Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children

Abstract

Background. We examined the relationship between overweight in preschool children and three environmental factors—the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight.

Methods. This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index ≥95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods.

Results. Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (±SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (±0.22) and 0.70 (±0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level.

Conclusions. Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.

Introduction

“Individual behavioral change can occur only in a supportive environment with accessible and affordable healthy food choices and opportunities for regular physical activity.” (The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, 2001).

The increasing prevalence of childhood obesity that is occurring in developed countries is now apparent among preschoolers [1], [2], [3], [4], [5], [6]. This trend foreshadows the enormous economic [7] and health burdens [8], [9] that these countries will face as their children age.

Decreasing the prevalence of obesity in a population requires modifications in the environment to facilitate individual behavior change [10], [11], [12]. Diverse groups, from policy makers to researchers to concerned parents, have nominated many environmental factors that make it difficult for adults to sustain healthy behaviors and to shape these behaviors in young children [13], [14], [15]. The sense of urgency to stem the childhood obesity epidemic [16] has helped catalyze a political process aimed at making environmental changes by altering public policy [17]. However, there has been insufficient research, especially in children, to suggest which environmental factors are the most important contributors to the current obesity epidemic. Such research is needed to shape the policy debate already underway.

There are no observational studies in children that have examined the relationship between the physical environment and obesity, and only a few have related the physical environment to children's diet or physical activity patterns. Access to recreational facilities is correlated to physical activity in young children [18], [19]. The availability of outdoor play spaces, such as public playgrounds, may be especially important in preschool children, a group for whom time spent outdoors is the strongest correlate of physical activity [19], [20], [21]. Even where public playgrounds are available, their use among preschoolers and, therefore, their impact on the prevalence of obesity, could differ according to neighborhood safety [22]. Low-income preschoolers, who are at greater risk for later obesity [23], may be more likely to reside in urban neighborhoods where there are fewer places for safe outdoor play.

Fast food restaurants may also be more concentrated in low-income neighborhoods [24]. The proportion of children's meals consumed at fast food restaurants has increased [25] in parallel with the childhood obesity epidemic, and consumption of fast food has been frequently implicated as an important cause of childhood obesity [26], [27]. We hypothesized that where fast food restaurants are located, in relation to where preschool children live, may influence fast food consumption, and, in turn, the prevalence of obesity in children.

In this study we examined the associations between overweight among low-income preschool children and three environmental factors—playground proximity, fast food restaurant proximity, and neighborhood safety. We hypothesized that overweight children, compared to nonoverweight children, lived farther from the nearest playground, closer to the nearest fast food restaurant, and in neighborhoods with higher crime rates. We further hypothesized that the relationship between childhood overweight and playground proximity might differ according to the level of neighborhood safety.