Mary Gorski Findling
Dissertation Title: "Understanding Policy Opportunities to Improve Health in Schools, Neighborhoods, and Communities"In this dissertation, I examine three settings where public policies can influence population health: schools, neighborhoods, and communities. Children and adolescents face significant barriers to achieving a healthy weight in their schools and neighborhoods. Understanding the relationship between public policies, the food environment, and weight is crucial for children’s current and future health at the population level. A different issue affecting health is discrimination against the U.S. Latino population. Latinos comprise the largest minority group in the U.S., and broad discrimination against Latinos is not well documented in national surveys. Because discrimination is associated with a wide range of adverse health outcomes, understanding the extent of discrimination against Latinos across different areas of their lives may partially explain the variation in health within the Latino community. Findings from my analyses have important implications for public policies related to foods available in schools, food assistance programs, and improving racial/ethnic equality in health outcomes.
In Chapter 1, I conduct an empirical evaluation using quasi-experimental methods to evaluate the effect of state snack food legislation on the food environment in Massachusetts middle schools and high schools. Using an original dataset of over 10,000 food and beverage items from 84 schools in Massachusetts and a control state over a 3-year period, co-authors and I find that the law’s implementation resulted in major improvements in the availability and nutritional quality of snack foods and beverages. Because the Massachusetts law closely mirrors a federal law implemented in 2016, our findings suggest that compliance with strict snack nutrition standards is feasible nationally. However, our findings also indicate that schools are likely to experience implementation challenges, and it will take time for nutritional improvements to be fully implemented.
In Chapter 2, I use a national household survey to estimate the association between children’s and adolescents’ neighborhood food access and overweight or obesity, and whether this relationship differs by Supplemental Nutrition Assistance Program (SNAP) participation or household food purchases. Co-authors and I find that greater neighborhood access to combination grocery/other stores (including independent drug, dollar, and general stores) is associated with higher obesity prevalence for children overall, as well as for children living in households participating in SNAP, non-Hispanic black children, and adolescents. Our findings suggest that higher income children from SNAP-ineligible households live in different retail food environments than SNAP and eligible non-SNAP children, and their households have different food and sugary beverage acquisition patterns. The presence of some types of food outlets (i.e., those with limited healthy grocery options) may serve as a proxy for obesity-promoting environments.
In Chapter 3, I use a 2017 national telephone survey of 803 Latino adults and 902 non-Hispanic White adults to examine the variation in experiences of discrimination against Latinos in the U.S. across institutional (jobs, equal pay, police interactions, political participation, higher education, housing, health care) and interpersonal (slurs, microaggressions, and fear) domains, and the extent of reported racial/ethnic discrimination against Latinos compared to Whites. Co-authors and I find that Latino adults in the U.S. experience widespread discrimination, at significantly higher levels than Whites. Being born in the U.S. and earning a college degree are not protective against discrimination for Latinos, suggesting that public policy efforts to eliminate discrimination beyond improving Latinos’ social, physical, and economic conditions are needed.