CARE: Community Alliance for Research and Engagement, Yale School of Public Health, USA.
Soc Sci Med. 2013 Oct;95:106-14. doi: 10.1016/j.socscimed.2013.04.003. Epub 2013 Apr 10.
Obesity prevalence among US children and adolescents has tripled in the past three decades. Consequently, dramatic increases in chronic disease incidence are expected, particularly among populations already experiencing health disparities. Recent evidence identifies characteristics of "obesogenic" neighborhood environments that affect weight and weight-related behaviors. This study aimed to examine associations between built, socioeconomic, and social characteristics of a child's residential environment on body mass index (BMI), diet, and physical activity. We focused on pre-adolescent children living in New Haven, Connecticut to better understand neighborhood environments' contribution to persistent health disparities. Participants were 1048 fifth and sixth grade students who completed school-based health surveys and physical measures in fall 2009. Student data were linked to US Census, parks, retailer, and crime data. Analyses were conducted using multilevel modeling. Property crimes and living further from a grocery store were associated with higher BMI. Students living within a 5-min walk of a fast food outlet had higher BMI, and those living in a tract with higher density of fast food outlets reported less frequent healthy eating and more frequent unhealthy eating. Students' reported perceptions of access to parks, playgrounds, and gyms were associated with more frequent healthy eating and exercise. Students living in more affluent neighborhoods reported more frequent healthy eating, less unhealthy eating, and less screen time. Neighborhood social ties were positively associated with frequency of exercise. In conclusion, distinct domains of neighborhood environment characteristics were independently related to children's BMI and health behaviors. Findings link healthy behaviors with built, social, and socioeconomic environment assets (access to parks, social ties, affluence), and unhealthy behaviors with built environment inhibitors (access to fast food outlets), suggesting neighborhood environments are an important level at which to intervene to prevent childhood obesity and its adverse consequences.
美国儿童和青少年的肥胖患病率在过去三十年中增加了两倍。因此，预计慢性疾病的发病率会大幅上升，尤其是在已经存在健康差异的人群中。最近的证据确定了影响体重和与体重相关行为的“肥胖环境”的特征。本研究旨在探讨儿童居住环境的建筑、社会经济和社会特征与体重指数（BMI）、饮食和身体活动之间的关系。我们专注于新罕布什尔州纽黑文的青春期前儿童，以更好地了解邻里环境对持续存在的健康差异的贡献。参与者是 1048 名五年级和六年级的学生，他们在 2009 年秋季完成了基于学校的健康调查和身体测量。学生数据与美国人口普查、公园、零售商和犯罪数据相关联。分析采用多层次建模进行。财产犯罪和离杂货店越远与 BMI 越高有关。住在离快餐店步行 5 分钟以内的学生 BMI 较高，而住在快餐店密度较高的地段的学生报告健康饮食频率较低，不健康饮食频率较高。学生对获得公园、游乐场和健身房的感知与更频繁的健康饮食和锻炼有关。居住在较富裕社区的学生报告更频繁的健康饮食、较少的不健康饮食和较少的屏幕时间。邻里社会关系与锻炼频率呈正相关。总之，邻里环境特征的不同领域与儿童的 BMI 和健康行为独立相关。研究结果将健康行为与建筑、社会和社会经济环境资产（获得公园、社会关系、富裕）联系起来，并将不健康行为与建筑环境抑制剂（获得快餐）联系起来，这表明邻里环境是预防儿童肥胖及其不良后果的一个重要干预层面。
