Nicolas M. Oreskovic

Obesity and the Built Environment Among Massachusetts Children

Background: The built environment may influence weight status. Method: Using cross-sectional data for children aged 2 to 18 years, the authors linked clinical and spatial data using geographic information systems and analyzed for associations between body mass index (BMI) and density of and distance to nearest built environment variable (schools, sidewalks, subway stations, bicycle trails, open space, and fast-food restaurants) using bivariate and multilevel analyses. Results: The study sampled 21 008 children; 54% were white, 26% Hispanic, 37% overweight, and 20% obese. In bivariate analysis, distance to nearest fast-food restaurant was inversely associated with BMI, whereas density of fast-food restaurants was positively associated with BMI. Distance to school and subway station, amount of open space, and density of subway stations were inversely associated with BMI. Controlling for sociodemographic factors, only living near a greater density of subway stations was inversely associated with overweight (odds ratio, 0.87; 95% confidence interval, 0.81-0.94) and obesity (odds ratio, 0.90; 95% confidence interval, 0.82-0.99). Conclusion: Distance to nearest subway station is associated with BMI among Massachusetts children.

Built Environment and Weight Disparities Among Children in High- and Low-Income Towns

OBJECTIVE To assess differences in built environment and child weight, and associations between them in high- and low-income communities. METHODS By means of cross-sectional clinical and demographic data for children aged 2 to 18 years from an integrated health system in Massachusetts, we linked subject (n = 6680) and spatial data from Geographic Information Systems. We selected towns with at least 100 subjects per town (n = 46 towns), and we divided towns into quartiles by household income. We compared highest and lowest quartile towns on environmental characteristics (density of fast food restaurants, distance to nearest fast food restaurant, distance to nearest age-appropriate school) and overweight and obesity prevalence. We used clustered logistic regression to assess for associations between environmental characteristics and weight and carried out similar analyses stratified by age (2 to <5, 5 to <12, 12 to 18 years). RESULTS Low-income towns had more sidewalks, less open space, a greater density of fast food restaurants, and higher rates of overweight/obesity. Among low-income-town children, after adjusting for age, gender, race, and town, density of fast food restaurants was positively associated with overweight and obesity, whereas distance to nearest age-appropriate school and fast food restaurant were inversely associated with obesity. Children from low-income towns appeared to have more consistent associations between weight status and the built environment. CONCLUSIONS Built environment varies by town income. Children living in low-income towns tend to have built environments that promote energy intake and decrease opportunities for energy expenditure.

Repeat Urine Cultures in Children Who Are Admitted With Urinary Tract Infections

OBJECTIVE. Urinary tract infections are a common cause of hospitalization in the pediatric population. Hospitalization for urinary tract infections in children usually involves intravenous antibiotics, invasive methods of obtaining sterile urine specimens, and imaging studies to assess the anatomy of the urinary system. The objective of this study was to determine the frequency of positive repeat urine cultures that are obtained after 2 days of antibiotics among pediatric inpatients who are admitted with diagnosed or suspected infections of the urinary tract. METHODS. A retrospective survey was conducted of all pediatric patients (≤18 years of age) who were admitted to Elmhurst Hospital in Queens, New York, with a suspected or diagnosed urinary infection from December 1998 through December 2004. Results of repeat urine cultures that were obtained after 2 days of antibiotics were abstracted from a computerized medical charts database. Nominal data analysis was used to establish the frequency of positive repeat urine cultures. RESULTS. A total of 328 (54.8%) of 599 eligible admissions met inclusion criteria. Of these 328 admissions, only 1 (0.3%) repeat urine culture was positive after 2 days of antimicrobial therapy. CONCLUSIONS. Positive repeat urine cultures after 2 days of antibiotics are exceedingly rare. Elimination of mandatory “proof-of-bacteriologic-cure” benchmarks before hospital discharge is supported by this study.

How do changes to the built environment influence walking behaviors? a longitudinal study within a university campus in Hong Kong

BackgroundPrevious studies testing the association between the built environment and walking behavior have been largely cross-sectional and have yielded mixed results. This study reports on a natural experiment in which changes to the built environment were implemented at a university campus in Hong Kong. Longitudinal data on walking behaviors were collected using surveys, one before and one after changes to the built environment, to test the influence of changes to the built environment on walking behavior.MethodsBuilt environment data are from a university campus in Hong Kong, and include land use, campus bus services, pedestrian network, and population density data collected from campus maps, the university developmental office, and field surveys. Walking behavior data were collected at baseline in March 2012 (n = 198) and after changes to the built environment from the same cohort of subjects in December 2012 (n = 169) using a walking diary. Geographic information systems (GIS) was used to map walking routes and built environment variables, and compare each subject’s walking behaviors and built environment exposure before and after the changes to the built environment. Walking behavior outcomes were changes in: i) walking distance, ii) destination-oriented walking, and iii) walked altitude range. Multivariable linear regression models were used to test for associations between changes to the built environment and changes in walking behaviors.ResultsGreater pedestrian network connectivity predicted longer walking distances and an increased likelihood of walking as a means of transportation. The increased use of recreational (vs. work) buildings, largely located at mid-range altitudes, as well as increased population density predicted greater walking distances.Having more bus services and a greater population density encouraged people to increase their walked altitude range.ConclusionsIn this longitudinal study, changes to the built environment were associated with changes in walking behaviors. Use of GIS combined with walking diaries presents a practical method for mapping and measuring changes in the built environment and walking behaviors, respectively. Additional longitudinal studies can help clarify the relationships between the built environment and walking behaviors identified in this natural experiment.

Optimism and the Socioeconomic Status Gradient in Adolescent Adiposity

PURPOSE To assess whether dispositional optimism is associated with adiposity and to explore whether dispositional optimism mediates the relationship between parent education and adiposity (body mass index [BMI] z-score). METHODS Multivariate regression analyses of data were collected from 1,298 non-Hispanic black and white adolescents aged 12-19 years from a single Midwestern public school district. RESULTS Less optimistic adolescents had higher BMI z-scores (r = -.09, p < .001). Addition of dispositional optimism to the regression model caused an approximately 10% attenuation of the parent education and BMI z-score relationship. Sobel tests confirmed that this attenuation indicated partial mediation. CONCLUSION Lower dispositional optimism is associated with higher adiposity and this association accounts for some of the influence of parent education on adolescent adiposity.

Tobacco Smoke Exposure and Chronic Conditions of Childhood

Two remarkable articles by Kwok et al1 and Brion et al2 in this months Pediatrics tighten the evidence around tobacco smoke exposure and chronic conditions of childhood. Their work adds to previous research findings that demonstrated associations between tobacco smoke exposure and various childhood morbidities and mortality (Table 1).3 Indeed, 3 important categories of chronic conditions of childhood (asthma, obesity, and mental health disorders) have small-to-moderate independent associations with tobacco smoke exposure either during pregnancy or in the postnatal period. Dental caries are one of the most common chronic conditions of childhood, and a moderate independent association with tobacco smoke exposure has been described.4 View this table: TABLE 1 Specific Health Effects of Prenatal and Postnatal Exposure to Tobacco Smoke Following a large Hong Kong birth cohort, Kwok et al1 found an association between tobacco smoke exposure of pregnant mothers and subsequent child overweight. The study is methodologically important, because it examined this effect among mothers who themselves did not smoke but were exposed by the father. That … Address correspondence to Jonathan P. Winickoff, MD, MPH, Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, 50 Staniford St, Suite 901, Boston, MA 02114. E-mail: jwinickoff{at}partners.org

Early Childhood Screen Time and Parental Attitudes Toward Child Television Viewing in a Low-Income Latino Population Attending the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND Early childhood media exposure is associated with obesity and multiple adverse health conditions. The aims of this study were to assess parental attitudes toward childhood television (TV) viewing in a low-income population and examine the extent to which child BMI, child/parent demographics, and household media environment are associated with adherence to American Academy of Pediatrics (AAP) guidelines for screen time. METHODS This was a cross-sectional survey study of 314 parents of children ages 0-5 years surveyed in English or Spanish by self-administered questionnaire at a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinic in Oregon. RESULTS In this majority Latino sample (73%), half (53%) of the children met AAP guidelines on screen time limits, 56% met AAP guidelines for no TV in the childs bedroom, and 29% met both. Children were more likely to meet AAP guidelines when there were <2 TVs in the home, there was no TV during dinner, or their parents spent less time viewing electronic media. Parents who spent less time viewing electronic media were more likely to report believing that TV provides little value or usefulness. CONCLUSIONS In this low-income, predominantly Latino population attending WIC, parent media-viewing and household media environment are strongly associated with child screen time. Programs aimed at reducing child screen time may benefit from interventions that address parental viewing habits.

Travel Patterns to School Among Children with Asthma

Background. Active commuting to school provides regular exercise, which can improve asthma symptoms. Little is known about how children with asthma travel to school. Objective. To identify travel patterns and parental perceptions surrounding mode of travel to school among children with asthma. Methods. Cross-sectional study of 176 children with asthma aged 5 to 15 years. Parents completed questionnaires assessing mode of travel to school, physical activity, asthma control, physician counseling, and factors influencing parental decisions. Data analysis included descriptive and bivariate statistics. Results. Few (16%) children with asthma actively commute to school. Active travelers lived closer to school, and “distance” was the most frequently reported factor influencing a parents decision regarding travel mode to school. Parents reported few concerns about pollution and little physician counseling on active travel. Conclusion. Few children with asthma actively travel to school. Asthma-specific concerns do not appear to guide parental decisions on travel mode to school.

Spatial analysis of crime incidence and adolescent physical activity.

OBJECTIVES Adolescents do not achieve recommended levels of physical activity. Crime is believed to be a barrier to physical activity among youth, but findings are inconsistent. This study compares the spatial distribution of crime incidences and moderate-to-vigorous physical activity (MVPA) among adolescents in Massachusetts between 2011 and 2012, and examines the correlation between crime and MVPA. METHODS Eighty adolescents provided objective physical activity (accelerometer) and location (Global Positioning Systems) data. Crime report data were obtained from the city police department. Data were mapped using geographic information systems, and crime and MVPA densities were calculated using kernel density estimations. Spearmans correlation tested for associations between crime and MVPA. RESULTS Overall, 1694 reported crimes and 16,702min of MVPA were included in analyses. A strong positive correlation was present between crime and adolescent MVPA (ρ=0.72, p<0.0001). Crime remained positively associated with MVPA in locations falling within the lowest quartile (ρ=0.43, p<0.0001) and highest quartile (ρ=0.32, p<0.0001) of crime density. CONCLUSIONS This study found a strong positive association between crime and adolescent MVPA, despite research suggesting the opposite relationship. This counterintuitive finding may be explained by the logic of a common destination: neighborhood spaces which are desirable destinations and promote physical activity may likewise attract crime.

Design and implementation of a physical activity intervention to enhance children's use of the built environment (the CUBE study)

BACKGROUND Adequate physical activity promotes physical and mental health and decreases obesity risk. However, most adolescents do not attain recommended physical activity levels and effective interventions are lacking. Physical activity trials rarely incorporate built environment use patterns. PURPOSE This paper describes the design and rationale of the Childrens Use of the Built Environment (CUBE) Study, an office-based intervention designed to teach youth how to use their surrounding built environment to increase physical activity. METHODS CUBE is a 6-month intervention trial among 60 overweight and obese 10-16 year old adolescents from a community health center in Massachusetts. The study began in the winter of 2013. Patients are sequentially assigned to either the intervention or control group. Baseline physical activity by accelerometry and location by GPS, along with measured height, weight, and blood pressure are collected. Control subjects receive standard of care lifestyle counseling. Intervention subjects receive tailored recommendations on how to increase their physical activity based on their accelerometer and GPS data. Data collections are repeated at end-of-treatment, and again 3 months later. CONCLUSION The findings from this study should help guide future efforts to design interventions aimed at increasing adolescent physical activity as well as to inform design professionals and government officials charged with creating outdoor spaces where adolescents spend time.