LAUSR

Healthy People 2030 estimates that 3 out of 4 children (ages 6-13) do not meet guidelines for aerobic physical activity, an important contributor to cardiovascular health. Determinants of physical activity (PA) occur at individual, household, and neighborhood levels yet little is known about how geospatial risk factors (neighborhood segregation and income inequity) interact with parental influences on child PA. The current study explored the association between index of concentration of extremes (ICE) and child cardiovascular health outcomes, and whether parents PA, child PA, and parent support of child PA modified this association. Methods: A subsample of parent-child dyads from the Family Matters Phase II cohort study (n=350) participated in a multi-method follow up study including survey, geospatial (American Community Survey), and biomarker data collection in Minneapolis-St. Paul, MN (2019-2022). Parents self-reported PA, child PA and parent support of child PA, and sociodemographic characteristics (e.g., family structure, educational attainment, annual household income) via an online survey. Children attended a clinic visit to measure height, weight, pulse, and systolic [SBP] and diastolic [DBP] blood pressure. ICE, used as a measure of census tract social polarization reflecting racial segregation and tract income inequity, was operationalized in these tertiles: concentrated deprivation, middle, and concentrated privilege. Multivariable linear regressions were used to evaluate the association between ICE tertiles and child cardiovascular health indicators (SBP, DBP, pulse, and BMI percentile). Models were adjusted for parent age, education, race and ethnicity, and household income. Interaction terms between ICE and parents PA, child PA, and parent support of child PA were further explored in these models. Results: Increases in parent engagement in light- and moderate-intensity PA (~30-45-minute increments) were associated with -2.65 mmHg lower DBP (P<0.001) and -2.39 mmHg lower SBP respectively (P=0.001) among children living in the least privileged tracts. The overall interaction of the relationship depended on the census tract privilege (Int. P=0.014), and there was no evidence of a favorable parent PA relationship in medium and most privileged tracts. Light parent PA and ICE interactions were consistent for child pulse and DBP (Int. P<0.05). Parent limiting of screen time had favorable interaction effects for child moderate PA in medium privilege tracts but not at the extremes (Int. P=0.024). Conclusions: Interventions targeting structural disadvantages should consider multilevel components that integrate parent support and modeling of PA to address cardiovascular health disparities in pre-adolescent children. In privileged contexts, alternative interventions may need to target sedentary behaviors to improve child PA.