title: School-level economic disadvantage and obesity in middle school children in central Texas, USA: a cross-sectional study.
abstract: BACKGROUND
  Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students.
  
  
  METHODS
  Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender.
  
  
  RESULTS
  Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (OR(Adj) =3.4, 95% CI: 1.1-11.4), Hispanic (OR(Adj)=1.8, 95% CI 1.1-3.0) and White (OR(Adj)=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity differences across school ED categories were found for Hispanic Spanish-speaking students, Hispanic English-speaking students (HES) attending high ED schools were 2.4 times more likely to be obese as HES students at low ED schools (p=.003).
  
  
  CONCLUSIONS
  Findings support the need to prioritize economically disadvantaged schools for obesity prevention efforts and support further exploration of school SES context in shaping children’s physical activity and dietary behaviors.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Springer
authors.forename: Linlin
authors.initials: L
authors.lastname: Li
authors.forename: Nalini
authors.initials: N
authors.lastname: Ranjit
authors.forename: Joanne
authors.initials: J
authors.lastname: Delk
authors.forename: Kajal
authors.initials: K
authors.lastname: Mehta
authors.forename: Steven H
authors.initials: SH
authors.lastname: Kelder
mesh_terms: D000293:Adolescent; D001741:Black or African American; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D011203:Poverty; D044469:Racial Groups; D012574:Schools; D012923:Social Class; D013781:Texas / Q000453:epidemiology; D044465:White People