Date of Award

Spring 2022

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Andrew T Kaczynski

Abstract

Youth obesity prevalence remains high, despite decades of intervention. Grounded in the social ecological model, neighborhoods and schools are important settings in addressing the complex systems that influence obesity. Contributing to disparities, by race/ethnicity, Black and Hispanic youth are more likely to live in segregated neighborhoods and attend segregated schools, which are also more likely to have high rates of poverty and are less likely to have high quality nutrition and built environments. Leveraging data from local school district (district and state department of education) and national datasets (ACS, Childhood Opportunity Index 2.0), this study examined the associations between school and neighborhood environments with obesity risk by race/ethnicity among a large sample of school-aged youth from. Exploring two specific aims, this study 1) used a series of cross-classified multilevel models to explore the associations between school and residential segregation and youth obesity, and 2) used parallel mediation analysis to determine if social/economic, health/built, and education environments mediated the association between residential segregation and youth obesity. Results of the CCMMs, indicated that school and neighborhood environments had a small, but unique influence on the variability in youth BMI z-score. After adjusting for relevant individual, school and neighborhood covariates, school segregation was negatively associated with BMI z-score among Black and Hispanic youth, compared to White youth, while residential segregation was positively associated with youth obesity among Black and Hispanic youth. The addition of an interaction term between Hispanic school segregation and youth race/ethnicity (Black and Hispanic, compared to White) indicated individual race/ethnicity may moderate the association between segregation and youth BMI z-score after controlling for other covariates in the model. Specifically, increased Hispanic school segregation may act as a protective factor for youth BMI z-score among Black and Hispanic youth. Results of the mediation analyses indicated that social/economic, health/built, and education environments may mediate the association between residential segregation and youth obesity. The significance and strength of associations, however, varied by type of residential segregation (Black or Hispanic) and youth race/ethnicity (Black or Hispanic). These findings highlight the important role of federal, state, and local governments and systems in creating equitable investment in infrastructure and resources within schools and neighborhoods and how structural racism can influence investment and access by race/ethnicity and socioeconomic status.

Rights

© 2022, Melissa L Fair

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