Associations of racialized economic segregation with the prevalence of unhealthy behaviors and poor mental health in the United States

Document Type

Article

Publication Date

5-19-2026

Publication Title

Preventive Medicine Reports

Abstract

Objective To examine the associations of racialized economic segregation with unhealthy behaviors and poor mental health. Methods We conducted an ecological study with census tract-level measures from the 2018–2022 American Community Survey and 2024 CDC PLACES. Exposure was racialized economic segregation, measured by the Index of Concentration at the Extremes (ICE). Outcomes were the prevalence of unhealthy behaviors (smoking, binge drinking, physical inactivity, obesity, and inadequate sleep) and poor mental health among adults aged ≥18 years. Covariates were census tract's socioeconomic status and metropolitan status. Associations were examined with multivariable linear regression models. Results Among 83,359 census tracts, the average prevalence was 15.1% for smoking, 17.2% for binge drinking, 25.4% for physical inactivity, 34.4% for obesity, 36.6% for inadequate sleep, and 17.1% for poor mental health. After adjustment, all outcomes except binge drinking showed negative dose-response associations with the ICE, i.e., higher privilege level, lower prevalence of unhealthy behaviors. The prevalence of poor mental health increased by 0.61 (0.55–0.66), 0.98 (0.92–1.04),1.48 (1.41–1.55), and 2.38 (2.30–2.45) percentage points in the four less privileged groups, compared to the most privileged group. Conclusion Racialized economic segregation is significantly associated with the prevalence of smoking, physical inactivity, obesity, inadequate sleep, and poor mental health.

PubMed ID

42199668

Volume

66

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