Child Development and the Community Environment: Understanding Overweight across the Income Gradient.

Abstract

Childhood obesity is associated with increased risk of long-term health consequences. Despite the wealth of research, prevalence rates are still high, particularly among lower-income groups. Little is known about variations in risk of overweight/obesity across income gradients and the adolescent developmental stage. This study examines the association between distal community factors and adolescent weight status across income gradients and whether this association is moderated by age. Using a nationally representative sample of 33,096 adolescents drawn from the National Survey of Children's Health (NSCH), this study assesses how age interacts with community factors and weight (overweight/obese vs. normal weight) after controlling for individual-level factors (gender, race/ethnicity, household composition, parental employment, education) in subsamples stratified by income quartile (according to federal poverty guidelines). Community factors include community risk (comprising community safety, school safety, neighborhood cohesion, and detracting neighborhood elements) and four neighborhood amenities (sidewalks, parks, recreation centers, libraries). Adolescents with low community risk in quartiles 1 and 3 had lower odds of overweight/obesity (by 32% and 35%, respectively) compared with the high community risk group. Age interacted with access to recreational centers in quartile 1 and sidewalks in quartile 4, indicating a decrease in odds of overweight/obesity (by 17% and 9%, respectively) with access to these amenities as youth age. Findings suggest that predictors of overweight/obesity can be diverse within income groups, and future research and interventions should address distinct features of each community. This includes reducing detracting elements and enhancing amenities and cohesion in lower quartiles, as well as improving walkability in the highest quartile.