Built Environment and Weight Disparities Among Children in High- and Low-Income Towns
Received 13 August 2008; accepted 26 February 2009. published online 28 May 2009.
Objective
To assess differences in built environment and child weight, and associations between them in high- and low-income communities.
Methods
By means of cross-sectional clinical and demographic data for children aged 2 to 18 years from an integrated health system in Massachusetts, we linked subject (n = 6680) and spatial data from Geographic Information Systems. We selected towns with at least 100 subjects per town (n = 46 towns), and we divided towns into quartiles by household income. We compared highest and lowest quartile towns on environmental characteristics (density of fast food restaurants, distance to nearest fast food restaurant, distance to nearest age-appropriate school) and overweight and obesity prevalence. We used clustered logistic regression to assess for associations between environmental characteristics and weight and carried out similar analyses stratified by age (2 to <5, 5 to <12, 12 to 18 years).
Results
Low-income towns had more sidewalks, less open space, a greater density of fast food restaurants, and higher rates of overweight/obesity. Among low-income-town children, after adjusting for age, gender, race, and town, density of fast food restaurants was positively associated with overweight and obesity, whereas distance to nearest age-appropriate school and fast food restaurant were inversely associated with obesity. Children from low-income towns appeared to have more consistent associations between weight status and the built environment.
Conclusions
Built environment varies by town income. Children living in low-income towns tend to have built environments that promote energy intake and decrease opportunities for energy expenditure.
Departments of Internal Medicine (Dr Oreskovic) and Pediatrics (Dr Oreskovic and Dr Perrin), Center for Child and Adolescent Health Policy (Dr Kuhlthau and Dr Romm), Massachusetts General Hospital, Boston, Mass
Address correspondence to Nicolas M. Oreskovic, MD, MPH, Massachusetts General Hospital, Center for Child and Adolescent Health Policy, 50 Staniford St, Suite 901, Boston, Massachusetts 02114.
Presented in part at the Pediatric Academic Societies Meeting, May 2008; Honolulu, Hawaii.
ABSTRACT