Longitudinal associations of neighborhood environment features with pediatric body mass index
Longitudinal associations of neighborhood environment features with pediatric body mass index
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DOI：
10.1016/j.healthplace.2021.102656
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发表时间：
2021-08-27
期刊：
影响因子：
4.8
通讯作者：
Roux, Ana V. Diez
中科院分区：
文献类型：
--
作者：
Daniels, Kimberly;Le-Scherban, Elice;Roux, Ana V. Diez
导言：有人认为，促进儿童健康和预防肥胖的政策应该针对社区环境，但关于社区对儿童体重影响的证据是相互矛盾的，而且纵向研究（有利于因果推理）很少。方法：我们使用来自城市儿科综合分娩系统的电子健康记录（2007-2016年），并将儿童（N = 51,873，年龄6-19岁，77%非裔美国人）与社区数据联系起来，调查社区环境变化与体重指数（BMI）变化的关系。社区环境的衡量标准是健康食品和体育活动资源（“资源”）、绿化、暴力犯罪率、感知安全性和社会凝聚力。固定效应模型估计邻里环境暴露变化与BMI z-score变化之间的关联，以及影响是否因性别、基线年龄、邻里社会经济地位和人口密度而异。结果：大约22%的队列肥胖（BMI z-score >=第95百分位）。在调整后的模型中，社区绿化和感知安全性的增加与BMI z-score的降低相关（两者增加1-SD时BMI z-score的平均变化：-0.012;95% CI=(-0.018, -0.007)）。提高社区安全对6-10岁儿童的影响比对大一点的儿童更大。社会凝聚力的增加与BMI z分数的增加有关（平均变化：0.005 95% CI =(0.003, 0.008)），特别是在男孩中。食物和体力活动资源的增加与BMI的变化无关。结论：本研究提示增加社区绿化和安全是降低儿童BMI的潜在途径。
Introduction: It has been posited that policies to promote child health and prevent obesity should target neighborhood environments but evidence on the impact of neighborhoods on child weight is conflicting and longitudinal studies (which have benefits for causal inference) are scarce.Methods: We used electronic health records (2007-2016) from an urban, pediatric integrated delivery system and linked children (N = 51,873, ages 6-19 years, 77% African American) to neighborhood-level data to investigate how changes in neighborhood environments relate to changes in body mass index (BMI). Measures of neighborhood environment were resources for healthy foods and physical activity ('resources'), greenness, violent crime rate, perceived safety and social cohesion. Fixed effects models estimated associations between changes in neighborhood environment exposures and changes in BMI z-score and whether effects differed by sex, baseline age, neighborhood socioeconomic status and population density.Results: Approximately 22% of the cohort was obese (BMI z-score >= 95th percentile). In adjusted models, increases in neighborhood greenness and perceived safety were associated with decreases in BMI z-score (mean change in BMI z-score for 1-SD increase for both: -0.012; 95% CI= (-0.018, -0.007)). Increases in neighborhood safety had a stronger effect in children ages 6-10 years than in older children. Increases in social cohesion were associated with increases in BMI z-score (mean change: 0.005 95% CI = (0.003, 0.008)) especially in boys. Increases in food and physical activity resources were not associated with changes in BMI.Conclusions: This study suggests that increasing neighborhood greenness and safety are potential approaches to reduce children's BMI.