Social and Environmental Correlates of Childhood Obesity Among Southern California Communities

Objective: This study aimed to identify key childhood obesity correlates in Southern California by analyzing individual components from four social determinants of health (SDoH) indices and explore their interactions. Methods: We utilized publicly available data from 330 cities across 10 counties, incorporating childhood obesity rates from the 2019 California Department of Education Physical Fitness Test (684,419 children, 40% Latino). Fifty-two individual SDoH were obtained from the Healthy Places Index, Social Vulnerability Index, CalEnviroScreen, and Child Opportunity Index (2015–2019). Weighted quantile sum regression and an interpretable machine-learning tool were used to identify which individual SDoH were significantly associated with childhood obesity. Results: We identified a SDoH mixture associated with increased percentile of childhood obesity (β [95% CI]: 10.1 [8.1, 12.1]). Fourteen factors significantly contributed, with the top six being school poverty, minority status, asthma emergency room visits, public assistance rates, hazardous waste sites, and lead exposure from housing. We also found positive associations between Latino percentage and key correlates. Cities with high school poverty and low-income housing burdens had higher obesity rates. Conclusions: This analysis moved beyond composite indices to examine specific SDoH observed alongside childhood obesity in Southern California, drawing attention to dimensions related to school, healthcare, social services, and environmental exposures. (Figure presented.).