Socioeconomic and Cultural County-level Factors Associated with Race/Ethnic Differences in Body Mass Index in 4th Grade Students in Texas

Purpose: To evaluate the relationship between county-level socioeconomic environment and the propensity to be overweight or obese by race/ethnic group in a sample of fourth grade children the Texas public school system. Methods: The data used come from the School Physical Activity and Nutrition (SPAN) surveillance study – a surveillance study of school-aged children in Texas. The outcome variable used was Body Mass Index (BMI) categorized as underweight/normal/healthy, overweight, and obese. Exposure variables were derived from county-level Hispanic and Black concentration and socioeconomic data using the Human Security Index (HSI) as a framework. We made comparisons between Non-Hispanic White, Black and Hispanic children enrolled in the fourth grade. We used bivariate and regression analysis using jackknife variance estimates. Results: Hispanic and Black children were more likely to be obese and overweight than non-Hispanic White children. Hispanic and Black children were more likely to live in counties with higher economic, educational and social stress than non-Hispanic White children. In the logistic regression analysis comparing the odds of overweight or obese to underweight/healthy/normal weight, both Hispanic and Black children continued to have a higher odds of overweight and obesity than non-Hispanic White children. In separate regression analyses for each race/ethnic group (ie, Hispanic, Black, and White students) the county-level educational and social stress variables had a significant association with overweight and obesity in Hispanic children only. Hispanic ethnic concentration was associated with the odds of being overweight but not obese, while percent Black was associated with obesity in Hispanic children. There were no significant associations between socioeconomic or ethnic concentration and overweight or obese in Black children. Discussion: The results from this study indicate that county-level effects on childhood obesity may be more than just socioeconomics and ethnic concentration. Future research should involve multiple levels of analysis, including census tract, school and home variables simultaneously, in order to understand how the environments children live in impact their risk for obesity and how these influences may vary by race/ethnicity