Small-area estimation and prioritizing communities for obesity control in Massachusetts

Am J Public Health. 2009 Mar;99(3):511-9. doi: 10.2105/AJPH.2008.137364. Epub 2009 Jan 15.


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 >or= 30 kg/m(2)) 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Child
  • Female
  • Humans
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Models, Statistical
  • Nutritional Status
  • Obesity / epidemiology
  • Obesity / prevention & control*
  • Population Surveillance
  • Prevalence
  • Public Health*
  • Residence Characteristics*
  • Risk Factors
  • Time Factors
  • Young Adult