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. 2021 Feb;147(2):e2020018903.
doi: 10.1542/peds.2020-018903.

Neighborhood Child Opportunity Index and Adolescent Cardiometabolic Risk

Izzuddin M Aris  1 , Sheryl L Rifas-Shiman  2 , Marcia P Jimenez  2   3 , Ling-Jun Li  4 , Marie-France Hivert  2   5 , Emily Oken  2   6 , Peter James  2   7
Affiliations

Neighborhood Child Opportunity Index and Adolescent Cardiometabolic Risk

Izzuddin M Aris et al. Pediatrics. 2021 Feb.

Abstract

Background and objectives: The Child Opportunity Index (ChOI) is a publicly available surveillance tool that incorporates traditional and novel attributes of neighborhood conditions that may promote or inhibit healthy child development. The extent to which ChOI relates to individual-level cardiometabolic risk remains unclear.

Methods: We geocoded residential addresses obtained from 743 participants in midchildhood (mean age 7.9 years) in Project Viva, a prebirth cohort from eastern Massachusetts, and linked each location with census tract-level ChOI data. We measured adiposity and cardiometabolic outcomes in midchildhood and early adolescence (mean age 13.1 years) and analyzed their associations with neighborhood-level ChOI in midchildhood using mixed-effects models, adjusting for individual and family sociodemographics.

Results: On the basis of nationwide distributions of ChOI, 11.2% (n = 83) of children resided in areas of very low overall opportunity (ChOI score <20 U) and 55.3% (n = 411) resided in areas of very high (ChOI score ≥80 U) overall opportunity. Children who resided in areas with higher overall opportunity in midchildhood had persistently lower levels of C-reactive protein from midchildhood to early adolescence (per 25-U increase in ChOI score: β = .14 mg/L; 95% confidence interval, .28 to .00). Additionally, certain ChOI indicators, such as greater number of high-quality childhood education centers, greater access to healthy food, and greater proximity to employment in midchildhood, were associated with persistently lower adiposity, C-reactive protein levels, insulin resistance, and metabolic risk z scores from midchildhood to early adolescence.

Conclusions: Our findings suggest more favorable neighborhood opportunities in midchildhood predict better cardiometabolic health from midchildhood to early adolescence.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
A and B, Associations of national-level overall and domain-specific ChOI scores in midchildhood with adiposity (A) and cardiometabolic risk markers (B) from midchildhood to early adolescence. Effect estimates reflect a per 25-U increase in ChOI scores. All models are adjusted for child sex (for outcomes that are not sex specific), child race or ethnicity, biparental educational level, household income, and maternal marital status. FMI, fat mass index; TFMI, trunk fat mass index.
FIGURE 2
FIGURE 2
A and B, Associations of each indicator in the education domain with adiposity (A) and cardiometabolic risk markers (B) from midchildhood to early adolescence. Effect estimates reflect a per SD-unit increase in each indicator. All models are adjusted for child sex (for outcomes that are not sex specific), child race or ethnicity, biparental educational level, household income, and maternal marital status. AP, advanced placement; ECE, early childhood education center; FMI, fat mass index; TFMI, trunk fat mass index.
FIGURE 3
FIGURE 3
A and B, Associations of each indicator in the health and environment domain with adiposity (A) and cardiometabolic risk markers (B) from midchildhood to early adolescence. Effect estimates reflect a per SD-unit increase in each indicator. All models are adjusted for child sex (for outcomes that are not sex specific), child race or ethnicity, biparental educational level, household income, and maternal marital status. FMI, fat mass index; PM2.5, particulate matter less than 2.5 microns; TFMI, trunk fat mass index.
FIGURE 4
FIGURE 4
A and B, Associations of each indicator in the social and economic domain with adiposity (A) and cardiometabolic risk markers (B) from midchildhood to early adolescence. Effect estimates reflect a per SD-unit increase in each indicator. All models are adjusted for child sex (for outcomes that are not sex specific), child race or ethnicity, biparental educational level, household income, and maternal marital status. FMI, fat mass index; TFMI, trunk fat mass index.
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