Are Neighborhood Crime and Poverty Associated with Obesity among Low-Income Preschoolers?

Neighborhoods interact with individual and community health in complex ways. Prior research has established a connection between perceived neighborhood safety and children’s physical activity levels and how low-income and racial- or ethnic-minority preschoolers disproportionately experience obesity. This recent study explored the association between two social determinants of health, the crime and poverty rates in a neighborhood, and experiences of being overweight and obese among low-income, preschool-aged primary care patients in Baltimore.

In this analysis, researchers used three datasets to determine the relationship between neighborhood crime and poverty rates and the prevalence of being overweight and obese among low-income preschoolers: patient data on 3,684 children from two urban, hospital-based pediatric primary care clinics in Baltimore, Maryland; census block group (CBG)–level data on violent crime from the Baltimore City Police Department; and CBG-level data on neighborhood socioeconomic status from the five-year 2013 American Community Survey. A census block group is the smallest geographic unit in census data and typically includes an area with a population of 600 to 3,000 people. To examine this connection, the researchers first determined the crime and poverty rates of the CBG in which the children lived. Next, they linked these data to children’s body mass index percentiles (calculated from the patient data).

Key findings

• The majority of preschoolers in the dataset (54 percent) lived in high-poverty neighborhoods (those with more than 20 percent of families living below the federal poverty level).
• Black patients were more likely to live in high-poverty CBGs compared with white patients.
• Black and Hispanic patients were more likely to live in CBGs with a high number of violent crimes compared with white patients.
• There was no statistically significant association between poverty and a child being overweight or obese for preschoolers among any of the three racial and ethnic groups studied (white, Black, and Hispanic).
• There was no statistically significant association between crime and obesity among white or Hispanic preschoolers. There was a negative association between crime and obesity among Black preschoolers, indicating that as crime rates increased, the odds of obesity decreased. This was counter to what the researchers expected to see. Although it was a statistically significant finding, it was not a “clinically” significant association.

Research implications

• This study represents one of the few to describe the geographic distribution and neighborhood environmental exposures for preschool-aged primary care patients.
• The researchers emphasized that measuring neighborhood exposures in a small geographic area (i.e., using a CBG as the area of interest) is important for understanding the relationship between neighborhood socioeconomic status, crime, and obesity risk among preschoolers in particular, as prior research has shown that the immediate surrounding areas where young children live most accurately reflect their lived experience.
• The researchers cited several pathways for future research examining the association between neighborhood environments and child overweight and obesity among clinical populations: consideration of both objective and perceived measures of neighborhood environments; utilization of longitudinal data in order to capture how changes in neighborhood environments affect children’s weight over time; and inclusion of additional child- and parent-level behavioral indictors (i.e., diet and physical activity) and neighborhood-level exposures (i.e., food environment and proximity to recreational spaces).
• Finally, instead of designating an arbitrary radius around each clinic as the catchment area, the researchers collected data to understand how many patients lived in each CBG in the city and then identified the areas where the majority of patients lived. This method can inform how clinics better understand their patients using information about where their patients live and the neighborhood exposures that impact their health.

*The How Housing Matters editorial team decided to use the term “Hispanic” to refer to people of Latin American origin, in alignment with the terminology used by the authors of the study. We recognize that the term “Latinx” is more inclusive of the way this group may self-identify. How Housing Matters strives to avoid language that is exclusive and will always attempt to explain the editorial rationale behind the labeling of certain groups.

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