Date on Master's Thesis/Doctoral Dissertation

5-2019

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

Baumgartner, Richard

Committee Co-Chair (if applicable)

Baumgartner, Kathy

Committee Member

Baumgartner, Kathy

Committee Member

Boone, Stephanie

Committee Member

Zierold, Kristina

Committee Member

Chen, Chau-Kuang

Author's Keywords

built environment; childhood obesity; adolescent health; West Louisville; perceived environment, African Americans

Abstract

Introduction: Few studies have considered how an individual’s perception of their built environment may be a risk factor for being overweight or obese. Adolescents may be particularly vulnerable in the context of “impoverished environments”, which they may perceive to be difficult, dangerous, resource deficient, and unaesthetic. This study aids in clarifying how the built environment influences the risk of obesity among adolescents residing in a neighborhood in Louisville, KY. Objective: The overall objective was to conduct a cross-sectional epidemiologic pilot study among adolescents aged 12-17 years residing in West Louisville, Kentucky to evaluate the association between perceptions of their neighborhood environment and overweight/obesity as defined from BMI. Methods: Focus groups were conducted with 20 male and female participants, aged 12-17 years, from a local youth center. Data collected from the focus groups were used to design a questionnaire that covered socio-behavioral and environmental categories administered to 154 adolescents. Analyses were based on the appropriate statistical test for demographic characteristics (Chi square, Analysis of Variance (ANOVA). Multivariable logistic regression was performed to evaluate the association between measures of the built environment (walkability, accessibility, aesthetics, traffic, crime, and perceptions of fear) and overweight/obesity, adjusting for pertinent confounders (physical activity, median household income, neighborhood region, perceptions of weight, weight goals, fruit and veggie scale, parental support scale, parent’s weight, and comfortability scale, ethnicity, age, and grade). Results: Adolescents who were moderately afraid of people in their neighborhood were 2.71 times more likely to be obese than those who were not afraid (p-value=0.21) after adjusting for individual and group-level covariates. Adolescents who were afraid of people in their neighborhood were 68% less likely to be obese than those who were not afraid (p-value=0.05) after adjusting for individual and group-level covariates. Scales for walkability (AOR = .09, p-value =0.09), traffic (AOR = 0.52, p-value=0.30), and crime (AOR = 0.43, p-value= 0.29) were associated with overweight/obesity. Conclusion: If adolescents experience psychological distress, they may have an elevated perception of physical harm or victimization. Adolescents who experience distress are more likely to engage in obesogenic sedentary behaviors than physical activity.

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