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Acad Pediatr. 2009 Sep-Oct;9(5):315-21. doi: 10.1016/j.acap.2009.02.009. Epub 2009 May 27.

Built environment and weight disparities among children in high- and low-income towns.

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Department of Internal Medicine, Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.



To assess differences in built environment and child weight, and associations between them in high- and low-income communities.


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).


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.


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.

[Indexed for MEDLINE]

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