title: Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.
abstract: BACKGROUND
  New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007.
  
  
  METHODS
  We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System.
  
  
  RESULTS
  Early childhood obesity prevalence declined in all study neighborhoods from 2004-2006 to 2008-2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004-2006 to 15.3% in 2008-2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn.
  
  
  CONCLUSIONS
  The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.
authors.affiliation: Division of Nutrition, New York State Department of Health, 150 Broadway, Menands, NY 12204. E-mail: Jackson.Sekhobo@health.ny.gov.
authors.forename: Jackson P
authors.initials: JP
authors.lastname: Sekhobo
authors.affiliation: New York State Department of Health, Albany, New York.
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Edmunds
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Karen
authors.initials: K
authors.lastname: Dalenius
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jan
authors.initials: J
authors.lastname: Jernigan
authors.affiliation: University at Albany School of Public Health, Albany, New York.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Davis
authors.affiliation: New York State Department of Health, Albany, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Giddings
authors.affiliation: ICF International, Atlanta, Georgia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lesesne
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Laura
authors.initials: L
authors.lastname: Kettel Khan
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence* / Q000592:standards*; D002664:Child Nutritional Physiological Phenomena; D005522:Food Services; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City; D063766:Pediatric Obesity / Q000453:epidemiology*; D011203:Poverty; D012111:Residence Characteristics; D012307:Risk Factors; D044465:White People