The present study examined the relationship among neighborhood characteristics, obesity, and the mental health outcomes of a nationally representative sample of African-American adolescent girls between the ages of 12 - 17. Using data from the 2011/2012 National Survey of Children’s Health, four questions were extracted to measure neighborhood amenities, neighborhood detractors, body mass index, and experience of depression. Ordinal regressions were calculated to estimate the relationships between all variables. The results indicated that over 25% of African-American girls, ages 12 - 14 were overweight and obese with fewer 15 - 17-year-old girls falling within these categories. African-American girls had access to fewer amenities in their communities while at the same time being exposed to more detracting elements within their neighborhoods. Finally over 25% of parents or caregivers reported that girls ages 12 - 17 expressed being depressed in the last 12 months and depression was found to be related to obesity. Overall, African-American adolescent girls tended to live in communities with fewer resources and were at greater risk for being overweight and obese and having poorer mental health outcomes than their white peers. They were also the least likely to receive mental health services. In addition, access to neighborhood amenities had been shown to lead to better health outcomes. Given the positive relationship between neighborhood amenities, access to quality healthcare and health outcomes, local, state, and federal governments should continue to advocate for the provision of resources to communities with a substantial number of detracting elements so as to reduce the health disparities within the community. In addition, psychologists and other health providers should continue to advocate for mental health services for African-American girls who are the least likely to receive them.
Over the last 20 years obesity has been on the rise within the United States. From the 1990’s until the present, the nation has gone from being mildly overweight to the current crisis where vast sectors of the population are overweight and obese (CDC, 2012) [
According to the National Institutes of Health, “social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (NIH, Healthy People, 2020) [
In 2012 [
The National Survey of Children’s Health (NSCH) 2011/12 is a nationally representative survey of US households with children ranging in age from 0 - 17 with a total of 95,677 child level interviews having been completed. The purpose of the NSCH is to assess the emotional and physical health as well as child well-being. The respondents were parents or guardians with knowledge of the health and healthcare of the target child. The survey uses a complex survey design and is stratified by state and sample type (landline or cell-phone). The survey was funded by United States Department of Health and Human Services, Health Resources and Services Administration, and the Maternal and Child Health Bureau (Center for Disease Control and Prevention, 2013) [
The demographic data for the NSCH survey includes indictors for US children by age group, sex of the child, the race and ethnicity distribution of the child population, the level of the child’s household income, children living in working poor households, and quality of the neighborhood. The sample for the current study consisted of data for 1623 African American girls ages 12 - 17.
The study consisted of two outcomes variables: child’s mental health and obesity status as well as two predictor variables neighborhood amenities and neighborhood detractors.
Mental health was assessed using the following question: “How often was this true for (child) during the past month: (He/she) is unhappy, sad, or depressed?” Parental/care- giver could respond as follows: never, rarely, sometimes, or (usually/always).
Obesity and overweight were assessed by Body Mass Index (BMI). BMI was measured by the following question “What is the weight status of children based on Body Mass Index (BMI) for age? The BMI was derived from the public use data file provided by the National Center for Health Statistics. Response categories were as follows: Underweight- less than the 5th percentile; Healthy weight-5th percentile to less than the 85th percentile; Overweight-85th to less than the 95th percentile; and Obese-equal to or greater than the 95th percentile.
Access to neighborhood amenities were measured using the following question: “How many children live in neighborhoods that contain certain amenities―parks, recreation centers, sidewalks or libraries?” Responses included: none, one of four, two of four, three of four, and all four.
Exposure to detracting neighborhood elements was evaluated using the following question: “How many children live in neighborhoods with detracting elements―vandalism, rundown housing or litter?” Responses included: none, one of three, two of three, all three.
Additional factors in the model included age, race, and gender. All factors were included in all models.
Descriptive statistics were calculated for the sample of African-American girls ages 12 - 17 frequency of reporting being depressed, BMI, the number of neighborhood amenities, and number of neighborhood detractors.
Statistical analyses were performed using SPSS 17 Complex Sample module to account for the complex survey design of NSCH survey. Data were weighted using the final sampling weight NSCHWT, stratum identifiers (STATE and SAMPLE) as well as the PSU (IDNUMR) provided in the dataset to calculate the proper variance estimation. Unweighted descriptive statistics were calculated. Ordinal regressions were performed for the two outcome variables obesity and mental health. Both models included all independent variables as well as the factors for age, race and gender.
Descriptive statistics were computed for adolescent girls between the ages of 12 - 17. 49.2% were 12 - 14 years of age and 51% were between the ages of 15 - 17. Girls between 12 - 14 years of age were reported to have healthy weight whereas 27.1% were either overweight or obese. With respect to neighborhood characteristics 24.4% of girls within the 12 - 14 year old age group were reported as having at least two amenities within their neighborhoods, with 33.6% of the girls’ caregivers reporting they had 3 or more detracting elements within their communities. Almost half (46.7%) of the 12 - 14 year old girls were reported as never feeling sad or depressed within the past 12 months.
Of the 15 - 17 year old girls 78.4% were reported as having healthy weight whereas 17.9% were classified as either overweight or obese. Approximately 16% of the 15 - 17 year old girls had either 2 or 4 amenities within their neighborhoods, 33.6% were reported as having 3 detracting elements in their neighborhoods and 42.4% were reported as never having experienced depression within the last 12 months (
Ordinal regression was conducted to determine which independent variable (age, race, gender and access to neighborhood amenities) were predictors for obesity. The overall model of 4 predictors accounted for 2.5% (Nagelkerke = 0.025) of the explanation for the BMI of adolescent girls. Wald statistics indicated that all variables significantly predicted BMI (
Ordinal regression was conducted to determine which independent variable (age, race, gender or number of detracting elements in the neighborhood) were predictors for obesity in adolescent girls. The overall model of 4 predictors accounted for 2.6% (Nagelkerke = 0.026) of the explanation for the BMI of adolescent girls. Wald statistics indicated that all variables significantly predicted BMI (
Ordinal regression was conducted to determine which independent variable (age, race, gender and experience of depression) were predictors for obesity in adolescent girls.
Weighted Estimates | Unweighted Estimates | |
---|---|---|
903,793.676 947,556.758 | 796 (49.2%) 827 (51.0%) | |
Characteristics | 187,909.530 2,535,979.539 603,681.280 405,466.082 148,268.662 3,094,781.099 390,381.109 314,758.605 | 287 (5.0%) 3976 (67.9%) 763 (16.2%) 494 (10.9%) 270 (3.8%) 5152 (78.4%) 619 (9.9%) 403 (8.0%) |
Female (12 - 14) (15 - 17) | 36,234.349 97,253.300 88,634.877 220,360.386 444,986.594 27,442.513 39,823.314 117,138.969 220,646.267 519,198.770 | 21 (17.7%) 62 (24.4%) 9 (11.7%) 174 (15.1%) 436 (15.2%) 31 (11.7%) 51 (12.1%) 95 (16.3%) 169 (15.0%) 464 (16.6%) |
***Number of detracting neighborhood elements (12 - 14) No detracting elements in the neighborhood Neighborhood has 1 detracting element from the list Neighborhood has 2 detracting element from the list Neighborhood has 3 detracting element from the list (15 - 17) No detracting elements in the neighborhood Neighborhood has 1 detracting element from the list Neighborhood has 2 detracting element from the list Neighborhood has 3 detracting element from the list | 594,333.665 177,251.049 54,022.990 62,827.936 650,890.669 1,515,149.542 96,687.539 33,544.484 | 547 (14.0%) 132 (18.2%) 59 (13.4%) 46 (33.6%) 544 (14.5%) 148 (16.9%) 74 (20.9%) 37 (19.8%) |
Experience of depression within age group (12 - 14) Never Rarely Sometimes Usually Always (15 - 17) Never Rarely Sometimes Usually Always | 420,539.811 211,587.950 254,371.913 4800.122 8545.444 398,317.781 248,242.051 239,231.968 26,605.687 26,232.896 | 354 (46.7%) 226 (23.5%) 189 (28.3%) 11 (0.5%) 14 (0.9%) 340 (42.4%) 203 (26.4%) 248 (25.5%) 15 (2.8%) 14 (2.8%) |
*Underweight―Less than the 5th percentile; Healthy weight―5th percentile to less than the 85th percentile; Overweight―85th to less than the 95th percentile; Obese―Equal to or greater than the 95th percentile. **Amenities consist of sidewalks, parks, recreation centers, or libraries. ***Detracting elements consist of litter, poorly kept or rundown housing or vandalism/graffiti.
Source | df1 | df2 | Adjusted Wald F | Significance |
---|---|---|---|---|
Age | 1 | 32,509 | 29.834 | 0.001 |
Race | 1 | 32,509 | 44.319 | 0.001 |
Gender | 1 | 32,509 | 29.536 | 0.001 |
Neighborhood Amenities | 3.836 | 124,702.949 | 6.249 | 0.001 |
Count of Amenities in Children’s Neighborhoods | Cumulative Odds Ratio | Confidence Interval | |
---|---|---|---|
Lower | Upper | ||
No amenities vs Neighborhood has all four from the list | 0.705 | 0.569 | 0.874 |
Neighborhood has 1 amenity vs all 4 from the list | 0.696 | 0.555 | 0.873 |
Neighborhood has 2 amenities vs all 4 from the list | 0.855 | 0.734 | 0.997 |
Neighborhood has 3 amenities vs all 4 from the list | 0.803 | 0.703 | 0.918 |
*Amenities consist of sidewalks, parks, recreation centers, or libraries.
Source | df1 | df2 | Adjusted Wald F | Significance |
---|---|---|---|---|
Age | 1 | 32,723 | 29.408 | 0.001 |
Race | 1 | 32,723 | 41.373 | 0.001 |
Gender | 1 | 32,723 | 28.701 | 0.001 |
Neighborhood Detractors | 2.782 | 91,026.02 | 6.937 | 0.001 |
Count of Detracting Neighborhood Elements | Cumulative Odds Ratio | Confidence Interval | |
---|---|---|---|
Lower | Upper | ||
No detracting elements vs Neighborhood has 3 detracting elements from the list | 1.180 | 0.873 | 1.595 |
Neighborhood has 1 detracting element vs 3 detracting elements from the list | 0.925 | 0.671 | 1.274 |
Neighborhood has 2 detracting element vs 3 detracting elements from the list | 0.759 | 0.510 | 1.128 |
*Detracting elements consist of litter, poorly kept or rundown housing, or vandalism/graffiti.
The overall model of 4 predictors accounted for 2.6% (Nagelkerke = 0.026) of the explanation for the BMI of adolescent girls. Wald statistics indicated that all variables significantly predicted BMI (
Source | df1 | df2 | Adjusted Wald F | Significance |
---|---|---|---|---|
Age | 1 | 32,851 | 32.808 | 0.001 |
Race | 1 | 32,851 | 43.049 | 0.001 |
Gender | 1 | 32,851 | 32.749 | 0.001 |
Depression | 3.809 | 125,130.849 | 5.159 | 0.001 |
Experience of Depression | Cumulative Odds Ratio | Confidence Interval | |
---|---|---|---|
Lower | Upper | ||
Never vs. Always | 1.551 | 0.877 | 2.743 |
Rarely vs. Always | 1.538 | 0.869 | 2.721 |
Sometimes vs. Always | 1.222 | 0.690 | 2.164 |
Usually vs. Always | 0.846 | 0.405 | 1.769 |
The study examined the relationship between neighborhood characteristics, obesity and the mental health of African-American girls. The present study adds to the work in the field because it directly addresses the relationship between the mental health of African-American girls and their body image. Moreover, it does so within the context of the social determinants of health. The above findings support previous research that has demonstrated that obesity is highest in low-income communities and that minority populations are at the greatest risk for suffering from this disease, with African-Ameri- can girls and women being at the greatest risk (Ogden et al., 2006) [
At the national level the CDC has supported a number prevention and intervention programs, which have been implemented at the school and community levels. Such programs include: “the CDC Guide to Strategies to Increase Physical Activity in the Community Obesity Prevention Strategies; the CDC Guide to Strategies to Increase Physical Activity in the Community; the CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables; the CDC Guide to Breastfeeding Interventions; School Health Guidelines to Promote Healthy Eating and Physical Activity which provides nine guidelines that serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students in grades K-12 and the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults” to name but a few programs (CDC, 2011) [
Following the lead of the CDC at the local level New York City has developed an exceptional number of excellent prevention and intervention programs to address the growing epidemic of obesity in the city. For example, Green Carts were established across the city and sell only fresh fruits and vegetables. In addition, the Health Department has begun to work with supermarkets in at risk communities across NYC to help improve the access and availability of quality fruits and vegetables in these communities. New York City has also promoted the Healthy Workplace and Heath High School initiatives which promote healthy eating and events around food. Finally, New York City has implemented a program called “Shape Up New York City” which is a free fitness program that is open to all family members in parks, community centers and housing facilities across the City (NYC.gov, 2012) [
In order to specifically address the needs of New York City youth, the NYC Department of Health created resources for adolescents and parents. For example, “Teens Speak about Getting Fit” is a resource that was designed by teens for teens, and the brochure on “Helping Children Reach a Healthy Weight: Proven Tips for Parents Brochure” provides parents with some quick ways of helping their children be healthy and maintain their weight. These resources as well as others have been developed to engage young people as well as their parents in maintaining a healthy lifestyle that includes a focus on positive mental health.
In short, the purpose of the present research was to examine the prevalence of obesity in adolescent African-American girls and its relationship to mental health and social determinants of health. The findings supported previous research that indicated that African-American girls have the greatest incidence of overweight and obesity and access to fewer resources within their neighborhoods.
Despite the contribution of the findings of the present study to the field some limitations should be noted. First although the study addresses the effect of neighborhood characteristics on the health outcomes of African-American girls it is not clear whether those characteristics are the same within rural, urban or suburban communities. Future research should take these geographical differences into account. In addition, the current study only addresses depression in girls, which is only one form of mental health challenge that girls experience. Future research should take into account the relationship between other mental health challenges experienced by African-American girls and their physical health.
A number of programs at both national and local levels, which have provided multiple successful supports and mechanisms to address the obesity of children, youth and families within communities were described. That said, while if any, a number of these programs have begun to address this epidemic, few if any have been targeted to specific communities, which means that the country is still a long way away from addressing the overall trends in obesity and mental health outcomes for African-American girls.
Obesity is linked to many diseases, such as diabetes, which is currently costing the nation a fortune to treat and if the problem is not attacked on multiple levels the costs will only continue to escalate. In addition, obesity is also linked to poor self-esteem which effects overall well-being and a failure to thrive. It not only affects low-income African-American girls and women, but also African-American women in other income brackets. In order to adequately address this problem, local communities will need to design programs that address needs of the local community because as has been shown what works well for one group does not necessarily work well for another group even when they come from similar individuals. The country would do well to address the other determinants of health that might be the root causes of obesity, such as stress, or risk another outbreak of disease within the African-American community. As demonstrated, the problem is complex, a simple solution will not be sufficient to eradicate the disease. Furthermore, as we move closer to attempting to reduce the cost of health care, if we don’t address the root causes of obesity, we will continue to invest in the treatment of this disease and eventually increase, rather than decrease the cost of health- care in the country. Policy makers would do well to hearken back to the wise words of Benjamin Franklin who stated “an ounce of prevention is worth a pound of cure” [
Flores, R.L. (2016) The Determinants of Health: Neighborhood Characteristics, Obesity and the Mental Health of African-American Adolescent Girls. Open Journal of Social Sciences, 4, 126-136. http://dx.doi.org/10.4236/jss.2016.412012