Race or Place: Neighborhood Determinants of Adolescent Obesity.

Purpose: Area-based socioeconomic factors contribute significantly to the complex relationship between neighborhood characteristics and obesity. This study examined the relationship between socioeconomic characteristics of school neighborhoods and the prevalence of obesity among adolescents in the United States.

Methods: We analyzed data for 21,392 students from a school-based blood pressure-screening project. Students were clustered into 28 neighborhoods based on their school matriculation, and weighted Area Deprivation Index measures were generated to represent each school's catchment area. The Area Deprivation Index was categorized into quartiles, with quartile 1 (Q1) representing schools in less-disadvantaged neighborhoods, and quartile 4 (Q4) representing schools in more disadvantaged neighborhoods. Logistic regression analyses were used to examine bivariate and adjusted associations.

Results: There was a stepwise increase in obesity prevalence, with the lowest prevalence in Q1 and the highest in Q4 among Hispanic students and Black students. White and Asian students attending schools in Q1 had the lowest prevalence of obesity. Multivariable regression analysis showed that younger age, male sex, race/ethnicity, high blood pressure status, and school neighborhood were significantly associated with obesity.

Discussion: Hispanic and Black students attending schools in high-poverty areas had the highest rates of obesity. Our findings suggest that, in addition to race/ethnicity, neighborhood-level poverty is a significant predictor of obesity rates, emphasizing the relationship between environmental and biological determinants of obesity.