Abstract
Introduction: Low-income and racial/ethnic minority preschoolers (aged 2–5 years) are disproportionately affected by obesity and its associated health consequences. Individual-level factors (e.g., diet) and environmental factors (e.g., neighborhood conditions) contribute to these disparities. However, there is limited research examining the role of neighborhood factors on obesity risk specifically among high-risk preschoolers. The objectives of this study are to describe the geographic distribution of preschool patients receiving care at two primary care pediatrics clinics affiliated with an academic medical center, and explore whether exposure to neighborhood crime and poverty is associated with obesity risk among this population.Methods: Cross-sectional multilevel study linking clinical administrative data on patient visits between 2007 and 2012 with data from the American Community Survey and the Baltimore City Police Department. Home addresses of 2–5 year-old patients were geocoded to their neighborhood (i.e., census block group) of residence. We used logistic regression to examine the cross-sectional relationship between obesity and overweight and neighborhood-level factors. All analyses were adjusted for age and gender, and stratified by race/ethnicity (Black, Hispanic, and White).Results: The majority of preschool patients lived in moderate or high crime (84%) or high poverty (54%) neighborhoods. A significantly higher proportion of Black preschoolers lived in high poverty neighborhoods compared to White preschoolers (61% vs. 38%, p < 0.001). Among this clinic-based sample of preschoolers, living in high crime or high poverty neighborhoods was not associated with a clinically significant increased odds of overweight or obesity.Conclusions: This study examines the association between neighborhood factors and obesity and overweight among a clinic-based population of low-income racial/ethnic minority preschoolers. The neighborhoods where preschoolers in this sample lived, on average had higher crime counts and poverty than the citywide average for Baltimore. Our findings also suggest that Black preschoolers are exposed to higher levels of neighborhood poverty compared to Whites. While no meaningful association between these neighborhood factors and odds of obesity or overweight was found in this cross-sectional analysis, our findings suggest avenues for future studies informative to the development of clinic-based obesity management interventions aimed at effectively addressing neighborhood contributors to early childhood obesity disparities.
Highlights
Low-income and racial/ethnic minority preschoolers are disproportionately affected by obesity and its associated health consequences
There was, a statistically significant association of the odds of obesity with crime among Black children such that adjusted odds of obesity was 0.978 for every increase of 10 violent crimes in a child’s neighborhood
Our findings are in contrast to some other studies that have found statistically significant associations between neighborhood SES and neighborhood crime and child obesity [11, 22,23,24]
Summary
Low-income and racial/ethnic minority preschoolers (aged 2–5 years) are disproportionately affected by obesity and its associated health consequences. The mechanisms responsible for producing and sustaining racial/ethnic- and SES-based obesity disparities are likely multifactorial and are hypothesized to include both individual risk factors (e.g., television viewing, increased intake of sugarsweetened beverage intake) and neighborhood conditions including neighborhood SES, neighborhood safety, and neighborhood crime exposure [5,6,7]. A recent systematic review of cohort studies demonstrated that living in unsafe neighborhoods was associated with a reduction in children’s (aged ≤17 years) physical activity level [8]. A prior review conducted by Davison and Lawson, demonstrated that objectively measured local crime rates were inversely associated with children’s reported physical activity level [9]. Most studies, those focused on preschoolers, have solely utilized subjective measures of neighborhood safety with significant heterogeneity or have examined these types of neighborhood environmental exposures over large geographic areas such as census tracts or counties [9,10,11,12]
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