Race, Place, and Health: Neighborhood Social-Environmental Influences on Adolescent Obesity and Overweight in the US

Purpose: The burden of obesity in the US is disproportionately shouldered by people of color and people coping with poverty. An ecological model of obesity highlights the social determinants of health that can shape and constrain individual health behavior, “get under the skin,” and contribute to health disparities. Research on the built environment and obesity has identified factors such as green spaces, walkability, and fresh food access, but less is known about social-environmental neighborhood characteristics and risk for obesity, and how these determinants may vary by race/ethnicity. We hypothesized that after controlling for background factors, neighborhood level poverty would be positively associated with higher rates of unhealthy weight status; and that perceived neighborhood safety, collective efficacy, and satisfaction would be associated with lower rates of unhealthy weight status one year later. Race/ethnic and gender differences were also examined.

Method: Using data from waves 1 and 2 of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we sampled adolescents in grades 7-12 who participated in both waves (n=13,570) and who had non-missing data on height and weight. Multivariable logistic regression was conducted in STATA with subgroup analyses by race/ethnicity and gender. Predictors were measured at wave 1, including an index of poverty based on five indicators from linked US Census data, and subjective neighborhood characteristics (e.g., perceived safety, collective efficacy, satisfaction with current neighborhood). The primary outcome at wave 2 was overweight or obese weight status based on BMI or on BMI percentiles per CDC’s sex and age adjusted Growth Charts for children. All analyses adjusted for background demographic characteristics and for the complex survey design.    

Results:  Hypothesis 1 was partially supported. Neighborhood poverty predicted overweight or obesity among females (OR=1.19, p<.01) and males (OR=1.10, p<.01). Further examination by race/ethnicity showed that among females, neighborhood poverty predicted overweight or obesity among White (OR=1.17, p<.01) but not among Latino, Asian nor Black females. Among males, neighborhood poverty predicted overweight or obesity only among Latinos (OR=1.22, p<.05) and Asians (OR=1.57, p<.05).  Hypothesis 2 was not supported. Unexpectedly, higher neighborhood collective efficacy predicted higher rates of overweight or obesity among Black females (OR=1.16, p<.05) but not Whites, Asians, or Latinas. Higher satisfaction with current neighborhood predicted overweight or obesity only among Latino males (OR=1.12, p<.05). 

Implications: Findings revealed diverse environmental influences on overweight and obesity among adolescents across gender and race/ethnicity. Neighborhood level poverty contributed to unhealthy weight status, net individual/family SES, and varied by race/ethnicity. Greater neighborhood collective efficacy and satisfaction, generally linked with well-being, was associated with overweight and obesity, possibly through enhanced shared norms and social comparisons that could exacerbate the observed “social contagion” aspect of obesity. This intriguing finding suggests that neighborhood level activism to counter obesogenic conditions and norms may be a promising direction for reducing health disparities and the disproportionate burden of obesity.