Role of neighborhood context on child body mass index, diet and physical activity: Disentangling built, socioeconomic, and social influences

Background. Obesity prevalence among US children has tripled in the past three decades. Recent evidence identifies characteristics of “obesogenic” neighborhoods that affect weight and related behaviors. This study aimed to examine associations between built, socioeconomic, and social characteristics of a child's residential environment on body mass index (BMI), diet, and physical activity to better understand the role of context on obesity. Methods. Participants were 1048 fifth and sixth grade children from New Haven, CT who completed school-based health surveys and physical measures in fall 2009. Student data were linked to 2000 US Census, parks, retailer, and crime data. Analyses were conducted using multilevel modeling. Results. Property crimes and living further from a grocery store were associated with higher BMI. Children living within a 5-minute walk of a fast food outlet had higher BMI, and those living in a tract with higher density of fast food reported less frequent healthy eating and more frequent unhealthy eating. Children's perceived access to parks and playgrounds was associated with more frequent healthy eating and exercise. Children from more affluent neighborhoods reported more healthy eating, less unhealthy eating, and less screen time. Neighborhood social ties were associated with more frequent exercise. Conclusion. A complex web of built, socioeconomic, and social neighborhood characteristics are related to children's BMI and health behaviors. Findings link obesity outcomes with neighborhood assets (e.g., social ties, park access), and inhibitors (e.g., crime, unhealthy food access), suggesting the importance of intervening at the neighborhood level to prevent childhood obesity and its consequences.