Perceived Weight, Actual Weight, and Risky Behaviors

216 Pages·2014·1.41 MB·English

Perceived Weight, Actual Weight, and Risky Behaviors:
Racial and Gender Disparities in U.S. Adolescents

BY
RAMONA CAMELIA KRAUSS
B.S., University of Illinois at Chicago, 2005
M.A., University of Illinois at Chicago, 2007

THESIS

Submitted as partial fulfillment of the requirements
for the degree of Doctor of Philosophy in Economics
in the Graduate College of the
University of Illinois at Chicago, 2014

Chicago, Illinois

Defense Committee:
Frank Chaloupka, Chair and Advisor
Barry Chiswick
Evelyn Lehrer
Lisa Powell, School of Public Health
Houston Stokes
Roy Wada, Institute for Health Research and Policy
This thesis is dedicated to the most important people in my life: my son Noah, who
always reminds me that life is beautiful and full of wonders, my husband Stephen, without whom
this would never have been accomplished, my late father Andrei and my mother Elena who made
me the person I am today, and my parents in law, Carl and Gladys who always believed in me
and supported me.

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Part of Chapter III was published in the article “Weight Misperceptions and Racial and Ethnic
Disparities in Adolescent Female Body Mass Index.” in Journal of Obesity,
doi:10.1155/2012/205393, co-authored with Dr. Lisa Powell and Dr. Roy Wada. I designed,
analyzed and wrote the study; Dr. Powell and Dr. Wada helped with the design of the study and
gave important feedback on the manuscript.

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TABLE OF CONTENTS
CHAPTER PAGE
I. INTROUCTION ............................................................................................................ 1
II. STUDY ONE: WEIGHT MISPERCEPTIONS AND ACTUAL WEIGHT —
A LONGITUDINAL ANALYSIS ................................................................................... 4
A. Literature Review ................................................................................................... 5
B. Research Questions and Hypotheses .................................................................... 11
C. Analytical Framework: Weight Perceptions and Healthy Weight ........................ 12
D. Methods ................................................................................................................ 17
E. Results ................................................................................................................... 23
F. Discussion ............................................................................................................. 41
III. STUDY TWO: WEIGHT MISPERCEPTIONS AND ACTUAL WEIGHT—
OAXACA DECOMPOSITION ...................................................................................... 47
A. Research Questions and Hypothesis ..................................................................... 48
B. Methods ................................................................................................................ 48
C. Results ................................................................................................................... 52
D. Discussion ............................................................................................................. 61
IV. STUDY THREE: WEIGHT MISPERCEPTIONS AND ACTUAL WEIGHT—
QUANTILE REGRESSIONS ......................................................................................... 65
A. Research Questions and Hypotheses .................................................................... 65
B. Methods ................................................................................................................ 66
C. Results ................................................................................................................... 69
D. Discussion ............................................................................................................. 86
V. STUDY FOUR: MEASURES OF BODY WEIGHT AND RISKY SEXUAL
BEHAVIORS .................................................................................................................. 89
A. Literature Review ................................................................................................. 89
B. Analytical Framework: Measures of Weight and Risky Sexual Behaviors. ......... 95
C. Research Questions and Hypotheses .................................................................... 98
D. Methods ................................................................................................................ 99
E. Results ................................................................................................................. 109

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TABLE OF CONTENTS (continued)
CHAPTER PAGE
F. Discussion ........................................................................................................... 164
G. Overall Conclusion ............................................................................................. 171
APPENDICES ............................................................................................................. 172
Appendix A……………………………………………………………………...171
Appendix B……………………………………………………………………...177
Appendix C……………………………………………………………………...184
CITED LITERATURE ............................................................................................. 1855
VITA ..................................................................................................................... …2022

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LIST OF TABLES
TABLE PAGE
I. SUMMARY STATISTICS: MEANS (STANDARD DEVIATIONS) AND
FREQUENCIES…………………………………………………………….………25

II. SUMMARY STATISTICS: WEIGHT MISPERCEPTIONS BY SUBGROUPS -
MEANS (STANDARD DEVIATIONS) AND FREQUENCIES………………….29

III. ESTIMATED EFFECTS OF UNDER-PERCEIVED AND OVER-PERCEIVED
WEIGHT STATUSES ON ADOLESCENT BODY MASS INDEX—MODEL
SPECIFICATION…………………………………………………………………..32

IV. INDIVIDUAL FIXED EFFECTS TWO LEAST SQUARES……………………...34

V. INDIVIDUAL-LEVEL FIXED EFFECTS ESTIMATES OF BODY MASS
INDEX—FULL SAMPLE………………………………………………………….37

VI. INDIVIDUAL-LEVEL FIXED EFFECTS ESTIMATES OF ADOLESCENT
FEMALE BODY MASS INDEX: FULL SAMPLE AND BY SUBGROUPS……40

VII. SUMMARY STATISTICS: MEANS (STANDARD DEVIATION) AND
FREQUENCIES…………………………………………………………………….54

VIII. FREQUENCIES OF CORRECTNESS OF WEIGHT PERCEPTIONS BY
GENDER, RACE/ETHNICITY, AND BY WEIGHT CATEGORIES…………….58

IX. PERCENTAGE CONTRIBUTIONS FROM DECOMPOSITION MODEL OF
RACIAL/ETHNIC DISPARITIES IN ADOLESCENT BODY MASS INDEX…..60

X. QUANTILE REGRESSION OF ADOLESCENT BODY MASS INDEX—MODEL
SPECIFICATION…...……………………………………………………………...72

XI. INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSIONS: FEMALE
ADOLESCENTS SAMPLE………………………………………………………...74

XII. INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSIONS: MALE
ADOLESCENTS SAMPLE………………………………………………………...76

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LIST OF TABLES (continued)

TABLE PAGE

XIII. ASSOCIATION OF WEIGHT UNDER-PERCEPTION WITH FEMALE BODY
MASS INDEX—INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSION BY
SUBGROUPS………………………………………………………………………79

XIV. ASSOCIATION OF WEIGHT UNDER-PERCEPTION WITH MALE BODY
MASS INDEX—INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSION BY
SUBGROUPS………………………………………………………………………81

XV. ASSOCIATION OF WEIGHT OVER-PERCEPTION WITH FEMALE BODY
MASS INDEX—INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSION BY
SUBGROUPS………………………………………………………………………83

XVI. ASSOCIATION OF WEIGHT OVER-PERCEPTION WITH MALE BODY MASS
INDEX—INDIVIDUAL FIXED EFFECTS QUANTILE REGRESSION BY
SUBGROUPS………………………………………………………………………85

XVII. SUMMARY STATISTICS—FEMALE ADOLESCENTS: MEANS (STANDARD
ERRORS) AND FREQUENCIES………………………………………………...110

XVIII. SUMMARY STATISTICS—MALE ADOLESCENTS: MEANS (STANDARD
ERRORS) AND FREQUENCIES………………………………………………...114

XIX. SUMMARY STATISTICS FEMALE ADOLESCENTS-FREQUENCIES AND
MEANS (STANDARD ERRORS)………………………………………………..117

XX. SUMMARY STATISTICS MALE ADOLESCENTS-FREQUENCIES AND
MEANS (STANDARD ERRORS)………………………………………………..119

XXI. EFFECT OF FEMALE ACTUAL WEIGHT ON EARLY SEXUAL DEBUT:
PROBIT RESULTS-ODDS RATIOS……………………………………………..123

XXII. EFFECT OF FEMALE PERCEIVED WEIGHT ON EARLY SEXUAL DEBUT:
PROBIT RESULTS-ODDS RATIOS……………………………………………..126

XXIII. EFFECT OF FEMALE MISPERCEIVED WEIGHT ON EARLY SEXUAL
DEBUT: PROBIT RESULTS-ODDS RATIOS…………………………………..128

XXIV. EFFECTS OF MALE ACTUAL WEIGHT ON EARLY SEXUAL DEBUT:
PROBIT RESULTS-ODDS RATIOS……………………………………………..131

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LIST OF TABLES (continued)

TABLE PAGE

XXV. EFFECT OF MALE WEIGHT PERCEPTIONS ON EARLY SEXUAL DEBUT:
PROBIT RESULTS-ODDS RATIOS………………………………………….134

XXVI. EFFECT OF MALE WEIGHT MISPERCEPTIONS ON EARLY SEXUAL
DEBUT-ODDS RATIOS………………………………………………………137

XXVII. EFFECT OF ACTUAL WEIGHT ON NUMBER OF SEX PARTNERS FOR
FEMALES: FE POISSON……………………………………………………...141

XXVIII. EFFECT OF WEIGHT PERCEPTIONS ON NUMBER OF SEX PARTNERS
FOR FEMALES: FE POISSON………………………………………………..143

XXIX. EFFECT OF WEIGHT MISPERCEPTIONS ON NUMBER OF SEX
PARTNERS FOR FEMALES: FE POISSON…………………………………145

XXX. EFFECT OF ACTUAL WEIGHT ON TIMES CONTRACEPTIVES USED FOR
FEMALES: FE POISSON……………………………………………………...147

XXXI. EFFECT OF PERCEIVED WEIGHT ON TIMES CONTRACEPTIVES USED
FOR FEMALES: FE POISSON………………………………………………..149

XXXII. EFFECT OF MISPERCEIVED WEIGHT ON TIMES CONTRACEPTIVES
USED FOR FEMALES: FE POISSON………………………………………..150

XXXIII. EFFECT OF ACTUAL WEIGHT ON NUMBER OF SEX PARTNERS FOR
MALES: FE POISSON…………………………………………….…………..151

XXXIV. EFFECT OF PERCEIVED WEIGHT ON NUMBER OF SEX PARTNERS FOR
MALES: FE POISSON…………………………………………………….…..154

XXXV. EFFECT OF MISPERCEIVED WEIGHT ON NUMBER OF SEX PARTNERS
FOR MALES: FE POISSON………………………………………………..…156

XXXVI. EFFECT OF ACTUAL WEIGHT ON TIMES CONTRACEPTIVES USED FOR
MALES: FE POISSON………………………………………………………...159

XXXVII. EFFECT OF PERCEIVED WEIGHT ON TIMES CONTRACEPTIVES USED
FOR MALES: FE POISSON…………………………………………..………161

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LIST OF TABLES (continued)

TABLE PAGE

XXXVIII. EFFECT OF MISPERCEIVED WEIGHT ON TIMES CONTRACEPTIVES
USED FOR MALES: FE POISSON…………………………………………163

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Summary
Parallel with the rise in obesity prevalence among adolescents there has been an
increasing prevalence in weight misperceptions with important differences across gender,
race/ethnicity, and socioeconomic status (SES). This dissertation is the first to investigate the
relationship between weight misperceptions and adolescent body mass index (BMI), the
importance of weight misperceptions as determinants of racial/ethnic disparities in BMI, the
differential effect of weight misperceptions across the adolescent BMI distribution, as well as the
importance of different measures of weight as determinants of adolescent risky sex, using a
nationally representative panel of adolescents. The results suggest that weight under-perceptions
are significantly associated with adolescent BMI even after controlling for time constant
individual-level unobservables. Results show that cross-sectional ordinary least squares methods
(OLS) over-estimates the association between weight under-perceptions and BMI. The results
based on the OLS model reveal that weight under-perception (compared to correct identification
of one’s weight status) is associated with 1.8 higher BMI units for female, and 2.7 higher BMI
units for male adolescents, respectively, compared to results based on an individual-fixed effects
model (FE) of 0.7 and 0.9 higher BMI units for adolescent females and males, respectively. I
find an income gradient for males but not for females, with male adolescents from high-income
households having statistically significant lower magnitudes of association of weight under-
perception and BMI than their low-income counterparts. In addition, the association between
weight under-perception and BMI is significantly higher for black compared to white female
adolescents. Analyses stratified by gender, race, and SES, reveal complex significant
associations between weight under-perception and adolescent BMI. Oaxaca-Blinder
decomposition analysis shows that accounting for weight misperceptions, in addition to
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