Finding the question. The "Eureka!" moment for Rashawn Ray's career came while he was visiting his mother in Ontario in southern California.
Ray was on his New Year's break from working on his PhD in sociology at Indiana University, enjoying the fact that it was far easier to be exercising outside in the California winter than it would have been in Bloomington. Then his sociologist's eye noticed some interesting patterns in who else was exercising, and where.
He saw White people running, biking, and skateboarding; Latinos playing soccer; and Blacks playing basketball. What he didn't see was any interaction among those different groups. "That got me thinking about the ways in which groups lay claim on public spaces," Ray recalls.
Those thoughts in turn led to more thoughts—about how it would be helpful for urban planners to understand the ways in which different racial and ethnic groups use the facilities in their communities, about how those differences might affect rates of obesity within those different groups, and about how different racial and ethnic groups perceive the need for exercise and the dangers of obesity.
Ray had already been planning on applying to the Robert Wood Johnson Foundation Scholars in Health Policy Research program, and his New Year's visit to his mom's house gave him a good idea of what he wanted to study there. The Scholars program provides paid full-time two-year fellowships to outstanding new PhDs in economics, political science, and sociology to advance their involvement in health policy research. See Program Results for more information about the program.
From Murfreesboro to Berkeley. Ray began developing his sociologist's eye from an early age. His was a peripatetic childhood. He was born in Murfreesboro, Tenn., near Nashville, an only child raised by a single mother. By the time Ray graduated high school he and his mother had moved 14 times. From Murfreesboro he made stops in Atlanta for elementary school, Memphis for undergraduate school, then Indiana for graduate school, Mannheim, Germany for a visiting lectureship, and Berkeley, Calif., for the Scholars program at the University of California.
"Moving around a lot gave me a lot of exposure to a lot of different people, different neighborhoods and different cities," Ray says. "I've lived in predominately Black areas, I've lived in predominantly White areas, I've lived in racially diverse areas. Urban areas, rural areas, I've lived in them all. So I've had the personal experience that lets me view things through a lens that most people don't."
Ray's background also gave him an interest in health care, given that his grandmother and mother were both nurses, and his wife is a nurse practitioner. During his high school years Ray worked at a V.A. hospital and a pharmacy; for a long time he was aiming himself toward medical school. In college he took a class in sociology and fell in love with the subject.
Ray received a fellowship from the Scholars program in 2010, spending two years at the University of California's campuses in Berkeley and San Francisco where he got to know the economists and political scientists in his cohort of Scholars. The Scholars program gave him the feeling he'd come "full circle," Ray says, by giving him the opportunity to tie sociology and health together.
Looking for answers. When he arrived at the Scholars program, Ray was aware of previous studies that found a generally consistent relationship between physical activity and class: the higher a person's socioeconomic status, the more likely he or she will be physically active. Other studies found, however, that this pattern doesn't hold among middle-class Blacks, who show high rates of physical inactivity despite their socioeconomic status. In fact, one study found that suburban Blacks are less physically active and more obese than urban Blacks.
"This is puzzling," Ray says, "considering that suburbanites supposedly have more access to recreational facilities, green spaces, and safer areas. So a key question becomes: Why are middle class Blacks less physically active than their White peers? And, more centrally, are barriers and incentives to physical activity different for middle-class Blacks and Whites?"
Ray spent his time as a Scholar investigating these questions with two studies of his own. In the first year he conducted a series of interviews and focus groups to learn more about physical activity habits in different areas of the country. Among those he talked to: groups of middle and working class Black women in Tennessee and California; personal trainers in California, Colorado, Ohio, and Indiana; and general managers of large fitness centers.
Ray's study that first year also included site visits to neighborhoods with different racial compositions (predominately Black, predominantly White, and mixed) in five cities or counties in four states (Oakland and Ontario, Calif.; Prince George's County, Md.; Cincinnati; and Nashville, Tenn.). Regarding those visits, Ray said, "I wanted to gain a national perspective about how neighborhoods are structured for physical activity, how public and green spaces are utilized, how physical activity resources are used, and how the percentage of racial groups in particular spaces influence physical activity. I paid particular attention to the number of fitness centers, restaurants, green spaces, sidewalks, and the race of individuals."
During his second year in the program, Ray expanded on his research by hiring the research firm Qualtrics to conduct a national online survey of 482 middle class Blacks and Whites, focusing on barriers and incentives to physical activity. All respondents were college-educated, between the ages of 22 and 64, employed, and living in either urban or suburban areas. In order to address under-representations in previous studies, Ray constructed his sample to focus in particular on Black women.
By combining his own findings with Census data and the results of other studies, Ray offers a number of key reasons why Blacks may be less likely to engage in physical activity than Whites:
- Time constraints. Finding time to exercise is a particular challenge for Black middle-class women because they are more likely to work full-time and have children and are less likely to be married or have a nanny or housekeeper than middle class White women. In fact, 25 percent of college-educated Black women are single mothers.
- Body image. Black women are more likely than White women to reinterpret their body image by underestimating their actual body size. Messages and images they receive from their peers and from the media tend to reinforce this acceptance, Ray says.
In addition, Ray says that Black women are more likely than White women to embrace what he calls "genetic determinism." "What I mean by that is that they believe that their genes determine what their bodies look like, more so than other groups. So if you believe that genes determine what your body looks like, then you're less likely to be physically active because you don't think physical activity is going to do anything to alter your body."
- The racial composition of neighborhoods. Middle-class Blacks may be less likely to exercise in predominantly White middle-class neighborhoods because they feel "racially marked" in those neighborhoods. "This heightened level of visibility increases the possibility of unjust treatment, leading to more stress and less community engagement," Ray says. "If you are less likely to engage in the community, then you are also less likely to walk, run, and be physically active in your community."
This is especially true for middle-class Black men, Ray adds, who may be viewed with suspicion in those predominantly White neighborhoods. "Their professional status does not preclude them from being mistaken for an outsider or criminal during a leisurely run around the neighborhood," Ray says.
Black women, on the other hand, are less likely to engage in physical activity in poorer neighborhoods because men tend to "claim" the (relatively limited) available exercise facilities, causing women who exercise there to feel "sexualized." Women in predominantly White neighborhoods can also feel sexualized when exercising with men, Ray says, but more often have access to "women only" exercise clubs or areas. Black women in poorer neighborhoods also may exercise less because of safety concerns.
Putting findings to use. These findings suggest the sorts of considerations that need to be taken into account when city managers and city councils think about where to build physical activity resources in different communities, Ray says. They also suggest the considerations physicians and health officials need to take into account as they try to educate members of different communities about the dangers of obesity and the benefits of exercise.
As Ray put it in an essay for RWJF's Human Capital Blog, physicians should not "beat around the bush" when advising patients. "Considering that less than 65 percent of obese adults receive advice about physical activity and healthy eating from their doctors," he wrote, "primary care providers (e.g., doctors, nurse practitioners, physician assistants) may hold the key."
Ray is in the process of incorporating his findings into a book and in a series of papers with titles that include "The (In) Significance of Perceived Body Image on Physical Activity: The Importance of the Intersection of Race and Gender," and "Black People Don't Run in My Neighborhood: The Effects of Perceptions of the Built Environment on the Physical Activity of Middle Class Blacks and Whites."
His research has also informed blog pieces he's written for the New York Times—"Black Man Vs. Criminal," "People Listen to Health Care Providers," about how physicians convey health advice to different racial and ethnic groups, and "Peer Pressure and Support," about attitudes of different racial groups toward spanking. His posting "Cause and Consequence" challenges another opinion writer who had written that Black women "choose" to be fat, citing in his rebuttal many of the findings he'd uncovered in Lake Merritt in Oakland, Calif. "If we want women to be healthier," he concluded, "we should encourage Blacks and Whites to interact and learn from one another, which will improve their mental and physical health."
As of March 2013, Ray is continuing his research on the uses of public spaces from his position as assistant professor of sociology at the University of Maryland and his home in nearby Prince George's County. He's invigorated, too, by his proximity to Washington, where he's able to interact on a regular basis with people who make the wheels of government turn. One of the lessons he learned during his RWJF fellowship, Ray says, is how to think about solutions in practical terms." That becomes very important because now when I start a project I have an end point in mind," he says. "I don't feel like we're writing papers and crunching numbers and doing all this research for no reason. I like to think we're doing it to make policy change and broader scale social change."
RWJF perspective. The Robert Wood Johnson Foundation Scholars in Health Policy Research program is designed to foster a new generation of creative thinkers in health policy research within the disciplines of economics, political science, and sociology. The fellowship program, established in 1991, annually selects a total of nine recent PhD graduates from among those three disciplines to spend two years studying at one of three participating sites (currently Harvard University, University of California, Berkeley/San Francisco, and University of Michigan).
Participants learn about health and health policy, gain exposure to the perspectives of the other two disciplines through seminars with peers, receive mentoring from prominent scholars, develop research ideas, and conduct research while receiving a stipend and benefits that free them from other professional obligations. "We're looking for people who aren't too far along in pursuing a specific research agenda. Our goal is to catch people early and tempt them into the field of health policy," says Lori Melichar, PhD, RWJF senior program officer for the program.
While in the Scholars program, participants have conducted research on issues and policies related to individual health, public health, social and economic determinants of health and health care, health care financing, and health care systems and institutions. After completing the program, alumni stay connected to their peers through a network facilitated by the Boston University Health Policy Institute, which serves as the national program office.
Scholars from the Health Policy Research Program have made significant contributions to their disciplines and to the field of health policy research. The program's 200-plus alumni, many of whom hold faculty appointments at universities and colleges, have authored hundreds of widely cited books and articles; held editorial posts at top scholarly journals; sat on scientific advisory panels; served as senior advisers to presidential, Congressional, federal agency, and national scientific councils; and received numerous professional awards for their research.
Although the original purpose of the program—to increase the number of economists, sociologists, and political scientists conducting health policy research—remains important, RWJF's focus has expanded to include "building the community" of health policy researchers and supporting them at institutions nationwide. "Now it's more about creating a critical mass so that we have a self-sustaining community [of researchers]," Melichar says.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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