Abstract
BACKGROUND: Indices of Concentration at the Extremes (ICEs) serve as joint proxies for social and environmental hazards for health disparities. We tested the hypothesis that ICEs at birth predict timing of menarche and adolescent overweight and investigated whether ICE associations are mediated by individual-level variables. METHODS: In this prospective study, a subset of offspring from the Child Health and Development Studies, born 1959-1967 in Oakland, CA were assessed for early age at menarche (<12 vs. >=12) and overweight body mass index, (BMI, >25 kg/m(2)) at ages 15-17 years. ICEs characterizing neighborhood of birth were calculated using 1960 census tract data for race, income, education, and combined income/race. Associations between ICEs and maternal serum DDT levels were estimated using generalized linear models. Log-linear models estimated associations between ICEs with early menarche and adolescent overweight, adjusted for individual factors including race, socioeconomic status and perinatal serum DDTs and family clustering. RESULTS: Address at birth was geocoded for 1749 (86.6 %); 42 % had overweight BMI; 15.6 % had early menarche. ICEs at birth predicted timing of menarche and adolescent overweight and were correlated with perinatal DDTs. Most ICE associations with adolescent outcomes were partly mediated by individual level socioeconomic variables, except for the income ICE association with early menarche [adjusted odds ratio: 1.6, 95 %CI:(1.0-2.6)]. CONCLUSIONS: ICEs are accessible metrics of area-level spatial and social segregation that were associated with adolescent overweight, early menarche and DDT exposure. ICEs are useful indicators of high-risk neighborhoods that can be targeted for individual and community-level prevention beginning at birth.