Development of a national childhood obesogenic environment index in the United States: differences by region and rurality

Abstract

Background: Diverse environmental factors are associated with physical activity (PA) and healthy eating (HE) among youth. However, no study has created a comprehensive obesogenic environment index for children that can be applied at a large geographic scale. The purpose of this study was to describe the development of a childhood obesogenic environment index (COEI) at the county level across the United States. Methods: A comprehensive search of review articles (n = 20) and input from experts (n = 12) were used to identify community-level variables associated with youth PA, HE, or overweight/obesity for potential inclusion in the index. Based on strength of associations in the literature, expert ratings, expertise of team members, and data source availability, 10 key variables were identifiedsix related to HE (# per 1000 residents for grocery/superstores, farmers markets, fast food restaurants, full-service restaurants, and convenience stores; as well as percentage of births at baby (breastfeeding)-friendly facilities) and four related to PA (percentage of population living close to exercise opportunities, percentage of population < 1 mile from a school, a composite walkability index, and number of violent crimes per 1000 residents). Data for each variable for all counties in the U.S. (n = 3142) were collected from publicly available sources. For each variable, all counties were ranked and assigned percentiles ranging from 0 to 100. Positive environmental variables (e.g., grocery stores, exercise opportunities) were reverse scored such that higher values for all variables indicated a more obesogenic environment. Finally, for each county, a total obesogenic environment index score was generated by calculating the average percentile for all 10 variables.

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

“…Other studies have shown that rates of obesity are higher among rural Black and White populations compared to their respective urban counterparts [ 113 ]. These higher rates of both obesity and physical inactivity may be due, in part, to obesogenic built environments that may be more prevalent in areas with larger racial/ethnic minority populations (i.e., the South) [ 114 , 115 ].…”

Family-focused obesity prevention program implementation in urban versus rural communities: a case study

“…Review of recent literature reveals that rural children are at greater risk for obesity than their urban peers [ 6 , 15 ] and previous studies involving rural families have been limited in scope and not specifically designed for the needs, interests, benefits and concerns of rural families [ 14 , 17 , 18 , 53 ]. Rural families face a number of unique challenges in an attempt to maintain behaviors to promote health and prevent obesity [ 54 ].…”

Formulación de políticas públicas en salud durante la pandemia de COVID-19 en países americanos

“…Por un lado, en algunos sectores se ha presentado un rezago epidemiológico derivado de la pobreza y marginación de ciertas comunidades 12 , es decir, los pobres se siguen muriendo por las mismas enfermedades "aparentemente controladas" en pleno siglo XXI. Por otro lado, la vacunación ha favorecido el aumento en el promedio de vida, pero como consecuencia, la aparición de enfermedades crónicas como la diabetes, enfermedades de corazón y la obesidad, que ahora aparecen cada vez en edades más jóvenes por la falta de políticas públicas de salud para enfrentar estilos de vida no saludables como el sedentarismo y la alimentación de comida chatarra que gestionaron un medio ambiente obesogénico 13 . En el continente americano, estas afecciones causan un gran impacto económico y social y han representado un reto de salud pública constante, y actualmente un factor de riesgo de mortalidad durante la pandemia causada por Covid 19, creando una crisis en materia de salud pública, económica y política 14 .…”