title: Family-based social determinants and child health: Cross-sectional study.
abstract: BACKGROUND
  The aim of this study was to evaluate the association between urbanization of residential area, parent education level, employment status, overweight/obesity, physical activity, and exposure to environmental tobacco smoke (ETS), in a sample of healthy Italian school-age children (5-11 years).
  
  
  METHODS
  A cross-sectional study was conducted on 432 children resident, respectively, in a highly urban and in a rural area (Latium Region) in 2014. Information on children and families were obtained via questionnaire.
  
  
  RESULTS
  One-third of children were overweight or obese, 15% did not participate in any sport outside school, and more than one-third were exposed to ETS in the domestic environment. Living in a rural area (adjusted OR, 2.55; 95%CI: 1.18-5.52) and lower maternal education (adjusted OR, 2.32; 95%CI: 1.03-5.27) were significant predictors of overweight/obese status. Moreover, lower maternal education level (adjusted OR, 2.74; 95%CI: 1.40-5.33) and paternal education level (adjusted OR, 3.06; 95%CI: 1.54-6.07) were significant predictors of ETS exposure.
  
  
  CONCLUSIONS
  It is essential to investigate the reasons underlying the higher frequency of overweight/obesity in children living in rural environments compared with those in urban areas; and preventative actions should be designed to be easily understood by those with lower education levels.
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Protano
authors.affiliation: Unit of Public Health, University of Rome Foro Italico, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Valeriani
authors.affiliation: Health Services and Management, Teaching Hospital Policlinico Umberto I, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Macedonio
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Cammarota
authors.affiliation: Unit of Public Health, University of Rome Foro Italico, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Romano Spica
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Orsi
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Vitali
mesh_terms: D002648:Child; D000067576:Child Health / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment; D015444:Exercise; D005260:Female; D006306:Health Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000209:etiology; D050177:Overweight / Q000453:epidemiology / Q000209:etiology; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data*; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: child; environmental tobacco smoke exposure; overweight/obesity; physical activity; social determinant