Original Contribution Racism, Segregation, and Risk of Obesity in the Black Women’s Health Study

We assessed the relation of experiences of racism to the incidence of obesity and the modifying impact of res-idential racial segregation in the BlackWomen’s Health Study, a follow-up study of US black women. Racism scores were created from 8 questions asked in 1997 and 2009 about the frequency of “everyday ” racism (e.g., “people act as if you are dishonest”) and of “lifetime ” racism (e.g., unfair treatment on the job). Residential segregation wasmea-sured by linking participant addresses to 2000 and 2010 US Census block group data on the percent of black res-idents. We used Cox proportional hazard models to estimate incidence rate ratios and 95 % confidence intervals. Based on 4,315 incident cases of obesity identified from 1997 through 2009, both everyday racism and lifetime racism were positively associated with increased incidence. The incidence rate ratios for women who were in the highest category of everyday racism or lifetime racism in both 1997 and 2009, relative to those in the lowest cate-gory, were 1.69 (95 % confidence interval: 1.45, 1.96; Ptrend < 0.01) and 1.38 (95 % confidence interval: 1.15, 1.66; Ptrend < 0.01), respectively. These associations were not modified by residential segregation. These results suggest that racism contributes to the higher incidence of obesity among African American women. African Americans; obesity; prospective studies; racism; segregation; women; women’s health Abbreviations: BMI, body mass index; BWHS, Black Women’s Health Study; CI, confidence interval; IRR, incidence rate ratio. The prevalence of obesity in the United States has in