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. 2014 Mar 5;311(9):929-36.
doi: 10.1001/jama.2014.604.

Association between casino opening or expansion and risk of childhood overweight and obesity

Jessica C Jones-Smith  1 , William H Dow  2 , Kristal Chichlowska  3
Affiliations

Association between casino opening or expansion and risk of childhood overweight and obesity

Jessica C Jones-Smith et al. JAMA. .

Abstract

Importance: Economic resources have been inversely associated with risk of childhood overweight/obesity. Few studies have evaluated whether this association is a direct effect of economic resources or is attributable to unmeasured confounding or reverse causation. American Indian-owned casinos have resulted in increased economic resources for some tribes and provide an opportunity to test whether these resources are associated with overweight/obesity.

Objective: To assess whether openings or expansions of American Indian-owned casinos were associated with childhood overweight/obesity risk.

Design, setting, and participants: We used repeated cross-sectional anthropometric measurements from fitness testing of American Indian children (aged 7-18 years) from 117 school districts that encompassed tribal lands in California between 2001 and 2012. Children in school districts encompassing American Indian tribal lands that either gained or expanded a casino were compared with children in districts with tribal lands that did not gain or expand a casino.

Main outcomes and measures: Per capita annual income, median annual household income, percentage of population in poverty, total population, child overweight/obesity (body mass index [BMI] ≥85th age- and sex-specific percentile) and BMI z score.

Results: Of the 117 school districts, 57 gained or expanded a casino, 24 had a preexisting casino but did not expand, and 36 never had a casino. The mean slots per capita was 7 (SD, 12) and the median was 3 (interquartile range [IQR], 0.3-8). Among districts where a casino opened or expanded, the mean change in slots per capita was 13 (SD, 19) and the median was 3 (IQR, 1-11). Forty-eight percent of the anthropometric measurements were classified as overweight/obese (11,048/22,863). Every casino slot machine per capita gained was associated with an increase in per capita annual income (β = $541; 95% CI, $245-$836) and a decrease in percentage in poverty (β = -0.6%; 95% CI, -1.1% to -0.20%) among American Indians living on tribal lands. Among American Indian children, every slot machine per capita gained was associated with a decreased probability of overweight/obesity by 0.19 percentage points (95% CI, -0.26 to -0.11 percentage points) and a decrease in BMI z score (β = -0.003; 95% CI, -0.005 to -0.0002).

Conclusions and relevance: In this study, opening or expanding a casino was associated with increased economic resources and decreased risk of childhood overweight/obesity. Given the limitations of an ecological study, further research is needed to better understand the mechanisms behind this association.

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Conflict of interest statement

The authors declare they have no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Flow diagram of study population.
See this image and copyright information in PMC

Comment in

References

    1. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009 Mar 28;373(9669):1083–1096. - PMC - PubMed
    1. Singh GK, Siahpush M, Kogan MD. Rising Social Inequalities in US Childhood Obesity, 2003–2007. Ann Epidemiol. 2010;20(1):40–52. - PubMed
    1. Greves Grow HM, Cook AJ, Arterburn DE, Saelens BE, Drewnowski A, Lozano P. Child obesity associated with social disadvantage of children’s neighborhoods. Social Science & Medicine. 2010;71(3):584–591. - PMC - PubMed
    1. Ludwig J, Sanbonmatsu L, Gennetian L, et al. Neighborhoods, obesity, and diabetes--a randomized social experiment. N Engl J Med. 2011 Oct 20;365(16):1509–1519. - PMC - PubMed
    1. Fernald LC, Gertler PJ, Neufeld LM. Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico’s Oportunidades. Lancet. 2008 Mar 8;371(9615):828–837. - PMC - PubMed

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