▪ Abstract Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.

Socioeconomic status and child development.

The current evidence suggests that many diet and exercise interventions to prevent obesity in children are not effective in preventing weight gain, but can be effective in promoting a healthy diet and increased physical activity levels.Being very overweight (obese) can cause health, psychological and social problems for children. Children who are obese are more likely to have weight and health problems as adults. Programmes designed to prevent obesity focus on modifying one or more of the factors considered to promote obesity.This review included 22 studies that tested a variety of intervention programmes, which involved increased physical activity and dietary changes, singly or in combination. Participants were under 18 and living in Asia, South America, Europe or North America. There is not enough evidence from trials to prove that any one particular programme can prevent obesity in children, although comprehensive strategies to address dietary and physical activity change, together with psycho-social support and environmental change may help. There was a trend for newer interventions to involve their respective communities and to include evaluations.Future research might usefully assess changes made on behalf of entire populations, such as improvements in the types of foods available at schools and in the availability of safe places to run and play, and should assess health effects and costs over several years.The programmes in this review used different strategies to prevent obesity so direct comparisons were difficult. Also, the duration of the studies ranged from 12 weeks to three years, but most lasted less than a year.

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Interventions for preventing obesity in children

Biological reactivity to psychological stressors comprises a complex, integrated, and highly conserved repertoire of central neural and peripheral neuroendocrine responses designed to prepare the organism for challenge or threat. Developmental experience plays a role, along with heritable, polygenic variation, in calibrating the response dynamics of these systems, with early adversity biasing their combined effects toward a profile of heightened or prolonged reactivity. Conventional views of such high reactivity suggest that it is an atavistic and pathogenic legacy of an evolutionary past in which threats to survival were more prevalent and severe. Recent evidence, however, indicates that (a) stress reactivity is not a unitary process, but rather incorporates counterregulatory circuits serving to modify or temper physiological arousal, and (b) the effects of high reactivity phenotypes on psychiatric and biomedical outcomes are bivalent, rather than univalent, in character, exerting both risk-augmenting and risk-protective effects in a context-dependent manner. These observations suggest that heightened stress reactivity may reflect, not simply exaggerated arousal under challenge, but rather an increased biological sensitivity to context, with potential for negative health effects under conditions of adversity and positive effects under conditions of support and protection. From an evolutionary perspective, the developmental plasticity of the stress response systems, along with their structured, context-dependent effects, suggests that these systems may constitute conditional adaptations: evolved psychobiological mechanisms that monitor specific features of childhood environments as a basis for calibrating the development of stress response systems to adaptively match those environments. Taken together, these theoretical perspectives generate a novel hypothesis: that there is a curvilinear, U-shaped relation between early exposures to adversity and the development of stress-reactive profiles, with high reactivity phenotypes disproportionately emerging within both highly stressful and highly protected early social environments.

https://cals.arizona.edu/fcs/sites/cals.arizona.edu.fcs/files/D&P%20Boyce%20&%20Ellis%202005.pdf

Biological sensitivity to context: I. An evolutionary–developmental theory of the origins and functions of stress reactivity

Background The World Health Organization estimates that 19 million deaths worldwide are attributable to physical inactivity Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease Objectives The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents Search strategy The search strategy included searching several databases In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews Primary authors of included studies were contacted as needed for additional information Selection criteria To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group Data collection and analysis Standardized tools were used by two independent reviewers to rate each studyﾒs methodological quality and for data extraction Where discrepancies existed discussion occurred until consensus was reached The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured Main results 13,841 titles were identified and screened and 482 articles were retrieved Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies) Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak In total 26 studies were included in the review There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects Authors' conclusions Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time

/pdf/school-based-physical-activity-programs-for-promoting-gw0a82ku2q.pdf

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18.

In the United States, health disparities in obesity and obesity-related illnesses have been the subject of growing concern. To better understand how obesity-related health disparities might relate to obesogenic built environments, the authors conducted a systematic review of the published scientific literature, screening for studies with relevance to disadvantaged individuals or areas, identified by low socioeconomic status, black race, or Hispanic ethnicity. A search for related terms in publication databases and topically related resources yielded 45 studies published between January 1995 and January 2009 with at least 100 participants or area residents that provided information on 1) the built environment correlates of obesity or related health behaviors within one or more disadvantaged groups or 2) the relative exposure these groups had to potentially obesogenic built environment characteristics. Upon consideration of the obesity and behavioral correlates of built environment characteristics, research provided the strongest support for food stores (supermarkets instead of smaller grocery/convenience stores), places to exercise, and safety as potentially influential for disadvantaged groups. There is also evidence that disadvantaged groups were living in worse environments with respect to food stores, places to exercise, aesthetic problems, and traffic or crime-related safety. One strategy to reduce obesity would involve changing the built environment to be more supportive of physical activity and a healthy diet. Based on the authors' review, increasing supermarket access, places to exercise, and neighborhood safety may also be promising strategies to reduce obesity-related health disparities.

http://www.ced.berkeley.edu/downloads/pubs/faculty/hutson_2009_epi-reviews.pdf

Built Environments and Obesity in Disadvantaged Populations

Objective: To test the hypothesis that third grade children (mean age = 8.7, SD = 0.5) who attended an 8-month after-school program would exhibit favorable changes in body composition, cardiovascular fitness, blood pressure, total cholesterol, and high-density lipoprotein-cholesterol compared with children in control condition.



Research Methods and Procedures: Subjects were 61% African-American, 31% white, and 8% other racial background from 18 public schools. Sixty-eight percent were eligible for free or reduced price lunch. Percentage body fat and bone mineral density were assessed by DXA, cardiovascular fitness by heart rate response to a step test, resting blood pressure with a Dinamap, and non-fasting total cholesterol and high-density lipoprotein-cholesterol by finger stick. Data pre- and post-intervention were available for 447 children. Children in the nine intervention schools who attended at least 40% of the after-school sessions were compared with control subjects.



Results: Compared with the control subjects and after controlling for race, sex, free/reduced price lunch status, and school-level covariates, youths in the intervention group showed a relative reduction of percentage body fat [−0.76 (95% confidence interval (CI), −1.42, −0.09)], a greater relative gain in bone mineral density [0.008 (95% CI, 0.001, 0.005)], and a greater relative reduction in heart rate response to the step test [−4.4 (95% CI, −8.2, 0.6)]. The other outcome variables showed non-significant trends in favor of the intervention subjects.



Discussion: These results are promising in light of the potential impact on the emerging childhood obesity epidemic. The Medical College of Georgia FitKid Project has the potential to be institutionalized because it is built on the existing infrastructure in most public schools in the U.S.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2005.267

An environmental approach to obesity prevention in children: Medical College of Georgia FitKid Project year 1 results.

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community.

OBJECTIVE The purposes of this study were 1) to examine the effects of stressful life events on cardiovascular reactivity to acute laboratory stressors in youth and 2) to determine whether these effects varied as a function of socioeconomic status, ethnicity, and/or sex. METHODS Four hundred eighty-three youths (mean age = 16.7 years; 249 Caucasian Americans [126 males, 123 females] and 234 African Americans [109 males, 125 females]) completed the Adolescent Resources Challenge Scale (ARCS), a measure of stressful life events, and underwent two laboratory stressors (a car-driving simulation and the Social Competence Interview) during which blood pressure, heart rate, cardiac output, and total peripheral resistance were assessed. RESULTS Youths who reported high levels of stressful life events showed smaller increases in blood pressure (both systolic and diastolic) and heart rate to the car-driving simulation but larger increases in cardiac output in response to the Social Competence Interview than did youths who reported low levels of stressful life events. The effect of stressful life events on cardiovascular reactivity was not moderated by sex, ethnicity, or socioeconomic status. Higher family socioeconomic status was associated with greater blood pressure, heart rate, and cardiac output increases in response to the Social Competence Interview. CONCLUSIONS The attenuating effects of stressful life events on cardiovascular reactivity in response to car-driving simulation in youths are consistent with an inoculation effect, whereas the potentiating impact of stressful life events on reactivity observed during the social stressor interview is compatible with a possible cost of coping effect.

The effects of life events on cardiovascular reactivity to behavioral stressors as a function of socioeconomic status, ethnicity, and sex.

OBJECTIVE: To examine changes in overweight in youth over a period of 7 years, within the context of ethnicity, gender, and socioeconomic status (SES). METHODS: Participants in a longitudinal study of cardiovascular (CV) risk factor development were evaluated on 2 occasions an average of 7.2 +/- 0.5 years apart. There were 253 subjects (121 Blacks, 132 Whites, 130 females) with a mean age of 8.8 +/- 2.0 years at the initial visit. SES was determined by Hollingshead Social Status Index and was categorized as low, middle (+/-1 standard deviation from mean), and high. Overweight was defined as >85th percentile in Body Mass Index (BMI) for age and gender (National Health and Nutrition Examination Survey [NHANES] norms). RESULTS: Standardized BMI increased significantly over the course of the study (P .05) but did significantly differ by SES (P<.001). Overall, the prevalence of overweight increased from 31% to 40% (P<.001); however, for those with low SES, the prevalence increased from 37% to 67% (P<.001). CONCLUSION: Lower SES youth, regardless of ethnicity or gender, exhibited extremely large increases in general adiposity over time and are at particular risk for development of a number of obesity-related problems, such as hypertension. Primary prevention of obesity is needed in youth, particularly among those from low SES backgrounds.

Changes in overweight in youth over a period of 7 years: impact of ethnicity, gender and socioeconomic status.

Inverse associations between socioeconomic status (SES) and cardiovascular (CV) morbidity and mortality have long been established. Although pathogenesis of CV disease (CVD) has its origins in childhood, few studies have examined relationships between SES and preclinical markers of CVD risk in youth (e.g., increased systolic blood pressure [SBP] and increased left ventricular mass [LVM]). Findings have been mixed with regard to relationships between SES and resting blood pressure (BP) in youth. To our knowledge only one pediatric study has examined SES and LVM; an inverse association was observed. 1

Donna B Moore

Papers

An environmental approach to obesity prevention in children: Medical College of Georgia FitKid Project year 1 results.

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community.

The effects of life events on cardiovascular reactivity to behavioral stressors as a function of socioeconomic status, ethnicity, and sex.

Changes in overweight in youth over a period of 7 years: impact of ethnicity, gender and socioeconomic status.

Stress responsivity and body fatness: links between socioeconomic status and cardiovascular risk factors in youth.