Prevalence of and Risk Factors for Childhood Obesity in Tennessee Using the 2010 Youth Risk Behavior Survey (YRBS) Data: a Multilevel Analysis

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Introduction: Childhood obesity has more than quadrupled in the last 30 years, with the prevalence in adolescents aged 12-17 years increasing from 5% in 1980 to 21% in 2012. The purpose of this study was to estimate the extent to which childhood obesity in Tennessee is associated with between-context differences (districts, schools and classes) and to identify factors at the district, school, class, and individual level that influence the individual weight status among 64,790 Tennessee children and adolescents. Methods: Crosssectional data from the Youth Risk Behavior Survey (YRBS) conducted in Tennessee (2010) were used to conduct multilevel analyses that account for the nesting of students in classes, classes in schools and schools in districts. The outcome variable was childhood obesity (>95th percentile). Explanatory variables included district-level factors (the proportion of children wearing seat belts or helmets in district and the proportion of being asked to show proof of age), school-level factors (current tobacco use in school, and HIV/AIDS education in school), class-level factors (the average of smoking days in past 30 days and the proportion of ever having exercised to lose weight in class) and individual-level factors (state geographical regions, age, gender, grade, ever ridden in a car driven by someone who had been drinking alcohol, ever carried a weapon, made a plan to kill yourself, ever used or early onset use of tobacco, alcohol, marijuana, exercised to control weight, school day television time, days of physical education (PE) classes. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported. Results: Multilevel analyses indicate that 0.90%, 0.08%, and 0.45% of the variation in obesity is associated with class, school and district differences, respectively. Male middle schoolers were at greater risk for obesity [OR: 1.82, C.I. (1.75, 1.89)] compared to females. For every one year increase in age, the relative odds of obesity increased by 11% (OR 0.89, 95% CI 0.88-0.91). Students with worse grades were more likely to have obesity [OR: 1.33, C.I. (1.13, 1.56)]. Students who watched TV 3 hours or more per day were more likely to be obese [OR: 1.31, C.I. (1.23, 1.40)] compared to those who did less than 3 hours per day. Similarly students who ever tried cigarettes were more likely to be obese [OR: 2.15, C.I. (1.62, 2.85)] compared to those students who did not. Students who reported wearing seat belts [OR: 0.05, C.I. (0.02, 0.16)] were less likely to be obese. Conclusions: This study highlights a number of modifiable factors on multiple levels associated with child and adolescent obesity in the state of Tennessee. The results emphasize the importance of targeting programs beyond individual adolescent factors to the child’s classes, schools, and school districts, to reduce the prevalence of obesity among Tennessee adolescents.


Johnson City, TN

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