Slide 1 A Multilevel Study of the Association between Economic and Social Context, Stage of Adolescence, and Physical Activity and BMI Caroline Mae McKay, PHD Bethany A Bell-Ellison, MPH Kirsten Wallace, MA, MSPH John M Ferron, PHD Slide 2 Study Rationale Three lines of interest 1: Growing burden of cardiovascular disease risk behavior among adolescents Approximately 30 percent overweight More than 30 percent no regular activity 2: Individual change prevention strategies limited; need to focus on broader factors Decontextualized approach incomplete Role of social environment in shaping risk Growing evidence of poverty Slide 3 Rationale and Purpose 3. Effect of context on behavior may differ by developmental stage Differential effect of place Transitions; EG, early, middle, late; may shape risk Moderating role of stage on contextual influence on behavior not well-studied Purpose: Examine economic and social contexts on odds of being inactive or overweight and determine if influences differed by stage of adolescence Slide 4 Methodology: Variables Multilevel modeling Individual level Outcomes Physical activity: yes, 0; or no, 1 BMI: normal, 0; or overweight or obese, 1 Control Sociodemographic characteristics Moderator Stage of adolescence: early, 10 to 13; middle, 14 to 16; late, 17 Slide 5 Methodology: Variables Contextual level Economic indicator Poverty: proportion of population less than 200 percent FPL Social capital indicators Social trust: aggregated responses: If my child were outside playing and got hurt or scared, there are adults nearby whom I trust to help my child Mutual aid: aggregated responses: People in my neighborhood help each other out Slide 6 Results: Context Leads to Physical Activity Economic Context No association found Social Context Mutual aid Regardless of age, higher odds of reporting inactivity if adolescent lives in a State with strong mutual aid; OR 4.27, 1.55 to 11 However, moderating influence found; effect greater among younger adolescents Slide 7 Context Leads to Physical Activity Social Context Social Trust Regardless of age, higher odds of reporting inactivity if adolescent lives in a State with strong social trust; OR 9.26, 1.74 to 49 Association not moderated by stage of adolescence Slide 8 Results: Context Leads to BMI Economic Context Poverty Regardless of age, higher odds of having above-normal BMI if adolescent lives in a State with more poverty; OR 2.12, 1.18 to 3.82 Association not moderated by stage of adolescence Slide 9 Context Leads to BMI Social Context Moderating influence found For late adolescence, youth who lived in States with higher levels of mutual aid and social trust had the greatest odds of having above-normal BMI; OR 1.68, 1.07 to 2.64; OR 3.11, 1.50 to 6.47 Slide 10 Context Leads to BMI Social Context Same pattern for both indicators For early adolescence, living in States with high levels of mutual aid and social trust protective; OR 0.61, 0.39 to 0.97 For late adolescence, living in States with high levels of mutual aid and social trust confers excess risk Slide 11 Summary of Findings No consistent pattern Direction of effect and mechanisms may operate differentially based on age and outcome Complexity of findings; EG, feature of development Evidence environment provides opportunities or barriers for individual action Slide 12 Implications Need for additional knowledge on contextual influences on adolescent risk Practice-related activities Policy-related endeavors Consideration of multilevel nature of growing problem of inactivity and obesity