Neighborhood disorder in Mexico: Is it associated with BMI and obesity? Restricted; Files Only
Ramirez, Natalia (Spring 2021)
Published
Abstract
Objective
Obesity and violence levels are leading public health concerns in Mexico, and both have continued rising without evidence of stopping in the last 30 years. Evidence of violence can be seen in neighborhoods through social and physical conditions. These conditions might be an indicator of potential threat and danger that may affects obesity and BMI through behavioral pathways such as lack of exercise. Therefore, the first objective of this study was to evaluate whether neighborhood disorder is associated with BMI and obesity status. The second objective was to test whether this association is mediated by perceived lack of safety, psychological distress, and exercise.
Methods
Data were analyzed for 7,276 adults from the third wave (2009-2012) of the Mexican Family Life Survey (MxFLS), a longitudinal, multi-thematic survey representative of the national, urban, rural, and regional population in Mexico. Measured weight and height were used to calculate BMI. Descriptive statistics were used to show the distribution of the demographic, health, and neighborhood characteristics of the participants. Multivariable linear and logistic regression models were used to evaluate the association of neighborhood disorder with BMI and obesity. In addition, potential mediation was assessed by comparing coefficient estimates between a model not including the mediators and a model adjusting for the potential mediators.
Results
The results indicate that neighborhood disorder is significantly positively associated with BMI but has a statistically non-significant association with obesity. Results further indicate that after adjustment, the association between neighborhood disorder and BMI is potentially mediated through exercising routinely. Meanwhile, in the final model for obesity, neighborhood disorder was not significant, and exercise was the only statistically significant mediating variable.
Conclusion
Neighborhood disorder was associated with BMI; exercise might be a mediator. Therefore, neighborhood disorder may discourage exercise and this decrease is associated with an increase in BMI. This study adds evidence on a topic that has been mostly studied in high-income countries where the threshold for disorder might be lower. These results suggest that public policy efforts should focus on the improvement of Mexican’s perceptions of their neighborhood environment as it might be an important element in reducing the current obesity epidemic.
Table of Contents
Table of Content
Chapter 1: Introduction 1……………………………………………………………………………………………………………1
1. Background…………………………………………………………………………………………………….1
2. Objective and Research Question……………………………………………………………………3
Chapter 2: Literature review…………………………………………………………………………………………………….5
1. Obesity in Mexico……………………………………………………………………………………………5
1-1. Prevalence of Obesity in Mexico…………………………………………………………….5
1-2. Nutrition transition in Mexico…………………………………………………………………5
2. Health impacts of obesity………………………………………………………………………………..6
3. Food security in Mexico…………………………………………………………………………………..6
4. Individual level risk factors of obesity……………………………………………………………..7
4-1. Family history/genetics ……………………………………………………………………………………..7
4-2. Demographic factors………………………………………………………………………………………….8
4-3. Behavioral factors………………………………………………………………………………………………8
4-4. Psychosocial stress factors……………………………………………………………………………….13
5. Neighborhood level risk factors of obesity……………………………………………………..13
5-1. Walkability……………………………………………………………………………………………………….13
5-2. Neighborhood deprivation………………………………………………………………………………..14
6. Crime and perceived safety in Mexico……………………………………………………………..15
6-1. Crime in Mexico…………………………………………………………………………………………………15
6-2. Perceived safety in Mexico…………………………………………………………………………………16
7. Neighborhood Disorder ……………………………………………………………………………………16
7-1. Neighborhood disorder definition………………………………………………………………………16
7-2. Perceived versus objective perception of safety and neighborhood environment.17
7-3. Neighborhood disorder and psychological distress…………………………………………….18
7-4. Neighborhood disorder/perceived safety and physical activity…………………………..18
7-5. Neighborhood disorder and perceived safety…………………………………………………….19
7-6. Link between neighborhood disorder and obesity……………………………………………..19
Chapter 3: Conceptual Framework…………………………………………………………………………………………..21
Chapter 4: Methods…………………………………………………………………………………………………………………..24
1. Data Source………………………………………………………………………………………………………24
2. Variables Creation…………………………………………………………………………………………….26
2-1. Outcome variables………………………………………………………………………………………..26
2-2. Main exposure……………………………………………………………………………………………….26
2-3. Mediating variables……………………………………………………………………………………….27
2-4. Control variables…………………………………………………………………………………………….28
3. Data preparation……………………………………………………………………………………………….30
3-1. Data used………………………………………………………………………………………………………30
3-2. Sample creation and data cleaning…………………………………………………………………31
4. Statistical analysis……………………………………………………………………………………………..32
4-1. Descriptive analysis ………………………………………………………………………………………..32
4-2. Modeling…………………………………………………………………………………………………………32
Chapter 4: Results……………………………………………………………………………………………………………………….37
1. Descriptive results of study population………………………………………………………………37
2. Association between neighborhood disorder and BMI/obesity………………………….38
3. Mediation pathways results……………………………………………………………………………….38
4. Additional results……………………………………………………………………………………………….40
Chapter 5: Discussion and Conclusion………………………………………………………………………………………….41
1. Main findings……………………………………………………………………………………………………..41
2. Other relevant findings……………………………………………………………………………………….44
3. Limitations and strengths……………………………………………………………………………………46
4. Conclusion………………………………………………………………………………………………………….48
References…………………………………………………………………………………………………………………………………..50
Tables and Figures………………………………………………………………………………………………………………………65
Figure 1. The conceptual framework between neighborhood disorder and BMI…….65
Figure 2. Distribution of number of neighborhood disorder by BMI categories
(n=7,275)……………………………………………………………………………………66
Table 1. Questions from MxFLS Mental Health Module, 2009………………………..66
Table 2: Demographic and Health Characteristics, MxFLS 2009-2012 (n=7,276)……67
Table 3: Neighborhood and safety descriptive characteristics, MxFLS 2009-2012
(n=7,276)…………………………………………………………………………………....70
Table 4: Association between Neighborhood disorder and BMI (n=7,276)…………...72
Table 5: Association between Neighborhood disorder and obesity (n=7,276)………...74
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