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Natural experiment examining the longitudinal association between change in residential segregation and youth cardiovascular health across race/ethnicity and gender in the USA
  1. Emily M D’Agostino1,
  2. Hersila H Patel1,
  3. Zafar Ahmed1,
  4. Eric Hansen1,
  5. M Sunil Mathew2,
  6. Maria I Nardi1,
  7. Sarah E Messiah2,3
  1. 1 Health and Fitness Division, Miami-Dade Department of Parks, Recreation and Open Spaces, Miami, Florida, USA
  2. 2 Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
  3. 3 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Emily M D’Agostino, Health and Fitness Division, Miami-Dade Department of Parks, Recreation and Open Spaces, Miami, FL 33128, USA; emily.dagostino{at}


Background Identifying how racial/ethnic residential segregation and mobility may impact health can guide innovative strategies for reducing youth disparities.

Methods This natural experiment examined the association between change in residential segregation and cardiovascular health outcomes across race/ethnicity and gender for youth (n=2250, mean age 9.1 years, 54% male; 51% Hispanic, 49% non-Hispanic black (NHB); 49% high area poverty) attending a multisite park-based afterschool fitness programme in Florida, USA. Two-level generalised linear mixed models with random intercepts for park effects were fit to test the change in segregation–cardiovascular health association over two school years.

Results After covariate adjustment (individual-level gender, race/ethnicity, age, time and park-area poverty), greater improvements in cardiovascular health including body mass index percentile, sum of skinfold thicknesses, systolic/diastolic blood pressure percentiles and 400 m run time were found for youth who attended the program in a less segregated area compared with their home area (p<0.05 for all outcomes). NHB girls showed the greatest cardiovascular health improvements. Specifically, compared with the reference group (no change in segregation), skinfold thicknesses and systolic blood pressure percentiles decreased 17% (incidence rate ratio (IRR) 95% CI 0.81 to 0.86) and 16% (IRR 95% CI 0.82 to 0.87), respectively, versus 1% increase for both outcomes (IRR 95% CI 0.98 to 1.05) and (IRR 95% CI 0.98 to 1.05), respectively, for movement to less versus more segregated areas.

Conclusion In light of a continually expanding youth obesity epidemic, the global effort to reduce health inequities may be supported through Parks and Recreation Departments given potential to expand geographic mobility for low resource subgroups.

  • Ethnicity
  • Gender
  • Health Inequalities
  • Neighborhood/place
  • Child Health

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  • Contributors For this manuscript, EMD designed and implemented the study, conducted the analysis and prepared all sections of the text. HHP prepared results for publication. ZA prepared GIS racial/ethnic distribution data and prepared figure 1. EH developed and supervised the data collection protocols. MSM developed data collection protocols and managed the data set. MIN provided data acquisition. SEM supervised all aspects of the study design, implementation, analysis and manuscript preparation. All authors reviewed all sections of the text and approved the final version of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Miami Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the Fit2Play data set are available, deidentified, only to this study’s authors in accordance with University of Miami Institutional Review Board approval. Consent forms for this study did not include information permitting data sharing to other parties.