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Neighborhood socio-economic environment as a predictor of diet quality, adiposity, and risk of obesity in children under two

Conrey, Shannon C., M.S.
http://orcid.org/0000-0003-3715-5842
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623241443082007

Abstract Details

2021, PhD, University of Cincinnati, Medicine: Epidemiology (Environmental Health).
Childhood obesity is a growing epidemic in the United States, with significant differences by race and income level. Evidence in older children shows that weight status is strongly connected to a healthy diet and influenced by social, structural, and economic differences in neighborhood environments, but there are critical gaps in understanding predictors of diet and adiposity in younger children. We analyzed data for children from birth to age two enrolled in the CDC-funded PREVAIL Cohort in Cincinnati, OH to examine differences by neighborhood socio-economic environment (SEE) in diet quality, adiposity, and risk of obesity to address this knowledge gap. Residential address and breastfeeding behaviors were self-reported by the mother. Child BMIz was calculated from measurements at study visits at 6 weeks and 6, 12, 18, and 24 months of age. Diet was assessed using a validated food frequency questionnaire beginning at 12 months and foods were categorized based on the primary component. Addresses were geocoded to the census tract-level and merged with the Deprivation Index, a validated measure of SEE. Subject residence was categorized as High SEE (least deprived), Low SEE (most deprived) or the middle quartiles of deprivation score. Breastfeeding behaviors were compared using logistic regression and survival analysis. Comparisons by time-point for all diet and adiposity outcomes were made using logistic, linear, or Poisson regression and longitudinally using generalized estimating equations (GEE). All subjects enrolled in PREVAIL were eligible for this analysis (n=245). Compared to High SEE tracts, subjects in Low SEE tracts were more likely to be Black, publicly insured, have a high school or lower education level, and a family income <$25,000 (all p<0.001). Subjects in High SEE tracts were more likely than subjects in Low SEE tracts to initiate breastfeeding (OR 6.7, p=0.004) and breastfeed for longer durations (270 vs 26 days, p<0.001). Children in High SEE consumed the most and those in Low SEE the least FV per day at all time-points (all p<0.05). Low SEE children were 13.4 times more likely to consume any SSB than High SEE at month 12 (p=0.001). In univariable GEE models, children in Low SEE tracts averaged one-third fewer servings of FV but were 6-times more likely to consume SSB than those in High SEE tracts (all p<0.01). Residence outside of the High SEE tracts was associated with increased BMIz at 18 (ß=0.48, p=0.006), 24 months (ß=0.60, p=0.001), and longitudinally (ß=0.22, p=0.047) and increased risk of obesity at 24 months (OR 4.0, p=0.003). Obesity risk was significantly mediated by duration of breastfeeding (ACME=0.028, p=0.008). The SEE measure of Deprivation Index generally outperformed other ecological and individual socio-demographic measures in predictive accuracy and model fit. In the PREVAIL cohort, residence in the least affluent census tracts was associated with decreased diet quality and increased adiposity in children from birth until age two. Risk of obesity in these neighborhoods was reduced by longer duration of breastfeeding. Efforts to improve obesity rates in low-SEP populations should identify high-risk neighborhoods and focus efforts on breastfeeding support and promotion.
Ardythe Morrow, Ph.D. (Committee Chair)
Richard Brokamp, Ph.D. (Committee Member)
Sarah Couch, Ph.D. (Committee Member)
Liang Niu, Ph.D. (Committee Member)
180 p.
Epidemiology
breastfeeding; diet quality; childhood obesity; social determinants of health; neighborhood deprivation; birth cohort

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Citations

  • Conrey, S. C. (2021). Neighborhood socio-economic environment as a predictor of diet quality, adiposity, and risk of obesity in children under two [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623241443082007

    APA Style (7th edition)

  • Conrey, Shannon. Neighborhood socio-economic environment as a predictor of diet quality, adiposity, and risk of obesity in children under two. 2021. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623241443082007.

    MLA Style (8th edition)

  • Conrey, Shannon. "Neighborhood socio-economic environment as a predictor of diet quality, adiposity, and risk of obesity in children under two." Doctoral dissertation, University of Cincinnati, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623241443082007

    Chicago Manual of Style (17th edition)

ucin1623241443082007
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This open access ETD is published by University of Cincinnati and OhioLINK.