Perceived neighborhood environments, activity patterns, and overweight status among US children

1
Perceived neighborhood environments, activity
patterns, and overweight status among US children

• Jihong Liu, Sc.D
• Research conducted jointly with
• Janice C. Probst, Ph.D.
• Russell R. Pate, Ph.D.
• The 12th Annual MCH EPI Conference
• December 6-8, 2006

2
Background

• Overweight, especially among children, has
  emerged as serious threats to our nations health
• Childhood obesity rates have tripled in the past
  30 years
• The rates are even higher among minority and
  low-income children
• Obesity tends to track from childhood to
  adolescence to adulthood

3
Background

• The causes of this epidemic are multi-factorial
• Lifestyle
• Socioeconomic
• Biological
• Other factors (e.g. built environments)

4
Environmental factors

• Individual behavioral change can occur only in a
  supportive environment with accessible and
  affordable healthy food choices and opportunities
  for regular physical activity.
• The Surgeon Generals Call to Action to Prevent
  And Decrease Overweight and Obesity, 2001

5
Literature Review

• Few studies focused on the impact of neighborhood
  environments on physical activity (PA).
• Previous studies have shown conflicting results
• Neighborhood safety was associated with more PA
  (Gordon-Larsen et al. 2000 Molnar et al. 2004,
  Romero 2005)
• Perceived neighborhood safety and access to
  facilities was not associated with PA levels
  (Adkins et al. 2004 Mota et al. 2005)
• Perception of more hazards was associated with
  more reported PA (Romero et al. 2001)

6
Literature Review

• Minimal empirical research has been done to
  assess the impact of neighborhood safety on
  childhood obesity
• Inverse association (Lumeng 2006, Timperio 2005)
• No association (Burdette Whitaker 2004, 2005)

7
Research hypotheses

• Neighborhood environments, measured as perceived
  safety in the neighborhood, at school, at home,
  and neighborhood cohesiveness, are associated
  with
• Higher proportion of children without physical
  activity
• Higher electronic media use among children
• Higher proportion of overweight children

8
The National Survey of Childrens Health, 2003

• NSCH was designed to produce national and
  state-based estimates on the health and
  well-being of children, their families, and their
  communities
• Telephone interviews
• 102,353 completed interviews (0-17 yrs old)
• Overall response rate 55.3

9
The National Survey of Childrens Health, 2003
10
Measures of neighborhood environments

• Parental report of neighborhood safety
• How often do you feel CHILD is safe in your
  community or neighborhood?
• How often do you feel CHILD is safe at school?
• How often do you feel CHILD is safe at home?
• Negative responses (never/sometimes) lack of
  safety in the neighborhood, at school and at home.

11
Measures of neighborhood environments

• Lack of cohesiveness was denoted as a
  somewhat/definite disagreement with at least 2 of
  the following 4 items
• People in this neighborhood help each other out
• We watch out for each others children in this
  neighborhood
• There are people I can count on in this
  neighborhood
• If my child were outside playing and got hurt or
  scared, there are adults nearby who I trust to
  help my child.

12
Physical activity measure

• Parental report of childs physical activity
• During the past week, on how many days did
  CHILD exercise or participate in physical
  activity for at least 20 minutes that made
  him/her sweat and breathe hard, such as
  basketball, soccer, running, swimming laps, fast
  bicycling, fast dancing, or similar aerobic
  activities?
• No physical activity 0 days of being physically
  active in the past week

13
Electronic media use

• Parental report of childs electronic media use
  per day
• On an average school day, about how many hours
  does CHILD use a computer for purposes other
  than schoolwork?
• On an average school day, about how many hours
  does CHILD usually watch TV, watch videos, or
  play video games?
• High electronic media use (? 2 hrs/day) v.s. low
  electronic media use (lt 2 hrs/day)

14
Overweight measure

• Parental reported height and weight
• 10-17 years old (unweighted n48,207)
• Overweight
• BMI ? 95th percentile of the BMI for age and sex
  based on NCHS norms

15
Methods

• Include 42,934 children aged 10-17 with complete
  responses to all variables except poverty
• SAS-callable SUDAAN was used to account for the
  complex survey design
• All results were weighted

16
Methods

• Logistic regression models
• Outcomes No physical activity high electronic
  media use being overweight
• Predictors Perceived safety at neighborhood,
  school, and home neighborhood cohesiveness
• Primary control variables
• Childs sex, age, race/ethnicity
• Highest education in the household, family
  income, primary language at home, family structure

17
Results Environmental ratings
18
Results Activity and overweight rates
19
Neighborhood environments and lack of physical
activity
20
Other predictors of lack of physical activity

• Older children (15-17), girls more likely to be
  inactive
• Race/ethnicity not significant
• Low parental education, non-traditional family
  structure (two-parent step families, single mom),
  English not spoken in the home associated with
  inactivity

21
Neighborhood environments and high electronic
media use
22
Other predictors of high media use

• All non-white children more likely to have high
  electronic media use
• Girls, younger children less likely
• Poverty, non-traditional family structure linked
  to high media use

23
Association between neighborhood environments and
overweight
24
Other predictors of overweight

• Younger, male, and nonwhite children are more
  likely to be overweight
• Absence of physical activity, use of electronic
  media
• Poverty

25
Discussion Neighborhood safety

• 1 out of 7 parents reported living in somewhat
  unsafe neighborhood
• Strong unadjusted effects
• Children in neighborhoods perceived to be unsafe
  are less likely to engage in physical activity
  and more likely to have high media use
• In adjusted analysis, family factors such as
  education and income erase neighborhood effects,
  suggesting that safety concerns are not evenly
  distributed
• Interventions should focus on creating safe
  havens for exercise in low SES communities

26
Discussion School Safety

• 1 out of 8 parents reported unsafe school
  environment
• In both unadjusted and adjusted analysis, school
  safety is significant (PA, EM use)
• From an intervention standpoint, school safety
  may be easier to address than neighborhood safety
• Infrastructure in place

27
Discussion Home safety

• Few parents reported that their child was unsafe
  at home (2)
• Strong unadjusted effects, but no significance in
  adjusted analysis
• May be capturing multiple concepts
• Neighborhood safety
• Domestic violence
• No immediate implications for interventions

28
Discussion Neighborhood trust

• 1 out of 8 parents reported lack of neighborhood
  trust
• Interesting new concept, with strong unadjusted
  effects on all outcomes, and adjusted effects on
  physical activity
• The only community variable associated with
  obesity in multivariate analysis
• Social capital within communities as a
  facilitator of healthy behaviors
• Interventions community building? Will require
  a different focus in public health research

29
Limitations

• Parental report of weight and height
• Parental report of childrens physical activity
• Lack of data on dietary factors

30
Conclusions

• For children aged 10-17 years old,
• Parental perception of the school as less safe
  was associated with increased risk of no physical
  activities
• Lack of neighborhood cohesiveness was associated
  with higher risk of both physical inactivity and
  obesity

31
Acknowledgment

• Hao Zhu, B.S. for his early support in data
  analysis