Abstract: Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.
Keywords: obesity; disparities; small-area analysis; multilevel regression; targeted interventions
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D'Agostino-McGowan, L.; Gennarelli, R.L.; Lyons, S.A.; Goodman, M.S. Using Small-Area Analysis to Estimate County-Level Racial Disparities in Obesity Demonstrating the Necessity of Targeted Interventions. Int. J. Environ. Res. Public Health 2014, 11, 418-428.
D'Agostino-McGowan L, Gennarelli RL, Lyons SA, Goodman MS. Using Small-Area Analysis to Estimate County-Level Racial Disparities in Obesity Demonstrating the Necessity of Targeted Interventions. International Journal of Environmental Research and Public Health. 2014; 11(1):418-428.
D'Agostino-McGowan, Lucy; Gennarelli, Renee L.; Lyons, Sarah A.; Goodman, Melody S. 2014. "Using Small-Area Analysis to Estimate County-Level Racial Disparities in Obesity Demonstrating the Necessity of Targeted Interventions." Int. J. Environ. Res. Public Health 11, no. 1: 418-428.