Familial environment in high- and middle-low-income municipalities: a survey in Italy to understand the distribution of potentially obesogenic factors.

ABSTRACT

OBJECTIVES: To explore the familial and social environment in high- and middle-low-income municipalities in Italy to evaluate the distribution of potentially obesogenic factors. A hybrid methodological approach was chosen. A survey of 1215 Italian children was performed to collect information regarding child, family and peer characteristics; additionally, income data were derived from national estimates based on zip codes. STUDY DESIGN: A cross-sectional study conducted via computer-assisted telephone interviews (CATI). METHODS: A CATI facility was used to interview 1215 Italian children aged 6-10 years. Information regarding family composition; body mass index (BMI) of the child, father and mother; mother's perception of the child's weight; levels of physical activity of the child, father and mother; time spent watching television or playing video games; use of social networks; leisure-time habits; and dietary habits of peers was collected. Income per year per person was obtained from the Italian National Institute of Statistics estimates. Municipalities were divided into two groups one representing the highest ranking income from the total Italian income distribution, and one representing middle-low incomes. Differences between middle-low-income and high-income groups for child and parent BMIs, social networks, and dietary and leisure-time habits were compared using Wilcoxon and McNemar tests, as appropriate. Multivariate analysis was conducted using logistic regression. RESULTS: In total, 604 high-income children and 611 middle-low-income children were identified. A significant difference in father's BMI was found between middle-low- and high-income groups 10.5% of fathers in middle-low-income municipalities were obese, compared with 3.8% in high-income areas (P < 0.001). On the contrary, this analysis found no association between income group and the mother's BMI. In this sample, middle-low-income children participated in less physical activity than high-income children (22.7% vs 34.8% participated in sporting activities for more than 3 h per week, P < 0.001), and spent more time in sedentary activities, such as watching television. However, middle-low-income children were not isolated and were surrounded by a wider social network than high-income children (80.4% vs 69% had more than three friends, P < 0.001). CONCLUSIONS: Significant differences were found in the distribution of obesogenic behaviours between middle-low- and high-income municipalities, suggesting that social factors as well as the physical environment should be considered in the development of health policies and interventions to reduce childhood obesity.