A socioeconomic and spatial analysis of obesity in West Virginia: Policy implications

This dissertation integrates both theoretical and empirical insights to facilitate understanding of the current obesity epidemic in WV given heterogeneity in socioeconomic, demographic and built environment characteristics of the state. In meeting this objective, county-level and individual-level health demand analyses using secondary data sources were conducted. County-level obesity differences were studied using spatial and non-spatial random and fixed effects frameworks under a panel data structure. Individual health demand was investigated by recursive estimation of individual health responses to ordered self-assessed health (SAH) in terms of lifestyle choices, socioeconomic, demographic and built environment characteristics using Behavioral Risk Factor Surveillance System (BRFSS) data.;County level findings reveal that, while the percentage of the population with a completed college degree and the number of food stores available per thousand population are negatively and significantly correlated to county prevalence of obesity, mean commuting time, average annual wage and the total number of business establishments per thousand population positively and significantly contribute to obesity. Although there is no evidence for unobserved county fixed effects or serial correlation, empirical and spatial investigations suggest that obesity is a spatially non-random event clustered in certain geographic regions which also have the highest poverty and least education.;The individual health demand analysis shows that the risk of obesity increases at a decreasing rate with per capita income and age. Marginal impacts indicate that as the level of education increases, the probability of being obese decreases by 3%. Physical inactivity increases the risk of being obese by 9%, while smoking reduces the risk of being obese by 14%. Fruit and vegetable consumption lowers the probability of being obese by 2%, while each one-minute increase in commute time raises the probability of being obese by 0.04%. In addition, individuals living in economically distressed counties are less likely to have good health. In general, the overall causes for, and consequences of, obesity are found to be complex and multifaceted.;In terms of policy interventions, educational attainment that raises both human and social capital, as well as changes in the built environment can play a vital role in controlling obesity in West Virginia.;Keywords. obesity, health, random and fixed effects, spatial and built environment characteristics, policy interventions