# Leveraging a Natural Experiment to Estimate the Effects of School Racial Segregation on Cardiovascular Risk Factors among Youth and Young Adults

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $808,862

## Abstract

ABSTRACT
 Cardiovascular disease (CVD) risk factors disproportionately affect black adults, and these disparities are
evident early in the life course. Genetic factors do not appear to explain this difference, and studies have
increasingly implicated socioeconomic risk factors. Among the most prominent risk factors for racial disparities
in CVD is educational attainment, which is strongly correlated with smoking, hypertension, and CVD over the
life course. Yet it is unclear which aspects of schooling are most salient. One possible explanation for racial
disparities in CVD is that black youth often attend highly racially segregated schools. Segregation is thought to
be linked with CVD due to increased stress and discrimination; social norms and peer influence; and the
constraining of socioeconomic opportunities that reduces income and healthcare access later in life. Yet
despite the fact that school segregation has increased in recent years, there are no studies examining the
effects of recent school segregation trends on CVD risk factors. The goal of this study is to provide this
urgently needed evidence. In particular, we take advantage of a unique natural experiment, overcoming
methodological challenges in the previous literature on the effects of education on CVD. Since 1990, numerous
local court decisions have resulted in “resegregation” in school districts across the country. We link nationwide
data on these court decisions and school district-level measures of school segregation with CVD outcome data
from two large nationally representative U.S. cohort studies of affected youth: the National Longitudinal Study
of Adolescent to Adult Health (Add Health, N≈90,000) and the Panel Study of Income Dynamics (N≈8,000). We
employ the quasi-experimental technique of instrumental variables analysis, which reduces typical confounding
by factors such as unobserved individual and family characteristics. In Aim 1, our goal is to estimate the short-
term effects of school segregation on CVD risk factors—including smoking, physical activity, obesity, and
mental health—among youth while they are still in school. In Aim 2, we will examine the long-term effects of
school segregation in the decades that follow, with outcomes including those in Aim 1 in addition to objectively
measured CVD biomarkers, diabetes, and hypertension. We will also undertake exploratory analyses to
determine possible mediating pathways. In Aim 3, we will identify vulnerable subgroups whose development of
CVD risk factors differs in response to school racial segregation. This will enable future interventions to be
tailored to the most vulnerable individuals. We will employ both hypothesis-driven and hypothesis-generating
statistical techniques, including innovative machine learning methods that allow for more complex and robust
subgroup identification. Overall, the expected outcome of this research is to produce rigorous evidence on the
effects of school racial segregation on CVD risk f...

## Key facts

- **NIH application ID:** 9943540
- **Project number:** 1R01HL151638-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Rita Hamad
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $808,862
- **Award type:** 1
- **Project period:** 2020-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9943540

## Citation

> US National Institutes of Health, RePORTER application 9943540, Leveraging a Natural Experiment to Estimate the Effects of School Racial Segregation on Cardiovascular Risk Factors among Youth and Young Adults (1R01HL151638-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9943540. Licensed CC0.

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