Racial and ethnic health disparities among fifth-graders in three cities.
BACKGROUND
For many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence.


METHODS
We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child's school) using partially adjusted models.


RESULTS
There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child's school were the most substantial mediators of racial and ethnic disparities.


CONCLUSIONS
We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.).
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA 02115, USA. mark.schuster@childrens.harvard.edu
Mark A
MA
Schuster
Marc N
MN
Elliott
David E
DE
Kanouse
Jan L
JL
Wallander
Susan R
SR
Tortolero
Jessica A
JA
Ratner
David J
DJ
Klein
Paula M
PM
Cuccaro
Susan L
SL
Davies
Stephen W
SW
Banspach
D001741:Black or African American / Q000706:statistics & numerical data*; D058445:Bullying; D002648:Child; D015444:Exercise; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011788:Quality of Life; D012044:Regression Analysis; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population; D014754:Violence / Q000208:ethnology / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*