Online Program

Longitudinal associations of neighborhood-level racial residential segregation with obesity among Blacks: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Monday, November 2, 2015

Jennifer Vahora, MPH, Institute for Public Health and Medicine, Northwestern University, Chicago, IL
Ana Diez-Roux, MD, PhD, MPH, School of Public Health, Drexel University, Philadelphia, PA
David Goff, Jr, MD, PhD, Colorado School of Public Health, Aurora, CO
Penny Gordon-Larsen, PhD, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
Whitney Robinson, PhD, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Peter De Chavez, MS, Department of Preventive Medicine, Northwestern University, Chicago, IL
Kiarri Kershaw, PhD, MPH, Preventive Medicine-Epidemiology, Northwestern University, Chicago, IL
Previous research has suggested larger social processes like racial residential segregation may contribute to obesity by constraining resources available for physical activity or healthy eating. However, prior studies relating segregation to obesity are cross-sectional and use self-reported outcomes. In this study we examined the longitudinal relationship between change in neighborhood-level racial residential segregation and obesity among 2,316 Black CARDIA participants living in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA at baseline (1985) and followed for 25 years (5 follow-up exams). We hypothesized that Blacks living in more segregated neighborhoods would be more likely to become obese over time. Racial residential segregation was measured at each exam using the Gi* statistic, a z-score measuring the extent to which the racial composition of a given neighborhood (census tract) deviates from the composition of the larger surrounding metropolitan area. A higher score indicates greater segregation. Body mass index (BMI) was measured (weight [kg]/height[m], squared). Logistic mixed modeling was used to estimate odds ratios (OR) for obesity (BMI ≥30) over time. At baseline, the median Gi* statistic score was 6.38 and 16.7% of participants were obese. By the fifth exam, the median Gi* statistic score was 4.33 and the prevalence of obesity increased to 55.7%. Each unit increase in segregation was associated with a 3% increase (95% Confidence Interval: 1.01, 1.04) in the odds of obesity after adjusting for age, exam year, field center, sex, marital status, physical activity level, current smoking status, and neighborhood poverty. The relationship between segregation and obesity did not statistically significantly differ across years in the study period (p=0.30). In summary, segregation was associated with obesity, even after controlling for individual and neighborhood characteristics.  These findings support previous cross-sectional studies and highlight the important contributions of social environment to obesity.

Learning Areas:

Public health or related public policy

Learning Objectives:
Describe the possible mechanisms linking residential segregation to obesity. Evaluate longitudinal associations of racial residential segregation with obesity. Identify potential mediators of the relationship between segregation and obesity.

Keyword(s): Health Disparities/Inequities, Obesity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a recent graduate of an epidemiology program, and I have studied and researched disparities in chronic disease for the past 3 years. My co-authors are leading researchers in health disparities and obesity research, and have extensive knowledge and expertise in social epidemiology research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.