Schuler Brittany R, O'Reilly Nicole
1 Vivian A. and James L. Curtis School of Social Work Research and Training Center, University of Michigan , Ann Arbor, MI.
2 School of Social Work, College of Health Sciences, Boise State University , Boise, ID.
Child Obes. 2017 Dec;13(6):479-489. doi: 10.1089/chi.2017.0025. Epub 2017 Jul 31.
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.
儿童肥胖与长期健康后果风险增加相关。尽管有大量研究，但肥胖患病率仍然很高，尤其是在低收入群体中。关于超重/肥胖风险在收入梯度和青少年发育阶段的差异知之甚少。本研究考察了不同收入梯度下社区远端因素与青少年体重状况之间的关联，以及这种关联是否受年龄的调节。
本研究使用从全国儿童健康调查（NSCH）中抽取的33096名青少年的全国代表性样本，在按收入四分位数（根据联邦贫困指南）分层的子样本中，在控制了个体层面因素（性别、种族/民族、家庭构成、父母就业、教育程度）后，评估年龄如何与社区因素和体重（超重/肥胖与正常体重）相互作用。社区因素包括社区风险（包括社区安全、学校安全、邻里凝聚力和有损邻里的因素）以及四项邻里便利设施（人行道、公园、娱乐中心、图书馆）。
与高社区风险组相比，第1和第3四分位数中社区风险低的青少年超重/肥胖几率较低（分别低32%和35%）。年龄与第1四分位数中娱乐中心的可及性以及第4四分位数中人行道的可及性存在相互作用，表明随着青少年年龄增长，获得这些便利设施会使超重/肥胖几率降低（分别降低17%和9%）。
研究结果表明，超重/肥胖的预测因素在收入群体中可能各不相同，未来的研究和干预措施应针对每个社区的不同特征。这包括减少有损因素，增强较低四分位数社区的便利设施和凝聚力，以及提高最高四分位数社区的步行便利性。
