Showell Nakiya N, Jennings Jacky M, Johnson Katherine A, Perin Jamie, Thornton Rachel L J
Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Front Pediatr. 2019 Jan 22;6:433. doi: 10.3389/fped.2018.00433. eCollection 2018.
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) 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. 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). 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%, < 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. 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.
低收入以及少数种族/族裔的学龄前儿童（2至5岁）受肥胖及其相关健康后果的影响尤为严重。个体层面的因素（如饮食）和环境因素（如社区环境）导致了这些差异。然而，专门针对高危学龄前儿童研究社区因素对肥胖风险影响的研究却很有限。本研究的目的是描述在一所学术医疗中心附属的两家初级保健儿科诊所接受治疗的学龄前患者的地理分布情况，并探讨社区犯罪和贫困与该人群肥胖风险之间是否存在关联。这是一项横断面多层次研究，将2007年至2012年患者就诊的临床管理数据与美国社区调查和巴尔的摩市警察局的数据相联系。对2至5岁患者的家庭住址进行地理编码，以确定其居住社区（即普查街区组）。我们使用逻辑回归分析来研究肥胖和超重与社区层面因素之间的横断面关系。所有分析均对年龄和性别进行了调整，并按种族/族裔（黑人、西班牙裔和白人）进行了分层。大多数学龄前患者生活在犯罪率中等或较高（84%）或贫困率较高（54%）的社区。与白人学龄前儿童相比，生活在高贫困社区的黑人学龄前儿童比例显著更高（61%对38%，<0.001）。在这个以诊所为基础的学龄前儿童样本中，生活在高犯罪或高贫困社区与超重或肥胖的临床显著增加几率无关。本研究调查了社区因素与以诊所为基础的低收入少数种族/族裔学龄前儿童人群肥胖和超重之间的关联。该样本中的学龄前儿童居住的社区平均犯罪率和贫困率高于巴尔的摩全市平均水平。我们的研究结果还表明，与白人相比，黑人学龄前儿童面临更高水平的社区贫困。虽然在这项横断面分析中未发现这些社区因素与肥胖或超重几率之间存在有意义的关联，但我们的研究结果为未来的研究提供了方向，有助于开发基于诊所的肥胖管理干预措施，以有效解决导致幼儿肥胖差异的社区因素。
