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Kim DK, Wang RM, Rohde CH, Ascherman JA. Disparities in pathways to reduction mammaplasty: A single institution review of 425 women with macromastia. J Plast Reconstr Aesthet Surg 2024; 96:175-185. [PMID: 39094372 DOI: 10.1016/j.bjps.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Reduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty. METHODS Patients with macromastia were identified via a chart review in a single institution from 2021-2022. The treatment pathway for each patient was characterized by reception of referral, completion of plastic surgery consultation, and eventual reception of surgery. After controlling for clinical covariates, multivariate logistic regression was applied to quantify the independent impact of race, insurance, and language status on the completion of surgery (p < 0.05). RESULTS The final patient cohort included 425 women with macromastia. Among the 151 patients who were first seen by a primary care physician, 64 (42%) completed an initial plastic surgery consultation. Among all patients, 160 (38%) eventually underwent reduction mammaplasty. Multivariate regression predictions indicated a lower likelihood of completing breast reduction surgery in patients with current smoking history (OR: 0.08, 95% CI: 0.01-0.59) and higher body mass index (BMI) (OR: 0.94, 95% CI: 0.90-0.97) (p < 0.05). Minority race and ethnicity, private insurance status, and primary language status were not significant predictors of this outcome (p > 0.05). CONCLUSIONS In this study, the socioeconomic variables were not independent predictors of breast reduction surgery completion. However, the association of minority race and ethnicity and nonprivate insurance status with the most common reasons for breast reduction deferral suggest an indirect influence of socioeconomic status on the treatment pathway.
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Affiliation(s)
- Dylan K Kim
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Ruiyan M Wang
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Jeffrey A Ascherman
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, United States.
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Ross JM, Hope MO, Volpe VV. Intersections of Racial/Ethnic and Religious Identities on Bodily Well-Being for Black College-Attending Emerging Adults. J Racial Ethn Health Disparities 2024; 11:1808-1818. [PMID: 37318713 DOI: 10.1007/s40615-023-01653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
Black undergraduates face threats to healthy weight and body image (i.e., bodily well-being). Having a strong racial/ethnic identity can promote health during emerging adulthood. However, less is known about the intersections of racial/ethnic and religious identities on the bodily well-being of Black college-attending emerging adults, despite evidence to indicate that aspects of religiosity are also associated with health. We use quantitative data from 767 Black college-attending emerging adults in the Multi-University Study of Identity and Culture to examine the independent contributions of racial/ethnic and religious identity for bodily health, and test a potential interaction between racial/ethnic and religious identity on bodily health outcomes. Results from a multivariate linear regression model indicate that Black college-attending emerging adults with both high religious identity and high racial/ethnic identity exploration had higher body mass index and less positive body image. Findings suggest ways to strengthen the development of culturally appropriate public health prevention and intervention efforts that target body image and weight for Black college-attending emerging adults. IMPACT STATEMENT: Black college-attending emerging adults face challenges to their health, particularly threats to healthy weight and body image during this period of psychosocial transitions. The developmental process of navigating racial/ethnic and religious identities during this time raises challenges and opportunities for health promotion for this population. Yet, research that explores the role of these identities remains scarce. We found that Black college-attending emerging adults had higher body mass index and more negative body image when they reported more racial/ethnic identity exploration coupled with higher religious identities. Results shed light on the complex ways that navigating both racial/ethnic and religious identities may put some Black college-attending emerging adults at greater health risk. Health education and promotion practice focused on improving Black emerging adult health in college contexts should ensure that behavioral interventions are appropriately nuanced and situated in these populations' developmental and cultural considerations.
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Affiliation(s)
- Julia M Ross
- Department of Psychology, North Carolina State University, Raleigh, NC, USA.
| | - Meredith O Hope
- Department of Psychology, The College of Wooster, Wooster, OH, USA
| | - Vanessa V Volpe
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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3
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Trejo S. Exploring the Fetal Origins Hypothesis Using Genetic Data. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2024; 102:1555-1581. [PMID: 38638179 PMCID: PMC11021852 DOI: 10.1093/sf/soae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/12/2023] [Accepted: 11/23/2023] [Indexed: 04/20/2024]
Abstract
Birth weight is a robust predictor of valued life course outcomes, emphasizing the importance of prenatal development. But does birth weight act as a proxy for environmental conditions in utero, or do biological processes surrounding birth weight themselves play a role in healthy development? To answer this question, we leverage variation in birth weight that is, within families, orthogonal to prenatal environmental conditions: one's genes. We construct polygenic scores in two longitudinal studies (Born in Bradford, N = 2008; Wisconsin Longitudinal Study, N = 8488) to empirically explore the molecular genetic correlates of birth weight. A 1 standard deviation increase in the polygenic score is associated with an ~100-grams increase in birth weight and a 1.4 pp (22 percent) decrease in low birth weight probability. Sibling comparisons illustrate that this association largely represents a causal effect. The polygenic score-birth weight association is increased for children who spend longer in the womb and whose mothers have higher body mass index, though we find no differences across maternal socioeconomic status. Finally, the polygenic score affects social and cognitive outcomes, suggesting that birth weight is itself related to healthy prenatal development.
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Affiliation(s)
- Sam Trejo
- Princeton University, Department of Sociology and Office of Population Research, United States
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4
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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review. Adv Nutr 2024; 15:100237. [PMID: 38710327 PMCID: PMC11180316 DOI: 10.1016/j.advnut.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helen Harris-Fry
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Offner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michele Zaman
- Department of Medicine, Queen's University, Ontario, Canada
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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DeAngelis R, Upenieks L, Louie P. Religious Involvement and Allostatic Resilience: Findings from a Community Study of Black and White Americans. J Racial Ethn Health Disparities 2024; 11:137-149. [PMID: 36598753 PMCID: PMC10754255 DOI: 10.1007/s40615-022-01505-1] [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: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
Wide inequities in stress and health have been documented between Black and White women and men in the United States. This study asks: How does religion factor into these inequities? We approach this open question from a biopsychosocial perspective, developing three hypotheses for the stress-coping effects of religiosity between groups. We then test our hypotheses with survey and biomarker data from the Nashville Stress and Health Study (2011-2014), a probability sample of Black and White women and men from Davidson County, Tennessee. We find that Black women score the highest on all indicators of religiosity, followed by Black men, White women, and White men. We also find that increased divine control and religious coping predict higher levels of resiliency biomarkers for Black women only and lower levels for White respondents, especially White men. We discuss how our findings inform broader population health inequities and outline several avenues for future research.
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Affiliation(s)
- Reed DeAngelis
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, 155 Pauli Murray Hall CB #3210, Chapel Hill, NC, 27599, USA.
| | - Laura Upenieks
- Department of Sociology, Baylor University, Waco, TX, USA
| | - Patricia Louie
- Department of Sociology, University of Washington, Seattle, WA, USA
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Savell SM, Niguse M, Caluori N, Brown-Iannuzzi JL, Wilson MN, Lemery-Chalfant K, Shaw DS. Cascading Influences of Caregiver Experiences of Discrimination and Adolescent Antisocial Behavior. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-15. [PMID: 38252485 PMCID: PMC11260903 DOI: 10.1080/15374416.2024.2301770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Although a growing body of work has found that parents' experiences of racial and socioeconomic (SES) based discrimination are directly related to their children's behavior problems , more work is needed to understand possible pathways by which these factors are related and to identify potential targets for prevention and/or intervention. METHOD Using a large (N = 572), longitudinal sample of low-income families from diverse racial backgrounds, the current study explored whether caregivers' experiences of racial and SES discrimination during their children's middle childhood (i.e. ages 7.5-9.5) predicted youth-reported antisocial behavior during adolescence and potential factors mediating these associations (e.g. caregiver depressive symptoms and positive parenting practices). RESULTS We found that higher levels of caregiver experiences of discrimination at child ages 7.5-9.5 predicted higher levels of caregiver depressive symptoms at child age 10.5, which were related to lower levels of caregiver endorsement of positive parenting practices at child age 14.5, which in turn, predicted higher levels of youth-reported antisocial behavior at age 16. CONCLUSION The findings highlight the adverse effects of racism and discrimination in American society. Second, the findings underscore the need to develop interventions which mitigate racism and discrimination among perpetrators and alleviate depressive symptoms among caregivers.
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Affiliation(s)
- Shannon M. Savell
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - Mihret Niguse
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - Nava Caluori
- Department of Psychology, University of Virginia, Charlottesville, VA
| | | | - Melvin N. Wilson
- Department of Psychology, University of Virginia, Charlottesville, VA
| | | | - Daniel S. Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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Bhatta TR. Intersecting Early-Life Selection Mechanisms: Socio-Historical Changes in Racially Stratified Effects of Education on Functional Limitations in the United States. J Aging Health 2023; 35:242-255. [PMID: 36073190 DOI: 10.1177/08982643221124657] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Scant research has focused on the role of sociohistorical changes in shaping intersecting early-life selection mechanisms and their impacts on racially stratified effects of education on health across cohorts. METHOD Drawing from the Health and Retirement Survey, this study fitted negative binomial regression models to assess the impacts of childhood socioeconomic status (SES) on the relationship between education and functional limitations for Black and White adults across birth cohorts (n = 16,269, born 1931-1959). RESULTS The disparities between Black adults and White adults in impacts of childhood SES on both education and functional limitations were more pronounced in recent cohorts. The racial stratification in the impacts of education on functional limitations was documented across cohorts. However, after adjusting for childhood SES, this stratification narrowed considerably in recent cohorts. DISCUSSION This study underscores the role of a sociohistorical context in shaping the effects of education on health at the intersection of race and cohort.
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Affiliation(s)
- Tirth R Bhatta
- Department of Sociology, University of Nevada, Las Vegas, NV, USA
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8
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Foster N, Kapiriri L, Grignon M, McKenzie K. "But…I survived": A phenomenological study of the health and wellbeing of aging Black women in the Greater Toronto Area, Canada. J Women Aging 2023; 35:22-37. [PMID: 35635795 DOI: 10.1080/08952841.2022.2079925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies that assess the association between race and health have focused intently on the cumulative impact of continuous exposure to racism over an extended period. While these studies have contributed significantly to the general understanding of the life experiences and health status of racialized people, few studies have explicitly bridged the experiences of aging with gender and the wide structural barriers and social factors that have shaped the lives of racialized older women. This study aimed to investigate the origins of health inequities to highlight factors that intersect to affect the health and wellbeing of older Black women across their life course. Descriptive phenomenology was used to describe older Black women's health and wellbeing, and factors that impact their health across their life course. Criteria-based sampling was used to recruit study participants (n = 27). To be eligible women needed to be 55 years or older, speak English, self-identify as a Black female, and live in the Greater Toronto Area. Data analysis was guided by phenomenology. Themes identified demonstrated that participants' health and wellbeing were influenced by gender bias, racism, abuse, and retirement later in life. Participants reported having poor mental health during childhood and adulthood due to anxiety and depression. Other chronic illnesses reported included hypertension, diabetes, and cancer. Qualitative methods provided details regarding events and exposures that illuminate pathways through which health inequities emerge across the life course.
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Affiliation(s)
- Nicoda Foster
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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9
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Thomas Tobin CS, Gutiérrez Á, Farmer HR, Erving CL, Hargrove TW. Intersectional Approaches to Minority Aging Research. CURR EPIDEMIOL REP 2023; 10:1-11. [PMID: 36644596 PMCID: PMC9830125 DOI: 10.1007/s40471-022-00317-5] [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: 11/30/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review Growing racial/ethnic diversity among America's older adults necessitates additional research specifically focused on health and well-being among aging minoritized populations. Although Black and Latinx adults in the USA tend to face worse health outcomes as they age, substantial evidence points to unexpected health patterns (e.g., the race paradox in mental health, the Latino health paradox) that challenge our understanding of health and aging among these populations. In this review, we demonstrate the value of intersectionality theory for clarifying these health patterns and highlight the ways that intersectionality has been applied to minority aging research. To advance the field, we also make several recommendations for incorporating intersectional approaches in future scholarship on minority aging. Recent Findings Scholars have applied intersectional approaches to health and aging to unravel how social statuses and social conditions, such as race, ethnicity, gender, nativity, incarceration history, geographic region, and age, produce distinct shared experiences that shape health trajectories through multiple mechanisms. Summary We highlight common intersectional approaches used in minority aging research and underscore the value of this perspective for elucidating the complex, and often unexpected, health patterns of aging minoritized populations. We identify several key lessons and propose recommendations to advance scholarship on minority aging.
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Affiliation(s)
- Courtney S. Thomas Tobin
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA USA
| | - Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine 128B 57 West Oxbow Trail, 1 Ohio University Drive, Athens, OH 45701-2979 USA
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE USA
| | | | - Taylor W. Hargrove
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Acciai F, DeWeese RS, Yedidia MJ, Lloyd K, Tulloch D, DeLia D, Ohri-Vachaspati P. Differential Associations Between Changes in Food Environment and Changes in BMI Among Adults Living in Urban, Low-Income Communities. J Nutr 2022; 152:2582-2590. [PMID: 36774124 PMCID: PMC9644168 DOI: 10.1093/jn/nxac186] [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] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Food environments can contribute to excess weight gain among adults, but the evidence is mixed. OBJECTIVES This longitudinal study investigated the associations between changes in the food environment and changes in BMI in adults and whether changes in the food environment differentially impact various subgroups. METHODS At 2 time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in 4 New Jersey cities. The counts of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences were collected at baseline and tracked until follow-up. A binary measure of social standing (social-advantage group, n = 219; social-disadvantage group, n = 298) was created through a latent class analysis using social, economic, and demographic variables. Multivariable linear regression modeled the associations between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of food environment and social standing were examined. RESULTS Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (β = -1.0; 95% CI: -1.9, -0.1; P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (β = 0.1; 95% CI: 0.01, 0.2; P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between changes in the food environment and changes in BMI varied by social standing. For instance, the association between changes in fast-food restaurants and changes in BMI was only observed in the social-disadvantage group (β = 0.1; 95% CI: 0.02, 0.2; P = 0.021). CONCLUSIONS In a sample of adults living in New Jersey, changes in the food environment had differential effects on individuals' BMIs, based on their social standing.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Robin S DeWeese
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Kristen Lloyd
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - David Tulloch
- Department of Landscape Architecture, Rutgers University, New Brunswick, NJ, USA
| | - Derek DeLia
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA
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Liwin LK. Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis. BMC Public Health 2022; 22:1004. [PMID: 35585591 PMCID: PMC9115941 DOI: 10.1186/s12889-022-13379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country. Methods Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts). Results In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men. Conclusion Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13379-3.
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Affiliation(s)
- Lilipramawanty Kewok Liwin
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia.
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12
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Skin Tone, Racial/Ethnic, and Gender Differences in Self-Reported Mental and Physical Health among U.S. Lawful Permanent Resident Immigrants. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022. [DOI: 10.1007/s12134-022-00950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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First do no harm: reconsidering our approach to weight in primary care. Br J Gen Pract 2022; 72:102-103. [PMID: 35210233 PMCID: PMC8884442 DOI: 10.3399/bjgp22x718565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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14
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Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-021-09691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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The role of food and activity environment in a bariatric surgery population: impact on postoperative weight loss. Surg Obes Relat Dis 2021; 18:365-372. [PMID: 35016840 DOI: 10.1016/j.soard.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/29/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Food and activity factors may have an impact on weight in the general population, but little is known about how this affects postbariatric surgery weight loss. OBJECTIVES To understand the impact of environmental food and activity factors on weight loss after bariatric surgery. SETTING A multidisciplinary integrated health system with an accredited bariatric surgery program. METHODS An institutional review board-approved retrospective review of patients who underwent bariatric surgery from 2001-2018 was completed. Food security, food retailers, and activity factors associated with postoperative percentage of total body weight loss (TBWL) at short-term (1-2 yr), medium-term (3-5 yr), and long-term (≥6 yr) follow-up were evaluated. RESULTS Overall, 1673 patients were included; 90% experienced ≥20% TBWL in the short term and 65% in the long term. No differences in mean TBWL were observed for food deserts or areas with high versus low food insecurity. Mean TBWL was significantly different for low versus high healthy food density (32.5% versus 33.4%, P = .024) and low versus high fitness facility density (32.6% versus 33.4%, P = .048) at short-term follow-up. Increased mean TBWL was observed for counties with more versus less exercise opportunities at short and medium-term follow-up (33.4% versus 32.5%, P = .025; 31.2% versus 29.7%, P = .019). CONCLUSION Patients experienced significant TBWL after bariatric surgery. Living in a food desert or area with high food insecurity did not significantly impact mean TBWL. Healthy food density, fitness facility density, and exercise opportunities had a short- to medium-term impact on TBWL. These data can be used to support patients to maximize the benefits of bariatric surgery.
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Ciciurkaite G. Race/ethnicity, gender and the SES gradient in BMI: The diminishing returns of SES for racial/ethnic minorities. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1754-1773. [PMID: 33884635 DOI: 10.1111/1467-9566.13267] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/23/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Using the 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES), this study uses the case of obesity to examine whether and to what extent racial and ethnic minorities experience fewer benefits from higher SES relative to their white counterparts. Study results provide support for the diminishing returns in health hypothesis and add an intersectional dimension to this perspective by uncovering stark gendered racial/ethnic disparities in BMI. Specifically, research findings demonstrate that higher income and education is associated with lower BMI among white but not black or Mexican American adults. The most substantial decrease in BMI associated with increase in individual-level SES was observed among white women. Taken together, empirical evidence from this study underscores difficulty in overcoming adverse health effects of lower ascribed status (i.e. gender or race/ethnicity) even with attainment of higher achieved social status (i.e. educational attainment or income) and offers promising avenues for future research on identifying complex hierarchies that shape population health outcomes.
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Affiliation(s)
- Gabriele Ciciurkaite
- Department of Sociology, Social Work and Anthropology, Utah State University, Utah, USA
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Homan P, Brown TH, King B. Structural Intersectionality as a New Direction for Health Disparities Research. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:350-370. [PMID: 34355603 PMCID: PMC8628816 DOI: 10.1177/00221465211032947] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article advances the field by integrating insights from intersectionality perspectives with the emerging literatures on structural racism and structural sexism-which point to promising new ways to measure systems of inequality at a macro level-to introduce a structural intersectionality approach to population health. We demonstrate an application of structural intersectionality using administrative data representing macrolevel structural racism, structural sexism, and income inequality in U.S. states linked to individual data from the Behavioral Risk Factor Surveillance System to estimate multilevel models (N = 420,644 individuals nested in 76 state-years) investigating how intersecting dimensions of structural oppression shape health. Analyses show that these structural inequalities: (1) vary considerably across U.S. states, (2) intersect in numerous ways but do not strongly or positively covary, (3) individually and jointly shape health, and (4) are most consistently associated with poor health for black women. We conclude by outlining an agenda for future research on structural intersectionality and health.
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Ezell JM, Pasquale D, Poudyal S, Azhar S, Monk E, Vidula M, Yeldandi V, Laumann E, Liao C, Schneider JA. Are skin color and body mass index associated with social network structure? Findings from a male sex market study. ETHNICITY & HEALTH 2021; 26:863-878. [PMID: 30870001 PMCID: PMC6745014 DOI: 10.1080/13557858.2019.1590537] [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] [Received: 08/22/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Objectives: There is a growing burden of HIV and sex-related diseases in South Asia and India. Sociological research illustrates that key axes of social stratification, such as race and ethnicity, affect social network structure which, in turn, impacts sexual health and wellbeing. Research on networks has increasingly begun to examine the ways in which networks drive or harness sexual behaviors, but has largely neglected the influence of culture and cultural markers in this continuum. Furthermore, much of the existing scholarship has been conducted in the U.S. or in Western contexts.Design: As part of an exploratory effort, we examined how skin color and body mass index (BMI) affected networks among 206 men who have with men (MSM) frequenting sex markets in Hyderabad, India. A novel phone-based network generation method of respondent-driven sampling was used for recruitment. In assessing how skin color and BMI drive these structures, we also compared how these factors contribute to networks relative to two more commonly referenced markers of social difference among Indians, caste and religion.Results: Our findings suggest that skin color and BMI contribute significantly more to network structure than do caste and religion.Conclusions: These findings tentatively illuminate the importance of individual-level heterogeneity in bodily attributes, factors which are seldom considered in conventional approaches to researching how social stratification and health inequalities are animated during the formation of networks.
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Affiliation(s)
- Jerel M. Ezell
- Department of Sociology, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Dana Pasquale
- Department of Sociology, Duke University, Durham, NC
| | - Shirish Poudyal
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sameena Azhar
- School of Social Service Administration, University of Chicago, Chicago, IL
| | - Ellis Monk
- Department of Sociology, Harvard University, Cambridge, MA
| | | | - Vijay Yeldandi
- International Center for Human Health Advancement, SHARE India, Hyderabad, India
- Department of Medicine, University of Illinois, Chicago, IL
| | - Edward Laumann
- Department of Sociology, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - John A. Schneider
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
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19
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Yang YC, Walsh CE, Johnson MP, Belsky DW, Reason M, Curran P, Aiello AE, Chanti-Ketterl M, Harris KM. Life-course trajectories of body mass index from adolescence to old age: Racial and educational disparities. Proc Natl Acad Sci U S A 2021; 118:e2020167118. [PMID: 33875595 PMCID: PMC8092468 DOI: 10.1073/pnas.2020167118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
No research exists on how body mass index (BMI) changes with age over the full life span and social disparities therein. This study aims to fill the gap using an innovative life-course research design and analytic methods to model BMI trajectories from early adolescence to old age across 20th-century birth cohorts and test sociodemographic variation in such trajectories. We conducted the pooled integrative data analysis (IDA) to combine data from four national population-based NIH longitudinal cohort studies that collectively cover multiple stages of the life course (Add Health, MIDUS, ACL, and HRS) and estimate mixed-effects models of age trajectories of BMI for men and women. We examined associations of BMI trajectories with birth cohort, race/ethnicity, parental education, and adult educational attainment. We found higher mean levels of and larger increases in BMI with age across more recent birth cohorts as compared with earlier-born cohorts. Black and Hispanic excesses in BMI compared with Whites were present early in life and persisted at all ages, and, in the case of Black-White disparities, were of larger magnitude for more recent cohorts. Higher parental and adulthood educational attainment were associated with lower levels of BMI at all ages. Women with college-educated parents also experienced less cohort increase in mean BMI. Both race and education disparities in BMI trajectories were larger for women compared with men.
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Affiliation(s)
- Yang Claire Yang
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Christine E Walsh
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516;
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Moira P Johnson
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Daniel W Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Max Reason
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Patrick Curran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Marianne Chanti-Ketterl
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC 27705
| | - Kathleen Mullan Harris
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
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20
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Harari L, Lee C. Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies. Soc Sci Med 2021; 277:113876. [PMID: 33866085 DOI: 10.1016/j.socscimed.2021.113876] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 01/12/2023]
Abstract
RATIONALE Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens. METHODS We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion. RESULTS Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages. CONCLUSION If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.
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Affiliation(s)
- Lexi Harari
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Chioun Lee
- Department of Sociology, University of California-Riverside, Riverside, CA, USA.
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21
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Ford CN, Chang S, Wood AC, Manson JE, Garcia DO, Laroche H, Bird CE, Vitolins MZ. On the joint role of non-Hispanic Black race/ethnicity and weight status in predicting postmenopausal weight gain. PLoS One 2021; 16:e0247821. [PMID: 33647066 PMCID: PMC7920337 DOI: 10.1371/journal.pone.0247821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine how baseline weight status contributes to differences in postmenopausal weight gain among non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). METHODS Data were included from 70,750 NHW and NHB postmenopausal women from the Women's Health Initiative Observational Study (WHI OS). Body Mass Index (BMI) at baseline was used to classify women as having normal weight, overweight, obese class I, obese class II or obese class III. Cox proportional hazards was used to estimate the hazard of a 10% or more increase in weight from baseline. RESULTS In both crude and adjusted models, NHBs were more likely to experience ≥10% weight gain than NHWs within the same category of baseline weight status. Moreover, NHBs who were normal weight at baseline were most likely to experience ≥10% weight gain in both crude and adjusted models. Age-stratified results were consistent with overall findings. In all age categories, NHBs who were normal weight at baseline were most likely to experience ≥10% weight gain. Based on the results of adjusted models, the joint influence of NHB race/ethnicity and weight status on risk of postmenopausal weight gain was both sub-additive and sub-multiplicative. CONCLUSION NHBs are more likely to experience postmenopausal weight gain than NHWs, and the disparity in risk is most pronounced among those who are normal weight at baseline. To address the disparity in postmenopausal obesity, future studies should focus on identifying and modifying factors that promote weight gain among normal weight NHBs.
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Affiliation(s)
- Christopher N. Ford
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, United States of America
| | - Shine Chang
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Alexis C. Wood
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States of America
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States of America
| | - Helena Laroche
- Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Hospital, Kansas City and University of Missouri, Kansas City, MO, United States of America
| | - Chloe E. Bird
- RAND Corporation, Santa Monica, CA, United States of America
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest, NC, United States of America
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22
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Sheehan CM, Walsemann KM, Ailshire JA. Race/ethnic differences in educational gradients in sleep duration and quality among U.S. adults. SSM Popul Health 2020; 12:100685. [PMID: 33204809 PMCID: PMC7653162 DOI: 10.1016/j.ssmph.2020.100685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022] Open
Abstract
At the population level, those with more education tend to report better sleep, mirroring the education gradient found in other health outcomes. But research has shown that higher educational attainment does not always confer the same health benefits for Non-Hispanic Black (Black) and Hispanic adults as it does for Non-Hispanic White (White) adults. It is therefore possible that the educational gradient in sleep varies across racial/ethnic groups in the United States. Using the 2004–2018 National Health Interview Survey (N = 356,048), we examined differences in self-reported sleep duration and sleep quality by level of educational attainment and race/ethnicity. Utilizing multinomial (sleep duration) and negative binomial (times in the past week with difficulty falling asleep and staying asleep) regression models, we found that, compared to their less educated counterparts, college or more educated Whites were more likely to report ideal sleep compared to short or long sleep, and also reported fewer times with difficulty falling or staying asleep. The education-sleep association was generally reversed for Black and Hispanic adults, with the worst sleep being reported by those with college-level education. These patterns remained after adjusting for health behaviors, health outcomes, and socioeconomic status. Our study suggests that education does not yield the same protective benefit for sleep among Black and Hispanic adults as it does for White adults, and that highly educated Black and Hispanic adults in particular experience a sleep disadvantage. The differential education gradient in sleep may, therefore, be an important factor underlying current racial and ethnic health disparities. Greater education was associated with fewer sleep problems for Whites. This association was generally reversed for Blacks and Hispanics. Education may be a “double-edged sword” for the sleep of Blacks and Hispanics.
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Affiliation(s)
- Connor M Sheehan
- T. Denny School of Social and Family Dynamics, Arizona State University, USA
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Holman D, Walker A. Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. Eur J Ageing 2020; 18:239-255. [PMID: 33082738 PMCID: PMC7561228 DOI: 10.1007/s10433-020-00582-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Intersectionality has received an increasing amount of attention in health inequalities research in recent years. It suggests that treating social characteristics separately—mainly age, gender, ethnicity, and socio-economic position—does not match the reality that people simultaneously embody multiple characteristics and are therefore potentially subject to multiple forms of discrimination. Yet the intersectionality literature has paid very little attention to the nature of ageing or the life course, and gerontology has rarely incorporated insights from intersectionality. In this paper, we aim to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. First we provide an overview of how intersectionality can be used in research on inequality, focusing on intersectional subgroups, discrimination, categorisation, and individual heterogeneity. We cover two key approaches—the use of interaction terms in conventional models and multilevel models which are particularly focussed on granular subgroup differences. In advancing a conceptual dialogue with the life course perspective, we discuss the concepts of roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. We conclude that the synergies between intersectionality and the life course hold exciting opportunities to bring new insights to unequal ageing and its attendant health inequalities.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
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Dougherty GB, Golden SH, Gross AL, Colantuoni E, Dean LT. Measuring Structural Racism and Its Association With BMI. Am J Prev Med 2020; 59:530-537. [PMID: 32863079 PMCID: PMC8147662 DOI: 10.1016/j.amepre.2020.05.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Structural racism has attracted increasing interest as an explanation for racial disparities in health, including differences in adiposity. Structural racism has been measured most often with single-indicator proxies (e.g., housing discrimination), which may leave important aspects of structural racism unaccounted for. This paper develops a multi-indicator scale measuring county structural racism in the U.S. and evaluates its association with BMI. METHODS County structural racism was estimated with a confirmatory factor model including indicators reflecting education, housing, employment, criminal justice, and health care. Using Behavioral Risk Factor Surveillance Survey data (2011-2012) and a mixed-effects model, individual BMI was regressed on county structural racism, controlling for county characteristics (mean age, percentage black, percentage female, percentage rural, median income, and region). Analysis occurred 2017-2019. RESULTS The study included 324,572 U.S. adults. A 7-indicator county structural racism model demonstrated acceptable fit. County structural racism was associated with lower BMI. Structural racism and black race exhibited a qualitative interaction with BMI, such that racism was associated with lower BMI in whites and higher BMI in blacks. In a further interaction analysis, county structural racism was associated with larger increases in BMI among black men than black women. County structural racism was associated with reduced BMI for white men and no change for white women. CONCLUSIONS The results confirm structural racism as a latent construct and demonstrate that structural racism can be measured in U.S. counties using publicly available data with methods offering a strong conceptual underpinning and content validity. Further study is necessary to determine whether addressing structural racism may reduce BMI among blacks.
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Affiliation(s)
- Geoff B Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Sherita H Golden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Kröger H, Leopold L. Education differences in women's body weight trajectories: The role of motherhood. PLoS One 2020; 15:e0236487. [PMID: 32956409 PMCID: PMC7505466 DOI: 10.1371/journal.pone.0236487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Studies have found that education differences in women's body weight increase until middle adulthood. The explanatory mechanisms behind this increase are not well-understood. This study examined the role of education differences in the prevalence of motherhood as a risk factor for weight gain and in vulnerability to its effects on weight gain. We used longitudinal data from the German Socio-economic Panel Study. Our sample included 2,668 women aged between 17 and 45 and observed at least twice between 2002 and 2016 (n = 13,899 panel observations). We used OLS regression models to estimate initial education differences in body weight and fixed-effects panel regression models to estimate education differences in body-weight trajectories. Motherhood was associated with increasing body weight, and the effects of motherhood on weight gain varied by education. Motherhood partially accounted for the increase of education differences during reproductive age. Until the age of 30, differences in the prevalence of motherhood accounted for about 20% of the bodyweight gap between lower and higher educated women. From age 35 until 45, differential vulnerability to the effects of motherhood on body weight explained about 15% of the education gap in body weight.
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Affiliation(s)
- Hannes Kröger
- German Socio-Economic Panel, German Institute for Economic Research (DIW), Berlin, Germany
| | - Liliya Leopold
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
- Professorship of Demography, University of Bamberg, Bamberg, Germany
- * E-mail:
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Zamora-Kapoor A, Sinclair K, Nelson L, Lee H, Buchwald D. Obesity risk factors in American Indians and Alaska Natives: a systematic review. Public Health 2019; 174:85-96. [PMID: 31326761 DOI: 10.1016/j.puhe.2019.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages. STUDY DESIGN We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American. METHODS We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs. RESULTS Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity. CONCLUSIONS Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.
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Affiliation(s)
- A Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
| | - K Sinclair
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - L Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - H Lee
- Department of Sociology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - D Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Medicine, Washington State University, Spokane, WA 99202, USA
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Campbell AD, Baker EH. Do income inequalities in higher weight status depend on social integration? SOCIAL SCIENCE RESEARCH 2019; 83:102301. [PMID: 31422839 PMCID: PMC8088976 DOI: 10.1016/j.ssresearch.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/27/2019] [Accepted: 04/18/2019] [Indexed: 05/03/2023]
Abstract
Those with higher incomes tend to have better health outcomes, including healthy weight status. We use data from the 2003-2008 National Health and Nutrition Examination Survey (NHANES) to examine whether the association between higher weight status and social integration varies by income. We examine gender differences in weight status, measured by BMI and obesity, by social integration and income, and find evidence that high social integration is a risk factor for higher weight status among low-income men. The association between income and higher weight status operates differently for women and men and is dependent, in part, on their level of social integration. Income is negatively associated with weight status for men who are highly integrated, but is positively associated with weight status among men who have low integration. We conclude that higher numbers of close friends and family places low-income men at greater risk of higher weight status.
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In Biomedicine, Thin Is Still In: Obesity Surveillance among Racialized, (Im)migrant, and Female Bodies. SOCIETIES 2019. [DOI: 10.3390/soc9030059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently there is a plethora of research literature which constructs obesity as an alarming new global pandemic associated with a multitude of acute and chronic diseases rooted in lifestyle factors. Although most of these claims related to obesity are well accepted in the research community, some challenges remain. For instance, lifestyle factors only partially explain the risks of developing obesity. In this paper, I advocated for greater caution in interpreting some of the medical claims of obesity due to the epistemological and methodological assumptions that inform certain groups of obesity researchers. While most of the literature has reported lifestyle factors and behavior modification as the major mechanisms to achieving health and wellbeing, a few scholars have raised issues about structural factors.
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Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393:2440-2454. [PMID: 31155275 DOI: 10.1016/s0140-6736(19)30652-x] [Citation(s) in RCA: 446] [Impact Index Per Article: 89.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
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Affiliation(s)
- Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | | | - Neisha Opper
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Maria Stavropoulou
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Caroline Harper
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Marcos Nascimento
- Programa de Posgraduação em Saúde da Criança e da Mulher, Instituto Fernandes Figueira-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Debrework Zewdie
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Lapalme J, Haines-Saah R, Frohlich KL. More than a buzzword: how intersectionality can advance social inequalities in health research. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1584271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Josée Lapalme
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche en santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Katherine L. Frohlich
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche en santé publique de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
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Hernández-Yumar A, Wemrell M, Abásolo Alessón I, González López-Valcárcel B, Leckie G, Merlo J. Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. PLoS One 2018; 13:e0208624. [PMID: 30532244 PMCID: PMC6287827 DOI: 10.1371/journal.pone.0208624] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022] Open
Abstract
Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.
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Affiliation(s)
- Aránzazu Hernández-Yumar
- Departamento de Economía Aplicada y Métodos Cuantitativos, Facultad de Economía, Empresa y Turismo, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Maria Wemrell
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Department of Gender Studies, Lund University, Lund, Sweden
| | - Ignacio Abásolo Alessón
- Departamento de Economía Aplicada y Métodos Cuantitativos, Facultad de Economía, Empresa y Turismo, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - Beatriz González López-Valcárcel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España
| | - George Leckie
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Multilevel Modelling, University of Bristol, Bristol, United Kingdom
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Primary Health Care Research, Region Skåne, Malmö, Sweden
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Hargrove TW. BMI Trajectories in Adulthood: The Intersection of Skin Color, Gender, and Age among African Americans. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:501-519. [PMID: 30303024 PMCID: PMC6657514 DOI: 10.1177/0022146518802439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study addresses three research questions critical to understanding if and how skin color shapes health among African Americans: (1) Does skin color predict trajectories of body mass index (BMI) among African Americans across ages 32 to 55? (2) To what extent is this relationship contingent on gender? (3) Do sociodemographic, psychosocial, and behavioral factors explain the skin color-BMI relationship? Using data from the Coronary Artery Risk Development in Young Adults Study and growth curve models, results indicate that dark-skinned women have the highest BMI across adulthood compared to all other skin color-gender groups. BMI differences between dark- and lighter-skinned women remain stable from ages 32 to 55. Among men, a BMI disadvantage emerges and widens between light- and dark-skinned men and their medium-skinned counterparts. Observed sociodemographic characteristics, stressors, and health behaviors do not explain these associations. Overall, findings suggest that skin color- and gender-specific experiences likely play an important role in generating BMI inequality.
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Affiliation(s)
- Taylor W Hargrove
- 1 The University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Hankivsky O, Springer KW, Hunting G. Beyond sex and gender difference in funding and reporting of health research. Res Integr Peer Rev 2018; 3:6. [PMID: 30167330 PMCID: PMC6112145 DOI: 10.1186/s41073-018-0050-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/30/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality. METHODS Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in "science" and the top five in "social science") and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives. RESULTS The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health. CONCLUSIONS The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health-an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies.
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Affiliation(s)
- Olena Hankivsky
- School of Public Policy, Institute for Intersectionality Research and Policy, Simon Fraser University, Harbour Centre Campus, Room 3274, 505 West Hastings Street, Vancouver, BC V68 5K3 Canada
| | - Kristen W. Springer
- Department of Sociology, Faculty Affiliate, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ 08901 USA
| | - Gemma Hunting
- Institute for Intersectionality Research and Policy, Simon Fraser University, Harbour Centre Campus, Room 3274, 505 West Hastings Street, Vancouver, BC V68 5K3 Canada
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Kroeger RA, Frank R. Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood. JOURNAL OF MARRIAGE AND THE FAMILY 2018; 80:444-462. [PMID: 29773921 PMCID: PMC5950716 DOI: 10.1111/jomf.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 10/09/2017] [Indexed: 06/08/2023]
Abstract
This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.
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Affiliation(s)
| | - Reanne Frank
- Department of Sociology, The Ohio State University
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Hargrove TW. Intersecting Social Inequalities and Body Mass Index Trajectories from Adolescence to Early Adulthood. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:56-73. [PMID: 29300495 PMCID: PMC6561119 DOI: 10.1177/0022146517746672] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study combines multiple-hierarchy stratification and life course perspectives to address two research questions critical to understanding U.S. young adult health. First, to what extent are racial-ethnic inequalities in body mass index (BMI) gendered and/or classed? Second, do racial-ethnic, gender, and socioeconomic inequalities in BMI widen or persist between adolescence and early adulthood? Using data from the National Longitudinal Survey of Youth 1997 cohort and growth curve models, results suggest that among white, black, and Hispanic American men and women ages 13 to 31, racial-ethnic inequality in BMI is greatest among women. Black women experience the highest adolescent BMI and the greatest increases in BMI with age. Furthermore, socioeconomic resources are less protective against weight gain for blacks and Hispanics, with the nature of these relationships varying by gender. Findings present a more nuanced picture of health inequality that renders visible the disproportionate burden of poor health experienced by marginalized groups.
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Burgard SA, Sonnega A. Occupational Differences in BMI, BMI Trajectories, and Implications for Employment Status among Older U.S. Workers. ACTA ACUST UNITED AC 2018; 4:21-36. [PMID: 31839977 DOI: 10.1093/workar/waw038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 11/25/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022]
Abstract
We examined associations between employment and obesity, arguing that risk for unhealthy weight may vary across occupational groups because they shape workplace exposures, social class standing, material resources, and norms and expectations about healthy behaviors and weight. We used a large sample of 51-61-year-old workers from the Health and Retirement study, tracking their body mass index (BMI) over time while accounting for potentially confounding influences of socioeconomic status and gender and exploring whether gender modified associations between occupational group, BMI, and retirement timing. Compared with women in professional occupations, women managers were less likely to be obese at baseline and were less likely to be in the obese upward trajectory class, while female professionals and operators and laborers were less likely than women in farm and precision production to be in the normal stable trajectory. Male professionals were less likely than men in sales, service, and operator and laborer positions to be obese at baseline and more often followed the normal upward trajectory than most other groups, though they and farm and precision production men were more likely to be in the overweight to obese trajectory than men in service occupations. Adjustment for sociodemographic and lifestyle characteristics reduced associations more for men than for women. While retirement risk differed across occupational groups, most of these differences were explained by socioeconomic, demographic, and lifestyle characteristics, especially for men. Obesity at baseline was an independent predictor of retirement but did not further explain differences in the timing of retirement by occupational group.
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Affiliation(s)
- Sarah A Burgard
- Department of Sociology and Population Studies Center, Institute for Social Research, University of Michigan
| | - Amanda Sonnega
- Survey Research Center, Institute for Social Research, University of Michigan
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37
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Gagné T, Veenstra G. Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income. Ethn Dis 2017; 27:371-378. [PMID: 29225437 DOI: 10.18865/ed.27.4.371] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001-2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.
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Affiliation(s)
- Thierry Gagné
- Département de médecine sociale et préventive, Université de Montréal, Canada.,Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Canada
| | - Gerry Veenstra
- Department of Sociology, University of British Columbia, Canada
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Medvedyuk S, Ali A, Raphael D. Ideology, obesity and the social determinants of health: a critical analysis of the obesity and health relationship. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1356910] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Stella Medvedyuk
- School of Health Policy and Management, Faculty of Health, York University , Toronto, Canada
| | - Ahmednur Ali
- School of Health Policy and Management, Faculty of Health, York University , Toronto, Canada
| | - Dennis Raphael
- School of Health Policy and Management, Faculty of Health, York University , Toronto, Canada
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39
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Fahs B, Swank E. Exploring stigma of “extreme” weight gain: The terror of fat possible selves in women's responses to hypothetically gaining one hundred pounds. WOMENS STUDIES INTERNATIONAL FORUM 2017. [DOI: 10.1016/j.wsif.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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40
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Richardson LJ, Brown TH. (En)gendering Racial Disparities in Health Trajectories: A Life Course and Intersectional Analysis. SSM Popul Health 2016; 2:425-435. [PMID: 28111630 PMCID: PMC5240637 DOI: 10.1016/j.ssmph.2016.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 12/03/2022] Open
Abstract
Historically, intersectionality has been an underutilized framework in sociological research on racial/ethnic and gender inequalities in health. To demonstrate its utility and importance, we conduct an intersectional analysis of the social stratification of health using the exemplar of hypertension-a health condition in which racial/ethnic and gender differences have been well-documented. Previous research has tended to examine these differences separately and ignore how the interaction of social status dimensions may influence health over time. Using seven waves of data from the Health and Retirement Study and multilevel logistic regression models, we found a multiplicative effect of race/ethnicity and gender on hypertension risk trajectories, consistent with both an intersectionality perspective and persistent inequality hypothesis. Group differences in past and contemporaneous socioeconomic and behavioral factors did not explain this effect.
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Affiliation(s)
- Liana J. Richardson
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC 27599-3210, USA
- Carolina Population Center, 206 W. Franklin Street, CB #8120, Chapel Hill, NC 27516-2524, USA
| | - Tyson H. Brown
- Department of Sociology, Duke University, 276 Soc/Psych Building, Box 90088, 417 Chapel Drive, Durham, NC 27708-0088, USA
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41
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Peek ME, Lopez FY, Williams HS, Xu LJ, McNulty MC, Acree ME, Schneider JA. Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians. J Gen Intern Med 2016; 31:677-87. [PMID: 27008649 PMCID: PMC4870421 DOI: 10.1007/s11606-016-3616-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, , The University of Chicago, Chicago, IL, USA.
| | - Fanny Y Lopez
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA
| | - H Sharif Williams
- Center for Culture, Sexuality and Spirituality, , Goddard College, Plainfield, VT, USA
- Undergraduate Programs, , Goddard College, Plainfield, VT, USA
| | - Lucy J Xu
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - M Ellen Acree
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, , University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, , University of Chicago, Chicago, IL, USA
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Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:200-22. [PMID: 27284076 PMCID: PMC4905600 DOI: 10.1177/0022146516645165] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.
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Affiliation(s)
| | | | | | - Courtney S Thomas
- University of California-Los Angeles, Los Angeles, CA, USA, and University of Kentucky, Lexington, KY, USA
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Nutter S, Russell-Mayhew S, Alberga AS, Arthur N, Kassan A, Lund DE, Sesma-Vazquez M, Williams E. Positioning of Weight Bias: Moving towards Social Justice. J Obes 2016; 2016:3753650. [PMID: 27747099 PMCID: PMC5055973 DOI: 10.1155/2016/3753650] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/16/2016] [Accepted: 08/28/2016] [Indexed: 11/29/2022] Open
Abstract
Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.
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Affiliation(s)
- Sarah Nutter
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
- *Sarah Nutter:
| | - Shelly Russell-Mayhew
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Angela S. Alberga
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Nancy Arthur
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Anusha Kassan
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Darren E. Lund
- Curriculum and Learning, Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Monica Sesma-Vazquez
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Emily Williams
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, Canada
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Liu SY, Manly JJ, Capistrant BD, Glymour MM. Historical Differences in School Term Length and Measured Blood Pressure: Contributions to Persistent Racial Disparities among US-Born Adults. PLoS One 2015; 10:e0129673. [PMID: 26076495 PMCID: PMC4467864 DOI: 10.1371/journal.pone.0129673] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 05/12/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Legally mandated segregation policies dictated significant differences in the educational experiences of black and white Americans through the first half of the 20th century, with markedly lower quality in schools attended by black children. We determined whether school term length, a common marker of school quality, was associated with blood pressure and hypertension among a cohort of older Americans who attended school during the de jure segregation era. METHODS National Health and Nutrition Examination Survey I and II data were linked to state level historical information on school term length. We used race and gender-stratified linear regression models adjusted for age, state and year of birth to estimate effects of term length on systolic and diastolic blood pressure (SBP and DBP) and hypertension for US-born adults. We also tested whether correcting years of schooling for term length differences attenuated estimated racial disparities. RESULTS Among black women, 10% longer school term was associated with lower SBP, DBP and hypertension prevalence (2.1 mmHg, 1.0 mmHg, and 5.0 percentage points respectively). Associations for whites and for black men were not statistically significant. Adjustment for education incorporating corrections for differences in school term length slightly attenuated estimated racial disparities. CONCLUSIONS Longer school term length predicted better BP outcomes among black women, but not black men or whites.
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Affiliation(s)
- Sze Yan Liu
- Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, Massachusetts, United States of America
| | - Jennifer J. Manly
- Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, and Department of Neurology, Columbia University Medical Center, New York, New York, United States of America
| | - Beatrix D. Capistrant
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
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Li M. Chronic exposure of grandparents to poverty and body mass index trajectories of grandchildren: a prospective intergenerational study. Am J Epidemiol 2015; 181:163-70. [PMID: 25587176 DOI: 10.1093/aje/kwu259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In this study, I used the growth curve model to examine the association between grandparents' (first generation (G1)) life-course exposure to chronic poverty and grandchildren's (third generation (G3)) body mass index (BMI; weight (kg)/height (m)(2)) growth trajectories. This association was estimated separately for male and female grandchildren. Analyses were based on prospective data from a US longitudinal survey, the Panel Study of Income Dynamics (1968-2011), and 2 of its supplemental studies: the Child Development Supplement (1997-2011) and the Transition into Adulthood Study (1997-2011). A prospectively enrolled nationally representative cohort of 2,613 G3 youth (1,323 male, 1,290 female) sampled in the 2 supplemental studies was linked to 1,719 grandparents from the Panel Study of Income Dynamics core sample. Chronic exposure to poverty among grandparents was prospectively ascertained annually over a 30-year period prior to the collection of data on grandchildren. Findings suggested that grandparents' chronic poverty exposure was positively associated with the slope of the BMI trajectory among granddaughters (β = 0.10, 95% confidence interval: 0.03, 0.17) but not among grandsons (β = 0.02, 95% confidence interval: -0.04, 0.08). The association between grandparents' chronic poverty exposure and granddaughters' BMI growth slope remained even after controlling for parental (second generation (G2)) socioeconomic status and BMI.
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Insaf TZ, Shaw BA, Yucel RM, Chasan-Taber L, Strogatz DS. Lifecourse socioeconomic position and 16 year body mass index trajectories: differences by race and sex. Prev Med 2014; 67:17-23. [PMID: 24967954 PMCID: PMC4167219 DOI: 10.1016/j.ypmed.2014.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/02/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the association between lifecourse socioeconomic position (SEP) and changes in body mass index (BMI), and assess disparities in these associations across racial/ethnic groups. METHODS With longitudinal data from 4 waves of the Americans' Changing Lives Study (1986-2002), we employed mixed-effects modeling to estimate BMI trajectories for 1174 Blacks and 2323 White adults. We also estimated associations between these trajectories and lifecourse SEP variables, including father's education, perceived childhood SEP, own education, income, wealth, and financial security. RESULTS Blacks had higher baseline BMIs, and steeper increases in BMI, compared to Whites. Childhood SEP, as measured by high father's education, was associated with lower baseline BMI among Whites. High education was associated with a lower baseline BMI within both race and sex categories. Income had contrasting effects among men and women. Higher income was associated with higher BMI only among males. Associations between indicators of SEP and BMI trajectories were only found for Whites. CONCLUSIONS Our study demonstrates that lifecourse SEP may influence adult BMI differently within different racial and sex groups.
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Affiliation(s)
- Tabassum Z Insaf
- University at Albany, State University of New York, Albany, NY, United States.
| | - Benjamin A Shaw
- University at Albany, State University of New York, Albany, NY, United States
| | - Recai M Yucel
- University at Albany, State University of New York, Albany, NY, United States
| | | | - David S Strogatz
- University at Albany, State University of New York, Albany, NY, United States; Bassett Research Institute, Cooperstown, NY, United States
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Denise EJ. Multiple disadvantaged statuses and health: the role of multiple forms of discrimination. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:3-19. [PMID: 24578393 DOI: 10.1177/0022146514521215] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The double disadvantage hypothesis predicts that adults who hold more than one disadvantaged status may experience worse health than their singly disadvantaged and privileged counterparts. Research that has tested this thesis has yielded mixed findings due partly to a failure to examine the role of discrimination. This article uses data from the National Survey of Midlife Development in the United States (N = 2,647) to investigate the relationship between multiple disadvantaged statuses and health, and whether multiple forms of interpersonal discrimination contribute to this association. The results suggest that multiply disadvantaged adults are more likely to experience major depression, poor physical health, and functional limitations than their singly disadvantaged and privileged counterparts. Further, multiple forms of discrimination partially mediate the relationship between multiple stigmatized statuses and health. Taken together, these findings suggest that multiply disadvantaged adults do face a "double disadvantage" in health, in part, because of their disproportionate exposure to discrimination.
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Steinberg DM, Levine EL, Askew S, Foley P, Bennett GG. Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study. J Med Internet Res 2013; 15:e244. [PMID: 24246427 PMCID: PMC3841371 DOI: 10.2196/jmir.2844] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/09/2013] [Accepted: 10/13/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. OBJECTIVE This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. METHODS Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. RESULTS The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference -2.41 kg, 95% CI -5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=-.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. CONCLUSIONS Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. TRIAL REGISTRATION Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1).
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Affiliation(s)
- Dori M Steinberg
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC, United States.
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Brown, Hargrove. Multidimensional Approaches to Examining Gender and Racial/Ethnic Stratification in Health. ACTA ACUST UNITED AC 2013. [DOI: 10.5406/womgenfamcol.1.2.0180] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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