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Maria N. Ness, M.P.H. Office of Family Health, Oregon Health Authority, Portland, OR

Correlates of Overweight and Obesity among American Indian/Alaskan Native and Non-Hispanic White Children and Adolescents. Maria N. Ness, M.P.H. Office of Family Health, Oregon Health Authority, Portland, OR Danielle T. Barradas, Ph.D.

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Maria N. Ness, M.P.H. Office of Family Health, Oregon Health Authority, Portland, OR

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  1. Correlates of Overweight and Obesity among American Indian/Alaskan Native and Non-Hispanic White Children and Adolescents Maria N. Ness, M.P.H. Office of Family Health, Oregon Health Authority, Portland, OR Danielle T. Barradas, Ph.D. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA Jennifer Irving, M.P.H. Great Plains Tribal Chairmen's Health Board, Northern Plains Tribal Epidemiology Center, Rapid City, SD Susan E. Manning, M.D., M.P.H. Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA Council of State and Territorial Epidemiologists Annual Conference June 13, 2011

  2. Background • Nationally, prevalence of overweight and obese children is rising at an alarming rate • Studies have shown rates of overweight and obesity to be consistently higher among American Indian/Alaska Native (AI/AN) children than other racial groups* • The development of overweight and obesity in childhood is a complex process, with many interrelated contributing factors * Anderson, S. E., & Whitaker, R. C. (2009). Prevalence of obesity among US preschool children in different racial and ethnic groups. Archives of Pediatric & Adolescent Medicine, 136, 344-348. Zephier, E., Himes, J. H., Story, M., & Zhou, X. (2006). Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Archives of Pediatric & Adolescent Medicine, 160, 34-39.

  3. Aim & Research Question • Aim: To contribute to the understanding of the risk factors for childhood overweight and obesity among AI/AN children, so that effective prevention and treatment strategies can be developed • Research Question: Do risk factors for overweight and obesity differ among AI/AN children compared to non-Hispanic (NH) white children?

  4. Methods • Secondary data analysis of the 2007 National Survey of Children’s Health • Telephone survey conducted in English and Spanish of parents with child under 18 years • Provides a broad range of information about children’s health and well-being • Survey results are weighted to represent the population of non-institutionalized children ages 0-17 nationally and in each state

  5. Sample • Analysis limited to: • Seven states that report AI/AN race as a distinct category (AK, AZ, MT, NM, ND, OK, SD) • Children aged 10-17 years because parent report of child’s height and weight not reliable for children < 10 years

  6. Measures Examined • Dependent variable: Overweight and obesity combined into one variable (referent group = normal weight) • Independent variables: • Weight-related behaviors (e.g. physical activity) • Household environment • Neighborhood environment • Demographic and socioeconomic characteristics

  7. Independent Variables Table 1: Weight Related Behaviors

  8. Independent Variables, cont. Table 2: Household Environment

  9. Independent Variables, cont. Table 3: Neighborhood Environment

  10. Independent Variables, cont. Table 4: Demographic & Socioeconomic Characteristics

  11. Statistical Analysis • Descriptive Analysis: Differences in variable distributions between NH white and AI/AN children were tested using Chi-square statistics • Bivariate Analysis: Bivariate associations between overweight/obesity and each independent variable were assessed • Multivariable Analysis: A multivariable logistic regression model was created including interaction terms in addition to all variables with significant odds ratios among any race in the bivariate regressions* *Kleinbaum DG and Klein M. Modeling Strategy Guidelines. In Logistic Regression: A Self-Learning Text (2nd ed). New York: Springer, 2005

  12. Descriptive Results • Characteristics which were statistically significantly differently distributed between NH white and AI/AN children: • Parental physical activity (p = 0.04) • Family meals/week (p < 0.001) • School safety (p = 0.001) • Parks in neighborhood (p = 0.007) • Household poverty status (p < 0.001) • Household structure (p = 0.002) • Of these, only household poverty status and household structure made it into the final multivariable model

  13. Bivariate Results Figure 1. Percent of overweight/obese children by risk factor

  14. Bivariate Results, cont. Table 5: Unadjusted risk factors for childhood overweight and obesity among 10 – 17 year old NH white & AI/AN children, NSCH 2007

  15. Multivariable Results Table 6: Adjusted risk factors for childhood overweight and obesity among 10 – 17 year old NH white & AI/AN children, NSCH 2007 1p for interaction term= 0.18

  16. Multivariable Results, cont. Table 6 continued: Adjusted risk factors for childhood overweight and obesity among 10 – 17 year old NH white & AI/AN children, NSCH 2007 n= 4743; Adjusted for all variables simultaneously

  17. Conclusions / Discussion • In general, correlates of overweight/obesity did not differ between non-Hispanic white and AI/AN children • Sports team participation was differentially related to overweight/obesity between racial groups (AI/AN children who did not participate on a sports team had a statistically significant 2.7 times increased odds of being overweight or obese) • Our findings also support TV viewing and neighborhood social support as potential areas for intervention among AI/AN children

  18. Limitations • Cross-sectional design of the NSCH means that temporality cannot be established; therefore cannot infer causality • No direct measurements of children’s height and weight; data is all parental report • Results can only be generalized to 7 states that report AI/AN race, and only to 10-17 year old children • Small sample size of AI/AN children • Overweight and obesity combined into a single variable, unable to examine risk factors for each separately • Potential significance of independent variables may not have been detected

  19. Public Health Implications • Increased sports participation may be a key area for targeted interventions among AI/AN children • Interventions could consist of increasing safe and easily accessible sports facilities, in school or an external setting • Funding could be sought from programs with aligned goals, such as the Special Diabetes Program for Indians • Alternatively, focus could be targeted towards improving AI/AN children’s access to sports facilities • Interventions to increase sports participation may be more effective among boys

  20. Acknowledgments • Deborah Rosenberg, Ph.D. & Kristin Rankin, Ph.D. • Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago • Kenneth D. Rosenberg, M.D., M.P.H. & Kathleen A. Anger, Ph.D. • Oregon Public Health Division, Office of Family Health, Portland OR

  21. Thank you! Questions? Please contact Maria Ness CDC/CSTE Applied Epidemiology FellowOregon Public Health DivisionOffice of Family Health800 NE Oregon Street, Suite 825Portland  OR  97232 maria.n.ness@state.or.us(971) 673-1564

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