obesity and food insufficiency or food insecurity8 after adjusting for other confounding variables (Alaimo et al., 2001b; Kaiser et al., 2002; Matheson et al., 2002). However, food insecurity is associated with adverse health outcomes in infants and toddlers below 36 months of age (Cook et al., 2004) and with negative academic and psychosocial outcomes including depression in older children (Alaimo et al., 2001a, 2002).

Many of the variables in Tables 3-1 and 3-2 may be potential mediators of the relationship between socioeconomic inequities and childhood obesity. Both food and physical activity options are more likely to be periodically inadequate, unpredictable, or of lower quality for those with low personal incomes or those living in low-income neighborhoods (Travers, 1996; Morland et al., 2002a,b; Addy et al., 2004; Fitzgibbon and Stolley, 2004; Molnar et al., 2004). Poverty and living in low-income neighborhoods limit access to healthful foods. Some types of leisure-time physical activity are theoretically available at low or no cost, but these options may be less available to children in low-income neighborhoods because of neighborhood safety concerns, lack of adult supervision, or limited community recreational or other resources. Addressing childhood obesity in these contexts will require attention to root causes, and attempts to mitigate the underlying social and environmental adversity will be needed (Travers, 1997).

Racial and Ethnic Disparities

The substantially higher prevalence of obesity in adults, children, and youth in some African-American, Hispanic, American-Indian, and Pacific Islander populations (see Chapter 2) generates considerations across the entire ecologic framework (see Figure 3-2). A relatively high obesity prevalence in some Hispanic and American-Indian groups was noted prior to the obesity epidemic (Kumanyika, 1993); the pattern of excess weight gain and accelerated rates of obesity prevalence in African-American children and youth is a more recent development. It is now understood that issues of race are much more complex than the traditional U.S. Census Bureau racial and ethnic groupings often used in epidemiological research (Cooper, 2003; Cooper et al., 2003). However, the different historical and geographical

8

Food insufficiency is defined as inadequacy in the amount of food intake because of limited money or resources. Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods, or the inability to acquire such foods in a socially acceptable way. Although these definitions are similar, food insecurity describes a broader condition that not only encompasses food insufficiency but also the psychological and other dimensions of the food system (Cook et al., 2004).



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