Does Neighborhood Opportunity Impact Adolescent Metabolic Risk?

​Izzuddin Aris, PhD

Family socioeconomic status and the environments where children live, learn and play (i.e., their homes, neighborhoods, and schools) are known to contribute to children’s and adolescents’ health trajectory and may specifically impact metabolic risk. .  Research shows that children living in deprived neighborhoods (i.e., high poverty and unemployment rates, lack of healthy food choices) are less likely to stay on a healthy developmental trajectory than their peers. Commonly used research indices on neighborhood environments only represent selected aspects of socioeconomic disadvantage, such as poverty, low income level and unemployment and don’t  adequately describe other conditions in the same neighborhood that may counteract the risks associated with living in disadvantaged neighborhoods, such as access to healthy food choices. 

​Researchers at Brandeis University developed the Child Opportunity Index (COI) as a summary measure of the quality of neighborhoods children would typically experience everyday across the United States to address these limitations. This index quantifies 29 indicators of neighborhood conditions that matter for children’s healthy development across three different domains: education, health and environment, and social and economic. The index incorporates both traditional (e.g., median household income) and novel (e.g., access to healthy food choices) attributes of neighborhood conditions that may promote or inhibit healthy child development. The COI provides a measure of neighborhood “opportunity” relative to other neighborhoods at the metropolitan, state or national level.. To date, it has been used to examine disparities in acute health care use among pediatric patients and shown to be associated with children’s stress physiology. However, it is still unclear whether the COI relates to individual-level cardiometabolic outcomes in early adolescence, an important question given the high and increasing prevalence of morbidity from these conditions.

In our latest study, we investigated the extent to which neighborhood-level COI in mid-childhood was associated with individual-level cardiometabolic outcomes in mid-childhood and early adolescence. We geocoded residential addresses obtained from participants in mid-childhood (~ 8 years of age) in Project Viva, a pre-birth cohort from eastern Massachusetts, and linked each geocoded location with publicly available census-tract level COI data. Within the study sample, we noted that more than 50% of children resided in areas of “very high” overall opportunity in mid-childhood (i.e., COI score equal to or greater than 80 units, on a scale of 0‒100 units). We observed that children who resided in neighborhoods with higher overall opportunity in mid-childhood had persistently lower levels of C-reactive protein (a marker of inflammation) from mid-childhood to early adolescence. We also noted that certain individual indicators of the COI, such as greater number of high-quality childhood education centers, greater access to healthy food and greater proximity to employment in mid-childhood, were associated with persistently lower adiposity and metabolic risk from mid-childhood to early adolescence.
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Our findings suggest that the COI could be a potentially useful index to target high risk children and tailor interventions for children at risk of developing adverse cardiometabolic health outcomes, by  addressing the disparate neighborhood contexts where they live, learn and play. The COI could also be used to guide place-based initiatives, such as neighborhood development projects, that aim to improve access to essential resources and provide families with the environments needed to support healthy child development. More research is needed to clarify whether initiatives that alter specific components of neighborhood opportunity would be effective in improving later cardiometabolic health.