Associations of multidimensional socioeconomic and built environment factors with body mass index trajectories among youth in geographically heterogeneous communities

Melissa N. Poulsen, Thomas A. Glass, Jonathan Pollak, Karen J Bandeen Roche, Annemarie G. Hirsch, Lisa Bailey-Davis, Brian S Schwartz

Research output: Contribution to journalArticle

Abstract

Understanding contextual influences on obesity requires comparison of heterogeneous communities and concurrent assessment of multiple contextual domains. We used a theoretically-based measurement model to assess multidimensional socioeconomic and built environment factors theorized to influence childhood obesity across a diverse geography ranging from rural to urban. Confirmatory factor analysis specified four factors—community socioeconomic deprivation (CSED), food outlet abundance (FOOD), fitness and recreational assets (FIT), and utilitarian physical activity favorability (UTIL)—which were assigned to communities (townships, boroughs, city census tracts) in 37 Pennsylvania counties. Using electronic health records from 2001 to 2012 from 163,820 youth aged 3–18 years from 1288 communities, we conducted multilevel linear regression analyses with factor quartiles and their cross products with age, age2, and age3 to test whether community factors impacted body mass index (BMI) growth trajectories. Models controlled for sex, age, race/ethnicity, and Medical Assistance. Factor scores were lowest in townships, indicating less deprivation, fewer food and physical activity outlets, and lower utilitarian physical activity favorability. BMI at average age was lower in townships versus boroughs (beta [SE]) (0.217 [0.027], P < 0.001) and cities (0.378 [0.036], P < 0.001), as was BMI growth over time. Factor distributions across community types lacked overlap, requiring stratified analyses to avoid extrapolation. In townships, FOOD, UTIL, and FIT were inversely associated with BMI trajectories. Across community types, youth in the lowest (versus higher) CSED quartiles had lower BMI at average age and slower BMI growth, signifying the importance of community deprivation to the obesogenicity of environments.

Original languageEnglish (US)
Article number100939
JournalPreventive Medicine Reports
Volume15
DOIs
StatePublished - Sep 1 2019

Fingerprint

Body Mass Index
Food Deprivation
Exercise
Growth
Medical Assistance
Geography
Electronic Health Records
Pediatric Obesity
Censuses
Statistical Factor Analysis
Linear Models
Obesity
Regression Analysis

Keywords

  • Built environment
  • Electronic health records
  • Pediatric obesity
  • Rural populations
  • Social environment

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Associations of multidimensional socioeconomic and built environment factors with body mass index trajectories among youth in geographically heterogeneous communities. / Poulsen, Melissa N.; Glass, Thomas A.; Pollak, Jonathan; Bandeen Roche, Karen J; Hirsch, Annemarie G.; Bailey-Davis, Lisa; Schwartz, Brian S.

In: Preventive Medicine Reports, Vol. 15, 100939, 01.09.2019.

Research output: Contribution to journalArticle

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