Exploring Mechanisms Underlying Social Determinants Of Health In Childhood Obesity And The Followed Strategy Building

Objective:Being overweight in childhood increases the risk of various chronic disease.Most of obese children are likely to be obese when they become adults and to have increased risk of premature mortality compared with those with normal weight in childhood.Unhealthy lifestyle brought by social environmental changes is the main cause of childhood obesity.Meanwhile,obesity is also a good point to expore the relationship between society and health.Current studies provide indeas for China.However,question still needs to be solved that what is the mechanism of social determinants of health.By exploring this mechanism in China,the present study aims to contribute to the current theory about social determiant of health related to childhood obesity.Then specific strategy for Shenyang would be raised to help childhood obesity prevention in the city.Methods:To explore the relationship between economic development and childhood obesity at the country level,data of 125 countries was collected including overweight and obesity(OWOB)prevalence,gross national income(GNI)per capita,post-materialistic orientation value shift score and so on.Then physical examination,questionnaires,Geographic Information System was used to collect data from 13 districts/counties in Shenyang.Relationship between obesity,built environment,social economic status and health behavior was explored.At last,qualitative study was used to built prevention strategy based on the information acquired by quatitative parts,on searching for policies of developed countries and on analyzing related policies in China.Results:1.OWOB prevalence for 2013 presented an inverted U-shaped relationship with GNI per capita for 2010,2011,2012,2013 and their average value.Spline regression models showed that a 1%increase in GNI per capita correlated with a 4.6%-4.7%increase for boys,3.5%-3.6%increase for girls in OWOB prevalence up to $US 20,000 and 6.6%-7.9%decrease for boys,7.6%-8.9%decrease for gilrs above $US 20,000,respectively.2.Post-materialistic orientation value was negatively correlated with OWOB prevalence,and after adjusting for post-materialistic orientation value shift in the spline regression models,the negative OWOB coefficient for GNI per capita beyond$US 20,000 was weakened and became non-significant.3.Household wealth and parents’education level interacted with each other in relation to obesity among girls(p<0.05 for both Wald test and LR test).In the 5th wealth quintile,OR for father’s education was 0.54(95%CI:0.29～0.99)and for mother’s education was 1.94(95%CI:1.03～3.66).4.Six types of social economic status were identified using clustering analysis.Highest obesity risk was for those girls from moderate wealth families with parents have secondary education and self-employed.While the lowest fisk was for those girls from rich faimilies with parents have high education and work as managers in institutions and enterprises.5.With the increase in social material resources,disparity increased on children’s BMI and waist to hip ratio between different social economic status.Children form poor families,type Ⅰ ffamilies,and type Ⅱ families were affected most.6.Built environment factors related to childhood obesity included:land use,phycial activity center,residential density,public transporation stations,desert shops,farmer market,convinence stores,fast-food resturants.7.Built environment related to physicial activity around schools,both built environment related to physical activity and diet around family could affect childhood obesity.8.Physical activity and vegetable diet mediated the relationship between social economic status and obesity among girls from type Ⅲmoderate families,type Ⅰ rich families,type Ⅱ rich families.Conclusion:1.Childhood obesity presented an inverted U-shaped relationship with GNI per capita.To a certain level of economic growth,post-materialism orientation values take effect on obesity prevalence,instead of material factors.2.For the mechanisms,household wealth and parents’ education interacts,social material environment resources and social economic status interacts and health behaviors mediates the social distribution of childhood obesity.3.The present implicated for childhood obesity prevention in Shenyang that moderate social economic status children has the highest obesity risk;low social economic status children are susceptible to environment;influencing environment factor includes land use,phycial activity center,residential density,public transporation stations,desert shops,farmer market,convinence stores,fast-food resturants;influencing behavioral factors includes physicial activity and vegetable diet.