Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children
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.
Section snippets
Overall study design and setting
We conducted a cross-sectional study of low-income 3- and 4-year-old children residing in Cincinnati, OH. All children were enrolled in the WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children). WIC is a federal program that provides supplemental food and nutrition counseling to low-income mothers and their children from birth until their 5th birthday. To be eligible for WIC, family income, based on household size, must be at or below 185% of the federal poverty
Results
The mean (±SD) age of the children was 50 (±7) months; 76% were black and 23% white. In this low-income population, the mean poverty ratio was lower for black children than for white children (0.64 ± 0.38 vs. 0.80 ± 0.42, P < 0.001).
The mean BMI z score was 0.16 (±1.2), 9.2% of the children had a BMI ≥ 95th percentile and 21.2% of the children had a BMI ≥ 85th percentile. Boys and girls had a similar prevalence of BMI ≥ 95th percentile (9.6% vs. 8.8%, P = 0.27) and of BMI ≥ 85th percentile
Discussion
In this population of urban, low-income 3- and 4-year-old children, we found no association between overweight and measures of neighborhood safety or the proximity of children's households to either playgrounds or fast food restaurants. Furthermore, the association between child overweight and playground proximity did not differ by neighborhood safety.
There is increasing public attention to the contribution of environmental factors to the epidemic of childhood obesity [33], [34]. Despite this,
Acknowledgements
This work was supported, in part, by a Food Assistance and Nutrition Research Grant (Obesity in Low-Income Mothers and Children, # 43-3-AEM-9-80100, Robert C. Whitaker, Principal Investigator) from the U.S. Department of Agriculture, Economic Research Service. The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
The
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