Autism Spectrum Disorder Diagnosis and Other Child, Family, and Community Risk Factors for Obesity among Children and Adolescents Aged Ten to Seventeen Years in the United States: A Mediation Analysis.

Background: This study explored whether there are mediated effects of child and family risk in the association between community and organizational risk and obesity among children and adolescents aged 10-17 years using 2017-2018 National Survey of Children's Health (NSCH) data, addressing autism spectrum disorder (ASD) and co-occurring conditions. Methods: This cross-sectional study ( N  = 27,157) used 2017-2018 NSCH data. Frequency distributions and chi-square tests were used to describe participants with and without ASD. Cumulative risk indices were created for child, family, community, and organizational level risk, and mediation analyses were conducted in a two-mediator model (X 1 : community risk, X 2 : organizational risk, M 1 : child risk, M 2 : family risk) for the dichotomous outcome (Y: obesity). Path analyses were performed using generalized structural equation modeling in Stata 16.0. Results: Direct effects for all four risk indices were associated with obesity in single index models (all p  < 0.001); only child and family risk indices were associated with obesity in a full model with all four risk indices (both p  < 0.001). When child and family risk indices were assessed as mediators, the indirect effects of community and organizational risk were significant (all p  < 0.0001). The total effect of community risk on obesity was significant with family risk as a mediator ( p  = 0.002). The total effect of organizational risk was not significant with either mediator. Conclusion: Findings suggest that child and family factors play a strong role in obesity risk and that ASD contributes to this risk. Community risk may be another strong predictor of obesity, mediated by family risk. Additional research on social-ecological risk factors for obesity is needed to identify leverage points to improve obesity risk in children and adolescents with and without ASD.