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Agbonlahor O, DeJarnett N, Hart JL, Bhatnagar A, McLeish AC, Walker KL. Racial/Ethnic Discrimination and Cardiometabolic Diseases: A Systematic Review. J Racial Ethn Health Disparities 2024; 11:783-807. [PMID: 36976513 PMCID: PMC10044132 DOI: 10.1007/s40615-023-01561-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases. METHODS The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease. RESULTS Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case-control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5%). African Americans/Blacks were the most frequently studied racial/ethnic group (53.1%), and American Indians the least (0.02%). Significant associations between racial/ethnic discrimination and cardiometabolic disease were found in 73.2% of the studies. DISCUSSION Racial/ethnic discrimination is positively associated with increased risk of cardiometabolic disease and higher levels of cardiometabolic biomarkers. Identifying racial/ethnic discrimination as a potential key contributor to the health inequities associated with cardiometabolic diseases is important for addressing the significant burden borne by racial/ethnic minorities.
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Affiliation(s)
- Osayande Agbonlahor
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
| | - Natasha DeJarnett
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- Division of Environmental Medicine, School of Medicine, University of Louisville, Louisville, KY USA
| | - Joy L. Hart
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- Division of Environmental Medicine, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
| | - Alison C. McLeish
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY USA
| | - Kandi L. Walker
- Department of Communication, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX USA
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Sheehy S, Brock M, Palmer JR, Albert MA, Cozier Y, Rosenberg L. Perceived Interpersonal Racism in Relation to Incident Coronary Heart Disease Among Black Women. Circulation 2024; 149:521-528. [PMID: 38235551 PMCID: PMC10926238 DOI: 10.1161/circulationaha.123.066471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Racism is highly prevalent in the United States. Few data exist about whether perceived interpersonal racism is associated with risk of coronary heart disease (CHD). METHODS We followed 48 305 participants in the Black Women's Health Study through biennial mailed and Internet-based health questionnaires from 1997, when they provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer, until the end of 2019. We averaged participant responses to 5 validated questions about perceived interpersonal racism in everyday activities, such as "people act as if they think you are dishonest." We summed the positive responses to 3 questions about perceived racism in interactions that involved jobs, housing, and police; scores ranged from 0 (no to all) to 3 (yes to all). CHD cases were defined as nonfatal myocardial infarctions confirmed through medical records, fatal cases identified through the National Death Index, and self-reported revascularization events. We used Cox proportional hazard models adjusting for major confounders to estimate hazard ratios (HRs). RESULTS During 22 years of follow-up, we identified 1947 incident CHD cases. For women who reported experiences of racism in employment, housing, or involving the police relative to women who reported no such experiences, the age-adjusted HR for CHD was 1.35 (95% CI, 1.13-1.61; Ptrend=0.006), and the multivariable HR for CHD was 1.26 (95% CI, 1.05-1.51; Ptrend=0.05). For women in the highest quartile of perceived interpersonal racism in daily life relative to women in the lowest quartile, the age-adjusted HR for CHD was 1.25 (95% CI, 1.07-1.46; Ptrend=0.006). After multivariable adjustment, the HR was attenuated and no longer statistically significant. CONCLUSIONS Perceived experiences of interpersonal racism in employment, in housing, and with the police were associated with higher incidence of CHD among Black women, whereas perceived racism in everyday life was not associated with higher risk.
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Affiliation(s)
| | | | | | | | - Yvette Cozier
- Slone Epidemiology Center at Boston University, Boston,
MA
- Boston University School of Public Health
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston,
MA
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Ruiz-Narváez EA, Cozier Y, Zirpoli G, Rosenberg L, Palmer JR. Perceived Experiences of racism in Relation to Genome-Wide DNA Methylation and Epigenetic Aging in the Black Women's Health Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01915-3. [PMID: 38324238 PMCID: PMC11303595 DOI: 10.1007/s40615-024-01915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND African American women have a disproportionate burden of disease compared to US non-Hispanic white women. Exposure to psychosocial stressors may contribute to these health disparities. Racial discrimination, a major stressor for African American women, could affect health through epigenetic mechanisms. METHODS We conducted an epigenome-wide association study (EWAS) to examine the association of interpersonal racism (in daily life and in institutional settings) with DNA methylation in blood in 384 participants of the Black Women's Health Study (BWHS). We also evaluated whether a greater number of perceived experiences of racism was associated with epigenetic aging as measured using different methylation clocks. Models were adjusted for chronological age, body mass index, years of education, neighborhood SES, geographic region of residence, alcohol drinking, smoking, and technical covariates. RESULTS Higher scores of racism in daily life were associated with higher methylation levels at the cg04494873 site in chromosome 5 (β = 0.64%; 95% CI = 0.41%, 0.87%; P = 6.35E-08). We also replicated one CpG site, cg03317714, which was inversely associated with racial discrimination in a previous EWAS among African American women. In the BWHS, higher scores of racism in daily life were associated with lower methylation levels at that CpG site (β = -0.94%; 95% CI = -1.37%, -0.51%; P = 2.2E-05). Higher racism scores were associated with accelerated epigenetic aging in more than one methylation clock. CONCLUSIONS Exposure to discriminatory events may affect the epigenome and accelerate biological aging, which may explain in part the earlier onset of disease in African American women.
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Affiliation(s)
- Edward A Ruiz-Narváez
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, 1860 SPH I, Ann Arbor, MI, 48109, USA.
| | - Yvette Cozier
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Gary Zirpoli
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
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Berry JA, Cranford J, Powell R. The Stress of Advancement: A Nurse Practitioner's Exploration in Providing Culturally Competent Obesity Prevention Counseling in Black Women. Health Promot Pract 2024:15248399231221767. [PMID: 38264870 DOI: 10.1177/15248399231221767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Black women are diagnosed, disabled, and die from obesity and associated chronic diseases at higher rates than any other sex or race. Advanced practice registered nurses (APRN) can potentially improve culturally relevant health education and counseling by using health literacy communication tools. OBJECTIVE Explore individualized barriers and APRNs' role in providing obesity prevention education and counseling by assessing the efficacy of the Teach-Back Method (TBM) to understand health habits and attitudes. METHODS Black women aged 18-45, previously diagnosed as overweight or obese, and identified with perceived barriers were recruited from a predominantly Black church in Atlanta. They engaged in weekly, 1-hour educational sessions via Zoom, addressing four common barriers identified in the literature. Sessions ended with a 5-10 minute Teach-Back session. Pre- and post-intervention Readiness to Change Questionnaire (RCQ) were completed. Descriptive statistics and quantitative data from surveys and pre- and post-RCQ were analyzed. RESULTS Twenty women completed the intervention. Paired sample t-test revealed no statistical significance or correlation between pre- and post-RCQ scores after using TBM in educational sessions. However, Pearson's correlation showed positive associations between elevated body mass index levels as one advances their education and annual income, with a p-value of 0.05. DISCUSSION Increased rates of obesity are experienced despite higher educational attainment or pay. Stress and high-coping mechanisms contributed to disordered eating, decreased physical activity engagement, and decreased motivation toward habit change. Clinicians should be held accountable for delivering culturally sensitive care using the TBM, addressing social determinants of health, performing routine stress assessments, and checking their implicit biases.
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Affiliation(s)
- Jasmine A Berry
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA
- Georgia State University, Atlanta, GA, USA
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Woo JM, Bookwalter DB, Green GY, Sandler DP. Early life socioeconomic position contributes to adult obesity independent of adult socioeconomic factors: Findings from the sister study cohort. SSM Popul Health 2023; 24:101556. [PMID: 38053627 PMCID: PMC10694340 DOI: 10.1016/j.ssmph.2023.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
Low socioeconomic position (SEP) has been associated with obesity within life stages; however, life course SEP may also alter downstream obesity risk. Research is needed to understand the impact of childhood SEP, independent of adult SEP, as well as SEP trajectories over the life course on adult obesity risk. We use data from the Sister Study, a prospective U.S. cohort of women aged 35-74 years (N = 50,884; enrollment: 2003-2009). Relative risks (RR) for adult obesity associated with childhood SEP (latent variable) and five latent life course SEP profiles were estimated in overall and race and ethnicity-stratified log binomial regression models. We estimated the direct effect of childhood SEP on adult obesity and mediation by adult SEP. Lower childhood SEP was associated with greater obesity risk (RR = 1.16, 95% CI: 1.15-1.17). In stratified models, RRs were elevated across groups though lower for Black and Hispanic/Latina participants, despite greater prevalence of obesity among Black participants. The direct effect of childhood SEP on adult obesity persisted in mediation models independent of adult SEP (RR = 1.10, 95% CI: 1.08-1.12) with adult SEP mediating approximately 40% of the total effect of childhood SEP on adult obesity. Furthermore, adult obesity risk was elevated for all life course SEP profiles compared to persistent high advantage. Life course SEP profiles indicating greater advantage in adulthood than childhood were not associated with reduced adult obesity risk among those experiencing less than high advantage in childhood. In conclusion, lower childhood SEP, independent of adult SEP, may be an important risk factor for adult obesity.
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Affiliation(s)
- Jennifer M.P. Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, NC, 27709, USA
| | | | | | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, NC, 27709, USA
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Palmer JR, Cozier YC, Rosenberg L. Research on Health Disparities: Strategies and Findings From the Black Women's Health Study. Am J Epidemiol 2023; 192:1806-1810. [PMID: 35136921 PMCID: PMC11004793 DOI: 10.1093/aje/kwac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 01/10/2023] Open
Abstract
The American Journal of Epidemiology has been a platform for findings from the Black Women's Health Study (BWHS) that are relevant to health disparities. Topics addressed have included methods of follow-up of a large cohort of Black women, disparities in health-care delivery, modifiable risk factors for health conditions that disproportionately affect Black women, associations with exposures that are highly prevalent in Black women, and methods for genetic research. BWHS papers have also highlighted the importance of considering social context, including perceived experiences of racism, in understanding health disparities. In the future, BWHS investigators will contribute to documentation of the role that structural racism plays in health disparities.
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Affiliation(s)
| | | | - Lynn Rosenberg
- Correspondence to Dr. Lynn Rosenberg, Slone Epidemiology Center at Boston University, 72 East Concord Street L7, Boston, MA 02118 (e-mail: )
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Davidson JC, Kent BV, Cozier YC, Kanaya AM, Warner ET, Eliassen AH, Williams DR, Shields AE. "Does Religious Service Attendance Modify the Relationship between Everyday Discrimination and Risk of Obesity? Results from the Study on Stress, Spirituality and Health". J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01765-5. [PMID: 37921946 PMCID: PMC11065965 DOI: 10.1007/s40615-023-01765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 11/05/2023]
Abstract
This study examined the association of everyday discrimination with risk of obesity and the potential modifying effect of religious service attendance. Participants included Black, South Asian, and white women in three cohort studies that belong to the Study on Stress, Spirituality and Health. Logistic regression models estimated odds of obesity classification (BMI ≥ 30) relative to experiences of everyday discrimination. In initial pooled analyses, high levels of discrimination were related to increased odds of obesity. Race-specific analyses revealed marginal associations for white and South Asian women. Among Black women, high levels of discrimination and religious service attendance were both associated with higher odds of obesity. However, among women who attended religious services frequently, higher levels of everyday discrimination were associated with slightly lower odds of obesity. These findings underline the complex association between obesity and religion/spirituality, suggesting that higher levels of discrimination may uniquely activate religious resources or coping strategies. Findings highlight the need for additional studies to examine the impact of everyday discrimination on risk of obesity across racial/ethnic communities and how religious practices or coping strategies might affect these dynamics.
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Affiliation(s)
- James Clark Davidson
- Massachussetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Westmont College, Santa Barbara, CA, USA.
| | - Blake Victor Kent
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Westmont College, Santa Barbara, CA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Alka M Kanaya
- University of California San Francisco, San Francisco, CA, USA
| | - Erica T Warner
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alexandra E Shields
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Khemka S, Reddy A, Garcia RI, Jacobs M, Reddy RP, Roghani AK, Pattoor V, Basu T, Sehar U, Reddy PH. Role of diet and exercise in aging, Alzheimer's disease, and other chronic diseases. Ageing Res Rev 2023; 91:102091. [PMID: 37832608 PMCID: PMC10842571 DOI: 10.1016/j.arr.2023.102091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by memory loss and multiple cognitive impairments. Genetic mutations cause a small proportion (1-2%) of early-onset AD, with mutations in amyloid precursor protein (APP), presenilin 1 (PS1) and presenilin 2 (PS2). Major contributing factors of late-onset AD are ApoE4 genotype, traumatic brain injury, diabetes, obesity, hypertension, cardiovascular conditions, in addition to lifestyle factors, such as unhealthy diet and lack of physical exercise. Disease progression can be delayed and/or prevented to a greater extent by adopting healthy lifestyle with balanced and antioxidant enriched diet and daily exercise. The interaction and interplay of diet, exercise, age, and pharmacological interventions holds a crucial role in the progression, pathogenesis and management of AD and its comorbidities, including diabetes, obesity, hypertension and cardiovascular conditions. Antioxidant enriched diet contributes to brain health, glucose control, weight management, and cardiovascular well-being. Regular exercise removes toxins including free radicals and enhances insulin sensitivity, and supports cardiovascular function. In the current article, we discussed, the role of diet, and exercise in aging, AD and other conditions including diabetes, obesity, hypertension, cardiovascular conditions. This article also highlights the impact of medication, socioeconomic and lifestyle factors, and pharmacological interventions. These aspects were discussed in different races and ethnic groups in Texas, and the US.
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Affiliation(s)
- Sachi Khemka
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Aananya Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Lubbock High School, Lubbock, TX 79401, USA
| | - Ricardo Isaiah Garcia
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Micheal Jacobs
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Biology, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Ruhananhad P Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Lubbock High School, Lubbock, TX 79401, USA
| | - Aryan Kia Roghani
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Frenship High School, Lubbock, TX 79382, USA
| | - Vasanthkumar Pattoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; University of South Florida, Tampa, FL 33620, USA
| | - Tanisha Basu
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department pf Speech, Language and Hearing Services, School Health Professions, Texas Tech University Healthy Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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Sheehy S, Aparicio HJ, Palmer JR, Cozier Y, Lioutas VA, Shulman JG, Rosenberg L. Perceived Interpersonal Racism and Incident Stroke Among US Black Women. JAMA Netw Open 2023; 6:e2343203. [PMID: 37948073 PMCID: PMC10638652 DOI: 10.1001/jamanetworkopen.2023.43203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Black individuals in the US experience stroke and stroke-related mortality at younger ages and more frequently than other racial groups. Studies examining the prospective association of interpersonal racism with stroke are lacking. Objective To examine the association of perceived interpersonal racism with incident stroke among US Black women. Design, Setting, and Participants The Black Women's Health Study, a prospective cohort study of 59 000 Black women from across the US, assessed the longitudinal association between perceived interpersonal racism and stroke incidence. Stroke-free participants were followed up from 1997 until onset of stroke, death, loss to follow-up, or the end of the study period (December 31, 2019). Cox models were used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major confounders, including education, neighborhood socioeconomic environment, and cardiometabolic factors. Data analysis was performed from March 2021 until December 2022. Exposure On a questionnaire completed in 1997, participants reported experiences of racism in everyday life and when dealing with situations that involved employment, housing, and interactions with police. Main Outcomes and Measures Strokes were identified through self-report on biennial questionnaires, medical records adjudication, and linkage with the National Death Index. Results In 1997, 48 375 Black women (mean [SD] age, 41 [10] years) provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer. During the 22 years of follow-up, 1664 incident stroke cases were identified; among them, 550 were definite cases confirmed by neurologist review and/or National Death Index linkage. Multivariable HRs for reported experiences of racism in all 3 domains of employment, housing, and interactions with police vs no such experiences were 1.38 (95% CI, 1.14-1.67), a 38% increase, for all incident cases and 1.37 (95% CI, 1.00-1.88) for definite cases. For comparisons of women in the highest quartile of everyday interpersonal racism score vs women in the lowest quartile, multivariable HRs were 1.14 (95% CI, 0.97-1.35) for analyses that included all incident stroke and 1.09 (95% CI, 0.83-1.45) for analyses that included definite cases only. Conclusions and Relevance In this study, Black women who reported experiences of interpersonal racism in situations involving employment, housing, and interactions with police appeared to have an increased risk of stroke, even after accounting for demographic and vascular risk factors, suggesting that the high burden of racism experienced by Black US women may contribute to racial disparities in stroke incidence.
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Affiliation(s)
- Shanshan Sheehy
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Hugo J. Aparicio
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
- Boston University Center for Antiracist Research, Boston, Massachusetts
| | - Julie R. Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Yvette Cozier
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Julie G. Shulman
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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Anyane-Yeboa A, Buadu MAE, Khalili H, Cozier YC. Epidemiology of Inflammatory Bowel Disease in a Cohort of US Black Women. Inflamm Bowel Dis 2023; 29:1517-1523. [PMID: 36946376 PMCID: PMC11045662 DOI: 10.1093/ibd/izad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, are inflammatory diseases of the gastrointestinal tract. The incidence of IBD is increasing in minority populations; however, little is known about the epidemiology and disease characteristics of IBD in Black women. METHODS Our study population included participants in the Black Women's Health Study. Diagnosis of IBD was self-reported through the biennial questionnaires starting at baseline in 1995. We estimated the incidence of IBD according to age and geographic region. A follow-up supplementary questionnaire was also sent to a subset of participants who reported diagnosis of IBD to evaluate the accuracy of self-reported diagnosis and to assess disease characteristics. RESULTS Through December 31, 2021, a total of 609 cases of IBD were reported, of which 142 were prevalent at baseline (prevalence, 0.24%), and 467 were incident (crude incidence rate, 33.2/100 000 person-years). The incidence of IBD was highest in the younger than 30 years age group and similar across geographic region. Among the participants who responded to the supplementary questionnaire, 57.1% had confirmed diagnosis of IBD. CONCLUSIONS In a large prospective cohort of US Black women, we found that the incidence of IBD was similar to previously published estimates in US White women. Future studies should focus on identifying risk factors for IBD in Black individuals in the United States.
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Affiliation(s)
- Adjoa Anyane-Yeboa
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
- Clinical Translational Epidemiology Unit, The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Maame Araba E Buadu
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
| | - Hamed Khalili
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
- Clinical Translational Epidemiology Unit, The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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Pichardo MS, Pichardo CM, Talavera GA, Gallo LC, Kuo CC, Castañeda SF, Chambers EC, Daviglus ML, Pirzada A, Perreira KM, Sotres-Alvarez D, Peña Ortiz TY, Plascak JJ. Change in Neighborhood Socioeconomic Status and Adherence to the Cancer Prevention Lifestyle Guidelines in Hispanic/Latino Adults: Results from the HCHS/SOL Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:1981-1991. [PMID: 37783658 PMCID: PMC10542571 DOI: 10.1158/2767-9764.crc-23-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023]
Abstract
Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults. SIGNIFICANCE This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Catherine M. Pichardo
- South Bay Latino Research Center, Department of Psychology, San Diego State University, San Diego, California
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Charlene C. Kuo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland
| | | | - Earle C. Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, New York
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Krista M. Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Jesse J. Plascak
- Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, Ohio
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12
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Kunin-Batson A, Carr C, Tate A, Trofholz A, Troy MF, Hardeman R, Berge JM. Interpersonal Discrimination, Neighborhood Inequities, and Children's Body Mass Index: A Descriptive, Cross-Sectional Analysis. FAMILY & COMMUNITY HEALTH 2023; 46:S30-S40. [PMID: 37696014 PMCID: PMC10503111 DOI: 10.1097/fch.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Psychosocial stressors have been implicated in childhood obesity, but the role of racism-related stressors is less clear. This study explored associations between neighborhood inequities, discrimination/harassment, and child body mass index (BMI). Parents of children aged 5-9 years from diverse racial/ethnic backgrounds (n = 1307), completed surveys of their child's exposure to discrimination/harassment. Census tract data derived from addresses were used to construct an index of concentration at the extremes, a measure of neighborhood social polarization. Child's height and weight were obtained from medical records. Multiple regression and hierarchical models examined child's BMI and racism at the individual and census tract levels. Children residing in the most Black-homogenous census tracts had 8.2 percentage units higher BMI percentile (95% confidence interval, 1.5-14.9) compared with white-homogenous tracts (P = .03). Household income and home values were lower, poverty rates higher, and single parent households more common among Black-homogeneous census tracts. Almost 30% of children experienced discrimination/harassment in the past year, which was associated with a 5.28-unit higher BMI percentile (95% confidence interval, 1.72-8.84; P = .004). Discrimination and racial/economic segregation were correlated with higher child BMI. Longitudinal studies are needed to understand whether these factors may be related to weight gain trajectories and future health.
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Affiliation(s)
- Alicia Kunin-Batson
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Michael F. Troy
- Children’s Minnesota, Minneapolis, Minnesota; Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota, Minneapolis, Minnesota
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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13
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Fields ND, Choi D, Patel SA. Social and economic factors and black-white disparities in cardiovascular health: A decomposition analysis. SSM Popul Health 2023; 23:101485. [PMID: 37635988 PMCID: PMC10448210 DOI: 10.1016/j.ssmph.2023.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
Background Cardiovascular health (CVH) in Black adults, and particularly in Black women, has lagged behind White adults for decades and contributes to higher mortality rates for Black adults. We quantified the contribution of five social and economic factors to observed racial disparities in CVH by gender. Methods We analyzed data from N = 8,019 adults aged ≥20 years free of cardiovascular disease assessed in the National Health and Nutrition Examination Survey, 2011-2018. Social and economic factors included self-reported education, income, employment, food security, and marital status. CVH was measured using eight behavioral and clinical indicators. We utilized Kitagawa-Blinder-Oaxaca decomposition to quantify gendered racial differences in CVH accounted for by these factors. Results Black women (mean CVH = 79.3) had a lower age-adjusted CVH score compared to White women (mean CVH = 82.3) (mean difference [MD] = -3.01; 95% CI: -5.18, -0.84). Social and economic factors accounted for a 3.26-point disadvantage (95% CI: -4.12, -2.40) and a 0.25-point CVH score advantage due to factors not accounted for in the model. In women, income had the largest coefficient associated with CVH score (b = -1.48; 95% CI: -2.04, -0.92). Among men, social and economic factors accounted for a 2.27-point disadvantage (95% CI: -2.97, -1.56) with educational attainment being the largest coefficient associated with CVH score (b = -1.55; 95% CI: -2.03, -1.06). However, the disadvantage in men was offset by a 1.99 CVH score advantage that was not accounted for by factors in the model resulting in no racial difference in age-adjusted CVH score (MD = -0.28; 95% CI: -3.78, 3.22). Conclusions Racial differences in social and economic factors may contribute a large portion to the observed disparity in CVH between U.S. Black and White women.
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Affiliation(s)
- Nicole D. Fields
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shivani A. Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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14
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Ferguson EL, Vittinghoff E, Zeki Al Hazzouri A, Allen N, Fitzpatrick A, Yaffe K. Contribution of life course cardiovascular risk factors to racial disparities in dementia incidence. FRONTIERS IN DEMENTIA 2023; 2:1215904. [PMID: 39081968 PMCID: PMC11285666 DOI: 10.3389/frdem.2023.1215904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 08/02/2024]
Abstract
Background Racial disparities in dementia outcomes persist in the United States. Targeting modifiable risk factors, including cardiovascular risk factors (CVRFs), is a conceivable way to reduce health disparities. Life course CVRFs are often higher in non-White adults and are associated with risk of dementia, but it is unknown whether they contribute to racial disparities in dementia and cognition. Methods Using a pooled cohort of 4,159 White and 939 Black participants aged 65-95 years, we conducted a mediation analysis to estimate the proportional effect of race on dementia that is explained by four CVRFs imputed over the life course (20-49, 50-69, and 70-89 years of age): body mass index, fasting glucose, systolic blood pressure, and low-density lipoprotein cholesterol. Results Compared to White participants, Black participants had greater risk of dementia (adjusted OR = 1.37; 95% CI: 1.17-1.60). BMI and fasting glucose over the life course were significant mediators of the effect of race on dementia risk, mediating 39.1% (95% CI: 10.5-67.8%) and 8.2% (95% CI: 0.1-16.2%) of the effect, adjusted for sex and age. All four CVRFs together were also significant mediators of the effect of race on scores on global cognition and processing speed, accounting for approximately 11% of the effect. Conclusions We found that CVRFs across the life course partially explain disparities in dementia risk and cognition in late-life. Improved prevention and treatment of CVRFs across the life course may be important to reduce health disparities for dementia.
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Affiliation(s)
- Erin L. Ferguson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Norrina Allen
- Department of Internal Medicine, Northwestern University, Chicago, IL, United States
| | - Annette Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, School of Public Health, University of Washington, Seattle, Washington, DC, United States
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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15
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Machado AV, Camelo LV, Menezes STD, Guimarães JMN, Chor D, Griep RH, Matos SMAD, Molina MDCB, Giatti L, Barreto SM. Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort. CIENCIA & SAUDE COLETIVA 2023; 28:1655-1662. [PMID: 37255143 DOI: 10.1590/1413-81232023286.14992022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/29/2022] [Indexed: 06/01/2023] Open
Abstract
We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.
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Affiliation(s)
- Amanda Viana Machado
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Lidyane V Camelo
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sara Teles de Menezes
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Joanna M N Guimarães
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Dora Chor
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Rosane Harter Griep
- Laboratório de Educação em Saúde e Meio Ambiente, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Maria Del Carmen Bisi Molina
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Programa de Pós-Graduação em Nutrição e Saúde da Universidade Federal de Ouro Preto. Vitória ES Brasil
| | - Luana Giatti
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sandhi Maria Barreto
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
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16
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Roseen EJ, Smith CN, Essien UR, Cozier YC, Joyce C, Morone NE, Phillips RS, Gergen Barnett K, Patterson CG, Wegener ST, Brennan GP, Delitto A, Saper RB, Beneciuk JM, Stevans JM. Racial and Ethnic Disparities in the Incidence of High-Impact Chronic Pain Among Primary Care Patients with Acute Low Back Pain: A Cohort Study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:633-643. [PMID: 36534910 PMCID: PMC10233486 DOI: 10.1093/pm/pnac193] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 10/20/2023]
Abstract
OBJECTIVE We assessed whether race or ethnicity was associated with the incidence of high-impact chronic low back pain (cLBP) among adults consulting a primary care provider for acute low back pain (aLBP). METHODS In this secondary analysis of a prospective cohort study, patients with aLBP were identified through screening at seventy-seven primary care practices from four geographic regions. Incidence of high-impact cLBP was defined as the subset of patients with cLBP and at least moderate disability on Oswestry Disability Index [ODI >30]) at 6 months. General linear mixed models provided adjusted estimates of association between race/ethnicity and high-impact cLBP. RESULTS We identified 9,088 patients with aLBP (81.3% White; 14.3% Black; 4.4% Hispanic). Black/Hispanic patients compared to White patients, were younger and more likely to be female, obese, have Medicaid insurance, worse disability on ODI, and were at higher risk of persistent disability on STarT Back Tool (all P < .0001). At 6 months, more Black and Hispanic patients reported high-impact cLBP (30% and 25%, respectively) compared to White patients (15%, P < .0001, n = 5,035). After adjusting for measured differences in socioeconomic and back-related risk factors, compared to White patients, the increased odds of high-impact cLBP remained statistically significant for Black but not Hispanic patients (adjusted odds ration [aOR] = 1.40, 95% confidence interval [CI]: 1.05-1.87 and aOR = 1.25, 95%CI: 0.83-1.90, respectively). CONCLUSIONS We observed an increased incidence of high-impact cLBP among Black and Hispanic patients compared to White patients. This disparity was partly explained by racial/ethnic differences in socioeconomic and back-related risk factors. Interventions that target these factors to reduce pain-related disparities should be evaluated. CLINICALTRIALS.GOV IDENTIFIER NCT02647658.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Department of Rehabilitation Sciences, MGH Institute for Health Professions, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Clair N Smith
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yvette C Cozier
- Slone Epidemiology Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christopher Joyce
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, USA
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Russell S Phillips
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Katherine Gergen Barnett
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Charity G Patterson
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gerard P Brennan
- Department of Physical Therapy, Intermountain Healthcare Rehabilitation Services, Murray, Utah, USA
| | - Anthony Delitto
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Robert B Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Joel M Stevans
- Department of Physical Therapy, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
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17
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Fields ND, VanKim NA, Whitcomb BW, Bertone-Johnson ER, Martínez AD, Chae DH. Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study. Womens Health Issues 2023; 33:153-159. [PMID: 36319516 PMCID: PMC10010936 DOI: 10.1016/j.whi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination. RESULTS Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63-5.21) and 2.6% higher body fat (95% CI, 0.32-4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI-0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14-1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58-4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09-0.55) compared with less frequent everyday discrimination. CONCLUSIONS Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.
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Affiliation(s)
- Nicole D Fields
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Airín D Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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18
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Cuevas AG, Mann FD, Krueger RF. Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions. Lifestyle Genom 2023; 16:90-97. [PMID: 36750036 PMCID: PMC11078300 DOI: 10.1159/000529527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation). METHODS This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. RESULTS We found that greater PRS-BMI was significantly associated with more reports of discrimination (β = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively. CONCLUSION Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.
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Affiliation(s)
- Adolfo G. Cuevas
- Department of Social and Behavioral Sciences Department, School of Global Public Health, New York University
| | - Frank D. Mann
- Department of Family, Population, and Preventative Medicine, Program in Public Health, Stony Brook University
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19
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Lofton H, Ard JD, Hunt RR, Knight MG. Obesity among African American people in the United States: A review. Obesity (Silver Spring) 2023; 31:306-315. [PMID: 36695059 PMCID: PMC10107750 DOI: 10.1002/oby.23640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.
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Affiliation(s)
- Holly Lofton
- NYU Grossman School of Medicine, New York, New York, USA
| | - Jamy D Ard
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rameck R Hunt
- Penn Medicine Princeton Health, Plainsboro Township, New Jersey, USA
- Rutgers RWJ Medical School, New Brunswick, New Jersey, USA
| | - Michael G Knight
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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20
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 252] [Impact Index Per Article: 252.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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21
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Smith GS, Archibald P, Thorpe RJ. Race and obesity disparities among adults living in gentrifying neighborhoods. J Racial Ethn Health Disparities 2023; 10:93-99. [PMID: 35083727 DOI: 10.1007/s40615-021-01199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
There is a paucity of research seeking to understand race disparities in obesity among individuals living in a gentrifying neighborhood. American Community Survey data were used to identify gentrifying neighborhoods. In a cross-sectional analysis, these data were then linked to the 2014 Medical Expenditure Panel Survey, yielding an analytic sample of 887 Black and White adults. Obesity was based on body mass index ≥ 30 kg/m2. After controlling for potential confounders, Black adults living in gentrifying neighborhoods had a higher prevalence of obesity (PR: 1.39; 95% CI: 1.03, 1.88) than White adults living in gentrifying neighborhoods. Gentrification may have no impact on reducing Black-White obesity disparities in the US.
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Affiliation(s)
- G S Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - P Archibald
- Department of Social Work, College of Staten Island-City University of New York School of Health Science, Staten Island, NY, USA
| | - R J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Program for Research On Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Chandrakumar H, Khatun N, Gupta T, Graham-Hill S, Zhyvotovska A, McFarlane SI. The Effects of Bariatric Surgery on Cardiovascular Outcomes and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e34723. [PMID: 36909063 PMCID: PMC9998117 DOI: 10.7759/cureus.34723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Obesity is a major public health problem that is associated with serious comorbidities and premature mortality. Cardiovascular disease (CVD) is the major cause of morbidity and mortality associated with obesity. Lifestyle modifications, pharmacological therapy, and weight reduction surgery are the major interventions to date available for obesity management. Bariatric surgery has been increasingly utilized as a therapeutic option for obesity. In this meta-analysis, we aim to assess the effects of bariatric surgery on CVD outcomes and cardiovascular mortality. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science were searched until 03/01/2022. Our search included three types of bariatric surgery: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and gastric banding (GB). All were searched in conjunction with "coronary artery disease," "ischemic heart disease," "myocardial infarction," "cerebrovascular accident," "stroke," "atrial fibrillation," "heart failure," "arrhythmias," and "mortality." We included 49 studies meeting the study criteria. Bariatric surgery showed a beneficial effect on coronary artery disease (CAD) (hazard ratio (HR) of 0.68 {95% confidence interval (CI): 0.52-0.91}, p = 0.008), myocardial infarction (MI) (HR of 0.53 {95% CI: 0.44-0.64}, p < 0.01) heart failure (HF) (HR of 0.45 {95% CI: 0.37-0.55}, p < 0.01), cerebrovascular accident (CVA) (HR of 0.68 {95% CI: 0.59-0.78}, p < 0.01), and cardiovascular mortality (HR of 0.48 {95% CI: 0.40-0.57}, p < 0.01). The effect on atrial fibrillation (AF) did not reach statistical significance: HR of 0.81 (95% CI: 0.65-1.01), p = 0.07. Our study, that is, an updated meta-analysis, including the three types of procedure, confirms beneficial effects on the major CVD outcomes, including coronary artery disease, myocardial infarction, cerebrovascular accident, and heart failure, and on CVD mortality. This study provides updated insights into the long-term CV effects of bariatric surgery, an increasingly common intervention for obesity.
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Affiliation(s)
- Harshith Chandrakumar
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | - Nazima Khatun
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | - Tanuj Gupta
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | | | | | - Samy I McFarlane
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
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23
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Zalla LC, Cole SR, Eron JJ, Adimora AA, Vines AI, Althoff KN, Silverberg MJ, Horberg MA, Marconi VC, Coburn SB, Lang R, Williams EC, Gill MJ, Gebo KA, Klein M, Sterling TR, Rebeiro PF, Mayor AM, Moore RD, Edwards JK. Association of Race and Ethnicity With Initial Prescription of Antiretroviral Therapy Among People With HIV in the US. JAMA 2023; 329:52-62. [PMID: 36594946 PMCID: PMC9856806 DOI: 10.1001/jama.2022.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Importance Integrase strand transfer inhibitor (INSTI)-containing antiretroviral therapy (ART) is currently the guideline-recommended first-line treatment for HIV. Delayed prescription of INSTI-containing ART may amplify differences and inequities in health outcomes. Objectives To estimate racial and ethnic differences in the prescription of INSTI-containing ART among adults newly entering HIV care in the US and to examine variation in these differences over time in relation to changes in treatment guidelines. Design, Setting, and Participants Retrospective observational study of 42 841 adults entering HIV care from October 12, 2007, when the first INSTI was approved by the US Food and Drug Administration, to April 30, 2019, at more than 200 clinical sites contributing to the North American AIDS Cohort Collaboration on Research and Design. Exposures Combined race and ethnicity as reported in patient medical records. Main Outcomes and Measures Probability of initial prescription of ART within 1 month of care entry and probability of being prescribed INSTI-containing ART. Differences among non-Hispanic Black and Hispanic patients compared with non-Hispanic White patients were estimated by calendar year and time period in relation to changes in national guidelines on the timing of treatment initiation and recommended initial treatment regimens. Results Of 41 263 patients with information on race and ethnicity, 19 378 (47%) as non-Hispanic Black, 6798 (16%) identified as Hispanic, and 13 539 (33%) as non-Hispanic White; 36 394 patients (85%) were male, and the median age was 42 years (IQR, 30 to 51). From 2007-2015, when guidelines recommended treatment initiation based on CD4+ cell count, the probability of ART initiation within 1 month of care entry was 45% among White patients, 45% among Black patients (difference, 0% [95% CI, -1% to 1%]), and 51% among Hispanic patients (difference, 5% [95% CI, 4% to 7%]). From 2016-2019, when guidelines strongly recommended treating all patients regardless of CD4+ cell count, this probability increased to 66% among White patients, 68% among Black patients (difference, 2% [95% CI, -1% to 5%]), and 71% among Hispanic patients (difference, 5% [95% CI, 1% to 9%]). INSTIs were prescribed to 22% of White patients and only 17% of Black patients (difference, -5% [95% CI, -7% to -4%]) and 17% of Hispanic patients (difference, -5% [95% CI, -7% to -3%]) from 2009-2014, when INSTIs were approved as initial therapy but were not yet guideline recommended. Significant differences persisted for Black patients (difference, -6% [95% CI, -8% to -4%]) but not for Hispanic patients (difference, -1% [95% CI, -4% to 2%]) compared with White patients from 2014-2017, when INSTI-containing ART was a guideline-recommended option for initial therapy; differences by race and ethnicity were not statistically significant from 2017-2019, when INSTI-containing ART was the single recommended initial therapy for most people with HIV. Conclusions and Relevance Among adults entering HIV care within a large US research consortium from 2007-2019, the 1-month probability of ART prescription was not significantly different across most races and ethnicities, although Black and Hispanic patients were significantly less likely than White patients to receive INSTI-containing ART in earlier time periods but not after INSTIs became guideline-recommended initial therapy for most people with HIV. Additional research is needed to understand the underlying racial and ethnic differences and whether the differences in prescribing were associated with clinical outcomes.
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Now with Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph J Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Keri N Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Vincent C Marconi
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sally B Coburn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Raynell Lang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, Washington
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly A Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Timothy R Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter F Rebeiro
- Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, Tennessee
- Division of Infectious Diseases, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Angel M Mayor
- Clinical Research Center, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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24
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Natale G, Zhang Y, Hanes DW, Clouston SAP. Obesity in Late-Life as a Protective Factor Against Dementia and Dementia-Related Mortality. Am J Alzheimers Dis Other Demen 2023; 38:15333175221111658. [PMID: 37391890 PMCID: PMC10580725 DOI: 10.1177/15333175221111658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVE We estimated the conversion from cognitively normal to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight, and obese older adults, where the timing of examinations is associated with the severity of dementia. METHODS We analyzed six waves of the National Health and Aging Trends Study (NHATS). Body mass (BMI) was computed from height and weight. Multi-state survival models (MSMs) examined misclassification probability, time-to-event ratios, and cognitive decline. RESULTS Participants (n = 6078) were 77 years old, 62% had overweight and/or obese BMI. After adjusting for the effects of cardiometabolic factors, age, sex, and race, obesity was protective against developing dementia (aHR=.44; 95%CI [.29-.67]) and dementia-related mortality (aHR=.63; 95%CI [.42-.95]). DISCUSSION We found a negative relationship between obesity and dementia and dementia-related mortality, a finding that has been underreported in the literature. The continuing obesity epidemic might complicate the diagnosis and treatment of dementia.
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Affiliation(s)
- Ginny Natale
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Yun Zhang
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Douglas William Hanes
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Sean AP Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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25
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Ames JL, Morgan EH, Giwa Onaiwu M, Qian Y, Massolo ML, Croen LA. Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:290-305. [PMID: 36601333 PMCID: PMC9807255 DOI: 10.1089/aut.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Address correspondence to: Jennifer L. Ames, PhD, MS, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612-5190, USA
| | - Elizabeth H. Morgan
- College of Education California State University Sacramento, Sacramento, California, USA
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, Houston, Texas, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Maria L. Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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26
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Schwartz GL, Wang G, Kershaw KN, McGowan C, Kim MH, Hamad R. The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans. Health Place 2022; 77:102904. [PMID: 36063651 PMCID: PMC10166594 DOI: 10.1016/j.healthplace.2022.102904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.
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Affiliation(s)
- Gabriel L Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States.
| | - Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N Kershaw
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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Dai D. Neighborhood characteristics of low radon testing activities: A longitudinal study in Atlanta, Georgia, United States. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155290. [PMID: 35447192 DOI: 10.1016/j.scitotenv.2022.155290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Radon testing remains low even nationwide although its exposure is the leading cause of lung cancer among non-smokers. Little has been done to examine the neighborhood characteristics with low testing prevalence. This study investigated the associations between indoor radon testing and neighborhood characteristics in an urban environment with the highest Radon potential. A total of 25 years (1990-2015) of radon tests (n = 6355) were pooled from public and private sources in DeKalb County, Georgia, United States. Neighborhoods were characterized using racial residential segregation for African Amercians in addition to other social indicators. The associations between neighborhood characteristics and radon testing rates were evaluated using Ordinary Least Squares and Spatial Regression Models, respectively. Results show that the testing rates were lower than 6.5% over the 25 years. Summers followed by early springs experienced more tests than the other seasons. Areas of low testing rates (≤1.55%) spatially matches the mostly segregated neighborhoods. Residential segregation expanded in the 25 years and was significantly correlated (P value < 0.05) with low testing rates, even after other social indicators were controlled. Associations with the other social indicators, such as income or education, were weaker. Concertedly identifying the culturally relevant interventions in segregated communities is necessary to reduce and eliminate threats from environmental radon.
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Affiliation(s)
- Dajun Dai
- Department of Geosciences, Georgia State University, 38 Peachtree Center Avenue, Atlanta, GA 30303, United States of America.
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28
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Qiu Y, Liao K, Zou Y, Huang G. A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10069. [PMID: 36011701 PMCID: PMC9408714 DOI: 10.3390/ijerph191610069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.
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Affiliation(s)
- Yanrong Qiu
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Kaihuai Liao
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Yanting Zou
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Gengzhi Huang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou 510275, China
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Brown NR, Wingate LT. The Influence of Memorable Message Receipt on Dietary and Exercise Behavior among Self-Identified Black Women. HEALTH COMMUNICATION 2022; 37:1157-1166. [PMID: 34402348 DOI: 10.1080/10410236.2021.1962587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Guided by Control Theory and the memorable messages framework, the current investigation examined the relationship between receipt of a health-related memorable message and self-reported diet and exercise behavior. A cross-sectional survey methodology was utilized to evaluate the relationship between receipt of a memorable message and dietary and exercise behaviors in a sample of Black women. Over 80% of the research sample (N = 121) reported receiving a memorable health message regarding diet and/or exercise. Women receiving a memorable message reported a significantly higher number of days engaging in healthy eating and exercise behaviors each week. Messages from medical professionals had the greatest impact on healthy dietary practices, while media-based messages were most influential on the enactment of exercise behavior. Additional research is warranted to determine how the utilization and reinforcement of memorable messages impacts health outcomes among Black women.
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Affiliation(s)
| | - La'Marcus T Wingate
- College of Pharmacy, Department of Clinical & Administrative Pharmacy Sciences, Howard University
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30
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Miller HN, Perrin N, Thorpe RJ, Evans MK, Zonderman AB, Allen J. The Association Between Perceived Discrimination and BMI Trajectory: A Prospective Study of African American and White Adults. FAMILY & COMMUNITY HEALTH 2022; 45:206-213. [PMID: 35385415 PMCID: PMC9156529 DOI: 10.1097/fch.0000000000000326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Evidence suggests that socioenvironmental stressors, such as discrimination, may serve as determinants of the ongoing obesity epidemic and persisting disparities in obesity prevalence. The objectives of these analyses were to examine whether perceived discrimination was associated with body mass index (BMI) trajectory and whether this relationship differed by race or sex. Data for these analyses came from the Healthy Aging in Neighborhoods of Diversity across the Life Span study, a prospective cohort study in Baltimore City. Mixed-effects linear regression was used in a sample of 1962 African American and white adults to test our hypotheses. We found that race was an effect modifier in the relationship between perceived discrimination and BMI trajectory (B = 0.063, P = .014). Specifically, higher baseline perceived discrimination was associated with positive BMI trajectory in African American adults (B = 0.031, P = .033) but not in white adults (B = -0.032 P = .128). In this longitudinal study of African American and white adults, the relationship between perceived discrimination and BMI trajectory differed by race. Future research should be conducted in diverse samples to understand the risk socioenvironmental stressors pose on the development and progression of overweight and obesity, in addition to how these differ in subgroups.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Duke University, Durham, North Carolina (Dr Miller); School of Nursing (Drs Perrin and Allen) and Bloomberg School of Public Health (Dr Thorpe), Johns Hopkins University, Baltimore, Maryland; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland (Drs Evans and Zonderman)
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Goyal A, Milner GE, Cimino-Mathews A, Visvanathan K, Wolff AC, Sharma D, Sheng JY. Weight Gain after Hormone Receptor-Positive Breast Cancer. Curr Oncol 2022; 29:4090-4103. [PMID: 35735435 PMCID: PMC9222132 DOI: 10.3390/curroncol29060326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022] Open
Abstract
Obesity following breast cancer diagnosis is associated with poor overall survival. Understanding weight trajectories will help inform breast cancer survivors at greater risk of weight gain, and those who would benefit from earlier anti-obesity interventions. We performed a retrospective chart review of women from the Breast Cancer Program Longitudinal Repository (BCPLR) at Johns Hopkins diagnosed with hormone receptor-positive Stage I-III breast cancer from 2010 to 2020. We investigated obesity (measured by body mass index [BMI]) over time, patient and tumor characteristics, as well as treatment and recurrence. We observed a significant ≥5% increase in BMI from diagnosis to most recent follow-up (p = 0.009), particularly among those who were overweight at diagnosis (p = 0.003). Additionally, among those up to 5 years since diagnosis, there was a significant association between experiencing a ≥0.1 kg/m2 increase per year since diagnosis and baseline BMI status (p = 0.009). A ≥0.6 kg/m2 decrease in BMI was observed for participants with obesity at diagnosis (p = 0.006). Our study highlights (i) the significant burden of obesity in women with a history of breast cancer and (ii) higher risks for increases in BMI and shifts in class of obesity among women who are overweight at diagnosis.
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Affiliation(s)
- Archita Goyal
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA;
| | | | - Ashley Cimino-Mathews
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Kala Visvanathan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (K.V.); (A.C.W.); (D.S.)
| | - Antonio C. Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (K.V.); (A.C.W.); (D.S.)
| | - Dipali Sharma
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (K.V.); (A.C.W.); (D.S.)
| | - Jennifer Y. Sheng
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (K.V.); (A.C.W.); (D.S.)
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Smith IA, Griffiths A. Microaggressions, Everyday Discrimination, Workplace Incivilities, and Other Subtle Slights at Work: A Meta-Synthesis. HUMAN RESOURCE DEVELOPMENT REVIEW 2022. [DOI: 10.1177/15344843221098756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subtle slights refer to a wide range of ambiguous negative interactions between people that may harm individual health, wellbeing and performance at work. This literature review aims to help human resource development practitioners and researchers understand the similarities and distinguishing features of disparate bodies of subtle slight research. A systematic review yielded 338 papers, the majority of which concerned three constructs: microaggressions, everyday discrimination and workplace incivilities. Meta-synthesis revealed that all three categories related to subtle, low-intensity interactions but differed in their descriptions of the type of perceived violation. The most common demographic factors under scrutiny were race or ethnicity, gender, sexual orientation, and age. We propose a framework that involves four dimensions common to all subtle slights: type of violation, intensity, duration and intent (VIDI). This framework may help future efforts to understand, monitor and address this issue of contemporary concern in the workplace.
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Affiliation(s)
- Iain A. Smith
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Griffiths
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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Aaron DG, Stanford FC. Medicine, structural racism, and systems. Soc Sci Med 2022; 298:114856. [PMID: 35282989 PMCID: PMC9124607 DOI: 10.1016/j.socscimed.2022.114856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 01/28/2023]
Abstract
Medicine is having a reckoning with systemic racism. While some continue to believe medicine is apolitical and grounded purely in science, history and research reveal that medicine is inseparable from underlying systems, laws, and policies. Obesity is a useful case study. Weight loss trials have shown the immense difficulty in achieving and sustaining weight loss without addressing overlying systems. Barriers are double for Black, Indigenous, and People of Color (BIPOC) with obesity, who must contend with multiple layers of oppressive systems. Increasingly, illness is not a matter of bad luck, but is a function of oppressive structures. COVID-19 likely originates in a deteriorating environment, we have an increasing global burden of disease from oppressive sales of food, sugar, alcohol, guns, nicotine, and other harmful products, and social inequality and resource hoarding are at a peak. Medicine can and must participate in redefining these systems. In doing so, it must center the experiences of BIPOC and push change that alleviates power disparities.
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Affiliation(s)
- Daniel G Aaron
- Harvard Law School, U.S. Food & Drug Administration, and the Justice Initiative, Cambridge, MA, USA.
| | - Fatima Cody Stanford
- Internal Medicine-Neuroendocrine Division and Pediatric Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mackey ER, Burton ET, Cadieux A, Getzoff E, Santos M, Ward W, Beck AR. Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth. Child Obes 2022; 18:75-83. [PMID: 34491828 DOI: 10.1089/chi.2021.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.
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Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Center for Translational Research, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adelle Cadieux
- Department of Behavioral Health, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing MI, USA
| | - Elizabeth Getzoff
- Department of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children's, Hartford, CT, USA
| | - Wendy Ward
- Department of Pediatrics, College of Medicine, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Amy R Beck
- Center for Children's Healthy Lifestyles and Nutrition and Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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Responding to Health Disparities in Behavioral Weight Loss Interventions and COVID-19 in Black Adults: Recommendations for Health Equity. J Racial Ethn Health Disparities 2022; 9:739-747. [PMID: 35192179 PMCID: PMC8862701 DOI: 10.1007/s40615-022-01269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022]
Abstract
COVID-19 has disproportionately impacted Black adults with high prevalence and mortality rates. Obesity is a central factor in the severity of COVID-19 and related treatment. Behavioral weight loss interventions are an efficacious treatment for obesity, but consistently, Black men and women are minimally represented, and weight loss outcomes are less than clinically significant thresholds. This commentary draws parallels between COVID-19 racial disparities, disparate obesity rates, weight loss treatment outcomes, and underlying systemic racial context. This paper also indicates paths forward to address racialized societal norms in obesity treatment to advance health equity in obesity and reduce acute disease vulnerability. Recommendations for behavioral medicine practice and policy include (1) expanding the research lens to prioritize Black scholars and institutions to generate innovative research questions, (2) creating trustworthy relationships with Black community members to bolster recruitment and retention, (3) employing qualitative methods to facilitate better intervention design and uncover influences of racialized social context, (4) centering Black adults in weight loss interventions, and (5) using multilevel approaches that integrate policy into interventions. Moving forward, this commentary aims to make plain the multilayered form and function of racism, its impact on COVID-19 and obesity, and offer pathways to improve behavioral weight loss interventions that can produce more equitable outcomes.
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Differential impact of telehealth extended-care programs for weight-loss maintenance in African American versus white adults. J Behav Med 2022; 45:580-588. [DOI: 10.1007/s10865-022-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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Nyrop KA, O'Hare EA, Teal R, Stein K, Muss HB, Charlot M. Person-centered communication about weight and weight management: Focus group discussions in a diverse sample of women with nonmetastatic breast cancer and obesity. Cancer 2021; 127:4266-4276. [PMID: 34374079 PMCID: PMC9907558 DOI: 10.1002/cncr.33843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with obesity are at higher risk for high-grade and/or advanced-stage breast cancer in comparison with women without obesity. Many women with a high body mass index (BMI) at breast cancer diagnosis experience further weight gain during and after treatment. This study investigated Black and White patient perspectives on conversations with their oncologists about weight and weight management. METHODS Focus groups using a virtual platform (Zoom) were conducted with women after primary treatment for stage I to III breast cancer who were 21 years or older and had a BMI ≥ 30 kg/m2 : 2 with Black women (n = 12) and 2 with White women (n = 14). RESULTS Participants asked that their oncologists be "transparent" about weight gain as a potential side effect of their cancer treatment and how excess weight might affect their prognosis and survival. They asked to be "seen as an individual" to facilitate both person-centered and culturally appropriate conversations about behavioral changes needed for weight management. Participants urged clinicians to take the lead in initiating conversations about weight to underscore its importance in cancer care and survivorship. They welcomed actionable recommendations about nutrition and exercise from either the oncology clinician or a specialist. Participants offered specific suggestions on how clinicians could initiate weight-related conversations, beginning with questions eliciting patients' perspectives on their weight and lifestyle. CONCLUSIONS Many women with early-stage breast cancer and obesity have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management. LAY SUMMARY Focus group discussions with Black and White women with early-stage breast cancer and obesity have elicited patient perspectives on conversations with their oncologists about weight and weight management. Many patients have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin A O'Hare
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Stein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marjory Charlot
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Polos J, Koning S, McDade T. Do intersecting identities structure social contexts to influence life course health? The case of school peer economic disadvantage and obesity. Soc Sci Med 2021; 289:114424. [PMID: 34649177 PMCID: PMC8631455 DOI: 10.1016/j.socscimed.2021.114424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/24/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022]
Abstract
Scholarship linking social contextual measures to health outcomes has grown in recent decades, but the role of individuals' intersecting identities in structuring social contexts to influence health remains unclear. Building on an existing intersectionality framework, we conceptualize how this may occur through social relationships. Then, we apply this framework to analyze whether adolescent peer social contextual disadvantage influences life-course obesity heterogeneously by individual gender, race, and early-life income. We take a life course approach as adolescence is a sensitive period for both social development and adult obesity development. In our analysis, we use cohort data from the National Longitudinal Study of Adolescent to Adult Health and leverage quasi-experimental variation in adolescent peers to addresses common sources of bias in prior observational studies. We find that among Black men from lower-income households in adolescence, there is a strong negative relationship between adolescent peer economic disadvantage and adult obesity that strengthens over time. By contrast, among Black women across adolescent household income levels, we find a strong positive relationship between adolescent peer economic disadvantage and obesity that emerges as women leave high school and endures into mid-adulthood. Among non-Black women, a more modest positive relationship appears between peer disadvantage and obesity. Among non-Black men, we find no relationship. These diverging patterns suggest that the pathways through which adolescent peer economic disadvantage influences health may differ or produce differential effects based on intersecting race, gender, and socioeconomic identities. Such heterogenous effects offer new insights, and future directions, for better understanding social life-course determinants of adult health and addressing inequities.
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Affiliation(s)
- Jessica Polos
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA.
| | - Stephanie Koning
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA
| | - Thomas McDade
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA; Department of Anthropology, Northwestern University, 1810 Hinman St., Evanston, IL, 60208-1310, USA
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Stanford FC, Maron JL. Conversations With the Editors: Combating Caregiver and Patient-Perceived Obesity Stigmatization. Clin Ther 2021; 43:1140-1146. [PMID: 34103177 PMCID: PMC9908365 DOI: 10.1016/j.clinthera.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jill L. Maron
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA
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40
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Machado AV, Camelo LV, Chor D, Griep RH, Guimarães JMN, Giatti L, Barreto SM. Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort. J Epidemiol Community Health 2021; 75:695-701. [PMID: 33419789 DOI: 10.1136/jech-2020-214740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.
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Affiliation(s)
- Amanda Viana Machado
- Postgraduate Program in Public Health, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation-National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joanna M N Guimarães
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Volz K, Wyckoff E, Medina TH, Denmat Z, Field C, LaRose J, Gorin A, Leahey T. Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program. J Behav Med 2021; 44:853-859. [PMID: 34160724 DOI: 10.1007/s10865-021-00238-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions. The present study examined whether lower income predicts treatment engagement and weight loss outcomes during an online behavioral weight loss (BWL) intervention. A total of N = 260 participants (79.2% female; 50.7 ± 11.9 years of age; 60.3% non-Hispanic White) were enrolled into an online BWL program and had their income, stress, program engagement, and weight measured. Results showed that stress fully mediated the effect of income on engagement in the online program. Further, lower income predicted poorer weight loss outcomes, and this effect was partially mediated by perceived stress. This is the first study to demonstrate that lower income is associated with poorer engagement and weight loss outcomes in an online weight loss program, underscoring the need for systems-level stress reduction programs and individual level stress management tools, particularly for individuals with lower income.
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Affiliation(s)
| | | | | | | | | | | | - Amy Gorin
- University of Connecticut, Storrs, CT, USA
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Moore JX, Bevel MS, Aslibekyan S, Akinyemiju T. Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018. Prev Med 2021; 147:106483. [PMID: 33640399 PMCID: PMC8826516 DOI: 10.1016/j.ypmed.2021.106483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malcolm S Bevel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e984-e1010. [PMID: 33882682 PMCID: PMC8493650 DOI: 10.1161/cir.0000000000000973] [Citation(s) in RCA: 990] [Impact Index Per Article: 330.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
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Contribution of Adipose Tissue Oxidative Stress to Obesity-Associated Diabetes Risk and Ethnic Differences: Focus on Women of African Ancestry. Antioxidants (Basel) 2021; 10:antiox10040622. [PMID: 33921645 PMCID: PMC8073769 DOI: 10.3390/antiox10040622] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Adipose tissue (AT) storage capacity is central in the maintenance of whole-body homeostasis, especially in obesity states. However, sustained nutrients overflow may dysregulate this function resulting in adipocytes hypertrophy, AT hypoxia, inflammation and oxidative stress. Systemic inflammation may also contribute to the disruption of AT redox equilibrium. AT and systemic oxidative stress have been involved in the development of obesity-associated insulin resistance (IR) and type 2 diabetes (T2D) through several mechanisms. Interestingly, fat accumulation, body fat distribution and the degree of how adiposity translates into cardio-metabolic diseases differ between ethnicities. Populations of African ancestry have a higher prevalence of obesity and higher T2D risk than populations of European ancestry, mainly driven by higher rates among African women. Considering the reported ethnic-specific differences in AT distribution and function and higher levels of systemic oxidative stress markers, oxidative stress is a potential contributor to the higher susceptibility for metabolic diseases in African women. This review summarizes existing evidence supporting this hypothesis while acknowledging a lack of data on AT oxidative stress in relation to IR in Africans, and the potential influence of other ethnicity-related modulators (e.g., genetic-environment interplay, socioeconomic factors) for consideration in future studies with different ethnicities.
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Lewis TT, Van Dyke ME, Matthews KA, Barinas-Mitchell E. Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women. Am J Epidemiol 2021; 190:576-587. [PMID: 33034337 DOI: 10.1093/aje/kwaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.
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Reed M, Wilbur J, Tangney CC, Miller AM, Schoeny ME, Webber-Ritchey KJ. Development and Feasibility of an Obesity Prevention Intervention for Black Adolescent Daughters and Their Mothers. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2021; 1:94-107. [PMID: 37789909 PMCID: PMC10544921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Black female adolescents and women have disproportionately higher rates of obesity than their racial/ethnic counterparts. There is an urgent need to address obesity prevention in Black adolescent females through interventions that enhance lifestyle physical activity and improve dietary behaviors. Middle adolescence presents an important opportunity to strengthen the daughter-mother bond and improve healthy behaviors such as physical activity and dietary intake. Because of the intersection of adolescent development, culture and structural racism, it is essential to include mothers; however, this approach is understudied in the literature. This pre-pilot proof of concept study, Black Girls Move, was conducted using a 12-week pre-post within-subjects design to assess feasibility of conducting and delivering the BGM intervention, program satisfaction, and ability to obtain outcome measures in Black ninth and tenth grade daughters and their mothers. Twenty-two dyads were recruited and 14 dyads completed baseline assessments; however, only eight daughters and their mothers attended the first session and remained for the entire study. All dyads had valid objective and self-reported physical activity data. However, two of eight daughters and one mother provided self-reported dietary data that were considered invalid. All individual sessions were rated highly. Excellent attendance, retention, and satisfaction among participants suggest that we succeeded in developing an accepted, culturally relevant intervention. This lifestyle intervention would be strengthened by modifications to recruitment and retention, as well as incorporation of a computerized dietary assessment tool, a tailored dietary app for self-monitoring, and increased photo-based and group homework activities.
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The Weight of Racial Discrimination: Examining the Association Between Racial Discrimination and Change in Adiposity Among Emerging Adult Women Enrolled in a Behavioral Weight Loss Program. J Racial Ethn Health Disparities 2021; 9:909-920. [PMID: 33782906 DOI: 10.1007/s40615-021-01030-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Non-Hispanic Black (NHB) emerging adult (EA) women are at disproportionate risk for obesity but experience limited benefit from behavioral weight loss (BWL) programs. Race-related stress could play a role; the goal of this study was to examine the association between racial discrimination (RD) and early (3 months) changes in adiposity, and to explore potential protective factors, among EA in an adapted BWL program. METHODS This is an ancillary study of non-Hispanic White (NHW) and NHB EA women enrolled in an adapted BWL trial (N = 49; 55.1% NHB; Age 21.2 (2.1); BMI = 33.0 + 4.3 kg/m2). At baseline, group- and personal-level RD (RD-group and RD-personal), racial identity (NHB women only), vigilant coping, and social support were assessed via validated questionnaires. Weight and waist circumference were measured objectively at 0 and 3 months. RESULTS NHW women manifested greater reductions in waist circumference relative to NHB women (p = .004). RD-personal did not predict change in waist circumference at 3 months (p = .402); however, the association between RD-group and change in waist circumference was statistically significant (p = .015), such that reporting greater group-level discrimination predicted a smaller decrease in waist circumference; the model explained 22% of the variance. Social support and vigilant coping were not statistically significant in the model. Among NHB women only, higher racial identity-centrality predicted greater reduction in waist circumference (p = .019). CONCLUSION Findings suggest racial discrimination could contribute to greater cardiometabolic risk during this developmental period. Future research should examine how experiences of racial discrimination unfold in the daily lives of NHB women to inform mechanistic interventions to enhance health and well-being. TRIAL REGISTRATION NCT02736981. Low Intensity Weight Loss for Young Adults.
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Gibbons FX, Gerrard M, Fleischli ME, Simons RL, Kingsbury JH. Perceived racial discrimination and healthy behavior among African Americans. Health Psychol 2021; 40:155-165. [PMID: 33630637 DOI: 10.1037/hea0001056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Numerous studies have found evidence of a link between perceived discrimination and unhealthy behavior, especially substance use. Within this body of literature, however, several studies have found unexpected evidence of a positive relation between perceived racial discrimination among African Americans-mostly women-and certain types of healthy behavior, primarily exercise and healthy eating. The current study further examined this positive relation, including an anticipated moderator: optimism. It also examined the relation between perceived racial discrimination and a correlate of unhealthy behavior: BMI. METHOD Six waves of data were collected over 14 years in three related samples of African Americans from families participating in the Family and Community Health Study. Each family included an adolescent (Mage = 10.5 at Wave 1), the adolescent's primary caregiver (Mage = 37), and, in some cases, an older sibling of that adolescent (Mage = 13). Wave 1 Ns were 889, 889, and 295, respectively. Healthy behavior was defined as diet and exercise. RESULTS There was very little evidence of a long-term relation between perceived racial discrimination and BMI in any sample, and no evidence of a relation between discrimination and healthy behavior among the males. However, correlational analyses revealed a positive prospective relation between discrimination and healthy behavior among all three groups of females; structural equation modeling indicated that this relation was stronger among women who were high in optimism. CONCLUSIONS Perceived racial discrimination does not appear to be related to BMI among African Americans, but it is related to healthy behavior among Black females who are high in dispositional optimism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
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Forde AT, Lewis TT, Kershaw KN, Bellamy SL, Diez Roux AV. Perceived Discrimination and Hypertension Risk Among Participants in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2021; 10:e019541. [PMID: 33596667 PMCID: PMC8174295 DOI: 10.1161/jaha.120.019541] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022]
Abstract
Background Black Americans have a higher risk of hypertension compared with White Americans. Perceived discrimination is a plausible explanation for these health disparities. Few studies have examined the impact of perceived discrimination on the incidence of hypertension among a racially diverse sample. Our study examined associations of everyday and lifetime discrimination with incidence of hypertension and whether these associations varied by sex, discrimination attribution, and racial residential segregation. Methods and Results The study included 3297 Black, Hispanic, Chinese, and White participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis who were without hypertension at exam 1 (2000-2002) and who completed at least 1 of 5 follow-up exams (2002-2018). Cox proportional hazards regression was used to estimate associations of perceived discrimination with incident hypertension. Over the follow-up period, 49% (n=1625) of participants developed hypertension. After adjustment for age, sex, socioeconomic status, hypertension risk factors, and study site, Black participants reporting any lifetime discrimination (compared with none) were more likely to develop hypertension (hazard ratio [HR], 1.35; 95% CI, 1.07-1.69). In fully adjusted models, everyday discrimination (high versus low) was associated with a lower risk for hypertension among Hispanic participants (HR, 0.73; 95% CI, 0.55-0.98). Statistically significant interactions of perceived discrimination (everyday and lifetime) with sex, discrimination attribution, and racial residential segregation were not observed. Conclusions This study suggests that lifetime, but not everyday discrimination is associated with incident hypertension in Black Americans.
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Affiliation(s)
- Allana T. Forde
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPA
- The Urban Health CollaborativeDrexel UniversityPhiladelphiaPA
| | - Tené T. Lewis
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGA
| | - Kiarri N. Kershaw
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Scarlett L. Bellamy
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPA
| | - Ana V. Diez Roux
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPA
- The Urban Health CollaborativeDrexel UniversityPhiladelphiaPA
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Prevalence of overweight and obesity and associated factors among women of childbearing age in Brazil. Public Health Nutr 2021; 24:5481-5490. [PMID: 33500016 DOI: 10.1017/s1368980021000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the factors associated with overweight and obesity among women of childbearing age in Brazil. DESIGN Cross-sectional study. SETTING Using the National Health Survey (PNS) database, from the year 2013. The socio-economic and demographic factors analysed were age, race/skin colour, region, marital status, education level, employment and family income. Concerning health history, diagnoses of hypertension, diabetes mellitus, high cholesterol, heart attack, stroke, chronic kidney disease, menarche, parity and depression were evaluated. For lifestyle information, health status, alcoholic beverage consumption, smoking and physical activity were included. The outcomes were obesity and overweight. The association of excess weight with socio-economic and demographic factors, health history and lifestyle characteristics was investigated according to the appropriate theoretical-conceptual model for the topic. PARTICIPANTS The sample size was 17 109 women aged 18-49 years. RESULTS The prevalence of women with excess weight was 55·20 %, with 33·26 % being overweight and 21·94 % with obesity. The factors associated with excess weight were age, non-white skin colour, having a partner, family income of up to two minimum wages, menarche before the age of 12, multiparity, diabetes mellitus, depression, hypertension, high cholesterol, stroke and heart attack. CONCLUSION The results showed an association between excess weight and socio-demographic factors, both determinants of general and reproductive health history. Implementation of effective public health policies is necessary to prevent unfavourable outcomes related to the health of women of childbearing age with excess weight.
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