| The major purpose of this study was to examine the relationship of health insurance to weight status in 19-26 year olds using body mass index (BMI) as the surrogate measure of body weight. It was hypothesized that having health insurance would predict lower BMIs. The study was conceptualized within an adapted social- ecological framework with emphasis on the interactions of individuals and their environments.;This secondary data analysis study included data from 3804 young adults in the 2004 Medical Expenditure Panel Survey. Multivariate logistic regression analyses (using STATA 8.0) tested a non-recursive causal/path analytic model and structural equations to explain the likelihood of being obese (BMI=>30kg/m 2). Youths' race, gender, and education, along with parental education and obesity, were primary explanatory variables. Being on a restricted diet was considered a response to being obese. Sensitivity analysis was conducted on causal effects of BMIs >35 kg/m2.;Being Black (OR 1.90, CI 1.46, 2.48), having a high school diploma or less (OR 2.07, CI 1.40, 3.07), with at least one obese parent (OR 1.99, CI 1.36, 2.92), all significantly increased the probability of being obese. Physical activity (OR 0.59, CI 0.47, 0.73) reduced obesity likelihoods but was less common in females and minorities. Private insurance was associated with lower BMIs yet was statistically insignificant (OR 0.82, 0.63, 1.05) whereas young adults on public insurance (OR 1.40, CI 1.01, 1.95) had higher BMIs, suggesting unobserved differences in socioeconomic status related to type of insurance. However, at BMIs greater than or equal to 35 kg/m2, private insurance (OR 0.57, CI 0.38, 0.86) was negatively associated and statistically significant at influencing lower BMI levels.;Insurance is a complex measure which reflected unmeasured characteristics associated with the type of insurance individuals had. Most importantly, having insurance did not offset unmeasured factors that contributed to being obese for those with public insurance.;Targeting health education to mitigate obesity, prevent future intergenerational transfer of obesity, and address the factors associated with obesity and public insurance in young adults may be effective. Understanding the relationship of health insurance to weight status in young adults has the potential to inform and guide public and health policy decision-making related to the utility of insurance to address the epidemic of obesity and support clinical interventions. |
