Abstract
This study examines ecological influences on adult obesity prevalence in the coterminous United States. Several secondary data sources are used in this study to construct a rich dataset of county-level demographic, socioeconomic, and environmental variables. This study uses a spatially explicit approach by using traditional regression methods (i.e., ordinary least squared regression (OLS)), along with geographic weighted regression (GWR) to explore non-stationarity in the relationships between obesity and selected covariates. OLS results reveal that there is a positive relationship between adult obesity and poverty, black residents, Native American residents, and adult physical inactivity at the county level. There is a negative relationship between the percentage of residents who are rural, Hispanic, and college educated. Furthermore, GWR results confirm that place matters and the relationship between ecological influences and obesity prevalence varies substantially across place. GWR provides an empirical basis to design interventions that effectively target obesity at a more local level.
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Ali, K., Partridge, M. D., & Olfert, M. R. (2007). Can geographically weighted regressions improve regional analysis and policy making? International Regional Science Review, 30, 300–329.
Allison, P. D. (1999). Multiple regressions: a primer. Thousand Oaks, CA: Pine Forge Press.
Anselin, L. (1988). Do spatial effects really matter in regression analysis? Papers of the Regional Science Association, 65, 11–34.
Arcaya, M., Brewster, M., Zigler, C. M., & Subramanian, S. V. (2012). Area variations in health: a spatial multilevelmodeling approach. Health P lace, 18(4), 824–831.
Baker, E. A., Schootman, M., Barnidge, E., & Kelly, C. (2006). The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Preventing Chronic Disease, 3(3), A76.
Berrigan, D., & Troiano, R. P. (2002). The association between urban form and physical activity in U.S. adults. American Journal of Preventive Medicine, 23, 74–79.
Bitter, C., Mulligan, G., & Dallerba, S. (2007). Incorporating spatial variation in housing attribute prices: a comparison of geographically weighted regression and the spatial expansion method. Journal of Geographical Systems, 9, 7–27.
Bodor, J., Rice, J., Farley, T., Swalm, C., & Rose, D. (2010). The association between obesity and urban food environments. Journal of Urban Health, 87, 771–781.
Bowman, S. A., & Vinyard, B. T. (2004). Fast food consumption of U.S. Adults: impact on energy and nutrient intakes and overweight status. Journal of the American College of Nutrition, 23, 163–168.
Brunsdon, C., Fotheringham, S., & Charlton, M. (1998). Geographically weighted regression-modelling spatial Non-stationarity. Journal of the Royal Statistical Society Series D (The Statistician), 47, 431–443.
Chalkias, C., Papadopoulos, A. G., Kalogeropoulos, K., Tambalis, K., Psarra, G., & Sidossis, L. (2013). Geographical heterogeneity of the relationship between childhood obesity and socio-environmental status: empirical evidence from Athens, Greece. Applied Geography, 37, 34–43.
Charlton, M., Fotheringham, S., Brunsdon, C., 2003. GWR 3. Software for geographically weighted regression. Spatial Analysis Research Group, Department of Geography,University of Newcastle upon Tyne,England.
Cossman, J. S., Cossman, R. E., James, W. L., Campbell, C. R., Blanchard, T. C., & Cosby, A. G. (2007). Persistent clusters of mortality in the United States. American Journal of Public Health, 97, 2148–2150.
Cummins, S., Curtis, S., Diez-Roux, A. V., & Macintyre, S. (2007). Understanding and representing ‘place’in health research: a relational approach. Social Science & Medicine, 65(9), 1825–1838.
Diez-Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186, 125–145.
Dorling, D. (2001). How much does place matter. Environment and Planning A, 33(8), 1335–1369.
Drewnowski, A., & Specter, S. E. (2004). Poverty and obesity: the role of energy density and energy costs. The American Journal of Clinical Nutrition, 79(1), 6–16.
Ezzat, M., Friedman, A. B., Kulkarni, S. C., & Murray, C. J. L. (2008). The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine, 5(4), 66.
Farber, S., & Páez, A. (2007). A systematic investigation of cross-validation in GWR model estimation: empirical analysis and Monte Carlo simulations. Journal of Geographical Systems, 9(4), 371–396.
Finkelstein, E. A., Trogon, J. G., Cohen, J. W., & Diez, W. (2009). Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs, 28(5), 822–831.
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Johnson, C. L. (2002). Prevalence and trends in obesity among US adults, 1999-2000.’. JAMA, the Journal of the American Medical Association, 288, 1723–1727.
Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA, the Journal of the American Medical Association, 307(5), 491–497.
Fotheringham, A. S., & Wong, D. W. S. (1991). The modifiable areal unit problem in statistical analysis. Environment and Planning, 23, 1025–1044.
Fotheringham, A. S., Brunsdon, C., & Charlton, M. E. (2002). Geographically weighted regression: the analysis of spatially varying relationships. Chichester: Wiley.
Fraser, L. K., Clarke, G. P., Cade, J. E., & Edwards, K. L. (2012). Fast food and obesity: a spatial analysis in a large United Kingdom population of children aged 13–15. American Journal of Preventive Medicine, 42(5), 77–85.
Geronimus, A. T., Bound, J., Waidmann, T. A., Hillemeier, M. A., & Burns, P. B. (1996). Excess mortality among blacks and whites in the United States. New England Journal of Medicine, 335, 1552–1558.
Goodchild, M. F. (2011). Formalizing place in geographic information systems communities, neighborhoods, and health. In L. M. M. Burton, S. A. P. Matthews, M. Leung, S. P. A. Kemp, & D. T. T. Takeuchi (Eds.), Social disparities in health and health care (pp. 21–33). New York: Springer.
House, J. S., Schoeni, R. F., Kaplan, G. A., & Pollack, H. (2009). The health effects of social and economic policy: the promise and challenge for research and policy. Ann Arbor, Michigan: The National Poverty Center.
Hu, F. B., Li, T. Y., Colditz, G. A., Willett, W. C., & Manson, J. E. (2003). Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA, the Journal of the American Medical Association, 289, 1785–1791.
Iceland, J. 2004. The multigroup entropy index (also known as Theil’s H or the information theory index). US Census Bureau. http://www.census.gov/hhes/www/housing/housing_patterns/multigroup_entropy.pdf.
Jackson, J., Doescher, M. P., Jerant, A. F., & Hart, L. G. (2005). A national study of obesity prevalence and trends by type of rural county. The Journal of Rural Health, 21, 140–148.
Jelinski, D., Wu, J., 1996. The modifiable areal unit problem and implications for landscape ecology Landscape Ecology 11, 129-140
Kearns, R. A., & Gesler, W. M. (1998). Putting health into place: landscape, identity, and well-being. Syracuse, New York: Syracuse University Press.
Kim, D., Subramanian, S. V., Gortmaker, S. L., & Kawachi, I. (2006). US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis. Social Science & Medicine, 63(4), 1045–1059.
Larson, N. I., Story, M. T., & Nelson, M. C. (2009). Neighborhood environments: disparities in access to healthy foods in the U.S. American Journal of Preventive Medicine, 36, 74–81.
Lean, M. (2010). Health consequences of overweight and obesity in adults. In D. Crawford, R. W. Jeffery, K. Ball, & J. Brug (Eds.), Obesity epidemiology: from Aetiology to public health (pp. 43–58). Oxford: Oxford University Press.
Ledikwe, J. H., Blanck, H. M., Khan, L. K., Serdula, M. K., Seymour, J. D., Tohill, B. C., et al. (2006). Dietary energy density is associated with energy intake and weight status in US adults. The American Journal of Clinical Nutrition, 83, 1362–1368.
Lobao, L., & Kraybill, D. S. (2005). The emerging roles of county governments in metropolitan and nonmetropolitan areas: findings from a national survey. Economic Development Quarterly, 19(3), 245–259.
Lovasi, G. S., Hutson, M. A., Guerra, M., & Neckerman, K. M. (2009). Built environments and obesity in disadvantaged populations. Epidemiologic Reviews, 31, 7–20.
Ludwig, D. S., Peterson, K. E., & Gortmaker, S. L. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet, 357, 505–508.
Lynch, J. W., & Kaplan, G. A. (1997). Understanding How inequality in the distribution of income affects health. Journal of Health Psychology, 2, 297–314.
Macintyre, S., Maciver, S., & Sooman, A. (1993). Area, class and health: should we be focusing on places or people? Journal of Social Policy, 22(02), 213–234.
Macintyre, S., Ellaway, A., & Cummins, S. (2002). Place effects on health: how can we conceptualise, operationalise and measure them? Social Science & Medicine, 55, 125–139.
Matthews SA. Spatial polygamy and the heterogeneity of place: studying people and place via egocentricmethods. In: Burton LM, Kemp SP, Leung M, Matthews SA, Takeuchi DT, editors. Communities,neighborhoods, and health: Expanding the boundaries of place. Springer; 2011. pp. 35–55.
Matthews, S. A., & Yang, T. C. (2012). Mapping the results of local statistics. Demographic Research, 26(6), 151–166.
McLaughlin, D. K., Stokes, C. S., Smith, P. J., & Nonoyama, A. (2007). Differential mortality across the United States: the influence of place-based inequality. In L. M. Lobao, G. Hooks, & A. R. Tickamyer (Eds.), The sociology of spatial inequality. Albany: State University of New York Press.
Menard, S. (2001). Sage publications. Incorporated.: Thousand Oaks, CA. Applied logistic regression analysis.
Mitchell, R. (2001). Multilevel modeling might not be the answer. Environment and planning A, 33(8), 1357–1360.
Morland, K., Wing, S., Diez-Roux, A., & Poole, C. (2002). Neighborhood characteristics associated with the location of food stores and food service places. American Journal of Preventive Medicine, 22, 23–29.
Murray, C. J. L., Sandeep, C. K., Michaud, C., Tomijima, N., Bulzacchelli, M., Iandiorio, T. J., et al. (2006). Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Medicine, 3, 1513–1524.
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents 1999-2010. JAMA, the Journal of the American Medical Association, 307(5), 483–490.
Openshaw S, Taylor PJ. 1981. The modifiable areal unit problem. In: Wrigley, N., Bennett, R., Kegan, P. (Eds), Quantitative Geography: A British View. London. pp. 60–69.
Pacione, M. (1984). Evaluating the quality of the residential environment in a high-rise public housing development. Applied Geography, 4, 59–70.
Popkin, B. M. (2008). The world is Fat—the fads, trends, policies, and products that Are fattening the human race. New York, NY: Avery-Penguin Group.
Procter, K. L., Clarke, G. P., Ransley, J. K., & Cade, J. (2008). Micro‐level analysis of childhood obesity, diet, physical activity, residential socioeconomic and social capital variables:where are the obesogenic environments in Leeds? Area, 40(3), 323–340.
Ramsey, P. W., & Glenn, L. L. (2002). Obesity and health status in rural, urban, and suburban southern women. Southern Medical Journal, 95, 666–671.
Rushton, G., Armstrong, M. P., Gittler, J., Greene, B. R., Pavlik, C. E., West, M. M., & Zimmerman, D. L. (Eds.). (2010). Geocoding health data: the use of geographic codes in cancer prevention and control, research and practice. CRC Press
Sallis, J. F., & Glanz, K. (2009). Physical activity and food environments: solutions to the obesity epidemic. Milbank Quarterly, 87, 123–154.
Schulze, M. B., Manson, J. E., Ludwig, D. S., Colditz, G. A., Stampfer, M. J., Willett, W. C., et al. (2004). Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle- aged women. JAMA, the Journal of the American Medical Association, 292, 927–934.
Schuurman, N., Peters, P. A., & Oliver, L. N. (2012). Are obesity and physical activity clustered? a spatial analysis linked to residential density. Obesity, 17(12), 2202–2209.
Shaw, M., Dorling, D., & Mitchell, R. (2002). Health, place, and society. Harlow: Pearson Education.
Thiele, S., & Weiss, C. (2003). Consumer demand for food diversity: evidence for Germany. Food Policy, 28(2), 99–115.
Tobler, W. (2004). On the first law of geography: a reply. Annals of the Association of American Geographers, 94(2), 304–310.
Tunstall, H. V. Z., Shaw, M., & Dorling, D. (2004). Places and health. Journal of Epidemiology and Community Health, 58(1), 6–10.
Wang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the united states—gender, Age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiologic Reviews, 29, 6–28.
Ward, M. D., & Gleditsch, K. (2008). Spatial regression models. London: Sage.
Wen, T. H., Chen, D. R., & Tsai, M. J. (2010). Identifying geographical variations in poverty-obesity relationships: empirical evidence from Taiwan. Geospatial Health, 4(2), 257–265.
Wheeler, D., & Tiefelsdorf, M. (2005). Multicollinearity and correlation among local regression coefficients in geographically weighted regression. Journal of Geographical Systems, 7(2), 161–187.
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Black, N.C. An Ecological Approach to Understanding Adult Obesity Prevalence in the United States: A County-level Analysis using Geographically Weighted Regression. Appl. Spatial Analysis 7, 283–299 (2014). https://doi.org/10.1007/s12061-014-9108-0
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DOI: https://doi.org/10.1007/s12061-014-9108-0