A Novel Approach to Disentangling the Relationship Between Neighborhood Environment, Adverse Childhood Experiences, and Childhood Obesity

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ABSTRACT Obesity populations on environmental obesity impacts 2.7 million American children. Children from racial/ethnic minority and low-income have higher obesity prevalence, contributing to health disparities. Obesity reduction efforts focused individual health behavior change have seen limited success, resulting in calls to examine social and factors that contribute to obesity. A better understanding of complex risk factors for childhood can inform targeted interventions, clinical practice, and policy. 1 Adverse childhood experiences (ACEs) are one understudied complex risk factor for childhood obesity. ACEs are traumatic experiences that occur during childhood such as sexual abuse, family member incarceration, or witnessing violent crime. Almost half of children have experienced ACEs and populations with ACEs have higher obesity prevalence. ACEs can increase obesity risk via sequelae of chronic or severe stress or by hindering healthy behaviors, though the impact of ACEs on childhood obesity is not well understood. Multi-level research examining the influence of neighborhood environment on the ACEs-obesity relationships is particularly lacking. Neighborhood factors such as lack of access to healthcare and high crime may contribute to both ACEs and obesity via indirect and overlapping pathways. It is difficult to disentangle the impact of neighborhood factors because many co-occur within the broader context of neighborhood poverty and racial segregation; sophisticated approaches such as geospatial analysis, longitudinal research, and novel methods for quantifying neighborhood risk are necessary. This study will be the first to examine the relationship between neighborhood environment, ACEs, and childhood obesity using advanced statistical methods. Aims 1a and 1b entail development and testing of a neighborhood ACEs index using existing multi-level geospatial data. Aim 2 entails examining the relationship between the neighborhood ACEs index and childhood obesity incidence using existing longitudinal data. Aim 3 entails determining neighborhood factors most associated with ACEs exposure and childhood obesity in order to identify potential targets for intervention, clinical practice, and policy. This study has the potential to inform targeted efforts for improving the health of millions of children who experience ACEs and obesity. The associated Career Development Plan focuses on ACEs, advanced statistics, and geospatial analysis. The Plan will advance my ability to use diverse, multi-level, geospatial data to examine complex childhood obesity risk factors - a skillset rare among nurse scientists but directly relevant to my research on how social determinants of health impact obesity. The Plan includes expert mentorship, focused coursework, and training at the inaugural NICHD P50 Translational Center for Child Maltreatment Studies. Collectively, this study will advance knowledge about the impact of ACEs on childhood obesity and simultaneously further my career goal to establish a program of research on understanding and reducing childhood obesity disparities.