title: Identifying risk profiles for childhood obesity using recursive partitioning based on individual, familial, and neighborhood environment factors.
abstract: BACKGROUND
  Few studies consider how risk factors within multiple levels of influence operate synergistically to determine childhood obesity. We used recursive partitioning analysis to identify unique combinations of individual, familial, and neighborhood factors that best predict obesity in children, and tested whether these predict 2-year changes in body mass index (BMI).
  
  
  METHODS
  Data were collected in 2005-2008 and in 2008-2011 for 512 Quebec youth (8-10 years at baseline) with a history of parental obesity (QUALITY study). CDC age- and sex-specific BMI percentiles were computed and children were considered obese if their BMI was ≥95th percentile. Individual (physical activity and sugar-sweetened beverage intake), familial (household socioeconomic status and measures of parental obesity including both BMI and waist circumference), and neighborhood (disadvantage, prestige, and presence of parks, convenience stores, and fast food restaurants) factors were examined. Recursive partitioning, a method that generates a classification tree predicting obesity based on combined exposure to a series of variables, was used. Associations between resulting varying risk group membership and BMI percentile at baseline and 2-year follow up were examined using linear regression.
  
  
  RESULTS
  Recursive partitioning yielded 7 subgroups with a prevalence of obesity equal to 8%, 11%, 26%, 28%, 41%, 60%, and 63%, respectively. The 2 highest risk subgroups comprised i) children not meeting physical activity guidelines, with at least one BMI-defined obese parent and 2 abdominally obese parents, living in disadvantaged neighborhoods without parks and, ii) children with these characteristics, except with access to ≥1 park and with access to ≥1 convenience store. Group membership was strongly associated with BMI at baseline, but did not systematically predict change in BMI.
  
  
  CONCLUSIONS
  Findings support the notion that obesity is predicted by multiple factors in different settings and provide some indications of potentially obesogenic environments. Alternate group definitions as well as longer duration of follow up should be investigated to predict change in obesity.
authors.affiliation: Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada. tracie.barnett@iaf.inrs.ca.|Centre de recherche du Centre Hospitalier Universitaire Sainte-Justine, 5757 Avenue Decelles, suite 100, Montréal, H3S 2C3, Québec, Canada. tracie.barnett@iaf.inrs.ca.
authors.forename: Andraea
authors.initials: A
authors.lastname: Van Hulst
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. marie.roy-gagnon@uottawa.ca.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Roy-Gagnon
authors.affiliation: Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada. lise.gauvin.2@umontreal.ca.|Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. lise.gauvin.2@umontreal.ca.|Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, Université de Montréal, Montreal, Quebec, Canada. lise.gauvin.2@umontreal.ca.
authors.forename: Lise
authors.initials: L
authors.lastname: Gauvin
authors.affiliation: Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada. yan.kestens@umontreal.ca.|Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. yan.kestens@umontreal.ca.|Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, Université de Montréal, Montreal, Quebec, Canada. yan.kestens@umontreal.ca.
authors.forename: Yan
authors.initials: Y
authors.lastname: Kestens
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire Sainte-Justine, 5757 Avenue Decelles, suite 100, Montréal, H3S 2C3, Québec, Canada. melanie.henderson.hsj@gmail.com.|Division of Endocrinology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal, Quebec, Canada. melanie.henderson.hsj@gmail.com.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Henderson
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire Sainte-Justine, 5757 Avenue Decelles, suite 100, Montréal, H3S 2C3, Québec, Canada. tracie.barnett@iaf.inrs.ca.|Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, QC, Canada. tracie.barnett@iaf.inrs.ca.
authors.forename: Tracie A
authors.initials: TA
authors.lastname: Barnett
mesh_terms: D015992:Body Mass Index; D002648:Child; D004032:Diet; D004777:Environment; D004779:Environment Design; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D056128:Obesity, Abdominal; D010290:Parents; D063766:Pediatric Obesity / Q000209:etiology*; D015995:Prevalence; D011792:Quebec; D012111:Residence Characteristics; D012147:Restaurants; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D055105:Waist Circumference