title: A multilevel approach to estimating small area childhood obesity prevalence at the census block-group level.
abstract: BACKGROUND
  Traditional survey methods for obtaining nationwide small-area estimates (SAEs) of childhood obesity are costly. This study applied a geocoded national health survey in a multilevel modeling framework to estimate prevalence of childhood obesity at the census block-group level.
  
  
  METHODS
  We constructed a multilevel logistic regression model to evaluate the influence of individual demographic characteristics, zip code, county, and state on the childhood obesity measures from the 2007 National Survey of Children's Health. The obesity risk for a child in each census block group was then estimated on the basis of this multilevel model. We compared direct survey and model-based SAEs to evaluate the model specification.
  
  
  RESULTS
  Multilevel models in this study explained about 60% of state-level variances associated with childhood obesity, 82.8% to 86.5% of county-level, and 93.1% of zip code-level. The 95% confidence intervals of block- group level SAEs have a wide range (0.795-20.0), a low median of 2.02, and a mean of 2.12. The model-based SAEs of childhood obesity prevalence ranged from 2.3% to 54.7% with a median of 16.0% at the block-group level.
  
  
  CONCLUSIONS
  The geographic variances among census block groups, counties, and states demonstrate that locale may be as significant as individual characteristics such as race/ethnicity in the development of the childhood obesity epidemic. Our estimates provide data to identify priority areas for local health programs and to establish feasible local intervention goals. Model-based SAEs of population health outcomes could be a tool of public health assessment and surveillance.
authors: Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS K67, Atlanta, GA 30341, USA. gyx8@cdc.gov
authors: Xingyou
authors: X
authors: Zhang
authors: Stephen
authors: S
authors: Onufrak
authors: James B
authors: JB
authors: Holt
authors: Janet B
authors: JB
authors: Croft
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D016540:Smoking Cessation
references: Health Aff (Millwood). 2010 Mar-Apr;29(3):503-12
references: 20194993
references: Popul Health Metr. 2010 Sep 29;8:26
references: 20920214
references: Arch Pediatr Adolesc Med. 2010 Jul;164(7):598-607
references: 20603458
references: Healthy People 2010 Stat Notes. 2002 Jul;(24):1-12
references: 12117004
references: Int J Health Geogr. 2011 Oct 31;10:58
references: 22040001
references: Vital Health Stat 2. 2012 Jan;(154):1-65
references: 22783637
references: Soc Sci Med. 2000 Apr;50(7-8):1109-20
references: 10714931
references: JAMA. 2006 Apr 5;295(13):1549-55
references: 16595758
references: JAMA. 2012 Feb 1;307(5):483-90
references: 22253364
references: Am J Public Health. 2009 Mar;99(3):470-9
references: 19150913
references: Health Rep. 2011 Sep;22(3):47-58
references: 22106789
references: MMWR Recomm Rep. 2009 Jul 24;58(RR-7):1-26
references: 19629029
references: Vital Health Stat 11. 2002 May;(246):1-190
references: 12043359
references: Int J Health Geogr. 2009 Jan 30;8:6
references: 19183458
references: Stat Med. 1999 Dec 15;18(23):3189-200
references: 10602144
references: Ann Epidemiol. 2008 Sep;18(9):682-95
references: 18794009
references: Health Place. 2009 Jun;15(2):596-605
references: 19083256
references: Am J Public Health. 2009 Mar;99(3):511-9
references: 19150906
references: Health Aff (Millwood). 2010 Mar-Apr;29(3):347-56
references: 20194972
references: Public Health Rep. 2008 Mar-Apr;123(2):117-25
references: 18457064
references: Prev Chronic Dis. 2011 Jul;8(4):A85
references: 21672409
references: Ann Epidemiol. 2010 Jan;20(1):40-52
references: 20006275