Large health gaps found among black, Latino, and white fifth-graders

The study is the most ambitious effort to date to investigate the potential drivers of racial and ethnic health disparities among preadolescents. Results emphasize the key role that schools and family income and education may play in health disparities. Mark A. Schuster, MD, Ph.D., Chief of General Pediatrics at Boston Children's Hospital and William Berenberg Professor of Pediatrics at Harvard Medical School, led a research team that conducted the study. Between 2004 and 2006, they interviewed about five thousand 10- and 11-year-olds and their parents, in and around Birmingham, AL, Houston, TX, and Los Angeles, CA. Findings were published in the August 23 issue of the New England Journal of Medicine.

"We found wide gaps between black and white children and between Latino and white children, in 5th grade," says Dr. Schuster, who began the research while at the RAND Corporation, a nonprofit research organization. "When we delved deeper, we found that factors like the child's school, household income, and parents' education were strongly related to children's health. When these key factors are taken into account, differences related to race and ethnicity are not as large. But substantial differences remain, particularly between black and white children. More work is needed to identify what is causing these disparities, so that we can find ways to improve all children's health."

The researchers examined 16 important health-related measures. Some key disparities included:

• Black children were four times more likely and Latino children were two times more likely than white children to see a threat or injury with a gun.
• Black children were more likely to smoke cigarettes and drink alcohol than Latino and white children.
• Rates of obesity were nearly twice as high among black and Latino children, who also reported less vigorous exercise than white children.
• Black and Latino children were much more likely to report worse overall state of health.
• Black and Latino children were significantly more likely to experience discrimination (because of a wide variety of characteristics, like race and ethnicity, weight, and income).
• Black and Latino children were less likely than white children to wear a seatbelt or a bike helmet.
• Black children reported higher levels of being victimized by peers than Latino and white children.

The study suggests that these disparities, which have been much more extensively studied in adolescents, have already begun at younger ages and that interventions and policies may need to start earlier than adolescence to help reduce racial and ethnic differences in child health. These behaviors, experiences, and outcomes can have serious, long-term effects, so that improving them may improve adult health as well. For instance, unintentional injuries are the leading cause of death in children and adolescents, and patterns of not using seatbelts or bike helmets set as children may persist as they grow older. Likewise, violence is the leading cause of death for black male adolescents, and the study found that one in five black children had already witnessed violence by fifth grade. Victimization by peers and obesity during childhood could also have psychological and physical health consequences later in adolescence and adulthood.

"Significant disparities in behaviors and experiences that raise health concerns are already present during elementary school," says Schuster. "We should be thinking about these issues when children are young enough to prevent bad outcomes before they occur. Our research suggests that schools may be a key leverage point for addressing gaps among different racial and ethnic groups. We need to figure out what we can learn from the schools that are doing better, even when they're in similar communities to schools that are not doing as well. Is it a visionary principal, committed teachers, a strong commitment to health education, an engaged PTA? We need to learn more."