Proximal and Distal Environmental Correlates of Adolescent Obesity

Document Type


Conference Title/Conference Publication

Combined Sections Meeting


American Physical Therapy Association


San Diego, CA

Conference Dates

January 21-24, 2013

Date of Presentation



PURPOSE/HYPOTHESIS: To determine how proximal (home) and distal (neighborhood) environmental characteristics interact to influence obesity in early and middle adolescents, ages 11-17.

NUMBER OF SUBJECTS: 39,542 children aged 11-17 from households identified from 2.8 million randomly generated landline telephone numbers from the Centers for Disease Control and Prevention's (CDC) National Immunization Survey (NIS) sampling frame.

MATERIALS/METHODS: Descriptive cross-sectional study design using data extracted from the 2007 National Survey of Children's Health (NCSH). Univariate logistic regression models and multiple logistic regression were used to examine the relationship between adolescent obesity and environmental factors, the relative strength of the direct and indirect association with adolescent obesity, and the influence of age and gender.

RESULTS: Proximal environmental factors were stronger correlates of adolescent obesity than distal environmental factors. The influence of TV watching time on obesity for middle adolescents was stronger than for early adolescents (OR 0.71, 95% CI 0.94-1.0). The effect of TV watching time on obesity for boys was stronger than for girls (OR 1.07, 95% CI 1.03-1.10). Sedentary behavior related to TV watching time was the strongest correlate of adolescent obesity overall.

CONCLUSIONS: The results of this US population-based study reveal the importance of proximal environmental characteristics on adolescent obesity relative to distal environmental characteristics, and the overall consistency of the influences of proximal and distal environmental factors on obesity across age groups and gender.

CLINICAL RELEVANCE: The results of this US population-based study begin to fill the gap in adolescent obesity research with an improved understanding of the relatedness and relative importance of home and neighborhood environmental correlates of adolescent obesity. Home, family, and community influences on adolescent obesity highlight the multidimensional nature of interactions with the environment during this stage of development. Insight into the influence of proximal and distal environmental attributes can inform theory for adolescent obesity intervention planning. Our findings suggest that obesity intervention strategies for adolescents should target sedentary behavior as well as opportunities for physical activity with a focus on the groups at a higher risk for obesity-early adolescents and boys.


Published as an Abstract in Pediatric Physical Therapy, Spring 2013, Volume 25, Issue 1, p. 118.

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