Racial Disparities in Context: Student-, School-, and County-Level Effects on the Likelihood of Obesity among Elementary School Students

Childhood obesity rates in the United States have risen since the 1980s and are especially high among racial minorities. Researchers document differentials in obesity rates by race, socioeconomic status, school characteristics, and place. In this study, the authors examine the impact of race on the likelihood of obesity at the student, school, and county levels and the interactions between student race and school racial composition. The data are from 74,661 third to fifth grade students in 317 schools in 38 North Carolina counties. Multilevel logistic regression models showed that racial differences in the likelihood of obesity persisted even when racial composition and socioeconomic disadvantage at the school level were controlled. The differences between white and nonwhite students slightly decreased once school-level measures were added. The magnitude of the effects of student-level race on the relative odds of obesity varied according to the racial composition of the school. These student- and school-level results held even when county-level race and socioeconomic variables were controlled. The results show that contextual factors at the school and county levels are important social determinants of racial disparities in the likelihood of childhood obesity.