Primary Submission Category: Race/Ethnicity
Are Minoritized Low-income Mothers of Sons at Greater Risk of Overweight/Obesity? An Indirect Test of the Costs of Institutional Racism and Chronic Stress
Authors: Molly A. Martin
Presenting Author: Molly A. Martin*
Low-income mothers are at greater risk of overweight/obesity and gaining weight relative to childfree low-income women, higher-income mothers, and low-income fathers (Gough et al. 2019; Martin et al. 2022; Martin and Lippert 2012). What remains unclear, however, is why and how this disparity among women arises. Initial investigations tested the role of physiological changes that accrue with pregnancy, the covariance with other status characteristics, differences in smoking and alcohol consumption (Martin and Lippert 2012), time spent watching television or exercising (Gough et al. 2019), and skipping meals (Martin et al. 2022). And while low-income mothers often differ on many of these weight-related traits and behaviors, these factors do not explain the income gradient in overweight/obesity for mothers (Gough et al. 2019; Martin et al. 2022; Martin and Lippert 2012).
An important, but difficult to test hypothesis is mothers’ differential exposure and/or reaction to stressful conditions. Chronic stress is associated with heavier body weights (Björntorp 2001) and change in psychosocial stress predicts changes in body weight among U.S. adults (Block et al. 2009). Because excess body weight usually requires years of small but accumulating change to override our metabolic system’s adaptability to promote stasis (Levin 2005), the stress model of obesity requires either exposure to chronic stress or repeated exposure to episodes of acute stressors to generate overweight or obesity (Tomiyama 2019).
Yet chronic stress exposure is unequal. People in lower socioeconomic positions are more exposed to stress than people in higher status positions (Moore and Cunningham 2012). Gender and parenthood also place people at differential risk for stress exposure. Male and female parents report more psychological distress than childfree adults (McLanahan and Adams 1987; Umberson and Gove 1989), but mothers report more stress than fathers during their time with children (Musick et al. 2016). Further, higher stress exposure is more strongly associated with less healthy diets and heavier body weights for women than men (Moore and Cunningham 2012). Finally, racial discrimination is associated with higher levels of perceived stress and higher psychological distress among African American young adults (Sellers et al. 2003). African Americans and Caribbean residents who report a high level of internalized racism have higher levels of perceived stress and more abdominal fat (Chambers et al. 2004; Tull et al. 2005) and higher body mass index (BMI) scores (Butler et al. 2002; Chambers et al. 2004). Together, these results suggest that low-income minoritized mothers are likely at greater risk of overweight/obesity than childfree adults, higher-income parents, non-Hispanic white parents, and minoritized fathers.
I argue that one additional and relatively random characteristic – the sex composition of one’s children – likely exacerbates these risks for minoritized low-income mothers. I hypothesize that a form of institutional and gendered racism – the surveillance and imprisonment of U.S. young men from racialized minority populations – creates additional health risks for minoritized low-income mothers raising sons. After the mid-1970s, the US incarceration rate skyrocketed and minoritized young men are now disproportionately likely to be policed, arrested, incarcerated, and subjected to harsher sentencing (Ruddell 2004). Among men born between 1965 and 1969, 3% of white men and 20% of black men had been imprisoned by their early thirties (Pettit and Western 2004). Incarceration rates are even higher for low-status black men born between 1965 and 1969, such that 18% of black male high school graduates and nearly 60% of black male high school dropouts had served time in prison by their early thirties (Pettit and Western 2004). Racialized minorities also at greater risk of experiencing police violence and police-involved fatal shooting (Zare et al. 2022) and greater surveillance during high school (Shedd 2015). Given the racial disparities in imprisonment are notably smaller among women (Harrison and Beck 2006), low-income mothers of black and brown sons have more reasons to fear police contact and violence and be more likely to have experienced their sons’ being surveilled and policed relative to mothers of white sons and the mothers of black and brown daughters. Based on the literature, I hypothesize the following:
Hypothesis 1: Minoritized low-income mothers raising sons will have higher rates of overweight/obesity than non-Hispanic white low-income mothers raising sons and minoritized low-income mothers raising daughters.
Given the pernicious nature and prevalence of racism, it is possible that minoritized moderate- and high-income mothers raising sons are also more likely to have overweight/obesity relative to non-Hispanic white moderate- and high-income mothers raising sons. Therefore, I also hypothesize:
Hypothesis 2: Minoritized moderate- and high-income mothers raising sons will have higher rates of overweight/obesity than non-Hispanic white moderate- and high-income mothers raising sons and minoritized moderate- and high-income mothers raising daughters.
Finally, given that police surveillance and violence is spatialized, often linked to past redlining practices (J. Mitchell and Chihaya 2022) and ongoing racialized residential segregation (Logan and Parman 2017; Massey 2020), it is likely that minoritized low-income mothers raising sons are more likely to feel threatened by police action and violence than minoritized moderate- and high-income mothers raising sons. My final hypothesis is as follows:
Hypothesis 3: Minoritized low-income mothers raising sons will have higher rates of overweight/obesity than minoritized moderate- and high-income mothers raising sons.
To test these hypotheses, I use the large, nationally-representative American Time Use Survey’s Eating and Health modules (i.e., 2006-08 and 2014-16) (Bureau of Labor Statistics 2017) made available through ATUS-X (Flood et al. 2022). I pool data from both Eating and Health modules to have sufficient power to test for significant differences in overweight/obesity across the four-way combination of sex, household income level, parenthood status, and the sex composition of their children. To arrive at my final analytic sample, I restrict the data to women and men ages 18-55 years old, drop pregnant women (n = 574), and use listwise deletion for missing data. Item non-response is relatively uncommon in these data, where the most missingness comes from body weight classification (n= 2,022; 4.7%), family income (n = 1,757; 4.1%), and usual work hours among those employed (1,354; 3.2%). Within the remaining sample (N= 37,417), over half are women (n=19,979).
Given that that the likelihood of having a living male child is approximately 50% and given that the total fertility rate has recently hovered or dipped below 2, we would expect that approximately ½ of all women with children have both a daughter and a son, ¼ have only daughters, and ¼ have only sons. The strongest theoretical tests will compare women with only daughters to women with only sons. Provided these approximations are reasonable and equivalent across income status groups, I anticipate having sufficient sample sizes for analyses with African American, Hispanic, and non-Hispanic white mothers and fathers.
I will estimate multivariate logistic regression models for the final sample of women, wherein I predict women’s weight status as a function of having children and the sex (and possibly age) of their children, race/ethnicity and whether they live in a low-income household. I will build the models starting with an additive specification, then add all two-way interactions, and conclude with the addition of the requisite three-way and four-way interactions. By rotating the omitted categories, I will test whether the risk of overweight/obesity is greater for low-income, African American and Hispanic mothers of sons.
In summary, I examine a group of mothers living on the frontlines of trying to protect and provide for their children under difficult conditions fueled by institutional racism – minoritized, low-income mothers raising sons. These mothers likely experience more chronic stressors and repeated acute stressors relative to other mothers given the institutionally racialized and gendered patterns of surveillance, over policing, and mass incarceration. Therefore, this study will not only help document the population health consequences of institutional racism enacted via racialized policing and incarceration practices, but also provide indirect evidence of the importance of chronic stress for low-income mothers’ greater risk of overweight/obesity.