Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mayur M. Desai


Objective: To evaluate whether race and ethnicity moderate the association between weight status and risk behaviors in a nationally-representative sample of adolescents.

Methods: The 2009 and 2011 Youth Risk Behavior Surveys were combined (N = 25,550), and used to compare substance use, risky sexual behaviors, and violent behaviors between healthy weight, overweight, and obese adolescents. In both overall and race-stratified samples, chi-square tests and logistic regression were used to determine associations between weight status and engagement in risk behaviors among White, Black, and Hispanic adolescents. These analyses were performed separately in males and females.

Results: Overweight and obese adolescents had a significantly higher prevalence of early cigarette, alcohol, and marijuana use when compared with their healthy weight peers among both males (p=0.004; p=0.004; p=0.045) and females (p=0.006; p<0.001; p<0.001). The same trend emerged for early initiation of sexual intercourse in males (p=0.016) and females (p<0.001) as well. Overweight and obese adolescents also reported increased participation in violence behaviors with males reporting a higher prevalence of ever carrying a weapon (p<0.001) or gun (p=0.019), and females showing elevated rates of ever carrying a weapon (p<0.001) or being in a physical fight (p<0.001). In race-stratified analyses these patterns were statistically significant largely among White adolescents, with overweight and obese Hispanic females trending towards this finding as well.

Conclusion: Overweight and obese adolescents may initiate risk behaviors earlier than their healthy weight peers as well as engage in violent behavior at higher rates. These trends vary by race, and appear most saliently among White youth. This work not only highlights early adolescence as a critical time to prevent health risk behaviors, but also the importance of considering gender, weight status, and race in prevention efforts and future research.


This is an Open Access Thesis.

Open Access

This Article is Open Access