Education, health behaviors, and the black-white difference in waist-to-hip ratio

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Life-course socio-economic factors, skin colour and abdominal obesity in adulthood in a Brazilian birth cohort

OBJECTIVE

Obesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults.

DESIGN

Population-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23-24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females).

RESULTS

In men, family income at birth and in 2004-5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables.

CONCLUSIONS

The effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.

Associations of abdominal fat with perceived racism and passive emotional responses to racism in African American women

OBJECTIVES

An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined.

METHODS

We controlled for body mass index in multiple logistic regression models among 447 African American women who completed a telephone interview on perceived racism.

RESULTS

Passive emotional responses were not related to WHR (odds ratio [OR]=1.4; 95% confidence interval [CI]=0.8, 2.4). High perceived racism was associated with a low WHR in this population (OR=0.4; 95% CI=0.3, 0.8). However, high daily stress was related to a high WHR (OR=2.7; 95% CI=1.1, 6.7).

CONCLUSIONS

Findings support an association between daily stress and WHR but do not support our hypothesis that passive emotional responses to perceived racism increase abdominal fat. Further study of the stress physiology of perceived racism in African American women is warranted.

Stroke: a review with an African perspective

The frequency of stroke and stroke-associated mortality are higher in Blacks than in other races. Several of the known risk factors for stroke, such as hypertension, diabetes and obesity, are more common in Blacks than Whites, and sickle-cell disease and HIV infection are stroke risk factors with particular relevance to Africans. Although the facilities for accurate stroke diagnosis and classification are unavailable in most parts of Africa, careful analysis of the clinical features can minimize the rates of misdiagnosis and misclassification. The high levels of stroke-attributable morbidity and mortality observed in Africans could be markedly reduced by instituting primary and secondary preventive measures and by educating health-care professionals on stroke-management strategies.

Social support and health behavior in hostile black and white men and women in CARDIA. Coronary Artery Risk Development in Young Adults

OBJECTIVE

These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores.

METHODS

The subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support.

RESULTS

After controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate.

CONCLUSIONS

We conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.