Abstract
BackgroundThe context of the close neighbourhood environment in which children live has gained increasing attention in epidemiological research. This study aimed to investigate if contextual neighbourhood socioeconomic position (SEP) was independently associated with overweight in young children aged 5–7 years while simultaneously considering a wide range of individual socioeconomic determinants and known risk factors for overweight.MethodsObjectively measured body mass index (BMI) data from 3499 children (53 % boys and 47 % girls) from three surveys between 2004 and 2007 clustered in 18 school enrolment zones in the city of Munich, Germany, were analysed with hierarchical logistic regression models. An index of neighbourhood SEP was calculated with principal component analysis using aggregated data. Individual socioeconomic data, maternal BMI, and birth weight were collected with parental questionnaires. We analysed how much of the between neighbourhood variance of overweight was attributable to individual factors and how much was explained by neighbourhood SEP.ResultsThe prevalence of overweight, including obesity, was 14.1 %. In the final adjusted model low neighbourhood SEP was independently associated with overweight (odds ratio (OR) = 1.42, 95 % confidence interval (CI) = 1.00-2.00) compared to high neighbourhood SEP. On the individual level low parental education (OR = 1.99, 95 % CI = 1.49-2.65) or middle parental education (OR = 1.50, 95 % CI = 1.16-1.95) compared to high parental education and nationality of the child other than German (OR = 1.53, 95 % CI = 1.17-1.99) compared to German nationality were independently associated with overweight.ConclusionsWhereas individual determinants were the main drivers in explaining between neighbourhood variance, neighbourhood SEP additionally explained differences in overweight between neighbourhoods. Thus, considering neighbourhood context in intervention planning could result in more effective strategies compared to measures only focusing on individual determinants of overweight.
Highlights
The context of the close neighbourhood environment in which children live has gained increasing attention in epidemiological research
Sex-specific prevalence was similar in boys (14.0 %) and girls (14.2 %). 8.5 % of the children had a high birth weight and 24.2 % of mothers were overweight or obese. 17.4 % of the parents had a low education. 13.1 % of the families were affected by relative poverty with a household income below 60 % of the median Bavarian equivalent household income
Apart from individual socioeconomic position (SEP) we considered birth weight and maternal body mass index (BMI) which are important risk factors for overweight in young children, too [16, 17]
Summary
The context of the close neighbourhood environment in which children live has gained increasing attention in epidemiological research. This study aimed to investigate if contextual neighbourhood socioeconomic position (SEP) was independently associated with overweight in young children aged 5–7 years while simultaneously considering a wide range of individual socioeconomic determinants and known risk factors for overweight. The increase of overweight and obesity in young children in middle and high income countries in recent decades is described as one of the most challenging public health problems [1, 2]. Socio-ecological approaches targeting supportive environments are attracting increasing attention for overweight prevention [5]. The research question how contextual neighbourhood factors influence overweight in children is of great interest. A contextual effect is present if factors on the neighbourhood level are independently associated with individual health outcomes while possible individual level risk factors are simultaneously considered to avoid an ecological fallacy. To separate out potential contextual effects from individual effects a multilevel modelling approach offers an appropriate analytic strategy [6–8]
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