Do Neighborhoods Matter? A Systematic Review of Modifiable Risk Factors for Obesity among Low Socio-Economic Status Black and Hispanic Children

Abstract

Background: Childhood obesity increases the risk of obesity and harmful comorbidities later in life. It is influenced by characteristics of a child's neighborhood, particularly among underserved groups. Our objective was to systematically review the evidence relating neighborhood environment and obesity risk among urban, low socioeconomic status (SES) Black and Hispanic children.

Methods: We included studies published from 1993 through early 2017 from PubMed, SCOPUS, Web of Science, and Sociological Abstracts databases investigating relationships between empirically measured neighborhood characteristics and obesity risk factors in the populations of interest. Databases were last searched on May 8, 2018. Initial analysis took place during 2014 and was completed during 2017. We extracted data on study population, design, and associations between neighborhood characteristics and obesity risk factors.

Results: We identified 2011 unique studies; 24 were included. Few studies demonstrated consistent patterns of association. Most neighborhood characteristics were not examined across multiple studies. BMI may be related to living in a lower-income neighborhood or convenience store access.

Conclusions: This review found that the body of evidence relating neighborhood exposures and obesity risk factors among urban, low SES Black (also commonly referred to in the literature as "non-Hispanic Black" or African American) and Hispanic children is limited. Given the high risk of obesity and cardiovascular disease among these populations throughout the life course, research on neighborhood determinants of obesity should specifically include these populations, ensuring adequate power and methodological rigor to detect differences.

Keywords: African American; Hispanic; childhood obesity; neighborhood; social determinants of health.

Figure 1.

PRISMA flow diagram.

Figure 2.

Study quality bar graph. *Global rating: Studies were considered strong if they had no weak ratings, moderate if they had one weak rating, and weak if they had two or more weak ratings. ⁺Selection bias: Selection bias was determined based on the extent to which the study population was deemed representative of the target population. Based on our racial inclusion criteria, the study team deemed all studies to be somewhat likely to be representative; this equated with a moderate quality with respect to selection bias. ^¥Study Design: To be rated strong, a study had to involve a randomized controlled design; none of the included studies did. Moderate studies used a longitudinal design. Weak studies used a cross sectional design. ^±Data Collection Methods: Strong studies used study or clinic staff to measure height and weight. Moderate studies used BMI measurements that were taken multiple times. Weak studies used self-reported BMI. ^£Analyses: We dichotomized this criterion into strong and weak to be more applicable for observational studies. Studies were rated as strong if they accounted for neighborhood-level clustering and weak if they did not account for neighborhood-level clustering.

Figure 3.

Neighborhood socioeconomic status forest plot. *Longitudinal study design. ^aStudies met inclusion criteria if ≥50% of the study populations were Black or Hispanic, or if the study reported on subgroup analyses by race or evaluated the extent to which a particular neighborhood exposure was associated with child BMI among Black or Hispanic study subpopulations. ^bOdds ratio obese vs. normal weight. ^cThis study did not report racial composition for the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Black participants who were obese. ^dThis study did not report racial composition for the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Hispanic participants who were obese. ^eThe study did not report mean age or age range. The study sample consisted of high school students ≥13 years. ^fThis study did not report racial composition of the overall study population; it did adjust for race/ethnicity and was composed of a nationally representative sample. ^gRisk ratio of BMI ≥95% percentile (obese). ^hThis study adjusted for race/ethnicity in analyses. HS, high school; KG, kindergarten; NR, not reported; OR, odds ratio.

Figure 4.

Neighborhood food environment forest plot. *Longitudinal study design. ^aStudies met inclusion criteria if ≥50% of the study populations were Black or Hispanic, or if the study reported on subgroup analyses by race or evaluated the extent to which a particular neighborhood exposure was associated with child BMI among Black or Hispanic study subpopulations. ^bOR child's BMI percentile being in the top tertile. ^cOR overweight or obese vs. normal weight. ^d0.5 mile radius buffer around child's residence. 0.25 mile radius buffer around child's residence. ^fDistance to nearest convenience store from child's home was measured in roadway network miles. ^gOR obese vs. normal weight. ^hThis study did not report racial composition of the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Black participants who were obese. ⁱThis study did not report racial composition of the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Hispanic participants who were obese. ^jThe study did not report mean age or age range. The study sample consisted of high school students ≥13 years. ^k400 m buffer zone around child's residence. ^lOverweight vs. normal weight. ^mDistance to the nearest fast food restaurant was measured via street networks from child's residence. ⁿRacial composition of the sample was not reported for all participants; only the percentage of Black was reported. ^o100 m buffer of path between child's home and school.

Figure 5.

Neighborhood physical activity environment forest plot. *Longitudinal study design. ^aStudies met inclusion criteria if ≥50% of the study populations were Black or Hispanic, or if the study reported on subgroup analyses by race or evaluated the extent to which a particular neighborhood exposure was associated with child BMI among Black or Hispanic study subpopulations. ^bObese vs. normal weight. ^cThis study did not report racial composition of the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Black participants who were obese. ^dThis study did not report racial composition of the overall study population; it adjusted for race/ethnicity. The study reported on the proportion of Hispanic participants who were obese. ^eThe study did not report mean age or age range. The study sample consisted of high school students ≥13 years. ^fBuffer drawn as a 0.5 km buffer around a line between the child's home and school. ^gOR overweight or obese vs. normal weight. ^hPark presence within half a mile radius of child's home. ⁱRacial composition of the sample was not reported for all participants; only the percentage of Black was reported. ^jOverweight vs. normal weight. ^kOR of increasing BMI-z over time. ^l1 km straight line circular buffer surrounding child's residence.

Figure 6.

Neighborhood crime forest plot. ^aStudies met inclusion criteria if ≥50% of the study populations were Black or Hispanic, or if the study reported on subgroup analyses by race or evaluated the extent to which a particular neighborhood exposure was associated with child BMI among Black or Hispanic study subpopulations. ^bOR for overweight or obese vs. normal weight. ^cNeighborhoods were measured as PACs, which include the block in which a child resided and adjacent blocks sharing a line segment or vertex. ^d0.5 km buffer around a line between child's home and school. NR, not reported; PAC, primary adjacency community.