Social, Environmental and Policy Influences on Health Research Lab

Health Equity Institute 

• Dr. Laura Mamo, PhD
  • Professor, Public Health and Health Equity Institute

Institute for Geographic Information Science (IGIS)

• Jerry Davis, Ph.D
  • Professor, School of the Environment
• Chloe Martin, M.A.
  • GISc Analyst/Consultant, Academic Coordinator for GIS Certificate Program

Department of Sociology & Sexuality Studies

• Dr. Rita Meléndez, PhD
  • Department Chair and Professor, Department of Sociology & Sexuality Studies

Department of Elementary Education

• Maria Zavala, PhD
  • Associate Professor, Elementary Education

Drexel University

• Brisa N. Sánchez, Ph.D.
  • Professor, Department of Epidemiology and Biostatistics

Johns Hopkins Bloomberg School of Public Health

• Mika Matsuzaki, Ph.D.
  • Assistant Professor, International Health and Human Nutrition

Center for Health Equity, University of California San Francisco

• Paula Braveman, MD, MPH
  • Professor, UCSF School of Medicine

Chicago Queer Latine Collaborative (CQL)

• Pedro Serrano
  • President Co-Chair Officer of the Board of Directors
• Alfredo Flores
  • Co-Founding Partner
• Juan Martinez
  • Community Health Partner

Racial, ethnic and socioeconomic health disparities often are shaped by environmental and social factors. Below are examples of the SoEPI lab's research related to this topic.

Publications

• Temporal Patterns in Fruit and Vegetable Intake Among Racially and Ethnically Diverse Children and Adolescents in California
  • Abstract: Childhood dietary behaviors, including fruit and vegetable intake, are associated with adult health. Most children do not meet daily recommended servings of fruits and vegetables. Less is known about temporal patterns in fruit and vegetable consumption or if they vary by race and ethnicity. We investigated temporal patterns in fruit and vegetable intake among California school-age children and adolescents overall and by race and ethnicity. We used 2-year cross-sectional datasets from the child and adolescent samples in the California Health Interview Surveys from 2011-2012 through 2019-2020 and modified Poisson regression models to estimate the likelihood of consuming 5 or more servings of fruits and vegetables in 2013-2016 and 2017-2020 compared with 2011-2012. Models controlled for age, race and ethnicity, gender, citizenship status, family income, and adult education and tested for differences by race and ethnicity. The samples included 16,125 children aged 5 to 11 years and 9,672 adolescents aged 12 to 17 years. Overall, 29.3% of children and 25.9% of adolescents reported intake of 5 or more fruits and vegetables per day. Among children, adjusted prevalence ratios (PR) of fruit and vegetable intake were higher in 2013-2016 (PR,1.25; 95% CI, 1.11-1.42) and 2017-2020 (PR,1.13; 95% CI, 0.99-1.30) compared with 2011-2012. Among adolescents, the adjusted prevalence did not differ significantly over time. We found no evidence of differential associations by race and ethnicity for children and adolescents. We found favorable temporal changes in fruit and vegetable consumption among children, but not among adolescents. Monitoring temporal patterns in fruit and vegetable intake remains critical for planning population-level interventions to increase consumption.
• Trends in school-neighborhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California
  • Abstract: It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States. We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models. Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients. The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.

The health of an individual can greatly vary by geographical location, suggesting powerful environmental influences on health. Below are examples of the SoEPI lab's research related to this topic.

Publications

• Food environment near schools and body weight-A systematic review of associations by race/ethnicity, gender, grade, and socio-economic factors
  • Abstract: Previous research reported modest associations between food environments near schools and adiposity among children overall. The associations within sociodemographic subgroups have not been synthesized. This review assessed the evidence on the associations between food environments near schools and childhood obesity within different demographic and socio-economic subgroups. PubMed and Scopus databases were searched to identify studies published in English between January 1, 1980, and April 25, 2019, examining the presence of fast food outlets, convenience stores, supermarkets, and grocery stores near schools and measures of overweight/obesity by race/ethnicity, gender, grade, and income level. Twelve cross-sectional and two ecological studies were included. Fast food outlets were most commonly examined (n = 12). The associations between fast food outlets near schools and obesity were generally positive among Latino, white, and African American students and across grade levels, although the strengths of evidence varied. The directions of association were mixed among Asian children. Three studies reported generally positive associations between convenience stores and obesity among Latino and African American children and mixed associations among white and Asian children. Longitudinal studies are needed in addition to studies examining underlying mechanisms of the differential influence of food environments near schools within each subgroup.
• Changes in Fast Food Outlet Availability Near Schools: Unequal Patterns by Income, Race/Ethnicity, and Urbanicity
  • Abstract: Previous research has observed income or racial/ethnic inequalities in fast food restaurant (FFR) availability near schools. The purpose of this study was to investigate changes in FFR availability near schools between 2000 and 2010 by school-neighborhood income, race/ethnicity and urbanicity. Using data from 7,466 California public schools, negative binomial regression models estimated relative ratios to evaluate the income gradient in FFR availability, examine differences in the income gradient in FFR availability between 2000 and 2010, and investigate if FFR availability changed in 2010 versus 2000, stratified by race/ethnicity and urbanicity. Analyses were conducted in 2018 and early 2019. In urban areas, there was a negative school-neighborhood income gradient in FFR availability in both 2000 and 2010, and across all race/ethnic groups, except majority African American schools. The income gradient in FFR availability was steeper in 2010 relative to 2000 among Latino majority urban schools. FFR availability increased in 2010 relative to 2000 among majority African American, majority Latino, and majority Asian schools in the least affluent neighborhoods. Among majority white schools in similar neighborhoods FFR did not change, but declined in the most affluent school neighborhoods. In non-urban areas, the income patterns in FFR availability were less clear, and FFR availability increased among majority white and Latino schools within the middle neighborhood income tertile. These findings suggest the need for future interventions to target schools in low-income urban neighborhoods. Additionally, reducing child health disparities and improving health for all children requires monitoring changes in the food environment near schools.

Health policies target an entire population, while interventions focus on changing behavioral outcomes among specific populations. Below are examples of the SoEPI lab's research related to this topic.

Publications

• "Competitive" Food and Beverage Laws and Obesity Among Diverse Youth in California High Schools
  • Abstract: To investigate associations between the California "competitive" food and beverage (CF&B) laws and overweight/obesity (OV/OB) among high school youth by gender, school-neighborhood income, and race/ethnicity, and to examine racial/ethnic OV/OB disparities before and after CF&B policies. Using an interrupted time series design paired with retrospective cross-sectional Fitnessgram data from 3,565,260 youth-level records on ninth-grade students in California public schools, we estimated gender, school-neighborhood income, and racial/ethnic OV/OB prevalence trends before (2002-2007) and after the CF&B policies were in effect (2008-2012). In the period before the CF&B policies, OV/OB prevalence increased annually among the majority of subgroups regardless of gender, school-neighborhood income and race/ethnicity. In the period after the policies took place, OV/OB increased at a slower rate, plateaued or declined. Changes in log odds of OV/OB trends ranged from -0.03 to -0.07. In the period before the CF&B policies, OV/OB disparities widened between African American and Latino versus White males within each school-neighborhood income tertile; afterwards, disparities ceased to increase or slightly narrowed. The California CF&B laws for high schools are associated with favorable trends in youth OV/OB. This is the first study to examine these associations among multiple socio-demographically diverse high school youth simultaneously considering gender, school-neighborhood income and race/ethnicity. The degree to which observed changes in OV/OB trends are attributable to CF&B policies is unclear. Nevertheless, the results suggest that strengthening CF&B policies may help further reduce OV/OB among youth of different genders and ethnicities in schools across neighborhoods of varying income levels.
• "Competitive" food and beverage policies and weight status: A systematic review of the evidence among sociodemographic subgroups
  • Abstract: Prior studies identified variable associations between competitive food and beverage policies (CF&B) and youth obesity, potentially due to differences across population subgroups. This review summarizes the evidence on associations between CF&B policies and childhood obesity within gender, grade level/ age, race/ethnicity, and/or socioeconomic levels. PubMed, EMBASE, CINAHL, and ERIC database searches identified studies published in English in Canada and the United States between January 1, 2000, and February 28, 2022. Of the 18 selected studies, six were cross-sectional, two correlational, nine were before/after designs, and one study utilized both a cross-sectional and pre-post design. Twelve studies reported findings stratified by a single sociodemographic factor, with grade level/age as the most frequently reported. Although the evidence varied, greater consistency in direction of associations and strengths of evidence were seen among middle school students. Six studies reported findings jointly by multiple sociodemographic subgroups with evidence suggesting CF&B associations with slower rate of increase or plateaus or declines in obesity among multiple subgroups, though the strengths of evidence varied. Over the past two decades, there have been relatively limited subgroup analyses on studies about CF&B policies and childhood obesity. Studies are needed with stronger designs and analyses disaggregated, particularly by race/ethnicities and socioeconomic factors, across places and time.
• School nutrition laws in the US: do they influence obesity among youth in a racially/ethnically diverse state?
  • Abstract: Little is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States' national policy "Healthy Hunger Free Kids Act" (HHFKA) on childhood OV/OB and racial/ethnic disparities. An interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002-2004); when only California policies were in effect (2005-2012); and when they were in effect simultaneously with HHFKA (2013-2016).Before the state's policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from -0.08 to -0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (-0.08 to -0.02, all p < 0.05) followed by Latino children (-0.06 to -0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large. State and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.