Abstract：
OBJECTIVE: Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk.
METHODS: We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well-child visits (2012-2017). We then recruited caregivers with children aged 5 to 13 years who lived in census tracts with mean child BMI percentile ≥72 (February 2020-August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal, and perceived neighborhood factors among families with children at a healthy weight (positive outliers [PO]) versus families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics.
RESULTS: Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). The frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers\' ability to minimize the negative health influences of family members and adhere to family routines.
CONCLUSIONS: There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.
METHODS: We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well-child visits (2012-2017). We then recruited caregivers with children aged 5 to 13 years who lived in census tracts with mean child BMI percentile ≥72 (February 2020-August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal, and perceived neighborhood factors among families with children at a healthy weight (positive outliers [PO]) versus families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics.
RESULTS: Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). The frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers\' ability to minimize the negative health influences of family members and adhere to family routines.
CONCLUSIONS: There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.
摘要：
目标：尽管肥胖的患病率很高，而且社区风险聚集，很少有研究研究了在肥胖风险高的社区中促进儿童健康体重的特征。我们旨在确定居住在高肥胖风险社区的儿童的保护因素。
方法：我们使用地理定位的电子健康记录数据和从健康儿童访视（2012-2017年）中测量的体重指数（BMI）确定了肥胖风险高的社区。然后，我们招募了5至13岁儿童的护理人员，这些儿童生活在平均儿童BMI百分位数≥72的人口普查区（2020年2月至2021年8月）。我们使用了顺序混合方法(定量调查，定性访谈)比较个人，人际关系,和感知邻里因素在有健康体重的孩子的家庭(正异常值[PO])与有≥1儿童超重或肥胖的家庭(对照)。使用回归模型和比较定性分析来识别保护特征。
结果：73名护理人员参与了定量阶段（41%PO；34%首选西班牙语），20名护理人员参与了定性阶段（50%PO；50%首选西班牙语）。健康照顾者行为的频率与PO相关（家庭健康行为量表父母评分调整后的β3.67；95％CI0.52-6.81和定性数据）。保护因素还包括护理人员将家庭成员的负面健康影响降至最低并遵守家庭常规的能力。
结论：PO家族和对照家族之间几乎没有差异。支持照顾者的健康习惯和坚持健康的家庭惯例成为肥胖风险高的社区预防儿童肥胖的机会。
方法：我们使用地理定位的电子健康记录数据和从健康儿童访视（2012-2017年）中测量的体重指数（BMI）确定了肥胖风险高的社区。然后，我们招募了5至13岁儿童的护理人员，这些儿童生活在平均儿童BMI百分位数≥72的人口普查区（2020年2月至2021年8月）。我们使用了顺序混合方法(定量调查，定性访谈)比较个人，人际关系,和感知邻里因素在有健康体重的孩子的家庭(正异常值[PO])与有≥1儿童超重或肥胖的家庭(对照)。使用回归模型和比较定性分析来识别保护特征。
结果：73名护理人员参与了定量阶段（41%PO；34%首选西班牙语），20名护理人员参与了定性阶段（50%PO；50%首选西班牙语）。健康照顾者行为的频率与PO相关（家庭健康行为量表父母评分调整后的β3.67；95％CI0.52-6.81和定性数据）。保护因素还包括护理人员将家庭成员的负面健康影响降至最低并遵守家庭常规的能力。
结论：PO家族和对照家族之间几乎没有差异。支持照顾者的健康习惯和坚持健康的家庭惯例成为肥胖风险高的社区预防儿童肥胖的机会。
