Structural barriers to health care as risk factors for preterm and small-for-gestational-age birth among US-born Black and White mothers.

We develop county-level measures of structural and institutional barriers to care, and test associations between these barriers and birth outcomes for US-born Black and White mothers using national birth records for 2014-2017. Results indicate elevated odds of greater preterm birth severity for Black mothers in counties with higher uninsurance rates among Black adults, fewer Black physicians per Black residents, and fewer publicly-funded contraceptive services. Most structural barriers were not associated with small-for-gestational-age birth, and barriers defined for Black residents were not associated with birth outcomes for White mothers, with the exception of Black uninsurance rate. Structural determinants of care may influence preterm birth risk for Black Americans.

Racial and Ethnic Disparities in Blood Pressure and Glycemic Control in the US Community Health Center Patient Population.

OBJECTIVE: To describe blood pressure and glycemic control by racial/ethnic group in the US Community Health Center (CHC) patient population, and whether center characteristics, proxying for higher resource levels and better quality of care, were associated with greater rates of controlled cardiometabolic conditions. METHODS: Data came from the Uniform Data System, representing aggregate patient clinical data for individual health centers in 2019. Descriptive analyses were conducted weighting by health center patient populations to produce race-specific national rates of blood pressure and glycemic control, and linear regression is used to test whether cardiometabolic control rates varied by center characteristics. RESULTS: Hypertension was controlled for 67.2% of non-Hispanic White, 66.9% of Hispanic, and 56.7% of non-Hispanic Black patients. Diabetes was controlled for 70.7% of non-Hispanic White, 65.7% of Hispanic, and 66.1% of non-Hispanic Black patients. The rate of blood pressure control was 2.54 to 3.99 percentage points higher across racial/ethnic groups in health centers that adopted a patient-centered medical home (PCMH) model of care relative to non-PCMH centers, while glycemic control was 1.08 to 2.27 pp. higher as a function of PCMH certification. Results for other center characteristics did not show consistent patterns across racial groups or outcomes. CONCLUSION: This study documented racial and ethnic health disparities in the CHC patient population after major expansion of the CHC program. CHCs with PCMH certification have improved clinical outcomes among patients with hypertension and diabetes across racial/ethnic groups relative to centers without this certification.

Social inequities in neighborhood health amenities over time in the Wasatch Front Region of Utah: Historical inequities, population selection, or differential investment?

Socially disadvantaged groups generally are more likely to reside in areas with less desirable conditions. We examined longitudinal relationships between neighborhood resident characteristics and amenities from 1990 to 2010 in an urban area of Utah, U.S. Four temporal patterns of social inequities are described using mixed-effects models: historical inequities; differential selection into amenity-rich tracts; differential investment in amenities; and simultaneous twenty-year change. Results indicate historical differences by neighborhood socioeconomic status, with lower status tracts having fewer green/natural amenities and higher air pollution in 1990 but also greater walkability and more food stores. Differences in amenities by neighborhood socioeconomic status widened over time as aggregate socioeconomic status disproportionately increased in tracts with more green/natural amenities, less air pollution, and lower walkability in 1990, consistent with differential selection. Tract percentage non-Hispanic White did not predict historical differences, but tracts that were less walkable and had fewer healthy food stores in 1990 experienced larger subsequent increases in racial/ethnic diversity. Tracts with higher relative to lower percentage non-Hispanic White in 1990 had larger decreases in air pollution but declining green/natural amenities. This study shows how social inequities in neighborhood amenities change over time, providing evidence of historical socioeconomic differences increasing from differential resident selection.

The changing food environment and neighborhood prevalence of type 2 diabetes.

In this ecological study, we used longitudinal data to assess if changes in neighborhood food environments were associated with type 2 diabetes mellitus (T2DM) prevalence, controlling for a host of neighborhood characteristics and spatial error correlation. We found that the population-adjusted prevalence of fast-food and pizza restaurants, grocery stores, and full-service restaurants along with changes in their numbers from 1990 to 2010 were associated with 2015 T2DM prevalence. The results suggested that neighborhoods where fast-food restaurants have increased and neighborhoods where full-service restaurants have decreased over time may be especially important targets for educational campaigns or other public health-related T2DM interventions.

Modern slavery and labor exploitation during the COVID-19 pandemic: a conceptual model.

BACKGROUND: Modern slavery is a complex global health problem that includes forced labor exploitation. An ecological systems perspective is needed to understand how contextual upstream and midstream factors contribute to labor exploitation, and how disruptive societal challenges, such as infectious disease pandemics, may exacerbate established pathways leading to exploitation. Accumulation of familial and societal risk factors likely heightens vulnerability; for instance, economic precarity for an individual interacts with poor livelihood options and lack of social welfare supports increasing their likelihood of accepting exploitative labor. However, few frameworks exist that account for the accumulation of and interdependence between risk factors at different levels and across contexts. OBJECTIVE: Using an ecological systems framework, we review literature on the pathways leading to labor exploitation, with the aim of developing a conceptual model grounded in existing research. Next, we discuss how pathways in this conceptual model are likely exacerbated by the COVID-19 pandemic. This conceptual model can guide future research to detect modifiable factors and strategic points of intervention. METHODS: A critical review of research articles and gray literature was performed with a primary focus on sub-Saharan Africa. The review utilized various scholarly databases to identify perspectives from multiple disciplines and to more fully account for complex processes linked to labor exploitation. RESULTS: A conceptual model of these pathways was developed that emphasizes established determinants and risk factors for labor exploitation in sub-Saharan Africa. The model highlights how the COVID-19 pandemic may have exacerbated these pathways. CONCLUSIONS: Future studies should carefully examine the direct and indirect pathways, accumulation of and interactions between factors, and specific external and personal stressors. Interdisciplinary research on multilevel interventions is needed to guide solutions to prevent the persistent problem of labor exploitation.

Highly public anti-Black violence and preterm birth odds for Black and White mothers.

Highly public anti-Black violence may increase preterm birth in the general population of pregnant women via stress-mediated paths, particularly Black women exposed in early gestation. To examine spillover from racial violence in the US, we included a total of 49 high publicity incidents of the following types: police lethal force toward Black persons, legal decisions not to indict/convict officers involved, and hate crime murders of Black victims. National search interest in these incidents was measured via Google Trends to proxy for public awareness of racial violence. Timing of racial violence was coded in relation to a three-month preconception period and subsequent pregnancy trimesters, with the primary hypothesis being that first trimester exposure is associated with higher preterm birth odds. The national sample included 1.6 million singleton live births to US-born Black mothers and 6.6 million births to US-born White mothers from 2014 to 2017. Using a preregistered analysis plan, findings show that Black mothers had 5% higher preterm birth odds when exposed to any high publicity racial incidents relative to none in their first trimester, and 2-3% higher preterm birth odds with each log10 increase in national interest. However, post hoc sensitivity tests that included month fixed effects attenuated these associations to null. For White mothers, associations were smaller but of a similar pattern, and were attenuated when including month fixed effects. Highly public anti-Black violence may act as a national stressor, yet whether racial violence is associated with reproductive outcomes in the population is unknown and merits further research.

Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers.

Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. CONTEXT: Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. METHODS: Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. FINDINGS: An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities. CONCLUSIONS: Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.

Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans.

OBJECTIVES: Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS: We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS: Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: ß = 1.92 [95% CI, 0.97-2.87]; Black: ß = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: ß = 2.40 [95% CI, 1.48-3.32]; Black: ß = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: ß = 1.54 [95% CI, 0.58-2.50]; Black: ß = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: ß = 1.98 [95% CI, 1.05-2.91]; Black: ß = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS: Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.

Highly public anti-Black violence is associated with poor mental health days for Black Americans.

Highly public anti-Black violence in the United States may cause widely experienced distress for Black Americans. This study identifies 49 publicized incidents of racial violence and quantifies national interest based on Google searches; incidents include police killings of Black individuals, decisions not to indict or convict the officer involved, and hate crime murders. Weekly time series of population mental health are produced for 2012 through 2017 using two sources: 1) Google Trends as national search volume for psychological distress terms and 2) the Behavioral Risk Factor Surveillance System (BRFSS) as average poor mental health days in the past 30 d among Black respondents (mean weekly sample size of 696). Autoregressive moving average (ARMA) models accounted for autocorrelation, monthly unemployment, season and year effects, 52-wk lags, news-related searches for suicide (for Google Trends), and depression prevalence and percent female (for BRFSS). National search interest varied more than 100-fold between racial violence incidents. Black BRFSS respondents reported 0.26 more poor mental health days during weeks with two or more racial incidents relative to none, and 0.13 more days with each log10 increase in national interest. Estimates were robust to sensitivity tests, including controlling for monthly number of Black homicide victims and weekly search interest in riots. As expected, racial incidents did not predict average poor mental health days among White BRFSS respondents. Results with national psychological distress from Google Trends were mixed but generally unsupportive of hypotheses. Reducing anti-Black violence may benefit Black Americans' mental health nationally.

Resting high-frequency heart rate variability moderates the association between early-life adversity and body adiposity.

This study investigates resting high-frequency heart rate variability as a moderator of the association between early-life adversity and two measures of body adiposity. Data were collected from 149 young adults attending a large university in the Midwestern United States (Mage = 18.8 years; 45% black; 55% white; 56% female). Self-reported early-life adversity was associated with greater waist-to-height ratio and body mass index. The strength of these associations was moderated by high-frequency heart rate variability, such that the link was stronger for individuals with lower heart rate variability. Resting high-frequency heart rate variability thus has potential health significance as a biomarker of stress vulnerability.

Associations between local government expenditures and low birth weight incidence: Evidence from national birth records.

Local governments play an integral role in providing public services to their residents, yet the population health benefits are frequently overlooked, especially when services are outside the traditional health domain. With data from the U.S. Census of Governments and national birth records (spanning from 1992 to 2014), we examined whether local government expenditures on parks and recreation services (PRS) and housing and community development (HCD) predicted county low birth weight outcomes (population incidence and black-white disparities). Hypotheses were tested using bias-corrected county-by-period fixed effects models in a sample of 956 U.S. counties with a total of 3619 observations (observations were defined as three-year pooled estimates), representing 24 million births. Adjusting for prior county low birth weight incidence, levels of total operational, health, and hospital expenditures, and time-varying county sociodemographics, an increase in per capita county PRS expenditures of $50 was associated with 1.25 fewer low birth weight cases per 1000. Change in county HCD expenditures was not associated with low birth weight incidence, and, contrary to hypotheses, neither expenditure type was linked to county black-white disparities. Further examination of the benefits to birth outcomes from increasing parks and recreation services is warranted.

Disparities in insulin resistance between black and white adults in the United States: The role of lifespan stress exposure.

BACKGROUND: Disparities in insulin resistance between Black and White adults in the United States are well documented, yet relatively little is known about the psychosocial or biological antecedents of these inequities. The current study examined childhood adversity and contemporaneous psychosocial stressors in adulthood as possible mediators of the racial disparity in insulin resistance. Inflammatory and hypothalamic-pituitary adrenal (HPA) axis mechanisms implicated in associations between lifespan stress exposure and insulin resistance were also considered. METHODS: Data were derived from the biomarker component of the Midlife in the United States Study (N = 1170, 20% Black, 56% female, Mean age = 54.7 years, SD = 11.6). A homeostatic model assessment of insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Twelve risk factors relating to household dysfunction, socioeconomic disadvantage, and maltreatment were sum scored to index childhood adversity. Measures of adult stress included socioeconomic adversity, major stressful events, everyday discrimination, and lifetime discrimination. RESULTS: Levels of insulin resistance were higher among Black than White adults. Childhood adversity was positively associated with HOMA-IR, and attenuated 18% of the race difference. Measures of adult stress mediated 33% of the association between childhood adversity and HOMA-IR, and accounted for an additional 47% of the race difference. Higher inflammation and lower nocturnal cortisol both played an important role in mediating the association between stress exposure and HOMA-IR. CONCLUSIONS: Findings are consistent with prior research showing that childhood adversity and adult stress are salient predictors of glucose metabolism, and extend this work by showing that lifespan stress exposures attenuate a significant portion of the Black-White disparity in HOMA-IR. Results also suggest stress effects on insulin resistance through inflammatory and HPA-axis pathways.

Longitudinal health consequences of socioeconomic disadvantage: Examining perceived discrimination as a mediator.

OBJECTIVE: Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual's risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health. METHOD: Participants in the Midlife in the United States (MIDUS) study were followed over 3 waves covering a 17- to 19-year period (N = 6,286; 53% female; 91% White; mean age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination-perceived inequality in work and everyday discrimination-were considered as mediators. RESULTS: Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17- to 19-year period (B = -.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages. CONCLUSION: Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. (PsycINFO Database Record

Habitual sleep as a contributor to racial differences in cardiometabolic risk.

Insufficient and disrupted sleep is linked with cardiovascular and metabolic dysregulation and morbidity. The current study examines the degree to which differences in sleep between black/African American (AA) and white/European American (EA) adults explain racial differences in cardiometabolic (CMB) disease risk. Total sleep time and sleep efficiency (percent of time in bed asleep) were assessed via seven nights of wrist actigraphy among 426 participants in the Midlife in the United States Study (31% AA; 69% EA; 61% female; mean age = 56.8 y). CMB risk was indexed as a composite of seven biomarkers [blood pressure, waist circumference, hemoglobin A1c (HbA1c), insulin resistance, triglycerides, HDL cholesterol (HDL-C), and C-reactive protein]. Covariates included sociodemographic characteristics and relevant health behaviors. Results indicated that AAs relative to EAs obtained less sleep (341 vs. 381 min) and had lower sleep efficiency (72.3 vs. 82.2%) (P values < 0.001). Further, 41% and 58% of the racial difference in CMB risk was explained by sleep time and sleep efficiency, respectively. In models stratified by sex, race was indirectly associated with CMB risk via sleep time and efficiency only among females (explaining 33% and 65% of the race difference, respectively). Indirect effects were robust to alternative model specifications that excluded participants with diabetes or heart disease. Consideration of sleep determinants and sleep health is therefore needed in efforts to reduce racial differences in CMB disease.

Racial Disparities in Blood Pressure Trajectories of Preterm Children: The Role of Family and Neighborhood Socioeconomic Status.

Racial disparities in cardiovascular disease mortality in the United States remain substantial. However, the childhood roots of these disparities are not well understood. In the current study, we examined racial differences in blood pressure trajectories across early childhood in a sample of African-American and European-American low-birth-weight preterm infants. Family and neighborhood socioeconomic status (SES), measured at baseline, were also examined as explanations for subsequent group disparities. Analyses focused on 407 African-American and 264 European-American children who participated in the Infant Health and Development Program, a US longitudinal study of preterm children born in 1985. Blood pressure was assessed on 6 occasions between the ages of 24 and 78 months, in 1987-1992. Across this age range, the average rate of change in both systolic and diastolic blood pressure was greater among African-American children than among European-American children. Neighborhood SES explained 29% and 24% of the racial difference in the average rate of change in systolic and diastolic blood pressure, respectively, whereas family SES did not account for group differences. The findings show that racial differences in blood pressure among preterm children emerge in early childhood and that neighborhood SES accounts for a portion of racial disparities.

Relationship Satisfaction Mediates the Link Between Partner Aggression and Relationship Dissolution: The Importance of Considering Severity.

Physically and psychologically aggressive behaviors between members of a couple often lead to relationship dissatisfaction and dissolution. The current study utilized data from 346 clinical couples to investigate associations between psychological and moderate physical aggression and relationship dissolution, and whether relationship satisfaction acts as a mediator of these associations. Results from two series of Actor-Partner Interdependence Models (APIMs) were considered in which cases of severe aggression were initially removed from the analytic sample and then were included for secondary analyses. The first series of models showed that dyadic physical aggression was a weak predictor of the male partner's steps taken to leave the relationship and was not associated with the female's steps. Dyadic psychological aggression, however, was related to steps taken toward leaving by both partners, accounting for approximately 14% of the variance. Relationship satisfaction mediated associations between physical and psychological partner aggression and steps taken to leave. Findings from the second series of models, including cases of severe aggression, showed a significant association between dyadic physical aggression and the female's steps toward leaving. Moreover, relationship satisfaction no longer fully mediated associations between psychological or physical aggression and relationship dissolution risk. The importance of considering severity of physical partner aggression in research and clinical practice is discussed.

Racial discrimination mediates race differences in sleep problems: A longitudinal analysis.

OBJECTIVES: To examine changes in sleep problems over a 1.5-year period among Black or African American (AA) and White or European American (EA) college students and to consider the role of racial discrimination as a mediator of race differences in sleep problems over time. METHOD: Students attending a large, predominantly White university (N = 133, 41% AA, 57% female, mean age = 18.8, SD = .90) reported on habitual sleep characteristics and experiences of racial discrimination at baseline and follow-up assessments. A latent variable for sleep problems was assessed from reports of sleep latency, duration, efficiency, and quality. Longitudinal models were used to examine race differences in sleep problems over time and the mediating role of perceived discrimination. Covariates included age, gender, parent education, parent income, body mass index, self-rated physical health, and depressive symptoms. Each of the individual sleep measures was also examined separately, and sensitivity analyses were conducted using alternative formulations of the sleep problems measure. RESULTS: AAs had greater increases in sleep problems than EAs. Perceived discrimination was also associated with increases in sleep problems over time and mediated racial disparities in sleep. This pattern of findings was similar when each of the sleep indicators was considered separately and held with alternative sleep problems measures. CONCLUSIONS: The findings highlight the importance of racial disparities in sleep across the college years and suggest that experiences of discrimination contribute to group disparities. (PsycINFO Database Record

Racial disparities in sleep: the role of neighborhood disadvantage.

OBJECTIVE: Disparities in sleep duration and efficiency between Black/African American (AA) and White/European American (EA) adults are well-documented. The objective of this study was to examine neighborhood disadvantage as an explanation for race differences in objectively measured sleep. METHODS: Data were from 133 AA and 293 EA adults who participated in the sleep assessment protocol of the Midlife in the United States (MIDUS) study (57% female; Mean Age = 56.8 years, SD = 11.4). Sleep minutes, onset latency, and waking after sleep onset (WASO) were assessed over seven nights using wrist actigraphy. Neighborhood characteristics were assessed by linking home addresses to tract-level socioeconomic data from the 2000 US Census. Multilevel models estimated associations between neighborhood disadvantage and sleep, and the degree to which neighborhood disadvantage mediated race differences in sleep controlling for family socioeconomic position and demographic variables. RESULTS: AAs had shorter sleep duration, greater onset latency, and higher WASO than EAs (ps < 0.001). Neighborhood disadvantage was significantly associated with WASO (B = 3.54, p = 0.028), but not sleep minutes (B = -2.21, p = 0.60) or latency (B = 1.55, p = 0.38). Furthermore, race was indirectly associated with WASO via neighborhood disadvantage (B = 4.63, p = 0.035), which explained 24% of the race difference. When measures of depression, health behaviors, and obesity were added to the model, the association between neighborhood disadvantage and WASO was attenuated by 11% but remained significant. CONCLUSION: Findings suggest that neighborhood disadvantage mediates a portion of race differences in WASO, an important indicator of sleep efficiency.

Longitudinal associations between self-regulation and health across childhood and adolescence.

OBJECTIVE: There is some evidence to suggest that one's ability to delay gratification is associated with a lower body mass index (BMI) and slower overall weight gain. Less is known about the role that a broader set of self-regulatory skills, including attention focusing, inhibitory control, and impulsivity, might play in fostering not only a healthy weight but also better overall health and health-related behaviors such as sleep. METHOD: Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were followed from birth through age 15 beginning in 1991. Self-regulation was assessed when children were 4.5 years old, whereas health-related outcomes were assessed regularly between toddlerhood and adolescence. Structural equation modeling was used to test direct associations between self-regulation and either physical health or sleep in childhood and adolescence. RESULTS: Findings suggest that there are long-term benefits of self-regulation, indexed by multiple dimensions, for children's health-related outcomes. Children with better self-regulatory skills demonstrated smaller increases in standardized BMI scores and maintained greater mother-reported health across childhood and adolescence. Furthermore, better self-regulation predicted fewer sleep problems and longer sleep duration when children were 8 and 11 but not when they were 15. CONCLUSIONS: Early self-regulation, marked by numerous skills, appears to have long-term benefits for children's health-related outcomes. These findings provide some evidence that targeting childhood self-regulatory skills for improvement may help reduce poor health-related outcomes later in life and offer important insight into potential avenues for intervention. (PsycINFO Database Record

Racial and socioeconomic disparities in body mass index among college students: understanding the role of early life adversity.

The role of early life adversity (ELA) in the development of health disparities has not received adequate attention. The current study examined differential exposure and differential vulnerability to ELA as explanations for socioeconomic and racial disparities in body mass index (BMI). Data were derived from a sample of 150 college students (M age  = 18.8, SD = 1.0; 45 % African American; 55 % European American) who reported on parents' education and income as well as on exposure to 21 early adverse experiences. Body measurements were directly assessed to determine BMI. In adjusted models, African American students had higher BMI than European Americans. Similarly, background socioeconomic status was inversely associated with BMI. Significant mediation of group disparities through the pathway of ELA was detected, attenuating disparities by approximately 40 %. Furthermore, ELA was more strongly associated with BMI for African Americans than for European Americans. Efforts to achieve health equity may need to more fully consider early adversity.