Evaluating the Contribution of the Built Environment on Obesity Among New York State Students

Adenantera Dwicaksono MA1,2, Ian Brissette PhD3, Guthrie S. Birkhead MD MPH4, Christine T. Bozlak PhD MPH5, Erika G. Martin PhD MPH1,6
1Department of Public Administration and Policy, University at Albany-State University of New York, Albany, NY, 2Institut Teknologi Bandung, Indonesia, 3Bureau of Chronic Disease Evaluation and Research New York State Department of Health, 4Department of Epidemiology and Biostatistics, School of Public Health,
University at Albany-State University of New York, Albany NY, 5Department of Health Policy, Management & Behavior, School of Public Health, University at Albany-State University of New York, Albany, NY, 6Nelson A. Rockefeller Institute of Government-State University of New York, Albany, NY
Contact: emartin@albany.edu or adwicaksono@albany.edu Supported by a grant from the Robert Wood Johnson Foundations Public Health Services & Systems Research Program [Grant ID#71597 to E.G.M. and G.S.B]
BACKGROUND: CHILDHOOD OBESITY IS AN IMPORTANT PUBLIC FINDINGS: FARMERS' MARKETS, LAND USE DIVERSITY FINDINGS: SPATIAL VARIATION IN EFFECT OF FAST FOOD
HEALTH ISSUE IN NEW YORK STATE, WITH REGIONAL VARIATION ASSOCIATED WITH LOWER CHILDHOOD OBESITY RESTAURANT DENSITY ON PROPORTION OF OBESE STUDENTS IN
Increasing obesity rates have caused substantial economic and financial consequences Farmers' markets Dependent variable: Proportion of obese students MIDDLE/HIGH SCHOOL
Childhood obesity has cost the US $14.1 billion annually in direct medical costs associated with lower Elementary school Middle/High school
New York State spent approximately $11.8 million annually for obesity-related treatment costs (Medicaid, obesity among beta (s.e) beta (s.e)
Medicare and private) The positive association
elementary students Free/reduced price lunch
0.174*** (0.016) 0.164*** (0.019) 0.234*** (0.017) 0.228*** (0.017)
Local Coefficients of Fast
New childhood obesity surveillance system has documented substantial variation in prevalence students (%) between availability of fast food Food Restaurant Density on
only
restaurant availability and Proportion of Obese Students
of overweight students across New York State Higher land use African-American students (%) -0.002 (0.032) 0.013 (0.032) -0.034 (0.039) -0.013 (0.04)
in Middle/High School Grades,
obesity rate among middle/high
The Student Weight Status Category Reporting System collects data on the proportion of obese and diversity is Hispanic students (%) 0.085*** (0.025) 0.086*** (0.026) -0.018 (0.028) -0.021 (0.029) New York State 2010-2012
school students was more
overweight students in the selected elementary and middle/high school grades every two years since 2008 associated with lower farmers' markets per square
-0.114*** (0.026) -0.096*** (0.027) 0.002 (0.031) 0.023 (0.032) pronounced in Capital District
The highest rates of obesity in school-aged children were in lower-income school districts obesity among mile Finger
and Hudson Valley Northeastern
middle/high school Supermarkets per square mile -0.002 (0.004) -0.001 (0.004) 0.001 (0.007) 0.001 (0.007) Lakes
RESEARCH QUESTIONS students only. Fast food restaurants per
-0.002 (0.002) -0.002 (0.002) 0.004** (0.002) 0.004** (0.002) Positive associations found in
New York

Fast food square mile Central

the western and central
Are there significant associations between built environment characteristics and obesity rates restaurants are Employment and household
-0.018 (0.016) -0.007 (0.016) -0.059*** (0.02) -0.049** (0.02) portion of the state may be
New York
associated with entropy Western
among New York State students? attributable to unobserved New York New York
higher obesity among Intersection density -0.0001 (0.0001) 0.0001 (0.0001) -0.0002* (0.0001) -0.0001 (0.0001)
Do these relationships vary across regions? localized characteristics that Penn
middle/high school Suburb 0.011 (0.01) 0.02 (0.013)
were not captured in the model Hudson
students students Rural/Town 0.026** (0.011) 0.033** (0.014) Valley
METHODS only
Constant 0.127*** (0.013) 0.100*** (0.017) 0.165*** (0.014) 0.131*** (0.021)
Suburban districts
Study population: had the lowest Observations 677 677 669 669 Nassau-
Suffolk
680 school districts across New York State, 2010-2012 excluding New York City obesity rates R2 0.325 0.333 0.374 0.38
New York City is exempted from reporting under the NYSED law Adjusted R2 0.317 0.323 0.367 0.37
Linear regression models to examine the relationships between obesity rates among students Note: Robust standard errors;*p<0.1;**p<0.05;***p<0.01
and the built environment
Control variables: Free/reduced price lunch students (%), African-American students (%), Hispanic students IMPLICATIONS FOR POLICY AND PRACTICE
(%), and urbanicity variables. FINDINGS: SPATIAL VARIATION IN EFFECT OF YEAR-ROUND
One-size-fits-all community-level interventions may be inadequate to address the obesity epidemic in
Separate analyses for elementary and middle/high school grades students FARMERS' MARKET DENSITY ON PROPORTION OF OBESE children and adolescents due to different determinants of obesity across age groups and geographical
Robust standard errors and multiple imputation for missing values
Sensitivity analysis: inclusion or exclusion of urbanicity variable STUDENTS IN ELEMENTARY SCHOOL regions
Geographically weighted regressions to evaluate whether relationships vary across local
Region-based and tailored policy interventions to improve the built environment to promote healthy
regions The inverse association between
Local Coefficients of Year-Round
living may be more effective due to significant geographical variations across regions in the
the availability of farmers' markets Farmers Markets Density on associations between the built environment and obesity rates
VARIABLES AND DATA SOURCES and obesity rates among Proportion of Obese Students in
Elementary School Grades, New
elementary school students was York State 2010-2012 Robust surveillance systems to document trends in childhood obesity rates are critical for documenting
more pronounced in Nassau regional disparities, changes over time, and determinants of health status
Variable Measurement Sources
Suffolk, Lower Hudson Valley
Finger
Proportion of obese students at elementary school grades NYS DOH Student Weight Status and Capital District regions Northeastern
Outcomes
Proportion of obese students at middle/high school grades Category Reporting System
Lakes
New York STUDY LIMITATIONS
Built Employment and household entropy (land use mix) US EPA Smart Location Database. No significant associations in
environment Total pedestrian weighted intersection density (design) Central New York and eastern Central Imperfect variables/measurements
portion of the Western Region
New York The outcome measures were only based on the selected school grades rather than based on entire grades
Socio- Proportion of students eligible for free or reduced lunch NYS Education Department School Western
New York Key built environment measures may have lost some precision during the conversion process from the
demographic benefit Report Card New York
Positive associations found in Penn census block to school district unit.
control Proportion of African-American students
Western New York may be Simplistic measures of food resource environment (e.g. density) may not capture the complex dimension of
Proportion of Hispanic students Hudson
attributable to unobserved accessibility to food resources: access to healthy or unhealthy food may not be constrained by geographical
Food resource Number of farmers' markets per mile square NYS Farmers Markets Directory Valley
localized characteristics that were boundaries.
environment Number of fast food restaurant per mile square NYS DOH Food Services
not captured in the model Analytical approach
Establishment Inspection Report Nassau-
Suffolk Cross-sectional analysis does not document trends or allow for assessment of causality
Number of supermarkets per mile square NYS Food Retail Store Database Ecological study design may lead to spurious associations if confounders not adequately controlled
Urbanicity City, suburban, and rural/town NCES Locale Code

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