Community and child energy balance: differential associations between neighborhood environment and overweight risk by gender.

Using data from the 2003 to 2004 continuous National Health Nutrition Examination Survey merged with the 2000 census and other geographic information systems-based neighborhood data, this study conducted gender-specific analyses to examine the influence of neighborhood characteristics on child risk for overweight (defined as gender-specific body mass index which is greater than the 85 percentile). Models of neighborhood influence that include institutional factors, built environment factors, and social modeling dynamics were tested. The study sample included 1753 (915 girls and 838 boys) children aged 2-11 years. Results indicate that institutional neighborhood features such as poverty in the census tract and rurality are associated with higher odds of risk of child overweight. Built environment factors also have connections to child risk of overweight, with long commute times within the census tract associated with higher overweight risk. Higher prevalence of physical activity is associated with lower risk of child overweight. Gender-specific analyses reveal that a higher prevalence of obesity (defined as BMI of greater than 30) within a census tract has a protective association with girls' risk of overweight. Boys' risk of overweight is associated with living in rural areas. These findings point to the importance of examining environmental aspects of child risk of overweight.