Online Program

Associations between residential environments and prevalence of obesity among Maryland children enrolled in Medicaid

Monday, November 4, 2013 : 9:30 a.m. - 9:50 a.m.

Lee Hurt, MS, DrPH, Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Cheryl De Pinto, MD, MPH, Office of School Health, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Loretta DiPietro, PhD, MPH, Department of Exercise Science, The George Washington University, School of Public Health and Health Services, Washington, DC
Katherine Hunting, PhD, MPH, Department of Environmental and Occupational Health, George Washington University School of Public Health and Health Services, Washington, DC
Background: In Maryland, 38% of child Medicaid recipients (ages 2-19) were overweight or obese in 2005-2009, higher than the prevalence among the general population. This study investigated the influence of built environment factors on childhood obesity prevalence among a population at increased risk for obesity, Maryland Medicaid recipients.

Methods: The study used data from a random sample of Maryland Medicaid recipients, ages 2-19 years. BMI percentiles for age and sex were computed for 8,781 children using directly measured weight and height extracted from medical records during a Medicaid quality assurance review (2005-09). Each child's residential address was geocoded and the proximity to the following environmental risk factors was computed: licensed food retailers (classified as healthy/unhealthy), parks/recreation facilities (including pocket parks), pedestrian deaths, traffic volume, land use, crime. Associations between BMI status and the built environment factors were evaluated with logistic regression.

Results: Increased risk for overweight/obesity was observed among children ages 12-19, AOR=2.43 (95% CI:1.41,4.17), Hispanic children, AOR=2.67 (CI:1.20,5.92), and male children, AOR=1.55 (CI:1.06,2.26) if their nearest food retailer was classified as unhealthy.

Hispanic children were also at increased risk if they had a low ratio of healthy to unhealthy food retailers within walking distance, AOR=8.45 (CI:1.92,37.13).

High traffic volume was also associated with increased risk of overweight/ obesity in some groups: children ages 2-5, AOR=1.21 (CI:1.04,1.41), non-Hispanic Whites, AOR=1.28 (CI:1.07,1.53).

Nearly significant associations were observed between overweight/obesity and living in areas without a park or recreational facility nearby for Hispanic children, AOR=1.54 (CI=0.96,2.45), and between high crime rates and overweight/obesity among girls, AOR=1.17 (CI=0.99,1.38).

No significant associations were observed between overweight/obesity and other environmental factors.

Conclusions: Residential proximity to unhealthy food retailers was most strongly associated with prevalence of overweight/obesity, especially among Hispanic children. Promoting healthy food retailers in residential neighborhoods may help prevent obesity among children receiving Medicaid.

Learning Areas:

Chronic disease management and prevention
Environmental health sciences
Public health or related public policy
Public health or related research

Learning Objectives:
Identify two built environment factors that were observed to have an association with the prevalence of overweight and obesity in Maryland children receiving Medicaid. Describe the age and race/ethnicity subgroups that were observed to have significant associations between elevated BMI levels and these built environment factors. Discuss the benefits and limitations of two novel data sources for built environment factors used in this study.

Keyword(s): Environmental Health, Obesity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Maternal and Child Health Epidemiologist at the Maryland Department of Health and Mental Hygiene. I have recently completed my DrPH in environmental and occupational health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.