The Role of the Neighborhood Fast Food Environment in Weight Status
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The Role of the Neighborhood Fast Food Environment in Weight Status of Inner-City Children Ofira Schwartz-Soicher Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2013 © 2013 Ofira Schwartz-Soicher All rights reserved ABSTRACT The Role of the Neighborhood Fast Food Environment in Weight Status of Inner-City Children Ofira Schwartz-Soicher In the past three decades prevalence of obesity has increased substantively in the US and has reached epidemic proportions both among adults and among children. Childhood obesity is of significant concern because it is associated with childhood morbidity, adverse social outcomes and may be associated with life-long implications. In recent years, there has been an increased interest in understanding the possible role of local food environment in shaping individual's behavior in ways that may encourage food consumption and affect weight status. This study examines whether fast food availability at the residential neighborhood may explain children's risk for obesity. Data from the Fragile Families and Child Wellbeing study, a population-based panel data of urban children and their families, were linked to locations of fast food outlets. Using both cross-sectional and longitudinal analytic techniques and numerous robustness checks, I find no discernible effect of exposure to fast food at the residential neighborhood on children's weight. Policies designed to reduce accessibility to fast food in children's residential neighborhood may not be effective in the effort to fight the childhood obesity epidemic. Table of Contents Index of Tables ............................................................................................................................................. i Index of Figures.......................................................................................................................................... vi Acknowledgements ................................................................................................................................... vii Dedication ................................................................................................................................................. viii 1. Introduction ............................................................................................................................................. 1 2. Background ............................................................................................................................................. 3 2.1 Trends and Consequences of Childhood Obesity ............................................................................... 3 2.2 Defining Overweight and Obesity ...................................................................................................... 4 2.3 Causes of Childhood Obesity .............................................................................................................. 4 2.3.1 Child Characteristics and Risk Factors ................................................................................. 4 2.3.2 Family Characteristics ........................................................................................................... 7 2.3.3 Built Environment ............................................................................................................... 10 2.3.3.1 Fast Outlets ................................................................................................................... 11 2.3.3.1.1 Fast Food Restaurants ......................................................................................... 11 3. Data ........................................................................................................................................................ 16 3.1. Data Sources .................................................................................................................................... 16 3.2. Measures of Fast Food ..................................................................................................................... 18 3.2.1. Fast Food Establishments Variables ................................................................................... 18 3.2.2. Geocoding Fast Food Establishments ................................................................................ 21 3.3. Outcome Variables ........................................................................................................................... 25 3.3.1. BMI z-scores ...................................................................................................................... 25 3.3.2. Obesity ............................................................................................................................... 26 3.4. Confounding Covariates ................................................................................................................... 26 3.5. Neighborhood Socioeconomic Contextual Covariates ..................................................................... 27 i 4. Analytic Strategy ................................................................................................................................... 29 4.1. Cross-Sectional Analytic Strategy .................................................................................................. 29 4.2. Change Models Analytic Strategy .................................................................................................. 32 5. Results .................................................................................................................................................... 35 5.1. Sample Description ......................................................................................................................... 36 5.2. Cross-Sectional Analyses Results ................................................................................................... 37 5.3. Sensitivity Analyses ........................................................................................................................ 47 5.4. Change Models Analyses Results ................................................................................................... 49 6. Discussion............................................................................................................................................... 56 6.1. Summary of Results ........................................................................................................................ 56 6.2. Strengths and Limitations ............................................................................................................... 57 6.3. Policy Implications ......................................................................................................................... 60 References .................................................................................................................................................. 62 Tables ......................................................................................................................................................... 68 Appendix .................................................................................................................................................... 92 ii Index of Tables Table 1. Child, Family and Neighborhood Characteristics - Fragile Families Year 9 ..............68 Table 2. Child, Family and Neighborhood Characteristics in High (≥8,320 people per square mile) and Low (<8,320 people per square mile) Population Density Census Tracts ...70 Table 3. Density of Fast Food Restaurants about Residential Addresses, Full Sample and Stratified by Obese and Normal Weight ....................................................................................72 Table 4. Density of Fast Food Restaurants, Full Sample and Stratified by High (≥8,320 people per square mile) and Low (<8,320 people per square mile) Population Density ..73 Table 5. Coefficients from OLS Regression Models Estimating the Association between Density of "Fast Food E.I.D.C" at 1-Kilometer Network Buffer and Year 9 BMI z-score ....................................................................................................................................................74 Table 6. Coefficients from OLS Regression Models Estimating the Association between Density of "Fast Food E.I.D.C" at 1-, 2-, 3- and 5- Kilometer Network Buffer and Year 9 BMI z-score ........................................................................................................76 Table 7. Coefficients from OLS Regression Models Estimating the Association between Density of Fast Food and Year 9 BMI z-score .................................................................78 Table 8. Odds Ratios from Logistic Regression Models Estimating the Association between Density of "Fast Food E.I.D.C." at 1-Kilometer Network Buffer and Year 9 Obesity ...79 Table 9. Coefficients from OLS Regression Models Estimating the Association between Density of "Fast Food E.I.D.C." at 1-Kilometer Network Buffer and Year 9 BMI z- score in High and Low Population Density Census Tracts .............................................81 Table 10. Coefficients from OLS Regression Models Estimating the Association between Density of Fast Food and Year 9 BMI z-score in Families who Own or Lease a Car ......83 Table 11. Coefficients from OLS Regression