A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents

Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand.     

Neighbourhood socioeconomic circumstances,adiposity and cardiometabolic risk measures in children with severe obesity

BackgroundIt has recently been shown that neighbourhood socioeconomic disadvantage in childhood is associated with obesity, hypertension, fatty liver, and type 2 diabetes in adulthood. However, it is largely unknown whether neighbourhood socioeconomic circumstances are important predictors of adiposity and associated measures in children, especially in those with severe obesity. Therefore, we evaluated the associations between neighbourhood socioeconomic factors with the severity of obesity, and related cardiometabolic risk factors in a cohort of obese children.MethodsThe Childhood Overweight BioRepository of Australia (COBRA) cohort study comprises 444 children (mean age 11.1 years, mean BMI z-score 2.5). Neighbourhood socioeconomic advantage/disadvantage was evaluated based on postcode information by the national Australian Socio-Economic Indexes for Areas (SEIFA) scores. Participants/parents also completed self-administered questionnaires on neighbourhood related facilities, family education and family income.ResultsIn analyses adjusted for age, sex and pubertal status, SEIFA indicating neighbourhood education/occupation was negatively associated with BMI, waist circumference and body fat%. Higher family education was associated with lower BMI. Neighbourhood walkability was related to lower waist circumference. Good shopping facilities in the neighbourhood were associated with increased risk of dyslipidemia and fatty liver, and the existence of parks and playgrounds nearby was related to dyslipidemia.ConclusionsThe present data suggest that neighbourhood-related issues are associated with less severe adiposity among children with established obesity. Concerning cardiometabolic risk factors, shopping facilities were related to dyslipidemia and fatty liver. These findings suggest that increased awareness and efforts are needed to diminish socioeconomic inequalities between neighbourhoods.     

Environmental equity is child's play: mapping public provision of recreation opportunities in urban neighbourhoods

Abstract

This paper examines the spatial distribution of recreational opportunities for children and youth in a mid-sized Canadian city (London, Ontario), in relation to the socioeconomic status of neighbourhoods and estimated local need for publicly provided recreation spaces. Public recreation facilities (N?=?537) throughout the city were identified, mapped and analysed in a geographic information system. To explore potential socio-environmental inequities, neighbourhoods (N?=?22) were characterized by socioeconomic and environmental variables, an index of neighbourhood social distress, a neighbourhood play space needs index, and measures of the prevalence and density of recreational opportunities. The results of the spatial analysis indicate there is no systematic socioenvironmental inequity with respect to the prevalence and density of publicly provided neighbourhood recreation spaces; however, there are several areas in the city where youth do not have access to formal play spaces. We argue that to promote physical activity among urban children and youth, city planners and health policy analysts should consider carefully the geographical distribution of existing recreational opportunities and ensure that new publicly funded recreation spaces are provided to neighbourhoods with the greatest need. Further research should seek to identify what kinds of recreation spaces are most effective for promoting healthy behaviours among vulnerable children and youth.     

Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands

We investigated the association between the neighbourhood socioeconomic environment and physical inactivity, and explored the contribution of neighbourhood characteristics to this association. Data were analysed of 20-69 years old participants of the Dutch GLOBE study who lived in 78 neighbourhoods of Eindhoven (n = 8.767). The neighbourhood socioeconomic environment was assessed from aggregated self-reported information of participants' education and occupation level, and employment status. Aspects of physical inactivity investigated were based on the time spent on (a) walking and cycling to shops or work, (b) walking, cycling and gardening in leisure time, and (c) participation in sports activities. Characteristics of neighbourhoods included the proximity to food shops, general physical design of neighbourhoods, quality of green facilities, noise pollution from traffic and required police attention as evaluated by municipal services (professionals) responsible for these characteristics. Compared to those living in the most advantaged neighbourhoods, residents living in the quartile of socio-economically most disadvantaged neighbourhoods were more likely to walk or cycle to shops or work, but less likely to walk, cycle or garden in leisure time and less likely to participate in sports activities (adjusted for age, sex and individual educational level). Neighbourhood inequalities in walking or cycling to shops or work were not mediated by specific neighbourhood characteristics included in our analyses. The increased probability of almost never walking, cycling and gardening in leisure time in the most disadvantaged neighbourhoods was partly mediated by a poorer general physical design in these neighbourhoods. Similarly, the increased probability of almost never participating in sports activities in the most disadvantaged neighbourhoods was partly mediated by larger amounts of required police attention. The direction of neighbourhood inequalities differs for aspects of physical inactivity. Neighbourhood characteristics are related to physical inactivity and contribute to neighbourhood socioeconomic inequalities in physical inactivity.     

Home and neighbourhood correlates of BMI among children living in socioeconomically disadvantaged neighbourhoods

A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5-12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = - 0·04, 95 % CI - 0·06, - 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.     

Mediators of longitudinal associations between television viewing and eating behaviours in adolescents

Background  

Television viewing has been associated with poor eating behaviours in adolescents. Changing unhealthy eating behaviours is most likely to be achieved by identifying and targeting factors shown to mediate the association between these behaviours. However, little is known about the mediators of the associations between television viewing and eating behaviours. The aim of this study was to examine mediators of the longitudinal associations between television viewing (TV) and eating behaviours among Australian adolescents.     

Sugar-Sweetened Beverage Consumption,Perceptions, and Disparities in Children and Adolescents

ObjectiveTo examine the association between sugar-sweetened beverage (SSB) perceptions—knowledge, attitudes, and norms and media literacy—and beverage consumption, and to identify differences in beverage consumption and SSB perceptions by race/ethnicity and socioeconomic status.DesignCross-sectional.SettingDiverse California school district.ParticipantsA total of 992 fifth-grade (elementary), seventh-grade (middle), and ninth–12th-grade (high school) students.Main Outcome MeasuresQuestionnaire-assessed continuous beverage consumption and perceptions.AnalysisLinear regression adjusting for school, grade, gender, race/ethnicity, and free and reduced-price meal (FRPM) eligibility.ResultsKnowledge, attitudes, and norms, and media literacy items were associated with SSB consumption in expected directions (P < 0.05). Among elementary students, FRPM-eligible and Black students had higher SSB consumption (P < 0.01). In middle/high school, non-Hispanic White students consumed fewer SSBs than all other racial/ethnic groups (P < 0.01). There were differences in SSB-related perceptions by race/ethnicity and socioeconomic status (eg, Black students perceived sugary drinks as less unhealthy); Black, Hispanic, and FRPM-eligible students expressed less distrust of food/beverage advertisements; and Black, Hispanic, Asian, multirace, and FRPM-eligible students perceived more frequent SSB consumption among their peers (P < 0.05).Conclusions and ImplicationsSugar-sweetened beverage perceptions were associated with SSB consumption. There were racial/ethnic and socioeconomic disparities in SSB consumption and perceptions. Sugar-sweetened beverage perceptions and related social and commercial determinants like marketing may be useful targets for reducing SSB consumption.     

Neighbourhood level and individual level SES effects on child problem behaviour: a multilevel analysis

OBJECTIVE: This study examined whether neighbourhood level socioeconomic variables have an independent effect on reported child behaviour problems over and above the effect of individual level measures of socioeconomic status. DESIGN AND SETTING: Multilevel analysis of cross sectional survey data relating individual level child behavioural problems and parental measures of socioeconomic status with neighbourhood level measures of socioeconomic deprivation in the city of Maastricht, the Netherlands. PARTICIPANTS: Children born in the years 1990-1991 attending the second grade of normal kindergarten schools in the city of Maastricht, the Netherlands. Out of 1417 eligible 5-7 year olds, the parents of 734 children (51.8%) agreed to participate. MAIN RESULTS: Child behaviour problems were more frequent in families of low parental occupation and education (F=14.51, df 3, 721, p<0.001; F=12.20, df 3, 721, p<0.001, respectively) and in families living in deprived neighbourhoods (F=13.26, df 2, 722, p<0.001). Multilevel random effects regression analysis showed that the effect of neighbourhood level deprivation remained after adjustment for individual level socioeconomic status (B over three levels of deprivation: 1.36; 95%CI=0.28, 2.45). CONCLUSIONS: Living in a more deprived neighbourhood is associated with higher levels of child problem behaviour, irrespective of individual level socioeconomic status. The additional effect of the neighbourhood may be attributable to contextual variables such as the level of social cohesion among residents.     

Assessing the longitudinal relationship between Peruvian children’s TV exposure and unhealthy food consumption

Studies have shown that heavy television exposure is a risk factor for childhood overweight and obesity. This relationship is most typically attributed to the influence of food advertising. Despite this growing array of studies, one limitation is that these studies have focused almost exclusively on high-income countries. It is unclear whether such findings hold true in low- or middle-income countries. To address this gap, this study investigated the relationship between television exposure and unhealthy snack consumption (a risk factor for childhood overweight/obesity) in a sample of Peruvian children aged 6–13 (n = 265). Results indicate that television exposure is indeed cross-sectionally and longitudinally related with unhealthy snack consumption. But for children from high socioeconomic status families, this relationship is even more pronounced. These findings justify efforts to help parents manage their children’s television viewing as well as efforts to regulate food advertising in Peru.     

Deprived yet healthy: Neighbourhood-level resilience in New Zealand

Geographical inequalities in health are omnipresent with health and related behaviours typically worse in socioeconomically deprived places. However, this is not always true. Deprived places with unexpectedly good health outcomes, or what might be considered ‘resilient’ places, have been noted. Few studies have quantitatively examined resilience in neighbourhoods or investigated potential explanations for this resilience. This paper examines the paradox of low mortality despite high social deprivation in New Zealand neighbourhoods and considers possible neighbourhood characteristics that contribute to unanticipated positive health outcomes. Using area-level mortality (2005–2007) and socioeconomic data, we developed the Resilience Index New Zealand to quantify neighbourhood levels of resilience across the country. We then examined relationships between this measure and a suite of built, physical and social characteristics. We found that resilient places tended to be densely populated, urban areas. We observed gradients and increases/decreases in the most resilient groups in access to or levels of physical environment factors (environmental deprivation, safe drinking water, air quality) and unhealthy living infrastructure (alcohol and gambling outlets). Since these factors are amenable to change, these findings are the strongest evidence that such improvements may lower mortality in similarly deprived places. The social environment of resilient areas was characterised by high levels of incoming residents. We also found some surprising associations and observed U-shaped relationships for a number of the neighbourhood factors. Such findings suggest the need to develop a better proxy of community cohesion and a better understanding of the interactions between people and their neighbourhoods, rather than simply the presence of certain factors. We argue that this study has identified amenable neighbourhood characteristics and highlighted the importance of ‘place-specific’ resilience factors that may be effective in reducing mortality in some neighbourhoods, but be less effective in others.     

Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics

PurposeThis study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage.MethodsThis cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models.ResultsSmoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect.ConclusionsSome neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.     

Neighbourhood socioeconomic status, health and working conditions of school teachers

OBJECTIVE: To investigate the associations of workplace neighbourhood socioeconomic status with health behaviours, health and working conditions among school teachers. Method: The survey responses and employer records of 1862 teachers were linked to census data on school neighbourhood socioeconomic status. In the multilevel analysis, adjustments were made for demographics, work factors and the socioeconomic status of the teacher's own residential area. SETTING: 226 public schools in Finland. RESULTS: Teachers working in schools from neighbourhoods with the lowest socioeconomic status reported heavy alcohol consumption (OR 2.25; 95% CI 1.32 to 3.83) and higher probability of doctor-diagnosed mental disorders (OR 1.47; 95% CI 1.02 to 2.12) more often than teachers working in schools located in the wealthiest neighbourhoods. After controlling for the socioeconomic status of the teacher's own residential area, only heavy alcohol consumption remained statistically significant. Teachers working in schools with lower socioeconomic status also reported lower frequency of workplace meetings, lower participation in occupational training, lower teaching efficacy and higher mental workload. CONCLUSIONS: School neighbourhood socioeconomic status is associated with working conditions and health of school teachers. The association with health is partially explained by the socioeconomic status of the teachers' own residential neighbourhoods. An independent association was found between low socioeconomic status of school neighbourhoods and heavy alcohol use among teachers.     

Screen-based sedentary behaviour and psychosocial well-being in childhood: Cross-sectional and longitudinal associations

ObjectiveSedentary behaviour is an important contributor to the development of non-communicable diseases worldwide. Less is known about the relationship between screen-based sedentary behaviour and child mental health problems. This study explores cross-sectional and longitudinal associations between screen time (electronic gaming and television viewing) and psychosocial well-being in early and late childhood.MethodTwo independent samples of Australian children were used to explore associations. Data were collected from the parents of 3956 young children (age 6) and 3862 older children (age 10) at baseline with a two year follow-up.ResultsAfter controlling for demographic and socioeconomic factors (e.g., sex, household income), we found that screen time was negatively associated with prosocial behaviour, and positively associated with hyperactivity, peer problems and conduct problems in both samples. We also found that high screen time related to the development of emotional symptoms in young children, and to the development of hyperactivity and conduct problems in older children, over two years. Important moderators were household income, parental education level, and neighbourhood socioeconomic position.ConclusionThese findings indicate that screen-based sedentary behaviour is related to the development of psychosocial difficulties in early and late childhood.     

Decrease in television viewing predicts lower body mass index at 1-year follow-up in adolescents, but not adults

ObjectiveTo examine associations between television viewing, sugar-sweetened beverage consumption, eating out, physical activity, and body weight change over 1 year.DesignSecondary data analysis from randomized intervention trial.SettingHouseholds in the community.ParticipantsAdults (n = 153) and adolescents (n = 72) from the same households.InterventionHouseholds were randomized to a home-based obesity prevention intervention or to a no-intervention control group for a 1-year period.Main Outcome MeasuresSelf-reported television viewing (TV) hours, diet, and physical activity. Body mass index (BMI) computed from measured weight and height (primary outcome measure).AnalysisMixed-model regression.ResultsAmong adolescents, a significant prospective association was observed between decreases in television viewing hours and lower BMI z score at 1-year follow-up (decreased TV hours: BMI z score mean = 0.65; no change or increase TV hours: BMI z score = 0.92; P < .02). No significant prospective associations were observed among adults.Conclusions and ImplicationsReducing television viewing may be an effective strategy to prevent excess weight gain among adolescents.     

Children's food consumption during television viewing

BACKGROUND: Television viewing is associated with childhood obesity. Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children's weight. OBJECTIVES: Our objectives were to describe the amounts and types of foods that children consume while watching television, compare those types with the types consumed at other times of the day, and examine the associations between children's body mass index (BMI) and the amounts and types of foods consumed during television viewing. DESIGN: Data were collected from 2 samples. The first sample consisted of ethnically diverse third-grade children, and the second consisted predominantly of Latino fifth-grade children. Three nonconsecutive 24-h dietary recalls were collected from each child. For each eating episode reported, children were asked whether they had been watching television. Height and weight were measured by using standard methods and were used to calculate BMI. RESULTS: On weekdays and weekend days, 17-18% and approximately 26% of total daily energy, respectively, were consumed during television viewing in the 2 samples. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off, less soda, fast food, fruit, and vegetables were consumed with the television on. The amount of food consumed during television viewing was not associated with children's BMI, but in the third-grade sample, the fat content of foods consumed during television viewing was associated with BMI. CONCLUSIONS: A significant proportion of children's daily energy intake is consumed during television viewing, and the consumption of high-fat foods on weekends may be associated with BMI in younger children.     

Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: findings from the Maternity Experiences Survey

Objectives

To examine the relationship between neighbourhood deprivation and concentration of immigrants, and abuse among immigrant women versus non-immigrant women.

Methods

Using data from the Canadian Maternity Experiences Survey (un-weighted sample N?=?5,679 and weighted sample N?=?68,719) linked to the neighbourhoods Census data, we performed contextual analysis to compare abuse prevalence among: immigrants ≤5?years, immigrants >5?years and Canadian-born. We identified two level effect modifiers: living in high (≤15?% of households at or below low-income cut-off- [LICO]) versus low-income (>15?% below LICO) neighbourhoods and living in high (≥25?%) versus low immigrant (<25?%) neighbourhoods. Individual socioeconomic position (SEP), family variables and neighbourhood SEP or percentage of immigrants were considered in different logistic regression models.

Results

Immigrant women were less likely to experience abuse even upon adjustment for individual SEP, family variables and neighbourhood characteristics. The protective effect of the neighborhood was stronger among immigrant women living in low-income and high immigrant neighborhoods, irrespective of length of stay in Canada.

Conclusion

Policies and interventions to reduce abuse among immigrant women need to consider neighbourhood’s SEP and concentration of immigrants.     

Susceptibility to Food Advertisements and Sugar-Sweetened Beverage Intake in Non-Hispanic Black and Non-Hispanic White Adolescents

Obesity among adolescents in the United States has risen by 16% in the past 30 years. One important contributing factor may be the increased consumption of sugar sweetened beverages (SSBs), which is encouraged by advertisements for unhealthy foods and drinks that are targeted to adolescents. The purpose of this analysis was to determine the association between susceptibility to food and drink advertisements and sugar-sweetened beverage (SSB) consumption in non-Hispanic black (NHB) and non-Hispanic white (NHW) adolescents and to examine if BMI is associated with SSB consumption. Data were obtained from 765 NHB and NHW of ages 14–17 who were surveyed in the Family Life, Activity, Sun, Health, and Eating study sponsored by the National Cancer Institute. Two weighted adjusted logistic regression models were conducted. The first examined the associations of advertisement susceptibility, race, and BMI with SSB consumption. The second examined the associations of race and BMI with advertisement susceptibility. Adolescents with high advertisement susceptibility were more likely to consume at least one SSB daily (OR 1.73, 95% CI?1.21, 2.47). Additionally, non-Hispanic blacks were more likely to consume at least one SSB daily (OR 1.75, 95% CI?1.08, 2.85) and more likely to be highly susceptible to advertisements (OR 1.72, 95% CI?1.19, 2.48) than non-Hispanic whites. No significant associations were found between BMI and advertising susceptibility or BMI and daily SSB consumption. One approach to addressing the consumption of SSBs may be to reduce advertising that markets unhealthy food and beverages to adolescents and minorities.     

Proximity to supermarkets associated with higher body mass index among overweight and obese preschool-age children

ObjectiveThe objective of this study is to examine associations of proximity to food establishments with body mass index (BMI) among preschool-age children.MethodsWe used baseline data from 438 children ages 2–6.9 years with a BMI ≥ 85th percentile participating in a RCT in Massachusetts from 2006 to 2009. We used a geographic information system to determine proximity to six types of food establishments: 1) convenience stores, 2) bakeries, coffee shops, candy stores, 3) full service restaurants, 4) large supermarkets, 5) small supermarkets, and 6) fast-food restaurants. The main outcome was child's BMI.ResultsChildren's mean (SD) BMI was 19.2 (2.4) kg/m²; 35% lived ≤ 1 mile from a large supermarket, 42% lived > 1 to 2 miles, and 22% lived > 2 miles. Compared to children living > 2 miles from a large supermarket, those who lived within 1 mile had a BMI 1.06 kg/m² higher. Adjustment for socioeconomic characteristics and distance to fast-food restaurants attenuated this estimate to 0.77 kg/m². Living in any other distance category from a large supermarket and proximity to other food establishments were not associated with child BMI.ConclusionsLiving closer to a large supermarket was associated with higher BMI among preschool-age children who were overweight or obese.     

The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy

STUDY OBJECTIVE: To evaluate the independent and mutual effects of neighbourhood deprivation and of individual socioeconomic conditions on mortality and to assess the trends over the past 30 years and the residual neighbourhood heterogeneity. DESIGN: General and cause specific mortality was analysed as a function of time period, highest educational level achieved, housing conditions, and neighbourhood deprivation, using multilevel Poisson models stratified by gender and age class. SETTING: The study was conducted in Turin, a city in north west Italy with nearly one million inhabitants and consisting of 23 neighbourhoods. PARTICIPANTS: The study population included three cohorts of persons aged 15 years or older, recorded in the censuses of 1971, 1981, and 1991 and followed up for 10 years after each census. MAIN RESULTS: Individual and contextual socioeconomic conditions showed an independent and significant impact on mortality, both among men and women, with significantly higher risks for coronary heart and respiratory diseases among people, aged less than 65 years, residing in deprived neighbourhoods (9% and 15% excess for coronary heart diseases, 20% and 24% for respiratory diseases, respectively for men and women living in deprived neighbourhoods compared with rich). The decreasing time trend in general mortality was less pronounced among men with lower education and poorer housing conditions, compared with their more advantaged counterparts; the same was found in less educated women aged less than 65 years. CONCLUSIONS: These results and further developments in the evaluation of impact and mechanisms of other contextual effects can provide information for both health and non-health oriented urban policies.