Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations
Introduction
Childhood obesity has been identified as one of the major public health problems in the United States and in many industrialized countries of the world 1, 2. The prevalence of U.S. childhood obesity has more than tripled in the past three decades. The obesity rate for children aged 6–11 years increased four-fold, from 4.0% in 1971–1974 to 18.8% in 2003–2004 3, 4. The prevalence of obesity among adolescents aged 12–19 years rose from 6.1% in the period 1971–1974 to 17.4% in 2003–2004 3, 4. Such marked increases in obesity prevalence are not just confined to a single demographic group but have been observed for both boys and girls in major racial and ethnic groups (3). Because of the relatively high prevalence and a rapidly increasing trend, childhood obesity has become one of the most pressing public health concerns in the country 1, 5.
National prevalence estimates of childhood obesity are routinely available for gender and major racial/ethnic groups in the United States 3, 4. To a lesser extent, socioeconomic status (SES) differentials have also been noted 2, 3, 6, 7, 8, and a recent study has shown an increasing income disparity over time in adolescent obesity (5). While several studies have examined independent associations between racial/ethnic, socioeconomic, and behavioral characteristics and childhood obesity in the United States, the extent to which social and behavioral influences on obesity vary by age, gender, race/ethnicity, and/or SES are less well studied 5, 6, 7, 8. No study, to our knowledge, has analyzed both the independent and joint influences of a wide range of social and behavioral determinants of childhood obesity in the same context using a large national database. The purpose of this study was therefore (1) to estimate crude and adjusted obesity prevalence among children and adolescents aged 10–17 years by such important characteristics as race/ethnicity, SES, place of residence, perceived neighborhood safety and social capital, physical inactivity, television viewing, and recreational computer use using a large, nationally representative sample of U.S. children; (2) to examine the extent to which racial/ethnic and socioeconomic variations in childhood obesity risks are accounted for by differences in physical activity (PA) and sedentary behaviors; and (3) to examine whether social and behavioral influences on obesity differ by child's age, gender, race/ethnicity, and SES.
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Methods
The data for the present analysis came from the National Survey of Children's Health (NSCH) 9, 10, 11. The survey was conducted by the National Center for Health Statistics (NCHS) with funding and direction from the Maternal and Child Health Bureau of the Health Resources and Services Administration 10, 11. The survey included an extensive array of questions about the family, including parental health, stress and coping behaviors, family activities, and parental concerns about their children 10
Results
Table 1 shows both overall and gender-specific differences in obesity rates by demographic, socioeconomic, and behavioral characteristics. Significant differences in obesity prevalence were observed across all covariates, except recreational computer use. About 15% of children aged 10–17 years were reported to be obese, with the prevalence being significantly higher for boys than girls (18.1% vs. 11.5%; χ21df = 122.33; p < 0.001). The obesity prevalence was highest among American Indian/Alaska
Discussion
Our study is one of the first attempts to examine both the independent and joint effects of various key socioeconomic, demographic, and behavioral characteristics on childhood and adolescent obesity in the United States, using a large and nationally representative sample of children. The factors shown to be independently associated with significantly higher risks of childhood and adolescent obesity include black and Hispanic ethnicity, non-metropolitan residence, lower household education and
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The views expressed are the authors’ and not necessarily those of the Health Resources and Services Administration or the US Department of Health and Human Services.
Conflicts of interest: None.