Longitudinal associations of neighborhood environment features with pediatric body mass index |
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| Affiliation: | 1. Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA;2. Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA;3. Applied Clinical Research Center, Department of Pediatrics, Children''s Hospital of Philadelphia, Philadelphia, PA, USA;1. Legal Aid Services of Oklahoma, Inc, Tulsa, OK, USA;2. Department of Pediatrics, OU-TU School of Community Medicine, Tulsa, OK, USA;3. Osage Nation Historic Preservation Office, Pawhuska, OK, USA;4. Anne and Henry Zarrow School of Social Work, University of Oklahoma, Tulsa, OK, USA;5. Department of Pediatrics, Integris Health, Miami, OK, USA;6. Department of Ophthalmology, Yale University, Newhaven, CT, USA;7. Department of Medical Informatics, OU-TU School of Community Medicine, Tulsa, OK, USA;8. Christopher C. Gibbs College of Architecture, University of Oklahoma, Tulsa, OK, USA;1. Department of Health and Human Performance, College of Charleston, 24 George Street Suite 336, Charleston, SC 29424, United States;2. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, United States;3. Prevention Research Center, Arnold School of Public Health, University of South Carolina, United States;4. Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, United States;5. York County Government, SC, United States;6. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States;1. Department of Public Health, Policy and Systems, University of Liverpool, UK;2. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK;3. Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, UK;1. Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria;2. Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria;3. Department of Ecology, University of Innsbruck, Innsbruck, Austria;4. Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, USA;5. Institute of Psychology, Jagiellonian University, Krakow, Poland |
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| Abstract: | IntroductionIt has been posited that policies to promote child health and prevent obesity should target neighborhood environments but evidence on the impact of neighborhoods on child weight is conflicting and longitudinal studies (which have benefits for causal inference) are scarce.MethodsWe used electronic health records (2007–2016) from an urban, pediatric integrated delivery system and linked children (N = 51,873, ages 6–19 years, 77% African American) to neighborhood-level data to investigate how changes in neighborhood environments relate to changes in body mass index (BMI). Measures of neighborhood environment were resources for healthy foods and physical activity (‘resources’), greenness, violent crime rate, perceived safety and social cohesion. Fixed effects models estimated associations between changes in neighborhood environment exposures and changes in BMI z-score and whether effects differed by sex, baseline age, neighborhood socioeconomic status and population density.ResultsApproximately 22% of the cohort was obese (BMI z-score ≥ 95th percentile). In adjusted models, increases in neighborhood greenness and perceived safety were associated with decreases in BMI z-score (mean change in BMI z-score for 1-SD increase for both: -0.012; 95% CI= (−0.018, −0.007)). Increases in neighborhood safety had a stronger effect in children ages 6–10 years than in older children. Increases in social cohesion were associated with increases in BMI z-score (mean change: 0.005 95% CI = (0.003, 0.008)) especially in boys. Increases in food and physical activity resources were not associated with changes in BMI.ConclusionsThis study suggests that increasing neighborhood greenness and safety are potential approaches to reduce children's BMI. |
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| Keywords: | Longitudinal Fixed effects model Child obesity Built environment Social environment |
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