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Developmental growth patterns of Canadian children and the effect of the neighbourhood environment on… Tu, Andrew 2014

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DEVELOPMENTAL GROWTH PATTERNS OF CANADIAN CHILDREN AND THE EFFECT OF THE NEIGHBOURHOOD ENVIRONMENT ON GROWTH DEVDLOPMNTDA DGRWHRSDAFNDCOIBNMUIbVDstDGMIbIUFDrsa cEIkSDgoouDnRWHRSDWIcsODdMkUNMDCOIBNMUIbVSDgooeDDLDAhlWiWDWCGniAAlfDi.DvLxAiLwDdCwdiwwnl.ADmdDAhlDxlpCixlnl.AWDdmxDAhlDfl1xllDmd DDfmrAmxDmdDvhiwmWmvh:DIODAhlDdLrCwA:DmdD1xLfCLAl DL.fDvmWAfmrAmxLw DWACfilWD2vs3 akbIsODkOPDv EaIHDhNkabFyDDAhlDC.ijlxWiA:DmdDGxiAiWhDrmwCnGiLD2jkOHs BNMyDDWN3bNcENMDgo45DD7DLOPMNTDA SDgo45DIIDDAbstract Background8DlttsMbUDkMNDON PNPDbsDIPNObItVDIOPIBIP kaUDkbDMIU0DstDENHscIO6DsENUNDbsDtkHIaIbkbN bF DPNBNas3cNObDkOPDIc3aNcNObkbIsODstDbkM6NbNP3MNBNObIsODUbMkbN6INURDAFNDsE9NHbIBNDstDbFIUDPIUUNMbkbIsODTkUDbsDIPNObItVDbFNDPNBNas3cNObkaDbMk9NHbsMINUDstDEsPVDckU IOPNQD2GniykcsO6DHFIaPMNODkUDbFNVDk6NDIObsDkP abFssPDOPDNQkcIONDFsTDbFNDONI6FEs MFssPDNOBIMsOcNObDIOta NOHNUDHFIaPFssPDsENUIbVDMkbNUDkOPDGni DPNBNas3cNObRDDDMethods8DfkbkDtMscDrkOkPk(UD. bIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFDTkUD UNPDtsMDbFIUDPIUUNMbkbIsORD1 s 3DEkUNPDbMk9NHbsMVDcsPNaIO6DTkUD U PDbs NQkcIONDNI6FbDTkBNUD245DVNkMUyDstDPkbkDbsDIPNObItVDPIUbIOHbDbMk9NHbsMINUDstDGniRD.NI6FEs MFssPDbV3NUDTNMNDPNtIONPDEVD6Ms 3IO6DONI6FEs MFssPUDTIbFDUIcIakMDkbbMIE bNUD UIO6DakbNObDHakUUDkOkaVUIURDLDcNPIkbIsODkOkaVUIUDTkUDbFNODHsOP HbNPDbsDkUUNUUDbFNDcNPIkbIO6DMsaNDstD3FVUIHkaDkHbIBIbVDkOPDUNPNObkMVDENFkBIs MDsODbFNDHMsUU)UNHbIsOkaDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDbV3NDkOPDsENUIbVRDAFNDMNa bIsOUFI3DENbTNNODONI6FEs MFssPDbV3NDkOPDsENUIbVDTkUDNQkcIONPDasO6Ib PIOkaaVD U 6DEsbFDBkMIkEaN)DkOPD3NMUsO)HNObMNPDk33MskHFNURDDResults8DAFIUDUb PVDIPNObItINPDts MDPIUbIOHbDGnibMk9NHbsMINUDkcsO6DHFIaPMNO8DasTSDPNHMNkUIO6cNPI cSDkOPDFI6FRDGsMODakM6NDtsMD6NUbkbIsOkaDk6NSDaIBIO6DIODkDM MkaDkMNkSDkOPDckbNMOkaDUcs0IO6DTNMNDkUUsHIkbNPDTIbFDbFNDFI6FDbMk9NHbsMVRDrFIaPMNODTNMNDts OP bsDaIBNDTIbFIODsONDstDtIBNDONI6FEs MFssPDbV3NURDrsc3kMNPDTIbFDHFIaPMNODaIBIO6DI kODktta NObD MEkODbV3NDONI6FEs MFssPSDFI6FNMDMkbNUDstDsENUIbVDTNMNDsEUNMBNPDIODbFNDMNckIOIO6Dts MDONI6FEs MFssPDbV3NURDvFVUIHkakHbIBIbVDkOPDUNPNObkMVDENFkBIs MDTNMNDts OPDbsD3kMbIkaaVDcNPIkbNDbFNMNakbIsOUFI3DENbTN ODONI6FEs MFssPDbV3NDkOPDsENUIbV- FsTNBNMSDOsbDkcsO6DHFIaPMNODaIBIO6DIOD3MNPscIOkObaVDM MkaONI6FEs MFssPURDrFIaPMNODaIBIO6DIOD3MNPscIOk baVDM MkaONI6FEs MFssPUDTNMNDts OPDbsDFkBNDkDUI6OItIHkObaVDFI6FNMDGniDbMk9NHbsMVDkOPDTNMNDcsMNDaI0NaVDbsDENDsODkDGniDbMk9 HbsMVDaNkPIO6DbsDsENUIbVDEVDkP abFssPRDDConclusions8DAFIUDPIUUNMbkbIsODIPNObItINPDHFIaPMNODkbDMIU0DstDENHscIO6DsENUNDEVDkP abFssPDkOPDONI6FEs MFssPDbV3NUDbFkbDkMNDcsUbDHsOP HIBNDstDHFIaPMNODPNBNas3IO6DsENUIbVRDDAFN M U abUDU 66NUbDbFkbD3MNBNObIsODNttsMbUDUFs aPDENDbkM6NbNPDbsDHFIaPMNODaIBIO6DIODM MkaDkMNkUkOPDbFkbDbFNUNDNttsMbUDUFs aPDPIttNMDtMscDbFsUNDk33aINPDIOD MEkODUNbbIO6URDvFVUIHkaDkHbIBIbVDNQ3akIOUDkDUckaaD3Ms3sMbIsODstDsENUIbVDMIU0DU 66NUbIO6DbFkbDsbFNMDtkHbsMUD2NR6RSDPINbyDckVD3akVDkODIc3sMbkObDMsaNDIODsENUIbVDMIU0DkUUsHIkbNPDTIbFDONI6FEs MFssPDtkHbsMURDDIIIDDPreface AFIUDUbkbNcNObDIUDbsDHNMbItVDbFkbDbFNDTsM0DIODbFIUDPIUUNMbkbIsODTkUDHsOHNIBNPSDHsOP HbNPSDkOkaVYNPSDkOPDTMIbbNODEVDLOPMNTDA RDLaaDMNUNkMHFDPNUHMIENPDIODbFIUDPIUUNMbkbIsODTkUDk33MsBNPDEVDbFNDCOIBNMUIbVDstDGMIbIUFDrsa cEIk(UD2CGryDGNFkBIs MkaDxNUNkMHFDlbFIHUDGskMPD2HNMbItIHkbNDh4g)ogu54yRDDDIBDDTable of Contents DAbstract .......................................................................................................................................... ii Preface ........................................................................................................................................... iii Table of Contents ......................................................................................................................... iv List of Tables .............................................................................................................................. viii List of Figures .................................................................................................................................x List of Abbreviations ................................................................................................................... xi Acknowledgements ..................................................................................................................... xii Dedication ................................................................................................................................... xiv Chapter 1: Introduction ................................................................................................................1 4R4 WI6OItIHkOHNDstDbFNDvMsEaNcDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4 4Rg mMI6IODstDbFNDxNUNkMHFDp NUbIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg 4Ru xNUNkMHFDmE9NHbIBNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD– 4R5 rsOHN3b kaDdMkcNTsM0DRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDe 4R5R4 wItNDrs MUNDL33MskHFDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;  4R5Rg WsHIkaDlHsas6IHkaDL33MskHFDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;  4R= AFNUIUDmBNMBINTDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD44 Chapter 2: Literature Review .....................................................................................................13 gR4 fNBNas3cNObDstDmENUIbVDf MIO6DrFIaPFssPDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4u gR4R4 lbIsas6VDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4u gR4Rg nNkU MNUDstDmENUIbVDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD45 gR4Ru fNtIOIO6DmENUIbVDIODrFIaPFssPDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4– BDDgR4R5 fNBNas3cNObkaDAMk9NHbsMINUDstDGniDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4;  gR4R5R4 AMkH0IO6DWb PINUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4;  gR4R5Rg 1MsTbFDr MBNDnsPNaIO6DRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4,  gR4R5Ru wkbNObDrakUUD1MsTbFDnsPNaUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDgo gRg .NI6FEs MFssPDlOBIMsOcNObDkOPDmENUIbVRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg= gRgR4 fNtIOIO6D.NI6FEs MFssPUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg– gRgRg nNkU MNcNObDstD.NI6FEs MFssPDLbbMIE bNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDge gRgRu .NI6FEs MFssPDWsHIsNHsOscIHDWbkb UDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg;  gRgR5 .NI6FEs MFssPDWsHIkaDlOBIMsOcNObRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg,  gRgR= .NI6FEs MFssPDvFVUIHkaD2G I byDlOBIMsOcNObDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDg,  gRgR=R4 .NI6FEs MFssPDlttNHbUDsODfINbDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDuo gRgR=Rg .NI6FEs MFssPDlttNHbUDsODvFVUIHkaDLHbIBIbVDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDu4 gRgR– wIcIbkbIsODstD.NI6FEs MFssPDWb PINUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDug gRgRe rsOHa UIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDuu Chapter 3: Body Mass Index Trajectories across Childhood ..................................................34 uR4 iObMsP HbIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDu5 uRg nNbFsPURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDu= uRgR4 fkbkDWs MHNDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDu= uRgRg nNkU MNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDue uRgRgR4 GsPVDnkUUDiOPNQDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDue uRgRgRg iOPIBIP kaDwNBNaDrsBkMIkbNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDue uRgRgRu dkcIaVDwNBNaDrsBkMIkbNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDue uRgRu WbkbIUbIHkaDLOkaVUNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDu;  BIDDuRgRuR4 rMsUU)jkaIPkbIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD5o uRgRuRg iPNObItIHkbIsODstDxIU0DdkHbsMUDtsMDAMk9NHbsMVDnNcENMUFI3DRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD54 uRu xNU abUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD54 uR5 fIUH UUIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD=g Chapter 4: Neighbourhood Class and Obesity ..........................................................................57 5R4 iObMsP HbIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD=e 5Rg nNbFsPURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–4 5RgR4 Wkc3aNRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–4 5RgRg .NI6FEs MFssPDnNkU MNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–4 5RgRu WsHIsNHsOscIHDnNkU MNURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–5 5RgR5 mENUIbVDkOPD*NI6Fb)xNak NPDGNFkBIs MUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–5 5RgR= LOkaVUIURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–= 5RgR=R4 wkbNObDrakUUDLOkaVUIUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–= 5RgR=Rg fNUHMI3bIsODstDwkbNObDrakUUNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–e 5RgR=Ru nNPIkbIsODLOkaVUIUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–e 5Ru xNU abUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–;  5RuR4 wkbNObDrakUUDLOkaVUIUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–;  5RuRg fNUHMI3bIsODstDwkbNObDrakUUNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–,  5RuRu nNPIkbIsODLOkaVUIUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDe5 5R5 fIUH UUIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDe– Chapter 5: Longitudinal Study of Neighbourhood Class and Obesity ...................................80 =R4 iObMsP HbIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;o  =Rg nNbFsPURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;g  BIIDD=RgR4 Wkc3aNRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;g  =RgRg nNkU MNUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;u  =RgRgR4 .NI6FEs MFssPDAV3NDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;u  =RgRgRg GsPVDnkUUDiOPNQDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;u  =RgRgRu WsHIsNHsOscIHDnNkU MNURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;5  =RgRu LOkaVUIURRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;5  =Ru xNU abUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;–  =R5 fIUH UUIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD,u  Chapter 6: Discussion ..................................................................................................................97 –R4 W cckMVDstDdIOPIO6USDWb PVDrsObMIE bIsOUSDkOPDic3aIHkbIsOUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD,e  –Rg WbMNO6bFUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4o= –Ru wIcIbkbIsOUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4o– –R5 xNHsccNOPkbIsOUDkOPDd b MNDxNUNkMHFDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4oe –R= rsOHa UIsODRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD44o Bibliography ...............................................................................................................................113 Appendices ..................................................................................................................................135 L33NOPIQDLRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4u= DBIIIDDList of Tables DAkEaND48DW cckMVDstDMNUNkMHFDUb PINUD UIO6D3NMUsO)H ObMNPDkOkaVbIHDk33MskHFNUDbsDUb PVIO6DGniD6MsTbFDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDgu AkEaNDg8DdIbDIOPIHNUDtsMDbFNDs3bIckaDO cENMDstDGniDbMk9NHbsMINUDEVDUNQDtMscDbFND.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD2.wWr:yDkOPDbFND.kbIsOkaDvs3 akbIsODhNkabFDW MBNVD2.vhWyDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD5u AkEaNDu8DGkUNaIONDUkc3aNDHFkMkHbNMIUbIHUDstDbFND.wWr:DHsFsMbDEVDUNQDkOPDGniDbMk9NHbsMVD6Ms 3RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD5,  AkEaND58DxNU abUDtMscDkP9 UbNPDc abIOscIkaDMN6MNUUIsODstD3MNPIHbsMUDkUUsHIkbNPDTIbFDbMk9NHbsMVDcNcENMUFI3DRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD=4 AkEaND=8DnsPNaDtIbDUbkbIUbIHUDtsMDakbNObDHakUUDkOkaVUIU stDgDbs ;DUsa bIsOUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–;  AkEaND–8DibNcDMNU3sOUND3MsEkEIaIbINUDtMscDakbNObDHakUUDkOkaVUIUD2O%ggS;u4yDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDeo AkEaNDe8DW cckMIYNPDHFkMkHbNMIUbIHUDstDONI6FEs MFssPDHakUUNUDkOPD0OsTODMNakbIsOUFI3UDTIbFDsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MUDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDe4 AkEaND;8DWsHIsNHsOscIHDUbkb USDTNI6FbDUbkb USDkOPDsENUs6NOIHDENFkBIs MUDEVDHakUUDcNcENMUFI3D2zyRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDeu AkEaND,8DGssbUbMk3DNUbIckbNUDkOPDEIkU)HsMMNHbNPD,=zDHsOtIPNOHNDIObNMBkaUDstDbFND3kbFDkOkaVUIUDENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbVRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRDe= AkEaND4o8DWkc3aNDHFkMkHbNMIUbIHUD2zyDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;e  AkEaND448DxNU abUDtMscDbFNDc abIa BN DkOkaVUIUDstDHFkO6NDIODGniDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;;  AkEaND4g8DvNMHNObk6NDstD3kMbIHI3kObUDTIbFIODNkHFDONI6FEs MFssPDkOPDGniDbMk9NHbsMVDRRRRRRRRRRRRRRRRD,o  AkEaND4u8DmPPUDMkbIsDtsMDbFNDc abIOscIkaDMN6MNUUIsOD3MNPIHbIO6DbMk9NHbsMVDcNcENMUFI3DRRRRRRRRRRRRRRD,4  IQDDAkEaND458DxNU abUDtMscDbFNDc abIaNBNaDkOkaVUIUDstDHFkO6NDIODGniDtsMDNkHFDU EUNbDRRRRRRRRRRRRRRRRRRRRRRD,g  DQDDList of Figures DdI6 MND4RDrsOHN3b kaDcsPNaDbsDIOBNUbI6kbNDONI6FEs MFssPDttNHbUD ODbFN bMk9NHbsMINUDstDGniDkcsO6DHFIaPMNORRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD4g dI6 MNDg8DGniDbMk9NHbsMINUDtMscDk6ND4DbsDgoDEVDU MBNVDHsFsMbDkOPDUNQ8DkyD.wWr:DFDckaN-DEyD.vhWDFDckaN-DHyD.wWr:DFDtNckaN-DPyD.vhWDFDtNckaNRDfsbbNPDaIONUDMN3MNUNObD*hmDH bDsttUDtsMDsBNMTNI6FbDkOPDsENUNRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD5= dI6 MNDu8DlUbIckbNPDGniDbMk9NHbsMINUDstDckaNUDIODbFND.wWr:DtMscDk6ND4 bsDgoD2O%uS–,uyRRRRRRRRRD5e dI6 MND58DlUbIckbNPDGniDbMk9NHbsMINUDstDt ckaNUDIODbFND.wWr:DtMscDk6ND4DbsDgoD2O%uS=–oyRRRRR5;  dI6 MND=8DnNPIkbIsODcsPNaDbNUbNPDIODbFIUDUb PVDRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD–o dI6 MND–8DGniDbMk9NHbsMINUDtMscDk6NDgDbsD4gRDfsbbNPDaIONUDMN3MNUNObD*hmDH b)sttUDtsMDsB MTNI6FbDkOPDsENUND2kBNMk6NPDENbTNNODUNQyRDRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRD;,  DQIDDList of Abbreviations kBNvvDFDkBNMk6ND3sUbNMIsMD3MsEkEIaIbVDGiLDFDEIsNaNHbMIHkaDIc3NPkOHNDkOkaVUIUDGirDFDGkVNUIkODIOtsMckbIsODHMIbNMIsODGniDFDEsPVDckUUDIOPNQDrfrD FDrNObNMUDtsMDfIUNkUNDrsObMsaDkOPDvMNBNObIsODlmWWDFlPcsObsODmENUIbVDWbk6IO6DWVUbNcDdinwDFDt aaDIOtsMckbIsODckQIc cDaI0NaIFssPD1GAnDFD6Ms 3DEkUNPDbMk9NHbsMVDcsPNaIO6DimAdDFDiObNMOkbIsOkaDmENUIbVDAkU0DdsMHNwrLDFDakbNObDHakUUDkOkaVUIUwnxDwxADFDws)nNOPNaa)x EIODaI0NaIFssPDMkbIsDbNUbD.wWr:DFD.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD.vhWDFD.kbIsOkaDvs3 akbIsODhNkabFDW MBNVDmrrDFDsPPUDstDHsMMNHbDHakUUItIHkbIsODvLDFD3FVUIHkaDkHbIBIbVDvnGDFD3NMUsODcsUbD0OsTaNP6NkEaNDWGDFUNPNObkMVDENFkBIs MDWfDFDUbkOPkMPDPNBIkbIsODWlWDFUsHIkaDNHsOscIHDUbkb UD*rDFDTkIUbDHIMH ctNMNOHND*hmDFD*sMaPDhNkabFDmM6kOIYkbIsOD*hxD FDTkIUb) s)FI3DMkbIsDQIIDDAcknowledgements W 33sMbDtsMDbFIUDPIUUNMbkbIsODTkUD3MsBIPNPDEVDkDrkOkPIkODiOUbIb bNDstDhNkabFDxNUNkMHFD2rihxy DfsHbsMkaDxNUNkMHFDLTkMPRDiOD PPIbIsOSDbMkBNaDkTkMPUDbsDkbbNOPDHsOtNMNOHNUDkOPDNP HkbIsOkaDHs MUNUDTkUDMNHNIBNPDtMscDbFNDCOIBNMUIbVDstDGMIbIUFDrsa cEIkSDrihxSDkOPDbFNDrkOkPIkODmENUIbVD.NbTsM0RDDiDTs aPDaI0NDbsDNQbNOPDcVDPNN3NUbD6MkbIb PNDbsDcVDU 3NMBIUsMSDfMRDrFMIUDxIHFkMPUsOSDtsMDFIUDsO6sIO6D6 IPkOHNSDNOHs Mk6NcNObSDkOPDkUUIUbkOHNDIODFNa3IO6DcNDHsc3aNbNDbFIUDPIUUNMbkbIsODkOPDPNBNas3DcVDIOPN3NOPNObDMNUNkMHFDHkMNNMRDiDTs aPDkaUsDaI0NDbsDbFkO0DcVDHsccIbbNNDcNcENMUSDfMURDws IUNDnHUUNSDWHsbbDwNkMSDkOPDrkMsaVOD1sbkVSDtsMDbFNIMDbFs 6Fbt aDIOUI6FbUS NQ3NMbIUNSDkOPDkPBIHNRDiDkcDIOHMNPIEaVDk33MNHIkbIBNDstDFsTDcVDHsccIbbNNDTsM0NPDkUDkDb kcDbsDFNa3D6 IPNDcVDMNUNkMHFDkOPDU 33sMbDcVDPNBNas3cNObRDiDkcDNU3NHIkaaVD6MkbNt 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33sMbRDAsDcVDPNkMDTItNSDI aINSDbFkO0 Vs DQIIIDDtsMDENIO6DcVDEI66NUbDU 33sMbNMDkOPDtsMDVs MDtMINOPUFI3SDasBNSDkOPD OPNMUbkOPIO6DP MIO6DbFIUDHFkaaNO6IO6DbIcNRDLOPDtIOkaaVSDbsDcVDVs O6DUsO 1MkVUsOSDVs DkMNDcVDcsbIBkbIsODbsDkaTkVUDPsDENbbNMDkOPDENDENbbNMRDDQIBDDDedication DDDEVLOPLMVNTA NGRWVH4DDChapter 1: Introduction 1.1 Significance of the Problem AFND3MNBkaNOHNDstDsENUIbVDFkUDIOHMNkUNPD6asEkaaVDsBNMDbFND3kUbDbFMNNDPNHkPNURJ4SgKDrkOkPkIUDOsDNQHN3bIsODbsDbFIUDbMNOPDkUDkP abDsENUIbVDMkbNUDFkBNDONkMaVDPs EaNPDtMscD45zDIOD4,e,DbsDg=zDIODgo44RJuS5KDLcsO6DrkOkPIkODHFIaPMNOD4eDVNkMUDstDk6NDkOPD OPNMSDsENUIbVDMkbNUDEkUNPDsODcNkU MNPDEsPVDckUUDIOPNQD2GniyDFkBNDIOHMNkUNPDtMscDuzDIOD4,e,DbsD;R5z IODgo44RJuS=KDAFND3NMHNObk6NDstDHFIaPMNODbFkbDTNMNDsBNMTNI6FbDkaUsDIOHMNkUNPDtMscD4gzDIOD4,e,DbsD4–R5zDIODgo44RJuS=KDAFNDbMNOPDtsMIOHMNkUIO6DMkbNUDstDsENUIbVD3MNBkaNOHNDFkUDENNODsEUNMBNPDIODkaaD3MsBIOHNUDstDrkOkPkRJ5KDmENUIbVDIODHFIaPFssPSDPNtIONPDIODbFIUD IUUNMbkbIsODkUDbFND3NMIsPDENbTNNODEIMbFDkOPDk6ND4,SDFkUDENNODIPNObItINPDkUDkDMIU0DtkHbsMDtsMDkDO cENMDstDHFMsOIHDFNkabFDHsOPIbIsOUDIOHa PIO6DkP abDsENUIbVSJ–KDHkMPIsBkUH akMDPIUNkUNSJeKDbV3NDii PIkENbNUDcNaaIb USJ;KDkOPDUscNDHkOHNMURJ,KDmBNMTNI6FbDsMDsENUNDVs bFDkMNDkaUsDkbDMIU0DstDPNBNas3IO6D3UVHFsUsHIkaDPIUsMPNMUDU DkUDPN3MNUUIsODkOPDasTDUNat)NUbNNcRJ4oKDxNUNkMHFNMUDFkBNDUFsTODbFkbDbFNDH c akbIBNDMNU abDstDPNBNas3IO6DsENUIbVDIODHFIaPFssPDIOHMNkUNUDbFNa 0NaIFssPDstDNkMaVDPNkbFRJ44KDd MbFNMcsMNSDbF DO cENMDstDFNkabFD3MsEaNcUDkUUsHIkbNPDTIbFDsENUIbVDIOHMNkUNUDItDsENUIbVD3NMUIUbUDt scDHFIaPFssPDIObsDkP abFssPRJ4gKDibDFkUDENNODNUbIckbNPDbFkbDbFNDNHsOscIHDHsUbDkUUsHIkbNPDTIbFDsENUIbV)MNakbNPDFNkabFD3MsEaNcUDIODrkOkPkDbsDENDENbTNNODL5R–DkOPDLeR4DEIaaIsODIODgoo;RJ4uKDLabFs 6FDbFNDsOUNbDstckOVDHFMsOIHDHsOPIbIsOUDMNakbNPDbsDsENUIbVD6NONMkaaVDsHH MDIODkP abFssPSDbFNDIOHMNkUNPD3 BkaNOHNDstDHFIaPFssPDsENUIbVDFkUDHsIOHIPNPDTIbFDkOD 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Question AFNDNbIsas6VDstDsENUIbVDIUDHsc3aNQDkOPDc abItkHNbNPRDibDIUDENaI B DbFkbDsENUIbVDIUDbFNDMNU abDstDIObNMkHbIsOUDENbTNNOD3VHFsas6IHkaSDUsHIkaSDNOBIMsOcNObkaSDENFkBIs MkaSD3FVUIsas6IHkaSDkOPDUsHINbkaDtkHbsMURJgoKDAFNDHsc3aNQDIObNMkHbIsOUDENbTNNODbFNUNDtkHbsMUDkMNaI0NaVDbsDMNU abDIODuDD OIM ND3kbbNMOUDstD6MsTbFDTIbFIODkD3s3 akbIsORDrFkMkHbNMIYIO6DbFNUNDPNBNas3cNObkaD3kbbNMOUDMN3MNUNObUDkODIc3sMbkObDtIMUbDUbN3DIODIc3MsBIO6Ds MDkEIaIbVDbsDIPNObItVDIOPIBIP kaUDkbD6MNkbNUbDMIU0DstDENHscIO6DsENUNDkbDkDakbNMDk6NDkOPDPNBNas3IO6DNkMaVDIObNMBNObIsODUbMkbN6INUDHk3kEa DstDMNP HIO6DbFNIMDMIU0DstDENHscIO6DsENUNRDDiPNObItVIO6D OIM ND3kbbNMOUDstD6MsTbFDMNM IMNUDasO6Ib PIOkaDPkbkRDAMkPIbIsOkaaVSDckOVDstDbFNDasO6Ib PIOkaDUb PINUDbFkbDFkBNDENNODHsOP HbNPDFkBND UNPDcNbFsPUDbFkbDkUU cNDbFkbD6MsTbFDIUDFscs6NONs UDTIbFIODkD3s3 akbIsORDhsTNBNMSD6MsTIO6DNBIPNOHNDtMscDbMkH0IO6DUb PINUD2Ub PINUDbFkbDkUUNUUDbFND3NMHNObk6NDstDIOPIBIP kaUDbFkbDckIObkIODsMDHFkO6NDbFNIMDTNI6FbDUbkb 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MFssP(UDUktNbVRJ5;S5,KDfNU3IbNDbFND6MsTIO6DO cENMDstDUb PINUDNQkcIOIO6DbFNDkUUsHI bIsODENbTNNODONI6FEs MFssPDkbbMIE bNUDkOPDsENUIbVDsMDTNI6Fb)MNakbNPDENFkBIs MUSDkDHsOUIUbNObD3kbbNMODstDMNU abUDFkUDVNbDbsDNcNM6NRJgeSg;KDmOND3sbNObIkaDMNkUsODtsMDbFN IOHsOUIUbNObDtIOPIO6UDIODbFNDUHINObItIHDaIbNMkb MNDckVDENDMNakbNPDbsDFN cNbFsPUDNc3asVNPDbsDc kU MNDkOPDUbkbIUbIHkaaVDcsPNaDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPUDkOPDMIU0DtsMDHFIaPFssPDsENUIbVRDWb PINUDstDbFNDONI6FEs MFssPDNOBIMsOcNObDHkODIOHa PNDkDakM6NDO cENMDstDkbbMIE bNURLDHscEIOkbIsODstDbFNUNDkbbMIE bNUDckVDkHbDUVONM6IUbIHkaaVDsODkODIOP BIP ka(UDMIU0 stDPNBNas3IO6DsENUIbVRDAsDkHHs ObDtsMDbFIUDUVONM6IUbIHDNttNHbSDOb Mk IsOUDENbTNNODkbbMIE bNUDkMNDIOHa PNPDIODcsPNaDNUbIckbIsORDhsTNBNMSDc abI3aNDIObNMkHbIsOUDbNMcUDIODkDcsPNaDckVDaNkPDbsDIUU NUDTIbFDUkc3aNDUIYNDMNM IMNcNObSDHsaaIONkMIbVSDkOPDsBNMtIbbIO6RJ=oS=4KDLODk33MskHFDbFkbDUscNDMNUNkMHFNMUDFkBND UNPDIUDbsDHMNkbND6Ms 3IO6UDstDONI6FEs MFssPUSD UIO6DcNbFsPUDU HFDkUDakbNObDHakU 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6DkDaM6NDOkbIsOkaaVDMN3MNUNObkbIBNDPkbkUNbDtMscDbFND.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD2.wWr:ySDHsOP HbNPDEVDWbkbIUbIHUDrkOkPkRDAFIUDUb PVD UNUDOsBNaDk33MskHFNUDbFkbDkHHs ObDtsMDFNbNMs6NONIbVDstDHFIaPFssPDGniD6MsTbFDkOPDONI6FEs MFssPDNOBIMsOcNObURDD1.3 Research Objectives AFIUDPIUUNMbkbIsODFkUDbFMNNDckIODsE9NHbIBNUDbFkbDkMNDPIUH UUNPDENasTDkasO6DTIbFDHsMMNU3sOPIO6DFV3sbFNUNURDmE9NHbIBND48DAsDkyDIPNObItVDkOPDBkaIPkbNDbFNDPIUbIOHbDMk9NHbsMINUDstDEsPVDckUUDIOPNQDbFkbDsHH MDtMscDk6ND4DbsDgoD UIO6DbTsDOkbIsOkaaVDMN3MNUNObkbIBNDasO6Ib PIOkaDU MBNVUDstDrkOkPIkODHFIaPMNODkOPDEyDHFkMkHbNMIYNDbFNDUsHIs)PNcs6Mk3FIHUDstDbFNDHFIaPMNODbFkbDENasO6DbsDbFNUNDbMk9NHbsMINURDDhV3sbFNUIUD48DAFNMNDkMNDPIUbIOHbDGniDbMk9NHbsMINUDbFkbDNQIUbDIODHFIaPFssPDkOPDUscNDstDbFNUNDbMk9NHbsMINUDaNkPDbsDkODsENUNDTNI6FbDUbkb UDEVDNkMaVkP abFssPRmE9NHbIBNDg8DAsDkyHMNkbNDHakUUNUSDsMD6Ms 3IO6USDst ONI6FEs MFssPUDEkUNPDsODONI6FEs MFssPDHFkMkHbNMIUbIHUD3MNBIs UaVDIPNObItI 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MFssPUDbFkbDkMNDkbDFI6FNMDMIU0DstDsENUIbVDTIaaDENDFI6FNMD23kMkaa aDE bDFI6FNMyDsMDIOHMNkUIO6DkbDkDFI6FNMDMkbND2Uas3IO6DFI6FNMyDbFkODHFIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDasTNMDMIU0DstDsENUIbVRDhV3sbFNUIUD58DrFIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDFI6FNMDMIU0DstDsENUIbVDTIaaDENDcsMNDaI0NaVDbsDtsaasTDkDGniDbMk9NHbsMVDaNkPIO6DbsDsENUIbVDbFkODHFIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDasTNMDMIU0DstDsENUIbVRDhV3sbFNUIUD=8DAFNDasO6NMDHFIaPMNODUbkVDIODONI6FEs MFssPUDbFkbDkMNDkbDFI6FNMDMIU0DstDsENUIbVSDbFNDakM6NMDbFNDkUUsHIkbIsODTIbFDsENUIbVD2NR6RSDFI6FNM kB Mk6NDGniDbMk9NHbsMVSDFI6FNMDsPPUDstDENasO6IO6DbsDkDbMk9NHbsMVDaNkPIO6DbsDsENUIbVyRD1.4 Conceptual Framework AFIUDPIUUNMbkbIsODIUDEkUNPDsODbFNDIObN6MkbIsODstDbTsDHsOHN3b kaDtMkcNTsM0U8DkDaItNDHs MUNDk33MskHFDkOPDkDUsHIkaDNHsas6IHkaDk33MskHFRDAFNDaItNDHs MUNDk33MskHFD3MsBIPNUDU 33sMbDtsMDbFNDasO6Ib PIOkaDOkb MNDstDbFNDUb PVDstDGniDTFIaNDbFNDUsHIka)NHsas6IHkaDk33MskHFD3MsBIPNUDU 33sMbDtsMDbFNDFINMkMHFIHkaDOkb MNDstDbFNDI 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OPDGniDbMk9NHbsMINUDbFkbDUbkMbNPDkbDkDOsMckaDTNI6FbDkOPD3Ms6MNUUIBNaVDENHkcNDsBNMTNI6FbDsBNMDbIcNJ4g4F4uoKDsMDPNHaIONPDtMscDsBNMTNI6FbDIObsDOsMckaDTNI6FbRJ4ggS4g=S4g,S4u4S4ugKDrsccsO DUNbUDstDPIUbIOHbDbMk9NHbsMINUDts OPDkHMsUUDUb PINUDPNU3IbNDPIttNMNOHNUDIODUb PVDcNbFsPUDU 66NUbDbFkbDGniD6MsTbFDP MIO6DHFIaPFssPDIUDFNbNMs6NONs URDD DguDDTable 1: Summary of research studies using person-centred analytic approaches to studying BMI growth Study Study period Sample Age Method Outcome Trajectory groups GkaIUbMNMIDODhss0Dgo44J4g4KD4,,; )gooeDCWD2.%4uS,eoyD=N–)4uN45D1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDmBNMTNI6FbD2rfry-DPIMNHbaVDcNkU MNPDGsVUD4RD.sMckaDTNI6FbD2=,zyDgRD1MkP kaDsOUNbDstDsBNMTNI6FbD2gezyDuRDLaTkVUDsBNMTNI6FbD24=zyD1IMaUD4RD.sMckaDTNI6FbD2==zyDgRD1MkP kaDsOUNbDstDsBNMTNI6FbD2g=zyDuRDLaTkVUDsBNMTNI6FbD2gozyDrkMbNMDNbDkaRDgo4gJ4uuKD4,,; )goo5Dp NENHD2.%4S=––yD5)4oD 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDGniDT)UHsMND2rfry-DPIMNHbaVDcNU MNPD4RDwsT)IOHMNkUIO6D2,RezyDgRDwsT)cNPI 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MNPDGsVUD4RDWbkEaNDbFIOD244zyDgRDWbkEaNDkBNMk6ND2e–zyUDuRDWbkEaNDFI6FNMDkBNMk6ND2e–zyUD5RDvMs6MNUUIBNDsBNMTNI6FbD2,RgzyD=RDvMs6MNUUIBNDsENUIbVD2uR;zyD1IMaUD4RDWbkEaNDbFIOD245zyDgRDWbkEaNDkBNMk6ND2–gzyUDuRDvMs6MNUUIBNDkBNMk6ND2,R=zyD5RDWbkEaNDFI6FNMDkBNMk6ND2–gzyUD=RDvMs6MNUUIBNDsBNMTNI6FbD244zyD–RDvMs6MNUUIBNDsENUIbVD2uRgzyDhN9kYIDNbDkaRDgoo, J4ggKD4,,– )goouDrkOkPkD2.%,egyDg);D 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDGni-D3kMNOb)MN3sMbNPDGsVUD4RDWbkEaNDOsMckaDGniD2eozyDgRDAMkOUINObDFI6FDGniD24,zyDuRDI)H MBNDMIUNDbsDsENUIbVD244zyD1IMaUD4RDWbkEaNDOsMckaDGniD2–5zyDgRDlkMaVDPNHaIOIO6DGniD2;zyDuRDwkbNDPNHaIOIO6DGniD245zyD5RDLHHNaNMkbIO6DMIUNDbsDsENUIbVD245zyDh kO6DNbDkaRDgo4uJ4g=KD4,;– )goo;DCWD2.%=4=–yD –)4;D 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDmENUND2rfry-DUNat)MN3sMbNPD4RD.sO)sENUND2;4zyDgRDiOHMNkUIO6D2=R4zyuRDfNHMNkUIO6D2=Rezy5RDrFMsOIHkaaVDsENUND2;R=zyDDg5DDStudy Study period Sample Age Method Outcome Trajectory groups I ODNbDkaRDgo4gJ4g–KD4,,– )goo4DCWD2.%4oS,eeyD4g)goD 1MsTbFDcIQb MNDcsPNaDGni-DUNat)MN3sMbNPDGsVUD4RDhNkabFD6MsTbFD2;5zyDgRDWbNkPVDsBNMTNI6FbD2eR–zyDuRDhNkabFVDbsDsENUND2eR4zyD5RDrsOUIUbNObDsENUND24RezyD1IMaUD4RDhNkabFD6MsTbFD2;;zyDgRDWbNkPVDsBNMTNI6FbD2uR=zyDuRDhNkabFVDbsDsENUND2eR5zyD5RDrsOUIUbNObDsENUND24RuzyDwIDNbDkaRDgooeJ4geKD4,;– )goooDCWD2.%4Seu,yD g)4gD 1MsTbFDcIQb MNDcsPNaDmENUND2rfry-DPIMNHbaVDcNkU MNPD4RD.sMckaD2;5zyDgRDlkMaVDsOUNbDsENUIbVD244zyDuRDwkbNDsOUNbDsENUIbVD2=RgzyDnk6NNDNbDkaRDgo4uJ4g;KDgoo5)go4oDL UbMkaIkD2.%5S–o4yD5)44D 1MsTbFDcIQb MNDcsPNaDGni-DPIMNHbaVDcNkU MNPD4RDhNkabFVD2;gzyDgRDwkbNMDsOUNbDsENUIbVD24gzyDuRDlkMaVDsOUNbDsENUIbVD25RozyD5RDhI6FDMIU0D2gRuzyDn UbIaasDNbDkaRDgoouJ4g,KD4,,u )goooD*NUbNMOD.sMbFDrkMsaIOkD2.%,,4y D, )4–D 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDmENUND2rfry-DPIMNHbaVDcNkU MNPD4RD.NBNMDsENUND2euzyDgRDLPsaNUHNObDsENUND2eR=zyDuRDrFIaPFssPDsENUND2=R4zyD5RDmENUND24=zyD.sOONck0NMDNbDkaRDgoo,J4u=KD4,,e )goouDCWD2.%;S,4eyD 4g)guD 1MsTbFDcIQb MNDcsPNaDGni-DUNat)MN3sMbNPD4RDwsTDMIU0D255zyDgRDwsT)bs)csPNMkbNDMIU0D2u–zyuRDnsPNMkbN)bs)FI6FDMIU0D24–zyD5RDhI6FDMIU0D25RuzyDm(GMINODNbDkaRDgooeJ4ugKD4,,4 )goo5Dn abI)UIbNDCWD2.%,–oyDg)4gD wkbNObDbMkOUIbIsODkOkaVUIUDmBNMTNI6FbD2rfry-DPIMNHbaVDcNkU MNPD4RD.NBNMDsBNMTNI6FbD2–ozyDgRDvMNUHFssaDsBNMTNI6FbD24,zyDuRDlaNcNObkMVDsBNMTNI6FbD24ozyD5RDxNb MODbsDOsMckaDTNI6FbD2eR5zyDvMVsMDNbDkaRDgo44J4u–KD4,,; )goo–Dp NENHD2.%4,=eyDoR=);D 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDGni-D3kMNOb)MN3sMbNPD 3DbsD=DVNkMU-DPIMNHbaVDcNkU MNPDtMscDk6ND–);D4RDwsT)UbkEaND2==zyDgRDnsPNMkbND254zyDuRDhI6F)MIUIO6D25R=zyDWaIOIO6DNbDkaRDgo4uJ4ueKD4,;uN;5)4,;=N;–DnNbMsDrNE SDvFIaI33IONUD2.%uSo;oyDo)gD 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDGni-DPIMNHbaVDcNkU MNPDGsVUD4RDrakUUD4D2gR4zyDgRDrakUUDgD245RgzyDuRDrakUUDuD2–RezyD5RDrakUUD5D24gRezyD=RDrakUUD=D2g–R,zyD–RDrakUUD–D2g5RezyDeRDrakUUDeD24gR,zyD1IMaUD4RDrakUUD4D25R;zyDgRDrakUUDgD2=R;zyDuRDrakUUDuD24=RezyD5RDrakUUD5D2g;R–zyD=RDrakUUD=D2g5RozyD–RDrakUUD–D24oRozyDeRDrakUUDeD244RgzyDDDDDDDg=DDStudy Study period Sample Age Method Outcome Trajectory groups WcIbFDNbDkaRDgo44J4uoKD4,;, )goo=D*NUbNMODL UbMkaIkD2.%gSu,eyDu)45D 1Ms 3)EkUNPDbMk9NHbsMVDcsPNaDGniDT)UHsMND2rfry-DPIMNHbaVDcNkU MNPD4RDjNMVDasT25RgzyDgRDwsTD2g5zyDuRDLBNMk6ND2u5zyD5RDLUHNOPIO6D2–R=zyD=RDnsPNMkbNDFI6FD2g–zyD–RDhI6FD2–RozyDjNOb MkDNbDkaRDgoo, J4u4KD.sb3MsBIPNPDrNObMkaDvNOOUVaBkOIkSDCWD2.%4;gyD=)4=D 1MsTbFDcIQb MNDcsPNaDGni-DPIMNHbaVDcNkU MNPD4RD=obFD3NMHNObIaNDbMkH0IO6D2uezyDgRD–obFD3NMHNObIaNDbMkH0IO6D2g,zyDuRDfNakVNPDPsTOTkMPD3NMHNObIaNDHMsUUIO6D2gozyD5RDC3TkMPD3NMHNObIaNDHMsUUIO6D245zyDUD3NMHNObk6NUDTNMNDHscEIONPDtsMD6Ms 3UDgDkOPDuDtsMDEsVUDkOPD6Ms 3UDgDkOPD5DtsMD6IMaDDiODU cckMVSDUb PINUDU 66NUbDbFkbDbFNMNDIUDFNbNMs6NONIbVDIODbFNDbMk9NHbsMINUDstDGniDP MIO6DHFIaPFssPRDhsTNBNMSDUI6OItIHkObD6k3UDMNckIODIOD OPNMUbkOPIO6DbFNDUFk3NDkOPD3kbbNMODstDbFNUNDbMk9NHbsMINUDkHMsUUDHFIaPFssPDkOPDIObsDkP abFssPRDrFk3bNMDuDstDbFIUDPIUUNMbkbIsODTIaaDHsOb IE NDbsDkPPMNUUDbFIUD6k3DIODbFNDUHINObItIHDaIbNMkb MNDEVDIPNObItVIO6DkOPDBkaIPkbIO6DbFNDPIUbIOHbDGniDbMk9NHbsMINUDbFkbDNQIUbDP MIO6DHFIaPFssPD UIO6DOkbIsOkaaVDMN3MNUN bkbIBNDasO6Ib PIOkaDPkbkRDLUDBkMIkEaN)H ObMNPDkOPD3NMUsO)HNObNPDk33MskHFNUD3MsBIPND OIM NDkOPDHsc3aNcNObkMVDIOtsMckbIsOSDEsbFDcNbFsPUDUFs aPDEND UNPDIODHsO9 OHbIsODsDUb PVDasO6Ib PIOkaD6MsTbFRJg=KDj kMIkEaN)H ObMNPDkOPD3NMUsO)HN bMNPDk33MskHFNUDTIaaDEsbFEND UNPDIODrFk3bNMD=DbsDkUUNUUDbFNDasO6Ib PIOkaDNttNHbDstDONI6FEs MFssPUDsODGniDPNBNas3cNObRDD2.2 Neighbourhood Environment and Obesity lkMaVDTsM0DIODbFND4,,o(UDts OPDbFkbDtNkb MNUDstDbFND3FVUIHkaDkOPDUsHIkaDNOBIMsOcNObDTNMNDkUUsHIkbNPDTIbFDFNkabFDs bHscNUDkOPDbFkbDbFNUNDkUUsHIkbIsOUDTNMNDOsbDNQ3akIONPDEVDBkMIkbIsODIODIOPIBIP kaDHFkMkHbNMIUbIHURJ4u;KDAFIUDtIOPIO6DaNPDUNBNMkaDMNUNkMHFNMUDbsDHsOHa PNDbFkbDbFNDONI6FEs MFssPDNOBIMsOcNObDI DTFIHFDIOPIBIP kaUDMNUIPNPDFkPDkODIc3kHbDsODFNkabFDkOP F kabFDENFkBIs MURDJ4u;F45oKDAFNDtIOPIO6UD3MsBIPNPDU 33sMbDtsMDbFNDUsHIka)NH as6IHkaDcsPNaDTFIHFD3sUIbUDbFkbDc abI3aNDaNBNaUDstDbFNDNOBIMsOcNObD2NR6RSDIOPIBIP kaSDtkcIaV Hscc OIbVyDIObNMkHbDbsDg–DDIOta NOHNDF kabFDENFkBIs MURJ–oS––KDdsMDNQkc3aNSDIOPIBIP kaDHFkMkHbNMIUbIHUSDU HFDkUDk6NSD6NOPNMSDkOPD3FVUIHkaDkHbIBIbVDaNBNaSDIObNMkHbDTIbFDtkcIaVDHFkMkHbNMIUbIHUSDU HFDkUD3kMNObIO6D3MkHbIHNUDkOPDUbVaNUSDTFIHFDIObNMkHbDTIbFDHscc OIbVDkOPDUsHINbkaDHFkMkHbNMIUbIHUSDU HFDkUDUHFssaD3Ms6MkcUDkOPDONI6FEs MFssPDHMIcNDMkbNRJ––KDWIOHNDbFNDNkMaVDgooo(USDbFNMNDFkUDENNODkD6MsTIO6DEsPVDstDNBIPNOHNDaIO0IO6DONI6FEs MFssPDHFkMkHbNMIUbIHUDTIbFDsENUIbVDsMDTN 6Fb MNakbNPDENFkBIs MURDAFNONI6FEs MFssPDIUDbFNsMIYNPDbsDkttNHb E bFDNONM6VDIObk0NDkOPDNONM6VDNQ3NOPIb MNDTFIHFDIODb MODkttNHbUDTNI6FbDUbkb UD2UNNDdI6 MND4R4yRDxNUNkMHFNMU FkBND3Ms3sUNPDbFMNNDPsckIOUDstDbFNDONI6FEs MFssPDNOBIMsOcNObDbFkbDckVDIc3kHbDsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MU8DONI6FEs MFssPDUsHIsNHsOscIHDNOBIMsOcNObSDONI6FEs MFssPDUsHIkaDNOBIMsOcNObSDkOPDONI6FEs MFssPD3FVUIHkaD2E IabyDNOBIMsOcNObRJ454KDAFNDNttNHbUDstDbFNUNDbFMNNDPsckIOUDsODHFIaPFssPDsENUIbVDkMNDPNUHMIENPDIODPNbkIaDIODbF DtsaasTIO6DUNHbIsOURD2.2.1 Defining Neighbourhoods nkOVDPNtIOIbIsOUDstDONI6FEs MFssPUDNQIUb-DFsTNBNMSDbFND6NONMkaDHsOUNOU UDIUDbFkbDkDONI6FEs MFssPDMN3MNUNObUDkDUckaaD6Ns6Mk3FIHDkMNkDbFkbDIccNPIkbNaVDU MMs OPUDkODIOPIBIP ka(UDMNUIPNOHNDkOPDIUDMNakbIBNaVDFscs6NOs UDIODckbNMIkaDkOP UsHIkaDHFkMkHbNMIUbIHURJ4u,S45gKDf NDbsDbFNDU E9NHbIBNDOkb MNDstDbFIUDPNtIOIbIsOSDONI6FEs MFssPDEs OPkMINUDFkBNDENNODPNtIONPDIOHsOUIUbNObaVDIODMNUNkMHFRDnsUbDUb PINUDFkBND UNPDkPcIOIUbMkbIBNDEs OPkMINUDU HF kUDHNOU bMkHbUSDNaNHbsMkaDTkMPUSsMDYI3N3sUbkaDHsPNURJ45oKDLabFs 6FDkPcIOIUbMkbIBNDEs OPkMINUD3MsBIPNDkODNkUVDkOPDMN3aIHkEaNDTkVDbsDHakUUItVD3Ns3aNSDbFNVDckVDOsbDMN3MNUNObDkODIOPIBIP ka(UD3NMHN3bIsODstDbFNIMDONI6FEs MFssPDMDM kObItVDbFNDHk UkaDtkHbsMUDbFkbDaIO0DONI6FEs MFssPUDTIbFDFNkabFRJ45oS45gKDiODkPPIbIsOSDIOPIBIP kaUDTFsDaIBNDsODbFNDNP6NDstDkODkPcIOIUbMkbIBNDEs OPkMVDckVDENDNM kaaVDIOta NOHNPDEVDbFNDk 9kHNObDkPcIOIUbMkbIBNDkMNkRDnsMND NHNObDUb PINUDFkBNDPNtIONPDONI6FEs MFssPUDEV  UIO6D1iWDbsDHMNkbNDU3kbIkaDkMNkUDkMs OPDk 3kMbIH akMDasHkbIsOSDU HFDkUDkDgeDDFs UNRDAFNUNDkMNkUDHkODENDHIMH akMDsMDEkUNPDsODMskPDONbTsM0UDOPDkMNDt McNPD UI 6DkDE ttNDPIUbkOHND2NR6RSD4D0cyDtMscDbFNDFscNDMNUIPNOHNRJ45uS455KDW3kbIkaDkMNkUDHMNkbNPDEVD1iWDFkBNDENNODts OPDbsDENDkDENbbNMD3MNPIHbsMDstDFNkabFDs bHscNDbFkODkPcIOIUbMkbIBNDEs OPkMINU-J455KDFsTNBNMSDbFNVDUbIaaDPsDOsbDkHHs ObDtsMDkODIOPIBIP ka(UD3NMHN3bIsODstDbFNDONI6FEs FssPRDiOPIBIP kaU(D3NMHN3bIsOUDkEs bDbFNIMDONI6FEs MFssPDkMND6NONMkaaVDkUHNMbkIONPDBIkDU MBNVURDxNUIPNObUDkMNDbV3IHkaaVDkU0NPDkEs bDbFNIMDk6MNNcNObDsMDPIUk6MNNcNObDTIbFDUbkbNcNObUDkEs bDbFNIMDONI6FEs MFssPD2NR6RSDbFNMNDIUDFNkBVDbMkttIHDIODs MDONI6FEs MFssPDUbMNNbU-DbF MNDkMNDU3s bIO6DBNO NUDTIbFIODs MDONI6FEs MFssPyRJ45=KDG bFD3NMHNIBNPDkOPDU3kbIkaDcNkU MNUDFkBNDENNODMNHsccNOPNPDEVDMNUNkMHFNMUDbsDPNtIONDONI6FEs MFssPURJ45gKD2.2.2 Measurement of Neighbourhood Attributes nNkU MNcNObUDstDONI6FEs MFssPDkbbMIE bNUDkMNDHsaaNHbNPDNIbFNMDsE9NHbIBNaVDsMDU E9NHbIBNaVRDW E9NHbIBNDcNkU MNUDkMNDsEbkIONPDtMscDU MBNVUDsMDIO)3NMUsODIObNMINTUDkOPDcNkU MNDNkHFDIOPIBIP ka(UD3NMHN3bIsODstDbFNDONI6FEs MFssPRJ45–KDmE9NHbIBNDcNkU MNUDkMNDsEbkIONPDNIbFNMDtMscDUVUbNckbIHDk PIbUD2NR6RSDbMkIONPDsEUNMBNMUDMNHsMPIO6DbFNDO cENMDkOPDasHkbIsODstDtssPDUbsMNUyDsMDtMscDNQIUbIO6DPkbkDUNbUD2NR6RSDHNOU UDPkbkSDE UIONUUDPIMNHbsMVyRJ45–KDlQIUbIO6DPkbkDUNbUDkMNDstbNODkOkaVYNPDIODHsO9 OHbIsODTIbFD1iWDbsDPNbNMcIONDbFNDM kObIbVDs D3Ms3sMbIsODst U3NHIt HDONI6FEs MFssPDkbbMIE bNUD2 R6RSD5)TkVDIObNMUNHbIsOUSD6MNNODU3kHNySDPIUbkOHNDbsDE UIONUUNUDkOPDtkHIaIbINUSDsMDbsDaIO0DkbbMIE bNUD2 R6RSDHMIcNDMkbNyDbsDU3NHItIHDasHkbIsOURDGsbFDU E9NHbIBNDkOPDsE9NHbIBNDcNkU MNcNObUDFkBNDbFNIMDPIUkPBkObk6NURDdsMDNQkc3aNSDU MB VDUb PINUDkMNDU E9NHbDbsDasTDMNU3sOUNDMkbNUDkOPDcNkU MNcNObDNMMsMRDmE9NHbIBNDcNkU MNUDHkODENDHsUbaVSDbIcNDHsOU cIO6SDkOPDMNM IMNDbNHFOIHkaDU0IaaURJ45–Kg;DD2.2.3 Neighbourhood Socioeconomic Status WNBNMkaDUb PINUDFkBNDts OPDkODIOBNMUNDkUUsHIkbIsODENbTNNODONI6FEs MFssPDUsHIsNHsOscIHDUbkb UD2WlWyDkOPDHFIaPFssPDsENUIbVDIOPN3NOPNObDstDIOPIBIP kaDWlWRJ45eF4=gKDdsMDNQkc3aNSDmaIBNMDkOPDhkVNUDaIO0NPDONI6FEs MFssPDIOPIHkbsMUDstDWlWDtMscDHNOU UDPkbkDTIbFDGniDPkbkDtMscDkDOkbIsOkaaVDMN3MNUNObkbIBNDU MBNVDstDHFIaPMNODkOPDkPsaNUHNObUDkOPDts OPDbFkbDbFND PPUstDENIO6DsBNMTNI6FbDIOHMNkUNPDTIbF PNHMNkUIO6DWlWDM IObIaNDktbNMDHsObMsaaIO6DtsMDIOPIBIP kaDWlWRJ4=oKDxNUIPNObUDstDasTDWlWDONI6FEs MFssPUDckVDFkBNDMNP HNPDkBkIakEIaIbVDsMDkHHNUUDbsDFNkabFVDtssPUDsMD3akHNUDbsDEND3FVUIHkaaVDkHbIBNRDdsM NQkc3aNSDasTDWlWDONI6FEs MFssPUDFkBNDENNODts OPDbsDFkBNDtNTNMDU 3NMckM0NbUSDENDt MbFNMDtMscDU 3NMckM0NbUSDFkBNDFI6FNMD3MIHNPSDasTNMDM 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UIO6DU E9NHbIBNDNOBIMsOcNObkaDcNkU MNUDkOPDU E9NHbIBND3FVUIHkaDkHbIBIbVDcNkU MNURJgeKAFNMNDIUDUbIaaDTsM0DONNPNPDbsDIc3MsBNDbFNDMNaIkEIaIbVDkOPDBkaIPIbVDstDsE9NHbIBNDkOPDU E9NH IBNDNOBIMsOcNObkaDcNkU MNUDkOPDbsDbNUbDbFNUNDcNkU MNUDIOD3MkHbIHkaDUNbbIO6URJ45–KDGNasTSDiDs aIONDbFNDbFNsMNbIHkaDcNHFkOIUcUDIODTFIHFDONI6FEs MFssPDNttNHbUDPINbDkOPD3FVUIHkaDkHbIBIbVDkOPD3MsBIPNDNQkc3aNUDstDbFNUNDIOta NOHNURD2.2.5.1 Neighbourhood Effects on Diet AFNDNttNHbDstDbFNDONI6FEs MFssPDsODPINbDHkO ENDHsOHN3b kaIYNPDbsDIOHa PNDtIBNDPIcNOUIsOU8DkBkIakEIaIbVSDkHHNUUIEIaIbVSDkttsMPkEIaIbVSDkHHN3bkEIaIbVSDkOPDkHHsccsPkbIsORJ54KDAFNDtIMUbDbFMNNDPIcNOUIsOUDMNtNMDbsDbFNDU 33aVSDNkUNDstDkHHNUUSDkOPDbFNDHsUbDstDFNkabFVDtssPUSDMNU3NHbIBNaVRDLHHN3bkEIaIbVDMNtNMUDbsDbFNDkbbIb PNUDbsTkMPUDbFNDM kaIbVDstDts PUDkBkIakEaNDIODbFNDONI6FEs MFssPRDLHHsccsPkbIsODMNtNMUDbsDFsTDTNaaDtssPDUbsMNUDIODbFNDONI6FEs MFssPDkMNDkEa bsDcNNbDbFNDONNPUDstDbFNIMDHaINObNaNRDLDMNH DUVUbNckbIHDMNBINTDts OPDbFkbD3NMHNIBNPDtssPDkBkIakEIaIbVD2NR6RSDQiDHkODPsDcsUbDstDcVDtssPDUFs33IO6DkbDUbsMNUDIODcVDasHkaDONI6FEs MFssPRyDkOPDsE9NHbIBNDcNkU MNUDstDkttsMPkEIaIbVD2NR6RSDIOPNQDstDtssPD3MIHNUDIODbFNDkMNkyDT MN sUIbIBNaVDMNakbNPDbsDFNkabFVDPINbkMVDs bHscNUD2NR6RSDIOHMNkUNPDtM IbDkOPDBN6NbkEaNDIObk0NyRJ54KDdNTDUb PINUDu4DDcNkU MNPDkHHN3bkEIaIbVD2NR6RSDbFNDtMNUFD3MsP HNDIODcVDkMNkDIUD U kaaVDstDFI6FDM kaIbVyDsMDkHHscsPkbIsOD2NR6RSDO cENMDstDFs MUDtssPDUbsMNUDkMNDs3NOyDE bDbFsUNDbFkbDPIPDts OPD3sUIbIBNDkUUsHIkbIsOUDTIbFDFNkabFVPI bkM Ds bHscNURJ54KD.sDsMDIOHsOUIUbNObDMNakbIsOUFI3UDENbTNNODsE9NHbIBNDcNkU MNUDstDkBkIakEIaIbVD2NR6RSDPNOUIbVDstDtssPDUbsMNUySD3NMHNIBNPD2NR6RSDPIttIH abINUDTIbFDbMkOU3sMbDbsDkOPDtMscDasHkaDtssPDUbsMNUyDsMDsE9NHbIBND2NR6RSDPIUbkOHNDbsDtssPDUbsMNUyDcNkU MNUDstDkHHNUUIEIaIbVSDkOPD3NMHNIBNPDkttsMPkEIaIbVD2NR6RSDiDPsDOsbDE VDckOVDtM IbUDENHk UN bFNVDHsUbDbssDc HFyDkOPDPINbkMVDs bHscNUDTNMNDts OPRJ54KDDWb PINUDFkBNDNQkcIONPDTFNbFNMDkBkIakEIaIbVDkOPDkHHNUUIEIaIbVDstD 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Neighbourhood Studies AFNMNDkMNDkDO cENMDstDaIcIbkbIsOUDbsDbFNDNQIUbIO6D b PINUDstDONI6FEs MFssPDkbbMIE bNUDsODsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MURDdIMUbSDbFNDakH0 stDk UbkOPkMPIYNPDcNbFsPDbsDPNtIONDONI6FEs MFssPUDsMDcNkU MNDbFNDsE9 HbIBNDsMDU E9NHbIBNDkbbMIE bNUDstDbFNDONI6FEs MFssPDNOBIMsOcNObDFkUDckPNDHsc3kMIUsOUDENbTNNODUb PINUHFkaa O6IO6RJ4;,KDnNkU MNcNObDPIttNMNOHNUDIODbFNDs bHscND2NR6RSDPINbDsMD3FVUIHkaDkHbIBIbVyDFkBNDkPPNPDbsDbFIUDHFkaaNO6NRDAF MNDIU kDONNP bsDUbkOPkMPIYNDcNkU MNcNObDk33MskHFNUDbsDck0NDMNU abUDcsMND6NONMkaIYkEaNDkOP H c3kMkEaRDDWNHsOPSDc HFDstDbFNDMNUNkMHFDIOBsaBIO6DONI6FEs MFssPDkbbMIE bNUDkDENNODHMsUU)UNHbIsOka-DbFNMNtsMNSDNBIPNOHNDtsMkDHk UkaDNttNHbDFkUDENNODTNk0RDmtD3kMbIH akMDHsOHNMODTIbFDHMsUU)UNHbIsOkaDUb PINUDIUDbFND3sbNObIkaDtsMDUNat)U aNHbIsODEIkURAFNDMNkUsODbFkbDMNUIPNObUDHFssUNDbsDaIBNDTIbFIODkD3kMbIH akMDONI6FEs MFssPDckVDENDMNakbNPDbsDbFNDNQ3sU MNDsMDs bHscNDstDUb PVDTFIHFDckVDEIkUDbFNDMNU abURJ4,oKDnNbFsPUDFkBNDENNODPNBNas3NPDbsDkP9 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NSDUscNDMNUNkMHFNMUDFkBND UNPD3NMUsO)HNObMNPDk33MskHFNUDU HFDkUDHa UbNMDkOkaVUIUDsMDkbNOb HakUUDkOkaVUIUDbsD6Ms 3DONI6FEs MFssPDkbbMIE bNUDIObsDcNkOIO6t aDU E6Ms 3UDU HFDbFkbDbFN 3MstIaNDstDkbbMIE bNUDTIbFIODkDU E6Ms 3DkMNDcsMNDUIcIakMDbFkODENbTNNODU E6Ms 3URJ4,4F4,5KDAFNUND6Ms 3UDHkODbFNODEND UNPDbsDcsPNaDkUUsHIkbIsOUDTIbFDFNkabFDs bHscNURD2.2.7 Conclusion xNUNkMHFDIObsDbFNDONI6FEs MFssPDNttNHbDsODsENUIbVDIUDUbIaaDIODIbUDIOtkOHVRDLDO cENMDstDaIcIbkbIsOUDIODH MMNObUDUb PINUDaIcIbDs MDkEIaIbVDbsDNa HIPkbNDbM NDkUUsHIkbIsOURDAFNMNDIU kDONNPDbsDIPNObItVDbFND3MsHNUUNUDsMDbFNDNQbNObDbsDTFIHFDPItt MNObD3MsHNUUNUDtkHIaIbkbNDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDkOPDsENUIbVRDrFk3bNMD5DTIaaDkPPMNUUDbFIUD6k3DIODbFNDaIbNMkb MNDEVDNQkcIOIO6DbFNDcNPIkbIO6DNttNHbDstD3FVUIHkaDkHbIBIbVDkOPDUNPNObkMVDENFkBIs MDsODbFNDkUUsHIkbIsODENbTNNODONI6FEs MFssPDkOPDsENUIbVRDrFk3bNMD5DTIaaDkaUsDkbbNc3bDbsDMNUsaBNDkDaIcIbkbIsODEVD UIO6DakbNObDHakUUDkOkaVUIUDbsD6Ms 3DHFIaPMNOIObsDcNkOIO6t aDONI6FEs MFssPDbV3NURDrFk3bNMD=DTIaaDkPPMNUUDkOsbFNMD6k3DIODbFNDaIbNMkb MNDEVD UIO6DkDasO6Ib PIOka PNUI ODbsDkUUNUUDbFNDkUUsHIkbIsOENbTNNODONI6FEs MFssPDbV3NDkOPDGniDbMk9NHbsMVDkOPDEVDHsOUIPNMIO6DNQ3sU MNDP MkbIsORDu5DDChapter 3: Body Mass Index Trajectories across Childhood 3.1 Introduction *IbFDbFNDIOHMNkUIO6D3MNBkaNOHNDstDHFIaPFssPDsENUIbVSJ4KDIbDIUDIc3 MbkObDbsD6kIODkDENbbNMD OPNMUbkOPIO6DstDFsTDHFIaPFssPDsENUIbVDNcNM6NUDkOPDTFsDIUDcsUbDkbDMIU0D tDENHscIO6DsENUNDIODsMPNMDbsDIOtsMcD3MNBNObIsODUbMkbN6INURDmONDk33MskHFDbsDIOBNUbI6kbIO6DFsTDsENUIbVDPNBNas3UDsBNMDbIcNDIOBsaBNUDk33aVIO6DkDaItNDHs MUND3NMU3NHbIBNRDAFNDaItNDHs MUNDk33MskHFDIUDkDtMkcNTsM0DtsMD OPNMUbkOPIO6DbFNDIOta NOHNDstDaItNDNB ObUDsODbFNDMIU0DstDPNBNas3IO6DFNkabFDs bHscNURJ4,=KDAFNDk33MskHFDFkUDENNOD UNPDbsDUb PVD0NVDbMkOUIbIsOD3NMIsPUSDU HFDkUDbFNDbMkOUIbIsODtMscDHFIaPFsP IObskP abFssPSDIODbFNDPNBNas3cNObDstDHFMsOIHDPIUNkUNUD UIO6DasO6Ib PIOkaDPNUI6OURJ4,–KDAsDPkbNSDc HFDstDbFNDMNUNkMHFDsODbFNDPNbNMcIOkObUDstDsENUIbVDFkUDENNODPNMIBNPDtMscDHMsUU)UNHbIsOkaDUb PINUDTFIHFDPsDOsbDtkHIaIbkbNDIOBNUbI6kbIsOUDstDIOPIBIP kaDHFkO6NDIODEsPVDckUUDIOPNQ 2Gni ysBNMDbIcNDOsMDbFNDPNbNMcIOkObUDstDU HFDHFkO6NRDmtDbFNDasO6Ib PIOkaDUb PINUDbFkbDFkBNDENNODHsOP HbNPSDcsUbDMNaVDsODkOkaVbIHDcNbFsPUDbFkbDkUU cNDFscs6NOs UD6MsTbFD2IRNRDkaaDIOPIBIP kaUTIbFIODkD3s3 akbIsODsMDU E3s3 akbIsODFkBNDbFNDUkcND3kbbNMODstD6MsTbFDsBNMDbIcNyRJ44oF44gS44=S4,eKDhsTNBNMSDbFNUNDcNbFsPUSDTFIHFDIOHa PNDc abIaNBNaDcsPNaUDkOPDUbM Hb MkaNM kbIsODcsPNaIO6SDHkOOsbD OHsBNMDbFNDIOPIBIP kaDbMk9NHbsMINUDbFkbDNQIUbDTIbFIODkD3s3 akbIsORD*I FDkPBkOHNcNObUDIODUbkbIUbIHkaDcNbFsPUSDUb PINUDFkBNDOsTDEN6 ODbsDIPNObItVD6Ms 3UDstDIOPIBIP kaUDTIbFD OIM ND3kbbNMOUDsMDbMk9NHbsMINUDstDGniD6MsTbFDTIbFIOD3s3 akbIsOURDAFNDIPNObItIHkbIsODstDPIUbIOHbDbMk9NHbsMINUDsMDU E)bV3NUDst sENUIbVDPNBNas3cNObDIUD6kIOIO6DkbbNObIsODkUDaNkPIO6DUHINObIUbUDHkaaDtsMDMNUNkMHFDbFkbDkPPMNUUNUDbFNDHsc3aNQDkOPDFNbNMs6NONs UDNbIsas6VDstDsENUIbVRJg–KDWbkbIUbIHkaDcNbFsPUDU HFDkUD6Ms 3DEkUNPDbMk9NHbsMVDcsPNaIO6D21GAnyDsMD6MsTbFDcIQb MNDcsPNaIO6DFkBNDENNODPNBNas3NPDbsDIPNObItVDUNbUDstD6MsT FD3kbbNMOUDEVD6Ms 3IO6DIOPIBIP kaUDTIbFDUIcIakMD6MsTbFD3kbbNMOUDIObsDakbNObDbMk9NHbsMVDHakUUNURJ4,;KDAF UNDakbNObDHak UNUDkMNDPNbNMcIONPDu=DDNc3IMIHkaaVDtMscDbFNDPkbkDkOPDkMNDOsbDtsMcNPDkD3MIsMIRDWb PINUDbFkbDFkBND UNPDbFNUNDcNbFsPUDbsDcsPNaDGniD6MsTbFDIODHFIaPMNODFkBNDbV3IHkaaVDts OPDbFMNNDsMDts MD6MsTbFDbMk9NHbsMINUDtsMDckaNUDkOPDtNckaNURJ4g4S4ggS4g5F4g,S4u4F4u–KDLabFs 6FDIOtsMckbIBNSDkDO cENMDstDcNbFsPsas6IHkaDIUU NUDaIcIbUDbFNDIObN6MkbIsODstDbFNUNDtIOPIO6UDkUDbFNDUb PINUDBkMINPDTIPNaVDIODUb PVD3s3 akbIsOUSDPNBNas3cNObkaD3NMIsPUDNQkcIONPD2NkMaVDHFIaPFssPJ4ggS4g5S4geS4g;S4ugS4uuS4u–KDbMkOUIbIsODIObsDkPsaNUHNOHNJ4g4S4g=S4g,S4u4S4u5KSDsMDkPsaNUHNOHNJ4g–S4u=KySDs bHscNDcsPNaNPD2GniJ4ggS4g5S4g–S4g;S4u4S4u5F –KSDGniDY)UHsMNJ4uuKSDsMDPIHFsbscs UDIOPIHkbsMDstDsBNMTNI6FbDsMDsENUIbVJ4g4S4g=S4geS4g,S4ugKySDkOPDkOkaVbIHDUbMkbN6VRDLUDOsDUb PINUDFkBNDNQkcIONPDGniDbMk9NHbsMINUDkHMsUUDbFNDNObIMNDHFIaPFssPD3NMIsPDIObsDNkMaVDkP abFssPSDbFNDO cENMDstbMk9NHbsMINUDbFkbDNQIUbUDMNckIOUD OHaNkMRDDdsaasTIO6DkDaItNDHs MUNDk33MskHFSDbFND3MIckMVDsE9NHbIBNDstDbFIUDUb PVDTkUDbsDIPNObItVDPIUbIOHbDGniDbMk9NHbsMINUDtMscDk6NUDsONDbsDgoD UIO6DbTsDOkbIsOkaaVDMN3MNUNObkbIBNDrkOkPIkODasO6Ib PIOkaDHsFsMbU8DsONDbsD6NONMkbNDbFNDGniDbMk9NHbsMINUDkOPDbFNDsbFNMDbsDHMsUU)Bka PkbNDbFNDMNU abURDAFNDPNbNMcIOkObUDstDbFNDIPNObItINPDaItNDHs MUNDbMk9NHbsMINUDstDGniDTNMNDkUUNUUNPD UIO6DkD3MIsMIDPNtIONPDIOPIBIP kaDkOPDtkcIaIkaDaNBNaDtkHbsMUDts OPDIOD3MNBIs UDUb PINUDbsDENDkUUsHIkbNPDTIbFDsENUIbVJ4,,KDbsDHMNkbNDMIU0D3MstIaNUDstDIOPIBIP kaUDbFkbDkMNDkbDFI6FDMIU0DstDP BNas3IO6DsENUIbVDIODkP abFssPRD3.2 Methods 3.2.1 Data Source fkbkDtMscDbFND.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD2.wWr:yJgooKDkOPDbFND.kbIsOkaDvs3 akbIsODhNkabFDW MBNVD2.vhWyJgo4KSDHsOP HbNPDEVDWbkbIUbIHUDrkOkPkDTNMND UNPDtsMDbFIUDUb PVRDGsbFDU MBNVUDHsaaNHbNPDIOtsMckbIsODstDbFNDFNkabFDstDrkOkPIkOUDEIkOO kaaVDUbkMbIO6DIOD4,,5N4,,=RDAFNDbkM6NbD3s3 akbIsODkbDEkUNaIONDTkUDHFIaPMNOD 3DbsDk6ND44DIODbFND4oD3MsBIOHNUstDu–DDrkOkPkDtsMDbFND.wWr:DkOPDFs UNFsaPDMNUIPNObUDstDkaaDk6NUDtsMDbFND.vhWRDlQHa PNPDTNMNDHFIaPMNODaIBIO6DsODMNUNMBNUDsMDrMsTODakOPSDMNUIPNObUDstDIOUbIb bIsOUSDHFIaPMNODstDt aa) IcNDcNcENMUDstDbFNDrkOkPIkODLMcNPDdsMHNUSDkOPDMNUIPNObUDstDU3NHItIHDMNcsbNDMN6IsO RDAFNDEkUNaIONDUkc3aNDstDbFND.wWr:DIOHa PNPDkDasO6Ib PIOkaDHsFsMbD2O%4;S,u=yDkOPDkDHMsUU)UNHbIsOkaDUkc3aND2O%uS;,–yRDdsMDNkHFDTkBNSDbFND3NMUsODcsUbD0OsTaNP6NkEaNDkEs bDbFNDHFIaPSDbV3IHkaaVDbFNDcsbFNMSDMNU3sOPNPDbsDbFNDU MBNVDM NUbIsOOkIMNRD*FNODHFIaPMNOMNkHFNPDk6ND4gSDbFNVDTNMNDU MBNVNPD UIO6DkODkPPIbIsOkaDM NUbIsOOkIMNRDAFNDUkc3aNDkOkaVYNPDIODbFIUDIOBNUbI6kbIsODTkUDHsc3sUNPDstDHFIaPMNODsONDbsD–DVNkMUDstDk6NDIODbFNDtIMUbDTkBNDTFsDTNMNDtsaasTNPD 3DbsDTkBND;D245)go VNkMUDstDk6N-DO%,S,u–yRDlQHa PNPDTNMNDHFIa MNODTFsDMN3sMbNPDMNM IMIO6DkDTFNNaHFkIMSDHFkO6NPDUNQDsMDENHkcND3MN6OkObDkbDkOVDbIcNDP MIO6DbFNDU MBNVD3NMIsPD2O%;;yDkOPDbFsUNDTIbFDtNTNMD kODbFMNNDGniDcNkU MNcNObUD2O%gS=,=ySDMNU abIO6DIODkODkOkaVbIHDUkc3aNDstDeSg=uD2uS–,uDckaNUDkOPDuS=–oDtNckaNUyRDDf NDbsDbFNDsBNMak3DIODk6NDkOPDU MBNVDbs3IHUDTIbFDbFND.wWr:SDbFND.vhWDPIPDOsbDUkc3aNDHFIaPMNOD OPNMD4gDIODbFNDtIMUbDTkBNRDiOUbNkPSDkDU EUkc3aNDstDbFNDEkUNaIOND.wWr:DHMsUU)UNHbIsOkaDUkc3aND2O%gSoggyDTkUDtsaasTNPDEVDbFND.vhWDIODU EUNM NObDVNkMURDAFND3NMUsODcsUbD0OsTaNP6NkEaNDkEs bDbFNDHFIaPD3MsBIPNPDMNU3sOUNUDtsMDHFIaPMNODaNUUDbFkOD4gDVNkMUDstDk6N-DsbFNMTIUNSDbFNDHFIaPDMNU3sOPNPDbsDbFNDM NUbIsOOkIMNRDAFNDUb PVDIOHa PNPD.vhW D3kMbIHI3kO UDTFsDTNMNDsONDbsD–DVNkMUDstDk6NDkbDEkUNaIONDkOPDTNMNDtsaasTNPD 3DbsDTkBND;D245)go VNkMUDstDk6N-DO%,––yRDlQHa PNPDTNMNDbFsUNDTIbFDtNTNMDbFkODuDGniDcNkU MNcNObUD2O%–=ySDMNU abIO6DIODkODkOkaVbIHDUkc3aNDstD,o4D25=gDckaNUDkOPD55,DtNckaNUyRDueDD3.2.2 Measures 3.2.2.1 Body Mass Index iODEsbFDbFND.wWr:DkOPDbFND.vhWSDFNI6FbDkOPDTNI6FbDTNMND3kMNOb)MN3sMbNPD 3DbsDk6ND44DkOPDUNat)MN3sMbNPDktbNMTkMPURDGniSDPNtIONPDkUDTNI6FbDPIBIPNPDEVDFNI6FbDUM kMNPD206NcgySDTkUDHkaH akbNPDtsMDNkHFDHFIaPDkbDNkHFDTkBNRDD3.2.2.2 Individual Level Covariates ATsDIOPIBIP kaDaNBNaDHsBkMIkbNUDTNMNDIOHa PNPDIODbFNDUb PV8DNbFOIHIbVDkOPDEIMbFDTNI6FbDtsMD6NUbkbIsOkaDk6NRDdsMDNbFOIHIbVSD3kMNObUDTNMNDkU0NPDbsDPNUHMIENDbFNDNbFOIHIbVDstDbFNDHFIaPRDxNU3sOUNUDTNMND6Ms 3NPDIObsDbFMNNDHkbN6sMINUD2*FIbNNl Ms3NkO-DLEsMI6IOka-DkOPDsbFNMyRDGIMbFDTNI6FbDtsMD6NUbkbIsOkaDk6NDTkUDHkbN6sMIYNPDIObsDbFMNNDHkbN6sMINU8DUckaaDts D6NUb IsOkaDk6NSDOsMckaSDkOPDakM6NDtsMD6NUbkbIsOkaDk6NRDWckaaDkOPDakM6NDEIMbFDTNI6FbDtsMD6NUbkbIsOkaDk6NDTNMNDPNtIONPDkUDbFNDasTNMDsMD 33NMD4oD3NMHNObDMNU3NHbIBNaVDkHHsMPIO6DbsDH MMNObDrkOkPIkODMNtNMNOHNURJgogKDAFIUDBkMIkEaNDTkUDPNMIBNPDtMscDbFMNNDIbNcUDIODbFND.wWr:8DEIMbFDTNI6FbSDTFNbFNMDbFNDHFIaPDTkUDEsMODENtsMNSDsOSDsMDktbNMDbFNDP NDPkbNSDkOPDbFNDO cENMDstDPkVUDEsMODENtsMNDsMDktbNMDbFNDP NDPkbNRDAFNDakbbNMDbTsDM NUbIsOUDTNMND UNPDbsDPNM BND6NUbkbIsOkaDk6N-DFsTNBNMSDbFNMNDTNMNDHsOUIPNMkEaNDcIUUIO6DPkbkDtsMDbFNDbFIMPDIbNcDENHk UNDIbDTkUDsOaVDkU0NPDItDbFNDHFIaPDTkUDVuDVNkMUDstDk6ND25ezDstDNaI6IEaNDUkc3aNyRDAsDkHHs ObDtsMDbFNUNDcIUUIO6DPkbkS c abI3aNDIc3 bkbIsODTkUD UNPDbsDIc3 bNDbFNDbFIMPDIbNcDEkUNPDsODIOtsMckbIsOD3MsBIPNPDEVDbFNDtIMUbDbTsDIbNcURD3.2.2.3 Family Level Covariates dkcIaIkaDaNBNaDHsBkMIkbNUDIOHa PNPDTFscDbFNDHFIaPDaIBNPDTIbFD2EsbFDEIsas6IHkaD3kMNObUDBURDsONDsMDOsDEIsas6IHkaD3kMNObySDaIBIO6DasHkbIsO2 MEkO8D3s3 akbIsODW=ooSooo-D MEkO8D3s3 akbIsOD4ooSooo)5,,S,,,-D MEkO8D3s3 akbIsODX4ooSooo-DkOPDM MkaySDckbNMOkaDkOPD3kbNMOkaDNP HkbIsOD2aNUUDbFkODFI6FDUHFssa-DFI6FDUHFssaD6MkP kbIsO-DUscNDbMkPNSDHsaaN6NSDsMD OIBNMUIbV-DbMkPNDHNMbItIHkbNDsMDu;DDHsaaN6NDsMD OIBNMUIbVDPN6MNNySDckbNMOkaDUcs0IO6D2VNUDBURDOsySDIOHscNDkPNM kHVD2asTNUbSDcIPPaNSDFI6FNUbySDkOPDtkcIaVDt OHbIsOIO6DUHkaNRDAsDkBsIPDFkBIO6DcIUUIO6D3kMNObkaDPkbkSDkDUN3kMkbNDHkbN6sMVD2OsDtkbFNM-DOsDcsbFNMyDTkUDHMNkbNPDtsMDbFND3kMNObkaDNP HkbIsODBkMIkEaNURDAFNDbTsD3kMNObkaDNP HkbIsODBkMIkEaNUDTNMNDbMNkbNPDkUDOscIOkaDPkbkRDf NDbsDUcka HNaaDUIYNSDbFNDQOsDcsbFNMRDkOPDQaNUUDbFkODFI6FDUHFssaRDHkbN6sMINUDTNMNDHscEIONPDtsMDckbNMOkaDNP HkbIsORDiOHscNDkPNM kHVDTkUDkDtIBNDHkbN6sMVDBkMIkEaNDPNMIBNPDEVDWbkbIUbIHUDrkOkPkDEkUNPDsODFs UNFsaPDIOHscND OPDFs UNFsaPDUIYNRDAFNDbTsDasTNUbDkOPDFI6FNUbDHkbN6sMINUDTNMND6Ms 3NPDtsMDbFIUDUb PVDP NDbsDasTDHNaaDHs ObURDDdkcIaVDt OHbIsODUHkaNDTkUD UNPDkUDkDcNkU MNDstDtkcIaVDPVUt OHbIsORJgooKDAFN UHkaNDHsOUIUbUDstD4gDIbNcUD2NR6RSDTNDHkODb MODbsDNkHFDsbFNMDtsMDU 33sMbSDTNDNQ3MNUUDtNNaIO6UDbsDNkHFDsbFNMSDTNDtNNaDkHHN3bNPDtsMDTFkbDTNDkMNyDkOPDUHsMNUDMkO6NDENbTNNODo)u– TIbFDkDFI6FNMDUHsM DIOPIHkbIO6DFI6FNMDtkcIaVDPVUt OHbIsORD3.2.3 Statistical Analyses LDWbkbkD2rsaaN6NDWbkbIsOSDANQkUSDCWLyDckHMsDPNBNas3NPDEVDbFND*sMaPDhNkabFDmM6kOIYkbIsOD2*hmyDTkUD UNPDbsDtak6DEIsas6IHkaaVDIc3ak UIEaNDcNkU MNUDstDFNI6FbSDTNI6FbSDsMDGniDtsMDNkHFDMNU3sOPNOb(UDk6NDkbDbIcNDstDcNkU MNcNObRJgouKJgo5KDAFNUNDNQbMNcNDcNkU MNcNObUSDTFIHFDkHHs ObNPDtsMDuRuzDstDkaaDGniDcNkU MNcNObUDstDEsbFDbFND.wWr:DkOPD.vhWSDTNMNDMNcsBNPDtMscDkOkaVUIURDAsDMNaIkEaVD3MsP HNDbMk9NHbsMINUDkOPDkUUI6ODIOPIBIP kaUDIObsDbMk9NHbsMVDHakUUNUSDkbDaNkUbDbFMNNDcNkU MNcNObUDstDGniDTNMNDMNM IMNPRDxNU3sOPNObUDTIbFDtNTNMDbFkODbFMNNDcNkU MNcNObUDstDGniDTNMNDNQHa PNPDtMscDbFNDkOkaVUIURDAFIUDMNU abNPDIODg–RuzDkOPD–RezDstDbFND.wWr:DkOPD.vhWDUkc3aNSDMNU3NHbIBNaVSDENIO6DNQHa PNPDtMscDkOkaVUIURDLDcIUUIO6DPkbkDkOkaVUIUDts OPDbFkbDbFsUNDNQHa PNPDtMscDbFND.wWr:DkOkaVUIUDTNMND NUUDaI0NaVDbsDEND*FIbNNl Ms3 kOSDaIBNDTIbFDEsbFDEIsas6IHkaD3kMNObUSDkOPDaIBNDIODkDFs UNFsaPDTIbFDFI6FNMDIOHscNDkPNM kHVDkOPDTNMNDcsMNDaI0NaVDbsDaIBNDIODkOD MEkODUNbbIO6DTIbFD3s3 akbIsODsBNMD=ooSoooSDFkBND3kMNObUDTIbFDasTNMDu, DDNP HkbIsOSDFkBNDkDcsbFNMDT sDUcs0NPSDkOPDFkBNDFI6FNMDtkcIaVDPVUt OHbIsORDAFNMNDTNMNDOsDUI6OItIHkObDPIttNMNOHNUDEVD6NOPNMDsMDEIMbFDT I6FbDtsMD6NUbkbIsOkaDk6NRDdsMDbFND.vhWDHsFsMbSDbFsUNDNQHa PNPDTNMNDaNUUDaI0NaVDbsDEND*FIbNNl Ms3NkO-DFsTNBNMSDbFNVDPIPDOsbDPIttNMDEVDFs UNFsaPDIOHscNDkPNM kHVSD6NOPNMSDsMD MEkODUNbbIO6RD1Ms 3)EkUNPDbMk9NHbsMVDcsPNaIO6D21GAnyDTkUD UNPDbsDcsPNaDbMk9NHbsMINUDstDGniRD1GAnDkUU cNUDFNbNMs6NONIbVDIOD6MsTbFDTIbFIODkDUIO6aND3s3 akbIsODkOPDbFkbDbFNUND OIM ND3kbbNMOUDstD6MsTbFDHkODENDPNUHMIENPD UIO6D3saVOscIkaDt OHbIs UDstDk6NDsMDbIcNRJgo=KD1MsTbFD3kMkcNbNMUDTNMNUbIckbNPDEkUNPDsODkD3MsEkEIaIbVDPIUbMIE bIsOD UIO6DckQIc cDaI0NaIFssPRDmOHNDkDtIOIbNDUNbDstDbMk9NHbsMINUDTNMNDIPNObItINPSDIOPIBIP kaUDTNMNDkUUI6ONPDkD3MsEkEIaIbVDstDENasO6IO6DIODNkHFDbMk9NHbsMVDEkUNPDsODbFNIMD3kbbNMODstD6MsTbFRDDLDWbkbkD3Ms6MkcDPNBNas3NPDEVDIsONUDkOPD.k6IODTkUD UNPDtsMDNUbIckbIO6DbFND1GAnRJgo–KDAMk9NHbsMINUDTNMNDcsPNaNPD UIO6DkDHNOUsMNPDOsMckaDPIUbMIE bIsORDL6NDIODcsObFUDHNObMNPDkbD4oDVNkMUDTkUD UNPDkUDbFNDcNkU MNDstDbIcNRDrsOUIUbNODTI FDMNHNObDMNHsccNOPkbIsOUDtMscDbFNDrkOkPIkODiOUbIb bNUDtsMDhNkabFDxNUNkMHFJgoeKDkOPD0OsTODUNQDPIttNMNOHNUDIOD6MsTbFSJ4ouKDkaaDkOkaVUIUDTNMNDUN3kMkbNPDEVDUNQRD1Ms 3 kUNPDbMk9NHbsMVDcsPNaIO6DkaasTUDtsMDkaaDkBkIakEaNDGniDcNkU MNcNObUDbsDENDIOHa PNPDIODcsPNaDNUbIckbNUD OPNMDbFNDkUU c3bIsODbFkbDcIUUIO6DGniDcNkU MNUDTNMNDcIUUIO6DkbDMkOPscRDAsDPNbNMcIONDbFNDO cENMDstDbMk9NHbsMINUDIODbFND3s3 akbIsOSDkDUbN3)TIUNDk33MskHFDTkUD UNPRDdIMUbSDkDsONDbMk9NHbsMVDcsPNaDTkUDtIbbNPDbsDbFNDPkbkRDAFNDUFk3NDstDbFNDbMk9NHbsMVDTkUDPNbNMcIONPDEVDtIMUbDtIbbIO6DbFNDbMk9NHbsMVDkUDkDH EIHDt OHbIsODkOPDbFNODMNP HIO6DbFNDt OHbIsOD2bsDM kPMkbIHSDUas3NSDsMDIObNMHN3bDsOaVyDItDbFNDGkVNUIkODiOtsMckbIsODrMIbNMIk 2GiryDIOPIHkbNPDIc3MsBNPDtIbRDWNHsOPSDcsPNaDtIbD3kMkcNbNMUDTNMNDMNHsMPNPDtsMDbFIUDcsPNaRDAFIMPSDbFNDO cENMDstDbMk9NHbsMINUDIODbFNDcsPNaDTkUDIOHMNkUNPDEVDsONDkOPDbFNDUbN3UDTNMNDMN3NkbNPRDAFIUD5oDD3MsHNP MNDTkUDHsObIO NPD ObIaDkbDaNkUbDsONDcsPNaDtIbD3kMkcNbNMDU 66NUbNPDkD3ssMDtIbbIO6DBNMkaaDcsPNaRDnsPNaDtIbDTkUDEkUNPDsODtIBNDHMIbNMIk8D4yDGirDIUDkDMNakbIBNDcNkU MNDstDcsPNaDtIbDTFNMNDkODIOHMNkUNDIODGirDstDkODkabNMOkbIBNDcsPNaD29yDMNakbIBNDbsDkDO aaDcsPNaD2IyDIUDIOPIHkbIBNDstDkDENbbNMDtIbDItDNGirI)Gir9DXD4N4oJgo=K-DgyDNObMs3VDMkO6NUDtMscDoDbsD4DkOPDIUDkDcNkU MNDstDFsTDTNaaDIOPIBIP kaUDkMNDHakUUItINPDIObsDbFNIMD6Ms 3U-DkDFI6FNMDBka NDIOPIHkbNUDENbbNMDtIbJgo;K-DuyDkBNMk6N 3sU IsMD3MsEkEIaIbVD2kBNvvyDcNkU MNUSDtsMDNkHFD6Ms 3SDFsTDTNaaDIOPIBIP kaUDkMNDHakUUItINP-DkDBka ND6MNkbNMDbFkODoReDIUDIOPIHkbIBNDstDkD6ssPDtIbJgo=K- 5yDsPPUDstDHsMMNHbDHakUUItIHkbIsOD2mrryDIUDkDcNkU MNDstDkUUI6OcNObDkHH MkHV-DkDFI6FNMDBka ND2W=yDIUDIOPIHkbIBNDstDkDENbbNMDtIbJgo=K-DkOPD=yDEIsas6IHkaD3ak UIEIaIbVDHsOUIUbUDstDNQkcIOIO6DbFNDNQbNObDbsDTFIHFDH MMNObDUHINObItIHDNBIPNOHNDU 33sM UDbF DIPNObItINPDbMk9NHbsMINURDDAMk9NHbsMINUDTNMNDHsc3kMNPDbsDbFND*hm DGniDH bDsttUDtsMDsBNMTNI6FbDkOPDsENUIbVRJ4ogSgo,KDD3.2.3.1 Cross-Validation rMsUU)BkaIPkbIsODTkUD3NMtsMcNPDbsDNOU MNDUbkEIaIbVDkOPD6NONMkaIYkEIaIbVDstDMNU abUDbsDbFNDrkOkPIkOD3s3 akbIsODkOPDbsDkBsIPDsBNM)tIbbIO6DcsPNaUDbsD OIM NDHFkMkHbNMIUbIHUDstDkDUIO6aNDPkbkUNbRDAFNMNDkMNDc OV 3sbNObIkaDbFMNkbUDbsDbFNDBkaIPIbVDstDbFIUDUb PVDbFkbDHs aPDTNk0NODbFNDIObNM3MNbkbIsODstDbFNDMNU abURDAFNUNDIOHa PNDcNkU MNcNObDEIkUDUbNccIO6DtMscDHFkO6IO6DtMscD3kMNOb)MN3sMbNPDbsDHFIaP)MN3sMbNPDGniSDUNaNHbIsODEIkUDUbNccIO6DtMscDPIttNMNOHNUDENbTNNODbFsU DIOHa PNPDkOPDNQHa PNPDtMscDbFNDkOkaVbIHDUkc3aNSDkOPDMNU3sOUNDEIkUDUbNccIO6DtMscDbFNDUNat)MN3sMbNPDOkb MNDstDU MBNVURDLabFs 6FDEsbFDU MBNVUDUFkMNDbFNDUkcNDbFMNkbUDbsDBkaIPIbVSDbFND3MNUNOHNDstDHsccsODbMk9NHbsMINUDkHMsUUDIOPN3NOPNObaVDkOkaVYNPDPkbkUNbUD3MsBIPNUDU 33sMbDtsMD FND6NONMkaIYkEIaIbVDstDbFNDMNU abUDbsDbFNDrkOkPIkOD3s3 akbIsORD1GAnDT U bFNMNtsMNDHsOP HbNPDUN3kMkbNaVDtsMDbFND.wWr:DkOPD.vhWDPkbkRDvkMkcNbNMDNUbIckbNUDtMscDEsbFDkOkaVUNUDTNMND54DDHsc3kMNPRDAFNDtIOkaDPNHIUIsODsODbFNDs3bIc cDO cENMDstDbMk9NHbsMVD6Ms 3U TkUDEkUNPDsOD3kMUIcsOVDkOPDkDUsa bIsODbFkbDHsObkIONPDbFNDbMk9NHbsMINUDHsccsODbsDEsbFDHsFsMbURDDD3.2.3.2 Identification of Risk Factors for Trajectory Membership AFND.vhWDTkUDPNUI6ONPDbsD3MsBIPND3s3 akbIsODNUbIckbNUDstDFNkabFDs bHscNUDkHMsUUDkaaDk6NUDkOPDbF UDIUD OPNM3sTNMNPDbsD3MsBIPNDMNaIkEaNDNUbIckbNUDstD3MNBkaNOHNDsMDMIU0DstDkDUckaaDk6N)U3NHItIHDU EUkc3aNRDAFNMNtsMNSDbFNDU abU tMsc bFND.wWr:DHsFsMbDTNMND UNPDtsMDkaaDU EUNM NObDkOkaVUNURDvMNPIHbsMUDstDbMk9NHbsMVDcNcENMUFI3DTNMNDNQkcIONPD UIO6Dc abIOscIkaDMN6MNUUIsODsONkHFDIOPIBIP ka(UDcsUbDaI0NaVDbMk9NHbsMVDHakUURDn abI3aNDIc3 bkbIsODEVDHFkIONPDNM kbIsOUDTkUD UNPDbsDkHHs ObDtsMDcIUUIO6DPkbkDkcsO6DbFNDIOPN3NOPNObDBkMIkEaNUDtsMDbFNDkP9 UbNPDcsPNaRDANODIc3 bkbIsODPkbkUNbUJg4oKDTNMNDNUbIckbNPD UIO6DIOtsMckbIsODtMscDbFNDIOPN3NOPNOb BkMIkEaNUDIODbFNDcsPNaRDLaaDIc3 bkbIsODTkUDHsOP HbNPDIODWbkbkD2BNMUIsOD4oyRDrsNttIHINObUDtMscDbFNDkP9 UbNPDcsPNaUDTNMNDHsOBNMbNPDbsDsPPUDMkbIsUDtsMDIObNM3MNbkbIsORDDwsO6Ib PIOkaDUkc3aNDTNI6FbUDPNMIBNPDEVDWbkbIUbIHUDrkOkPkDTNMNDk33aINPDbsDkaaDkOkaVUNURD*NI6FbUDTNMNDPNBNas3NPDbsDkP9 UbDtsMDOsO)MNU3sOUNDk PDbsDckbHFD3s3 akbIsODNUbIckbNUDstDk6NDkOPDUNQDTIbFIODNkHFD3MsBIOHNRDWIOHNDUkc3aIO6DtMscDbFIUDUb PVDEN6kODkbDTkBNDsONDtsMDEsbFDU MBNVUSDasO6Ib PIOkaDTNI6FbUDkbDTkBNDsONDTNMND UNPRD*NI6FbUDTNMNDUbkOPkMPIYNPDEVDPIBIPIO6DNkHFDTNI6FbDEVDbFNDkBNMk6NDstDkaaDTNI6FbURDLaaDNUbIckbNUDMNtaNHbD3MNBkaNOHNDIOD4,,5N4,,=RD3.3 Results rFIaPMNODTNMNDNBNOaVDPIUbMIE bNPDkHMsUUDEkUNaIONDk6NDtsMDbFND.wWr:DkOPD.vhWRDAFN NDTNMNDsODkBNMk6ND=Re=D2WfD4R–oyDkOPD–R–,D2WfD4Ru–yDGniDcNkU MNcNObU 3NMDHFIaPDtsMDbFND.wWr:DkOPD.vhWDMNU3NHbIBNaVRDLacsUbDkaaDHFIaPMNOD2,;zyDtMscDEsbFDHsFsMbUDTNMNDEsMODIODrkOkPkRDDAFND6Ms 3)EkUNPDbMk9NHbsMVDcsPNaIO6DstDbFND.wWr:DPkbkDMNU abNPDIODkDts M)HakUUDUsa bIs tsMDckaNUDkOPDtNckaNUDkUDbFNDs3bIckaDtIbRDnsPNaDtIbDUbkbIUbIHUDkMNDPIU3akVNPDIODAkEaNDgDkOPDUFsTDbFkbD5gDDGirDHsObIO NUDbsDPNHMNkUNDkUDbFNDO cENMDstDHakUUNUDIOHMNkUNDIOPIHkbIO6DENbbNMDtIb-DFsTNBNMSDbFNDtIBN)HakUUDUsa bIsODtsMDckaNUDkOPDtNckaNUDMNU abNPDIODkD3ssMNMDHakUUItIHkbIsODsMDkDUckaaDHakUUDUIYND2X4zySDMNU3NHbIBNaVRDLOkaVUIUDstDbFND.vhWDPkbkUNbDIOPIHkbNPDkODs3bIckaDUsa bIsODstDtIBNDHakUUNUDtsMDckaNUDkOPDts MDHakUUNUDtsMDtNckaNUD2AkEaNDgyRDLODkPPIbIsOkaDHakUUDtsMDEsbFDckaNUDkOPDtNckaNUDPIPDOsbDIc3MsBNDbFNDcsPNaDEkUNPDsODbFNDGirR5uDDTable 2: Fit indices for the optimal number of BMI trajectories by sex from the National Longitudinal Survey of Children and Youth (NLSCY) and the National Population Health Survey (NPHS) D D Gir D GirDstDcsPNaDTIbFD4DaNUUDHakUUDGirDstDcsPNaDTIbFD4DcsMNDHakUUDlObMs3VD zDUkc3aND LBNMk6NDvsUbNMIsMDvMsEkEIaIbVDmPPUDstDrsMMNHbDrakUUItIHkbIsODnkaND .wWr:D2O%u–,uyD)eg–=–R5D )eg;g;ReD )eg==oReD oRe54D D D DD DDDDrakUUD4 D D D D –=ReD oR,o=D 5R,eDD DDDDrakUUDg D D D D 4=RoD oRegoD 45R–DD DDDDrakUUDu D D D D 4uR5D oReuoD 4eR5DD DDDDrakUUD5 D D D D =R;D oR;=5D ,5ReDD .vhWD2O%5=gyD );4goR4gD );4ugR–D );4u4RuD oRe4oD D D DD DDDDrakUUD4 D D D D uoRuD oR;u5D 44R–DD DDDDrakUUDg D D D D geR=D oReugD eRgoDD DDDDrakUUDu D D D D 4,R,D oR,g;D =4R,DD DDDDrakUUD5 D D D D 4;R;D oRe4;D 44RoDD DDDDrakUUD= D D D D uR–D oR,egD ,uoReDD D D D D D D D DdNckaND .wWr:D2O%u=–oyD)e4=,–RuD )e4;ogRgD ))e45e–RuD oR–;,D D D DD DDDDrakUUD4 D D D D 5–R=D oR;=;D –R,=DD DDDDrakUUDg D D D D u=R5D oRe=5D =R–oDD DDDDrakUUDu D D D D 4oRgD oRe=uD euR;DD DDDDrakUUD5 D D D D ;RoD oR;,uD u=RgDD .vhWD2O%55,yD )e,55Re,D )e,euReD )e,5gR,D oRe;–D D D DD DDDDrakUUD4 D D D D =;RgD oR,44D eRu=DD DDDDrakUUDg D D D D ggR,D oR;g4D 4=R5DD DDDDrakUUDu D D D D 4uR;D oR;4–D geReDD DDDDrakUUD5 D D D D =RgD oR,e,D ;5,R, DD55DDAsDHMsUU)BkaIPkbNDbFNDMNU abUSDbFNDbMk9NHbsMINUDts OPDIOD.wWr:DUsa bIsODTNMNDHsc3kMNPDbsDbFsUNDts OPDIODbFND.vhWDUsa bIsOD2dI6 MNDgyRD sMDEsbFDckaNUDkOPDtNckaNUSDbFNDUsa bIsOUDTNMNDUIcIakMDNQHN3bDbFkbDbTsDstDbFNDts MDbMk9NHbsMI U2HakUUD4DkOPDuyDts OPDIODbFND.wWr:DckaNDUsa bIsODk33NkMNPDbsDU3aIbDIObsD FMNNDbMk9NHbsMINUD2Hak UD4SDgSDkOPDuyDts OPDIODbFNDtIBNHakUUD.vhW DckaNDUsa bIsOD2PIMNHbDHsc3kMIUsOUDHkODENDts OPDIODL33NOPIQDLyRDiObNMNUbIO6aVSDbFNDsbFNMDbMk9NHbsMINUDTNMNDUIcIakMRDAFNDkBNMk6NDPIUbkOHND2kHMsUUDbFNDaNO6bFDstDNkHFDbMk9NHbsMVyDENbTNNODbFNDsEUNMBNPDHsc3kMkEaNDbMk9NHbsMINUDstDbFND.wWr:DkOPDbFND.vhWDtsMDckaNUDMkO6NPDtMscDoR,,DbsD4R;, D06NcgDTIbFDkDcNkODPIUbkOHNDstD4RugD06NcgD2.wWr:DHakUUD4DbsD.vhWDHakUUD4DFDoR,,D06Ncg-D.wWr:DHakUUD4DbsD.vhWDHakUUDgDF4R4;D06Ncg-D.wWr:DHakUUDuDbsD.vhWDHakUUDgDFD4Re=D06Ncg-D.wWr:DHakUUDuDbsD.vhWDHakUUDuDFD4Ro;D06Ncg-D.wWr:DHakUUDgDbsD.vhWDHakUUD5DFD4R;,D06Ncg-D.wWr:DHakUUD5DbsD.vhWDHakUUD=DFD4RguD06NcgyRDAFNDkBNMk6NDPIUbkOHNDENbTNNODbFNDsEUNMBNPDHsc3kMkEaNDbMk9NHbsMINUDstDbFND.wWr:DkOPDbFND.vhWDtsMDtNckaNUDMkO6NPDtMscDoR4–DbsD4R54D06NcgDTIbFDkDcNkODPIUbkOHNDstDoR––D06NcgD2.wWr:DHakUUD4DbsD.vhWDHakUUD4DFDoR4–D06Ncg-D.wWr:DHakUUDgDbsD.vhWDHakUUDgDFoRuoD06Ncg-D.wWr:DHakUUDuDbsD.vhWDHakUUDuDFDoRe–D06Ncg- .wWr:DHakUUD5DbsD.vhWDHakUUD5DF4R54D06NcgyRDrsOUIPNMIO6DbFkbDGniDBka NUD6NONMkaaVDO6NPDtMscDgoDbsD5oD06NcgDtMscDbFNDasTNUbDbsDFI6FNUbDGniDIODkOVD6IBNODVNkMDIODEsbFDbFND.wWr:DkOPD.vhWSDkODkBNMk6NDPIttNMNOHNDIODPIUbkOHNDstDkEs bD4D06NcgDsBNMDkDgoDVNkMDU3kODENbTNN Hsc3kMkEaNDbMk9NHbsMINUDIUDMNakbIBNaVDUckaaRDdsMD3kMUIcsOVDkOPDbsDMNP HNDbFNDO cENMDstD3kMkcNbNMUDNUbIckbNPSDbFNDts MDbMk9NHbsMVDUsa bIsOUDTNMNDMNbkIONPDtsMDEsbFDckaNUDkOPDtNckaNURD5=DDDFigure 2: BMI trajectories from age 1 to 20 by survey cohort and sex: a) NLSCY – male; b) NPHS – male; c) NLSCY – female; d) NPHS – female. Dotted lines represent WHO cut offs for overweight and obese.  2kyD D D D D D 2EyD 2HyD D D D D D 2PyDDD5–DDDdI6 MNUDuDkOPD5DPIU3akVDbFNDtIOkaDts MDbMk9NHbsMVDUsa bIsOD UIO6DPkbkDtMscDbFND.wWr:DstDckaNUDkOPDtNckaNUDMNU3NHbIBNaVRDGkUNPDsODbFNDMNakbIBND3sUIbIsODsODbFNDGniDUHkaNDkOPDsODbFNIMDMIU0DstDPNBNas3IO6DsENUIbVDIODkP abFssPSDbMk9NHbsMINUDTNMNDakENaNPDasTD2–=RezDckaNU-D5–R=zDtNckaNUySDPNHMNkUIO6D24=RozDckaNU-D;RozDtNckaNUySDcNPI cD24uR5zDckaNU-Du=R5zDtNckaNUySDkOPDFI6FD2=R;zDckaNU-D4oRgzDtNckaNUyRDLDPNHMNkUIO6DbMk9NHbsMVDTkUDckM0NPDEVDkODsENUNDUbkbNDIODNkMaVDHFIaPFssPDPNHaIOIO6DbsDkDOsMckaDTNI6FbDIODkPsaNUHNOHNRDGniDtsMDckaNUIODbFNDasTSDPNHMNkUIO6SDcNPI cSDkOPDFI6FDbMk9NHbsMVDkbDk6NDgoDTNMNDggR–SDg=RoSDg,RuSDkOPDu5R,D06NcgSDMNU3NHbIBNaVRDGVDk6NDgoSDtNckaNUDIODbFNDasTSDPNHMNkUIO6SDcNPI cSDkOPDFI6FDbMk9NHbsMVDTNMNDkbDGniDstDgoR–SDguR–SDg5R=SDkOPDugRoD06NcgSDMNU3NHbIBNaVRDAkEaNDuDPIU3akVU HFkMkHbNMIUbIHUDstDbFNDHsFsMbDEVDbMk9NHbsMVD6Ms 3R5eDDFigure 3: Estimated BMI trajectories of males in the NLSCY from age 1 to 20 (n=3,693). Dotted lines represent WHO cut offs for overweight and obese.  DDDD 1MsTbFDvkMkcNbNMUD2WbkOPkMPDNMMsMyUDD iObNMHN3bD Was3ND p kPMkbIHD r EIHDwsTDD 4–R,e5D2oRo,4yD oR5uoD2oRoggyD oRo54D2oRoogyD )oRoouD2oRooouyDfNHMNkUIO6DD g4RuegD2oR==4yD oR5–uD2oRo54yD )oRo4oD2oRo4oyD DnNPI cDD 4,R4ugD2oR54=yD oR,guD2oR44gyD oRo–oD2oRo4oyD )oRoo=D2oRoo4yDhI6FD guR=g;D2oRu,gyD 4Rue=D2oRo,,yD oRouuD2oRoo;yD )oRoo–D2oRoo4yDUnsPNaNPDTIbFDk6NDkUDcNkU MNDstDbIcNRDL6NDTkUDHNObMNPDkbD4oDVNkMURDD5;DDFigure 4: Estimated BMI trajectories of females in the NLSCY from age 1 to 20 (n=3,560). Dotted lines represent WHO cut offs for overweight and obese DD 1MsTbFDvkMkcNbNMUD2WbkOPkMPDNMMsMyUDD iObNMHN3bD Was3ND p kPMkbIHD r EIHDwsTDD 4–R5ooD2oR45gyD oR5–4D2oRo4;yD oRou=D2oRoogyD )oRoo5D2oRooouyDfNHMNkUIO6DD g4Reu;D2oRg;;yD )oRo,gD2oRo,eyD )oRog,D2oRoo,yD oRoo–D2oRoogyDnNPI cDD 4;R–,eD2oRgo;yD oR=e;D2oRo5–yD oRouuD2oRoo5yD )oRoouD2oRoo4yDhI6FD ggR––4D2oRgu4yD oR,=4D2oRo;uyD oRo4eD2oRoo–yD )oRoogD2oRoogyDUnsPNaNPDTIbFDk6NDkUDcNkU MNDstDbIcNRDL6NDTkUDHNObMNPDkbD4oDVNkMUR5, DDTable 3: Baseline sample characteristics of the NLSCY cohort by sex and BMI trajectory group (percentages unless noted)* D nkaND dNckaNDD wsTDxIU0D2O%g5;,yDfNHaIOIO6DxIU0D2O%=–oyDnsPNMkbNDxIU0D2O%5o,yDhI6FDxIU0D2O%gu=yDwsTDxIU0D2O%4–u=yDfNHaIOIO6DxIU0D2O%guuyDnsPNMkbNDxIU0D2O%4g;4yDhI6FDxIU0D2O%544yDIndividual Characteristics D D D D D D D DlbFOIHIbVD D D D D D D D DDDDDrk HkUIkOD ;;RuD ;5ReD ;;RoD ,4R4D ;,RuD ;eR–D ,4R5D ;oReDDDDDLEsMI6IOkaD uReD eRuD =R=D 5RgD uRgD 5R=D uR5D 5R;DDDDDmbFNMD ;RoD ;RoD –R–D 5ReD eR–D eR,D =R4D 45R–DGIMbFDTNI6FbDtsMD6NUbkbIsOkaDk6ND D D D D D D D DDDDDWckaaDtsMD6NUbkbIsOkaDk6ND 4uR=D 4oR5D 4uRuD eRuD 4–RoD 4,RgD 4oRuD 4gRoDDDDD.sMckaD eeR–D e;R;D e–R–D ;5R–D eeR=D euR5D e;RoD e–R=DDDDDwkM6NDtsMD6NUbkbIsOkaDk6ND ;R,D 4oReD 4oRoD ;R4D –R=D eR5D 44ReD 44R=DFamily characteristics D D D D D D D DwIBIO6DasHkbIsOD D D D D D D D DDDDDDCMEkO8D=ooSoooSD 5uR4D u;ReD ugR,D uoRgD 5–R;D =oR4D 5uR,D g,R4DDDDDDCMEkO8D4ooSooo)5,,S,,, D 4,R;D 4eRuD g4ReD g–R=D 4;R=D 4=RuD 4;R=D 4eR4DDDDDDCMEkO8DX4ooSoooD 4;ReD g4RoD goR–D g=R5D 4,R=D 4eRoD 4,RgD g5RgDDDDDDx MkaD 4;R5D guRoD g5R;D 4eR;D 4=RgD 4eReD 4;RuD g,ReDrFIaPDaIBNUDTIbF D D D D D D D DDDDDDGsbFDEIsas6IHkaD3kMNObUD ;gR=D e;ReD ;gRuD ;–R4D ;=R,D egR–D ;5RgD e,R–DDDDDDmONDsMDOsDEIsas6IHkaD3kMNObUD 4eR=D g4RuD 4eReD 4uR,D 45RgD geR5D 4=R,D goR5DnNkODtkcIaVDt OHbIsOIO6DUHsMND2WfyD eR–=D2oR4;yD ;RouD2oRu;yD eR5oD2oRu;yD –Re5D2oR=;yD eR=eD2oRg4yD ;R5uD2oR=eyD ;RugD2oRg5yD eR;,D2oRu5yDiOHscNDkPNM kHVD D D D D D D D DDDDDwsTNUbD 4–ReD goRgD 4eRoD 4;R,D 45ReD g4R4D 4–R=D 4,ReDDDDDnIPPaND g,ReD ugRuD uuRoD g,R5D uoReD uuRoD ugR;D u;R;DDDDDhI6FNUbD =uR–D 5eR=D =oRoD =4ReD =5ReD 5=R;D =oReD 54R=DnsbFNM(UDlP HkbIsOD D D D D D D D DDDDD.s csbFNMNwNUUDbFkODFI6FDUHFssaD 4uR–D 4;R–D 44R;D ggReD 4gR4D 4=R5D 4gR–D 4eR5DDDDDhI6FDUHFssaD 4eR,D 4;RoD 4–R;D 4;R;D 4eRuD u4R–D ggR4D 4;RgDDDDDrsaaN6NNDbMkPNDUHFssaD g;ReD g;R;D uoReD g–ReD g,R,D 4,R,D g–R,D uuR–DDDDDCOIBNMUIbVDPN6MNND u,R;D u5ReD 5oReD u4R,D 5oR;D uuRgD u;RuD uoR,DdkbFNM(UDlP HkbIsOD D D D D D D D DDDDD.s tkbFNMD 4uRgD 4;R4D 44RgD 4gReD ,R;D g4R–D 4gR5D 45RoDDDDDwNUUDbFkODFI6FDUHFssaD 4oR,D 4–RgD 4gR,D g5R=D 4gRoD 45RgD 45RoD 4,RoDDDDDhI6FDUHFssaD 4uR;D 4,R=D 45RuD g4R,D 45R–D g4ReD 4;R4D 4,R4DDDDDrsaaN6NNDbMkPNDUHFssaD ggRuD 4=R5D g5R5D 4gReD ggReD 4uR;D goRoD ggR=DDDDDCOIBNMUIbVDPN6MNND u,R;D uoR;D ueRgD g;RgD 5oR,D g;ReD u=R=D g=R=DnkbNMOkaDWcs0IO6D D D D D D D D DDDDD:NUD g4R–D ugR,D g5RgD u5RoD 4;RgD u5R–D g5R;D u5RuDDDDD.s e;R5D –eR4D e=R;D ––RoD ;4R;D –5R=D e=RgD –=ReDU3NMHNObk6NUDkMNDTNI6FbNPDbsDMNtaNHbDbFNDrkOkPIkOD3s3 akbIsOD=oDDxNU abUDtMscDbFNDc abIOscIkaDMN6MNUUIsODbFkbDNQkcIONPD3MNPIHbsMUDstDbMk9NHbsMVDcNcENMUFI3DkMNDPIU3akVNPDIODAkEaND5RDxNU abUDtsMDbFNDckaNUDUFsTNPDbFkbDaIBIO6DIODkDM MkaDkMNkDTkUDUI6OItIHkObaVDkUUsHIkbNPDTIbFDENasO6IO6DIODbFNDcNPI cDbMk9NHbsMVDHsc3kMNPDTIbFDbFNDasTDbMk9NHbsMVRDiODHsObMkUbSDHFIaPMNODaIBIO6DIODkDM MkaDkMNkSDEsMODakM6NDtsMD6NUbkbIsOkaDk6NSDkOPDF BIO6DkDcsb FNMDTFsDUcs0NUDTNMNDcsMNDaI0NaVDbsDENasO6DIODbFNDPNHMNkUIO6DkOPDFI6FDbMk9NHbsMINUDbFkODbFNDasTDbMk9NHbsMVDkOPDaNUUDaI0NaVDbsDENasO6DItDEsMODUckaaDtsMD6NUbkbIsOkaDk6NRDLEsMI6IOkaDNbFOIHIbVDkOPDFkBIO6DkDtkbFNMDTIbFDaNUUDbFkODFI6FDUHFssaDNP HkbIsODTNMNDt MbFNMDkUUsHIkbNPDTIbFDENasO6IO6DIODbFNDPNHMNkUIO6DbMk9NHbsMVDHsc3kMNPDTIbFDbFNDasTDbMk9NHbsMVRDDdsMDtNckaNUSDLEsMI6IOkaDNbFOIHIbVSDFkBIO6DkDtkbFNMDTIbFDaNUUDbFkODFI6FDUHFssaDNP HkbIsOSDkOPDckbNMOkaDUcs0IO6DTNMNDkUUsHIkbNPDTIbFDENasO6IO6DIODbFNDPNHMNkUIO6DbMk9NH sMVDHsc3kMNPDTIbFDbFNDasTDbMk9NHbsMVD2AkEaND5yRDrFIaPMNODakM6NDtsMD6NUbkbIsOkaDk6NSDFkBIO6DkDcsbFNMDTFsDUcs0NUSDkOPDaIBIO6DTIbFDFI6FNMDtkcIaVDPVUt OHbIsODTNMNDcsMNDaI0NaVDbsDENasO6DIODbFNDcNPI cDbMk9NHbsMVSDTFIaNDENIO6DUckaaDtsMD6NUbkbIsOkaDk6NDTkU 3MsbNHbIBNRDGNIO6DOsO)rk HkUIkOSDaIBIO6DIODkOD MEkODkMNkDstDaNUUDbFkOD4ooSoooD3s3 akbIsODsMDkDM MkaDkMNkSDENIO6EsMO ak 6N ts D6NUbkbIsOkaDk6NSDFkBIO6DkDtkbFNMDTIbFDaNUUDbFkODFI6FDUHFssaDsMDFI6FDUHFssaDNP HkbIsOSDkOPDckbNMOkaDUcs0IO6DTNMNDkaaDMIU0DtkHbsMUDtsMDENasO6IO6DIODbFNDFI6FDbMk9NHbsMVR=4DDTable 4: Results from adjusted multinomial regression of predictors associated with trajectory membership. Results are presented as odds ratios and 95% confidence intervals (low trajectory group is the reference). D nkaND dNckaNDD fNHMNkUIO6D nNPI c D hI6FD fNHMNkUIO6D nNPI c D hI6FDIndividual CharacteristicsD D D D D D DlbFOIHIbVD D D D D D DDDDDrk HkUIkOD xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDDDDDLEsMI6IOkaD 4R5,D24Rou)gR4=yUD 4RggD2oRe;)4R,4yD oRe;D2oR54)4R=oyD 4R;5D24Ro5)uRg–yUD oR,;D2oR––)4R5=yD 4RegD24Roe)gReeyUDDDDDmbFNMD oR,4D2oR=g)4R=;yD 4RgoD2oR–;)gR4oyD oR,oD2oRu;)gR4gyD oRe=D2oRug)4R;oyD oR,5D2oR–g)4R5gyD 4R,oD24Ro,)uRugyUDGIMbFDTNI6FbDtsMD6NUbkbIsOkaDk6ND D D D D D DDDDDWckaaDtsMD6NUbkbIsOkaDk6ND oR–=D2oR5–)oR,4yUD oR,eD2oReo)4Ru=yD oR=uD2oRug)oR;,yUD oR,=D2oR–o)4R=oyD oReeD2oR–o)oR,,yUD oR;;D2oR–o)4RuoyDDDDD.sMckaD xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDDDDDwkM6NDtsMD6NUbkbIsOkaDk6ND 4R=uD24R45)gRo–yUUD 4R5uD2oR,;)gRo;yD 4R=;D24Ro5)gR5gyUD 4RguD2oReo)gR4=yD 4Ru;D24Ro5)4R;uyUD 4R–4D24Roe)gR5gyUDFamily characteristicsD D D D D D DwIBIO6DasHkbIsOD D D D D D DDDDDDCMEkO8D=ooSoooSD xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDDDDDDCMEkO8D4ooSooo)5,,S,,, D 4R44D2oR;4)4R=uyD 4R4uD2oRe,)4R–gyD 4R;–D24R4u)uRo;yUD 4Rg4D2oRee)4R,4yD 4R4gD2oR;;)4R54yD 4R55D2oR,=)gR4,yDDDDDDCMEkO8DX4ooSoooD 4R4eD2oR;–)4R=;yD 4Rg,D2oR,4)4R;4yD 4Re;D24Ro,)gR,oyUD oR,4D2oR=;)4R5uyD 4Ro–D2oR;=)4Ru5yD 4Re–D24R4,)gR–oyUUDDDDDDx MkaD 4R5uD24Ro–)4R,5yUD 4R5–D24Rou)gRo–yUD 4R–;D24Rog)gRe;yUD 4RugD2oR;=)gRo–yD 4R4gD2oR;;)4R54yD gR==D24Reu)uReeyUUUDrFIaPDaIBNUDTIbF D D D D D DDDDDDGsbFDEIsas6IHkaD3kMNObUD xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDDDDDDmONDsMDOsDEIsas6IHkaD3kMNObUD oR;gD2oR5,)4Ru;yD 4Rg5D2oRee)gRo4yD oR5oD2oR4=)4Ro,yD 4Rg=D2oR–5)gR5uyD oR,gD2oR–g)4RueyD oR,;D2oR==)4Re=yDdkcIaVDt OHbIsOIO6DUHsMN 4RogD24Roo)4Ro5yD 4Ro4D2oR,,)4RouyD 4RooD2oR,;)4RouyD 4RogD2oR,,)4Ro=yD 4RogD24Ro4)4Ro5yUUD 4Ro4D2oR,;)4RouyDiOHscNDkPNM kHVD D D D D D DDDDDwsTNUbD oR,gD2oR–;)4Rg5yD oR,oD2oR–5)4Rg–yD 4R4uD2oReu)4ReuyD 4RouD2oR–e)4R=,yD 4Ro5D2oR;g)4Ru5yD 4R44D2oRe;)4R=;yDDDDDnIPPaND oR,–D2oRee)4R4,yD oR,uD2oReu)4R4,yD 4R4,D2oR;–)4R–5yD oR;eD2oR–g)4RguyD 4Ro,D2oR,4)4Rg,yD 4RgoD2oR,u)4R=–yDDDDDhI6FNUbD xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDnsbFNM(UDlP HkbIsOD D D D D D DDDDD.s csbFNMNwNUUDbFkODFI6FDUHFssaD 4R45D2oR;g)4R=eyD oR,,D2oR–;)4R5=yD 4Ru5D2oR;=)gR44yD 4Ru;D2oR;e)gRg4yD 4R44D2oR;=)4R5uyD oR,5D2oR–5)4Ru,yDDDDDhI6FDUHFssaD 4Ro=D2oRe,)4Ru,yD 4RogD2oRe=)4R5oyD 4Ro4D2oR–e)4R=gyD 4R5–D2oR,e)gR4,yD 4RoeD2oR;–)4Ru5yD 4RouD2oRe5)4R55yDDDDDrsaaN6NNDbMkPNDUHFssaD 4RoeD2oR;u)4Ru–yD 4R4eD2oR;,)4R=uyD 4R44D2oRe;)4R–oyD oR,gD2oR–u)4RueyD 4RogD2oR;5)4RguyD 4Ro;D2oR;4)4R5=yDDDDDCOIBNMUIbVDPN6MNND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDdkbFNM(UDlP HkbIsOD D D D D D DDDDD.s tkbFNMD 4R=4D2oR;o)gR;uyD oR;4D2oR5u)4R=gyD gR=5D2oR;5)eR–,yD 4R=uD2oR–,)uRueyD 4Ro–D2oR––)4Re4yD 4R5=D2oReu)gR;,yDDDDDwNUUDbFkODFI6FDUHFssaD 4R54D24Ro5)4R,4yUD 4RueD2oR,–)4R,=yD 4Ru,D2oR,4)gR4uyD 4R=eD24Roo)gR5eyUD 4R4uD2oR;;)4R5=yD 4R––D24R4=)gR5oyUUDDDDDhI6FDUHFssaD 4RuoD2oR,e)4Re5yD 4R4uD2oR;4)4R=,yD 4Ro;D2oReo)4R–=yD 4RuoD2oR;u)gRouyD 4R4oD2oR;;)4Ru,yD 4R54D2oR,;)gRouyDDDDDrsaaN6NNDbMkPNDUHFssaD oR,gD2oReo)4RggyD 4Rg5D2oR,g)4R–eyD oReuD2oR5;)4R44yD oRe,D2oR=o)4Rg5yD oR;eD2oReo)4Ro;yD 4R45D2oR;4)4R–oyDDDDDCOIBNMUIbVDPN6MNND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDnkbNMOkaDWcs0IO6D D D D D D DDDDD:NUD 4R5gD24R45)4ReeyUUD 4R4=D2oR;,)4R5,yD 4R;=D24Ru–)gR=4yUUUD 4R=uD24R44)gR4oyUUD 4R=;D24Rug)4R;,yUUUD gRugD24R;o)gR,eyUUUDDDDD.s xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHND xNtNMNOHNDU3XoRo=-DUU3XoRo4-DUUU3XoRoo4=gDD3.4 Discussion AFIUDUb PVDts OPDbFkbDrkOkPIkODHFIaPMNODtsaasTDts MDPIUbIOHbDGniDbMk9NHbsMINU8DasTSDPNHMNkUIO6SDcNPI cSDkOPDFI6FRDAFNUNDbMk9NHbsMINUDMN3MNUNObDbFNDkBNMk6ND6MsTbFDstDbFNDcNcENMUDstDNkHFD6Ms 3RDLabFs 6FDbFND6MsTbFD3kbbNMOUDkMNDUIcIakMDENbTNNODckaNUDkOPDtNckaNUSD F MN kM DU QDPIttNMNOHNUDIODMNakbIsODbsDbFND*hm DH DsttUDtsMDsBNMTNI6FbDkOPDsENUIbVRDdsMDckaNUSDbFNDcNPI cDkOPDFI6FDbMk9NHbsMINUDHasUNaVDtsaasTDkOPDNBNOb kaaVDU M3kUUSDE bTNNODk6N D–DbsD;SDbFN*hm DH bDsttUDtsMDsBNMTNI6FbDkOPDsENUIbVSDMNU3NHbIBNaVRDiODHsObMkU SDbFNDtNck cNPI c DkOPDFI6FDbMk9NHbsMINUDHasUNaVDtsaasTDbFND*hm DH bDsttDtsMDsBNMTNI6FbDkOPDsENUIbVDbFMs 6Fs bDHFIaPFssPDIObsDkPsaNUHNOHN-DFNOHNSDbFNDUckaaNMDbMk9NHbsMVDUIYNUDstDckaNUDtsMDbFsUND6Ms 3URDiODEsbFDHkUNUSDbFNDcNPI cDkOPDFI6FD6Ms 3UDPIttNMNObIkbNDtMscDbFNDasTD6Ms 3DIODNkMaVDHFIaPFssPSDIOPIHkbIO6DkDUbMsO6DIOta NOHNDstDNkMaVDaItNDtkHbsMUDsODsENUIbVDMIU0RDAFNMNDkMNDkaUsDPIttNMNOHNUDIODbFNDPNHMNkUIO6DbMk9NHbsMVDEVDUNQRDGVDk6ND4gSDtNckaNUDIODbFNDPNHMNkUIO6DbMk9NHbsMVDbMkOUIbIsODbsDkDOsMckaDTNI6FbDtMscDENIO6DsBNMTNI6FbDsMDsENUN-DTFNMNkUDbFIUDPsNUDOsbDsHH MD ObIaDk6ND4–DtsMDckaNURDDAFNDtIOPIO6DstDts MDPIUbIOHbDGniDbMk9NHbsMINUDIODHFIaPFssPDTkUDUIcIakMDbsD3MNBIs UDUb PINURJ4g=S4g–S4g;S4g,S4u4F4uuS4u=KDnsMNsBNMSDbFNDts MDbMk9NHbsMINUDkMNDUIcIakMDIOD3kbbNMODbsDbFsUNDts OPDIODbFNDck9sMIbVDstDbFsUNDUb PINUSJ4g=S4g–S4g;S4g,S4u4S4ugKDIOPIHkbIO6DbFkbDbFNUNDbMk9NHbsMINUDckVDEND6NONMkaIYkEaNDbsDsbFNMD3s3 akbIsOUstDHFIaP NODkOPDVs bFR COaI0NDsbFNMDUb PINUSDTNDck33NPDs bDbFNUNDbMk9NHbsMINUDEVDUNQDkOPDtsM bFNDNObIMNDHFIaPFssPD3NMIsPSD3MsBIPIO6DkDcsMNDHsc3aNbND OPNMUbkOPIO6DstDbFNDMIU0DstDsENUIbVDIODkP abFssPRDWb PINUDstDsOaVDNkMaVDHFIaPFssPDsMDkPsaNUHNOHNDTs aPDFkBNDcIUUNPDbFNDbMkOUIbIsODstDbFNDPNHMNkUIO6DbMk9NHbsMVDtMscDsBNMTNI6FbDbsDOsMckaDTNI6FbRDdsMDNQkc3aNSD.sOONck0NMDNbDkaRDNQkcIONPDGniDbMk9NHbsMINUDkcsO6DLcNMIHkODkPsaNUHNObUDtMscDk6ND4gDbsDguRJ u=KDAFNVDts OPDts MDbMk9NHbsMINUDbFkbDONBNMDHMsUUNPDNkHFDsbFNMSDIOPIHkbIO6DbFkbDbFIUDUb PVDckV FkBNDcIUUNPDbFNDbMkOUIbIsODstDbFNDPNHMNkUIO6DbMk9NHbsMVRDWb PINUDstD=uDDHFIaPMNODbFkbDk6NDtMscDHFIaPFssPDbsDkPsaNUHNOHN PsDHk3b MNDbFIUDbMkOUIbIsOJ4g=S4g,S4u4K-DFsTNBNMSDTIbFs bDtsaasTIO6DbFNDHFIaPMNODbsDkP abFssPDIbDENHscNUD OHaNkMDItDbFsUNDIODbFNDPNHMNkUIO6DbMk9NHbsMVDMNb 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6NUDIODIObNM3MNbkEIaIbVSDNU3NHIkaaVDTIbFDu)TkVDsMDFI6FNMDIObNMkHbIsOUSDkOPDUNBNMkacNbFsPsas6IHkaDHFkaaNO6NUDIOHa PIO6DkDFI6FDUkc3aNDUIYNDONNPNPSDFI6FDHsMMNakbIsODENbTNNODkbbMIE bNUSDkOPDcsPNaDsBNMtIbbIO6RJ=oS=4KDLODk33MskHFDbFkbDUscNDMNUNkMHFNMUDFkBND UNPDbsDsBNMHscNDbFNUNDIUU NUDIUDbsD6Ms 3DONI6FEs MFssPUDTIbFDUIcIakMD3kbbNMOUDstDkbbMIE bNUD UIO6UbkbIUbIHkaDcNbFsPUD  HFDkUakbNObDHakUUDkOkaVUIUD2wrLyRJ4,4F4,5KDwrLDIUDkDbNHFOIM NDbFkbDNOkEaNUDMNUNkMHFNMUDbsD6Ms 3DONI6FEs MFssPUDIObsDakbNObDHakUUNUDU HFDbF bDONI6FEs MFssPUDTIbFIODNkHDHakUUDkMNDcsMNDkaI0NDIODbNMcUDstDbFNIMDkbbMIE bNUDbFkODONI6FEs MFssPUDENbTNNODHakUUNURDiODHsObMkUbDbsDass0IO6DkbDIOPN3NOPNObDNttNHbUDstDNkHFDONI6FEs MFssPDkbbMIE bNSDwrLDNOkEaNUDMNUNkMHFNMUDbsDIPNObItVD6Ms 3UDstDONI6FEs MFssPUDTIbFDPIUbIOHbDHFkMkHbNMIUbIHD3MstIaNUDHsc3sUNPDstDkaaDONI6FEs MFssPDkbbMIE bNUDkOPDU EUNM NObaVDI BNUbI6kbNDFsTDbFNUND6Ms 3UDPIttNMDIODbNMcUDstDbFNIMDMNakbIsOUFI3UDTIbFDs bHscNUDstDIObNMNUbD2IRNRSDsENUIbVyRD*kaa NbDkaRDHsc3kMNPDUbkbIUbIHkaDk33MskHFNUDbsDkOkaVYIO6DbFNDNttNHbUDstDONI6FEs MFssPDHFkMkHbNMIUbIHUDsODkPsaNUHNObDTNI6FbDUbkb UDkOPDMNHsccNOPNPDwrL kUDkDcNkOUDstDkPPMNUUIO6DbFIUDMNakbIsOUFI3DP NDbsDbFNDHsc3aNQIbVDstDbFNDONI6FEs MFssPDNOBIMsOcNObRJ4,5KD=, DDfNU3IbNDbFNDakM6NDO cENMDstDUb PINUDNQkcIOIO6DNOBIMsOcNObkaDIOta NOHNUDsODsENUIbVSDtNTDUb PINUDFkBNDNQkcIONPDbFNDcNPIkbIO6DNttNHbDstDvLDsMDWGRDjNIbHFDNbDkaRDts OPDOsDcNPIkbIO6DNttNHbDstDkDMkO6NDstDsE9NHbIBNDkOPDU E9NHbIBNDvLDkOPDWGDcNkU MNU s DbFNDMNakbIsOUFI3DENbTNNODUsHIkaDONbTsM0UDkOPDUsHIkaDHsFNUIsODkOPDGniRJ4–uKDWIcIakMaVSDkDUb PVDNQkcIOIO6D3NMHNIBNPDONI6FEs MFssPDPIUsMPNMDkOPDsENUIbVDts OPDOsDcNPIkbIO6DNttNHbDstDsE9NHbIBNaVDcNkU MNPDvLRJ4–=KDDLabFs 6FDUb PINUDFkBNDts OPDOsDcNPIkbIO6DNttNHbDstDvLDkOPDWGDTIbFDIOPIBIP kaDONI6FEs MFssPDkbbMIE bNUSDOsDUb PVDFkUDHsOUIPNMNPDakbNObDHakUUNUDstDONI6FEs MFssPUDkUDkD OIbDstDcNkU MNcNObRDCOPNMUbkOPIO6DbFNDHk UkaD3kbFTkVDbFMs 6FDTFIHFDONI6FEs MFssPUDIOta NHNDTNI6FbDUbkb UDTIaaDFNa3DIc3MsBNDIObNMBNObIsODNttsMbURDAFND6skaDstDbFIUDUb PVDTkUDsDNQ cIONDbFNDcNPIkbIO6DMsaNDstDvLDkOPDWGDsODbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDbV3NDkOPDsENUIbVDIODkDOkbIsOkaaVDMN3MNUNObkbIBNDUkc3aNDstDrkOkPIkODHFIaPMNOD2dI6 MND=yRD.NI6FEs MFssPDbV3NDTkUDPNbNMcIONPDEVDwrLD UIO6DUsHIkaSDUsHIsNHsOscIHSDkOPD3FVUIHkaDkbbMIE bNUDstDbFNDONI6FEs MFssPRDibDTkUDFV3sbFNUIYNPDbFkbDvLDkOPDWGDTs aPDcNPIkbNDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDbV3NDkOPDsENUIbVRDD D–oDDFigure 5: Mediation model tested in this study DkyDfIMNHbDNttNHbD2 OkP9 UbNPDEVDcNPIkbsMUyDDDDDDDEyDnNPIkbIsODcsPNaDDDDDDDDDDDDD DnNPIkbsMUD.NI6FEs MFssPDHakUUD mENUIbVDmM6kOIYNPDU3sMbUDCOsM6kOIYNPDU3sMbUDAjDbIcNDL6NDWNQDiOHscNDkPNM kHVDnkbNMOkaDNP HkbIsODvkbNMOkaDNP HkbIsODiOPN3NOPNObDBkMIkEaNDfN3NOPNObDBkMIkEaNDrsBkMIkbNUDvkbFDkDvkbFDEvkbFDHYDD.NI6FEs MFssPDHakUUD mENUIbVDvkbFDHDDL6NDWNQDiOHscNDkPNM kHVDnkbNMOkaDNP HkbIsODvkbNMOkaDNP HkbIsODrsBkMIkbNUD–4DD4.2 Methods 4.2.1 Sample fkbkDtMscDbFND.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD2.wWr:yJgugKDTNMND UNPDtsMDbFIUDUb PVRDAFNDU MBNVSDHsOP HbNPDEVDWbkbIUbIHUDrkOkPkSDUbkMbNPDHsaaNHbIO6DIOtsMckbIsODstDHFIaPMNODtMscD4,,5N,=DEIkOO kaaVRDAFNDEkUNaIONDUkc3aNDHsOUIUbNPDstDHFIaPMNODk6NPDoDbsD44DtMscDbFND4oD3MsBIOHNUDstDrkOkPkRDlQHa PNPDTNMNDHFIaPMNODaIBIO6DsODMNUNMBNDsMDrMsTODakOPSDMNUIPNObUDstDIOUbIb bIsOUSDHFIaPMNODstDt aa)bIcN cNcENMUDstDbFNDLMcNPDdsMHNUSDkOPDMNUIPNObUDstDU3NHItIHDMNcsbNDMN6IsOURDAMkIONPDIObNMBINTNMUDHsOP HbNPDbFNDU MBNVDIOD3NMUsODkbDbFNDFscNDstDbFNDHFIaPRDAFND3NMUsODcsUbD0OsTaNP6NkEaND2vnGyDkEs bDbFNDHFIaPSDbV3IHkaaVDbFNDcsbFNMSDMNU3sOPNPDbsDbFNDU MBNVDM NUbIsOURDC3sODHsc3aNbIsODstDbFNDU MBNVSDIObNMBINTNMUDTNMNDbkU0NPDTIbFDkOUTNMIO6DkDO cENMDstDM NUbIsOUDkEs bDbFNDONI6FEs MFssPDNOBIMsOcNObDstDbFNDMNU3sOPNObRDAFIUHMsUU)UNHbIsOkaDUb PVDIOHa PNPDbFNDEkUNaIONDMNU3sOUNUDMNakbIO6DbsDkaaDHFIaPMNODbFkbD3kMbIHI3kbNPDIODbFNDU MBNVD2.%ggS;u4yRDDD4.2.2 Neighbourhood Measures AFNDck9sMIbVDstDbFNDONI6FEs MFssPDcNkU 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6DHFIaPMNORJguoKD.NI6FEs MFssPDUsHIkaDHsFNUIsO8DWsHIkaDHsFNUIsODTkUDcNkU MNPDEVDtIBNDIbNcU8D4yDONI6FEs MUDPNkaDTIbFD3MsEaNcUDbs6NbFNM-DgyDbNDkMNDkP abUDbFkbDHFIaPMNODHkODass0D 3Dbs-DuyD3Ns3aNDkMNDTIaaIO6DbsDFNa3DbFNIMDONI6FEs MU-D5yDkP abUDTkbHFDs bDbFkbDHFIaPMNODkMNDUktNDkOPDPsO(bD6NbDIODbMs EaN-DkOPD=yDItDi(cDkTkVSDcVDONI6FEs MUDTIaaD0NN3DbFNIMDNVNUDs3NODtsMD3sUUIEa DbMs EaNRDibNcUDTNMNDPIHFsbscIYNPDbsDk6MNNDkOPDPIUk6MNNRDhI6FDONI6FEs MFssPDHsFNUIsODFkUDENNODkUUsHIkbNPDTIbFDasTDEsPVDckUUDIOPNQD2GniyDkcsO6DHFIaPMNORJ4–uKD.NI6FEs MFssPDPIUsMPNM8DxNU3sOPNObUDTNMNDkU0NPDbsDIOPIHkbNDTFNbFNMDbFNDtsaasTIO6DtIBNDUbkbNcNObUDTNMND3MsEaNcUDIODbFNDONI6FEs MFssP8D4yDaIbbNMSDEMs0NOD6akUUSDsMD6kMEk6NDIODbFNDUbMNNbDsMDsODbFNDUIPNTka0SDsMDIODVkMPU-DgyDUNaaIO6DsMD UIO6DPM 6U-DuyDkaHsFsaIHUDkOPDNQHNUUIBNDPMIO0IO6DIOD3 EaIH-D5yD6Ms 3UDstDVs O6D3Ns3aNDTFsDHk UNDbMs EaN-DkOPD=yDE 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MFssPDkNUbFNbIHU8DiObNMBINTNMUDTNMNDkU0NPDbsDMkbNDbFND6NONMkaDHsOPIbIsODstDcsUbDstDbFNDE IaPIO6UDsODbFNDEasH0NsMDTIbFIOD4ooDVkMPUDstDbFNDMNU3sOPNObUDFs UNDsODk ts M)3sIObDUHkaND2EkPaVDPNbNMIsMkbNP-D3ssMDHsOPIbIsODTIbFD3NNaIO6D3kIObDkOPDONNPDstDMN3kIM-DtkIMDHsOPIbIsO-DkOPDTNaa)0N3bDTIbFD6ssPDMN3kIMDkOPDNQbNMIsMDU MtkHNyRDAFIUDIbNcDTkUDPIHFsbscIYNP bsDTNaa)0 3bDHsOPIbIsODkOPDtkIMDbsD3ssMDHsOPIbIsORDhI6FDTka0kEaNDONI6FEs MFssPUDFkB E NODts PDbsDFkBNDENbbNMDkNUbFNbIHUDbFkODasTDTka0kEaNDONI6FEs MFssPURJgu=KDwIBIO6DasHkbIsO8DxNU3sOPNObUDTNMNDkUUI6ONPDIObsD MEkODkOPDM MkaDHkbN6sMINUDEVDaIO0IO6D3sUbkaDHsPNDPkbkDTIbFDbFND V3NDkOPD3s3 akbIsODUIYNDstDbFNDc OIHI3kaIbVDbFNVDMNUIPNPDTIbFIOD2 MEkODTIbFD3s3 akbIsODZ=ooSooo-D MEkODTIbFD3s3 akbIsOD4ooSooo)5,,S o-D MEkODTIbFD3s3 akbIsODuoSooo),,S,,,-D MEkODTIbFD3s3 akbIsOD4=Sooo)g,S,,,-D MEkODTIbFD3s3 akbIsODV4=Sooo-DM MkayRDAFIUDBkMIkEaNDTkUDMNHsPNPDbsDbFMNNDHkbN6sMINU8D MEkODZ4ooSoooSDU cI) MEkOD4=Sooo),,S,,,SDkOPDM MkaDX4=SoooDEkUNPDsODEMNk0PsTOUDtMscD3MNBIs UDUb PINURJ4uuKDx MkaDONI6FEs MFssPUDFkBNDENNODts OPDbsDFkBNDFI6FNMDsENUIbVD3MNBkaNOHNDbFkOD MEkODONI6FEs MFssPURJgu–KDnkbNMIkaDkOPDUsHIkaDPN3MIBkbIsO8DCUIO6DHNOU UDPkbkSDbFNDp NENHDnIOIUbMVDstDhNkabFDkOPDWsHIkaDWNMBIHNUDkOPDiOUbIb bNDstDv EaIHDhNkabFDHMNkbNPDOkbIsOkaDaNBNaDckbNMIkaDkOPDUsHIkaDPN3MIBkbIsODIOPIHNURJgueKDWIQDIOPIHkbsMUDTNMNDHFsUNODtMscDHNOU UDPkbkDEkUNPDsOD0OsTODkUUsHIkbIsOUDTIbFDFNkabFDs bHscNUDkOPDIOHa PNPDIODkD3MIOHI3kaDHsc3sONObDkOkaVUIURDAFNDkOkaVUIUDMNBNkaNPDbTsDHsc3sONObU8DkDckbNMIkaDHsc3sONObDHsOUIUbIO6DstDIOPIHkbsMUDPNUHMIEIO6DaNBNaUDstDNc3asVcNObSDNP HkbIsOSDkOPDIOHscN- kOPDkDUsHIkaDHsc3sONObDHsOUIUbIO6DstDIOPIHkbsMUDPNUHMIEIO6D–5DDbFND3Ms3sMbIsODstDbFND3s3 akbIsODaIBIO6DkasONSDTFsDkMNDUN3kMkbNPSDPIBsMHNPSDsMDTIPsTNPSDkOPDUIO6aN)3kMNObDtkcIaINURDdkHbsMDUHsMNUDTNMND UNPDbsDHMNkbNDHNObIaNUDstDckbNMIkaDkOPDUsHIkaDPN3MIBkbIsODtsMDNkHFDNO cNMkbIsODkMNkDtMscDaNkUbDPN3MIBNPD24yDbsDcsUbDPN3MIBNPD24ooyRDfN3MIBkbIsODIOPIHNUDTNMNDkBkIakEaNDtsMDbFNDHNOU UDVNkMUDstD4,,4SD4,,–SDgoo4SDkOPDgoo–RDdsMDbFIUDUb PVSD4,,–DPN3MIBkbIsODIOPIHNUDTNMND UNPDkUDbFIUDTkUDHasUNUbDbsDbFNDU MBNVDVNkMDIODTFIHFDONI6FEs MFssPDPkbkDTNMNHsaaNHbNPRDGsbFDckbNMIkaDkOPDUsHIkaDPN3MIBkbIsODTNMNDMNHsPNPDbsDbNMbIaNUDMN3MNUNObIO6DasTSDcNPI cSDkOPDFI6FDPN3MIBkbIsORDwIBIO6DIODkDcsMNDPN3MIBNPDONI6FEs MFssPDFkUDENNODaIO0NPDTIbFD6MNkbNMDGniDkOPDTNI6FbD6kIORJgu;K4.2.3 Socioeconomic Measures AFMNNDcNkU MNUDstDUsHIsNHsOscIHDUbkb UDTNMNDIOHa PNPDIODbFNDUb PV8DIOHscNDkPNM kHVSD3kbNMOkaDNP HkbIsOSDkOPDckbNMOkaDNP HkbIsORDiOHscNDkPNM kHVDTkUDPNMIBNPDEVDWbkbIUbIHUDrkOkPkDkOPDHscEIONUDEsbFDFs UNFsaPDUIYNDkOPDFs UNFsaPDIOHscNDIObsDtIBNDHkbN6sMINUDstDIOHscNDkPNM kHV8DasTNUbSDasTNMDcIPPaNSDcIP aNSD 33NMDcIPPaNSDkOPDFI6FNUbRDnkbNMOkaDkOPD3kbNMOkaDNP HkbIsODTNMNDHkbN6sMIYNPDIObsDts MDHkbN6sMINUD2aNUUDbFkODFI6FDUHFssaSDFI6FDUHFssaD6MkP kbIsOSDENVsOPDFI6FDUHFssaSDkOPDHsaaN6NDsMD OIBNMUIbVDPN6MNNyRDLDtItbFDHkbN6sMVD2OsDtkbFNMNOsDcsbFNMyDTkUDkPPNPDbsDEsbFDNP HkbIsODBkMIkEaNUDbsDIOPIHkbNDItDbFNDHFIaPDPIPDOsbDFkBNDkDtkbFNMDsMDcsbFNMDtI6 MNDkOPDbsDkBsIPDcIUUIO6DPkbkRDGsbFD3kMNObkaDNP HkbIsODBkMIkEaNUDTNMNDbMNkbNPDkUDOscIOkaDPkbkRDD4.2.4 Obesity and Weight-Related Behaviours mENUIbV8DGsPVDckUUDIOPNQD2GniySDPNtIONPDkUDTNI6FbDPIBIPNPDEVDFNI6FbDUM kMNPD206NcgySDTkUDHkaH akbNPDtMscD3kMNOb)MN3sMbNPDFNI6FbDkOPDTNI6FbDtsMDkaaDHFIaPMNORDGIsas6IHkaaVDIc3ak UIEaNDcNkU MNcNObUDstDFNI6FbSDTNI6FbSDkOPDGniDtsMDNkHFDHFIaP(UDk6NDkOPDUNQDTNMNDtak66NPSD UIO6DkDWbkbkDckHMsDPNBNas3NPDEVDbFND*sMaPDhNkabFDmM6kOIYkbIsOSJgouKDkOPDMNcsBNPDtMscDbFNDkOkaVUIURD–=DDAFNDckHMsDkaUsD3MsBIPNPDGniDY)UHsMNUDtsMDNkHFDHFIaPRDmBNMTNI6FbDkOPDsENUIbVDTNMNDPNtI NPDkHHsMPIO6DbsDbFND*hmDHMIbNMIkDkUDGniDY)UHsMNDW4DkOPDWDgSDMNU3NHbIBNaVRJgo,KDvFVUIHkaDkHbIBIbV8DAFNDvnGUDstDHFIaPMNODk6NDts MDkOPD 3DTNMNDkU0NPDbTsDM NUbIsOUDbsDPNUHMIENDbFNDkcs ObDstD3FVUIHkaDkHbIBIbVDstDbFNDHFIaPRDAFNDtIMUbDM NUbIsOUDkU0NPDkEs bDbFNDkcs ObDstDsM6kOIYNPDU3sMbUDTFIHFDIOBsaBNDHskHFIO6DsM IOUbM HbIsODbFk DbFNDHFIaPDbss0D3kMbDIODsBNMDbFNDakUbD4gDcsObFURDAFNDUNHsOPDM NUbIsODkU0NPDkEs bDbFND OsM6kOIYNPDU3sMbUDbFkbDbFNDHFIaPDbss0D3kMbDIODsBNMDbFNDakUbD4gDcsObFURDAFNMNDTNMNDtIBNDMNU3sOUNDHkbN6sMINUDtsMDEsbFDM NUbIsOU8DcsUbDPkVU-DkDtNTDbIcNUDkDTNN0-DkEs bDsOHNDkDTNN0-DkEs bDsOHNDkDcsObF-DkOPDkacsUbDONBNMRDDWNPNObkMVDENFkBIs M8DAFNDvnGUDstDHFIaPMNODk6NDts MDkOPD 3DTNMNDkU0NPDbTsDM NUbIsO 8D4yDsODkBNMk6NSDFsTDckOVDPkVUDkDTNN0DPIPbFNIMDHFIaPDTkbHFDAjDkOPDgyDsO bFsUNDPkVUSDFsTDckOVDFs MUDstDAjDPIPDbFNVDTkbHFRDA NDMNU3sOUNUDTNMNDc abI3aINPDbsDHMNkbNDkDBkMIkEaNDIOPIHkbIO6DbFNDO cENMDstDFs MUD3NMDTNN0DbFNDHFIaPDTkbHFNPDAjRDD4.2.5 Analysis LaaDkOkaVUNUDTNMNDTNI6FbNPSD UIO6DHMsUU)UNHb sOkaDTNI6FbUDPNMIBNPDEVDWbkbIUbIHUDrkOkPkSDbsDMNtaNHbD3s3 akbIsODNU IckbNUDstDHFIaPMNODIOD4,,5N,=RDvMIsMDbsDTNI6FbIO6SDTNI6FbUDTNMNDUbkOPkMPIYNPDEVDPIBIPIO6DNkHFDTNI6FbDEVDbFNDkBNMk6NDstDkaaDTNI6FbURDWbkbkDBR4oR4D2WbkbkrsM3SDrsaaN6NDWbkbIsOSDANQkUyDTkUD UNPDbsD3MsHNUUDbFNDPkbkDkOPDHsOP HbDtMNM NOHINUDkOPDcNkOUDkOPDn3a UDBR=RgD2n bF[ODODn bF[OSDwsUDLO6NaNUSDrkaItsMOIkyDTkUD UNPDbsDHsOP HbDbFNDwrLDkOPD3kbFDkOkaVUIURD4.2.5.1 Latent Class Analysis LDwrLDTkUD UNPDbsDIPNObItVDkDUNbDstDPIUbIOHbDONI6FEs MFssPDbV3NURDAFNDakbNObDHakUUNUDTNMDPNMIBNPDtMscDMNU3sOUNUDbsDkDUNbDstDONI6FEs MFssP cNkU MNUDTIbFDNkHFDU MBNVDMNU3sOPNObDkUUI6ONPDkD3MsEkEIaIbVDstDENasO6IO6DIODNkHFDHakUUDkHHsMPIO6DbsDbFNIMDU3NHItIHD3kbbNMODstDMNU3sOUNUD––DDbsDbFsUNDcNkU MNURDW cckMVDUHsMNUDstDONI6FEs MFssPDUktNbVSDHsFNUIsOSDkOPDPIUsMPNMDTNMNDHMNkbNPDEVDkBNMk6IO6DbFNDIbNcUDTIbFIO NkHFDHsOUbM HbRDlkHFDUHsMNDTkUDbFNODHkbN6sMIYNPDbsDasTSDcNPI cSDkOPDFI6FDEkUNPDsODNBNODH bD3sIObUDsODbFNDUHkaNRDlkHFDONI6FEs MFssPDHsOUbM HbDTkUDbFNODIOHa PNPDIODbFNDwrL-DFsTNBNMSDbFNDMNU abIO6DNObMs3VD2kDcNkU MNDbFkbDIOPIHkbNUDFsTDTNaaDONI6FEs MFssPUDTNMNDHakUUItINPDIObsD6Ms 3UyDTkU 3ssMRDiOHa PIO6DkaaDONI6FEs MFssPDIbNcUDPNUHMIENPDIODbFNDcNkU MNUDUNHbIsOSDTIbFs bDUHkaIO6SD3MsBIPNPDIc3MsBNPDcsPNaDtIbRDAFNMNtsMNDkaaD4;DONI6FEs MFssPDIbNcUDTNMNIOHa PNPDIODbFNDwrLRDnIUUIO6ONUUDkcsO6DONI6FEs MFssPDIbNcUDtMscDbFND.wWr:DMkO6NPDENbTNNODozDkOPD;RezDTIbFDcsUbDFkBIO6DaNUUDbFkOD=z DcIUUIO6RD.IONbNNOD3NMHNObDstDMNU3sOPNObUDFkPDcIUUIO6D3sUbkaDHsPNDIOtsMckbIsO-DbFNMNtsMNSDbFNVDHs aPD sbDENDaIO0 PTIbFDONI6FEs MFssPDPN3MIBkbIsODIOPIHNURDi P BIP kaUDcIUUIO6D3sUbkaDHsPNDPkbkTNMNDcsMNDaI0NaVDbsDENDM MkaDMNUIPNObURDnsPNaUDTNMNDNUbIckbNPD UIO6Dt aaDIOtsMckbIsODckQIc cDaI0NaIFssPD2dinwyRDdinwD UNUDkaaDkBkIakEaNDPkbkDbsDNUbIckbNDbFNDcsPNaDkOPDFkUDENNODts OPDbsDFkBNDUIcIakMDMNU abUDkUDc abI3aNDIc3 bkbIsODTFNODNUbIckbIO6DcsPNaUDTIbFDcIUUIO6DPkbkRJgu,KDnsPNaDtIbDUbkbIUbIHUDTNMNDNQkcIONPDtsMD4)Dbs –)HakUUDUsa bIsOUDbsDIPNObItVDbFNDs3bIckaDO cENMDstDHakUUNUDbFkbDtIbDbFNDPkbkRDATsDIOPIHkbsMUDstDcsPNaDtIbDTNMND UNPDbsDNBka kbNDNkHFDUsa bIsO8DbFNDws)nNOPNaa)x EIOD2wnxyDaI0NaIFssPDMkbIsDbNUbD2wxAyDkOPDbFNDGkVNUIkODiOtsMckbIsODrMIbNMIsOD2GiryRJg5oKDdsMDNkHFDkPPIbIsOkaDakbNObDHakUUSDbFNDwnxDwxADHsc3kMNUDbFNDcsPNaDtIbDk6kIOUbDbFND3MNBIs UDUsa bIsODTIbFDsONDaNUUDHakUUD2IRNRDbFNDg)HakUU Usa bIsODIUDHsc3kMNPDTIbFDkD4)HakUUDUsa bIsOyRDLD3)Bka NDaNUUDbFkODoRo=DIOPIHkbNUDbFkbDbFNDH MMNObDUsa bIsODIUDkDUbkbIUbIHkaaVDUI6OItIHkObDIc3MsBNcNObDIODtIbDsBNMDbFND3MNBIs UDUsa bIsORDwI0NDbFNDwnxDwxASDbFNDGirDIUDkDMNakbIBNDcNkU MNDstDcsPNaDtIbRDLDasTNMDGirDIOPIHkbNUDIc3MsBNPDcsPNaDtIbDTF ODHsc3kMNPDTIbFDkDcsPNaDTIbFDsONDaNUUDHakUURDmOHNDbFNDcsUbDs3bIckaDUsa bIsODTkUDts OPSDIOPIBIP kaUDTNMNDkUUI6ONPDbsDbFND3MstIaNDbFNVDFkPDbFNDFI6FNUbD3MsEkEIaIbVDstDENasO6IO6RDD–eDD4.2.5.2 Description of Latent Classes nNkU MNUDstDUsHIsNHsOscIHDUbkb USDsENUIbVSDvLDkOPDWGDTNMNDHkaH akbN tsM NkHFDstDbFNDONI6FEs MFssPDHakUUNURDdsMDkOkaVUIUDIOBsaBIO6DvLDkOPDWGSDbFNDUkc3aNDTkUDMNUbMIHbNPDbsDHFIaPMNODk6ND=DkOPDsaPNMDkUDvLDkOPDUNPNObkMVD6 IPNaIONUDkMNDbFNDUkcNDtsMDHFIaPMNODk6NUD=DbsD44RJg54KDnIUUIO6DPkbkDtsMDbFNDUsHIsNHsOscIHDUbkb USDvLSDkOPDWGDcNkU MNUDMkO6NPDENbTNNODoDkOPD=zRDlI6FbNNOD3NMHNObDstDMNU3sOPNObUDTNMNDcIUUIO6DGniDPkbkRDmtDHFIaPMNODk6ND=DkOPDsaPNMSD45zDTNMNDcIUUIO6DGniDIOtsMckbIsORDAFsUNDcIUUIO6DGniDPkbkDTNMNDcsMNDaI0NaVDbsDFkBNDasTNMDIOHscNDkPNM kHVSDasTNMD3kMNObkaDNP HkbIsOSD3kMbIHI3kbNPDIODtNTNMDvLSDkOPDFkPDFI6FNMDAjDbIcNRDD4.2.5.3 Mediation Analysis LD3kbFDkOkaVUIUDTkUD UNPDbsDPNbNMcIONDbFNDNQbNObDbsDTFIHFDaNBNaUDstDvLDk PWGDcNPIkbNPDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbVD2dI6 MND4yRDf NDbsDbFNDHkbN6sMIHkaDOkb MNDstDbFNDPN3NOPNObDBkMIkEaNSDkD sE UbDTNI6FbNPDaNkUbDUM kMNDk33MskHFDTkUD UNPDbsDNUbIckbNDbFND3kMkcNbNMURJg5gKDCUIO6DbFIUDk33MskHFSD3kbFTkVUDtMscDEIOkMVDkOPDHsObIO s UDIOPN3NOPNObDBkMIkEaNUDTNMNDNUbIckbNPDEVD3MsEIbDkOPDaIONkMDMN6MNUUIsOSDMNU3NHbIBNaVRD.NI6FEs MFssPDHakUUNUDTNMNDP ccVDHsPNPDTIbFDbFNDakM6NUbDHakUUD UNPDkUDkDMNtNMNOHND6Ms 3RJg5uKDWbkOPkMPDNMMsMUDtsMDbFNDIOPIMNHbDkOPDPIMNHbDNttNHbUDTNMNDNUbIckbNPD UIO6DEssbUbMk3DUkc3aIO6DTIbFD4SoooDMN3aIHkbIsOUDkOPDEIkU)HsMMNHbNPDEssbUbMk3DHsOtIPNOHNDIObNMBkaUDTNMNDNUbIckbNPRJg55KGssbUbMk33IO6DFkUDENNODMNHsccNOPNPDbsDcsMNDkHH MkbNaVDNUbIckbNDUbkOPkMPDNMMsMURJg55KDAsDkHHs ObDts DbFNDc abI3aNDbNUbUDP NDbsDbFNDHkbN6sMIHkaDOkb MNDstDbFNDIOPN3NOPNObDBkMIkEaNSDkD3)Bka NDstDoRo4DT UD UNP tsMDUbkbIUbIHkaDUI6OItIHkOHNDtsMDbFND3kbFDkOkaVUIURJg5uKDv IMTIUNDPNaNbIsODTkUD UNPDbsDkHHs ObDtsMDcIUUIO6DPkbkRDnNkU MNUDstD3FVUIHkaDkHbIBIbVDtMNM NOHVDTNMNDPIHFsbscIYNPDbsDQsOHNDkDTNN0DsMDcsMNRDkOPDQaNUUDbFkODsOHNDkDTNN0RDtsMDbFND3kbFDkOkaVUIURDlBIPNOHNDstDcNPIkbIsODTkUDPNbNMcIONPDItDkbDaNkUbDsONDIOPIMNHbD3kbFTkVDtMscDbFNDONI6FEs MFssPDIOPIHkbsMUDbsDsENUIbVDTkUD–;DDUI6OItIHkObRJg5uKDitDbFNDMNakbIsOUFI3DENbTNNODbFNDIOPN3NOPNObDBkMIkEaNDkOPDbFNDs bHscNDENHkcNDIOUI6OItIHkObDktbNMDkP9 UbIO6DtsMDbFNDcNPIkbsMUSDHsc3aNbNDcNPIkbIsODTkUDHsOUIPNMNPDbsDFkBNDsHH MMNPRDitDEsbFDbFNDPIMNHbDkOPDIOPIMNHbD3kbFTkVDtMscDIOPN3NOPNObDBMIkEaNDkOPDs bHsc DT MNDUI6OItIHkObSD3kMbIkaDcNPIkbIsODTkUDHsOUIPNMNPDbsDFkBNDsHH MMNPRDLUDcsUbDstDbFNDBk IkEaNUDIODbFN3kbFDkOkaVUIUDTNMNDEIOkMVDsMDP ccV)Hs NPSD OUbkOPkMPIYNPDMNU abUDTNMND3MNUNObNPDtsMDIObNM3MNbkEIaIbVRJg5=KDWbkOPkMPIYkbIsODstDHkbN6sMIHkaDPkbkDFkUDENNODPIUHs Mk6NPDEVDUscNDMNUNkMHFNMURJg5uKD4.3 Results vkMbIHI3kObUDTNMNDNM kaaVDPIUbMIE bNPDEVDk6ND2cNkOD=R=DVNkMUDJWfDuR5KyDkOPDUNQD25;RezDtNckaNyRDLacsUbDkaaDHFIaPMNODTNMNDEsMODIODrkOkPkD2,–RozyDkOPD,oRgzDTNMND3kMNOb)PNUHMIENPDkUD*FIbNNl Ms3NkORDmBNMTNI6FbDkOPDsENUNDHFIaPMNODckPND 3DgoR5zDkOPDg4R4zDstDbFNDUkc3aNSDMNU3NHbIBNaVRD4.3.1 Latent Class Analysis nsPNaDtIbDUbkbIUbIHUDtsMDbFNDwrLDHkODENDts OPDIODAkEaND=RDGirDHsObIO NPDbs PNHMNkUNDTIbFDNkHFDkPPIbIsOkaDHakUU-DFsTNBNMSDbFNDwnxDwxADIOPIHkbNPDbFkbDbFND–)HakUUDUsa bIsODPIPDOsbDUI6OItIHkObaVDIc3MsBNDtIbRDGkUNPDsODbFIUDIOtsMckbIsOSDbFND=)HakUUDUsa bIsODTkUDHFsUNODkUDbFNDENUbDtIbbIO6DcsPNaDtsMDbFNDPkbkRDTable 5: Model fit statistics for latent class analysis of 2 to 8 solutions rakUUD Gir D ws)nNOPNa)x EIOD3)Bka NDlObMs3VDgD 545–ggR5g,D XoRoo4D oR;geDuD 5o;oggR4=eD XoRoo4D oR;o4D5D 5ou;–;R=;–D XoRoo4D oReo;D=D 5oo5u5Rg=eD XoRoo4D oReg=D–D u,;–geR;o–D oRgu=D oReu4DDD–, DD4.3.2 Description of Latent Classes ibNcDMNU3sOUND3MsEkEIaIbINUDtsMDNOPsMUIO6DNkHFDONI6FEs MFssPDHFkMkHbNMIUbIHDkHMsUUDbFND=DakbNObDHakUUNUDkMNDPIU3akVNPDIODAkEaND–RDrakUUD4DHsOUIUbNPDstDg=R5zDstDbFND3s3 akbIsODkOPDTkUDPIUbIO6 IUFNPDEVDFI6FD3MsEkEIaIbINUDstD3NMHNIBNPDUktNbVSDHsFNUIsOSD3kM0UDkOPD3akVDU3kHNUSDaIBIO6DIODkDM MkaDkMNkSDkOPDckbNMIkaDPN3MIBkbIsODkOPDasTD3MsEkEIaIbVDstDPIUsMPNMSDbMkttIHSDkOPDUsHIkaDPN3MIBkbIsORDrakUUDgDkHHs ObNPDtsMD–RozDstDbFND3s3 akbIsODkOPDFkPDFI6FD3MsEkEIaIbINUDstDPIUsMPNMDIbNcUSDaIBIO6DIODkOD MEkODkMNkSDckbNMIkaDPN3MIBkbIsOSDkOPDUsHIkaDPN3MIBkbIsODkOPDasTD3MsEkEIaIbINUDstDUktNbVSDHsFNUIsODkOPDkNUbFNbIHURDrakUUDuDTkUDckPND 3DstD44R5zDstDbFND3s3 akbIsODkOPDTkUDPIUbIO6 IUFNPDEVDFI6FD3MsEkEIaIbINUDstD ktNbVSD3kM0UDkOPD3akVDU3kHNUSDaIBIO6DIODkOD MEkODkMNkSDckbNMIkaDPN3MIBkbIsODkOPDUsHIkaDPN3MIBkbIsODkOPDasTD3MsEkEIaIbINUDstDIbNcUDstDHsFNUIsODkOPDPIUsMPNMRDrakUUD5DTkUDbFNDakM6NUbDHakUUDkOPDHsOUIUbNPDstDu;RgzDstDbFND3s3 akbIsORDAFIUDHakUUDTkUDckM0NPDEVDFI6FD3MsEkEIaIbINUDstDUktNbVSDHsFNUIsOSD3kM0UDkOPD3akVDU3kHNUSDkNUbFNbIHUSDaIBIO6DIODkOD MEkODkMNkDkOPDasTD3MsEkEIaIbINUDstDPIUsMPNMSDbMkttIHSDckbNMIkaDPN3MIBkbIsOSDkOPDUsHIkaDPN3MIBkbIsORDrakUUD=DkHHs ObNPDtsMD4,R4zDstDbFND3s3 akbIsODkOPDFkPDONI6FEs MFssPUDTIbFDkDFI6FD3MsEkEIaIbVDstDUktNbVSDHsFNUIsOSD3kM0UDkOPD3akVDU3kHNUSDckbNMIkaDPN3MIBkbIsOSDkOPDUsHIkaDPN3MIBkbIsORDDD DeoDDTable 6: Item response probabilities from latent class analysis (n=22,831) D rakUUD4D2O%;S=–o-Dg=R5zyDrakUUDgD2O%4S4–e-D–RozyDrakUUDuD2O%gSu,u-D44R5zyDrakUUD5D2O%–Seo4-Du;RgzyDrakUUD=2O%5So4o-D4,R4zyDibDIUDUktNDbsDTka0DkasONDIODbFIUDONI6FEs MFssPDktbNMDPkM0DoR,u4 oRuouD oReooD oR;=,D oR=;gDibDIUDUktNDtsMDHFIaPMNODbsD3akVDs bUIPNDP MIO6DbFNDPkVDoR,,uD oR5e–D oR;u5D oR,5=D oRe;uD.NI6FEs MUDPNkaDTIbFD3MsEaNcUDbs6NbFNMDoR;=4D oR4ggD oR4=–D oR,ogD oRe–4DAFNMNDkMNDkP abUDbFkbDHFIaPMNODHkODass0D 3DbsDoR,–;D oRg;,D oR5=,D oR,e5D oR,guDvNs3aNDkMNDTIaaIO6DbsDFNa3DbFNIMDONI6FEs MUDoR,,=D oRu44D oR=eoD oR,,–D oR,;–DLP abUDTkbHFDs bDbFkbDHFIaPMNODkMNDUktND oR,,oD oRgo4D oR=–,D oR,;, D oR,4–DitDi(cDkTkVSDcVDONI6FEs MUDTIaaD0NN3DbFNIMDNVNUDs3NODtsMD3sUUIEaNDbMs EaNDoR,;eD oRu4–D oR–u;D oR,;5D oR,=uDAFNMNDkMND6ssPD3kM0UDkOPD3akVDU3kHNUD oR–;= oR=5=D oReo=D oR,o5D oR;4;DvMNUNOHNDstDaIbbNMSDEMs0NOD6akUUSDsMD6kMEk6NDIODbFNDUbMNNbDsMDUIPNTka0DoR4guD oRe;5D oR4e;D oRoeeD oR=u;DvMNUNOHNDstD3Ns3aNDUNaaIO6DsMD UIO6DPM 6UDoRou–D oR=,=D oRo=gD oRo4;D oRu,=DvMNUNOHNDstDkaHsFsaIHUDkOPDNQHNUUIBNDPMIO0IO6DIOD3 EaIHDoRo54D oR–o=D oRo––D oRoo,D oRu;4DvMNUNOHNDstD6Ms 3UDstDVs O6D3Ns3aNDTFsDHk UNDbMs EaNDoRo;gD oRe,=D oRgg4D oR45gD oR–g=DvMNUNOHNDstDE M6akMVDstDFscNUDkOPDk3kMbcNObUDoR4–,D oR=eeD oRg==D oR5oeD oR–=5DnsPNMkbNDbsDFNkBVDbMkttIHDsODbFNDUbMNNboRg5–D oR–g=D oRu==D oR45uD oR5euDG IaPIO6UDIODONI6FEs MFssPDIODTNaa)0N3bDHsOPIbIsODoR–=–D oRgo5D oR=,,D oR,o4D oR5=eDwIBIO6DasHkbIsOD D D D D DDDDDx MkaD2X4=SoooyD oR–eoD oRo;4D oR4,;D oRo–;D oRg4;DDDDDWNcI) MEkOD24=Sooo),,S,,,y D oR4oeD oR4=5D oR4ggD oR4oeD oR4ooDDDDDCMEkOD2W4ooSoooyD oRgggD oRe–=D oR–;oD oR;g=D oR–;gDnkbNMIkaDPN3MIBkbIsOD D D D D DDDDDwsTD oRo;gD oR4ggD oRg;–D oR=;;D oR4;,DDDDDnNPI c D oRu5oD oRgugD oRu54D oRu5,D oRu;,DDDDDhI6FD oR=e;D oR–5–D oRueuD oRo–uD oR5guDWsHIkaDPN3MIBkbIsOD D D D D DDDDDwsTD oR5,uD oRo;–D oRg5gD oR5g5D oRgeuDDDDDnNPI c D oRuguD oR4e4D oRuuuD oRu;gD oRg5gDDDDDhI6FD oR4;5D oRe5uD oR5g–D oR4,=D oR5;=DDe4DDW cckMINUDstDNkHFDHakUUDkOPDbFNIMD0OsTODMNakbIsOUFI3DTIbFDsENUIbVDsMDsENUs6NOIHDENFkBIs MUDkMNDPIU3akVNPDIODAkEaNDeRrakUUD5DFkUDbFNDcsUbDO cENMDstDkbbMIE bNUDbFkbkMND3sU bIB aVDMNakbNPDbsD3FVUIHkaDkHbIBIbVRDrakUUDgDFkUDbFNDcsUbDO cENMDstDkbbMIE bNUDbFkbDON6 IBNaVDMNakbNPDbsD3FVUIHkaDkHbIBIbVRDGkUNPDsODbFNDkbbMIE bND3kIMIO6UD OIM NDbsDNkHFDHakUUSDONI6FEs MFssP DTNMNDakENaNP8DFI6FDM Mka)FI6FDUktNbVD2HakUUD4y-DasTDUktNbV)asTDHsFNUIsOD2HakUUDgySDasT PIUsMPNM)FI6FDPN3MIBkbIsOD2HakUUDuy-DFI6F UktNbV)asTDPN3MIBkbIsOD2HakUUD5y-DkOPDFI6FDHsFNUIsO) I6FDPN3MIBkbIsOD2HakUUD=yRDDDTable 7: Summarized characteristics of neighbourhood classes and known relationships with obesity or weight related behaviours* D rakUUD4 rakUUDg rakUUDu rakUUD5 rakUUD=WktNbVD hI6FD2SyD wsT)nIPD2)NoyD hI6FD2SyD hI6FD2SyD nIP)hI6FD2oNSyDrsFNUIsOD hI6FD2SyD wsTD2)yD wsT)nIPD2)NoyD hI6FD2SyD hI6FD2SyDvkM0UDkOPD3akVDU3kHNUDhI6FD2SyD nIPD2oyD hI6FD2SyD hI6FD2SyD hI6FD2SyDfIUsMPNMD wsTD2SyD nIP)hI6FD2oN)yD wsTD2SyD wsT)nIPD2SNoyD nIPD2oyDAMkttIHD wsTD2SyD nIPD2oyD nIPD2oyD wsTD2SyD nIPD2oyDLNUbFNbIHUD nIPD2oyD wsTD2)yD nIPD2oyD hI6FD2SyD nIPD2oyDwIBIO6DasHkbIsOD x MkaD2)yD CMEkOD2SyDD CMEkOD2SyDD CMEkOD2SyD CMEkOD2SyDDnkbNMIkaDPN3MIBkbIsODhI6FD2)yD hI6FD2)yD hI6FD2)yD wsTD2SyD hI6FD2)yDWsHIkaDPN3MIBkbIsOD wsTD2SyD hI6FD2)yD hI6FD2)yD wsTD2SyD hI6FD2)yDUhI6FNnIPNwsTDPNtIONPDEVDHsMMNU3sOPIO6DIbNcDMNU3sOUND3MsEkEIaIbVDbNMbIaNURDdsMDbFMNNDHkbN6sMVDIbNcUSDbFNDFI6FNUbD3MsEkEIaIbVDTkUD UNPDbsDPNUHMIENDbFNDHakUURDAFNDSNoN)DUVc saUDIODEMkH0NbUDMN3MNUNObD3sUIbIBNNON bMkaNON6kbIBNDkUUsHIkbIsOUDTIbFDsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MUDts OPDIOD3kUbDUb PINURDDD DegDDAkEaND; PIU3akVUDbFND3NMHNObk6NUDkOPDcNkOUDstDbFNDONI6FEs MFssPDHakUUNUDEVDUsHIsNHsOscIHDUbkb USDsENUIbVSDvLSDkOPDWGcNkU MNURDrFIaPMNODaIBIO6DIODasTDUktNbV)asT HsFNUIsOD2HakUUDgyDONI6FEs MFssPUDFkPDasTNMDIOHscNDkPNM kHVSDckbNMOkaDkOPD3kbNMOkaDNP HkbIsOSDkOPDsM6kOIYNPDkOPD OsM6kOIYNPDvLDkOPDFI6FNMDsENUIbVDkOPDAjDbIcNDbFkODbFNDsbFNMDHakUUNURDiODHsObMkUbSDHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsOD2HakUUD5yDONI6FEs MFssPUDFkPDbFNDFI6FNUbD3NMHNObk6NDstD3kMNObkaDNP HkbIsOSDIOHscNDkPNM kHVSDkOPDsM6kOIYNPDvLDkOPDbFNDasTNUbDENUIbVD3NMHNObk6NDkOPDAjDbIcNDbFkODbFNDsbFNMDHakUUNURDhI6FDM ka)FI6FD kt bV 2HakUUD4yDONI6FEs MFssPUDFkPDbFNDFI6FNUbD3NMHNObk6NDstD OsM6 OIYNPDvLRD DeuDDTable 8: Socioeconomic status, weight status, and obesogenic behaviours by class membership (%)* D rakUUD4D2FI6FDM Mka)FI6FDUktNbVyDrakUUDgD2asTDUktNbV)asTDHsFNUIsOyDrakUUDuD2asTDPIUsMPNM)FI6FDPN3MIBkbIsOyDrakUUD5D2FI6FDUktNbV)asTDPN3MIBkbIsOyDrakUUD=D2FI6FDHsFNUIsO)FI6FDPN3MIBkbIsOyD3)Bka NDWsHIsNHsOscIHDUbkb UD D D D D D DDDDDiOHscNDkPNM kHVD D D D D D XoRoo4DDDDDDDDDwsTNUb uR4D eR–D 5RgD 4RgD gR–D DDDDDDDDDwsTNMDcIPPaND 4–R–D u–R=D goR;D –ReD ggR;D DDDDDDDDDnIPPaN u;RgD uuRuD u;RgD g5R,D u4R5D DDDDDDDDDC33NMDcIPPaND uuR=D 4,R=D g–ReD 5gR=D u4R;D DDDDDDDDDhI6FNUb ;ReD uRgD 4oRgD g5ReD 44R5D DDDDDnkbNMOkaDNP HkbIsOD D D D D D XoRoo4DDDDDDDDD.sDcsbFNMD 4RgD gR4D 4ReD oR;D 4RoD DDDDDDDDDwNUU bFkODFI6FDUHFssaD 4,R–D uuReD g4R=D ;RuD 4;R5D DDDDDDDDDhI6FDUHFssaD ggRgD 4–R–D 4=ReD 4eR5D 4–R–D DDDDDDDDDGNVsOPDFI6FDUHFssaD g–ReD g=ReD g;RoD geRoD uoR–D DDDDDDDDDrsaaN6NNCOIBNMUIbVDPN6MNNDuoRuD g4R,D uuR4D 5–R=D uuR5D DDDDDvkbNMOkaDNP HkbIsOD D D D D D XoRoo4DDDDDDDDD.sDtkbFNMD 44RuD u=R;D g4RoD ,RoD 4;RuD DDDDDDDDDwNUU bFkODFI6FDUHFssaD goR=D 4eR,D 4–R5D eR–D 4=R4D DDDDDDDDDhI6FDUHFssaD 4,R4D 4oR–D 4oR=D 4uR=D 45R4D DDDDDDDDDGNVsOPDFI6FDUHFssaD 4,R5D 4=RuD 4,R,D goR5D guRgD DDDDDDDDDrsaaN6NNCOIBNMUIbVDPN6MNNDg,ReD goR=D ugR4D 5,R=D g,R5D DD D D D D D D*NI6FbDUbkb UD D D D D D XoRoo4DDDDD.sMckaDTNI6FbD =–R5D =oRgD =;RgD –4R,D =–R;D DDDDDmBNMTNI6FbD g4R–D 4;R;D 4,R4D 4,R;D g4R5D DDDDDmENUND ggR4D u4RoD ggReD 4;RuD g4R;D DmM6kOIYNPDvLUUD D D D D D XoRoo4DDDDDnsUbDPkVUD uReD gR=D gR;D =RuD uR–D DDDDDL tNTDbIcNUDkDTNN0g,R5D 4eR,D guR=D u=R=D g;R=D DDDDDmOHNDkDTNN0D g4R;D 4eR=D g5ReD g–RoD ggR4D DDDDDmOHNDkDcsObFD uR–D uR5D uRuD 5R–D 5R=D DDDDDLacsUbDONBNMD 54R=D =;R;D 5=ReD g;R–D 54RgD DCOsM6kOIYNPDvLUUD D D D D D XoRoo4DDDDDnsUbDPkVUD u,RoD ggRuD g–R5D u=RoD uoR,D DDDDDL tNTDbIcNUDkDTNN0g–RuD g4R4D ggRoD g,RuD geRgD DDDDDmOHNDkDTNN0D 45RgD 4,ReD goR,D 4eRoD 4–RgD DDDDDmOHNDkDcsObFD =RuD 44R5D –RuD =R=D –R,D DDDDDLacsUbDONBNMD 4=RgD g=R–D g5R5D 4uR4D 4;R,D DnNkODAjDbIcND2WfyUUD 4gR=D2oR4–yD45R=D2oR5;yD4gReD2oRuuyD 44R5D2oR4eyD 4gRuD2oRg5yD XoRoo4DULaaDPNUHMI3bIBNUDTNMNDTNI6FbNPD UIO6DUkc3aIO6DTNI6FbURDUUxNU abUDTNMNDMNUbMIHbNPDbsDHFIaPMNODZD= VNkMUDstDk6NRe5DD4.3.3 Mediation Analysis xNU abUDtMscDbFNDcNPIkbIsODkOkaVUIUDkMNDts OPDIODAkEaND, RAFNDFI6FDUktNbV)asTDPN3MIBkbIsOD2HakUUD5yDONI6FEs MFssPDTkUD UNPDkUDbFNDMNtNMNOHND6Ms 3RDAFNMNDTNMNDUI6OItIHkObDkUUsHIkbIsOUDENbTNNODNkHFDONI6FEs M ssPDHakUUDkOPDkbDaNkUbDsONDcNPIkbsMD23kbFDkyDTIbFDMNakbIsOUFI3UDIODbFNDNQ3NHbNPDPIMNHbIsOD2aNUUDvLDkOPDcsMNDAjDbIcNDHsc3kMNPDTIbFDMNtNMNOHNyRDCOsM6kOIYNPDvLDTkUDON6kbIBNaVDkUUsHIkbNPDkOPDAjDbIcNDTkUD3sUIbIBNaVDkUUsHIkbNPDTIbFDsENUIbVD23kbFDEyRDiODHsc3kMIUsODTIbFDbFNDMNtNMNOHNDONI6FEs MFssPSDHFIaPMNODaIBIO6DTIbFIODbFNDsbFNMDONI6FEs MFssPDHakUUNUDTNMNDUI6OItIHkObaVDcsMNDaI0NaVDbsDENDsENUND23kbFDHyRDAFNDPIMNHbD3kbFUDENbTNNODONI6FEs MFssPDHakUUNUDkOPDsENUIbVDMNckIONPDUI6OItIHkObDktbNMDkP9 UbIO6DtsMDbFNDc NPIkbsMUD23kbFDHYyRAFNDIOPIMNHbD3kbFTkVDtMscDONI6FEs MFssPDHakUUDbsDsENUIbVDTkUDUI6OItIHkObDtsMDkaaDONI6FEs MFssPDHakUUNUDNQHN3bDtsMDbFNDFI6FDM Mka)FI6FDUkt bVD2HakUUD4yDONI6FEs MFssPDIOPIHkbIO6D3kMbIkaDcNPIkbIsORDAFND3Ms3sMbIsODstDbFNDbsbkaDNttNHbDcNPIkbNPDMkO6NPDtMscD–R–zDbsD4gRuzDkcsO6DbFNDONI6FEs MFssPUDTIbFDUI6OItIHkObDIOPIMNHbDNttNHbURe=DDTable 9: Bootstrap estimates and bias-corrected 95% confidence intervals of the path analysis between neighbourhood class and obesity. High safety-low deprivation (class 4) was the reference. Analysis was restricted to children age 5 or greater.*  D lttNHbDsODsM6kOIYNPDvLD23kbFDkSD\]nyDlttNHbDsOD OsM6kOIYNPDvLD23kbFDkSD\]nyDlttNHbDsODAjDbIcND23kbFDkSD\]nyDnNPIkbsMDNttNHbDsODsENUIbVD23kbFDESDn]: yDfIMNHbDNttNHbD2 OkP9 UbNP-D3kbFDHSD\]:y DfIMNHbDNttNHbD2kP9 UbNPDtsMDcNPIkbsM-D3kbFDHYSD\):y DiOPIMNHbDNttNHbD2\]n]:y DD D D D D D D DhI6FDM Mka)FI6FDUktNbVD2rakUUD4y-0.115  (-0.175– -0.055) oRoo,D2)oRo=;FoRo;oyD0.372  (0.081–0.728) D 0.143  (0.060-0.212) 0.143 (0.071–0.214) oRoooD2)oRo4oFoRooeyDwsTDUktNbV)asTDHsFNUIsOD2rakUUDgy-0.346  (-0.468– -0.237) -0.386  (-0.501– -0.276) 1.352 (0.712–1.960) D 0.249 (0.112-0.383) 0.222  (0.092–0.350) 0.031 (0.013–0.050) wsTDPIUsMPNM)FI6FDPN3MIBkbIsOD2rakUUDuy-0.183  (-0.272– -0.112) -0.301  (-0.387– -0.213) oRu,oD2)oRo5uFoR;ugyDD 0.188 (0.090-0.281) 0.167  (0.069–0.264) 0.021  (0.009–0.037) hI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD2rakUUD=y-0.130  (-0.193– -0.060) -0.167  (-0.236– -0.094) oRgo–D2)oR4–=FoR=eoyDD 0.168 (0.078-0.249) 0.157  (0.069–0.237) 0.011  (0.003–0.022) mM6kOIYNPDvLDD D D oRo4eD2)oRogeFoRo–oy D D DCOsM6kOIYNPDvLDD D D -0.074  (-0.120– -0.029) D D DAjDbIcND D D D 0.006  (0.001–0.010) D D DUDEsaPDIUDUI6OItIHkObe–DD4.4 Discussion CUIO6DsE9NHbIBNDkOPDU E9NHbIBNDcNkU MNUDstDONI6FEs MFssPUSDTNDTNMNDkEaNDbsDHakUUItVDHFIaPMNODkUDaIBIO6DTIbFIODsONDstDtIBNDPIttNMNObDONI6FEs MFssPDHakUUNURDGkUNPDsOD OIM NDHscEIOkbIsOUDstDONI6FEs MFssPDkbbMIE bNUSDbFNUNDHakUUNUDHkODENDUNNODkU8DFI6FDM Mka)FI6FDUktNbV-DasTDUktNbV)asTDHsFNUIsO-DasTDPIUsMPNM)FI6FDPN3MIBkbIsO-DFI6FDUktNbV)asTDP 3MIBkbIsO-DkOPDFI6FDHsFNUIsO)FI6FDPN3MIBkbIsORDAFNDFI6FDUktNbV)asTDPN3MIBkbIsODkOPDasTDUktNbV)asTDHsFNUIsODONI6FEs MFssPUDFkBNDM kaIbINUDbFkbDkMNDcsUbaVD3sUIbIBNDkOPDON6kbIBNSDMNU3NHbIBNaVSDbsTkMPUDsENUIbVRDAFNDsb MDONI6FEs MFssPDbV3NUDFkBNDkDcIQDstD3sUIbIBNDkOPDON6kbIBNDONI6FEs MFssPDkbbMIE bNURDAFNMNDTNMNDUI6OItIHkObDPIttNMNOHNUDENbTNNODONI6FEs MFssPDHakUUNUDkOPDaNBNaUDstDsM6kOIYNPDkOPD OsM6kOIYNPDvLSDAjDbIcNSDkOPDsENUIbVRDLDcNPIkbIsODkOkaVUIUDU 66NUbNPDbFkbDcNkU MNUDstDvLDkOPDWGD3kMbIkaaVDcNPIkbNPD23Ms3sMb sODst bsbkaDNttNHbDMkO6NPDENbTNNOD–R–zDkOPD4gRuzyDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbVRGVD UIO6DwrLDTNDTNMNDkEaNDbsDNQkcIONDbFNDNtt HbDstDPIUbIOHbD3MstIaNUDstDkDUNbDstDONI6FEs MFssPDkbbMIE bNUD0OsTODbsDENDMNakbNPDbsDsENUIbVDsMDTNI6Fb)MNakbNPDENFkBIs MUDsODsENUIbVRDrFIaPMNODMNUIPIO6DTIbFIODNkHFDIPNObItINPDONI6FEs MFssPDHakUUDNQ3NMINOHNPDkDUIcIakMDUNbDstONI6FEs MFssPDkbbMIE bNURDf NDbsDbFND3sb ObIkaDUVONM6IUbIHDNttNHbDstDONI6FEs MFssPDkbbMIE bNUDkOPDHsMMNakbIsODENbTNNODkbbMIE bNUS cN FsPUDU HFDkUDc abIBkMIkEaNDMN6MNUUIsODTs aPDOsbDENDkEaNDbsDPIUNObkO6aNDbFNDIOPN3NOPNObDNttNHbUDstDNkHFDHFkMkHbNMIUbI DsODsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MURJ4,5KDhsTNBNMSDUb PINUD UIO6DU HFDcNbFsPUDkMNDUbIaaDHsccsOSDTFIHFDckVDNQ3akIODbFNDIOHsOUIUbNObDtIOPIO6UDDbFNDaIbNMkb MNDsODbFNDMNakbIsOUFI3DENbT NODE IabDNOBIMsOcNObDtkHbsMUDkOPDsENUIbVRJgeSg;S4egS4e5KDdsMDNQkc3aNSDUb PINUD UIO6DakbNObDcNbFsPUDFkBNDts OPDkUUsHIkbIsOUDENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbV TFNODbMkPIbIsOkaDkOkaVUIUDstDIOPIBIP kaDNOBIMsOcNObkaDkbbMIE bNUDPIPDOsbDMNBNkaDkOVDkUUsHIkbIsORJg5–Sg5eKDi DckVDENDbFkbD OIM NDHscEIOkbIsOUDstDeeDDONI6FEs MFssPDkbbMIE bNUSDTFIHFDbNOPDOsbDbsDENDNQkcIONPDIODckOVDMN6MNUUIsO)EkUNPDk33MskHFNUSDkHbDUVONM6IUbIHkaaVDsMDPNbMIcNObkaaVDsODTNI6FbDMN kbNPDENFkBIs MUDHMNkbIO6DPIU3kMIbINUDIODsENUIbVD3MNBkaNOHNRDDLabFs 6FDUb PINUDFkBNDUFsTODkUUsHIkbIsOUDENbTNNODONI6FEs MFssPDHFkMkHbNMIUbIHUDkOPDaNBNaUDstDvLSDWGSDkOPDsENUIbVSDbFIUDIUDbFNDtIMUbDUb PV bsDUFsTDbFkbDvLDkOPDWGD3kMbIkaaVDcNPIkbNDbFNDMNakbIsOUFI3DENbTNNODU3NHItIHDONI6FEs MFssPDbV3NUDkOPDsENUIbVDkcsO6DHFIaPMNORDmbFNMDUb PINUDFkBNDts OPDOsDcNPIkbIO6DNttNHbDstDvLDsMDWGDsODbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDkbbMIE bNUDkOPDsENUIbVRJ4–uS4–=Sg5;KDAFNDkcs ObDstDcNPIkbIsODTkUDasTDkcsO6DbFNDPIttNMNObDONI6FEs MFssPDbV3NUSDFI6FaI6FbIO6DbFNDONNPDtsMDO I6FEs MFssPDIObNMBNObIsOUDbFkbDkHbDsODkDMkO6NDstDTNI6Fb)MNakbNPDENFkBIs MUDkOPDOsbD9 UbDvLDkOPDWGRDdsMDNQkc3aNSDIc3MsBIO6DE IabDNOBIMsOcNObDkbbMIE bNUD2NR6RSDUbMNNbDHsOONHbIBIbVSDHMsUUTka0USDaI6FbIO6yDkasO6D3kbFTkVUDbsDtssPDUbsMNUDbFkbDHkMMVDFNkabFVDtssPD3MsP HbUDckVDIc3MsBNDEsbFDvLDkOPDPINbRDxNakbIBNDbsDbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPSDOsDcNPIkbIO6DNttNHbDTkUDts OPDkcsO6DHFIaPMNODaIBIO6DIODFI6FDM Mka)FI6 DUktNbVDONI6FEs MFssPURDhI6FD ktNbV)asTDPN3MIBkbIsODkOPDFI6FDM Mka)FI6FDUktNbVDONI6FEs MFssPUDkMND3MNPscIOkObaVD MEkODkOPDM MkaSDMNU3NHbIBNaVRDrFIaPMNODaIBIO6DIODFI6FDM Mka) UktNbVDONI6FEs MFssPUDFkPDasTNMDaNBNaUDstDsM6kOIYNPDvLDE bDUIcIakMDaNBNaUDstD OsM6kOIYNPDvLDbFkODHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPURDA NDPIttNMNOHNDIODsM6kOIYNPDvLDkcsO6D MEkO kOPDM MkaDONI6FEs MFssPUDHs aPDENDMNakbNPDbsDtNTNMD3FVUIHkaDkHbIBIbVDtkHIaIbINUDIODM MkaDHscc OIbINURJg5,KDwkH0DstDcNPIkbIO6DNttNHbUDU 66NUbUDbFkbDPIttNMNOHNUDIODsENUIbVD3MNBkaNOHNDckVDENDMNakbNPDbsDsbFNMDTNI6FbDMNakbNPDENFkBIs MUSDU HFDkUDPINbRDx MkaDHFIaPMNODFkBNDENNODts 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PINUDFkBNDUFsTODbFkbDU3NHItIHDONI6FEs MFssPDHFkMkHbNMIUbIHUSDU HFDkUDtssPD3MIHNUJg=4KDkOPDPIUbkOHNDbsDHsOBNOINOHNDUbsMNUDsMDtkUbDtssPDMNUbk MkObUSJg=gKDkMNDkUUsHIkbNPDTIbFDPINbkMVDENFkBIs MRDAFNDIOHa UIsODstDPINbkMVDENFkBIs MUDk DkODkPPIbIsOkaDcNPIkbsMDe, DDckVDNQ3akIODcsMNDstDbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbVRDwkUbaVSDbFNMNDTNMNDUI6OItIHkObDPIttNMNOHNUDIODbFNDIOPIBIP kaDHFkMkHbNMIUb HUDstDMNU3sOPNObUDTIbFDcIUUIO6DkOPDOsO)cIUUIO6DPkbkRDAFNUNDIOPIBIP kaUDTNMNDcsMNDPIUkPBkObk6NPDkOPDaI0NaVDaIBNPDIODcsMNDPN3MIBNPONI6FEs MFssPU-DbFNMNtsMNSDMNU abUDTs aPDENDEIkUNPDbsTkMPUDbFNDO aaRDDfNU3IbNDbFNUNDaIcIbkbIsOUSDbFNDUbMNO6bFDstDbFIUD  PVDIUDbFND UNDstDkDOsBNaDk33MskHFDstDUb PVIO6DbFNDkUUsHIkbIsODENbTNNODONI6FEs MFssPDkbbMIE bNUDkOPDsENUIbVRDwrLDkPPMNUUNUDbFND3sbNObIkaDUVONM6IUbIHDNttNHbDstDO I6FEs MFssPDkbbMIE bNUDkOPDHMNkbNUDcNkOIO6t aDHakUUNUDstDONI6FEs MFssPDbV3NURDrsObIO NPD UNDstDbFIUDcNbFsPDckVD3MsBIPNDUbMsO6NMDkOPDcsMNDHsOUIUbNObDU 33sMbDtsMDONI6FEs MFssPDNOBIMsOcNObDkUDkDHk UNDstDsENUIbVDkOPDIPNObItVD0NVDHFkMkHbNMIUbIHUDbFkbDFkBNDcsMNDIOta NOHNDsODsENUIbVDMIU0RDiODkPPIbIsOSDbFNDUb PVDckPND UNDstDkDakM6NDOkbIsOkaaVDMN3MNUNObkbIBNDUkc3aNDstDrkOkPIkODHFIaPMNODTFIHFDU 33sMbUDbFND6NONMkaIYkEIaIbVDbsDrkOkPkDkUDkDTFsaNRDiODHsOHa UIsOSDbFNDtIOPIO6UDU 66NUbDbFkbDbFNDONI6FEs MFssPUDHFIaPMNODMNUIPNDTIbFIODHkODEND6Ms 3NPDIObsDUIcIakMDbV3sas6INUSDTFIHFDkMNDkUUsHIkbNPDTIbFDvLSDWGSDkOPDsENUIbVRDd b MNDUb PINUDNQkcIOIO6DONI6FEs MFssPDNttNHbUDsODsENUIbVDsMDTNI6FbDMNakbNPDENFkBIs MUDUFs aPDHsOUIPNMDcNbFsPUDbFkbDkaasTDtsMDbFND6Ms 3IO6DstDONI6FEs MFssPDkbbMIE bNURDCOsM6kOIYNPDvLDkOPDAjDbIcNDTNMNDts OPDbsDENDsODbFND3kbFTkVDENbTNNODONI6FEs MFssPDHakUUDkOPDsENUIbV-DFsTNBNMSDbFNDcNPIkbIO6DNttNHbDstDbFNUNDkHbsMUsODsENUIbVDMIU0DIUDasTRDiObNMBNObIsODUbMkbN6INUDsDM P HNDsENUIbVDkbDbFNDONI6FEs MFssPDaNBNaDkMNDONNPNPDbFkbDbkM6 bDc abI3aNDsENUs6NOIHDENFkBIs MUDU HFDkUDPINbSDvLSDkOPDWGDkOPDOsbD9 UbDvLDkOPDWGDkasONRDDDDDD D;oDDChapter 5: Longitudinal Study of Neighbourhood Class and Obesity 5.1 Introduction mENUIbVDFkUDENHscNDkDck9sMD3 EaIHDFNkabFDIUU NDIODrkOkPkDTFNMNDMNHNObDMNUNkMHFDIOPIHkbNUDbFkb–ozDstDkP abUJg=uKDkOPDugzDstDHFIaPMNOJ=KDkMNDsBNMTNI6FbDsMDsENUNRDibDFkUDENNODU 66NUbNPDbFkbDbFNDIOHMNkUIO6DUNPNObkMIONUUDkOPDHsOU c3bIsODstDFI6FDHkasMIHDPINbUDckVDENDIc3sMbkObDPNbNMcIOkObUDstbFNDFI6FDMkbNUDstDsENUIbVRJ4gKDdsaasTIO6DbFNDUsHIka)NHsas6IHkaDcsPNaSDMNUNkMHFNMUDFkBNDU 66NUbNPDbFkbDcsPItVIO6DONI6FEs MFssPUDbsDENDcsMNDHsOP HIBNDbsD3FVUIHkaDkHbIBIbVDkOPDFNkabFVDNkbIO6DckVDIc3MsBNDbFNDFNkabFDENFkBIs MUDstDMNUIPNObUDTIbFIODbFNDONI6FEs MFssPRJ5oS–=KDAFNDO cENMDstDUb PINUDMNakbIO6DONI6FEs MFssPDkbbMIE bNUDTIbFDsENUIbVDFkUD6MsTODU EUbkObIkaaVDsBNMDbFND3kUb PNHkPN-DFsTNBNMSDUVUbNckbIHMNBINTUDakM6NaVDFkBNDts OPDcIQNPDMNU abURJgeSg;KDdNTDUb PINUDFkBNDUVUbNckbIHkaaVDNQ3asMNPDbFNDUVONM6IUbIHDNttNHbUDstDONI6FEs MFssPDkbbMIE bNUDsODsENUIbVSDTFIHFDckVD3kMbIkaaVDNQ3akIODTFVDbFNDMNU abUDMN3sMbNPDIODbFNDaIbNMkb MNDFkBNDENNODcIQNPRDiODr Fk3bNMD5SDiD UNPDakbNObDHakUUDkOkaVUIUDbsD6Ms 3DUIcIakMDONI6FEs MFssPUDEkUNPDsODkDUNbDstDkbbMIE bNUDU HFDbFkbDONI6FEs MFssPUDTIbFIODkD6Ms 3DFkP csMNDUIcIak D3MstIaNDstDkbbMIE bNUDbFkODbFsUNDENbTNNOD6Ms 3URDdIBNDbV3NUDstDONI6FEs MFssPUDTNMNDts OP8DFI6FDM Mka)FI6F UktNbVD2g=R5zy-DasTDUktNbV)asTDHsFNUIsOD2–Rozy-DasTDPIUsMPNM)FI6FDPN3MIBkbIsOD244R5zy-DFI6FDUktNbV)asTDPN3MIBkbIsOD2u;Rgzy-DkOPDFI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD24,R4zyRDrMsUU) NHbIsOkaDkUUsHIkbIsOUDENbTNNODONI6FEs MFssPDMs 3DkOPDsENUIbVDTNMNDts OPSDU HFDbFkbDHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDFkPDkDasTNMDMIU0DstDsENUIbVDbFkODHFIaPMNODaIBIO6DTIbFIODkaaDsbFNMDONI6FEs MFssPDbV3NURDmONDIc3sMbkObDaIcIbkbIsODstDbFNDMNU abUDtMscDr Fk3bNMD5DIUDbFkbDbFNDNQbNObstDbFNDkUUsHIkbIsODENbTNNODONI6FEs MFssPD6Ms 3DkOPDsENUIbVDHkOOsbDENDkUUNUUNPE NPDsODbFNDHMsUU)UNHbIsOkaD;4DDPNUI6ODstDbFNDUb PVRDwsO6Ib PIOkaDUb PINUD3MsBIPNDUbMsO6NMDNBIPNOHNDstDHk UkaDkUUsHIkbIsORDW3NHItIHkaaVSD sO6Ib PIOkaDUb PINUDHkODNQkcIONDPIttNMNOHNUDIOD6MsTbFDbMk9NHbsMINUDENbTNNODHFIaPMNODaIBIO6DTIbFIO bFNDPIttNMNObDONI6FEs MFssPDbV3NURDiODkPPIbIsOSDasO6Ib PIOkaDPkbkDHkODkUUNUUDbFNDIc3kHbDstD3MsasO6NPDNQ3sU MNDsODFNkabFDbMk9NHbsMVRDh M YckODNbDkaRDFV3sbFNUIYNPDbFkbDbFNDIObNOUIbVDkOPDP MkbIsODstDNkMaVDaItNDNOBIMsOcNObkaDNQ3sU MNDckVDkttNHbDt b MNDFNkabFDs bHscNUSDkHHsMPIO6DbsDkDPsUN)MNU3sOUNDMNakbIsOUFI3RJ–;KDdsMDNQkc3aNSDIBIO6DIODkDONI6FEs MFssPDbV3N sbFNMDbFkODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPD2NR6RSDkDONI6FEs MFssPDbV3NDkbDFI6FNMDMIU0DstDsENUIbVyDsBNMDbIcNDckVDON6kbIBNaVDIc3kHbDkO OPIBIP ka(UDGniDbMk9NHbsMVRDDwsO6Ib PIOkaDUb PINUDkUUsHIkbIO6DbFNDONI6FEs MFssPDNOBIMsOcNObDTIbFDsO6sIO6DHFkO6NDIODGniDFkBNDbV3IHkaaVD UNPDBkMIkEaN)HNObNPDkOkaVbIHDk33MskHFNUDbsDcsPNaD6MsTbFRDjkMIkEaN)HNObMNPDk33MskHFNUSDU HFDkUDbMkPIbIsOkaDMN6MNUUIsODkOkaVUIUDsMDc abIaNBNaDcsPNaUSDtsH UDsODbFNDMNakbIsOUFI3DkcsO6DBkMIkEaNURJ44eKDAFNDk33MskHFDkUU cNUDbFkbDBkMIkEaNUDkttNHbDHFkO6NDsODsbFNMDBkMIkEaNUDkOPDbFkbDbFIUDHFkO6NDIUDFscs6NOs UDTIbFIODkD3s3 akbIsOD2IRNRSD6MsTbFDIUDFscs6NOs UyRJg=KDhsTNBNMSDMNU abUDtMscDr Fk3bNMDuDts OPDbFkbDbFND3kbbNMODstDGni6MsTbFDTkUDFNbNMs6NOs UDkOPDbFkbDbFND3MNPIHbsMUDstDNkHFD6MsTbFD3kbbNMODTNMNDPIttNMNObRDi DHsObMkUbDbsDBkMIkEaN)HNObMNPDk33MskHFNUSD3NMUsO)HNObMNPDk33MskHFNUSDU HFDkUD6MsTbFDcIQb MNDcsPNaIO6DsMD6Ms 3)EkUNPDbMk9NHbsMVDcsPNaIO6SDtsH UDsODbFNDMNakbIsOUFI3DkcsO6DIOP BIP kaURJ44eKDjkMIkEaNUDkMNDbMNkbNPDkUD3Ms3NMbINUDstDIOPIBIP kaUSDkOPDPIttNMNObDIOPIBIP kaUDFkBNDPIttNMNObDUNbUDstD3Ms3NMbINURJg=KDAFND6 kaDIUDbsD6Ms 3DIOPIBIP kaUDTIbFDUIcIakMDbMk9NHbsMINUDstD6MsTbF-DbF USDkaasTIO6DtsMDFNbNMs6NONIbVDTIbFIODbFND3s3 akbIsORDGsbFDBkMIkEaN)DkOPD3NMUsO)HN bMNPDk33MskHFNUD3MsBIPND OIM NDIOtsMckbIsODbFkbDckVDFNa3DIOD OPNMUbkOPIO6DbFND3MsHNUUNUDstD6MsTbFRJg=KDDdsaasTIO6DbFNDMNU abUDtMscDr Fk3bNMUDuDkOPD5SDbFIUDUb PVDTIaaDNQkcIONDbFNDasO6Ib PIOkaDkUUsHIkbIsODENbTNNODaIBIO6DIODkDU3NHItIHDONI6FEs MFssPDbV3NDkOPDGniD6MsTbFDkcsO6DkDOkbIsOkaaVD;gDDMN3MNUNObkbIBNDUkc3aNDstDrkOkPIkODHFIaPMNOD UIO6DEsbFDBkMIkEaN)DkOPD3NMUsO)HNObMNPDk33MskHFNUDbsDcsPNaIO6DasO6Ib PIOkaDPkbkRDW3NHItIHkaaVSDbFMNNDFV3sbFNUDTNMND QkcIONP8D4R AFNDkBNMk6NDGniDbMk9NHbsMVDkcsO6DHFIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDFI6FNMDMIU0DstDsENUIbVTIaaDENDFI6FNMD23kMkaaNaDE bDFI6FNMyDsMDIOHMNkUNDkbDk FI6FNMDMkbND2Uas3IO6DFI6FNMyDbFkODHFIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDa TNMDMIU0DstDsENUIbVRD2BkMIkEaN)HNObMNPDk33MskHFyDDgR r FIaPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDkbDFI6FNM MIU0DstDsENUIbVDTIaaDENDcsMNaI0NaVDbsDtsaasTDkDGniDbMk9NHbsMVDaNkPIO6DbsDsENUIbVDbFkODHF aPMNODaIBIO6DIODONI6FEs MFssPUDbFkbDkMNDasT MDMIU0DstDsENUIbVRD23NM sO)HNObMNPDk33MskHFyDuR AFNDasO6NMDHFIaPMNODUbkVDIODONI6FEs MFssPUDbFkbDkMNDkbDFI6FNM MIU0DstDsENUIbVSDbFNDUbMsO6NMDbFNDkUUsHIkbIsODTIbFDsENUIbVD2NR6RSDFI6FNMDkBNMk6NDGniDbMk9NHbsMVSDFI6FNMDsPPUDstDENasO6IO6DbsDkDbMk9NHbsMVDaNkPIO6DbsDsENUIbVyRD5.2 Methods 5.2.1 Sample AFND.kbIsOkaDwsO6Ib PIOkaDW MBNVDstDrFIaPMNODkOPD:s bFD2.wWr:yJgooKDTkU HsOP HbNPDEVDWbkbIUbIHUDrkOkPkDkOPDHsaaNHbNPDIOtsMckbIsODstDHFIaPMNODEIkOO kaaVDUbkMbIO6DIOD4,,5N,=RDrFIaPMNODtMscDEIMbFDbsDk6ND44DMNUIPIO6DIODbFND4oD3MsBIOHNUDstDrkOkPkDTNMNDNaI6IEaNDtsMD3kMbIHI3kbIsODkbDEkUNaIONRDlQHa PNPDTNMNDHFIaPMNODaIBIO6DsODMNUNMBNDsMDrMsTODakOPSDMNUIPNObUDstDIOUbIb bIsOUSDHFIaPMNODstDt aa)bIcNDcNcENMUDstDbFNDLMcNPDdsMHNUSDkOPDMNUIPNObUDstDU3NHItIHDMNcsbNDMN6IsOURDxNU3sOUNUDTNMND3MsBIPNPDEVDbFND3NMUsODcsUbD0OsTaNP6NkEaND2vnGyDkEs bDbFNDHFIaPSDbV3IHkaaVDbFNDcsbFNMRDAFNDUkc3aNDtMscDbFIUDUb PVDHsOUIUbNPDstDHFIaPMNODENbTNNODk6NUDgDkOPD5DkbDEkUNaIOND2O%5S;4eyDkOPDtsaasTNPDtsMD 3DbsDtIBNDTkBNUD2k6ND4o)4gyRDAFIUDk6NDMkO6NDTkUDcNkObDbsDHk3b MNDbFND3NMIsPDUbkMbIO6DtMscDbFNDNkMaVDUbk6NU stDTka0IO6DbsD3MN)kPsaNUHNOHNRDiDNQHa PNPDg4D;uDD2oR5zyDHFIaPMNODTFsDMN3sMbNPDMNM I IO6DkDTFNNaHFkIMDsMDHFkO6IO6UNQSaNkBIO6D5Se,–DNaI6IEaND3kMbIHI3kObURD5.2.2 Measures 5.2.2.1 Neighbourhood Type .NI6FEs MFssPDbV3NUSDsMDHakUUNUSDFkBNDENNODPNUHMIENPDIODbFND3MNBIs UDHFk3NMRDGM NtaVSD DakbNObDHakUUDkOkaVUIUDTkUD UNPDbsDIPNObItVDPIUbIOHbDbV3NUDstDONI6FEs MFssPUD UIO6D4;DIbNcUDPNUHMIEIO6DkbbMIE bNUDstDbFNDONI6FEs MFssPSDHNOU UDNO cNMkbIsODkMNkSDkOPDHscc OIbVRDLbbMIE bNUDIOHa PNPD3NMHNIBNPDONI6FEs MFssPDUktNbVSDUsHIkaDHsFNUIsOSDkH NUUDbsD3kM0UDkOPD3akVDU3kHNUSDPIUsMPNMSDbMkttIHSDkOPDkNUbFNbIHUSDaIBIO6DasHkbIsOSDkOPDckbNMIkaDkOPDUsHIkaDPN3MIBkbIsORLaaDkbbMIE bNUDFkBNDENNOD3MNBIs UaVDIPNObItINPDIODbFNDaIbNMkb MNDkUDENIO6DUUsHI bNPDTIbFDsENUIbVDsMDTNI6Fb)MNakbNPDENFkBIs MURDDd BNDONI6FEs MFssPDbV3NUDTNMNDIPNObItINPDkOPD UHMIENPDEkUNPDsOD OIM NDHscEIOkbIsOUDsMD3MstIaNUDstDONI6FEs MFssPDkbbMIE bNU8DFI6FDM Mka)FI6FDUktNbV-DasTDUktNbV)asTDHsFNUIsO-DasTDPIUsMPNM)FI6FDPN3MIBkbIsO-DFI6FDUktNbV)asTDPN3MIBkbIsO-DkOPDFI6FDHsFNUIsO)FI6 DPN3MIBkbIsOD2UNNDrFk3bNMD5yRD5.2.2.2 Body Mass Index GsPVDckUUDIOPNQD2GniySDPNtIONPDkUDTNI6FbDPIBIPNPDEVDFNI6FbDUM kMNPD206NcgySDTkUDHkaH akbNPDtMscD3kMNOb)MN3sM NPDFNI6FbDkOPDTNI6FbDtsMDkaaDHFIaPMNORD*NDNQHa PNPDEIsas6IHkaaVDIc3ak UIEaNDcNkU MNcNObUDstDFNI6FbSDTNI6FbSDkOPDGniDtsMDNkHFDHFIaP(UDk6NDkOPDUNQD25R=zDstDkaaDcNkU MNcNObUyDkUDPNbNMcIONPDEVDkDWbkbkDckHMsDPNBNas3NPDEVDbFND*sMaPDhNkabFDmM6kOIYkbIsOD2*hmyRJgouSgo5KDDr bDsttUDtsMDsBNMTNI6FbDkOPDsENUNDtsaasTNPDbFND*hmDMNHsccNOPkbIsOUDstS4DkOPDSgDUbkOPkMPDPNBIkbIsOSDMNU3NHbIBNaVRJ4ouKD;5DD5.2.2.3 Socioeconomic Measures iOPIBIP kaDUsHIsNHsOscIHDUbkb UDTkUDPNUHMIENPDEVDbFMNNDBkMIkEaNU8DIOHscNDkPNM kHVSDckbNMOkaDNP HkbIsOSDkOPD3kbNMOkaDNP HkbIsORDiOHscNDkPNM kHVDTkUDPNMIBNPDEVDWbkbIUbIHUDrkOkPkDkOPDHscEIONUDEsbFDFs UNFsaPDUIYNDkOPDFs UNFsaPDIOHscNDIObsDtIBNDHkbN6sMINUDstDIOHscNDkPNM kHV8DasTNUbSDasTNMDcIPPaNSDcIPPaNSD 33NMDcIPPaNSDkOPDFI6FNUbRDnkbNMOkaDkOPD3kbNMOkaDNP HkbIsODTNMNDHkbN6sMIYNPDIObsD5DHkbN6sMINUD2aNUUDbFkODFI6FDUHFssaSDFI6FDUHFssaD6MkP kbIsOSDENVsOPDFI6FDUHFssaSDkOPDHsaaN6NDsMD OIBNMUIbVDPN6MNNyRDLDtItbFDHkbN6sMVD2OsDtkbFNMNOsDcsbFNMyDTkUDkPPNPDbsDEsbFDNP HkbIsODBkMIkEaNUDbsDIOPIHkbNDItDbFNDHFIaPDPIPDOsbDFkBNDkDtkbFNMDsMDcsbFNMDtI6 MNDkOPDbsDkBsIPDcIUUIO6DPkbkRDGsbFD3kMNObkaDNP HkbIsODBkMIkEaNUDTNMNDbMNkbNPDkUDOscIOkaDPkbkRD5.2.3 Analysis LUDcsUbDONI6FEs MFssPDcNkU MNUDTNMNDsOaVDkBkIakEaNDkbDEkUNaIONSDTNDHs aPDOsbDkUUNUUDHFkO6NUDIODNQ3sU MNDItD3kMbIHI3kObUDcsBNPDMNUIPNOHNURDLOkaVUIUDTkUDMNUbMIHbNPDbsD3kMbIHI3kObUDTIbFDkbDaNkUbDbTsDcNkU MNUDstDGniD2O%uSe,;yRDAFNDMNM IMNcNObDstDbTsDcNkU MNcNObUDstDGniDIOUbNkPDstDbFMNNDTkUD UNPDIODbFIUDUb PVDbsDMNP HNDbFNDO cENMDstDcIUUIO6DBka URDvkMbIHI3kObUDT bFDtNTNMDbFkODbTsDGniDcNkU MNcNObUDTNMNDcsMNDaI0NaVDbsDFkBNDasTNMDIOHscNDkPNM kHVSD3kMNObUDTIbFDasTNMDNP HkbIsOSDcsBNPDMNUIPNOHNUSDkOPDaIBNPDTIbFIODcsMND N3MIBNPDO I6FEs MFssPURDAsDkUUNUUDTFNbFNMDaIBIO6DTIbFIODHNMbkIODONI6FEs MFssPUDTkUDkUUsHIkbNPDTIbFDkDFI6FNMDkBNMk6NDGniDbMk9NHbsMVDMNakbIBNDbsDHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUD2FV3sbFNUIUD4ySDkBkMI EaN)H ObMNPDkOkaVUIUDstDHFkO6NDIODGniDTkUDNUbIckbNP  UIO6DkDc abIaNBNaDcsPNaDTIbFDcNkU MNcNObDsHHkUIsODONUbNPDTIbFIODNkHFDHFIaPRDdIQNPDbNMcUDIOHa PNPDIODbFNDcsPNaDTNMNDkODIObNMHN3bD2GniDkbDbIcNDoySDk6ND2Uas3NDbNMcDstDbFNDGniDbMk9NHbsMVySDk6NDUM kMNPD2M kPMkbIHDbNMcDstDbFNDGniDbMk9NHbsMVySDP ccVDHsPIO6UDstDbFNDONI6FEs MFssPDHakUUNUDTIbFDbFNDFI6FDUktNbVSDasTDPN3MIBkbIsODHakUUDkUDbFNDMNtNMNOHNSDkDBk IkEa DIOPIHkbIO6DTFNbFNMDbFND3kMbIHI3kObDHFkO6NPD;=DDMNUIPNOHNDP MIO6DbFNDtIMUbDuDTkBNUSDkOPDkaa Hs kMIkbNUD2UNQSDWlWDcNkU MNUyRDxkOPscDbNMcUDIOHa PNPDIODbFNDcsPNaDTNMNDkODIObNMHN3bD2MN3MNUNObIO6DbFNDBkMIkEIaIbVDstDbFNDIObNMHN3bDbNMcyDkOPDk6ND2MN3MNUNObIO6DbFNDBkMIkEIaIVDstDbFNDU s3NDbNMcyRDL6NDHNObMNPDkb bTsDTkUD UNPDkUDbFNDcNkU MNDstDbIcNRDAs kUUNUUDTFNbFNMDGniDbMk9NHbsMINUDIOHMNkUNPDkbDkDFI6FNMDMkbNDIODHNMbkIODONI6FEs M ssPUDMNakbIBNDbsDHFIaPMNODaIBIO6DIODFI6F UktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUSDHsUU)aNBNaDIObNMkHbIsOUDENbTNNODONI6FEs MFssPDbV3NDkOPDk6NDTNMNDkPPNPDbsDbFNDcsPNaDbsDNQkcIONDbFNDBkMIkEIaIbVDstDbFNDUas3NDbNMcDkHMsUUDONI6FEs MFssPDbV3NURDAsDkUNUUDTFNbFNMDaIBIO6DTIbFIODHNMbkIODONI6FEs MFssPUDTNMNDkbDFI6FNMDMIU0DstDENasO6IO6DbsDkDGniDbMk9NHbsMVDaNkPIO6DbsDsENUIbVDMNakbIBNDbsDHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTD N3MIBkbIs DONI6FEs MFssPUD2FV3sbFNUIUDgySD6Ms 3)EkUNPDbMk9NHbsMVDcsPNaIO6D21GAnyDTkUDHsOP HbNPDbsDcsPNaDPIUbIOHbDbMk9NHbsMINUDstDGniRDAMk9NHbsMINUDTNMNDcsPNaNPD UIO6DkDHNOUsMNPDOsMckaDPIUbMIE bIsORDL6NDHNObMNPDkbDbTsDTkUD UNPDkUDbFNDcNkU MNDst bIcNRDAFNDUkcNDHsBkMIkbNUDkUDbFNDc abIaNBNaDcsPNaDTNMNDIOHa PNPDIODNUbIckbIO6DbFNDbMk9NHbsMINURDAFNDs3bIckaDO cEN DstDbMk9NHbsMINUDTkUDPNbNMcIONPD UIO6DbFNDUkcNDHMIbNMIkDkUDPNUHMIENPDIODrFk3bNMDuRDn abIOscIkaDMN6MNUUIsODkOkaVUIUDTkUDHsOP HbNPD UIO6DNkHFD PIBIP ka(UDcsUbDaI0NaVDbMk9NHbsMVDHakUUDkUDbFNDPN3NOPNObDBkMIkEaNRDDAsDkUUNUUDbFNDIc3kHbDstDUbkVIO6 IODkDONI6FEs MFssPDsBNMDbIcND2FV3sbFNUIUDuySDbFNDc abIaNBNaDkOkaVUIUDTk DHsOP HbNPDsODbFMNNDUN3kMkbNDUNbUDstD3kMbIHI3kObU8DbFNDt aaDUkc3aNSDkDU EUNbDstDbFNDUkc3aNDbFkbDPIPDOsbDHFkO6NDMNUIPNOHNDtsMDuDTkBNUD25DVNkMUySDkOPDkDU EUNbDstDbFNDUkc3aNDbFkbDPIPDOsbDHFkO6NDMNUIPNOHNDtsMD=DTkBNUD2;DVNkMUyRDGsbFDc abIaNBNaDcsPNaIO6DkOPD1GAnDkUU cNDbFkbDkOVDcIUUIO6DGniDIUDcIUUIO6DkbDMkOPscRDAFNMNtsMNSDkaaDkBkIakEaNDPkbkDTNMND UNPDtsMDbFNDkOkaVUIURDLaaDkOkaVUNUDTNMNDTNI6FbNPD;–DD UIO6DasO6Ib PIOkaDTNI6FbUSDPNMIBNPDEVDWbkbIUbIHU rkOkPkRD*NI6FbUDTNMNDUbkOPkMPIYNPDEVDPIBIPIO6DNkHFDTNI6FbDEVDbFNDkBNMk6NDstDkaaDTNI6FbUD3MIsMDbsDTNI6FbIO6RD5.3 Results Wkc3aNDHFkMkHbNMIUbIHUDkMNDPIU3akVNPDIODAkEaND4oRDLcsO6Ukc3aNSD=;RuzDMNckIONPDIODbFNDUkcNDMNUIPNOHNDtsMDuDTkBNUDstDbFNDU MBNVDkOPD5–RezDMNckIONPDtsM =DTkBNURDAFsUNDbFkbDHFkO6NPDMNUIPNOHNUDTNMNDcsMNDaI0NaVDbsDFkBND sTNMDIOHscNDkPNM kHVDkOPD3k NObUDTIbFDaNUUDNP HkbIsODkOPDaNUUDaI0NaVDbsDaIBNDTIbFIODkDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPRDDD D;e DDTable 10: Sample characteristics (%)* D vNMHNObk6NUD2O%ue,;yDL6ND DDDDDg uuRuDDDDDu uuRuDDDDD5 uuR=DWNQD DDDDDnkaND =oR5DDDDDdNckaND 5,R–DGkUNaIONDTNI6FbDUbkb UD DDDDD.sMckaD =uRuDDDDDmBNMTNI6FbD goR=DDDDDmENUND g–RgDiOHscNDkPNM kHVD DDDDDwsTNUbD gR=DDDDDwsTNMDcIPPaND 45R,DDDDDnIPPaND uoR,DDDDDC33NMDcIPPaND ueRoDDDDDhI6FNUbD 45ReDnkbNMOkaDNP HkbIsOD DDDDD.s csbFNMD oR;DDDDDwNUUDbFkODFI6FDUHFssaD 4gR;DDDDDhI6FDUHFssaD6MkP kbND 4,RgDDDDDrsaaN6NNbMkPNDUHFssa geRuDDDDDCOIBNMUIbVDPN6MNND 5oRoDvkbNMOkaDNP HkbIsOD DDDDD.s tkbFNMD 4uR,DDDDDwNUUDbFkODFI6FDUHFssaD 44R,DDDDDhI6FDUHFssaD6MkP kbND 4–R;DDDDDrsaaN6NNbMkPNDUHFssa goR4DDDDDCOIBNMUIbVDPN6MNND ueRuD.NI6FEs MFssPDHakUUD DDDDDhI6FDM Mka)FI6FDUktNbVD g=ReDDDDDwsTDUktNbV)asTDHsFNUIsOD =R,DDDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD 44RoDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD u;RgDDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD 4,RuDULaaD3NMHNObk6NUDkMNDTNI6FbNPD UIO6DUkc3aNDTNI6FbUDD D;; DDAkEaND44DPIU3akVUDbFNDMNU abUDstDbFNDc abIaNBNaDcsPNaDstDGniRDrFIaPMNODaIBIO6DIODFI6FM Mka)FI6FDUktNbVDONI6FEs MFssPUDFkPDkDUI6OItIHkObaVDFI6FNMDGniDbMk9NHbsMVDbFkODHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUD2MNtNMNOHNDHkbN6sMVyRD.sD bFNMDONI6FEs MFssPDHakUUDFkPDkDUI6OItIHkObaVDPIttNMNObDGniDbMk9NHbsMVDbFkODbFNDMNtNNOHNDO I6FEs M ssPRDrMsUU)aNBNaDIObNMkHbIsOUDENbTNNODONI6FEs MFssPDbV3NDkOPDk6NDTNMNDkPPNPDbsDbFNDcsPNaUDbsDbNUbDtsMDUI6OItIHkObDBkMIkOHNDstDbFNDUas3NDHsNttIHINObDtsMDNkHFDONI6FEs MFssP-DFsTNBNMSDOsONDstDbFN IOb MkHbIsOUDTNMNDUI6OItIHkObDkOPDbFNMNtsMNSDOsbDIOHa PNPDIODbFNDtIOkaDcsPNaRDDTable 11: Results from the multilevel analysis of change in BMI* D rsNttIHINObD WbkOPkMPDNMMsM3)Bka NDFull sample D D DrsOUbkObD 4–R==4D oR4=gD XoRoo4DL6ND )oRgegD oRo=5D XoRoo4DL6NgD oRo=uD oRoo=D XoRoo4D.NI6FEs MFssPDHakUUD D D DDDDDhI6FDM Mka)FI6FDUktNbVD oRu5oD oRo,uD XoRoo4DDDDDwsTDUktNbV)asTDHsFNUIsOD oRu5–D oR4,uD oRoegDDDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD oRo,gD oR4ueD oR=ouDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD xNtNMNOHND D DDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD oRoegD oR44uD oR=ggDUrsBkMIkbNUDIOHa PNPDIODbFNDcsPNaDE bDOsbDUFsTODkMNDUNQSDIOHscNDkPNM kHVSDckbNMOkaDNP HkbIsOSD3kbNMOkaDNP HkbIsOSDkOPDPIHFsbscs UDIOPIHkbsMDItDbFND3kMbIHI3kObDcsBNPDP MIO6DbFNDtIMUbDuDTkBNUDDD D;, DDxNU abUDtMscDbFND6Ms 3)EkUNPDbMk9NHbsMVDcsPNaIO6DIOPIHkbNPDbFkbDbFNDbFMNNDHakUUDUsa bIsODTkUDbFNDENUbDtIbbIO6DcsPNaDtsMDNkHFDU EUNbRDdI6 MND–DPIU3akVUDbFND6Mk3FDstDbFNDGniDbMk9NHbsMINUDts OPDIODbFIUDUkc3aNRDGkUNPDsODbFNDakENaIO6DIODrFk3bNMDuSDbFNDbFMNNDbMk9NHbsMINUDHkODENDHsOUIPNMNPDkUDasTD2e,R4zySDPNHMNkUIO6D2eR=zySDkOPDIOHMNkUIO6D24uR5zyRDFigure 6: BMI trajectories from age 2 to 12. Dotted lines represent WHO cut-offs for overweight and obese (averaged between sex). DDDD D,o DDAkEaND4gDPIU3akVUDbFND3NMHNObk6NDstD3kMbIHI3kObUDTIbFIODNkHFDONI6FEs MFssPDHakUUDbFkbDtkaaUDTIbFIODNkHFDGniDbMk9NHbsMVRD*IbFIODNkHFDONI6FEs MFssPDbV3NSDbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDFkBNDbFNDFI6FNUbD3NMHNObk6NDstDHFIaPMNODIODbFNDasTDbMk9NHbsMVDkOPDbFNDasTNUbD3NMHNObk6NDIODbFNDIOHMNkUIO6DbMk9NHbsMVRDDDTable 12: Percentage of participants within each neighbourhood and BMI trajectory* D Low Decreasing Increasing Total Full sample D D D D.NI6FEs MFssPDHakUUD D D D DDDDDhI6FDM Mka)FI6FDUktNbVD euR,D ,R4D 4eRoD g=ReDDDDDwsTDUktNbV)asTDHsFNUIsOD –uR;D 4eR5D 4;R;D =R,DDDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD ;5ReD eR,D eR5D 44RoDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD ;–R5D eR–D –R4D u;RgDDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD euRgD 4R,D g5R,D 4,RuDAsbkaD e,R4D eR=D 4uR5D DULaaD3NMHNObk6NUDkMNDTNI6FbNPD UIO6DUkc3aNDTNI6FbUDD D,4 DDAFNDMNU abUDstDbFNDc abIOscIkaDMN6MNUUIsODkMNDPIU3akVNPDIODAkEaND4uRrFIaPMNODaIBIO6DIODFI6FDM Mka)FI6FDUktNbVSDFI6FDHsFNUIsO)FI6FDPN3MIBkbIsOSDsMDasTDUktNbV)asTDHsFNUIsODONI6FEs MFssPUDTNMNDUI6OItIHkObaVDcsMNDaI0NaVDbsDENDIODbFNDIOHMNkUIO6DbMk9NHbsMVDbFkOD3kMbIHI3kObUDaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDHsc3kMNPDbsDbFNDasTDGniDbMk9NHbsMVRDrFIaPMNODaIBIO6DIODasTDUktNbV)asTDHsFNUIsODONI6FEs MFssPUDTNMNDcsMNDaI0NaVDbsDENDIODbFNDPNHMNkUIO6DbMk9NHbsMVDTFIaNDHFIaPMNODaIBIO6DIODbFNDFI6FDHsFNUIsO)FI6F PN3MIBkbIsO ONI6FE  MFssPUDTNMND3MsbNHbIBNDk6kIOUbDENIO6DIODbFNDPNHMNkUIO6DbMk9NHbsMVRDTable 13: Odds ratio for the multinomial regression predicting trajectory membership (low trajectory group is the reference)* D mPPUDMkbIsDfNHMNkUIO6DbMk9NHbsMVD D.NI6FEs MFssPDHakUUD DDDDDhI6FDM Mka)FI6FDUktNbVD 4Rg, D2oR;4)gRo=yDDDDDwsTDUktNbV)asTDHsFNUIsOD 2.86 (1.22-6.68) DDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsODoR,–D2oR=5)4RegyDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD xNtNMNOHNDDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD0.24 (0.12-0.47) D DiOHMNkUIO6DbMk9NHbsMVD D.NI6FEs MFssPDHakUUD DDDDDhI6FDM Mka)FI6FDUktNbVD 2.86 (1.99-4.13) DDDDwsTDUktNbV)asTDHsFNUIsOD 3.22 (1.58-6.54) DDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD4RoeD2oR–4)4R;; yDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD xNtNMNOHNDDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD4.40 (2.82-6.87) UDrsBkMIkbNUDIOHa PNPDIODbFNDcsPNaDE bDOsbDUFsTODkMNDUNQSDIOHscNDkPNM kHVSDckbNMOkaDNP HkbIsOSD3kbNMOkaDNP HkbIsOSDkOPDPIHFsbscs UDIOPIHkbsMDItDbFND3kMbIHI3kObDcsBNPDP MIO6DbFNDtIMUbDuDTkBNUDDGsaPDIOPIHkbNUDUI6OItIHkOHNDkbD3XoRo=RDDD D,g DDAkEaND45DPIU3akVUDbFNDMNU abUDstDbFNDc abIaNBNaDMN6MNUUIsODkOkaVUIUDsODbFNDU EUNbDstDbFNDUkc3aNDbFkbDPIPDOsbDcsBNDtsMDu)DkOPD=)DTkBNURDWIcIakMDbsDbFNDMNU abUDtMscDbFNDt aaDUkc3aNSDsOaVDHFIaPMNODaIBIO6DIODFI6FDM Mka)FI6FDUktNbVDONI6FEs MFssPUDFkPDUI6OItIHkObaVDFI6FNMDGniDbMk9NHbsMINUDbFkODHFIaPMNODaIBIO6DIODbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPURDAFNDPIttNMNOHNDIODGniDENbTNNODHFIaPMNODaIBIO6DIODbFNDFI6FDM Mka)F 6F UktNbVDONI6FEs FssPDkOPDbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPDIOHMNcNObkaaVDIOHMNkUNPDkUDkOkaVUIUDTkUDMNUbMIHbNPDbsDHFIaPMNODbFkbDPIPDOsbDcsBNDtsMDu) kOPD=) TkBNURDDTable 14: Results from the multilevel analysis of change in BMI for each subset* D rsNttIHINObD WbkOPkMPDNMMsM3)Bka NDDid not move for 3 waves D D DrsOUbkObD 4–R555D oR4e–D XoRoo4DL6ND )oRg4=D oRo=;D XoRoo4DL6NgD oRo5,D oRoo=D XoRoo4D.NI6FEs MFssPDHakUUD D D DDDDDhI6FDM Mka)FI6FDUktNbVD oRu–,D oR44–D oRoogDDDDDwsTDUktNbV)asTDHsFNUIsOD oR5;eD oRu4=D oR4ggDDDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD oRg5eD oR4;eD oR4;;DDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD xNtNMNOHND D DDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD )oR45oD oR45uD oRuuoDD D D DDid not move for 5 waves D D DrsOUbkObD 4–R54uD oR4,=D XoRoo4DL6ND )oRgg=D oRo–=D oRoo4DL6NgD oRo=oD oRoo–D XoRoo4D.NI6FEs MFssPDHakUUD D D DDDDDhI6FDM Mka)FI6FDUktNbVD oR5uoD oR4g=D oRoo4DDDDDwsTDUktNbV)asTDHsFNUIsOD oRuo=D oRu=uD oRu;;DDDDDwsTDPIUsMPNM)FI6FDPN3MIBkbIsOD oRoueD oRguoD oR;euDDDDDhI6FDUktNbV)asTDPN3MIBkbIsOD xNtNMNOHND D DDDDDhI6FDHsFNUIsO)FI6FDPN3MIBkbIsOD )oR4–,D oR4–oD oRg,uDUrsBkMIkbNUDIOHa PNPDIODbFNDcsPNaDE bDOsbDUFsTODkMNDUNQSDIOHscNDkPNM kHVSDckbNMOkaDNP HkbIsOSDkOPD3kbNMOkaDNP HkbIsODD D,u DD5.4 Discussion CUIO6DkDBkMIkEaN)HNObMNPDk33MskHFSDbFIUDUb PVDNQkcIONPDTFNbFNMDbFNDkBNMk6NDGniDbMk9NHbsMVDstDHFIaPMNODaIBIO6DIODPIUbIOHbDONI6FEs MFssPDbV3NUDPIttNMNPDkOPDTFNbFNMDbFIUDPIttNMNOHNDIOHMNkUPDsBNMDbIcNRDAFNDBkMIkEaN)HNObMNPDk33MskHFDIOPIHkbNPDbFkbDHFIaPMNODaIBIO6DIODFI6FDM Mka)FI6FDUktNbVDONI6FEs MFssPUSDsODkBNMk6NSDFkPDkDFI6FNMDGniDbMk9NHbsMVDbFkODHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPURDrM U)aNBNaDIObNMkHbIsOUDENbTNNODONI6FEs MFssPDbV3NDkOPDk6NDTNMNDOsbDUI6OItIHkObDIOPIHkbIO6DbFkbDGniDbMk9NHbsMINUDPIPDOsbDIOHMNkUNDkbDkDFI6FNMDMkbNDsBNMDbIcNDHsc3kMNPDTIbFDbFNDGniDbMk9NHbsMVDstDHFIaPMNODaIBIO6DIODFI6FDUktNbV)asT PN3MIBkbIsODONI6FEs MFssPURDAFND3NMUsO)HN bMNPDk33MskHFDts OPDbFkbD6MsTbFDHs aPDENDPNUHMIENPDEVDbFMNNDGniDbMk9NHbsMINUDTIbFIODbFIUDHsFsMbRDAFNUNDbMk9NHbsMINUDUFkMNPDUIcIakMD3kbbNMOUDbsDbFNDbMk9NHbsMINUDts OPDIODr Fk3bNMDuDTIbFDbFNDNQHN3bIsODbFkbDbFNDIOHMNkUIO6DbMk9NHbsMVDstDbFNDt aaDUkc3aNDaI0NaVDMN3MNUNObNPDkDHscEIOkbIsODstDbFNDcNPI cDkOPDFI6FDbMk9NHbsMVRDAFNDtIOPIO6UDtMscDbFND3NMUsO)HNObMNPDk33MskHFDIOPIHkbNPDbFkbDHFIaPMNODaIBIO6DTIbFIODbFNDFI6FDM Mka)FI6F UktNbVSDasTDUktNbV)asTDHsFNUIsOSDkOPDFI6FDHsFNUIsO)FI6FDPN3MIBkbIsODONI6FEs MFssPUDTNMNDkbDFI6FNMDMIU0DstDENasO6IO6DkDGniDbMk9NHbsMVDaNkPIO6DbsDsENUIbVDkbDkDakbNMDk6NDbFkODHFIaPMNODaIBIO6DIODbFNDFI6FDUktNbV)asT PN3MIB bIsODONI6FEs MFssPURDAFNMNDTkUDOsDHaNkMDNBIPNOHNDbFkbDMNckIOIO6DIODkDONI6FEs MFssPDbV3NDsBNMDbIc DON6kbIBNaVDkttNHbNPDHFIaPMNO(UDGniDbMk9NHbsMVRDLDakM6NMDPIttNMNOHNDTkUDts OPDENbTNNODHFIaPMNODaIBIO6DIODbFNDFI6FDM Mka)FI6FDUktNbVDkOPDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDTFNODHsc3kMIO6DbFNDt aaDUkc3aNDU EUNbDTIbFD=) kBNDOsO)csBNMDU EUNb-DFsTNBNMSDbFIUDPIttNMNOHNDTkUDUckaaD2oRo;D06NcgyDkOPDaI0NaVDOsbDHaIOIHkaaVDMNaNBkObRDAFNDtIOPIO6UDU 66NUbDbFkbDbMk9NHbsMINUDckVDENDUNbDNkMaVDIODaItNDkOPDkMNDOsbDcsPItINPDEVDHsOUbkObDNQ3sU MNDbsDbFNDUkcNDONI6FEs MFssPDNOBIMsOcNObRDlIbFNMDbFND,5 DD3MsasO6NPDONI6FEs MFssPDNQ3sU MNDPsNUDOsbDMNU abDIODkODIOHMNkUIO6aVDPNbMIcNObkaDNttNHbD2IRNRSDOsDNBIPNOHNDstDkDP UN)MNU3sOUNDNttNHbyDsMDIOPIBIP kaUDkPk3bDbsDbFNIMDNOBIMsOcNObDON6kbIO6Dt MbFNMDNUHkakbIsOUDIODbFNIMDGniDbMk9NHbsMVRDnsMNDMNUNkMHFDIUDONNPNPDbsDNQkcIONDFsTDHFkO6IO6DONI6FEs MFssPDNOBIMsOcNObUSDNIbFNMDbFMs 6FDcsEIaIbVDsMDbFMs 6FDHFkO6NUDbsDbFNIMDH MMNObDNOBIMsOcNObSDkttNHbDGniDbMk9NHbsMINURDAFNDPIttNMNOHNDENbTNNODbFNDkBNMk6NDGniDbMk9NHbsMVDstDHFIaPMNODaIBIO6DTIbFIODbFNDFI6FDM Mka)FI6FDUktNbVDkOPDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDNQIUbNPDkbDEkUNaIONDkOPDTNMNDckIObkIONPDU 66NUbIO6DbFkbDNkMaVDaItNDtkHbsMUDHsObMIE bNPDbsDbFNDPIttNMNOHNRDmO D0NVDPIttNMNOH DENbTNNODbFNUNDbTsDONI6FEs MFssPDbV3NUDIUDbFkbDbFNDFI6FDM Mka)FI6 DUktNbVDONI6FEs MFssPUDkMND3MNPscIOkObaVDM MkaDkOPDbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPUDkMND3MNPscIOkObaVD MEkORDibDIUD OHaNkMDtMscDbFIUDUb PVDTFkbDNkMaVDaItNtkHbsMUDckVDF BNDHsObMIE bNPDbsDPIttNMNOHNUDIODGniDbMk9NHbsMV-DFsTNBNMSDUb PINUDFkBNDts OPDPIttNMNOHNUDIODMkbNUDstDsENUIbVSJgu–Sg=5KDPINbSJg=oKDkOPDckbNMOkaDUcs0IO6Jg==KDkcsO6DM MkaDkOPD MEkODMNUIPNObURDnkbNMOkaDTNI6FbDUbkb USDPINbSDkOPDUcs0IO6DP MIO6D3MN6OkOHVDFkBNDENNODts OPDbsDENDMNakbNPDbsDHFIaPD6MsTbFDkOPDFNkabFDENFkBIs MUDIODakbNMDaItNRJg4gSg=–Sg=eKDiODkOsbFNMDUb PVDstDGniDbMk9NHbsMINUSDrkMbNMDNbDkaRDts OPDbFkbDckbNMOkaDsENUIbVSDckbNMOkaDUcs0IO6SDkOPDIOtkObDsBNMNkbIO6DTNMNDkUUsHIkbNPDTIbFDkDHsOUIUbNObaVDFI6FDGniDbMk9NHbsMVRJ4uuKDAFNMNDkMNDUNBNMkaaIcIbkbIsOUDbsDbFIUDUb PVRDdIMUbSDTNDsOaVDFkPDIOtsMckbIsODkEs bD3kMbIHI3kObU(D NI6FEs MFssPUDkbDEkUNaIONRDAFNMNtsMNSDTNDHs aPDOsbDkUUNUUDbFNDIc3kHbDbFkbDHFkO6IO6DONI6FEs MFssPUDtM cDsONDHakUUDbsDkOsbFNMDF PDsODGniDbMk9NHbsMVRDi DTkUDkaUsDkUU cNPDbFkbDbFNDEkUNaIONDONI6FEs MFssPDHakUUDMNckIONPDbFNDUkcNDbFMs 6Fs bDbFNDUb PVD3NMIsPRDiODtkHbSDONI6FEs MFssPDbV3NUDHs aPDFkBNDHFkO6NPDsBNMDbIcNDbsDENDcsMNDsMDaNUUDU 33sMbIBNDstDTNI6FbDMNakbNPDENFkBIs MURDWNHsOPSDbFNDHFIaPMNO(UDGni UTNMND3kMNOb) 3sMbNPRDLDUb PVDstDrkOkPIkOD,= DDOkbIsOkaDPkbkDts OPDbFkbDGniDTkUDsBNMNUbIckbNPDTFNOD3kMNOb)MN3sMbNPDkOPDbFkbDbFIUDEIkUDPIttNMNPDEVDbFNDk6NDkOPDUNQDstDbFNDHFIaPRJ,–KDhsTNBNMSDkUDbFNDckIODs bHscNDstDbFNDUb PVDTkUDHFkO6NDIODGniSDIbDIUDOsbDHaNkMDFsTD3kMNOb)MN3sMbNPDGniDsBNMDbIcNDIOta NOHNPDbFNDMNU abURDA IMPSDPIBIPIO6DbFNDUkc3aNDEVDONI6FEs MFssPDHakUUDkOPDGniDbMk9NHbsMVDHMNkbNPDUscNDUckaaDHNaaDUIYNUDaI0NaVDaNkPIO6DbsDbFNDakM6NDUbkOPkMPDNMMsMUDkOPDHsOtIPNOHNDIObNMBkaUDstDbFNDMNU abURDLDFI6FNMDUkc3aNDUIYNDckVDFkBNDbFND3sTNMDbsDPNbNHbDc MNDUI6OItIHkObDMNU abUDENbTNNODONI6FEs MFssPDHakUUDkOPDGniDbMk9NHbsMVRDwkUbaVSDMNU abUDtMscDbFNDc abIaNBNaDcsPNaDIOPIHkbNDbFkbDbFNDPIttNMNOHNDENbTNNODbFNDFI6FDUktNbV)asTDPN3MIBkbIsODkOPDFI6FDM Mka)FI6FDUktNbVDGniDbMk9NHbsMVDsHH MMNPD3MIsMDbsDbFNDUbkMbDstDbFNDUb PV-DbFNMNtsMNSDTNDHkOOsbDM aNDs bDUNat)UNaNHbIsODEIkUDkUDkD3sUUIEaNDNQ3akOkbIsORDWb PINUDF BNDts OPDbFkbDHFssUIO6DbsDaIBNDIODcsMNDTka0kEaNDONI6FEs MFssPUDTkUDMNakbNPDbsDasTNMDGniRJg=;KDLDUbMNO6bFDstDbFIUDUb PVDTkUDbFND UN stDEsbFDBkMIkEaN)DkOPD3NMUsO)HNObMNPDk33MskHFNUDbsDcsPNaIO6DasO6Ib PIOkaDPkbkRDAFNDBkMIkEaN)HNObMNPDk33MskHFDkaasTNPD UDbsDkUUNUUDPIttNMNOHNUDENbTNNODbFNDkBNMk6ND6MsTbFDstDNkHFDONI6FEs MFssPDHakUUDkOPDbFND3NMUsO)H ObM PDk33MskHFDkaasTNPD UDbsDIPNObItVDPIttNMNOHNUDkcsO6DbFNDGniDbMk9NHbsMI URDLUDNkHFDIOPIBIP kaDkOkaVUIUDFkUDHNMbkIODaIcIbkbIsOUDkOPDkUU c3bIsOUSDHsOtIMckbIsODstDMNU abUD UIO6DbTsD OIM NDE bDHsc3aNcNObkMVDUbkbIUbIHkaDk33MskHFNUDaNOPDHMNPIEIaIbVDbsDbFNDMNU abURDD iODHsOHa UIsOSDONI6FEs MFssPDHakUUDTkUDasO6Ib PIOkaaVDkUUsHIkbNPDTIbFDGniDbMk9NHbsMVDU HFDbFkbDHFIaPMNODaIBIO6DIODbFNDFI6FDM Mka)FI6FDUktNbVDONI6FEs MFssPUDFkPDkDFI6FNMDGniDbMk9NHbsMVDbFkODHFIaPMNODaIBIO6DIODbFNDFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPURDiODkPPIbIsOSDHFIaPMNODaIBIO6DIODFI6FDM Mka)FI6FDUktNbVDkOPDasTDUktNbV)asTDHsFNUIsODONI6FEs MFssPUDTNMNDcsMNDaI0NaVDbsDENasO6DbsDkDGniDbMk9NHbsMVDaNkPIO6DbsDsENUIbVDbFkODHFIaPMNODaIBIO6DIODFI6FDUktNbV)asTDPN3MIBkbIsODONI6FEs MFssPURDDGniDbMk9NHbsMINUDTNMNDOsbDkttNHbNPDEVDbIcND2IRNRSDUas3NDstDGniDbMk9NHbsMINUDPIPDOsb IOHMNkUNDkbDkDtkUbNMDMkbNDsBNMDbIcNyDsMDNQ3sU MNDP MkbIsORDAFND NU abUDIc3aVD,– DDbFkbDHFIaPMNODkMNDUNbDsODbFNIMDbMk9NHbsMINUDIODNkMaVDaItNDkOPDHsObIO NPDNQ3sU MNDbsDbFNIMDONI6FEs MFssPDNOBIMsOcNObDPsNUDOsbDkttNHbDbFNIMDakbNMDGniDbMk9NHbsMVRDibDIUD OHaNkMDtMsc FIUDUb PVDTFNbFNMDHFkO6IO6DONI6FEs MFssPDbV3NDEVDHFkO6IO6DMNUIPNOHNDkttNHbUDGniDbMk9NHbsMVRDd b MNDUb PINUDUFs aPDNQkcIONDbFNDNttNHbDstDMNUIPNObIkaDcsEIaIbVDsODFNkabFDENFkBIs MUDkOPDFNkabFDs bHscNURDDDDD D,e DDChapter 6: Discussion 6.1 Summary of Findings, Study Contributions, and Implications AFIUDPIUUNMbkbIsODHsc3MIUNUDkDUNMI UDstDUb PINUDNQkcIOIO6DbFNDPNBNas3cNObkaDbMk9NHbsMINUDstDGniDIODHFIaPMNODkOPDbFNDMNakbIsOUFI3DENbTNNODHFIaPFssPDGniDkOPDbFNDONI6FEs MFssPDNOBIMsOcNObRDAFNDtIMUbDUb PVDtsaasTNPDkDaItNDHs MUND33MskHFDbsD OPNMUbkOPIO6DbFNDPNBNas3cNObkaDbMk9NHbsMINUDstDGniDbFkbDNQIUbDkcsO6DrkOkPIkODHFIaPMNODkUDbFNVDk6NDIObsDkP abFssPRDAFNDUNHsOPDUb PVDk33aINPDkDUsHIka)NHsas6IHkaD3NMU3NHbIBNDIODkUUNUUIO6DbFNDcNPIkbIO6DMsaNDstD3FVUIHkaDkHbIBIbVDkOPDUNPNObkMVDENFkBIs MDsODbFNDMNakbIsOUFI3DENbTNNODONI6FEs MFssPDNOBIMsOcNObDkOPDsENUIbVRDrscEIOIO6DbFNDMNU abUDtMscDbFNDtIMUbDbTsDUb PINUSDbFNDbFIMPDUb PVDNQkcIONPDbFNDasO6Ib PIOkaDkUUsHIkbIsODENbTNNODONI6FEs MFssPDNOBIMsOcNObDkOPDGniDbMk9NHbsMVRiODbFNDtIMUbDUb PVD2r Fk3bNM uySDiDNQ3asMNPDbFNDFNbNMs6NONIbVDstDPNBNas3cNObDEVDIPNObItVIO6DkOPDBkaIPkbIO6DbFNDPIUbIOHbDbMk9NHbsMINUDstDGniDbFkbDNQIUbDkcsO6DHFIaPMNODkUDbFNVDk6NDIObsDkP abFssPRDCUIO6DPkbkDtMscDkDOkbIsOkaaVDMN3MNUNObkbIBNDasO6Ib PIOkaDU MBNVDstDHFIaPMNOSDiDts PDts MD OIM 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OIbVDPNUI6ODkOPD3FVUIHkaDkHbIBIbVDIODHFIaPMNORDLcDIDvMNBDnNPDgo4u-5=8u;–F,gRDDD D4u=DDAppendices Appendix A    Figure 1: Direct comparisons between similar male patterns of BMI trajectories from the NLSCY and the NPHS. Dotted lines represent WHO cut offs for overweight and obese.  kyD D DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDEyDDDDDDDDHyD D D D D D DDDDDDDDPyDD D4u–DDFigure 2: Direct comparisons between similar female patterns of BMI trajectories from the NLSCY and the NPHS. Dotted lines represent WHO cut offs for overweight and obese.  DkyD D D D D D DDDDDDDDEyDDDDDDDDHyD D D D D D DDDDDDDDPyDD

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