Enduring Health Implications of Structural Racism: Residential Segregation in Adolescence and Cardiometabolic Risk in U.S. Black Men and Women

Residential segregation — a key manifestation of structural racism — reflects historical practices of exclusion and concentrated resource deprivation, producing health disparities between Black and White Americans. Existing evidence indicates that concentrated disadvantage limits social cohesion among Black adults, a critical determinant of Black health. Yet, evidence remains mixed on whether adolescent residential segregation influences cardiovascular risk and whether within-race sex differences underlie cardiometabolic disparities. Using Waves I and V of Add Health (N = 1,087), I employ structural equation modeling to assess adolescent residential segregation and adult cardiometabolic risk (CMR), an indicator of stress-related physiological dysfunction, among U.S. Black adults. I test whether concentrated disadvantage and social cohesion mediate this association, then apply sex-stratified modeling to assess pathways to adult CMR. Results show weak evidence linking adolescent residential segregation to CMR, though sex-stratified models reveal this association varies by sex — Black women benefit from adolescent segregation while Black men do not.