Obesity and place: A study of the South Texas Veterans Health Care System (STVHCS) user population
Research on obesity among Veterans Health Administration (VHA) users has not explored the relationship between obesity and the larger social environment. It is crucial to identify and elucidate these relationships because the fusion of the individual and environment creates patterns in health that produce disparities in the care needs of population subgroups. This dissertation uses characteristics of both individual VHA patients and their environment to examine variation in individual obesity status. The Social Determinants of Health Model is used to provide a theoretical foundation for exploring associations in individual demographic and health status measures and obesity as well as residential patterns in socioeconomic status, land use, the availability of health sustaining resources, and segregation and individual obesity at the structural level. With obesity higher among VHA users compared to the general population, a focus on the social epidemiology of obesity in this population will provide the information needed to improve prevention programs and ensure that policy makers allocate resources to address the underlying ecological causes of obesity rather than continuing to blame individuals when behaviorally targeted programs and policies do not lead to obesity reduction. VHA data have been merged with data from the U.S. Census, the Texas Natural Resources Information System, the Texas Department of Public Safety, and County Business Pattern data to examine this issue. Results of this research indicate stability in individual estimates once a control is added for area effects suggesting that interventions may be less efficacious if the characteristics of individuals in specific areas are not considered during implementation. Despite a great deal of missing race and ethnicity data, this research also suggests an ethnic density effect operates with regard to obesity outcomes. Finally, results of spatial analyses suggest that obesity prevalence in one location is affected by obesity prevalence in neighboring areas. This result further supports the importance of considering the characteristics of individuals in specific places when planning interventions.