Understanding Childhood Obesity in America

Linkages Between Household Income, Community Resources, and Children's Behaviors

Taylor F. Eagle, BS; Anne Sheetz,MPH; Roopa Gurm, MS; Alan C. Woodward,MD; Eva Kline-Rogers,MS, RN, NP; Robert Leibowitz, PhD; Jean DuRussel-Weston, RN,MPH, CHES; LaVaughn Palma-Davis, MA; Susan Aaronson,MA, RD; Catherine M. Fitzgerald, MA, RD; Lindsey R. Mitchell, MPH; Bruce Rogers, BS; Patricia Bruenger, BA, CCRC; Katherine A. Skala,MPH, CHES; Caren Goldberg, MD; Elizabeth A. Jackson,MD, MPH; Steven R. Erickson, PharmD; Kim A. Eagle, MD


Am Heart J. 2012;163(5):836-843. 

In This Article


Socioeconomic Status versus BMI

To evaluate the relationship between socioeconomic status and BMI, we analyzed data obtained from 109,634 children screened in the Massachusetts public schools in 2009. Massachusetts legislation mandated BMI screening by school nurses in all public school grades 1, 4, 7, and 10 effective in 2011. However, school nurses in 80 districts submitted their data in 2010, facilitating the Massachusetts Department of Public Health's beginning analysis of the prevalence and distribution of childhood obesity in children. Measured height and weight were used to estimate BMI. To correlate BMI and socioeconomic status in the communities studied, we compared the prevalence of children who were overweight or obese versus the percentage of students in each district identified as low income. "Low-income" families were defined based on eligibility for free/reduced price lunch, received transitional aid, or were eligible for food stamps. Overweight/obese was calculated based on sex-specific Centers for Disease Control and Prevention (CDC) growth charts. Differences were assessed using a 1-way analysis of variance.

Socioeconomic Status versus Health-related Behaviors

As part of an intervention called Project Healthy Schools, we studied sixth graders in 4 different Michigan communities: Ann Arbor, Corunna, Ypsilanti, and Detroit.[12,13] The 5 primary goals of the school-based program are to encourage students to eat more fruits and vegetables, make better beverage choices (less sugar), exercise at least 150 minutes a week, eat fewer fast and fatty foods, and spend less time in front of a TV or a computer screen.[12,13] In this analysis, we were interested in differences in health-related behaviors among children in the 4 communities. Our hypothesis was that children residing in towns of lower socioeconomic status would have poorer self-reported health behaviors than those residing in communities with more resources. We used a standardized questionnaire to evaluate exercise patterns, dietary intake, and time spent doing leisure activities.[14] We compared self-reported behaviors among students in the 4 different school systems using a Kruskal-Wallis 1-way analysis of variance using SPSS software (IBM SPSS Statistics 19; IBM Corp, Armonk, NY). Self-reported consumption of meat, French fries, fried foods, fruits, vegetables, and milk were compared. For activity, we assessed previous week's participation in vigorous exercise, moderate exercise, physical education classes, and hours per day spent in front of a TV/video, computer, and/or video games. We also assessed the percentage of overweight or obese students who completed the standardized questionnaires. Body mass index was calculated based on sex-specific CDC growth charts for each child after Project Healthy Schools health coordinators measured height and weight for each participant. In Ann Arbor, Ypsilanti, and Corunna, students in all public middle schools participate in Project Healthy Schools. In Detroit, the 2 charter schools included students selected from various neighborhoods based on financial need and academic potential. Thus, we believe that the students included in this analysis are representative of those in their communities.

Estimating Median Household Income for Michigan Communities

Addresses for schools in Michigan participating in Project Healthy Schools were entered into a publicly available mapping program (Google Maps) to determine their geographic location within the state. Census tract maps of the counties and cities corresponding to each school were downloaded from the State of Michigan Web site (http://www.michigan.gov/cgi/0,1607,7-158-52927_53037_12540_13863-185972–,00.html). Location of each school on the census tract map was performed by plotting the school onto the census tract map from the Google Map location. This allowed for the identification of census tracts in which the school resided, along with those immediately touching the school tract border. Median household income for each census tract used for this study was obtained from the American Community Survey (US Census Bureau) using the Fact Finder Web site (http://factfinder.census.gov/home/saff/main.html?_lang=en). The mean of the household incomes was determined for each school by averaging the median household income documented for each census tract assigned to represent each school.

Project Healthy Schools has been supported by a number of health systems, foundations, and individuals. These include the University of Michigan Health System; the Thompson Foundation; the Hewlett Foundation; the Mardigian Foundation; the Memorial Healthcare System; the William Beaumont Health System; the Robert C. Atkins Foundation; the Massachusetts Department of Public Health; Harvard Medical Group; Richard and Norma Sarns; the Ann Arbor Area Community Foundation; AstraZeneca Foundation; Borders, Inc; Robert Beard Foundation; Allen Foundation; and Mr James Nicholson.

The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: