Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City
Introduction
Neighborhood built and social environments may shape physical activity and obesity throughout the life course (Davison and Lawson, 2006, Lee and Moudon, 2004, Papas et al., 2007). Very young children may be more responsive to the home environment (Rundle et al., 2009a, Suglia et al., 2012), while adolescents are able to take advantage of neighborhood physical activity facilities (Evenson et al., 2007, Gordon-Larsen et al., 2006, Grow et al., 2008). A few studies have shown the relevance of the neighborhood built environment to physical activity and adiposity for preschool aged children (Kerr et al., 2006, Lovasi et al., 2011, McDonald, 2008, Spence et al., 2008) but evidence remains mixed (Burdette and Whitaker, 2004, Davison and Lawson, 2006).
Many built environment and health studies have focused on walkable urban form (Ewing and Cervero, 2010, Papas et al., 2007, Saelens and Handy, 2008), including features such as residential density, land use mix, and street design. However, these measures of walkability may not be salient for all population groups (Lovasi et al., 2009a, Lovasi et al., 2009b). Further, even neighborhoods with highly walkable urban form may have safety or aesthetic problems, particularly in economically deprived areas (Neckerman et al., 2009, Zhu and Lee, 2008).
Green spaces such as tree-lined streets and parks may encourage physical activity and a healthy weight (Boldemann et al., 2006, Larsen et al., 2009, Lovasi et al., 2011, Lovasi et al., 2012a). Yet accounting for other aspects of the environment, such as safety, may be crucial for understanding disparate quality of green space available to residents of low-income urban neighborhoods (Weiss et al., 2011).
Children in resource-limited urban settings may be particularly vulnerable to safety problems that could stop parents from allowing their children to play outdoors (Carver et al., 2010, Lovasi et al., 2011, Weir et al., 2006). Although perceived safety has been previously linked to childhood physical activity and obesity (Davison and Lawson, 2006, Lumeng et al., 2006), point-level objective (audit-based or GIS) measures of safety are not widely investigated and studies have not consistently accounted for other aspects of neighborhood context that may confound an association between safety and obesity.
To advance our understanding of how walkability, green space, and safety affect early life adiposity, we used data from a large population of preschool children from low-income families. Geographic data were linked to individual sociodemographic and anthropometric data. We hypothesized that children living in areas with more crime and traffic safety hazards (indicated by homicide rate and pedestrian-fatality rate) would have a higher BMI z-score and obesity prevalence, even after accounting for walkable urban form and green space (street trees and parks), which were hypothesized to predict lower BMI z-score and obesity prevalence.
Section snippets
Subjects and setting
Data were from a cross-sectional census of 16,176 unique enrollment records for a large preschool program in New York City (NYC) as of October 2004 (Young et al., 2006). Eligibility to enroll in this preschool program was based on whether household income was below the federal poverty line. Analyses of these data were approved by the Columbia University Medical Center Institutional Review Board.
Individual anthropometric and sociodemographic data
Measured height and weight were recorded by the child's health care provider, along with demographic
Results
Of 16,176 records, 11,562 (71%) were ages 3–5 years at the time of their physical exam in 2003 or 2004, and were successfully matched to neighborhood characteristics based on buffered ZIP codes, and had valid BMI z-scores and complete covariate data (Table 1).
Neighborhood sociodemographic composition, built environment measures, and safety hazard indicators varied across ZIP codes (Table 2). These neighborhood characteristics, based on ZIP code plus a 400-m buffer, have been rescaled for ease of
Discussion
Among preschool children from low-income NYC families, neighborhood homicide rate was associated with a higher BMI z-score and a higher risk of obesity. Neighborhood poverty had an unexpected association with lower BMI z-score and lower obesity prevalence in fully adjusted models. Street tree density was associated with lower obesity prevalence. Walkability, park access, and pedestrian-auto fatalities were not significantly associated with adiposity in this study.
These findings add to a
Conclusions
Among preschool children from low-income NYC families, homicide rate was associated with a higher BMI z-score and a higher risk of obesity, and street trees were associated with a lower risk of obesity in some of our models. Examining the likely effectiveness of neighborhood improvement strategies to support health and reduce obesity in early life remains an important public health priority (Ogden et al., 2012, Van Cleave et al., 2010).
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
The authors would like to thank the Robert Wood Johnson Foundation Health and Society Scholars program, the National Institute for Environmental Health Science (5R01ES014229), the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK079885), and the National Institute for Child Health and Human Development (K01HD067390) for their financial support. The authors also thank Shadi Chamany and all members of the Built Environment and Health research group (beh.columbia.edu) for
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