Small-area estimation and prioritizing communities for obesity control in Massachusetts.
OBJECTIVE
We developed a method to evaluate geographic and temporal variations in community-level obesity prevalence and used that method to identify communities in Massachusetts that should be considered high priority communities for obesity control.


METHODS
We developed small-area estimation models to estimate community-level obesity prevalence among community-living adults 18 years or older. Individual-level data from the Behavioral Risk Factors Surveillance System from 1999 to 2005 were integrated with community-level data from the 2000 US Census. Small-area estimation models assessed the associations of obesity (body mass index >or= 30 kg/m(2)) with individual- and community-level characteristics. A classification system based on level and precision of obesity prevalence estimates was then used to identify high-priority communities.


RESULTS
Estimates of the prevalence of community-level obesity ranged from 9% to 38% in 2005 and increased in all communities from 1999 to 2005. Fewer than 7% of communities met the Healthy People 2010 objective of prevalence rates below 15%. The highest prevalence rates occurred in communities characterized by lower income, less education, and more blue-collar workers.


CONCLUSIONS
Similar to the rest of the nation, Massachusetts faces a great challenge in reaching the national obesity control objective. Targeting high-priority communities identified by small-area estimation may maximize use of limited resources.
Li
Wenjun
W
University of Massachusetts Medical School, 55 Lake Avenue N, Shaw SH2-230, Worcester, MA 01655, USA. wenjun.li@umassmed.edu
Kelsey
Jennifer L
JL
Zhang
Zi
Z
Lemon
Stephenie C
SC
Mezgebu
Solomon
S
Boddie-Willis
Cynthia
C
Reed
George W
GW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015233:Models, Statistical; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D015995:Prevalence; D011634:Public Health; D012111:Residence Characteristics; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult