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AJPH First Look, published online ahead of print Jan 15, 2009
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March 2009, Vol 99, No. 3 | American Journal of Public Health 511-519
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.137364

RESEARCH AND PRACTICE

Small-Area Estimation and Prioritizing Communities for Obesity Control in Massachusetts

Wenjun Li, PhD, Jennifer L. Kelsey, PhD, Zi Zhang, MD, MPH, Stephenie C. Lemon, PhD, Solomon Mezgebu, MS, Cynthia Boddie-Willis, MD, MPH and George W. Reed, PhD

Wenjun Li, Jennifer L. Kelsey, Stephenie C. Lemon, and George W. Reed are with the University of Massachusetts Medical School, Worcester. Zi Zhang, Solomon Mezgebu, and Cynthia Boddie-Willis are with the Massachusetts Department of Public Health, Boston.

Correspondence: Requests for reprints should be sent to Wenjun Li, PhD, University of Massachusetts Medical School, 55 Lake Avenue N, Shaw SH2-230, Worcester, MA 01655 (e-mail: wenjun.li{at}umassmed.edu).

Objectives. We developed a method to evaluate geographic and temporal variations in community-level obesity prevalence and used that method to identify communities in Massachusetts that should be considered high priority communities for obesity control.

Methods. We developed small-area estimation models to estimate community-level obesity prevalence among community-living adults 18 years or older. Individual-level data from the Behavioral Risk Factors Surveillance System from 1999 to 2005 were integrated with community-level data from the 2000 US Census. Small-area estimation models assessed the associations of obesity (body mass index ≥ 30 kg/m2) with individual- and community-level characteristics. A classification system based on level and precision of obesity prevalence estimates was then used to identify high-priority communities.

Results. Estimates of the prevalence of community-level obesity ranged from 9% to 38% in 2005 and increased in all communities from 1999 to 2005. Fewer than 7% of communities met the Healthy People 2010 objective of prevalence rates below 15%. The highest prevalence rates occurred in communities characterized by lower income, less education, and more blue-collar workers.

Conclusions. Similar to the rest of the nation, Massachusetts faces a great challenge in reaching the national obesity control objective. Targeting high-priority communities identified by small-area estimation may maximize use of limited resources.






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Copyright © 2009 by the American Public Health Association