Socioeconomic and behavioral correlates of body mass index in black adults: the Pitt County Study

Wealth index and other behavioral and sociodemographic characteristics associated with body mass index in Ethiopia

Background:

Nowadays, the burden of non-communicable diseases including obesity has been an increasing public health concern. This menace can be monitored using indexing method like body mass index. Studies indicate that socioeconomic indicators such as income, biology, behavior, and demographic factors associated with body mass index. In Ethiopia, few studies associate wealth index with body mass index in people of ages between 15 and 49. This study was aimed to assess the association of body mass index with wealth index, and behavioral and sociodemographic population characteristics.

Methods:

A cross-sectional population-based study was conducted using the 2016 Ethiopian Demographic and Health Survey population of ages 15–49. A total of 10,245 individuals were considered to detect the effect of socioeconomic, biological, behavioral, and demographic factors on body mass index using logistic regression.

Results:

The prevalence of underweight, overweight, and obesity among men are 23.8%, 6.6%, and 2.0%, respectively, which is lower than that of women (underweight 25.3%, overweight 9.1%, and obesity 2.9%). The poorest men had higher odds of being underweight (adjusted odds ratio = 2.395%; 95% confidence interval = 2.020–3.544) as compared to the richest men. Merchants and government employees have lower odds (adjusted odds ratio = 0.744; 95% confidence interval = 0.588–0.899) compared to men whose occupation is farming and labor, indicating that merchants and government employees are more likely to become overweight and obese compared to men who are farmers and laborers.

Conclusion:

It is concluded that wealth index is an important socioeconomic determinant of body mass index among men and women of age 15–49 in Ethiopia. A high prevalence of underweight, and overweight, and obesity is observed, which increases instances of non-communicable diseases. Effects of socioeconomic, biological, behavioral, and demographic indicators on body mass index differed according to sex.

Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women

The high prevalence of obesity among Black Americans warrants additional investigation into its relationship with socioeconomic position (SEP), sex, and ethnicity. This cross-sectional study utilizes 2001–2003 data from the National Survey of American Life, a nationally representative sample of 3570 African-Americans and 1621 Caribbean-Blacks aged 18 years and older. Multivariate logistic regression models stratified by ethnicity and sex describe the independent associations between obesity and multilevel socioeconomic factors after adjustment for age, other SEP measures at the individual, family and neighborhood levels, and health behaviors such as physical activity, alcohol intake, and smoking. A positive relationship was observed between obesity and family income among African-American and Caribbean-Black men. Receipt of public assistance was a strongly associated factor for obesity in Caribbean-Black men and women. Among African-American women, inverse relationships were observed between obesity and education, occupation, and family income; residence within a neighborhood with a supermarket also decreased their odds of obesity. Residence in a neighborhood with a park decreased the odds of obesity only among African-American men, whereas residence in a neighborhood with a supermarket decreased the odds of obesity among Caribbean-Black men. The social patterning of obesity by individual, household, and neighborhood socioeconomic resources differs for African-American and Caribbean-Black men and women within these cross-sectional analyses; an appreciation of these differences may be a prerequisite for developing effective weight control interventions and policies for these two populations.

Engaging High-Risk Populations in Community-Level Fitness Promotion: ROCK! Richmond

The purpose of this study was to determine whether ROCK! Richmond, a healthy nutrition and physical activity promotion initiative of the Richmond (Virginia) City Department of Public Health was effectively recruiting the high-risk individuals for whom this lifestyle change intervention was intended. The effectiveness of recruitment, participant demographic and health status characteristics were compared with those of respondents to a random sample survey conducted 18 months earlier. Relatively high-risk residents were recruited. ROCK! Richmond participants were disproportionately African American and female, had significantly higher body mass indices (BMIs), and were more likely to report a family history of chronic disease. However, their employment, education, and income levels were higher than those of the citywide sample. Certain high-risk segments of the population were successfully reached and involved in community fitness activities. Different recruitment methods may need to be used to recruit more from among the lowest socioeconomic strata.

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children's body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women's hair cortisol levels were not associated with their BMI or PSS scores. Women's PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children's hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child's zBMI. Children's hair cortisol levels were not associated with their zBMI or with their mother's PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk.

Trends in energy and macronutrient intakes by weight status over four decades

OBJECTIVE

To examine whether the recent increasing prevalence of obesity was accompanied by variations in energy and macronutrient intakes by weight status.

DESIGN

Time series of cross-sectional surveys.

SETTING

National Health and Nutrition Examination Surveys (NHANES) in the USA.

SUBJECTS

Adult participants of NHANES I (1971-1974), II (1976-1980), III (1988-1994) and continuous (1999-2004).

RESULTS

Daily energy intake increased over time for men (9832 to 11 652 kJ, P < 0·01) and women (6418 to 8142 kJ, P < 0·01) in all BMI classes. Percentage of energy intake from carbohydrate increased over time (men: 42·7% to 48·0%, P < 0·01; women: 45·4% to 50·6%, P < 0·01), whereas percentage of energy intake from fat (men: 36·7% to 33·1%, P < 0·01; women: 36·1% to 33·8%, P < 0·01) and protein (men: 16·4% to 15·1%, P < 0·01; women: 16·9% to 14·7%, P < 0·01) decreased. With surveys combined, daily energy intake varied among BMI classes for women (underweight/normal weight: 7460 kJ; overweight: 6799 kJ; obese I: 7033 kJ; obese II/III: 7401 kJ; P < 0·01) but not men. Percentage of energy intake from carbohydrate decreased with increasing BMI class (men: 46·6% to 45·5%, P < 0·01; women: 49·0% to 48·6%, P < 0·01) whereas percentage of energy intake from fat (men: 34·3% to 36·5%, P < 0·01; women: 34·4% to 35·4%, P < 0·01) and protein (men: 15·3% to 16·5%, P < 0·01; women: 15·2% to 16·0%, P < 0·01) increased. Interactions of survey period and BMI class were not statistically significant.

CONCLUSIONS

Time trends in energy and macronutrient intakes were similar across BMI classes. Research examining how individuals respond differently to varying dietary compositions may provide greater insight about contributors to the rise in obesity.

Educational attainment and obesity: a systematic review

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

Voices From the Inside: African American Women’s Perspectives on Healthy Lifestyles

The author of this study conducted focus groups with African American women to explore their perspectives on obesity, disease causation, and their ideas on the functionality of cultural, social, historical, environmental, and psychological forces in altering healthy eating habits. Reoccurring themes centered on four areas: (a) the definition of health as a mind, body, and spiritual construct; (b) conceptualizations of cultural norms regarding healthy foods versus unhealthy foods; (c) the importance of eating and social rituals on food choices; and (d) the impact of the environment in sustaining healthy initiatives. Structural constraints that uphold legacies of disenfranchisement, environmental injustice, and segregation influence the food choices available in low-wealth communities. These factors continue to operate and are vital issues to consider when designing culturally relevant wellness programs.

The effects of socio-economic status on BMI, waist:hip ratio and waist circumference in a group of Iranian women

OBJECTIVE

To assess the effects of socio-economic status (SES) on BMI, waist:hip ratio (WHR) and waist circumference (WC) in a group of Iranian women.

METHODS

A cross-sectional study was conducted on 888 women in Sistan and Baluchestan Province. SES was measured using level of education. In addition, parity, marital status and physical activity were assessed. Standardized measurements were taken, BMI and WHR were calculated.

RESULTS

Low education level was a strong determinant of overweight and obesity among Iranian women. After controlling for age, women with higher education level had significantly lower BMI, WC and parity. Multiple linear regression analysis found a significant negative association of BMI and WC with education level and a significant positive association of BMI and WC with parity. Significant factors associated with obesity by a logistic regression model were education level (OR for university graduates v. illiterate or low literacy levels: 1.00 v. 3.70; P = 0.01), living with spouse (OR for married v. single subjects: 1.00 v. 0.15; P = 0.05), parity (OR for more than five v. less than two pregnancies: 1.00 v. 0.34; P = 0.03) and WC (OR for < 0.88 cm v. > or = 0.88 cm: 1.00 v. 11.20; P = 0.001).

CONCLUSION

The present study revealed that educational level, multiple pregnancies, marital status and lack of exercise are some possible explanations for the obesity among Sistan and Baluchestan women.

Lifecourse socioeconomic position and weight change among blacks: The Pitt County study

OBJECTIVE

The elevated prevalence of obesity among U.S. blacks has been attributed to low socioeconomic position (SEP), despite inconsistent empirical findings. It is unclear whether low SEP at various lifecourse stages differentially influences adulthood BMI and BMI change.

RESEARCH METHODS AND PROCEDURES

Among 1167 black adults in the Pitt County Study, we examined independent cross-sectional and longitudinal associations between SEP, measured in childhood and adulthood, and BMI and 13-year BMI change. Low vs. high childhood SEP was measured by parental occupation and childhood household deprivation; low vs. high adulthood SEP was assessed by employment status, education, and occupation. Using childhood and adulthood SEP, four lifecourse SEP categories were created: low-low, low-high, high-low, high-high.

RESULTS

We found no consistent associations between SEP and BMI or BMI change among men. Among women, we observed the expected inverse association between SEP and BMI at baseline. In multivariable-adjusted analyses, socioeconomically advantaged women demonstrated larger 13-year increases in BMI: skilled vs. unskilled parental occupation (6.1 vs. 4.8 kg/m2, p = 0.04); college-educated vs. < high school (6.2 vs. 4.5 kg/m2, p = 0.04); white-collar vs. blue-collar job (5.8 vs. 4.8 kg/m2, p = 0.05); and high-high vs. low-low lifecourse SEP (6.5 vs. 4.6 kg/m2, p = 0.02).

DISCUSSION

For women in this black cohort, lower SEP predicted earlier onset of obesity; however, low SEP was less predictive of BMI increases over time. Our findings demonstrate complex patterns of association between SEP and BMI change among black women.

Environmental factors associated with body mass index in a population of Southern France

STUDY OBJECTIVE

Environmental-factor changes may largely be accountable for the dramatic increase of obesity prevalence in industrialized countries. This study investigated the relationships between body mass index (BMI) and various socio-economic, clinical, behavioural and reproductive factors in a population from Southern France.

METHODS

Using a cross-sectional study, a sample of 3127 current and former salaried workers (1658 men and 1469 women) completed a questionnaire on personal and medical histories, and had a clinical examination including height and weight measurements. Age-adjusted and multiple linear regression analyses were performed.

RESULTS

The overall prevalence of obesity (BMI> or =30 kg/m) was 9.8% and was higher in men than in women (11.1 versus 8.3%). Multivariate analyses showed that in both sexes, low educational level, television watching, low physical activity and ex-smoking habits, were independently associated with a higher BMI. Furthermore, in women, we found independent and positive associations between BMI and the number of naps per week, short sleep duration, daily alcohol consumption, the number of pregnancies, early age at menarche or the non-use of oral contraceptives.

CONCLUSIONS

Our results reveal the complexity that exists between BMI and environmental factors and stress the need to analyse and to handle these factors simultaneously.

Life-course socioeconomic position and obesity in African American Women: the Pitt County Study

OBJECTIVES

We studied obesity in African American women in relationship to their socioeconomic position (SEP) in childhood and adulthood.

METHODS

On the basis of parents' occupation, we classified 679 women in the Pitt County (North Carolina) Study into low and high childhood SEP. Women's education, occupation, employment status, and home ownership were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood.

RESULTS

The odds of obesity were twice as high among women from low versus high childhood SEP backgrounds, and 25% higher among women of low versus high adulthood SEP. Compared to that in women of high SEP in both childhood and adulthood, the odds of obesity doubled for low/low SEP women, were 55% higher for low/high SEP women, and were comparable for high/low SEP women.

CONCLUSIONS

Socioeconomic deprivation in childhood was a strong predictor of adulthood obesity in this community sample of African American women. Findings are consistent with both critical period and cumulative burden models of life-course socioeconomic deprivation and long-term risk for obesity in African American women.

Obesity and socioeconomic position measured at three stages of the life course in the elderly

OBJECTIVE

To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly.

DESIGN

Cross-sectional study carried out in 2000-2001.

SUBJECTS

In total, 4009 subjects aged 60 y and older, representative of the Spanish noninstitutionalised population.

RESEARCH METHODS AND PROCEDURES

We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two.

RESULTS

In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables.

CONCLUSIONS

In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

Factors associated with overweight and obesity in Quebec adults

OBJECTIVE

To measure the independent correlates of excess body weight and obesity in Quebec in 1993 and 1997.

DESIGN

A population-based, cross-sectional survey in three settings in the province of Quebec.

SUBJECTS

A total of 10014 individuals aged 18-64 y.

MEASUREMENTS

Excess body weight was defined as a body mass index (BMI) (self-reported weight and height) greater than or equal to 25 kg/m(2) and obesity as BMI greater than or equal to 30 kg/m(2). Data were collected by a questionnaire completed at home by the participants. Diet was assessed by a food frequency questionnaire.

RESULTS

The correlates varied according to gender. While university achievement, smoking habit and physical activity level reduced the risk of excess body weight in both genders, increased dietary fat intake was positively associated with overweight and obesity in men only. In women, greater family income lowered the risk of having a BMI over 25. Increasing age, speaking a language other than French and living in a rural environment elevated the risk.

CONCLUSION

Future interventions for the control of obesity should be gender-specific. Target groups should include individuals with low education, those living in rural environments and non-caucasian women. Dietary interventions should target men in particular.

Cumulative Disadvantage and Health: Long-Term Consequences of Obesity?

Drawing from cumulative disadvantage theory, the health consequences of obesity are considered in light of the accumulation of risk factors over the life course. Two forms of compensation are also examined to determine if the risk due to obesity is persistent or modifiable. Analyses make use of data from a national survey to examine the consequences of obesity on disability among respondents 45 years of age or older, tracked across 20 years (N = 4,106). Results from tobit models indicate that obesity, especially when experienced early in life, is consistently related to lower-body disability. The results also show that obesity has long-term health consequences during adulthood, altering the life course in an enduring way. Compensation was not manifest from risk-factor elimination (weight loss), but rather through regular exercise. Although there is evidence for long-term consequences of risk factors on health, the findings suggest that more attention should be given to compensatory mechanisms in the development of cumulative disadvantage theory.

Food stamp program participation is positively related to obesity in low income women

This study examined the relationship between Food Stamp Program (FSP) participation and the obesity of low income individuals using data from the National Longitudinal Survey of Youth 1979. Obesity was defined as body mass index >or= 30 kg/m(2). The data were arranged as a panel with multiple observations per individual, and the models of obesity included current and long-term FSP participation, additional demographic, socioeconomic and environment characteristics and individual fixed effects. Individual fixed effects were used to take into account unobserved differences across individuals that did not vary over time. In ordinary least squares models, current and long-term FSP participation were significantly related to the obesity of low income women (P < 0.05), but not of low income men. For low income women, current participation in the FSP was associated with a 9.1% increase in the predicted probability of current obesity. Participation in the FSP in each of the previous five years compared to no participation over that time period was associated with approximately a 20.5% increase in the predicted probability of current obesity. These models did not control for food insecurity, and this omission potentially complicates the interpretation of the FSP participation variables.

Association of body mass index with educational level in Iranian men and women

OBJECTIVE

Investigation of the relationship between educational level, body mass index (BMI), waist-to-hip ratio (WHR), physical activity and parity in a group of Iranian men and women living in Tehran.

DESIGN

A cross-sectional study in a group of Iranian men and women. The subjects were classified into two educational levels: low education (< or =12 y schooling) and high education (>12 y schooling); and BMI, WHR, physical activity and parity (in women) were compared in two groups in men and women, separately.

SETTING

Metabolic Unit of Tehran University of Medical Sciences in Tehran.

SUBJECTS

Three hundred and fifteen men aged 33.1 (22-46) and 403 women aged 27.9 (22-45).

RESULTS

After controlling for age and smoking, women with a higher level of education showed a significantly lower mean BMI than less educated women (24.8+/-4.2 vs 28.3+/-4.9, P <0.01), while more educated men had a higher mean BMI than less educated men (28.4+/-4.3 vs 26.7+/-4.5). In multiple regression analysis, physical activity in leisure time in men and years of education in women were the only determinants of BMI. After controlling for BMI, WHR was not related to the level of education in either men or women.

CONCLUSION

The present data indicated an educational difference in BMI for the study population. In Iranian women, like the women in developed countries, the level of education was negatively related to BMI, while in men the association was positive.

SPONSORSHIP

This work was financially supported by the Institute of Public Health, Tehran University of Medical Sciences.

An assessment of obesity among African-American women in an inner city primary care clinic

Despite multiple patient assessments and interventions, obesity continues to cause significant morbidity and mortality nationwide. This study assesses the prevalence of obesity and weight control practices among middle-aged African-American women. In 1995, 307 women 30 years of age and older were consecutively selected in a non-random fashion from three clinic sites located within a public university hospital that served largely indigent, inner city African-American populations. Interviewers surveyed the respondents using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). The prevailing demographic profile of patients in the clinic was middle-aged, indigent, ill, and of low educational attainment. Over 35% of individuals were classified as being overweight (BMI 25 to 29.9 kg/m2) and 45% were classified as being obese (BMI > or = 30 kg/m2). Therefore, more than 80% of individuals in this study were either overweight or obese, with BMI exceeding 25 kg/m2. Of the overweight and obese African-American women in this study, only 40% were attempting current weight loss practices, and weight loss attempts varied directly with body mass index. Although 80% of women attempted weight loss by restricting caloric intake, only 50% were also using physical activity as part of their regime. African-American women in this population have a higher prevalence of obesity and encounter great difficulty losing weight. Counselors should emphasize the value and ease of adopting a moderate regimen of physical activity and not just reducing caloric intake when advising African-American women and their peer network.

Self-perception of being overweight in Spanish adults

OBJECTIVE

To describe the frequency, distribution and trend in misperceived overweight and obesity.

DESIGN

Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population.

SETTING

Spanish adult population aged 20 y and over.

SUBJECTS AND INTERVENTIONS

A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) >or=25 kg/m(2).

MAIN OUTCOME MEASURES

Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height.

RESULTS

Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25-26.9 kg/m(2) in 1995/1997 did not perceive themselves to be overweight.

CONCLUSIONS

Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

Stroke: a review with an African perspective

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

Trend in the prevalence of overweight and obesity among urban African American hospital employees and public housing residents

INTRODUCTION

To help understand the impact of socioeconomic status, we examined the current prevalence and age-specific trend in overweight and obesity among two socioeconomically diverse groups of African Americans in the Washington, DC, area.

MATERIALS AND METHODS

Data on height and weight were collected between March 1995 and December 1996 as a part of nutrition survey to develop a food frequency questionnaire. Gender-stratified multiple logistic regression analyses were used to examine factors related to the current prevalence of overweight and obesity.

RESULTS

Three hundred nine African American public housing residents and 293 African American hospital employees participated in this survey. Overall, hospital workers and public housing residents differed significantly in the distribution of BMI (p = 0.003). Among men, the prevalence of overweight and obesity were 34.9% and 29.4% for hospital workers and 27.0% and 18.2% for public housing residents, respectively. For females these rates were 31.3% and 46.3% for hospital employees and 26.1% and 42.9% for public housing residents, respectively.

CONCLUSION

Overweight and obesity were highly prevalent among all age and socioeconomic groups. Future research should focus on a more in-depth study of the relationship between socioeconomic status and the correlates of obesity among African-Americans, particularly women.

The size of obesity differences associated with educational level in Spain, 1987 and 1995/97

OBJECTIVE

To determine the size of obesity differences associated with educational level in the adult population in Spain.

DESIGN

Three cross sectional studies representative of the adult population in Spain were carried out in 1987, 1995, and 1997.

SETTING

The general population in Spain.

PARTICIPANTS

11 461 men and 10 219 women aged 25 to 64 years.

MAIN RESULTS

For both men and women the obesity prevalence was highest in those with elementary education. In 1987 the obesity prevalence proportion associated with less than third level education (PA) was 24.5% (95% CI 6.0 to 42.8) and 47.9% (15.7 to 71.8) in men and women, respectively. The PAs in 1995/97 were 19.8% (0.2 to 40.2) and 55.1% (21.3 to 72.8).

CONCLUSIONS

In 1995/97 the burden of obesity associated with less than third level education was 20% in men and 55% in women aged 25 to 64 years. Between 1987 and 1997 the obesity prevalence proportion associated with less than third level education increased in women and decreased in men.

Socio-economic status and serum lipids: a cross-sectional study in a Chinese urban population

Socio-economic status and serum lipids are important factors in the progression of cardiovascular disease. We studied the association between socio-economic status and serum lipids in a Chinese urban population. In all, 4,541 respondents (2,231 men and 2,310 women) between 25-64 years of age participated in a cross-sectional population survey carried out in Tianjin, China, and provided blood samples. Three socio-economic indicators (education, occupation, and income), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were determined. People in higher socio-economic groups had a more unfavorable serum lipid profile compared with those in lower socio-economic groups. This significant association was especially apparent in men. Education seemed to be the most important predictor of serum lipids in the three socio-economic indicators. The direction of the association between high socio-economic status and poor serum lipid profiles appears to be opposite to those observed in the developed countries.

Assessing cardiovascular disease risk in women: a cultural approach

BACKGROUND

Cardiovascular disease among American women is affected by a number of high-risk lifestyle factors, but little is known about the perceptions of high-risk behavior among women in an inner-city population. The two purposes of this study were to identify the perceptions of an inner-city, predominantly African-American community as they pertain to a high-risk lifestyle for cardiovascular disease as well as to develop a culturally sensitive survey instrument for women.

METHODS

There were two components to the study. In the first, four focus groups were conducted to obtain qualitative data on women's attitudes and lifestyles regarding cardiovascular disease risk. In the second, focus group data were used to construct a survey on women's attitudes and lifestyles regarding cardiovascular disease risk that was modified using a fifth focus group and then pilot-tested with a sample of 27 women.

RESULTS

Focus group and pilot-testing data suggest interesting differences between the behaviors and perceptions of inner-city women and the general population.

OBESITY

Obesity was more loosely defined by this community than by guidelines based on standard height and weight measures. Being heavy was not necessarily equated with being fat and was felt at least partially to reflect muscle tone and muscle mass. STRESS: It was volunteered almost unanimously as a distinct risk factor for cardiovascular disease among women, although it rarely is listed on risk factor questionnaires. EXERCISE: Standard aerobic exercise participation was low, but participation in daily physical activity such as casual walking and housework was high.

CONCLUSIONS

Health care providers, in attempting to reduce a patient's risk for cardiovascular disease, should be aware of the cultural and socioeconomic factors that might influence that patient's perceptions of cardiovascular disease risk. These perceptions should shape a provider's approach to lifestyle modification advice.

Leptin and obesity in mother-child pairs

Defects in the leptin gene or the leptin receptor may be a genetic cause of obesity, but little is known about the familial associations of leptin and obesity. This study compared plasma leptin and measures of obesity in a sample of 248 subjects (124 mother-offspring pairs); 34% were African American and 66% were white. Youth were aged 12 to 16 years. Plasma leptin and body mass index (BMI) were higher in mothers than in their offspring and, among the offspring, higher in girls than boys, even after correcting for BMI or body fat. Racial differences in leptin were present in both mothers and youth when adjusting for percentage body fat but disappeared when adjusting for BMI. In univariate analyses of the associations between mothers and offspring, BMI was associated with leptin in all groups but was most strongly associated in white pairs and in mother-son pairs. In multiple regression analyses, when adjusting for BMI, significant predictors of leptin levelfor the boys and girls together were gender, BMI, and pubertal status of the offspring; in girls only BMI was significant (R2 = 0.72), and in boys the significant predictors were their BMI (R2 = 0.66) followed by their pubertal status (R2 = 0.06) and the leptin level of their mothers (R2 = 0.02). When adjusting for body fat, the predictors were the offspring's percentage bodyfat (R2 = 0. 67) and mother's leptin (R2 = 0.03), with similar results in gender-specific analyses. The authors conclude that leptin levels of youth are most closely associated with their degree of obesity or body fat; mother's leptin and, for boys only, pubertal status also play a small role. Although the small association between maternal leptin on leptin in their offspring could be due to either heredity or shared environment, the results of this study suggest that individual obesity and environmental factors are important predictors of leptin levels in children.

Risk factor distribution among sociodemographically diverse African American adults

Because African Americans tend to have lower socioeconomic status (SES) than whites and numerous health indicators are related to SES variables, it is important when examining between-group differences in health indices to account for SES differences. This study examined the effects of income and education on several biologic and behavioral risk factors in a sample of sociodemographically diverse African American adults. Approximately 1,000 African American adults (aged 18-87) were recruited from 14 churches with predominantly black membership to participate in a nutrition education intervention. Demographics, height, weight, blood pressure, self-reported cigarette and alcohol use, self-reported diet by food frequency questionnaire, serum carotenoids, serum total cholesterol, and nutrition knowledge were assessed. The association of these risk factors were examined by four levels of education and income. For men, body mass index, blood pressure, total cholesterol, daily intake of fruits and vegetables, serum carotenoids, heavy alcohol use, or exercise were not associated significantly with income or education using analysis of variance (ANOVA). Past month alcohol use and nutrition knowledge were associated positively with education, but not income. For women, body mass index and smoking were associated inversely with income, but not with education. Blood pressure, total cholesterol, intake of fruits and vegetables, heavy alcohol use, and exercise were not associated with either income or education using ANOVA. Serum carotenoids, any 30-day alcohol use, and nutrition knowledge were associated positively with both income and education. Results using linear regression generally were similar for men and women, although a few more variables were associated significantly with SES compared to ANOVA analyses. Several health indicators that have been associated with socioeconomic variables in whites were not associated or only weakly associated in this diverse sample of African Americans. One interpretation of these findings is that SES factors may function differently among blacks and whites.

The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population

PURPOSE

To assess whether two indicators of social class, education and occupation, have independent and/or synergistic effects in determining the body mass and overweight.

METHODS

Body mass index (BMI), education, and occupation were assessed in a survey of 1767 men and 1268 women from a representative sample of currently working people of the general population of Geneva, Switzerland. Education and occupation were categorized as low, medium, and high. Overweight was defined as BMI > or = 25 kg/m(2).

RESULTS

The prevalence of overweight was 52.1% in men and 28.7% in women. Men with overweight were more likely to have low education while women with overweight had lower education and lower occupation. Education and occupation were inversely related to BMI in both genders and, in women, had a synergistic effect (p-value for the interaction = 0.03).

CONCLUSIONS

Education and occupation have independent and, in women, synergistic effects on BMI. The two indicators may express different mechanisms through which low social class is related to high body mass.

Early risk factors for increased adiposity: a cohort study of African American subjects followed from birth to young adulthood

BACKGROUND

Obesity is an increasing concern in the United States. Effective prevention of obesity requires the risk factors to be well defined. African Americans have a high risk of obesity.

OBJECTIVE

The objective of this study was to identify risk factors, present at birth, for increased adiposity in adulthood in an African American population.

DESIGN

In this retrospective analysis of a prospective cohort study, anthropometric and socioeconomic variables were collected at birth. A representative sample of 447 African American subjects was followed up until young adulthood, when skinfold thickness was measured. Associations between the independent variables and increased adiposity (skinfold thickness above the 85th percentile) were explored by using unadjusted and adjusted analyses.

RESULTS

Three variables measured at birth were independently associated with adiposity in young adulthood, explaining 12% of the variance. The odds ratios (with 95% CIs) of these variables for increased adiposity were 2.7 (1.2, 6.2) for female sex, 4.0 (1.4, 11. 2) for first-born status, and 1.15 (1.06, 1.25) for each unit increment in maternal prepregnancy body mass index (BMI; in kg/m(2)). After adjustment for these variables, birth weight for gestational age and socioeconomic variables were not associated with adiposity.

CONCLUSIONS

This cohort study of African American subjects was the first to identify first-born status as an independent risk factor for increased adiposity in adulthood in a US population. The results of the study strengthen previous reports of the effect of female sex and maternal BMI on adulthood obesity. Identification of risk factors early in life may help target prevention toward high-risk children and allow healthy lifestyles to be established before the onset of obesity.

Clinical implications of body image among rural African-American women

OBJECTIVE

To increase understanding of body image among rural, African-American women through open-ended interviews.

DESIGN

Individuals' perceptions of body image were investigated using open-ended, in-depth interviews that were tape-recorded, transcribed, and analyzed to identify common themes and to compare thematic data across three body mass index categories (obese, overweight, and normal).

SETTING

University-affiliated rural community health center.

PARTICIPANTS

Twenty-four African-American women, aged 21 to 47 years.

MAIN RESULTS

Respondents reported the following common themes: dissatisfaction with current weight; fluctuating levels of dissatisfaction (including periods of satisfaction); family and social pressure to be self-accepting; and social and physical barriers to weight loss. The interviews revealed ambivalence and conflicts with regard to body image and weight. Among these women, there was strong cultural pressure to be self-accepting of their physical shape, to "be happy with what God gave you," and to make the most of their appearance.

CONCLUSIONS

The pressure to be self-accepting often conflicted with these obese women's dissatisfaction with their own appearance and weight. Although the respondents believed they could lose weight "if [they] put [their] mind to it," those women wanting to lose weight found that they lacked the necessary social support and resources to do so. The conflicts stemming from social pressures and their own ambivalence may result in additional barriers to the prevention of obesity, and an understanding of these issues can help health care providers better address the needs of their patients.

Obesity differences between African-American men and women

The purpose of this study was to examine the socio-demographic and behavioral differences related to obesity between African-American men and women. Obesity was defined as a body mass index of greater than 27.3 kg/m2 for women and 27.8 kg/m2 for men. Data were collected from 661 African-Americans, 418 women and 243 men, residing in wards 7 and 8 in Washington, DC through telephone interviews. Obesity was prevalent among 38.3% of the women and 20.1% of the men (p < 0.01). For women age 55 or older, annual income over $20K, having less than a high school education, and alcohol and tobacco consumption were associated with being overweight in the initial bivariate analysis (p < 0.05). For men, being 35 years or older and unemployment were significant factors associated with obesity. Our final analysis, when known dietary risk factors were adjusted, revealed that in women, obesity was associated with age, hard liquor consumption and non use of tobacco. For men, older age was a primary association. We concluded that gender, with increasing age, plays a significant role in predicting obesity, as defined by concurrent national standards. African American men 55 years of age or older are the most likely group to be overweight even after predisposing and behavioral risk factors are considered.

Health-promoting lifestyles and exercise: a comparison of older African American women above and below poverty level

The purpose of this study was to compare the health-promoting behaviors and exercise behaviors of older African American women above and below poverty level. Fifty-eight African American women completed a demographic form and the Health Promoting Lifestyle Profile (HPLP). Results indicated that African American women living above the poverty level had higher overall scores on the total HPLP and higher scores on the exercise subscale of the HPLP than women living below poverty level. Implications include teaching culturally specific, practical, and inexpensive exercise activities in primary care and community settings.

Dietary fat patterns in urban African American women

The purpose of this study was to describe the scope of fatty food preferences of urban African American women and to examine factors associated with the selection of high fat foods. A volunteer sample of urban African American women church-goers were invited for dietary and risk factor screening at health fairs held following Sunday services. A standardized instrument, the Fat Intake Scale (FIS), was administered primarily by dietitians to estimate dietary fat intake and usual food choices. A sum score of 25 or more is thought to be associated with higher fat and cholesterol intake. As a validation of the FIS, a 24-hour recall was administered to a subsample. Sociodemographics, smoking status and comorbidity were assessed by self-report. Body weight, height, and total blood serum cholesterol were assessed using standardized measurement techniques. In the 521 participating women, 61% were classified as obese based on national reference norms for body mass index (BMI). More than 81% had an FIS of 25 or greater. On multiple logistic regression analysis, significant predictors of a higher fat diet (FIS > or = 25) included age greater than 45 years, obesity, and the absence of comorbidity. These findings suggest that there are independent predictors of selection of a diet high in fat. This has implications for planning and targeting community-based nutrition interventions for African American women who exhibit among the highest rates of obesity in the U.S. and who suffer an excess burden of obesity-related diseases.

The contribution of baseline weight and weight gain to blood pressure change in African Americans: the Pitt County Study

PURPOSE

The positive association between obesity and blood pressure has been less consistent in African Americans than whites. This is especially true for African American men. This study investigated the sex-specific associations between baseline body mass index (BMI), weight change (kilograms), and five-year hypertension incidence and changes in blood pressure in a cohort of African Americans ages 25-50 years at baseline.

METHODS

The Pitt County Study is a longitudinal investigation of anthropometric, psychosocial, and behavioral predictors of hypertension in African Americans. Data were obtained through household interviews and physical examinations in 1988 and 1993.

RESULTS

Baseline BMI was positively and independently associated with changes in blood pressure after controlling for weight change and other covariates. When participants were stratified by sex-specific overweight vs. nonoverweight status at baseline, weight gain was significantly associated with increases in blood pressure only among the initially nonoverweight.

CONCLUSIONS

Baseline weight for all respondents, and weight gain among the nonoverweight at baseline, were independent predictors of blood pressure increases in this cohort of African Americans.

Equity is out of fashion? An essay on autonomy and health policy in the individualized society

It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to one's position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.

Total daily energy expenditure in free-living older African-Americans and Caucasians

Low rates of daily energy expenditure, increased energy intake, or a combination of both contribute to obesity in African-Americans. We examined whether African-Americans have lower rates of free-living daily energy expenditure than Caucasians. One hundred sixty-four (> 55 yr) volunteers (37 African-American women, 52 Caucasian women, 28 African-American men, and 47 Caucasian men) were characterized for total daily energy expenditure, resting metabolic rate, and physical activity energy expenditure from the doubly labeled water method and indirect calorimetry. Absolute total daily energy expenditure was lower in women than men but was not different between African-Americans and Caucasians. However, we found race and gender differences in total daily energy expenditure after controlling for differences in fat-free mass. Total daily energy expenditure was 10% lower (P < 0.01) in African-Americans compared with Caucasians due to a 5% lower resting metabolic rate (P < 0.01) and 19% lower physical activity energy expenditure (P = 0.08). Moreover, total daily energy expenditure was 16% lower (P < 0.01) in women compared with men due to a 6% lower resting metabolic rate (P = 0.09) and a 37% lower physical activity energy expenditure (P = 0.06). Low rates of energy expenditure may be a predisposing factor for obesity, particularly in African-American women.

Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments

OBJECTIVE

To determine if body mass Index (BMI = weight [kg]/height [m]2), predictive of mortality in longitudinal epidemiologic studies, was also predictive of mortality in a sample of seriously ill hospitalized subjects.

DESIGN

Prospective, multicenter study.

SETTING

Five tertiary care medical centers in the United States.

PATIENTS

Patients > or = 18 yrs of age who had one of nine illnesses of sufficient severity to anticipate a 6-month mortality rate of 50% were enrolled at five participating sites in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients were asked their current height and weight as part of the demographic data. Stratifying body mass index by percentile rank (< or = 15, 15 to 85, and > or = 85th percentiles), risk ratios for mortality were calculated by Cox Proportional Hazards using the 15th to 85th percentile of body mass index as the reference group while controlling for multiple variables such as prior weight loss, albumin, and Acute Physiology Score. A body mass index in the < or = 15th percentile was associated with an excess risk of mortality (risk ratio = 1.23; p < .001) within 6 months. High body mass index (> or = 85th percentile) was not significantly related to risk of mortality.

CONCLUSIONS

Body mass index, a simple anthropometric measure of nutrition employed in community epidemiologic studies, has now been demonstrated to be a predictor of mortality in an acutely ill population of adults at five different tertiary centers. Even when controlling for multiple disease states and physiologic variables and removing from the analysis all patients with significant prior weight loss, a body mass index below the 15th percentile remained a significant and independent predictor of mortality. Examination of patient vs. proxy data did not change the results. Future studies examining variables predictive of mortality should include body mass index, even in acutely ill populations with a poor probability of survival.

Using neural networks to identify patients unlikely to achieve a reduction in bodily pain after total hip replacement surgery

OBJECTIVES

Fourteen patient-provided variables were chosen as potential predictors for improvement after total hip replacement surgery. These variables included patient demographic information, as well as preoperative physical function.

METHODS

A neural network was trained to predict the relative success of total hip replacement surgery using this presurgical patient survey information. The outcome measure was improvement in the Medical Outcomes Study 36 Short Form Health Survey pain score between the preoperative assessment and the 1-year postoperative assessment. For the study sample, 221 patients were selected who had complete information for the composite outcome variable. A backpropagation feedforward neural network was trained to predict the output variable using the jackknife method.

RESULTS

Performance of the neural network was assessed by calculating the area under the receiver operating characteristic curve for the network's ability to predict whether the pain score was improved after total hip replacement surgery. The observed area under the receiver operating characteristic curve was 0.79. For comparison, a linear regression model built using the same data had a receiver operating characteristic area of 0.74 (P = 0.23).

CONCLUSIONS

This research therefore showed the ability of neural networks to predict the success of total hip replacement more accurately. Our results further indicate that it may be possible to predict which patients are at greatest risk of a poor outcome.

Health-promoting behaviors of black and white college women

There is growing recognition that race and socioeconomic variables in health research demand greater attention. The investigators compared racial differences in health definition, health value, and health-promoting behavior of 62 pairs (N = 124) of Black and White college women matched on age, body mass index, and socioeconomic status. Both groups of women had similar definitions of health, valued health to the same extent, and reported similar levels of self-actualization, health responsibility, exercise, and stress management. Black women, relative to White women, practiced fewer nutrition behaviors and had less interpersonal support. Interventions to reduce health risk associated with nutrition practices of Black women are warranted and further research is needed to explore the influence of the social structure of educational institutions on interpersonal relationships and other health behaviors. When socioeconomic status is taken into consideration, Black and White college women demonstrated more commonalities in health behavior than differences.

Leisure time activities of elementary school children

The three most common leisure time activities of 2,200 third and fourth grade children (mean age 8.8 + 0.8; 50.7% girls) and the association of the intensity levels of those activities with demographic variables and risk factors for cardiovascular disease are reported. Activities reported most often by boys were playing video games (33%), playing football (32%), bicycling (31%), watching television (28%), and playing basketball (26%). The girls reported doing homework (39%), bicycling (31%), watching television (30%), dancing (27%), and reading (23%). Overall, the children, especially girls, reported fairly sedentary activities, with an average metabolic equivalent level of 4.2 for girls and 4.8 for boys. Among boys, African Americans reported more vigorous activities than Whites, but the activities reported by White girls were somewhat more vigorous than those reported by non-White girls. Children from a higher socioeconomic status (SES), especially boys, reported a greater proportion of sedentary activities than lower SES children. The risk factors of cholesterol, blood pressure, skinfold thickness, and body mass index were not significantly associated with total activity score. However, significantly more nonobese than obese children reported a vigorous (high-intensity) activity as one of their top three activities.

Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women

BACKGROUND

It has been previously demonstrated that obesity is common among women with low socioeconomic status (SES), but the factors accounting for this association are not well known. According to our hypothesis, low SES is associated with psychosocial stress, an unhealthy lifestyle, and reproductive history, which may increase the likelihood of women with low SES to be overweight or obese.

METHODS

We examined overweight and obesity in relation to SES among 300 healthy women ages 30-65 years, who constitute the control group of the Stockholm Female Coronary Risk Study, a population-based case-control study of women with coronary heart disease. This control group was compared with a large population-based sample and found to be representative of healthy Swedish women ages 30-65 years. We used an aggregate of education and occupation as a measure of SES and defined overweight as body mass index (BMI) between 23.8 and 28.6 kg/m2 and obesity as BMI > 28.6 kg/m2.

RESULTS

Low SES was a strong determinant of overweight and obesity among middle-aged healthy Swedish women. The odds of being overweight or obese increased with lower social position. After adjustment for age, the odds ratios for overweight and obesity among women in a low vs high position were 2.2 [95% confidence interval (CI) 1.1 to 4.4) and 2.7 (95% CI 1.1 to 6.7), respectively. Both low social position and obesity were related to reproductive history (higher parity and earlier age at menarche), unhealthy dietary habits, and unfavorable psychosocial factors (poor quality of life, low self-esteem, and job strain). These factors together explained 53% of the low-SES-obesity association.

CONCLUSIONS

Reproductive history, unhealthy dietary habits, and psychosocial stress accounted for a large part of the association between low SES and obesity. Dietary habits and psychosocial stress are potentially modifiable factors, which should be taken into account in intervention programs among women with low SES.

Hypertension and obesity in African-American patients undergoing surgery

This study was designed to determine the prevalence of hypertension and obesity in a population of African-American patients scheduled to undergo surgery. Weight and blood pressure were measured in 431 randomly selected patients. This included 282 women (65%) and 149 men (35%). Hypertension was present in 27% of the women and 32% of the men. Obesity was present in 58% of the women and 23% of the men. Fifteen percent of all patients met the criteria for having both hypertension and obesity. This study confirms the high incidence of hypertension and obesity in the African-American population. The high morbidity and mortality associated with these conditions suggest that a renewed community-wide effort and public education program on the part of health-care providers is needed to inform this patient population of these dangers.

Health practices of adults with elder care responsibilities

BACKGROUND

This study examined health-risk behaviors and preventive health care activities among caregivers for older adults.

METHODS

Survey questionnaires regarding health practices were completed by 272 caregivers and 917 noncaregivers selected through a stratified random sample of persons age 50 or older who were members of the Kaiser Foundation Health Plan in Northern California.

RESULTS

Controlling for age, gender, race, education, marital status, and income level, caregivers were more likely than noncaregivers to eat breakfast daily, get flu shots, and receive pneumonia vaccines. Caregivers and noncaregivers did not differ significantly with regard to any of 10 other health practices or to the total number of positive health behaviors. Poorer health practices were associated with nonwhite racial identification, low income level, part-time employment, and health limitations.

CONCLUSIONS

These findings suggest that, at least for caregivers who have access to the extensive health promotion resources of a large health maintenance organization, caregiving responsibilities may not always have the deleterious impact on health and health practices that had previously been assumed.

Coronary heart disease risk factors and cigarette smoking among rural African Americans

Cigarette smoking has been reported to worsen high-density lipoprotein (HDL) cholesterol and other cardiac risk factors, yet no studies have examined this issue among rural African Americans. This study examines the association between cigarette smoking and cardiac risk factors among rural African Americans. A population-based sample of 403 African-American adults from two rural Virginia counties underwent total cholesterol (TC), HDL, systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), serum glucose, and glycosylated hemoglobin (GlyHb) measurements. Cross-sectional multivariate analyses were used to compare risk factors across categories of cigarette use. Age, BMI, alcohol consumption, and the use of antihypertensive medications were covariates in the analysis. Results indicated that female light smokers had significantly lower SBP and DBP, and lower HDL. Female heavy smokers had significantly lower HDL and BMI and significantly higher TC/HDL ratios. Male heavy smokers had significantly higher SBP. More than 33% of males and more than 50% of females were overweight, and increasing BMI was associated with significantly or nearly significantly worsening of all other risk factor levels. Both cigarette smoking and obesity adversely affect other cardiac risk factors. Novel approaches are needed to decrease both smoking and obesity in this difficult to reach population.

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

Few epidemiologic studies have investigated the impact of body mass index, low educational attainment, cigarette smoking, and physical activity on the considerable black-white difference in waist-to-hip ratio. These relationships were assessed with multivariable linear regression among 3,094 adults (24% black) who were examined in 1987 in South Carolina. The unadjusted mean waist-to-hip ratio was lower for black men than for white men (-0.03 units) and higher for black women than for white women (+0.03 units). After adjustment for age, body mass index, education, smoking, and physical activity, the black-white difference in mean waist-to-hip ratio was -0.02 units (p < 0.001) among men and +0.01 units (p < 0.01) among women. Although differing distributions of age, body mass index, and educational attainment accounted for a 59% reduction in the black-white difference among women, these factors did not explain the difference among men. Thus, these results suggest that other environmental or biologic factors may also play an important role in the marked variation in body fat distribution between the two ethnic groups. The results also support the importance of the prevention of cigarette smoking and overweight in potentially preventing abdominal obesity in both black adults and white adults.

Body mass index in young adults: Associations with parental body size and education in the CARDIA Study

OBJECTIVES

Associations of parental education, parental body size, and offspring's education with body mass index and 7-year change in body mass index were examined among participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

METHODS

CARDIA is a study of coronary artery disease risk factors in 5115 Black and White persons aged 18 to 30 at baseline. Analyses of covariance were carried out with body mass index and change in body mass index as the dependent variables, and with parental education, parental body size, and participant education as the major independent variables.

RESULTS

Father's body size was positively associated with participant's baseline body mass index among Black men, White men, and White women. Mother's body size was positively associated with baseline body mass index among all race-sex groups, and with change in body mass index among White women. Father's education was inversely associated with baseline body mass index among Black men and White women, and with change among White women.

CONCLUSIONS

Parental education may influence body mass index and changes in young adulthood, especially among White women. Such associations may be both genetic and environmental and may be important for obesity prevention efforts.

Trends in obesity differences by educational level in Spain

Our objective was to study the trend in differences in the frequency of obesity by educational level in the general population 20 to 64 years of age. We used data from two cross-sectional health surveys carried out in 1987 and 1993 in representative samples of the Spanish population. We investigated the relation between obesity and educational level during the periods 1987 and 1993, taking into account the main factors confounding the relation. We used, as setting, the National Health Interview Surveys representative of the whole Spanish population. In both men and women, the highest odds ratios (ORs) for obesity were observed at lower educational levels. These differences increased in women between 1987 and 1993, while they decreased in men during the same period. Evidence of increased educational differences in the frequency of obesity indicates that future studies should focus on the evaluation and monitoring of this trend in the population.

Psychosocial factors influencing weight control behavior of African American women

The purpose of this descriptive study was to seek directly from college-educated African American women factors which they perceived influenced their individual weight control behavior, and those that influenced African American women collectively. Face-to-face, in-depth interviews were conducted, primarily in their homes, with 36 African American women. Thirteen major categories were identified. Six factors that influenced the women's individual weight control behavior were emotions/feelings, beliefs, life events, self-control, discipline, and commitment. Perceived benefits of the behavior and perceived barriers to the behavior were influential in determining the attractiveness, the type, and the extent of the weight control behavior. Five factors related to the African American culture were identified and described by the women. Recognition of psychosocial determinants of weight control behavior may enable health professionals to design unique interventions relevant to African American women.

Measurement of physical activity among black and white obese women

Several recent self-reported surveys have suggested that African-American women may engage in less leisure-time physical activity (PA) than whites. Objective measurements of PA have not been performed, however. Therefore, the purpose of this study was to compare the components of energy expenditure, including PA, between black and white obese women. Using the doubly labeled water method, total daily energy expenditure (TDEE), basal metabolic rate (BMR), thermic effect of a meal (TEM), and PA were measured in 14 black and 15 white moderately obese women over 2 weeks. No statistically significant differences were seen between the 2 groups in BMR, TEM or TDEE. Mean PA was significantly (p = 0.05) lower among black women compared to whites when expressed as MJ. d-1 (3.49 vs. 4.30) or kJ.kg-1.d-1 (37.6 vs. 47.7). Our study supports the survey differences seen in PA among black and white women.