title: Urban Park Development and Pediatric Obesity Rates: A Quasi-Experiment Using Electronic Health Record Data.
abstract: BACKGROUND
  Childhood obesity affects ~20% of children in the United States. Environmental influences, such as parks, are linked with increased physical activity (PA).
  
  
  OBJECTIVE
  To examine whether changes in Body Mass Index (BMI) z-score were associated with construction of a new park.
  
  
  METHODS
  A quasi-experimental design was used to determine whether living in proximity of a park was associated with a reduction in BMI z-score. Children were selected from health clinics within an 11 mile radius of the park. A repeated-measure ANOVA was employed for analysis of the relationship between exposure (new park) and BMI z-score.
  
  
  RESULTS
  Participants were 1443 (median age 10.3 range (2-17.9 years), BMI: z-score 0.84 ± 1.09) African American (77.4%) adolescents. Change in BMI z-score was not statistically different for children living at different distances from the park after controlling for age, gender, race, ethnicity, or payer type (p = 0.4482). We did observe a small 0.03 increase in BMI z-score from pre- to post-park (p = 0.0007). There was a significant positive association between child's baseline age and BMI z-score (p < 0.001).
  
  
  CONCLUSIONS
  This study found proximity to a park was not associated with reductions in BMI z-score. Additional efforts to understand the complex relationship between park proximity, access, and PA are warranted.
authors.affiliation: Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA. tgoldsby@uab.edu.|Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA. tgoldsby@uab.edu.
authors.forename: TaShauna U
authors.initials: TU
authors.lastname: Goldsby
authors.affiliation: Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA. brgeorge@uab.edu.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: George
authors.affiliation: Department of Global Health Management and Policy, Tulane University, New Orleans, LA 70112, USA. vayeager@tulane.edu.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Yeager
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294, USA. bsen@uab.edu.
authors.forename: Bisakha P
authors.initials: BP
authors.lastname: Sen
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center, College Station, TX 77843, USA. ferdinand@tamhsc.edu.
authors.forename: Alva
authors.initials: A
authors.lastname: Ferdinand
authors.affiliation: Scientific Technologies Corporation, Scottsdale, AZ 85258, USA. devon_sims@stchome.com.
authors.forename: Devon M T
authors.initials: DM
authors.lastname: Sims
authors.affiliation: Jefferson County Department of Health, Birmingham, AL 35233, USA. bryn.manzella@jcdh.org.
authors.forename: Bryn
authors.initials: B
authors.lastname: Manzella
authors.affiliation: Division of General Internal Medicine, The Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA. asheley.skinner@duke.edu.
authors.forename: Asheley
authors.initials: A
authors.lastname: Cockrell Skinner
authors.affiliation: Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA. dallison@uab.edu.|Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA. dallison@uab.edu.|Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA. dallison@uab.edu.
authors.forename: David B
authors.initials: DB
authors.lastname: Allison
authors.affiliation: Department Health Policy and Management, Indiana University, Indianapolis, IN 46202, USA. nirmena@iu.edu.
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D000293:Adolescent; D000407:Alabama / Q000453:epidemiology; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D000068316:Parks, Recreational; D063766:Pediatric Obesity / Q000453:epidemiology*; D044469:Racial Groups; D014506:Urban Renewal
keywords: built environment; childhood obesity; electronic health records; quasi-experiment