Health Behaviors and Social Determinants of Health in Children from Under-resourced Communities: Does Weight Status Play a Role?

Background: Social determinants of health (SDOHs) may affect children’s health and health behaviors. This study aimed to understand the relationship between health behaviors and SDOHs in a child population from under-resourced communities (i.e., Medicaid eligible or enrolled, overweight or with obesity [OWOB], predominantly Black or African Americans). Methods: Following a stratified sampling strategy, parent proxies (N = 311) completed an online survey to measure participants’ (5-12 years old) health behaviors (i.e., physical activity, screen time, sleep, and diet) and SDOHs including socioeconomic status (SES; area deprivation index [ADI], household income), living conditions, and food insecurity. Results: Participants with OWOB showed greater screen time than those with normal weight (NW). Health behaviors (i.e., physical activity, screen time, sleep, dietary behavior) generally favored the higher SES group (considering household income and ADI). SDOHs (as a variant) correlated with health behaviors (the other variant; Canonical r = 0.27, p < 0.05). Of the SDOHs, household chaos negatively correlated with regular bedtime routines in both weight status groups (NW: r = - 0.19, p < 0.05; OWOB: r = - 0.24, p < 0.01). Adverse living conditions and greater food insecurity were associated with more screen time and, unexpected, with more physical activity (r ranged from 0.19 to 0.22, ps < 0.05) in NW participants. Conclusions: The findings unraveled differences in health behaviors by weight status and SDOHs. SDOHs showed significant correlations with health behaviors, and these correlations were slightly greater in NW children. Weight status plays an important role in the relationship between health behaviors and SDOHs among children from under-resourced communities.