Longitudinal Effects of Transportation Vulnerability on the Association Between Racial/Ethnic Segregation and Youth Card
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Longitudinal Effects of Transportation Vulnerability on the Association Between Racial/Ethnic Segregation and Youth Cardiovascular Health Emily M. D’Agostino 1,2
&
Hersila H. Patel 2 & Eric Hansen 2 & M. Sunil Mathew 3,4 & Sarah E. Messiah 3,4,5
Received: 2 March 2020 / Accepted: 10 July 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Background Transportation vulnerability (defined as lack of personal/public transportation access) is particularly prevalent in areas with high racial/ethnic segregation where communities typically lack proximity to quality education, jobs, healthy food, playgrounds, and medical care. Prior research has shown an association between residential segregation and youth cardiovascular health, although little work has examined the effects of transportation vulnerability on this relationship. Methods Longitudinal mixed methods were used to compare the effects of transportation vulnerability on the association between changes in exposure to residential segregation (defined as the uneven geographic distribution of minorities) and five cardiovascular health outcomes across sex in minority youth for up to four consecutive years of participation in an afterschool fitness program during 2010–2018 (n = 2742; Miami-Dade County, Florida, US). Results After accounting for child race/ethnicity, age, year, and poverty, girls with high transportation vulnerability and reduced exposure to segregation (vs. increased or no change in segregation) showed the most improvements across all outcomes, including body mass index percentile (26% (95% CI 23.84, 28.30)), sum of skinfold thicknesses (18% (95% CI 14.90, 20.46)), run time (17% (95% CI 14.88, 18.64)), systolic blood pressure percentile (15% (95% CI 11.96, 17.08)), and diastolic blood pressure percentile (12% (95% CI 9.09, 14.61)). Conclusion Transportation inequities related to concentrated racial/ethnic segregation may be an important factor in reducing disparities in youth cardiovascular health, particularly among girls. These study findings provide important longitudinal evidence in support of health interventions to reduce transportation vulnerability for racial/ethnic minority youth in underserved areas. Keywords Cardiovascular health . Fitness . Health disparities . Racial/ethnic segregation . Transportation vulnerability . Youth
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40615-020-00821-8) contains supplementary material, which is available to authorized users. * Emily M. D’Agostino [email protected] 1
Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main St., Office 623, 6th Fl, Durham, NC 27705, USA
2
Miami-Dade County Department of Parks, Recreation and Open Spaces, 275 NW 2nd St, Miami, FL 33128, USA
3
Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA
4
School of Public Health, University of Texas Health Science Center, Dallas, TX, USA
5
Center for Pediatric P
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