Skip to main content

Advertisement

Log in

Separate and Sick: Residential Segregation and the Health of Children and Youth in Metropolitan Statistical Areas

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

The purpose of this study was to better understand residential segregation and child/youth health by examining the relationship between a measure of Black-White residential segregation, the index of dissimilarity, and a suite of child and youth health measures in 235 U.S. metropolitan statistical areas (MSAs). MSAs are urban areas with a population of 50,000 or more and adjacent communities that share a high degree of economic and social integration. MSAs are defined by the Office of Management and Budget. Health-related measures included child mortality (CDC WONDER), teen births (NCHS natality data), children in poverty (SAIPE program), and disconnected youth (Measure of America). Simple linear regression and two-level hierarchical linear regression models, controlling for income, total population, % Black, and census region, examined the association between segregation and Black health, White health, and Black-White disparities in health. As segregation increased, Black children and youth had worse health across all four measures, regardless of MSA total and Black population size. White children and youth in small MSAs with large Black populations had worse levels of disconnected youth and teen births with increasing segregation, but no associations were found for White children and youth in other MSAs. Segregation worsened Black-White health disparities across all four measures, regardless of MSA total and Black population size. Segregation adversely affects the health of Black children in all MSAs and White children in smaller MSAs with large Black populations, and these effects are seen in measures that span all of childhood. Residential segregation may be an important target to consider in efforts to improve neighborhood conditions that influence the health of families and children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rossen LM, Schoendorf KC. Trends in racial and ethnic disparities in infant mortality rates in the United States, 1989–2006. Am J Public Health. 2014;104(8):1549–56.

    Article  PubMed  PubMed Central  Google Scholar 

  2. National Center for Health S. Health, United States. In: Health, United States, 2015: with special feature on racial and ethnic health disparities. Hyattsville (MD): National Center for Health Statistics (US), 2016.

  3. Zeng C, Wen W, Morgans AK, Pao W, Shu X-O, Zheng W. Disparities by race, age, and sex in the improvement of survival for major cancers. JAMA Oncology. 2015;1(1):88–96.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Centers for Disease Control and Prevention U. Health disparities experienced by black or African Americans—United States. MMWR: Morb Mortal Wkly Rep. 2005;54(1):1–3.

    Google Scholar 

  5. Diez Roux AV. Neighborhoods and health: where are we and were do we go from here? Rev Epidemiol Sante Publique. 2007;55(1):13–21.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kawachi I, Berkman LF. Neighborhoods and health: Oxford, UK: Oxford University Press; 2003.

  7. Massey DS, Denton NA. The dimensions of residential segregation. Social Forces. 1988;67(2):281–315.

    Article  Google Scholar 

  8. Cutler David M, Glaeser Edward L, Vigdor Jacob L. The rise and decline of the American ghetto. J Polit Econ. 1999;107(3):455–506.

    Article  Google Scholar 

  9. Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31(1):178–94.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Williams DR. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit. The Milbank Quarterly. 2002;80(4):677–707.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol. 2007;58(1):201–25.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Massey DS, Rothwell J, Domina T. The changing bases of segregation in the United States. Ann Am Acad Polit Soc Sci. 2009;626(1):74–90.

    Article  Google Scholar 

  14. Bird ST. Separate black and white infant mortality models: differences in the importance of structural variables. Soc Sci Med. 1995;41(11):1507–12.

    Article  CAS  PubMed  Google Scholar 

  15. Polednak AP. Black-white differences in infant mortality in 38 standard metropolitan statistical areas. Am J Public Health. 1991;81(11):1480–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. LaVeist TA. Segregation, poverty, and empowerment: health consequences for African Americans. The Milbank Quarterly. 1993;71:41–64.

    Article  CAS  PubMed  Google Scholar 

  17. Collins CA. Racism and health: segregation and causes of death amenable to medical intervention in major U.S. cities. Ann N Y Acad Sci. 1999;896(1):396–8.

    Article  CAS  PubMed  Google Scholar 

  18. Hart KD, Kunitz SJ, Sell RR, Mukamel DB. Metropolitan governance, residential segregation, and mortality among African Americans. Am J Public Health. 1998;88(3):434–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jackson SA, Anderson RT, Johnson NJ, Sorlie PD. The relation of residential segregation to all-cause mortality: a study in black and white. Am J Public Health. 2000;90(4):615–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Polednak AP. Poverty, residential segregation, and black/white mortality ratios in urban areas. J Health Care Poor Underserved. 1993;4(4):363–73.

    Article  CAS  PubMed  Google Scholar 

  21. Osypuk TL, Acevedo-Garcia D. Are racial disparities in preterm birth larger in Hypersegregated areas? Am J Epidemiol. 2008;167(11):1295–304.

    Article  PubMed  Google Scholar 

  22. Ig E. Is segregation bad for your health? The case of low birth weight [with comments]. Brookings-Wharton Papers on Urban Affairs. 2000;203

  23. Grady SC. Racial disparities in low birthweight and the contribution of residential segregation: a multilevel analysis. Soc Sci Med. 2006;63(12):3013–29.

    Article  PubMed  Google Scholar 

  24. Bell JF, Zimmerman FJ, Almgren GR, Mayer JD, Huebner CE. Birth outcomes among urban African-American women: a multilevel analysis of the role of racial residential segregation. Soc Sci Med. 2006;63(12):3030–45.

    Article  PubMed  Google Scholar 

  25. Masi CM, Hawkley LC, Harry Piotrowski Z, Pickett KE. Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population. Soc Sci Med. 2007;65(12):2440–57.

    Article  PubMed  Google Scholar 

  26. Fang J, Madhavan S, Bosworth W, Alderman MH. Residential segregation and mortality in New York City. Soc Sci Med. 1998;47(4):469–76.

    Article  CAS  PubMed  Google Scholar 

  27. Hutchinson RN, Putt MA, Dean LT, Long JA, Montagnet CA, Armstrong K. Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia. Soc Sci Med. 2009;68(10):1859–65.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch SM. Residential segregation and Latino, Black and White mortality in New York City. J Urban Health. 2006;83(3):406–20.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Acevedo-Garcia D, McArdle N, Osypuk T, Lefkowitz B, Krimgold B. Children left behind. Boston, MA: Center for Advancement of Health at Harvard School of Public Health;2007.

  30. Phillips DA, Shonkoff JP. From neurons to neighborhoods: the science of early childhood development: Washington, DC: National Academies Press; 2000.

  31. Francesconi M. Adult outcomes for children of teenage mothers. Scand J Econ. 2008;110(1):93–117.

    Article  Google Scholar 

  32. Wood D. Effect of child and family poverty on child health in the United States. Pediatrics. 2003;112(3 Part 2):707–11.

    PubMed  Google Scholar 

  33. Lewis K, Burd-Sharps S. Zeroing in on place and race. Brooklyn, NY: Measure of America, 2015.

  34. Besharov DJ, Gardiner KN. Preventing youthful disconnectedness. Child Youth Serv Rev. 1998;20(9):797–818.

    Article  Google Scholar 

  35. Tandon SD, Marshall B, Templeman AJ, Sonenstein FL. Health access and status of adolescents and young adults using youth employment and training programs in an urban environment. J Adolesc Health. 43(1):30–7.

  36. Vancea M, Utzet M. How unemployment and precarious employment affect the health of young people: a scoping study on social determinants. Scand J Public Health. 2017;45(1):73–84.

    Article  PubMed  Google Scholar 

  37. Morrell SL, Taylor RJ, Jobless KCB. Unemployment and young people’s health. Med J Aust. 1998;168(5):236–40.

    Article  CAS  PubMed  Google Scholar 

  38. Office of Management and Budget. 2010 standards for delineating metropolitan and micropolitan statistical areas. Fed Regist. 2010;75(23):37245–52.

    Google Scholar 

  39. Osypuk TL, Galea S. What level macro? Choosing appropriate levels to assess how place influences population health. In: Macrosocial determinants of population health. p. 399–435.

  40. Powell LM, Chaloupka FJ, Bao Y. The availability of fast-food and full-service restaurants in the United States: associations with neighborhood characteristics. Am J Prev Med. 2007;33(4, Supplement):S240–5.

    Article  PubMed  Google Scholar 

  41. Powell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96(9):1676–80.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44(3):189–95.

    Article  PubMed  Google Scholar 

  43. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.

    PubMed  PubMed Central  Google Scholar 

  44. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351(6):575–84.

    Article  CAS  PubMed  Google Scholar 

  45. Lurie N, Buntin MB. Health disparities and the quality of ambulatory care. N Engl J Med. 2002;347(21):1709–10.

    Article  PubMed  Google Scholar 

  46. Smith DB, Feng Z, Fennell ML, Zinn JS, Mor V. Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes. Health Aff. 2007;26(5):1448–58.

    Article  Google Scholar 

  47. Morello-Frosch R, Shenassa ED. The environmental ‘riskscape’ and social inequality: implications for explaining maternal and child health disparities. Environ Health Perspect. 2006;114(8):1150–3.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Morello-Frosch R, Lopez R. The riskscape and the color line: examining the role of segregation in environmental health disparities. Environ Res. 2006;102(2):181–96.

    Article  CAS  PubMed  Google Scholar 

  49. Chang VW. Racial residential segregation and weight status among US adults. Soc Sci Med. 2006;63(5):1289–303.

    Article  PubMed  Google Scholar 

  50. Bower KM, Thorpe RJ, Yenokyan G, McGinty EEE, Dubay L, Gaskin DJ. Racial residential segregation and disparities in obesity among women. J Urban Health. 2015;92(5):843–52.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hunt MO, Wise LA, Jipguep M-C, Cozier YC, Rosenberg L. Neighborhood racial composition and perceptions of racial discrimination: evidence from the black women’s health study. Soc Psychol Q. 2007;70(3):272–89.

    Article  Google Scholar 

  52. LaVeist TA. Segregation, poverty, and empowerment: health consequences for African Americans. The Milbank Quarterly. 1993;71(1):41–64.

    Article  CAS  PubMed  Google Scholar 

  53. LaVeist TA. The political empowerment and health status of African-Americans: mapping a new territory. Am J Sociol. 1992;97(4):1080–95.

    Article  Google Scholar 

  54. Clampet-Lundquist S, Massey Douglas S. Neighborhood effects on economic self-sufficiency: a reconsideration of the moving to opportunity experiment. Am J Sociol. 2008;114(1):107–43.

    Article  Google Scholar 

  55. Acevedo-Garcia D, Osypuk TL, McArdle N, Williams DR. Toward a policy-relevant analysis of geographic and racial/ethnic disparities in child health. Health Aff. 2008;27(2):321–33.

    Article  Google Scholar 

Download references

Acknowledgments

This project was financially sponsored by the University of Wisconsin School of Medicine and Public Health, the Herman and Gwendolyn Shapiro Foundation, and the University of Wisconsin Department of Population Health Sciences. The sponsor played no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the article; or in the decision to submit it for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Keith P. Gennuso.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kotecki, J.A., Gennuso, K.P., Givens, M.L. et al. Separate and Sick: Residential Segregation and the Health of Children and Youth in Metropolitan Statistical Areas. J Urban Health 96, 149–158 (2019). https://doi.org/10.1007/s11524-018-00330-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-018-00330-4

Keywords

Navigation