Document Type

Capstone Experience

Graduation Date

5-2019

Degree Name

Master of Public Health

Department

Health Promotion

First Committee Member

Dr. David Dzewaltowski

Second Committee Member

Dr. Jennie Hill

Third Committee Member

Holly Dingman

Abstract

BACKGROUND: The prevalence of childhood obesity is a serious public health concern in the United States. Although several individual-level factors have been found to be associated with obesity in children, neighborhood environmental and social factors likely play an important role. The main goal of this study was to describe the prevalence of child obesity in Omaha, Nebraska by various demographic subgroups, determine if obesity prevalence varies by neighborhood operationalized as zip code, and examine the association between neighborhood-level child obesity prevalence and neighborhood-level socioeconomic status. It was hypothesized that child obesity prevalence varies by demographic subgroup and by zip code and that neighborhood SES is significantly associated with child obesity prevalence.

METHOD: Electronic health record data from Children’s Hospital & Medical Center’s primary care network was utilized to examine child obesity based on objectively measured heights and weights from a sample of 40,303 children aged two to 20 years in 34 zip codes in Omaha, Nebraska. Chi-square test of independence assessed the association between individual-level demographic variables and obesity. Child obesity was mapped by zip code. Pearson correlation assessed the relationship between neighborhood-level obesity and neighborhood-level median household income and percent of individuals below poverty in a subsample.

RESULTS: Chi-square analyses revealed that obesity is significantly associated with gender (Χ2(1) = 26.42, p < .0001), age (Χ2(3) = 300.69, p < .0001), race (Χ2(7) = 951.40, p < .0001), ethnicity (Χ2(1) = 593.75, p < .0001), and medical insurance provider (Χ2(1) = 629.50, p < .0001). Demographic subgroups more likely to be obese were males, children 12 to 17 years old, Native Hawaiian and Other Pacific Islanders, Hispanics, and those on Medicaid. Obesity prevalence by zip code ranged from 6.7% to 26.7%. Neighborhood-level child obesity, defined by percent obese in each neighborhood, was significantly associated with both neighborhood-level median household income (r=-0.69406, p<.0001) and percent of individuals below poverty (0.72843, p<.0001).

CONCLUSION: This study provides a preliminary cross-sectional analysis of current child obesity prevalence in Omaha, Nebraska. Child obesity prevalence varied by zip code, and significant associations were found between each individual-level variable and child obesity and between both neighborhood-level variables and neighborhood-level child obesity. Future studies should utilize a multi-unit statistical model approach to data analysis, examine obesity trends longitudinally to examine the underlying factors causing obesity, and examine neighborhood variation in child obesity at multiple geographic scales. Future community interventions should include a focus on geospatial areas and use of multi-setting, multi-strategy approaches in order to impact the neighborhood factors influencing child obesity.

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