# Presentation: 137005

## A Multilevel Study of the Association between Economic and Social Context, Stage of Adolescence, and Physical Activity and BMI

- Caroline Mae McKay, Ph.D.
- Bethany A. Bell-Ellison, M.P.H.
- Kirsten Wallace, M.A., M.S.P.H.
- John M. Ferron, Ph.D.

## Study Rationale

- 3 lines of interest
- Growing burden of cardiovascular disease risk behavior among adolescents
- Approximately 30% overweight
- Over 30% no regular activity
- Individual change prevention strategies limited; need to focus on broader factors
- Decontextualized approach incomplete
- Role of social environment in shaping risk
- Growing evidence of poverty

## Rationale and Purpose

- 3.   Effect of context on behavior may differ by developmental stage
- Differential effect of place
- Transitions (e.g., early, middle, late) may shape risk
- Moderating role of stage on contextual influence on behavior not well studied
**Purpose**: Examine economic and social contexts on odds of being inactive or overweight and determine if influences differed by stage of adolescence

## Methodology – Variables

- Multilevel Modeling
- _Individual-level_
- Outcomes
- Physical activity: yes (= 0) OR no (= 1)
- BMI: normal (= 0) OR overweight/obese (=1)
- Control
- Sociodemographic characteristics
- Moderator
- Stage of adolescence: early (10-13), middle (14-16), late (17)

## Methodology - Variables

- _Contextual-level_
- Economic indicator
- Poverty: proportion of population < 200% FPL
- Social capital indicators
- Social trust: aggregated responses (“If my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child”)
- Mutual aid: aggregated responses (“People in my neighborhood help each other out”)

## Results: Context       Physical Activity

- Economic Context
- No association found
- Social Context
- Mutual aid
- Regardless of age, higher odds of reporting inactivity if adolescent lives in a state with strong mutual aid (OR 4.27, 1.55 - 11)
- However, moderating influence found – effect greater among younger adolescents

## Context           Physical Activity

- Social Context
- Social Trust
- Regardless of age, higher odds of reporting inactivity if adolescent lives in a state with strong social trust (OR 9.26, 1.74 – 49.)
- Association **not** moderated by stage of adolescence

## Results: Context           BMI

- Economic Context
- Poverty
- Regardless of age, higher odds of having above-normal BMI if adolescent lives in a state with more poverty (OR 2.12, 1.18 – 3.82)
- Association **not** moderated by stage of adolescence

## Context          BMI

- Social Context
- Moderating influence found
- For late adolescence, youth who lived in states with higher levels of mutual aid and social trust had the greatest odds of having having above-normal BMI (OR 1.68, 1.07 – 2.64; OR 3.11, 1.50 – 6.47)

## Context          BMI (con’t.)

- Social Context
- Same pattern for both indicators
- For early adolescence, living in states with high levels of mutual aid and social trust protective (OR 0.61, 0.39-0.97)
- For late adolescence, living in states with high levels of mutual aid and social trust confers excess risk

## Summary of Findings

- No consistent pattern
- Direction of effect and mechanisms may differentially operate based on age and outcome
- Complexity of findings (e.g., feature of development)
- Evidence environment provides opportunities or barriers for individual action

## Implications

- Need for additional knowledge on contextual influences on adolescent risk
- Practice-related activities
- Policy-related endeavors
- Consideration of multilevel nature of growing problem of inactivity and obesity