Childhood Obesity in Context: Examining the Role of Ecological Factors Related to Childhood Obesity among West Virginia\u27s Youth

Nearly one third of youth in the United States are overweight or obese and rates are disproportionately higher among rural youth. These rates are cause for alarm given the many short- and long-term consequences of childhood obesity. A growing body of research has begun to explore how factors outside the individual might influence obesity and obesity-related behaviors. Guided by ecological frameworks, this research has demonstrated that factors such as the socioeconomic status of the community, access to physical activity opportunities, and quality of the community food environment may contribute to this epidemic. However, much of the research to date has focused on metropolitan regions, despite the increased risk of obesity observed in rural areas. West Virginia (WV) offers an important context to examine the environmental influences of obesity in that it is a largely rural area and consistently ranks among states with the highest rates of adult and childhood obesity. The main objective of this project was to improve the current understanding of environmental influences on obesity among WV\u27s youth. In the first study, a secondary analysis of qualitative data was used to examine community member perceptions with regard to environmental factors associated with obesity. Data from focus groups conducted with community members (N=38) across five WV counties were transcribed and coding was guided by Social Ecology Theory. The findings indicated that factors at the individual-, interpersonal-, and environmental-level play a role in influencing obesity and related health behaviors. Participants noted that community environments in particular present barriers to physical activity and healthy eating through lack of access, suggesting that further study using quantitative methods is warranted. The themes identified in this study were then quantified in studies 2 and 3 by measuring the social and built environments within the communities surrounding WV elementary schools. Google Maps, Yellowpages.com, and local parks and recreation pages were used to establish a database of food and physical activity resources within a 1km and 5km distance from schools. Data regarding median household income, percent of residents with less than a high school education and percent of residents unemployed were extracted from Census.gov at the block group level and used to calculate the socioeconomic condition for the community environment around schools. Across studies 2 and 3, resource counts indicated greater access to unhealthy food outlets (fast food stores and conveniences stores) when compared with resources that support positive health behaviors such as grocery stores, supercenters, and physical activity resources. When data regarding school facilities made available to the public were considered in study 2, access to physical activity opportunities dramatically increased. Associations between environments and school-level obesity (N=34 schools) were also examined in study 2. Negative binomial regressions were run using IBM SPSS 19 for males only and females only; no significant relationships were found at p\u3c.05. The third study took this work further by examining the direct and indirect effects of the environment in relation to more proximal outcomes related to obesity (daily fruit and vegetable consumption and physical activity). Results obtained from a series of structural equation models using AMOS 18 indicated the more favorable the socioeconomic condition of the community, the greater the density of healthy and unhealthy food outlets and the greater the density of physical activity resources. No significant associations were observed between the social or built environment and either physical activity or fruit and vegetable consumption. Despite the lack of significant associations observed, quantifying the resources around WV schools demonstrated limited opportunities for engaging in positive health behaviors and the potential challenges of achieving energy balance for residents of these communities. The findings from studies 2 and 3 also support themes identified through focus groups in study 1. Major strengths of this research are that it expanded the rural focused ecological research on childhood obesity, it incorporated broader measures of the food and physical activity environment, and it applied methods used in previous research to a largely rural area. This research has implication for health policies, such as improving access to school facilities through joint use agreements and requiring healthy food options be available at non-traditional locations such as convenience stores. Future work is needed to consider where rural youth are active, the quality and condition of nutrition and physical activity resources, and to identify other variables influencing access to resources