Research examining the differential access to various resources along racial and ethnic lines is ubiquitous. Certain things are now universally recognized; for example, black and Hispanic citizens are disparately impacted by the availability of supermarkets, healthy food sources, park areas, and walking trails. Such issues of environmental justice can have an obvious impact on health (Hilmers et al. 2012
; Taylor et al. 2006
). Blacks and Hispanics have higher infant death mortality rates and are more likely to be a victim of homicide and homicide by discharge of a firearm (Xu et al. 2018
). Considering this reality, it is not surprising that blacks and Hispanics are specifically and disproportionately represented among the obese compared to non-Hispanic whites (National Center for Health Statistics 2018
What has not been well elucidated is whether exposure to and threat of violence in neighborhoods may influence obesity by further constricting avenues toward a healthy lifestyle or by engendering stress-induced obesity. Such a possibility deserves exploration, as the consequences of obesity can be grave. If there is a discernible nexus, not only are blacks and Hispanics victimized by violence directly more often, but it is reasonable to assume that dwelling in a violence-plagued neighborhood may amplify obesity and its consequences by fostering psychological distress or by cultivating a sedentary, homebound lifestyle. The effect of violent crime on obesity is expected to be especially relevant for black and Hispanic citizens, because they are disproportionately represented in violence-plagued neighborhoods as a direct result of residential segregation, and because they have a greater proclivity than whites to be victims of serious violent crime (Morgan and Truman 2018
To evaluate the above, data are culled from NYC’s 2012 and 2014 Community Health Survey and from other sources to explore whether the violent crime rate moderates the relationship between race, ethnicity, and obesity for 12,645 residents living in 34 New York City neighborhoods, net controls. Multilevel analyses are then performed. Prior to discussing the results, the extant literature, though limited, is presented.
Obesity remains a serious public health concern (Bassett and Perl 2004
). Nearly 35% of adult Americans (78.6 million Americans) ages 20 and older are obese (Ogden et al. 2014
). This obesity problem is by no means isolated to the adult population. Childhood obesity in the U.S. has more than tripled since the 1970s (Fryar et al. 2014
), with nearly 17% of children considered to be obese (Ogden et al. 2014
). Obesity is projected to rise in the immediate future. The number of adult Americans who are considered obese is expected to increase from 35% to around 42% by 2030 (Finkelstein et al. 2012
Obesity is especially problematic for black Americans, as they are 1.4 times more likely than non-Hispanic whites to be obese (National Center for Health Statistics 2012
). Blacks have the highest age-adjusted rate of obesity, at 47.8%, whereas Hispanics are slightly less, at 42.5% (Ogden et al. 2014
). In contrast, non-Hispanic whites are 15 percentage points lower than blacks, at 32.6%, and nearly 10 percentage points lower than Hispanics, regarding the likelihood of being obese. Similar patterns are evident for minority children and young adults. Analyzing data collected from the National Health and Nutrition Examination Survey (NHANES), Ogden et al.
) reports that both Hispanics and non-Hispanic black children between the ages of 2–19 have the highest rates of childhood obesity, 22.4% and 20.2% respectively, compared to 14.1% of Non-Hispanic whites in the same age range. In another important study, Scharoun-Lee et al.
) examined a nationally representative sample of 11,200 young adults with a mean age of 22 years and found that obesity prevalence was highest in minority children, particularly blacks and Hispanics, with the disparity increasing dramatically for these two groups from adolescence to young adulthood.
The health-related problems engendered directly from being obese are vast and profuse. Obesity is known to be associated strongly with cardiovascular diseases such as heart failure, stroke, and coronary heart disease (Nordestgaard et al. 2012
). Additionally, obesity has a direct causal link to a variety of other diseases, such as hypertension, type-II diabetes, arthritis, sleep apnea, depression, and various types of cancer (Graves 2010
). In the most extreme cases, individuals can lose their lives to this disease. (Masters et al. 2013
) report that obesity is associated with nearly 1 in 5 U.S. deaths, which is more than three times previous estimates.
There are also monetary costs associated with obesity. The medical expenses resulting from an obese adolescent between the ages of 11 to 17 is approximately 1098 USD more per year than for a normal-weight adolescent in the same age range (Biener et al. 2014
). Regarding adult obesity, Wang et al.
) report that adult obesity cost states nearly eight billion dollars a year in Medicaid programs. It is estimated that the total cost of health-related issues due to obesity in the U.S. is as much as 147 billion USD a year, or roughly 9% of all medical expenses paid out yearly (Finkelstein et al. 2009
), with this cost expected to increase to upwards of 700 billion USD by 2030 (Wang et al. 2008
Although a variety of factors are adduced in the literature to explain the racial and ethnic disparities in obesity (Baskin 2015
), one causal factor that has not been fully explored is the potential effect of violent crime. This oversight is surprising when one considers that the fear of crime engenders psychological stress (Kliewer 2006
), which, in turn, is associated with obesity (Moore and Cunningham 2012
). The short-term reduction in anxiety, depression, and frustration among those living under chronic, stressful conditions often outweighs the associated concerns of unhealthy behaviors, such as overeating (Jackson et al. 2010
). In fact, “Overeating is an effective, early, well-learned response to chronic environmental stressors that only strengthens over the life course” (Jackson et al. 2010, p. 937
). Living in a violence-plagued neighborhood may also engender obesity by cultivating a more sedentary lifestyle, because people are less apt to be active and leave their homes when they are fearful of being criminally victimized (Bennett et al. 2007
; Burdette et al. 2006
; Gómez et al. 2004
; Weir et al. 2006
Despite these theoretical assertions, and some notable exceptions (Sandy et al. 2013
), most prior research studies typically report only a weak association between violent crime and obesity (Black et al. 2010
; Powell-Wiley et al. 2017
; Sandy et al. 2011
). There is also little research investigating whether violent crime moderates the relationship between race, ethnicity, and obesity. This dearth of research is problematic, as the effect of violent crime on obesity should be greater for black and Hispanic citizens, because they often are compelled to live in violence-plagued neighborhoods due to residential segregation (Massey 2004
). This situation enhances the likelihood that a black or Hispanic resident will become a victim of a serious violent crime. To illustrate, the difference in likelihood of being a crime victim of homicide between blacks and whites is five to one (Lauritsen 2009
). Moreover, even after exposure risk is considered, fear of crime is related positively to victimization risk (Stafford and Galle 1984
). Further elevating the fear of crime among black citizens is that they tend to distrust the police. An analysis of combined data taken from Gallup polls conducted between 2011 to 2014 shows that, while 59% of white citizens have a great deal or quite a lot of confidence in the police, only 37% of black citizens do (Newport 2014
). A negative view of the police has been shown to enhance a person’s fear of crime (Dowler 2003
). Taken together, the actual and perceived risks of living in high-crime neighborhoods while not trusting the authorities charged with protecting residents may cultivate obesity among particularly minority residents via induced stress and by constraining freedom of movement because of fear.
In this study, we use both survey and census data drawn from 34 Neighborhoods in NYC and a multilevel study design to ascertain the strength of the interaction between the race and ethnicity of the survey respondent and the violent crime rate on obesity, net the effects of both micro-level and macro-level control variables. Following the logic articulated above, we theorize that obesity is not determined entirely by a respondent’s race, ethnicity or by the violent crime rate. Rather, a key determinate for predicting obesity is the interaction between a respondent’s race, ethnicity, and a neighborhood’s violent crime rate. The salience of these interactions hinges on the assumption that, if living in a violence-plagued neighborhood increases obesity, it should have an amplified effect on black and Hispanic residents, because they are much more likely than white residents to dwell in crime-ridden neighborhoods and to be victims of serious violent crimes. The primary objective of this study, then, is to test empirically whether a high violent crime rate conditions the relationships between race, ethnicity, and obesity.
4. Hierarchical Generalized Linear Results
A visual inspection of Table 3
reveals that, at the resident level, there are several demographic and health variables that are statistically noteworthy in the equation. Compared to non-Hispanic white residents, black and Hispanic residents have a higher probability of being obese. Survey respondents who are female, ages 25–64, not widowed, less educated, and in the labor force, are also more likely to be obese. In addition, many of the health-related variables included in the equation are of substantive importance. These variables include high blood pressure, general health status, physical activity, smoker, and mental illness. The likelihood of obesity is lower for people with good general health status, who partake regularly in physical activities, and smokers. The likelihood of obesity also tends to be higher for people with high blood pressure and for residents who have been told by their healthcare professional that they have a mental illness.
also shows the results for the effects of the neighborhood-level variables on the likelihood of obesity. If violence is engendering obesity, there is a natural expectation that the likelihood of a resident being obese will be higher in neighborhoods plagued by violent crime. However, despite our assumption, findings reveal a nonconsequential effect of the violent crime rate on the general likelihood of obesity. The small and non-statistically significant effect of the violent crime rate variable in the model can be interpreted as evidence against the position that violent crime is contributing to obesity by fostering resident stress or by cultivating a sedentary lifestyle. A visual examination of Table 3
also shows that none of the aggregate variables have any predictive power in the model.
The results for the black–white and Hispanic–white obesity differentials are also reported in Table 3
. An examination of these models reveals that there is a consequential effect of the violent crime rate on racial and ethnic differences in obesity. Our finding of the moderating effect of the violent crime rate on the black–white and Hispanic–white obesity differentials supports the position that being exposed to violent crime has a greater influence on obesity among black and Hispanic residents. It is important to recognize that just because blacks, Hispanics and whites might live in the same neighborhood plagued by violent crime does not necessarily mean that these racial and ethnic groups have the same likelihood of victimization. Blacks and Hispanics are more apt than whites to be seriously victimized by criminals. The results displayed in Table 3
also reveal that none of the other aggregate variables have any substantive moderating effects.
Although a sizable body of quantitative research on the relationships between race, ethnicity, and obesity has accrued in recent years, the underlying causal factors responsible for the observed racial and ethnic disparities in obesity remains elusive. We argued here that the violent crime rate might not have a direct effect on obesity, as theorized in previous research. Rather, it is plausible that violent crime moderates the relationship between race, ethnicity, and obesity, as blacks and Hispanics have a greater proclivity to live in violence-plagued neighborhoods due to residential segregation. Black and Hispanic residents are also much more apt than whites to be victims of serious violent crime. We proffered that this thesis could be tested empirically by analyzing multilevel data to ascertain whether the violent crime rate explains racial and ethnic differences in obesity. Thus, black and Hispanic residents should be more likely to be obese and have a higher BMI in neighborhoods where the violent crime rate is more pronounced, controlling for other relevant factors related to obesity.
Findings from our multilevel analysis show that, controlling for several theoretically relevant variables, the violent crime rate has a null effect on the likelihood that a person living in one of the 34 neighborhoods in NYC will be obese or have a higher BMI. Residents in neighborhoods with higher levels of violent crime are not more inclined to be obese. However, while there is not a direct relationship between neighborhood violence and obesity, the violent crime rate does appear to condition the relationships between a resident’s race, ethnicity and the likelihood that he or she will be obese. In neighborhoods with a high violent crime rate, we find that black and Hispanic residents are more apt to be obese and have a higher BMI. These effects persist despite the inclusion of both micro-level and macro-level predictors of obesity.
Our results, showing that neighborhood violence amplifies obesity among black and Hispanic residents, underscore the critical importance of considering the possibility that contextual variables have a moderating effect on micro-level variables such as race and ethnicity in explaining obesity. A comprehensive understanding of the racial and ethnic disparities in obesity necessitates the simultaneous consideration of individual and environmental factors, because they may interact with each other to create a situation that produces obesity. The statistically noteworthy effects between the violent crime rate and racial and ethnic differences in obesity have important consequences for future research, as many previous studies on obesity neglected to contemplate the possibility that the violent crime rate influenced blacks and Hispanics differently than whites. Our findings show that the failure to explicitly consider these relationships can be misleading and detract from our understanding of the principal causes of racial and ethnic differences in obesity.
Limitations and Recommendations
A couple of caveats should be contemplated when evaluating the import of our findings. First, although the data gathered by NYC furnished us with an excellent opportunity to investigate the effect of the violent crime rate on racial and ethnic differences in obesity, a question remains as to whether our findings are applicable to other cities. Because we focused on neighborhoods situated in a single city, it is of vital importance for other researchers to conduct similar studies in other cities. If these studies produce similar results, then confidence in the moderating effect of violent crime on the relationships between race, ethnicity, and obesity will be enhanced. Second, despite our inclusion of extensive controls for predicting obesity and BMI, other salient factors may remain inadequately measured or even unspecified. For instance, although our analyses show that the violent crime rate conditions the relationships between race, ethnicity, and obesity, the precise mechanisms linking these variables remain elusive. It is conceivable that stress influences obesity. For example, as violence rises in a neighborhood, black and Hispanic citizens may increasingly perceive that they have a greater likelihood of becoming a crime victim. Yet, because of data constraints, we are unable to directly measure fear of crime among black, Hispanic and white residents in our study. Consequently, such theorizing remains merely speculative in the absence of attitudinal survey data.
Adequate access to venues and opportunities for making healthy lifestyle choices that attenuate obesity are diminished for blacks and Hispanics, as initially pointed out. We did evaluate daily physical activity and other variables, such as whether the respondent drank daily sodas, but this may not be enough for adequate controls in the analysis. Future research may wish to rectify this problem, although other datasets with this type of information would need to be identified.