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Shannon C Conrey1,2, PhD, Allison R Burrell1,2, BSN, Cole Brokamp1,3, PhD, Rachel M Burke4, PhD, Sarah C Couch5, PhD, RD, Liang Niu1, PhD, Claire P Mattison4,6, MPH, Daniel C Payne7, PhD, Mary A Staat1,2, MD, MPH, and Ardythe L Morrow1,2, PhD1University of Cincinnati College of Medicine, Department of Environmental and Public Health Sciences, Cincinnati, Ohio, United States of America2Cincinnati Children’s Hospital Medical Center, Department of Infectious Disease, Cincinnati, Ohio, United States of America3Cincinnati Children’s Hospital Medical Center, Department of Biostatistics and Epidemiology, Cincinnati, Ohio, United States of America4Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, Georgia, United States of America5University of Cincinnati College of Allied Health Sciences, Department of Rehabilitation, Exercise and Nutrition Science, Cincinnati, Ohio, United States of America6Cherokee Nation Assurance, Arlington, Virginia, United States of America7Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, Atlanta, Georgia, United States of AmericaPart of the book: Environmental Health: Poverty, Race and Child Health in the Time of COVID-19Chapter DOI: https://doi.org/10.52305/NZMV3463AbstractNearly 14% of American children aged 2–5 have obesity, with higher rates in children from lower-income and Black families. While evidence connects neighborhood socio-economic environment (SEE) and obesity in adults and adolescents, little is known of this relationship in young children. We compared measures of SEE and family-level socio[1]demographic factors as predictors of obesity at age two. Methods: Family-level data from the PREVAIL Cohort, a CDC-funded birth cohort in Cincinnati, Ohio, were collected prenatally from the mothers. Residential addresses were geocoded and assigned validated measures of census tract-level SEE, including USDA food desert indicators and the Deprivation Index. Family-level and ecological SEE were compared as predictors of obesity (BMIz ≥1.65) at age two in terms of proportional differences, relative risk, and model fit statistics. Results: Residing outside of Deprivation Index High SEE neighborhoods was significantly associated with higher proportion (20.0% vs 5.9%; χ2=4.36, p=0.037) and increased risk of obesity in univariable (RR = 3.4, 95%CI: 1.26–13.86) and multivariable models (RR = 3.5, 95%CI: 1.06–11.71). There were no differences in proportion or risk of obesity by USDA food desert indicators or family-level factors. Models using categorical Deprivation Index performed better than the family-level and the USDA food desert variables in terms of model fit. Conclusion: In the PREVAIL Cohort, only category of Deprivation Index was a significant predictor of obesity in two-year-old children. Future studies are needed to evaluate the Deprivation Index as a generalizable tool to identify neighborhoods at higher risk for obesity.References[1] Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences ofchildhood obesity. Gerontology 2014;60(3):222-8.[2] Llewellyn A, Simmonds M, Owen CG, Woolacott N. 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