Elsevier

Preventive Medicine

Volume 57, Issue 3, September 2013, Pages 189-193
Preventive Medicine

Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City

https://doi.org/10.1016/j.ypmed.2013.05.012Get rights and content

Highlights

  • Neighborhood homicide rate was associated with more obesity

  • Street tree density was associated with less obesity

  • Pedestrian-auto fatalities, parks, and walkability did not predict obesity

Abstract

Background

Neighborhood safety, green space, walkability, and sociodemographics may influence physical activity and childhood obesity.

Methods

Data on measured height and weight, demographic characteristics, and home ZIP code were collected from year 2004 enrollees in a means-tested preschool program in New York City. Each ZIP code was surrounded by a 400-m buffer and characterized using data from the US census, local government departments, New York Times website, and Transportation Alternatives. Linear and Poisson models were constructed using cluster robust standard errors and adjusting for child's sex, race, ethnicity, age, and neighborhood characteristics.

Results

Analyses included 11,562 children ages 3–5 years living in 160 residential ZIP codes. A higher homicide rate (at the 75th vs 25th percentile) was associated with a 22% higher prevalence of obesity (95% CI for the prevalence ratio (PR): 1.05 to 1.41). A higher density of street trees (at the 75th vs 25th percentile) was associated with 12% lower prevalence of obesity (95% CI for the PR: 0.79 to 0.99). Other neighborhood characteristics did not have significant associations with childhood obesity.

Conclusions

Among preschool children from low-income families, neighborhood homicide rate was associated with more obesity and street tree density was associated with less obesity.

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

References (48)

  • X. Zhu et al.

    Walkability and safety around elementary schools economic and ethnic disparities

    Am. J. Prev. Med.

    (2008)
  • M.A. Alfonzo

    To walk or not to walk? The hierarchy of walking needs

    Environ. Behav.

    (2005)
  • J. Beyea et al.

    Geographic exposure modeling: a valuable extension of geographic information systems for use in environmental epidemiology

    Environ. Health Perspect.

    (1999)
  • H.S. Brown et al.

    Crime rates and sedentary behavior among 4th grade Texas school children

    Int. J. Behav. Nutr. Phys. Act.

    (2008)
  • H.L. Burdette et al.

    A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children

    Pediatrics

    (2005)
  • S.S. Casagrande et al.

    Association of walkability with obesity in Baltimore City

    Maryland. Am. J. Public Health

    (2011)
  • N.G. Cosco et al.

    Behavior mapping: a method for linking preschool physical activity and outdoor design

    Med. Sci. Sports Exerc.

    (2010)
  • K.K. Davison et al.

    Do attributes in the physical environment influence children's physical activity? A review of the literature

    Int. J. Behav. Nutr. Phys. Act.

    (2006)
  • C.P. Durand et al.

    Does community type moderate the relationship between parent perceptions of the neighborhood and physical activity in children?

    Am. J. Health Promot.

    (2012)
  • K.R. Evenson et al.

    Girls' perception of neighborhood factors on physical activity, sedentary behavior, and BMI

    Obesity (Silver Spring)

    (2007)
  • R. Ewing et al.

    Travel and the built environment

    J. Am. Plan. Assoc.

    (2010)
  • L. Freeman et al.

    Neighborhood walkability and active travel (walking and cycling) in New York City

    J. Urban Health

    (2012)
  • P. Gordon-Larsen et al.

    Inequality in the built environment underlies key health disparities in physical activity and obesity

    Pediatrics

    (2006)
  • H.M. Grow et al.

    Where are youth active? Roles of proximity, active transport, and built environment

    Med. Sci. Sports Exerc.

    (2008)
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