Effects of Neighborhood Social Norms on Children's Diets and Weight Outcome in China

Objectives Examine influences of community social norms on school children's dietary intake and body mass index (BMI). Methods Contextual effect models were fit using data from the 1991‐2011 China Health and Nutrition Survey for school‐age children (6‐18 y, n=6034), from 9 provinces and over 200 communities across China. Local community level average dietary intake was used as the proxy of food consumption norms in a given reference social context (“community”). Dietary intakes were measured using 24‐hour dietary recalls. Weight and height were measured. Rich data on community were collected from key informants. Results The contextual (social norms) effects on child dietary intake, namely fat, carbohydrate, and protein were significant. In 1991, every 10g daily fat intake increase was associated with a 6.4g fat intake increase at individual (P>0.01). The effect became slightly smaller in 2011 with about a 5.5g increase (P>0.01). For carbohydrate and protein intake, every 10g daily intake increase was associated with about 6g increase for both in 1991 (P>0.01), but the effect decreased to 4.9g (P>0.01) for carbohydrate and increased to 6.6 for protein in 2011. All the temporal changes were not statistically significant indicating fairly strong and stable contextual effect overtime. We did not find significant association between the contextual effect of the community dietary intake and child BMI. Conclusions Chinese children's dietary intake was influenced by the neighborhood context. Child BMI was not found associated with the community social norm of child dietary intake as indicated by average intakes. Funding NIH U54 center grant, HD070725