Date of Award

January 2022

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola L. Hawley


AbstractObjective: Household chaos – sustained disorganization, disorder, and hurriedness in the home setting – has been shown to be associated with a variety of adverse health effects for children. The present study examines the relationship of household chaos with childhood overweight and obesity among Samoan children aged 5 to 12 years. Additionally, the present study explores characteristics of the home environment that may be captured by the household chaos measure. Methods: This analysis uses data from the third wave (2019-2020) of data collection in the Ola Tuputupua’e cohort study. Height and weight were used to construct the childhood overweight/obesity outcome (BMI-for-age Z-score > +1) based on WHO growth standards. Household chaos was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Mother-child dyads (n= 390) were included for analysis. Results: Children in households belonging to the third CHAOS quartile had 46% lower odds of overweight/obesity, compared to those in the first CHAOS quartile (p=0.04). This association persisted after adjustment for demographic variables but was attenuated after adjustment for other household and parental characteristics related to household chaos. These characteristics included maternal marital status (p=0.09), household asset score (p=0.02), and person-to-room ratio (p=0.04). Participants from households in the third quartile of household asset score had significantly lower odds of childhood overweight/obesity (OR=0.45, 95%CI [0.22,0.92], p=0.03), as did those from households with the highest person-to-room ratio (>5 people/room) (OR=0.34, 95%CI [0.14,0.82], p=0.02). Conclusions: Findings from the present study suggest that household chaos is associated with lower odds of childhood overweight/obesity. The observed relationship appears to be explained in part by other household characteristics, especially household asset score and person-to-room ratio. Future research is needed to further clarify the relationship of household assets and crowdedness with chaos and child nutritional outcomes, especially in global settings beyond the United States.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/19/2024