Neighborhood Cohesion and the Prevalence of Obesity in Early Childhood Restricted; Files Only

Le, San Linh (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/ff3655303?locale=en
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Abstract

Introduction: In the last forty years, obesity has become a significant concern in the United States. Prevalence of obesity in children rose from 5% in the 1970s to almost 17% in 2012. Research has shown that the neighborhood social environment may be associated with obesity, but few studies have focused on neighborhood cohesion as the primary exposure in relation to obesity in youth. This analysis aims to investigate the association between individual-level neighborhood cohesion, its constructs, and the prevalence of obesity in children while also considering potential interaction with race/ethnicity.

Methods: Data on 1,711 families were taken from the Fragile Families and Child Wellbeing Study, a nationally representative study conducted to collect five waves of data beginning in February 1998. Using only baseline and age five data, linear and logistic regression models were run to examine the association between total neighborhood cohesion (TNC), BMI percentile, and obesity status. Logistic regression models were also run with each of the three neighborhood cohesion constructs – attachment to neighborhood, safety, trust/value (attitude) consensus – as the sole exposure and obesity status as the outcome.

Results: In the linear regression model including race/ethnicity interaction and adjusted for sex, baseline household income, mother marital status, and mother’s BMI, an increase in TNC score was associated with a 0.76 increase in unit of BMI (p<0.05). In the fully adjusted logistic regression model without race/ethnicity interaction, the odds of being obese were 0.85 (95% CI: 0.65, 1.11). Being Hispanic may influence the association between TNC and BMI percentile, but not obesity status. Neighborhoods with higher trust/value (attitude) consensus had lower odds of being obese. 

Conclusions: Youth who live in higher socially cohesive neighborhoods have increased likelihood of having higher BMI percentile but lower odds of being considered obese than those who live in lower socially cohesive neighborhoods. Identifying as Hispanic may have influenced this result. As this is the first study to consider neighborhood cohesion, its constructs, and obesity specifically in youth, future research is needed to better understand the possible pathways and mechanisms in which neighborhood cohesion influences obesity among this population.

Table of Contents

I. Chapter 1: Background/Literature Review.................................................1

Obesity Overview................................................................................1

Neighborhood Environments...............................................................2

Neighborhood Social Environment......................................................3

Neighborhood Cohesion......................................................................4

Interaction Between Race/Ethnicity and Neighborhood Cohesion......6

Neighborhood Cohesion Constructs....................................................7

Literature Summary & Overview of Analysis.....................................8

 

II. Chapter 2: Manuscript........................................................................10

Abstract..........................................................................................10

Introduction.....................................................................................11

Methods..........................................................................................14

Results............................................................................................25

Discussion.......................................................................................31

Limitations......................................................................................39

Strengths........................................................................................40

References......................................................................................42

Tables.............................................................................................50

 

III: Summary, Public Health Implications, Possible Future Directions.............68

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