Introduction
Structural racism has attracted increasing interest as an explanation for racial disparities
in health, including differences in adiposity. Structural racism has been measured
most often with single-indicator proxies (e.g., housing discrimination), which may
leave important aspects of structural racism unaccounted for. This paper develops
a multi-indicator scale measuring county structural racism in the U.S. and evaluates
its association with BMI.
Methods
County structural racism was estimated with a confirmatory factor model including
indicators reflecting education, housing, employment, criminal justice, and health
care. Using Behavioral Risk Factor Surveillance Survey data (2011–2012) and a mixed-effects
model, individual BMI was regressed on county structural racism, controlling for county
characteristics (mean age, percentage black, percentage female, percentage rural,
median income, and region). Analysis occurred 2017–2019.
Results
The study included 324,572 U.S. adults. A 7-indicator county structural racism model
demonstrated acceptable fit. County structural racism was associated with lower BMI.
Structural racism and black race exhibited a qualitative interaction with BMI, such
that racism was associated with lower BMI in whites and higher BMI in blacks. In a
further interaction analysis, county structural racism was associated with larger
increases in BMI among black men than black women. County structural racism was associated
with reduced BMI for white men and no change for white women.
Conclusions
The results confirm structural racism as a latent construct and demonstrate that structural
racism can be measured in U.S. counties using publicly available data with methods
offering a strong conceptual underpinning and content validity. Further study is necessary
to determine whether addressing structural racism may reduce BMI among blacks.
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Article info
Publication history
Published online: August 27, 2020
Identification
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© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
