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标题：Income Disparities in Obesity Trends Among California Adolescents
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作者：Susan H. Babey ; Theresa A. Hastert ; Joelle Wolstein 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：100
期号：11
页码：2149-2155
DOI：10.2105/AJPH.2010.192641
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed income-specific trends in obesity rates among a diverse population of California adolescents. Methods. We used data from 17 535 adolescents who responded to the California Health Interview Survey between 2001 and 2007 to examine disparities in obesity prevalence by family income and gender. Results. Between 2001 and 2007, obesity prevalence significantly increased among lower-income adolescents but showed no statistically significant differences among higher-income adolescents after adjustment for age, gender, and race/ethnicity. Although the overall disparity in obesity by family income doubled in this time period, trends were more consistent among male adolescents than among female adolescents. Conclusions. The magnitude of the income disparity in obesity prevalence among California adolescents more than doubled between 2001–2007. The overall leveling off of adolescent obesity prevalence rates could indicate that efforts to decrease childhood obesity are having an impact; however, our results suggest that efforts to prevent childhood obesity may be failing to help adolescents from lower-income families, particularly male adolescents. The prevalence of childhood obesity in the United States has risen dramatically over the past 30 years, increasing from 6% to 17% among those aged 12 to 19 years between the early 1970s and 2003–2004.^{1 – 4} Recent data from the National Health and Nutrition Examination Survey indicate that there was no significant change in obesity prevalence rates between 2003–2004 and 2005–2006, and no significant trend since 1999 in the 12–19–year age group, suggesting that the prevalence of childhood obesity could be leveling off nationally.⁵ However, rates remain high, with approximately 18% of US adolescents considered to be obese.⁵ Overweight and obesity in childhood are associated with an increased risk of developing a number of serious health conditions, including type 2 diabetes, heart disease, hypertension, and a variety of musculoskeletal disorders, as well as a higher risk of obesity in adulthood.^{6 – 9} The rise in obesity and comorbid conditions has also led experts to predict a decrease in life expectancy and increased health care costs.^{10 – 12} Cross-sectional data have shown an inverse relationship between family income and obesity prevalence among children and adolescents, although some studies suggest that the relationship differs according to race/ethnicity and gender.^{4 , 13 – 16} In addition, research conducted by Goodman et al. suggests that the public health impact of family income on obesity among children is large in terms of the number of cases that could be prevented if families living in poverty had higher incomes.¹⁶ Related research suggests significant trends in obesity prevalence over time as a function of family income among older adolescents but not among younger ones.¹⁷ However, other studies have suggested that the association between socioeconomic status (SES) and obesity has been weakening in recent years.¹⁵ Similar disparities have been noted among the racial/ethnic groups most likely to live in poverty. Although obesity prevalence rates have increased among all racial/ethnic groups, the increase has been noticeably greater among African Americans and Latinos, including adolescents in these groups.^{18 , 19} Recent evidence suggests that the prevalence of childhood obesity may no longer be increasing. This leveling off could indicate that recent efforts aimed at reducing childhood obesity have been effective. However, trends in the overall population can mask important differences in trends among groups at increased risk of obesity, such as low-income adolescents, and examining changes in obesity across different levels of SES is important in evaluating efforts to reduce health disparities. We used data from the California Health Interview Survey (CHIS) to test for differential trends in obesity over time among lower-income adolescents relative to higher-income adolescents. Specifically, we tested the hypothesis that obesity prevalence has increased more among lower-income adolescents than among higher-income adolescents. Adolescents in families with higher incomes are likely to have access to greater resources that may better protect them from preventable conditions.^{20 , 21} Other recent studies assessing trends in adolescent obesity rates either did not examine SES differences⁵ or used less recent data than that used in our study.^{15 , 22} In addition, because environmental influences on obesity have been shown to differ among male and female adolescents, we examined whether any changes in the income disparity in obesity rates might vary by gender.^{15 , 22 , 23}