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Child Obes. 2015 Jun;11(3):260-8. doi: 10.1089/chi.2014.0139. Epub 2015 Apr 29.

Food environments and childhood weight status: effects of neighborhood median income.

Author information

1
1Department of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA.
2
2Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
3
3Partners Health Care System, Boston, MA.
4
4Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA.
5
5Department of Population Health, New York University School of Medicine, New York, NY.
6
6Department of Environmental Health, Harvard School of Public Health, Boston, MA.
7
7Department of Nutrition, Harvard School of Public Health, Boston, MA.

Abstract

BACKGROUND:

A key aspect of any intervention to improve obesity is to better understand the environment in which decisions are being made related to health behaviors, including the food environment.

METHODS:

Our aim was to examine the extent to which proximity to six types of food establishments is associated with BMI z-score and explore potential effect modification of this relationship. We used geographical information software to determine proximity from 49,770 pediatric patients' residences to six types of food establishments. BMI z-score obtained from the electronic health record was the primary outcome.

RESULTS:

In multivariable analyses, living in closest proximity to large (β, -0.09 units; 95% confidence interval [CI], -0.13, -0.05) and small supermarkets (-0.08 units; 95% CI, -0.11, -0.04) was associated with lower BMI z-score; living in closest proximity to fast food (0.09 units; 95% CI, 0.03, 0.15) and full-service restaurants (0.07 units; 95% CI, 0.01, 0.14) was associated with a higher BMI z-score versus those living farthest away. Neighborhood median income was an effect modifier of the relationships of convenience stores and full-service restaurants with BMI z-score. In both cases, closest proximity to these establishments had more of an adverse effect on BMI z-score in lower-income neighborhoods.

CONCLUSIONS:

Living closer to supermarkets and farther from fast food and full-service restaurants was associated with lower BMI z-score. Neighborhood median income was an effect modifier; convenience stores and full-service restaurants had a stronger adverse effect on BMI z-score in lower-income neighborhoods.

PMID:
25923838
PMCID:
PMC4559156
DOI:
10.1089/chi.2014.0139
[Indexed for MEDLINE]
Free PMC Article

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