Time-varying Effects of Screen Media Exposure in the Relationship Between Socioeconomic Background and Childhood Obesity
ackground: We investigated to what extent social inequalities in childhood obesity could be reduced by eliminating differences in screen media exposure. Methods: We used longitudinal data from the UK-wide Millennium Cohort Study (n = 11,413). The study measured mother’s educational level at child’s age 5. We calculated screen media exposure as a combination of television viewing and computer use at ages 7 and 11. We derived obesity at age 14 from anthropometric measures. We estimated a counterfactual disparity measure of the unmediated association between mother’s education and obesity by fitting an inverse probability-weighted marginal structural model, adjusting for mediator–outcome confounders. Results: Compared with children of mothers with a university degree, children of mothers with education to age 16 were 1.9 (95% confidence interval [CI] = 1.5, 2.3) times as likely to be obese. Those whose mothers had no qualifications were 2.0 (95% CI = 1.5, 2.5) times as likely to be obese. Compared with mothers with university qualifications, the estimated counterfactual disparity in obesity at age 14, if educational differences in screen media exposure at age 7 and 11 were eliminated, was 1.8 (95% CI = 1.4, 2.2) for mothers with education to age 16 and 1.8 (95% CI = 1.4, 2.4) for mothers with no qualifications on the risk ratio scale. Hence, relative inequalities in childhood obesity would reduce by 13% (95% CI = 1%, 26%) and 17% (95% CI = 1%, 33%). Estimated reductions on the risk difference scale (absolute inequalities) were of similar magnitude. Conclusions: Our findings are consistent with the hypothesis that social inequalities in screen media exposure contribute substantially to social inequalities in childhood obesity.
|Keywords||Causal mediation analysis, Childhood obesity, Health inequalities, Marginal structural model, Screen media exposure|
|Persistent URL||dx.doi.org/10.1097/ede.0000000000001210, hdl.handle.net/1765/128506|
Groeniger, J. O., de Koster, W, & van der Waal, J. (2020). Time-varying Effects of Screen Media Exposure in the Relationship Between Socioeconomic Background and Childhood Obesity. Epidemiology, 31(4), 578–586. doi:10.1097/ede.0000000000001210