title: Association between economic status and body mass index among adolescents: a community-based cross-sectional study in Japan.
abstract: BACKGROUND
  Childhood overweight and obesity is a growing health challenge in Japan and might be associated with childhood poverty. We aimed to investigate the association between low economic status and body mass index (BMI) and to reveal the mediators of this association among junior high school students in Japan.
  
  
  METHODS
  Junior high school students (N= 2968) from two cities in Shizuoka, Japan, were surveyed. Questionnaires assessed subjective economic status, weight, and height. Economic status was categorized into low and non-low, and BMI z-scores were calculated using the WHO Growth Reference. Multivariate regression analyses were conducted to determine the association between economic status and BMI z-scores, adjusted for covariates and stratified by gender.
  
  
  RESULTS
  Among girls, low economic status was significantly positively associated with BMI z-scores in the crude model (coefficient: 0.35;p= 0.001). In a model adjusted for breakfast skipping, the coefficient of economic status decreased by 28.57 % but remained significant (coefficient: 0.25;p= 0.017). In the final model adjusted for other possible covariates, low economic status remained significantly positively associated with BMI z-score (coefficient: 0.22;p= 0.044). The same association was not found for boys.
  
  
  CONCLUSIONS
  Low economic status was positively associated with higher BMI among girls in junior high school in Japan, but this was not true for boys. Childhood poverty might be associated with overweight and obesity among adolescent girls in Japan. Health policies at junior high schools to discourage breakfast skipping might be effective for countering the association between childhood poverty and overweight in adolescent girls.
authors.affiliation: Department of Community Health Nursing, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192 Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Mizuta
authors.affiliation: Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan.
authors.forename: Takeo
authors.identifier: 0000-0002-1074-3954
authors.initials: T
authors.lastname: Fujiwara
authors.affiliation: Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192 Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ojima
keywords: Adolescent; BMI; BMI z-score; Breakfast skipping; Economic status