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Measuring Structural Racism and Its Association With BMI.

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Structural racism is linked to body mass index (BMI) disparities. A new county-level measure found racism associated with lower BMI in whites and higher BMI in blacks, highlighting complex health inequities.

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Area of Science:

  • Public Health
  • Sociology
  • Health Disparities Research

Background:

  • Racial disparities in health, particularly in adiposity, are increasingly linked to structural racism.
  • Existing measures of structural racism often use single indicators, potentially missing crucial aspects of this complex construct.
  • A comprehensive, multi-indicator approach is needed to accurately assess county-level structural racism.

Purpose of the Study:

  • To develop and validate a multi-indicator scale for measuring structural racism at the U.S. county level.
  • To evaluate the association between this county structural racism scale and individual body mass index (BMI).
  • To explore the interaction between structural racism, race, and BMI.

Main Methods:

  • A 7-indicator confirmatory factor model was used to estimate county structural racism, incorporating data on education, housing, employment, criminal justice, and healthcare.
  • Behavioral Risk Factor Surveillance System data (2011-2012) from 324,572 U.S. adults were analyzed using a mixed-effects model.
  • Individual BMI was regressed on county structural racism, controlling for various county-level characteristics and demographic factors.

Main Results:

  • The 7-indicator model demonstrated acceptable fit, confirming structural racism as a measurable latent construct at the county level.
  • County structural racism was significantly associated with BMI, showing a differential impact based on race.
  • A qualitative interaction was observed: structural racism was linked to lower BMI in white individuals and higher BMI in Black individuals. Further analysis indicated larger BMI increases among Black men compared to Black women in areas with high structural racism.

Conclusions:

  • The developed multi-indicator scale provides a valid and conceptually sound method for measuring county structural racism using publicly available data.
  • The findings confirm the association between structural racism and BMI disparities, underscoring its role in health inequities.
  • Further research is warranted to investigate whether interventions targeting structural racism can effectively reduce BMI among Black populations.