Using Small-Area Estimation Method to Calculate County-Level Prevalence of Obesity in Mississippi, 2007-2009

INTRODUCTION Obesity is one of Mississippi's pressing public health problems. Since 2005, the state has ranked first in the nation in adult obesity prevalence. For authorities to take targeted action against the obesity epidemic, counties, regions, and subpopulations that are most affected by obesity need to be identified. The objective of this study was to assess the scope, socioeconomic and geographic characteristics, and temporal trends of the obesity epidemic in Mississippi. METHODS Using 2007-2009 Mississippi Behavioral Risk Factor Surveillance System data and auxiliary data, we applied a small-area estimation method to estimate county-level obesity prevalence in 2007 through 2009, to assess the association between obesity and socioeconomic factors and to evaluate temporal trends. We determined geographic patterns by mapping obesity prevalence. We appraised the precision of estimates by the width of 95% confidence intervals, and we validated our small-area estimates by comparing them with direct estimates. RESULTS In 2009, the county prevalence of obesity ranged from 30.5% to 44.2%. Counties with the highest prevalence of obesity were in the Delta region and along the Mississippi River. The obesity prevalence increased from 2007 through 2009. Age, sex, race, education, and employment status were associated with obesity. CONCLUSION The 2009 obesity prevalence in all Mississippi counties was substantially higher than the national average and differed by geography and race. Although urgent intervention measures are needed in the entire state, policies and programs giving higher priority to higher-risk areas and subpopulations identified by this study may be better strategies.