Childhood Obesity in a Low-Income, Urban Neighborhood: Social Determinants From a Systems Perspective
The incidence of childhood obesity in the United States has nearly tripled since 1980 and is more prevalent in children from minority and low income families (CDC, 2012; Vieweg et al., 2007). Most policies to address childhood obesity fall short in achieving their goals (Budd, Schwarz, Yount, Haire-Joshu, 2009). Systems-oriented approaches are needed to understand how biology, built environment, and social-economic environment interact over time to influence childhood obesity trends (Huang et al., 2009). A major challenge is that the community processes involving built environment and social-economic factors influencing childhood obesity trends can vary from community to community. This poses a major challenge to studying and improving the effectiveness of community prevention strategies (IOM, 2012)
This study, funded by the NIH/OBSSR as part of the Envision Comparative Modeling Network, focused on understanding the role of social determinants of childhood obesity trends from a feedback perspective at the community level. Specifically, what are the structures of the underlying system driving childhood obesity trends?
Methods:
The study took community based participatory research (CBPR) approach using group model building (GMB) methods to develop a systems model (Homer and Hirsch, 2006; Hovmand et al., 2012; IOM, 2012; Vennix, 1996). The study was based in an urban neighborhood of approximately 6,500 people, 94% African American with median household income of $14,820 and 45% of families with children living below poverty. The Special Community Workgroup (SCWG) led the study in a three-year collaboration between a community center, university, and evaluation agency, and included residents, community leaders, and researchers. The SCWG led four sets of GMB sessions involving approximately 80 community participants including clergy, health care providers, parents, and children, youth, and young adults. Data from each session were cleaned based on recorder notes and integrated into a single multilevel systems model with each step being reviewed by the SCWG and presented back to the community.
Results:
The model identifies 7 subsystems across multiple levels including weight, healthy eating, friendly environment and physical activity, access to food, social and mental health issues, and crime. Highlights from the study include neighborhood specific interpretations of community level processes involving corner stores and community gardens. Corner stores, which are generally seen in the literature as sources of unhealthy food choices, were discovered to provide a critical role in the social reproduction of gangs. Participants also identified novel hypotheses about the role of community gardens as interventions that emphasized the role of developing social networks as their primary benefit. Importantly, a number of community identified prevention strategies were readily accepted and implemented by residents.
Conclusions:
Systems oriented approaches such as GMB conducted in community settings are not only feasible as a CBPR method and can involve diverse participants from young children to older adults, but can lead to the identification of novel community specific processes and prevention strategies with shared ownership of the resulting systems model. The study also highlights important roles for social worker in addressing social determinants of childhood obesity.