Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis

PURPOSE: This study assessed the contribution of neighborhood poverty, measured at the census tract level, to the risk of male-to-female and female-to-male partner violence (MFPV, FMPV) among white, black, and Hispanic couples in the United States. METHODS: As part of the 1995 National Alcohol Survey, a representative sample of married/cohabiting couples was obtained through a multistage, multicluster household probability sampling frame. The outcome variables, MFPV and FMPV, were measured through the Conflict Tactics Scale, Form R. Sociodemographic, psychosocial, and alcohol consumption covariates that were statistically significant through bivariate analysis were retained as individual-level predictors. Neighborhood poverty, indicating residence in a census tract where greater than 20% of the population lived below the Federal poverty line, was assessed by appending 1990 Census data to the primary data set. Multilevel logistic regression models were constructed, with separate analyses performed for each outcome (MFPV, FMPV) among the white, black, and Hispanic couples. RESULTS: Couples residing in impoverished neighborhoods are at increased risk for both MFPV and FMPV. The association between residence in an impoverished neighborhood and MFPV was statistically significant for black couples (Odds Ratio [OR] 2.87; 95% Confidence Interval [CI] 1.36, 6.07). The association between residence in an impoverished neighborhood and FMPV was statistically significant for black couples and white couples. CONCLUSIONS: Characteristics of the socioenvironment, such as neighborhood poverty, are associated with the risk of partner violence, particularly among black couples. Policies aimed at reducing community poverty may contribute to effective partner violence prevention strategies.     

Homicide risk across race and class: a small-area analysis in Massachusetts and Rhode Island

Areas with higher absolute poverty and higher income inequality have been associated with higher risk of homicide victimization. In addition, studies of differential homicide rates have indicated that black persons are at a higher risk of homicide compared to white persons. However, few studies directly compared risk of homicide offending or victimization between Hispanic persons and non-Hispanic white persons, and few studies have attempted to examine the interaction between race and residential neighborhood socioeconomic measures on homicide risk. This population-based retrospective study comprised all white, black, and Hispanic 15-to 44-year-old men included in the 1990 US Census as Rhode Island or Massachusetts residents. Vital statistics registries were linked to 1990 US Census data to provide information on small-area characteristics. Overall, we observed a trend of increasing homicide risk as block-group socioeconomic position descended. The data indicated that block-group poverty, female-headed households, home ownership, and higher education were all strongly associated with homicide risk after stratifying by race and age of victim and adjusting for other block-group socioeconomic characteristics. Race was a strong modifier for absolute risk difference for the relation between risk of homicide and socioeconomic surroundings. Our analyses suggested that area-based interventions that would improve neighborhood social and economic conditions would be effective in decreasing risk of homicide for men.     

Neighborhood socioeconomic status,maternal race and preterm delivery: a case-control study

PURPOSE: To explore associations between neighborhood socioeconomic context and preterm delivery, independent of maternal and family socioeconomic status, in African-American and white women. METHODS: A case-control study of African-American (n = 417) and white (n = 1244) women delivering infants at the University of California, San Francisco's Moffitt Hospital, between 1980 and 1990. RESULTS: Neighborhood socioeconomic contexts were associated with preterm delivery but associations were non-linear and varied with race/ethnicity. For African-American women, living in a neighborhood with either high or low median household income was associated with an increased risk of spontaneous preterm delivery, as was living in a neighborhood with large increases or decreases in the proportion of African-American residents during the study decade. Residence in neighborhoods with high and low rates of male unemployment was associated with a decreased risk of preterm delivery. Among white women only large positive and negative changes in neighborhood male unemployment were associated with risk of preterm delivery. CONCLUSIONS: Neighborhood factors and changes in neighborhoods over time are related to preterm delivery, although the mechanisms linking local environments to maternal risk remain to be specified.     

Place matters: variation in the black/white very preterm birth rate across U.S. metropolitan areas, 2002-2004

OBJECTIVE: We reported on the distribution of very preterm (VPT) birth rates by race across metropolitan statistical areas (MSAs). METHODS: Rates of singleton VPT birth for non-Hispanic white, non-Hispanic black, and Hispanic women were calculated with National Center for Health Statistics 2002-2004 natality files for infants in 168 MSAs. Subanalysis included stratification by parity, age, smoking, maternal education, metropolitan size, region, proportion of MSA that was black, proportion of black population living below the poverty line, and indices of residential segregation. RESULTS: The mean metropolitan-level VPT birth rate was 12.3, 34.8, and 15.7 per 1,000 live births for white, black, and Hispanic women, respectively. There was virtually no overlap in the white and black distributions. The variation in mean risk across cities was three times greater for black women compared with white women. The threefold disparity in mean rate, and two- to threefold increased variation as indicated by standard deviation, was maintained in all subanalyses. CONCLUSION: Compared with white women, black women have three times the mean VPT birth risk, as well as three times the variance in city-level rates. The racial disparity in VPT birth rates was composed of characteristics that were constant across MSAs, as well as factors that varied by MSA. The increased sensitivity to place for black women was unexplained by measured maternal and metropolitan factors. Understanding determinants of differences in both the mean risk and the variation of risk among black and white women may contribute to reducing the disparity in risk between races.     

Neighborhood Disadvantage Measures and COVID-19 Cases in Boston, 2020

ObjectiveUnderstanding the pattern of population risk for coronavirus disease 2019 (COVID-19) is critically important for health systems and policy makers. The objective of this study was to describe the association between neighborhood factors and number of COVID-19 cases. We hypothesized an association between disadvantaged neighborhoods and clusters of COVID-19 cases.MethodsWe analyzed data on patients presenting to a large health care system in Boston during February 5–May 4, 2020. We used a bivariate local join-count procedure to determine colocation between census tracts with high rates of neighborhood demographic characteristics (eg, Hispanic race/ethnicity) and measures of disadvantage (eg, health insurance status) and COVID-19 cases. We used negative binomial models to assess independent associations between neighborhood factors and the incidence of COVID-19.ResultsA total of 9898 COVID-19 patients were in the cohort. The overall crude incidence in the study area was 32 cases per 10 000 population, and the adjusted incidence per census tract ranged from 2 to 405 per 10 000 population. We found significant colocation of several neighborhood factors and the top quintile of cases: percentage of population that was Hispanic, non-Hispanic Black, without health insurance, receiving Supplemental Nutrition Assistance Program benefits, and living in poverty. Factors associated with increased incidence of COVID-19 included percentage of population that is Hispanic (incidence rate ratio [IRR] = 1.25; 95% CI, 1.23-1.28) and percentage of households living in poverty (IRR = 1.25; 95% CI, 1.19-1.32).ConclusionsWe found a significant association between neighborhoods with high rates of disadvantage and COVID-19. Policy makers need to consider these health inequities when responding to the pandemic and planning for subsequent health needs.     

Neighborhood Gun Violence and Birth Outcomes in Chicago

Objectives

To examine the association between gun violence and birth outcomes among women in Chicago.

Methods

Using a 5-year set of birth files (2011–2015) merged with census and police data, birth outcomes including low birth weight (LBW, BW < 2500 g), preterm birth (PTB, < 37 weeks gestation), and small-for-gestational-age (SGA, BW < 10th percentile) were examined among non-Hispanic (NH) white, NH black, and Hispanic women in Chicago. Gun violence rates were categorized into tertiles. Multilevel, multiple logistic regression examined the effects of gun violence and race/ethnicity on birth outcomes.

Results

Of 175,065 births, 10.6% of LBW, 10.6% of PTB, and 9.1% of SGA occurred in high violence tertile. Using white women in low violence tertile as reference, the OR for LBW among black women ranged 1.9–2.1 across all tertiles, and 0.8–1.2 among Hispanic women. OR for PTB for black women were 1.6–1.7 and 1.0–1.2 for Hispanic women, and OR for SGA for black women were 1.6–1.7 and for Hispanic women 0.9–1.0.

Conclusions for Practice

In Chicago, race/ethnicity was associated with birth outcomes, regardless of the level of exposure to gun violence, in 2011–2015. The differences in racial/ethnic composition across the violence exposure levels suggest that, rather than gun violence alone, residential segregation and the geographic inequities likely contribute to disparate birth outcomes.

     

Demographic correlates of HIV testing, high-risk behaviors, and condom/STD consultation among a multi-ethnic sample of women

BACKGROUND: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women. METHODS: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted. RESULTS: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education,income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast. CONCLUSIONS: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.     

Individual versus neighborhood socioeconomic status and race as predictors of adolescent ambulatory blood pressure and heart rate

Socioeconomic status (SES) disparities are linked to increased cardiovascular disease risk. Although typically considered an individual or family indicator, SES alternatively can be derived from neighborhood characteristics. Previous research has found both family and neighborhood SES predict laboratory blood pressure responses in youth. The question remains as to whether this SES gradient predicts blood pressure during daily living situations. We evaluated individual versus neighborhood SES and race as predictors of ambulatory blood pressure and heart rate. Participants were recruited from two schools in Pittsburgh, diverse in terms of both race and SES. Adolescents' (N=212, 14.5 years, 50% black) cardiovascular responses were measured at school and home. Individual (parent education, household income) and neighborhood SES indices (derived from 78 census tracts: percentage with high school degree or less, percentage below poverty) were assessed. A neighborhood index of race based on the proportion of blacks in the census tract was also derived as a counterpart to individuals' race. Multi-level modeling indicated neighborhood income predicted systolic blood pressure. Individual race predicted diastolic blood pressure. Individual income and education, and neighborhood race each predicted heart rate. These results have important public health implications as they suggest individual and neighborhood SES and race are linked to cardiovascular risk disparities as early as adolescence.     

Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women--United States, 1991-1997

In the United States in 1997, the Hispanic, Asian/Pacific Islander, and American Indian/ Alaska Native population represented 16% of all reproductive-age women (aged 15-49 years) but accounted for 23.5% of all live births (1,2). Although statistics by race/ethnicity are available for maternal deaths (3), pregnancy-related mortality ratios (PRMRs) have been reported regularly only for black and white women. Pregnancy-related deaths in Hispanic women have been studied (4); however, combining pregnancy-related mortality risk among Asians/Pacific Islanders and American Indians/Alaska Natives into an "other" category masks differences in their health status. This report presents PRMRs among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women in the United States during 1991-1997. The findings indicate that these groups have higher PRMRs than non-Hispanic white (white) women and lower ratios than non-Hispanic black (black) women and underscore the need for targeted interventions that address the maternal health needs of racial/ethnic minority women.     

Environment, obesity, and cardiovascular disease risk in low-income women

BACKGROUND: Financially disadvantaged populations are more likely to live in communities that do not support healthy choices. This paper investigates whether certain characteristics of the built environment are associated with obesity or coronary heart disease (CHD) risk among uninsured low-income women. METHODS: Using a sample of 2001-2002 data from 2692 women enrolled in the WISEWOMAN program of the Centers for Disease Control and Prevention, the study team performed regression analysis (conducted in January-April 2005) to estimate body mass index (BMI) and the log of 10-year CHD risk as a function of the built environment and socioecologic measures. RESULTS: For women living in an environment of maximum mixed land use (i.e., an environment more conducive to healthy living), BMI was lower by 2.60 kg/m2 and CHD risk was lower by 20% than for women living in single-use uniform environments (i.e., environments less conducive to healthy living). An additional fitness facility per 1000 residents was associated with BMI and CHD risk that were lower by 1.39 kg/m2 and 15.1%, respectively. Crime was positively associated with BMI and CHD risk, whereas neighborhood affluence was negatively associated. Living in more racially segregated areas was negatively associated with CHD risk among black, Hispanic, and Asian women and positively associated with CHD risk among American Indian women. CONCLUSIONS: The built environment and socioecologic characteristics of financially disadvantaged women were associated with BMI and CHD risk. More research is needed to understand the effects of racial segregation or acculturation on health for specific subpopulations.     

Domestic violence and help-seeking behaviors among rural women: results from a shelter-based study

Research on domestic violence and help-seeking behaviors of women living in rural communities has been limited. This study adds to existing knowledge by examining this type of violence along with mental health characteristics and related help-seeking behaviors of a sample of predominantly Hispanic women seeking shelter at a rural domestic violence shelter. Study participants experienced physical, verbal, emotional, and sexual abuse, harassment, stalking, and abuse with a weapon in their current intimate relationship. Twenty-four percent of study participants of Hispanic backgrounds and 10% of participants from all other racial/ethnic groups reported experiencing all types of abuse listed above. When compared with other study participants, a greater percentage of Hispanic participants indicated that they had thought of and/or attempted suicide. Participants' help-seeking behaviors from formal support systems suggest a mismatch between the types of abuse experienced and the resultant help-seeking behaviors they used. These help-seeking behaviors also indicate the relevance of mental health characteristics (e.g., suicide ideation) in these behaviors. These and findings from other studies may provide the impetus for a systematic documentation of domestic violence and help-seeking behaviors of women living in rural communities.     

Demographic Correlates of HIV Testing,High-Risk Behaviors,and Condom/STD Consultation Among a Multi-Ethnic Sample of Women

ABSTRACT

Background: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high-risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women.

Methods: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted.

Results: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education, income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast.

Conclusions: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.     

Relationship of race and poverty to lower extremity function and decline: findings from the Women's Health and Aging Study

Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women's Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking (1/4) mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years.     

Inequities in Community Exposure to Deadly Gun Violence by Race/Ethnicity,Poverty, and Neighborhood Disadvantage among Youth in Large US Cities

Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2–18% of youth resided within 600 m of a gun homicide occurring in the past 14–365 days. These percentages were 3–25% for incidents within 800 m and 5–37% for those within a 1300-m radius. Black and Latinx youth were 3–7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5–10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.     

Intimate partner violence and depression among Whites, Blacks, and Hispanics

PURPOSE: To examine the relationship between intimate partner violence and depression. METHODS: A household probability sample of Whites (n=616), Blacks (n=377), and Hispanics (n=592) age 18 or older was interviewed in 1995. The response rate was 85%. Logistic analysis is used to identify predictors of depression. RESULTS: Among men, Black (OR=.29; 95% CI, 0.13-.65) and Hispanic (OR=0.4; 95% CI, 0.2-0.8) ethnicity were protective against depression. Factors of risk for men included victimization by female to male partner violence (OR=4.04; 95% CI, 1.15-14.11), unemployment (OR=7.65; 95% CI, 1.59-16.39), and living in a high-unemployment neighborhood (OR=4.6; 95% CI, 1.86-11.37). Among women, the predictors are perpetration of moderate (OR=4.08; 95% CI, 1.33-12.47) or severe (OR=6.57; 95% CI, 1.76-24.52) female to male partner violence, and impulsivity (OR=1.82; 95% CI, 3.87-20.71). CONCLUSIONS: Knowledge from surveys using general population samples is important for developing prevention interventions in the community. Because predictors of depression in these samples are both individual and contextual at neighborhood level, prevention interventions to be effective must address not only individual factors of risk but also structural conditions in the environment where individuals live.     

Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis

The racial/ethnic composition of a neighborhood may be related to residents’ depressive symptoms through differential levels of neighborhood social support and/or stressors. We used the Multi-Ethnic Study of Atherosclerosis to investigate cross-sectional associations of neighborhood racial/ethnic composition with the Center for Epidemiologic Studies-Depression (CES-D) scale in adults aged 45–84. The key exposure was a census-derived measure of the percentage of residents of the same racial/ethnic background in each participant’s census tract. Two-level multilevel models were used to estimate associations of neighborhood racial/ethnic composition with CES-D scores after controlling for age, income, marital status, education and nativity. We found that living in a neighborhood with a higher percentage of residents of the same race/ethnicity was associated with increased CES-D scores in African American men (p < 0.05), and decreased CES-D scores in Hispanic men and women and Chinese women, although these differences were not statistically significant. Models were further adjusted for neighborhood-level covariates (social cohesion, safety, problems, aesthetic quality and socioeconomic factors) derived from survey responses and census data. Adjusting for other neighborhood characteristics strengthened protective associations amongst Hispanics, but did not change the significant associations in African American men. These results demonstrate heterogeneity in the associations of race/ethnic composition with mental health and the need for further exploration of which aspects of neighborhood environments may contribute to these associations.     

Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003

OBJECTIVE: We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors. METHODS: Using the National Health Interview Survey 2000-2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents). RESULTS: The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03). CONCLUSIONS: This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

The Beneficial Effect of Family Meals on Obesity Differs by Race, Sex, and Household Education: The National Survey of Children's Health, 2003-2004

Studies have indicated that family meals may be a protective factor for childhood obesity; however, limited evidence is available in children with different racial, socioeconomic, and individual characteristics. The purpose of this study was to examine family meal frequency as a protective factor for obesity in a US–based sample of non-Hispanic white, non-Hispanic black, and Hispanic children age 6 to 11 years, and to identify individual, familial, and socioeconomic factors that moderate this association. Data were from the 2003 National Survey of Children's Health (n=16,770). Multinomial logistic regression analyses were used to test the association between family meal frequency and weight status, and the moderating effects of household structure, education, poverty level, and sex, by racial group. Non-Hispanic white children who consumed family meals every day were less likely to be obese than those eating family meals zero or a few days per week. A moderating effect for sex was observed in non-Hispanic black children such that family meal frequency was marginally protective in boys but not in girls. Higher family meal frequency was a marginal risk factor for obesity in Hispanic boys from low-education households, but not in girls from similar households. In conclusion, family meals seem to be protective of obesity in non-Hispanic white children and non-Hispanic black boys, whereas they may put Hispanic boys living in low-education households at risk. Greater emphasis is needed in future research on assessing why this association differs among different race/ethnic groups, and evaluating the influence of the quality and quantity of family meals on child obesity.