,141 block faces.
Parental estimates of hours youth spent in recreational programming were used to estimate physical activity. A scale of residents' assessment of neighborhood safety for children's play was created; disorder measures came from videotaped observations.
Physical activity averaged 2.7 hours/week (SD = 5.0), varying significantly across neighborhoods. Using hierarchical linear regression, SES, age, and male gender, but not body mass index, were independently associated with physical activity. Lower neighborhood safety and social disorder were significantly associated with less activity, controlling for demographics.
One mechanism for reduced physical activity among youth may be the influence of unsafe neighborhoods. Neighborhood interventions to increase safety and reduce disorder may be efficacious in increasing physical activity, thereby reducing risk of overweight and cardiovascular disease.
The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States.
To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements.
As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002.
Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group.
Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity.
There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
The aims of this chapter are as follows: to summarize evidence on the principal health consequences of child and adolescent obesity, in the short term (for the obese child/adolescent) and in the long term (for the adult who was obese as a child or adolescent); to distinguish between the well-established health consequences - derived largely from older evidence that had been reviewed systematically - and the emerging adverse consequences identified from more recent studies. The chapter also shows that evidence on the long-term effect of child and adolescent obesity has been increasing: nine new studies are summarized that tested for associations between child or adolescent obesity and adult risk of morbidity or premature mortality.
Physical inactivity is an important risk factor for premature morbidity and mortality, especially among high-risk populations. Although health-promotion programs have targeted high-risk groups (i.e., older adults, women, and racial/ethnic minorities), barriers exist that may affect their physical activity level. Identifying and reducing specific barriers (e.g., lack of knowledge of the health benefits of physical activity, limited access to facilities, low self-efficacy, and environmental issues [2-6]) are important for efforts designed to increase physical activity. Concerns about neighborhood safety may be a barrier to physical activity. To characterize the association between neighborhood safety and physical inactivity, CDC analyzed data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS) in Maryland, Montana, Ohio, Pennsylvania, and Virginia. This report summarizes the results of this analysis, which indicate that persons who perceived their neighborhood to be unsafe were more likely to be physically inactive.
Background:
The amount of time children spend in play spaces (ie, physical locations that are appropriate for children's physical activity) near their homes is correlated with their level of physical activity.Objective:
To examine factors used in parents' decisions about the selection of play spaces for their children.Subjects:
Parents (primarily mothers) of 178 Mexican American and 122 white children who were a mean age of 4.9 years old at the first measurement.Measures:
In individual interviews, parents rated 24 factors on their importance in selecting for their children a play space that is away from their home or yard. Decision factors were rated from 1 (ie, not important at all) to 5 (ie, very important).Results:
The most important factors, with ratings ranging from 4.8 to 4.2, were safety and availability of toilets, drinking water, lighting, and shade. Mexican American parents rated 8 of 24 items significantly higher than did white parents, including lighted at night, organized activities, play supplies, and drinking water. White parents rated 5 of 24 items significantly higher than did Mexican American parents, including distance from home, cost of admission, and child's friends go there. The rated importance of 7 of 24 items increased during 1 year, including play supplies, drinking water, distance from home, and parents' friends or relatives go there.Conclusions:
These results indicate that parents can identify factors they use in selecting places for their young children to play, and selection factors differ somewhat by ethnicity or socioeconomic status. Further studies are needed to determine whether improvements on the most important selection factors might be effective in increasing the use of play spaces by children and their parents. Clinicians may be able to use the most highly rated decision factors to help parents assess the acceptability of play spaces in their areas.Arch Pediatr Adolesc Med. 1997;151:414-417
Health policy-makers seeking to estimate the burden of childhood obesity and healthpromotion workers designing interventions to reduce prevalence levels need to be aware of trends and the extent of the problem of childhood obesity. Representative surveys of child obesity prevalence are required, and they depend on agreed definitions of child obesity, taking account of children's natural growth - especially the changes in growth rates found in early infancy and puberty. There are several approaches to measuring obesity in children, and these give differing estimates of the extent of the problem. This chapter discusses the definition of child overweight and obesity, prevalence levels in childhood and adolescence, and secular trends in prevalence.
Objectives
To test whether increased television viewing is associated with increased total energy intake and with increased consumption of foods commonly advertised on television, and to test whether increased consumption of these foods mediates the relationship between television viewing and total energy intake.
Design
Prospective observational study with baseline (fall 1995) and follow-up (spring 1997) measures of youth diet, physical activity, and television viewing. We used food advertising data to identify 6 food groups for study (sweet baked snacks, candy, fried potatoes, main courses commonly served as fast food, salty snacks, and sugar-sweetened beverages).
Setting and Participants
Five public schools in 4 communities near Boston. The sample included 548 students (mean age at baseline, 11.70 years; 48.4% female; and 63.5% white).
Main Outcome Measures
Change in total energy intake and intake of foods commonly advertised on television from baseline to follow-up.
Results
After adjusting for baseline covariates, each hour increase in television viewing was associated with an additional 167 kcal/d (95% confidence interval, 136-198 kcal/d; P<.001) and with increases in the consumption of foods commonly advertised on television. Including changes in intakes of these foods in regression models provided evidence of their mediating role, diminishing or rendering nonsignificant the associations between change in television viewing and change in total energy intake.
Conclusions
Increases in television viewing are associated with increased calorie intake among youth. This association is mediated by increasing consumption of calorie-dense low-nutrient foods frequently advertised on television.
This study explores the demographic and ecological characteristics of urban neighborhoods according to variations in their levels of visible drug sales. In addition to standard socio-demographic measures, extensive data on a number of licit businesses located in different neighborhoods are also included. These range from those that residents are likely to consider desirable (e.g., bookstores) to those they are likely to consider undesirable (e.g., massage parlors). It is suggested that an elaboration of the concept of collective efficacy may be useful in understanding the relation between business location and public drug dealing. Specifically, we propose that collective efficacy can be understood not only in terms of neighborhood residents' capacity to resist the incursion of factors perceived as threatening, but also their capacity to attract those perceived as potentially enhancing the quality of life. The results indicate that the neighborhoods most burdened by visible drug markets are distinctive not so much by virtue of the undesirable licit businesses that they contain, but by the dearth of desirable ones. This suggests not only that neighborhoods with higher levels of visible drug sales lack the type of collective efficacy that would enable residents to keep out criminal activity, but they also appear to lack the ability to draw in desirable businesses.
The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C-reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents.
We administered a standard glucose-tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements included blood pressure and plasma lipid, C-reactive protein, and adiponectin levels. Levels of triglycerides, high-density lipoprotein cholesterol, and blood pressure were adjusted for age and sex. Because the body-mass index varies according to age, we standardized the value for age and sex with the use of conversion to a z score.
The prevalence of the metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese youngsters. Each half-unit increase in the body-mass index, converted to a z score, was associated with an increase in the risk of the metabolic syndrome among overweight and obese subjects (odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08), as was each unit of increase in insulin resistance as assessed with the homeostatic model (odds ratio, 1.12; 95 percent confidence interval, 1.07 to 1.18 for each additional unit of insulin resistance). The prevalence of the metabolic syndrome increased significantly with increasing insulin resistance (P for trend, <0.001) after adjustment for race or ethnic group and the degree of obesity. C-reactive protein levels increased and adiponectin levels decreased with increasing obesity.
The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.
This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus definition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The first section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease and premature mortality. In the final section, the small body of research on the long-term morbidity and mortality associated with childhood obesity is reviewed. These studies suggest that risk of cardiovascular disease and all-cause mortality is elevated among those who were overweight during childhood. The high prevalence and dramatic secular trend toward increasing childhood obesity suggest that without aggressive approaches to prevention and treatment, the attendant health and social consequences will be both substantial and long-lasting.
This study examines the importance of food prices and restaurant and food store outlet availability for child body mass index (BMI). We use the 1998, 2000 and 2002 waves of the child–mother merged files from the 1979 cohort of the National Longitudinal Survey of Youth combined with fruit and vegetable and fast food price data obtained from the American Chamber of Commerce Researchers Association and outlet density data on fast food and full-service restaurants and supermarkets, grocery stores and convenience stores obtained from Dun & Bradstreet. Using a random effects estimation model, we found that a 10% increase in the price of fruits and vegetables was associated with a 0.7% increase in child BMI. Fast food prices were not found to be statistically significant in the full sample but were weakly negatively associated with BMI among adolescents with an estimated price elasticity of −0.12. The price estimates were robust to whether we controlled for outlet availability based on a per capita or per land area basis; however, the association between food outlets and child BMI differed depending on the definition. The associations of fruit and vegetable and fast food prices with BMI were significantly stronger both economically and statistically among low- versus high-socioeconomic status children. The estimated fruit and vegetable and fast food price elasticities were 0.14 and −0.26, respectively, among low-income children and 0.09 and −0.13, respectively, among children with less educated mothers.
This research examines the relationship between neighborhood physical and social disorder and incarceration history among urban drug users. A cohort of 358 African American and White urban drug users completed a clinical interview and psychological assessment that emphasized cognitive and social-behavioral HIV risk factors. The Neighborhood Inventory for Environmental Typology was used to assess indicators of physical and social disorder. After controlling for age, gender, education, and having a place to live, multivariable analyses revealed that living in a neighborhood with moderate or high levels of disorder (odds ratio [OR] = 1.63; 95% confidence interval [CI] = [1.02, 2.59]) and drinking alcohol every day or nearly every day for 3 months or more (OR = 2.03; 95% CI [1.24, 3.31]) were associated with incarceration history. Findings suggest that select characteristics of disadvantaged communities may be important determinants of incarceration vulnerability among urban substance users. Residential improvements hold promise to enhance interventions aimed to reduce incarceration.
OBJECTIVES: Evidence from the Alameda County Study indicated that residential area has an independent effect on mortality risk. The current research examined the effect of poverty area residence on change in physical activity (n = 1737). METHODS: Data were from a longitudinal population-based cohort. Multiple linear regression analyses were used. RESULTS: Age- and sex-adjusted change scores between 1965 and 1974 for physical activity were 0.67 units lower for people living in poverty areas (P = .0001). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with physical activity change. CONCLUSION: These results further support the hypothesis that place affects health behaviors.
Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition.
A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability.
Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score.
Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.
The amount of time children spend in play spaces (ie, physical locations that are appropriate for children's physical activity) near their homes is correlated with their level of physical activity.
To examine factors used in parents' decisions about the selection of play spaces for their children.
Parents (primarily mothers) of 178 Mexican American and 122 white children who were a mean age of 4.9 years old at the first measurement.
In individual interviews, parents rated 24 factors on their importance in selecting for their children a play space that is away from their home or yard. Decision factors were rated from 1 (ie, not important at all) to 5 (ie, very important).
The most important factors, with ratings ranging from 4.8 to 4.2, were safety and availability of toilets, drinking water, lighting, and shade. Mexican American parents rated 8 of 24 items significantly higher than did white parents, including lighted at night, organized activities, play supplies, and drinking water. White parents rated 5 of 24 items significantly higher than did Mexican American parents, including distance from home, cost of admission, and child's friends go there. The rated importance of 7 of 24 items increased during 1 year, including play supplies, drinking water, distance from home, and parents' friends or relatives go there.
These results indicate that parents can identify factors they use in selecting places for their young children to play, and selection factors differ somewhat by ethnicity or socioeconomic status. Further studies are needed to determine whether improvements on the most important selection factors might be effective in increasing the use of play spaces by children and their parents. Clinicians may be able to use the most highly rated decision factors to help parents assess the acceptability of play spaces in their areas.
It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to
intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782
residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields
a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics,
measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability
with violence are largely mediated by collective efficacy.
Obesity threatens to become the foremost cause of chronic disease in the world. Being obese can induce multiple metabolic abnormalities that contribute to cardiovascular disease, diabetes mellitus, and other chronic disorders. Unfortunately, prevalence of obesity is increasing both in the United States and worldwide. Reasons for the rising prevalence include urbanization of the world's population, increased availability of food supplies, and reduction of physical activity. Although severe obesity has received much attention in the clinical setting, most obesity in the general public is only moderate. Even so, moderate obesity can elicit several metabolic abnormalities that are precursors to chronic disease. Therefore, for the population as a whole, moderate obesity is responsible for most obesity-related disorders. Moderate obesity is undoubtedly multifactorial in origin, and acquired influences probably exceed genetic factors in its causation. These acquired causes thus deserve greater attention in the development of a public health strategy for the control of overweight in the general population. A major public health effort is urgently needed to counter the increasing frequency of moderate obesity in the United States and throughout the world.
Evidence from the Alameda County Study indicated that residential area has an independent effect on mortality risk. The current research examined the effect of poverty area residence on change in physical activity (n = 1737).
Data were from a longitudinal population-based cohort. Multiple linear regression analyses were used.
Age- and sex-adjusted change scores between 1965 and 1974 for physical activity were 0.67 units lower for people living in poverty areas (P = .0001). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with physical activity change.
These results further support the hypothesis that place affects health behaviors.
This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus definition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The first section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease and premature mortality. In the final section, the small body of research on the long-term morbidity and mortality associated with childhood obesity is reviewed. These studies suggest that risk of cardiovascular disease and all-cause mortality is elevated among those who were overweight during childhood. The high prevalence and dramatic secular trend toward increasing childhood obesity suggest that without aggressive approaches to prevention and treatment, the attendant health and social consequences will be both substantial and long-lasting.
Neighborhood context could affect health behaviors because of structure or contagion. We expected that residents of US neighborhoods where a high percentage of residents are poor and do not have college degrees would be more likely to smoke and less likely to walk and exercise. We examined the hypotheses using multi-level data in which survey information from a representative sample of Illinois residents is linked to census-tract information about poverty and education in their neighborhood. Contrary to expectations we found that residents of poor neighborhoods were more likely to walk than those in less disadvantaged places, adjusting for individual poverty, household income, education, race, ethnicity, sex, age, and marital status. This was the case despite the fact that residents of poor neighborhoods were more afraid to leave the house and feared being victimized on the streets. Consistent with expectations we found that residents of neighborhoods where a high percentage of residents are college educated are more likely to walk. Thus, the two aspects of neighborhood socioeconomic status had opposite effects on walking. Neighborhood context had no effect on the likelihood of exercising strenuously. Men in poor neighborhoods were more likely to smoke than those in less disadvantaged places, but neighborhood context had no significant effect on women's likelihood of smoking.
In this review, we address the natural history of obesity in children, the most promising family- and school-based approaches to the prevention of obesity, and the barriers and opportunities associated with secondary prevention. In childhood, the most important periods of risk appear to be the periods of adiposity rebound and adolescence. Caution regarding the period of adiposity rebound is still warranted, because it is not yet clear that early rebound is attributable to changes in body fat. Families and schools represent the most important foci for preventive efforts in children and adolescents. One productive approach is to proceed from an examination of factors that affect energy balance to the identification of more proximal influences on those factors. This approach may help to narrow the strategies necessary to prevent or treat childhood obesity. For example, television viewing affects both energy intake and energy expenditure, and therefore represents a logical target for interventions. Anticipatory guidance by pediatricians may offer an effective mechanism by which to change parental attitudes and practices regarding television viewing. A similar process is used to emphasize the potential influence of school-based interventions directed at changes in food choices and sedentary behavior.
Obesity has increased dramatically over the past two decades and currently about 50% of US adults and 25% of US children are overweight. The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. This chapter reviews what is known about environmental influences on physical activity and eating behaviors. Recent trends in food supply, eating out, physical activity, and inactivity are reviewed, as are the effects of advertising, promotion, and pricing on eating and physical activity. Public health interventions, opportunities, and potential strategies to combat the obesity epidemic by promoting an environment that supports healthy eating and physical activity are discussed.
Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation.
Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation.
Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]=0.3, 95% confidence interval [CI]=0.1-0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR=4.3, 95% CI=1.5-12.5).
Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.
The link between the built environment and human behavior has long been of interest to the field of urban planning, but direct assessments of the links between the built environment and physical activity as it influences personal health are still rare in the field. Yet the concepts, theories, and methods used by urban planners provide a foundation for an emerging body of research on the relationship between the built environment and physical activity. Recent research efforts in urban planning have focused on the idea that land use and design policies can be used to increase transit use as well as walking and bicycling. The development of appropriate measures for the built environment and for travel behavior is an essential element of this research. The link between the built environment and travel behavior is then made using theoretical frameworks borrowed from economics, and in particular, the concept of travel as a derived demand. The available evidence lends itself to the argument that a combination of urban design, land use patterns, and transportation systems that promotes walking and bicycling will help create active, healthier, and more livable communities. To provide more conclusive evidence, however, researchers must address the following issues: An alternative to the derived-demand framework must be developed for walking, measures of the built environment must be refined, and more-complete data on walking must be developed. In addition, detailed data on the built environment must be spatially matched to detailed data on travel behavior.
During the past two decades, the prevalence of obesity in children has risen greatly worldwide. Obesity in childhood causes a wide range of serious complications, and increases the risk of premature illness and death later in life, raising public-health concerns. Results of research have provided new insights into the physiological basis of bodyweight regulation. However, treatment for childhood obesity remains largely ineffective. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist.
Violence traditionally had been considered a problem exclusively within the criminal justice domain, although it is now widely viewed as a public health issue as well. Public health has brought new and complementary tools for understanding and preventing violence. Whereas public health has long recognized the environment as a determinant of disease and injury, it has paid less attention to the environment when considering violence prevention strategies. For several decades though, some criminologists and others have been researching environmental factors in crime prevention. This article aims to discuss the main environmental crime-prevention strategies, provide examples of promising interventions, review public health literature that uses these strategies, discuss what public health can contribute, and suggest public health research to test the hypothesis that violence can be prevented and controlled through environmental modifications.
Socioeconomic status is associated with mortality, yet does not fully explain health disparities. This study analyzed data from the Project on Human Development in Chicago Neighborhoods (PHDCN), in the USA, to identify neighborhood-level factors associated with premature mortality. 1990 US Census data and mortality data from Chicago were merged with data from PHDCN, a study of 8782 residents in 343 Chicago neighborhoods. We performed a multivariate analysis to determine the association between premature mortality and concentrated disadvantage, residential stability, immigrant concentration, "collective efficacy" (a measure of willingness to help out for the common good), and "broken windows" (boarded up stores and homes, litter, and graffiti). Both collective efficacy and broken windows appeared to mediate the effect of concentrated disadvantage on all-cause premature mortality and mortality from cardiovascular disease and homicide, but there was also an interaction between broken windows and collective efficacy. Non-income characteristics associated with poverty should be further investigated. Interventions to determine whether these factors are causally related to health are needed.
Health-related problems are strongly associated with the social characteristics of communities and neighborhoods. We need to treat community contexts as important units of analysis in their own right, which in turn calls for new measurement strategies as well as theoretical frameworks that do not simply treat the neighborhood as a "trait" of the individual. Recent findings from the Project on Human Development in Chicago Neighborhoods support this thesis. Two major themes merit special attention: (1) the importance of collective efficacy for understanding health disparities in the modern city; and (2) the salience of spatial dynamics that go beyond the confines of local neighborhoods. Further efforts to explain the causes of variation in collective processes associated with healthy communities may provide innovative opportunities for preventive intervention.
We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight.
This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods.
Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level.
Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.
Identifying environmental factors that can influence physical activity is a public health priority. We examined associations of perceived environmental attributes with walking for four different purposes: general neighborhood walking, walking for exercise, walking for pleasure, and walking to get to and from places.
Participants (n =399; 57% women) were surveyed by mail. They reported place of residence, walking behaviors, and perceptions of neighborhood environmental attributes.
Men with the most positive perceptions of neighborhood "aesthetics" were significantly more likely (odds ratio [OR]=7.4) to be in the highest category of neighborhood walking. Men who perceived the weather as not inhibiting their walking were much more likely (OR=4.7) to be high exercise walkers. Women who perceived the weather as not inhibiting their walking were significantly more likely to be high neighborhood walkers (OR=3.8) and those with moderate perceptions of "accessibility" were much more likely to do more walking for pleasure (OR=3.5).
Different environmental attributes were associated with different types of walking and these differed between men and women. Approaches to increasing physical activity might usefully focus on those attributes of the local environment that might influence particular subsets of walking behavior.
Obesity is a major health problem in the United States and around the world. To date, relationships between obesity and aspects of the built environment have not been evaluated empirically at the individual level.
To evaluate the relationship between the built environment around each participant's place of residence and self-reported travel patterns (walking and time in a car), body mass index (BMI), and obesity for specific gender and ethnicity classifications.
Body Mass Index, minutes spent in a car, kilometers walked, age, income, educational attainment, and gender were derived through a travel survey of 10,878 participants in the Atlanta, Georgia region. Objective measures of land use mix, net residential density, and street connectivity were developed within a 1-kilometer network distance of each participant's place of residence. A cross-sectional design was used to associate urban form measures with obesity, BMI, and transportation-related activity when adjusting for sociodemographic covariates. Discrete analyses were conducted across gender and ethnicity. The data were collected between 2000 and 2002 and analysis was conducted in 2004.
Land-use mix had the strongest association with obesity (BMI >/= 30 kg/m(2)), with each quartile increase being associated with a 12.2% reduction in the likelihood of obesity across gender and ethnicity. Each additional hour spent in a car per day was associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity. As a continuous measure, BMI was significantly associated with urban form for white cohorts. Relationships among urban form, walk distance, and time in a car were stronger among white than black cohorts.
Measures of the built environment and travel patterns are important predictors of obesity across gender and ethnicity, yet relationships among the built environment, travel patterns, and weight may vary across gender and ethnicity. Strategies to increase land-use mix and distance walked while reducing time in a car can be effective as health interventions.