title: 'Fish out of water': a cross-sectional study on the interaction between social and neighbourhood effects on weight management behaviours.
abstract: OBJECTIVE
  To analyse whether an individual's neighbourhood influences the uptake of weight management strategies and whether there is an interaction between individual socio-economic status and neighbourhood deprivation.
  
  
  METHODS
  Data were collected from the Yorkshire Health Study (2010-2012) for 27 806 individuals on the use of the following weight management strategies: 'slimming clubs', 'healthy eating', 'increasing exercise' and 'controlling portion size'. A multi-level logistic regression was fit to analyse the use of these strategies, controlling for age, sex, body mass index, education, neighbourhood deprivation and neighbourhood population turnover (a proxy for neighbourhood social capital). A cross-level interaction term was included for education and neighbourhood deprivation. Lower Super Output Area was used as the geographical scale for the areal unit of analysis.
  
  
  RESULTS
  Significant neighbourhood effects were observed for use of 'slimming clubs', 'healthy eating' and 'increasing exercise' as weight management strategies, independent of individual- and area-level covariates. A significant interaction between education and neighbourhood deprivation was observed across all strategies, suggesting that as an area becomes more deprived, individuals of the lowest education are more likely not to use any strategy compared with those of the highest education.
  
  
  CONCLUSIONS
  Neighbourhoods modify/amplify individual disadvantage and social inequalities, with individuals of low education disproportionally affected by deprivation. It is important to include neighbourhood-based explanations in the development of community-based policy interventions to help tackle obesity.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Green
authors.affiliation: School of Public Health, Harvard, Boston, MA, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: M
authors.initials: M
authors.lastname: Strong
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Cooper
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Loban
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bissell
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004038:Diet, Reducing / Q000523:psychology; D004522:Educational Status; D004739:England / Q000453:epidemiology; D015444:Exercise / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D015995:Prevalence; D012111:Residence Characteristics; D012931:Social Environment; D012959:Socioeconomic Factors
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