Dietary fat patterns in urban African American women

A qualitative study of barriers and enablers associated with colorectal cancer screening among Somali men in Minnesota

The rate of cancer screening is generally increasing in the US. In Minnesota, the statewide average rate of screening for colorectal cancer (CRC) is 73%. However, screening completion is relatively low among Somali men; overall, only 27% of Somali immigrants have been screened for CRC. Factors contributing to this disparity have not been well researched. The purpose of this pilot study was to employ focus group methodology to describe and advance understanding of the barriers and enablers associated with CRC screening among Somali men ages 50-74 in Minnesota. Three focus groups were conducted among 27 Somali men in Minnesota. A 9-question, semi-structured interview guide was used. The sessions were audio recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Three research team members utilized the constant comparative method and NVivo to conduct data analysis. Five barriers to CRC screening emerged from the analyses: (1) lack of knowledge, (2) emotional barriers, (3) acculturation, (4) accountability, and (5) fatalistic beliefs. In addition, two factors enabling CRC screening and prevention emerged: the need for tailored interventions and preventive lifestyle behaviors. The insights gained from this research will assist in developing health promotion and education-focused interventions that encourage Somali immigrants in Minnesota and beyond to seek early detection screening for CRC.Abbreviations: CRC: Colorectal Cancer; FIT: Fecal Immunochemical Test; FOBT: Fecal Occult Blood Test; FQHC: Federally Qualified Health Center; PA: Project Assistant; PI: Principal Investigator.

Paradoxes in obesity with mid-life African American women

PURPOSE

To examine the relationship among socioeconomic status, psychological factors (ie, health locus of control, health satisfaction), and health behaviors (ie, physical exercise, eating patterns) in a volunteer sample of mid-life African American women residing within Washington, DC.

METHODS

The study's sample included 351 African American women who participated in the 12-week Prime Time Sister Circles (PTSC) intervention and completed the initial self-report survey. Of the women completing the baseline survey, clinical assessments were taken on 277 participants.

RESULTS

The majority (64.4%) of the women were either obese or extremely obese based upon their body mass index (BMI). Fewer than one-third of the women were satisfied with their weight. Despite these outcomes, most (61.8%) of the sample rated their health, in comparison to other African American women, as either good or very good. Further, more than one-half of the women were somewhat to very satisfied with their health knowledge, attitudes, behaviors, and their physical, emotional, and spiritual health. There was no significant relationship between obesity level and socioeconomic status, as measured by education, personal income, and total household income. Additionally, there were no significant differences in weight or eating behaviors by education, personal income, and total household income. The findings revealed a significant difference in the number of days the women reported engaging in physical exercise by personal income (p < .01) and total household income (p = .05), surprisingly, with the women in the lower-income categories reporting engaging in more days of physical exercise than women in the higher-income categories.

CONCLUSIONS

This study documents the paradox of obesity in mid-life African American women related to socioeconomic status inasmuch as there were no differences observed in the prevalence of obesity by socioeconomic status indicators. The obese women of lower socioeconomic status reported exercising more than obese women of high socioeconomic status. Paradoxically, most of the obese women were dissatisfied with their body weight, shape, and physical health, but more than 50% were satisfied with their health attitudes and behaviors and 61.8% rated their health favorably. The paradoxes of obesity and African American women across various income levels are important to understand for interventions to success.

Behavioral Predictors of Low Fat Intake among Economically Disadvantaged African-American Adolescents

Purpose.

To determine whether five behaviors shown to predict low fat intake in adults predicted low fat intake among economically disadvantaged African-American adolescents.

Design.

Cross-sectional.

Subjects and Measures.

Recruited through youth services agencies serving low-income communities in New York and New Jersey, participants were 265 African-American adolescents aged 10 to 14 years. Participants completed the Block Fat Screener and scales for measuring the following behaviors: avoiding fat as a seasoning, modifying meat to make it lower in fat, substituting high-fat foods with manufactured low-fat equivalents, replacing high-fat foods with fruits and vegetables, and replacing high-fat foods with low-fat foods other than fruits and vegetables.

Analysis.

The reliability and construct validity of the scales were assessed using internal consistency reliability and correlation analyses. Multiple regression analysis was used to determine behavioral predictors of low fat intake.

Results.

Scale coefficient alphas ranged from .60 to .80. Fat avoidance, substitution, and replacement with fruits and vegetables were significantly associated with fat intake. The regression equation containing these behaviors accounted for 12% of the variance in intake. All three behaviors were significant predictors of low fat intake.

Conclusions.

Fewer behaviors have salience for predicting low fat intake among economically disadvantaged African-American adolescents than among adults. Interventions to lower youths' intake should emphasize fat avoidance, substitution, and replacement with fruits and vegetables.

Determinants of low-fat eating behaviors among midlife African American women

OBJECTIVE

The purpose of this study was to explore midlife African American women's low-fat eating habits in the context of health attitudes, social support, and food preferences.

DESIGN

A cross-sectional design was used.

SETTINGS

One Midwestern and 1 national African American women's organization were targeted for data collection.

PARTICIPANTS

African American women between the ages of 45 and 64.

MAIN OUTCOME MEASURES

Health Attitudes Scale, Social Support Scale, Eating Behaviors subscale, and Low-Fat Eating subscale.

ANALYSIS

A hierarchical multiple regression analysis was performed.

RESULTS

Highly educated women did not engage in better eating habits than women with less education. Family members provided more criticism and friends provided more encouragement for healthful eating. However, only family encouragement and criticism for healthful eating and food preferences remained predictive of low-fat eating habits in midlife African American women in the final regression model.

CONCLUSIONS AND IMPLICATIONS

Changing attitudes may not influence changes in behaviors. Women experience family support as a significant influence to eating habits. Future nutrition interventions should be inclusive of women at every educational level and have a multidimensional focus that targets family involvement and changing behaviors.

Dietary fat intake among urban, African American adolescents

This study examined commonly consumed high-fat food sources to estimate dietary fat intake among 314 urban, African American adolescents (mean age (SD)=12.57 (.98) years; 66% female; 91% African American non-Hispanic; and 9% African American Hispanic). Youths' fat intake was measured using the Block Fat Screener. Most (77%) participants had diets very high in fat (i.e., 40% to 50% of energy). Mean frequencies of consumption revealed youths' preferences for the following high-fat food items: corn chips, potato chips, popcorn, and crackers; fried chicken; and doughnuts, pastries, cake, and cookies. Total fat intake differed based on youths' age. Urban, African American adolescents can benefit from intervention to lower their fat intake. Programs that target and address the food preferences and eating habits of this population are clearly needed.

Perceived value in food selection when dining out: comparison of African Americans and Euro-Americans

This descriptive study compares African Americans' and Euro-Americans' perceived value of food selection pertaining to cost, portion size, and meal satisfaction when eating away from home. A stratified sample was drawn from a southern U.S. metropolitan area (N= 1,011; 486 African American, 525 Euro-American). Analysis showed no difference between African-American and Euro-American adults by sex or how often they dined out. These two groups significantly differed across years of education, age, and answering 14 of 18 rated statements on value perceptions. African-Americans' value perceptions were influenced more by lower cost foods and larger portion sizes than those of Euro-Americans. For meal satisfaction, African Americans were more likely to agree with statements that indicate preferring foods high in energy and low in essential micronutrient density. This study supports the need for more investigation.

Comparison of three methods of measuring dietary fat consumption by African-American adults

OBJECTIVE

To determine dietary fat consumption by African-American adults using three methods that capture different domains of fat consumption and assess the degree of agreement between the three instruments.

DESIGN/SUBJECTS

Data were self-reported from a population-based cross-sectional survey of 658 African Americans, aged 18 to 70 years, in North Carolina using an 11-page questionnaire. Fat consumption was based on a household inventory of high-fat and low-fat foods, fat-related dietary behaviors, and total and saturated fat intakes. Demographic, behavioral, and diet-related psychosocial factors were also assessed.

STATISTICAL ANALYSES

Descriptive statistics were computed. Linear regression and Pearson's correlations examined the degree of agreement between the three dietary fat assessment methods. Linear regression was also used to assess associations of participant characteristics with fat consumption.

RESULTS

The participant mean age was 43.9+/-11.6 years, 41% were men, 37% were college graduates, and 75% were overweight/obese. High proportions of respondents had high-fat foods in their homes (78% had full-fat salad dressing and butter/margarine), whereas fewer had reduced-fat food items (only 19% had 1% or skim milk). Similarly, few respondents practiced healthful fat-related dietary behaviors; for example, 48% did not take the skin off chicken. There was good concordance among the three measures of fat consumption; for example, among those with more high-fat foods in the home, adjusted total and saturated fat intakes were 39.6 g and 14.9 g (compared to 24.1 g and 9.2 g, respectively, for those with none/few high-fat foods), P<0.0001. Pearson's correlation coefficients among the three methods ranged from 0.18 to 0.58 (P<0.0001).

CONCLUSIONS

There was good agreement among three instruments capturing different domains of dietary fat consumption by African Americans. The household food inventory is a brief and practical measure that may be a useful alternative dietary assessment tool in this population.

Dietary patterns related to caries in a low-income adult population

The aim of this study was to examine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2 food frequency questionnaire. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n = 839) having at least one cavitated lesion. Nearly three quarters of the adult participants were overweight or obese. This population had severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tap water, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.

A preliminary analysis of binge episodes: comparison of a treatment-seeking sample of Black and White women

OBJECTIVE

This study sought to examine differences in the nutritional composition of binges, both qualitatively and quantitatively, between participants with binge eating disorder (BED) and bulimia nervosa (BN) taken from a sample of treatment-seeking Black and White women. Overall qualitative and quantitative differences between diagnostic categories, regardless of ethnicity, were also explored.

METHOD

Patients seeking treatment for eating disorders were assessed on binge content. Black (n=26) and White (n=26) participants were matched on age and body mass index (BMI).

RESULTS

The binges of individuals with BN were lower in percent protein, but higher in calories, carbohydrates, and sugar, than those individuals with BED. However, there was little difference as a function of ethnicity between treatment-seeking Black and White women.

DISCUSSION

Preliminary data suggest that health professionals are faced with similar binge eating pathology, regardless of ethnicity, despite, probably, etiologic variation. The importance of the role of ethnicity in the expression of eating disorders is discussed.

Dietary deficiencies and excesses: a sample of African American mothers and daughters eligible for nutrition assistance programs

The purpose of the study detailed in this article was to identify nutritional excesses and deficiencies of selected dietary nutrients for a sample of low-income African American mothers and their daughters. Anthropometrics, physical activity questionnaires, food frequency questionnaires, and 24-hour food recalls were collected from a sample of 108 African American mothers and daughters (n = 42 and n = 66, respectively). Results revealed information regarding nutritional deficiencies and excesses that may be useful for modifying nutrition education and services offered through nutrition assistance programs designed for people earning low incomes and receiving financial assistance.

Controlling Blood Pressure in 50% of All Hypertensive Patients: An Achievable Goal in the Healthy People 2010 Report?

Background

One important objective defined in the Healthy People 2010 report was to improve blood pressure (BP) control to < 140/90 mm Hg in 50% of all hypertensive patients. Because the US population is becoming older, more obese, and ethnically diverse, the health and economic benefits of reaching this goal become more valuable each year. Hypertension control rates are currently at ∼ 31% of all hypertensives and have risen slowly and erratically since 1988. In the absence of a coordinated strategic plan, achieving this critically important goal for BP control is highly unlikely.

Methods

A selected literature review was undertaken to briefly assess the cardiovascular benefits of controlling hypertension. Greater focus was placed on variables that impact hypertension awareness, treatment, and control. The impact on hypertension control rates of theoretic changes in awareness, treatment, and control individually and collectively was examined. Four categories of potential barriers to optimizing BP control are discussed: systems, provider, patient, and treatment factors.

Results

Raising awareness to 80% of all hypertensives, ensuring treatment of 90% of aware hypertensives, and controlling BP to < 140/90 mm Hg in 70% of treated patients would achieve control rates of 50%.

Conclusions

The barriers to achieving the Healthy People 2010 goal of controlling hypertension in 50% of all patients are formidable but appear to be resolvable with a coordinated strategic plan. Given projected demographic changes in the United States, the health and economic benefits of attaining the national goal for hypertension control would seem to merit a serious integrated effort.

A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr

BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical.

METHODS

The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention.

RESULTS

This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers.

CONCLUSIONS

The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.

Food intake patterns and body mass index in observational studies

OBJECTIVE

To review studies of patterns of food intake, as assessed by diet index, factor analysis or cluster analysis, and their associations with body mass index or obesity (BMI/Ob).

DESIGN

Systematic literature review MEDLINE search with crosscheck of references.

STUDIES

Thirty observational studies relating food intake patterns to anthropometric information were identified and reviewed. Food intake patterns were defined using a diet index, factor or cluster analysis in 12, nine and nine studies, respectively. Measures of body mass were made concurrently with the diet assessment in all studies, and only in a few cases were the primary outcomes related to BMI/Ob.

RESULTS

The food intake patterns identified could, in most factor or cluster analysis studies, be categorised as: (a) meat, fatty, sweet or energy dense foods; (b) vegetables, fruit, whole grain and low-fat foods; or (c) by high alcohol consumption. The diet indexes were designed to capture a high diversity and/or food combinations matching the recommendations. The relationships with BMI/Ob were inconsistent-ten studies found that intake patterns, which we categorised as fatty, sweet or energy dense were positively associated with BMI/Ob, while similar patterns in four other studies were negatively associated with BMI. The significant associations between diet index score and BMI/Ob were consistently negative, while the associations between factor scores or cluster membership and BMI/Ob were less clear in terms of food intake pattern. Men and women had similar food intake patterns, but food intake patterns were less often positively associated with BMI/Ob in women. In 11 studies, there were no significant associations between food intake pattern and BMI/Ob.

CONCLUSION

This review showed that no consistent associations could be identified between BMI or Ob and food intake patterns, derived from diet index, factor analysis or cluster analysis. However, the heterogeneity of food intake patterns identified by such analyses and the lack of gold standards for the application of these techniques hampers consistent analysis of a relation between food intake patterns and health.

Heuristic model linking contextual processes to self-management in African American adults with type 2 diabetes

PURPOSE

This article examines the influence of various environmental factors on the diabetes self-care practices of African American adults with type 2 diabetes.

METHODS

A heuristic model was developed that considers how community barriers and supports, availability and use of insurance, diabetes education, medical provider-patient relationships, extended family processes, and psychological functioning may indirectly affect metabolic control through the patient's ability to regulate diabetes.

RESULTS

The proposed model offers a framework to demonstrate the complexity of diabetes management that may be unique to the African American experience.

CONCLUSIONS

A comprehensive view of the environmental context will lead to new and more effective approaches in diabetes education and counseling for African American adults with type 2 diabetes.

Implications of gender differences on coronary artery disease risk reduction in women

Differences in the clinical presentation and resultant treatment of coronary artery disease (CAD) for men and women have sensitized advanced practice nurses to the importance of addressing gender issues when caring for women with CAD. Certain patient characteristics and clinical conditions may place women at higher risk of CAD development or progression. These factors include depression, African American status, menopausal status, age, type 2 diabetes, and thyroid function. In addition, female gender may adversely influence the relative benefits of cholesterol lowering in elderly women with borderline high serum cholesterol levels and response to interventions for modification of sedentary behavior and for smoking cessation. This article addresses emerging knowledge regarding gender differences in CAD risk factors and responsiveness to risk reduction interventions, issues regarding patient management, the implications of emerging knowledge on early detection of CAD risk factors more prevalent in women, and the development of targeted intervention approaches.

Birth characteristics and subsequent risk for breast cancer in very young women

There is growing evidence that prenatal exposures may influence later breast cancer risk. This matched case-control study used linked New York State birth and tumor registry data to examine the association between birth characteristics and breast cancer risk among women aged 14-37 years. Cases were women diagnosed with breast cancer between 1978 and 1995 who were also born in New York after 1957 (n = 484). For each case, selected controls were the next six liveborn females with the same maternal county of residence. The authors found a J-shaped association between birth weight and breast cancer risk, and very high birth weight (> or =4,500 g) was associated with the greatest elevation in risk (adjusted odds ratio (OR) = 3.10, 95% confidence interval (CI): 1.18, 7.97). The association of maternal age with breast cancer risk was also J-shaped, with maternal age of more than 24 years showing a positive, linear association (adjusted OR = 1.94, 95% CI: 1.18, 3.18 for maternal age > or =35 vs. 20-24 years; p for trend = 0.02). In contrast, women born very preterm had a lower risk (adjusted OR = 0.11, 95% CI: 0.02, 0.79 for gestational age <33 vs. > or =37 weeks). These findings support a role for early life factors in the development of breast cancer in very young women.