Association between the urban environment, parents’ related concerns and perceptions, and childhood obesity and lifestyle in Barcelona, Spain

BACKGROUND: Environmental features and parental perceptions shape children's lifestyle and weight, yet these links remain unexplored in deprived neighbourhoods. We examined (i) the link between parents' perceptions of the urban environment and actual urban characteristics, (ii) the association between parents' perceptions of the urban environment and child body mass index (BMI), screen time, and physical activity, and (iii) whether parent perceptions moderate the association between urban environment and child obesity and lifestyle. METHODS: This cross-sectional study included 1517 parent-child pairs from low-income Barcelona neighborhoods. Parents reported children's physical activity and screen time; BMI z-scores were derived from measured height and weight. Urban and perceived neighbourhood environments were assessed, and associations were analyzed using linear and logistic multivariate regressions. RESULTS: Greener neighborhoods increased perceived safety but reduced perceived diversity and access, while more built environments showed the opposite pattern. Perceived walkability and aesthetics were linked to lower overweight/obesity risk. Greater road intersection density was associated with overweight/obesity risk (OR(95%CI) 1.33(1.06-1.68)). Lower concern about traffic hazards and safety was protective against insufficient child physical activity (<60min/day) (OR(95%CI) 0.71(0.52-0.97)). Greener neighbourhoods were associated with lower child overweight/obesity risk when caregivers perceived lower neighbourhood diversity (OR per IQR(95%CI) 0.81(0.67-0.98)) and higher safety (OR per IQR(95%CI) 0.78(0.63-0.96)). Greater walkability and land use mix were associated with <2h/day of screen time when parents perceived lower safety. CONCLUSION: Associations between environmental factors and children's physical activity, screen time, and obesity-related outcomes varied by parental neighbourhood perceptions, highlighting the nuanced interplay between environmental context and family concerns.