Association between snack intake behaviors of children and neighboring women: A population-based cross-sectional analysis with spatial regionalization

Background: Accumulated evidence indicates that neighborhood environments affect children's health behaviors. However, measuring neighborhood environments remains challenging because there exist strengths and weaknesses both in objective and perceived environment measures. Drawing on a recent conceptual model of how environment, perception, and behavior interact, we hypothesized that neighbors' behavioral similarities indicate the combined influence of physical and social environmental opportunities on specific behaviors. We then examined how these similarities (i.e. the behavioral tendencies of children's adult neighbors) relate to children's obesogenic dietary behaviors. Methods: We used data for 2275 women and 821 elementary schoolchildren from a 2012-2013 population-based survey in greater Tokyo, Japan. Snack intake was defined as the total consumption of various types of snacks, estimated using a validated self-administered diet history questionnaire. Spatial regionalization, a type of spatial clustering, was used to empirically identify segments that could effectively differentiate regional variation in women's snack intake behaviors. We conducted multiple regression analysis to assess the cross-sectional association between children's snack intake and the mean snack intake of neighborhood women, adjusting for mother's intake. Results: A 1-g increase in the mean snack intake of neighborhood women was associated with a 0.23-g (95% confidence interval: 0.00-0.45) increase in children's intake, while a 1-g increase in mother's intake was associated with a 0.34-g (95% confidence interval: 0.26-0.41) increase in children's intake. Discussion: The results suggest that the out-of-home physical and social neighborhood environments may have non-ignorable associations with children's dietary behaviors by offering behavioral opportunities in addition to maternal influence.