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The Role of Residential Segregation in Racial Health Disparities During Childhood

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The Role of Residential Segregation in Racial Health Disparities During Childhood The Role of Residential Segregation in Racial Health Disparities during Childhood DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Bethany L. Boettner, M.A. Graduate Program in Sociology The Ohio State University 2011 Dissertation Committee: Cynthia G. Colen, Co-Advisor Zhenchao Qian, Co-Advisor John Casterline Reanne Frank Copyrighted by Bethany Lynn Boettner 2011 Abstract As individual-level explanations have generally proven insufficient for explaining racial differences in health, researchers have increasingly turned to residential contexts as a source of population health disparities. Residential segregation is a key defining characteristic of the American landscape and a powerful force for explaining racial inequality. Furthermore, segregation has been found to be a key explanatory mechanism for understand racial disparities in health through its impact on individual and neighborhood level socioeconomic status, discrimination and race-related stressors, and neighborhood quality. In this dissertation, I draw on life course perspectives and stress process models of health to explore how the distribution of social contexts along racial divisions are associated with physical health outcomes among children. Using longitudinal data from the Early Childhood Longitudinal Survey Kindergarten Class of 1998-1999 data (ECLS-K), I address three specific research questions regarding the role of residential segregation on child well-being. First, what is the relationship between residential segregation and child health outcomes such as obesity, asthma, and parent-rated health, and are the effects of segregation cumulative over the early life course? Second, how do neighborhood racial/ethnic tensions and social cohesion work in tandem to influence child health, and do these impacts vary by race? Third, does residential segregation exacerbate the negative effects of family stressful events on health outcomes for school-aged children? ii I find that the relationship between segregation and physical wellbeing varies by race, and cumulative measures of segregation are more powerful predictors of childhood health than indicators captured at a single point in time. Moreover, parental involvement in school programs, as a measure of social cohesion, is protective against negative health outcomes for White and Hispanic children, even in neighborhoods characterized by high levels of racial tensions, and is more predictive for some diseases (obesity) than others (asthma). Finally, residential segregation measures do not exacerbate the negative effect of stress events on child health. Given these findings, it is apparent that the neighborhood racial context plays a key but complex role in producing and acerbating child health inequalities during the early part of the life course and may set the stage for the further entrenchment of these disparities as individuals age. iii Dedication Dedicated to my parents, Richard and Diane, who taught me the value of education. iv Acknowledgments First and foremost I must acknowledge Cynthia Colen, my co-advisor, who pushed me to finish my degree and helped give me the confidence that I could do it. Cindy also provided much needed advice and knowledge on the entire process of research, from beginning to end. Her guidance made this dissertation possible. I also wish to thank Cindy for the opportunity to work with her as a research assistant and colleague for the last few years of my studies, as I‟ve learned a great deal about research and collaboration. I would also like to thank Zhenchao Qian, co-advisor, and committee members Reanne Frank and John Casterline for their suggestions, thoughts, and time in helping mentor me through this project. Thank you also the Initiative for Population Research and the Department of Sociology for providing travel support, office space for secure data, and an environment of excellent scholarship and collegiality. I wish to thank fellow graduate students Jamie Lynch, Lauri McCloud, Alexa Trumpy, Dan Carlson, Tom Maher, and Lauren Pinkus for their advice and friendship through this process, and for encouraging my love of good food, trivia, and Ultimate. Thank you to my family, who has been there for me in more ways than I can possibly count. And to Andy Fisher, my boyfriend, who taught me how to ride a bike and who motivates me to be a better scholar, worker, and partner. v Vita 2000................................................................Stow-Munroe Falls High School 2004................................................................B.A. Sociology and French, The Ohio State University 2007................................................................M.A. Sociology, The Ohio State University 2004 to present ..............................................Graduate Teaching Associate and Lecturer, Department Sociology, The Ohio State University Publications Nicholson, Lisa M., Patricia M Schwirian, Elizabeth G Klein, Theresa Skybo, Lisa Murray-Johnson, Bethany Boettner, Gina French, Judith A Groner. 2011. “Recruitment and Retention Strategies in Longitudinal Clinical Studies with Low-Income Populations.” Contemporary Clinical Trials 32:3 353-362. Tsai, Shane F., Mira Trivedi, Bethany Boettner, and Curt Daniels. 2011. “Usefulness of Cardiovascular Magnetic Resonance Imaging to Detect Aortic Abnormalities After Repair of Coarctation of the Aorta.” American Journal of Cardiology 102:2 297-201. Egan, Matthew J., Sharon L. Hill, Bethany L. Boettner, Ralf J. Holzer, Alistair B. Phillips, Mark Galantowicz, John P. Cheatham, and John P. Kovalchin. 2011. “Predictors of Retrograde Aortic Arch Obstruction After Hybrid Palliation of Hypoplastic Left Heart Syndrome.” Pediatric Cardiology 32:1 67-75. Luce, Wendy A., Randall M. Schwartz, Wendi Beauseau, Peter J. Giannone, Bethany Boettner, John P. Cheatham, Mark E. Galantowicz, Clifford L. Cua. 2011. “Necrotizing vi Enterocolitis in Neonates Undergoing the Hybrid Approach to Complex Congenital Heart Disease.” Pediatric Critical Care Medicine 12:1 46-51. Tsai, Shane F., David P. Chan, Pamela S. Ro, Bethany Boettner, Curt J. Daniels. 2010. “Rate of Inducible Ventricular Arrhythmia in Adults With Congenital Heart Disease.” American Journal of Cardiology 106: 730-36. Birnbaum, B., Berger, G., Fenstermaker, B., Rowland, D. G., Boettner, B., Olshove, V., Galantowicz, M., Cheatham, J. P. and Cua, C. L. 2010. “Echocardiographic Parameters that Predict Outcome in Aortic Atresia Patients Undergoing Comprehensive Stage II Procedure.” Congenital Heart Disease 5: 409-415. Fields of Study Major Field: Sociology vii Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi Table of Contents ............................................................................................................. viii List of Tables ..................................................................................................................... ix Chapter 1: Introduction ....................................................................................................... 1 Chapter 2: Exposure to Segregation and Health Outcomes in Childhood ........................ 14 Chapter 3: Racial and Ethnic Tensions in the School and Neighborhood Environment: Consequences for Child Physical Health .......................................................................... 46 Chapter 4: Segregation, Family Stress, and Racial Disparities in Childhood Physical Health ................................................................................................................................ 72 Chapter 5: Conclusion....................................................................................................... 97 References ....................................................................................................................... 103 viii List of Tables Table 1: Weighted Descriptive Statistics by First and Last Interview and Race .............. 40 Table 2: Odds Ratios from Logistic Regression of Segregation on Poor Health ............. 41 Table 3: Odds Ratios from Logistic Regression of Segregation on Asthma .................... 42 Table 4: Odds Ratios from Logistic Regression of Segregation on Obesity .................... 43 Table 5: Cumulative Exposure to Segregation by Race in Last Interview ....................... 44 Table 6: Odds Ratios from Logistic Regression of Chronic Exposure to Segregation on Health ................................................................................................................................ 45 Table 7: Weighted Neighborhood, School, and Individual Characteristics, by Race....... 67 Table 8: Odds Ratios from Logistic Regression of Neighborhood and School Contexts on Obesity .............................................................................................................................. 68 Table 9: Odds Ratios from Logistic Regression of Neighborhood and School Contexts on Asthma .............................................................................................................................
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