Not So Black and White: The Racial/Ethnic Structure of School Environments and Cardiometabolic and Reproductive Health across the Life Course Open Access
Grooms, Kya (Fall 2020)
Abstract
Background: Given the public health burden of adverse cardiometabolic and reproductive outcomes, it is critical to investigate the social determinants of that occur in adolescence and childhood. We sought to investigate the association between the racial structure of schools and three connected outcomes: adolescent obesity (Aim 1), inflammation in early adulthood (Aim 2), and experiences of preterm birth (PTB) (Aim 3).
Methods: We utilized data from the National Study of Adolescent to Adult Health. School racial composition was assessed using the proportion of Black/non-White students, and racial diversity. District-level segregation was assessed using the Black-White dissimilarity and exposure indices. Adolescent obesity was categorized as not overweight/obese (< 85th percentile) and overweight/obese (≥ 85th percentile). Inflammation was classified using two categories of high-sensitivity C-reactive protein concentrations: (1) low/average: ≤ 3 mg/L, and (2) high: 3-10 mg/L. PTBs were defined as any birth that occurred prior to 37 gestational weeks. The predicted prevalences of the outcomes were estimated from cluster- and sample-weight adjusted logistic regression models. Models were stratified by race/ethnicity and adjusted for school-, neighborhood-, and individual-level characteristics.
Results: In Aim 1, Asian/Native American/Other adolescents who attended schools with 26-50% Black students were 2.11 times more likely to be overweight/obese (95% CI: 1.08, 4.15) than those who attended schools with 0-10% Black students. Non-Hispanic Black adolescents who attended schools with 0-10% non-White students were 1.83 times more likely to be overweight/obese (95% CI: 1.07, 3.11) than those who attended schools with 0-10% non-White students. In Aim 2, there were no meaningful associations observed between school environments and inflammation. In Aim 3, Hispanic mothers were 0.05 times as likely (95% CI: 0.00, 0.56) to experience a PTB for every one-unit change (0-100%) in the proportion of Black students in a school.
Conclusion: There were racial/ethnic differences in the types of schools attended that U.S. adolescents attended. The relationships between the racial structure of school environments and cardiometabolic and reproductive health across the life course also varied by race/ethnicity.
Table of Contents
Table of Contents
Chapter 1: Background and Significance…………………………………………………………..…….. 4
Chapter 2: Specific Aim 1 ……………………………………………………………………………………. 37
Significance ……………….……………………………………………………………………………. 40
Methods ……………………………………………………………………….…………………………. 44
Results ……………………………………………………………………………………………………. 51
Discussion ………………………………………………………………….……………………………. 56
Aim 1 Tables and Figures …………………………………………………………………….……. 62
Aim 1 Appendix …………………………..………………………………………………………..…. 72
Chapter 3: Specific Aim 2 ………………………………………………….….……………………………. 81
Significance ……………….……………………………………………………………………………. 84
Methods ………………………………………………………………………………………….………. 87
Results ……………………………………………………………………………………………………. 95
Discussion ……………………………………………………………………………………………... 100
Aim 2 Tables and Figures …………………………………………………………………..……. 105
Aim 2 Appendix …………………………..……………………………………..…………….…….. 117
Chapter 4: Specific Aim 3 ………………………………………………………………………………….. 142
Significance ……………….…………………………………………………….…………………….. 145
Methods …………………………………………………………………………………..……………. 149
Results ………………………………………………………………………………………….……….. 157
Discussion …………………………………………………………………………………….…….…. 162
Aim 3 Tables and Figures ……………………………………………………………………..…. 167
Aim 3 Appendix …………………………..……………………………………………………...…. 178
Chapter 5: Conclusion …………………………………………………………………………………….... 199
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