Anenberg, Susan

Patwa, Gopika

English

George Washington University: Health Sciences Research Commons (HSRC)

The objective of this study was to the answer the question: “Does neighborhood access to green space influence the prevalence of childhood obesity in cities globally?” OBJECTIVEBACKGROUNDI conducted a review following the Navigation Guide, a systematic review methodology to transparently evaluate the quality of individual studies, as well as the strength of the overall body of evidence. Using this methodology, the following steps were completed: 1) Specify the study question, 2) Select the evidence, 3) Rate the quality and strength of evidence. The “Population”, “Exposure,” “Comparator,” and “Outcomes” (PECO) statement is briefly outlined below.Population. Children living in cities globallyExposure. Neighborhoods with access to green spaceComparator. Neighborhoods with less access to green spaceOutcomes. Obesity and/or BMI. Data sources: I searched the databases SCOPUS and PubMed using the search terms. All the included studies were published in the last five years. METHODSRESULTSCONCLUSIONSBased on the analysis and interpretation of the evidence, it was concluded that there is a slight positive association between exposure to green space and the outcome of childhood obesity. However, since a majority of the studies have a cross-sectional design, there was a limited ability for a causal inference on the associations that were evaluated. The overall quality of the human evidence was given a rating of “moderate”.Further studies are necessary to confirm the results and minimize the effect of confounders such as physical activity and diet. PAPERS REVIEWEDBao et al. (2021). https://doi.org/10.1016/j.envres.2020.110289Manandhar et al. (2019).https://doi.org/10.15171/ijoem.2019.1425Mears et al. (2020). https://doi.org/10.1111/ijpo.12629Petraviciene et al. (2018). https://doi.org/10.3390/ijerph15030449Poulain et al. (2020).. https://doi.org/10.3390/ijerph17176321Sanders et al. (2015). https://doi.org/10.1038/ijo.2015.69Schalkwijk et al. (2018). https://doi.org/10.1093/eurpub/ckx037Yang et al. (2020). https://doi.org/10.1016/j.tbs.2020.03.001ACKNOWLEDGEMENTS & CONTACT INFOI would like to thank my advisor, Dr. Susan Anenberg, and my culminating experience professor, Dr. Lance Price for their guidance and support throughout this systematic literature review.Contact info: gpatwa1019@gwmail.gwu.eduObesity has become global public health issue. Being overweight or obese puts individuals at risk for developing a number of chronic diseases such as diabetes and heart disease. Increasing accessibility to greenspaces, such as parks, can encourage and create opportunities for physical activity, which is an important aspect of combating obesity.In addition to promoting physical activity, a number of reviews have  found significant associations between greenspace and higher levels of social interaction, which can lower the risk of obesity Furthermore, greenspaces have been shown to alleviate stress, as well as ambient pollution and noise, all of which can reduce the risk of childhood obesity (Figure 1).Does Neighborhood Access to Green Space Influence the Prevalence of Childhood Obesity in Cities Globally? A Systematic ReviewGopika Patwa, Dr. Susan AnenbergRecords through database searchingn= 219After duplicates were removedn= 182Records excludedn= 161Full text articles assessedn= 21Studies included in qualitative analysisn= 8Rating of Quality of EvidenceCategory DowngradesRisk of Bias -1Indirectness 0Inconsistency 0Imprecision 0Publication Bias 0UpgradesLarge magnitude of effect 0Confounding Minimizes Effect +1Overall Quality of Evidence ModerateRating of Strength of EvidenceQuality of the Body of EvidenceModerateDirection of Effect Estimate A greater proximity to green space was associated with lower BMI Confidence in Effect Estimate High confidence in direction of effect estimateOther Attributes NoneOverall Strength of Evidence LimitedSource Selection bias Exposure AssessmentOutcome     AssessmentConfounding Conflict of InterestOther biasBao et al. 2021Manandhar 2019Mears et al. 2020Petraviciene et al. 2018Poulain et al. 2020Sanders et al. 2015Schalkwijk et al. 2018Yang et al. 2020Low Risk Probably Low Risk Probably High RiskHigh Risk Not EvaluatedAccess to green spacePromotes physical activityIncreases social interactionReduces ambient air pollution and noiseAlleviates stressReduced risk of childhood obesityTable 2: Summary of risk of bias judgements designated by low, probably low risk, probably high risk and high risk for each individual study.Table 1. Summary of findings, quality of evidence and strength of evidence for urban green space and childhood obesity.One downgrading factor (-1) and one upgrading factor (+1) for the quality of evidence across studies (Table 1) . The overall quality of the human evidence was given a rating of “moderate” The risk of bias across all studies was determined to be “probably high” due to confounding bias. Five of eight studies were also at a risk of high bias for exposure (Table 2)Figure 1. Access to green space reduces the risk of childhood obesity through multiple pathways

Does Neighborhood Access to Green Space Influence the Prevalence of Childhood Obesity in Cities Globally? A Systematic Review

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1033&context=gw_research_showcase

Does Neighborhood Access to Green Space Influence the Prevalence of Childhood Obesity in Cities Globally? A Systematic Review

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