Ethnic-immigrant disparities in total and abdominal obesity in the US

Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health

After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.

Cancer Mortality Patterns by Birthplace and Generation Status of Mexican Latinos: The Multiethnic Cohort

BACKGROUND

Latinos are the largest minority group in the United States. We assessed cancer mortality by birthplace and generation status of Mexican Latinos in the Multiethnic Cohort.

METHODS

We included 26 751 Latinos of Mexican origin and 6093 non-Latino Whites aged 45-74 years at cohort entry (1993-1996) from the California Multiethnic Cohort component. The Mexican Latinos comprised 42% first-generation Mexico-born immigrants, 42% second-generation (28% US-born with both parents Mexico-born and 14% US-born with 1 parent US-born and 1 parent Mexico-born), and 16% third-generation or more who were US-born with both parents US-born. Multivariable Cox models were used to calculate covariate adjusted hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality by birthplace and generation status. All statistical tests were 2-sided.

RESULTS

Cancer death rate was highest among the US-born with 1 parent US-born and 1 parent Mexico-born (age-adjusted rate = 471.0 per 100 000 person-years) and US-born with both parents US-born (age-adjusted rate = 469.0 per 100 000 person-years) groups. The US-born with both parents Mexico-born group had a 30% (hazard ratio = 1.30, 95% confidence interval = 1.18 to 1.44) higher risk of cancer death than the first-generation Mexico-born immigrants group, showing US birthplace was associated with an elevated cancer mortality. For cancer-specific mortality, US birthplace was positively associated with colorectal, liver and lung, and ovarian cancer (P values ranged from .04 to .005). Among US-born Mexican Latinos, generation status was not statistically significantly associated with overall cancer or site-specific cancer mortality.

CONCLUSIONS

Our findings suggest that US birthplace is a risk factor for cancer death in Mexican Americans. Identification of the contributing factors is important to curtail patterns of increasing cancer mortality in US-born Mexican Latinos.

Diabetes prevalence among diverse Hispanic populations: considering nativity, ethnic discrimination, acculturation, and BMI

PURPOSE

To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI.

METHODS

Data from 6223 Hispanic respondents from the nationally representative NESARC-III study was used. Sociodemographic characteristics were compared across nativity groups, and adjusted odds of self-reported diabetes diagnosis (past year) tested. Differences by perceived discrimination (using endorsement of individual items assessing specific experiences) and by nativity were examined when accounting for sociodemographic characteristics, acculturation, and BMI.

RESULTS

Prevalence of self-reported diabetes diagnosis was significantly higher among the Puerto Rico-born Hispanics, and remained significantly elevated when adjusting for perceived discrimination, acculturation, and health risk behaviors. When adjusting further for BMI, there were no significant differences in the odds of diabetes by nativity. Prevalence of lifetime perceived discrimination was significantly lower among Cuba-born Hispanics. Mean BMI was significantly lower in South/Central America-born Hispanic individuals relative to U.S. state-, Mexico-, and Puerto Rico-born Hispanic groups. Higher BMI was associated with significantly greater risk of diabetes diagnosis across groups.

CONCLUSION

Marked heterogeneity exists in prevalence and in factors associated with diabetes risk and weight status across Hispanic groups in the U.S. Experiences with discrimination may play an important role in accounting for these differences. This should be considered when planning future research to inform the most optimal patient-centered prevention efforts.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort analytic study.

Frailty in ethnic minority women

In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this 'sex-frailty paradox' is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.

Stressful Life Events and Obesity in the United States: The Role of Nativity and Length of Residence

PURPOSE

Obesity is a public health issue in the United States (US), that disproportionately affects marginalized group members. Stressful life events (SLE) have been implicated as an obesogenic risk factor. However, there is scant research examining of the role of nativity status and length of residence in the relationship between SLE and obesity.

DESIGN

Cross-sectional survey.

SETTING

Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

SAMPLE

A total of 34,653 participants were included in these analyses, of whom 10,169 (29.39%) had obesity.

MEASURES

Obesity (measured using body mass index), stressful life events, race/ethnicity, gender, educational attainment, family income, marital status, current smoking status, and alcohol abuse.

ANALYSIS

Weighted logistic regression analysis.

RESULTS

A total of 10,169 (29.39%) had obesity. There was a significant interaction between SLE and nativity status/length of residence [F (3, 34,642) = 60.50, p < 0.01]. Based on stratified analyses, SLE were associated with greater odds of obesity for US-born individuals (OR = 1.07; 95% CI [1.05, 1.08]) and foreign-born individuals living in the US for ≥ 20 years (OR = 1.17; 95% CI [1.10, 1.25]). There was no evidence that SLE were associated with greater odds of obesity for foreign-born individuals living in the US <10 years (OR = 1.06; 95% CI [0.94, 1.21]) and 11-19 years (OR = 1.00; 95% CI [0.91, 1.09]).

CONCLUSIONS

Number of SLE may be a risk factor for obesity, particularly for US-born adults and foreign-born adults living the US >20 years. Further research is needed to understand the pathways that may link SLE to obesity among these groups.

Assessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity

OBJECTIVE

This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults.

METHODS

Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants.

RESULTS

SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals.

CONCLUSIONS

Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.

The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity.

METHODS

We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors.

RESULTS

The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001].

CONCLUSION

Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.

Obesity: Ethnic and Regional Differences in the Diet and Gut Microbiota (Review)

Problems of obesity, nutrition and microbiota are discussed in this review. In a world of constant economic and cultural changes traditional diet is being replaced by western diet, rich in free sugars, saturated fats, salt, and characterized by increased average daily dietary energy consumption intake. Such «western-style» diet is associated with high weight gain, leading to metabolic disorders, namely diet-related obesity, which is rapidly increasing globally. The impact of ethnicity to the development of obesity as inter-ethnic and intra-ethnic differences in dietary habits is showed. Dietary habits of different countries, including ethnic minorities, provide a specific pattern of gut microbiota and microbiome. In the context of globalization, international migration and rapid urbanization, changes in dietary habits occurred without proper adaptation of gut microbiota. Gut microbiota plays the fundamental role in regulation and pathogenesis of metabolic disorders due to making metabolites for normal human development, therefore gut microbiota dysbiosis may lead to metabolic dysfunction, including obesity. The review shows actual worldwide data of evolution of adult obesity over time, dietary energy consumption in different country and different climatic regions. It analyzes changes in gut microbiota composition depending on traditional or western diet, and on nationality and race.

Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany

Background: Health-related lifestyle behaviors such as smoking, alcohol consumption, physical inactivity and obesity are major cardiovascular risk factors. Previous studies have mostly demonstrated a favorable association between religiosity and these cardiovascular risk factors; however, no studies have investigated this relationship in Polish immigrants. The aim of this cross-sectional study was to examine the association between health-related lifestyle behaviors and religiosity in Polish immigrants in Germany. Methods: The smoking patterns, frequency of alcohol consumption, physical activity, and presence of overweight/obesity were assessed in 257 first-generation immigrants of Polish origin living in Germany. Religiosity was measured with the Centrality of Religiosity Scale (CRS, Huber, 2003) consisting of 15 items that categorized the respondents into intrinsically, extrinsically, and not/marginally religious. Results: After adjusting for various sociodemographic, migration, and health-related characteristics, intrinsic religiosity was significantly associated with a lower risk of being a smoker (odds ratios (OR) = 0.34, confidence intervals (CI) = 0.15–0.76) and was also associated with a lower risk of alcohol consumption (OR = 0.33, CI = 0.15–0.71), but a higher risk of being overweight/obese (OR = 2.53, CI = 1.15–5.56) in comparison with extrinsic/marginal religiosity. No significant relationship was found between religiosity and physical activity. Conclusions: In Polish immigrants, intrinsic religiosity acts as a protective factor against some cardiovascular risk factors (smoking and alcohol consumption).

A Comprehensive Assessment of the Racial and Ethnic Disparities in the Incidence of Gastric Cancer in the United States, 1992-2014

Purpose

This study aimed to evaluate the racial and ethnic disparities in the incidence of gastric cancer and their temporal trends in the United States.

Materials and Methods

Using data from 13 cancer registries in the Surveillance, Epidemiology, and End Results database, we assessed such disparities during 1992-2014 in the United States using a variety of disparity metrics.

Results

The age-standardized incidence rate of non-cardia gastric cancer was highest in Asian and Pacific Islanders, while the incidence of cardia gastric was highest in non-Hispanic whites in men and was similarly low in all groups in women. The incidence of non-cardia gastric cancer decreased in all groups over time, particularly in Asian and Pacific Islanders (on average by 3% per year). The incidence of cardia gastric remained relatively stable in virtually all racial/ethnic groups. The racial and ethnic disparities in gastric cancer incidence steadily decreased over time as measured on the absolute scale, which was mainly driven by the reduced disparities in non-cardia gastric cancer. The range difference in the incidence of gastric cancer decreased on average by 4.1% per year in men and by 2.6% per year in women from 1992 to 2014. The between group variance decreased by 5.6% per year in men and by 3.4% per year in women. The relative-scale disparity measures generally remained stable over time.

Conclusion

This study demonstrates decreased racial and ethnic disparities in the incidence of gastric cancer over time in the United States, particularly as measured on the absolute scale.

A US/Mexico Study of Joint Associations of Physical Activity and Sedentary Behavior on Anthropometric Indicators, Migration Status, Country of Birth and Country of Residence

Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011–2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors. Results: Analyses showed that even among those in the category with the lowest risk behavior, “physically active and low sedentary”, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico. Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity.

Racial and Ethnic Disparities in the Incidence of Esophageal Cancer in the United States, 1992-2013

Racial and ethnic disparities in the incidence of esophageal cancer have not been thoroughly characterized with quantitative health-disparity measures. Using data from 1992-2013 from 13 US cancer registries in the Surveillance, Epidemiology, and End Results database, we assessed such disparities according to histological type, based on a variety of disparity metrics. The age-standardized incidence rate of squamous cell carcinoma (SCC) was highest among black persons, while adenocarcinoma mainly affected white men. The rate of SCC decreased over time in all racial/ethnic groups, and this was most pronounced in black persons (by 5.7% per year among men and 5.0% among women). The adenocarcinoma rate rose among non-Hispanic whites and among black men. Racial/ethnic disparities in the incidence of total esophageal cancer decreased over time, which was due mainly to reduced disparities in SCC. The 2 absolute disparity measures-range difference and between-group variance-for adenocarcinoma rose by 3.2% and 6.8% per year, respectively, in men and by 1.8% and 5.3% per year, respectively, in women. This study demonstrates decreased racial/ethnic disparities in the incidence of esophageal SCC over time in the United States, while disparities increased in adenocarcinoma incidence as measured on the absolute scale.

Obesity in International Migrant Populations

PURPOSE OF REVIEW

This review examines the risk of obesity in migrant groups-specifically migrants from countries with lower prevalence of obesity to countries with higher prevalence of obesity. We examine obesity prevalence within migrant groups compared with native populations and the evidence on factors that might shape obesity risk in these migrant groups.

RECENT FINDINGS

Migrants may arrive in new countries with a health advantage including generally a healthier body weight. Genetic and epi-genetic factors, as well as body size preference, socio-economic factors, and stress exposure, may play a role in increasing unhealthy weight gain in migrant populations. This unhealthy weight gain leads to similar or greater obesity risk in migrant populations compared with native populations 10-15 years after migration. Meeting the challenge of prevention and treatment of obesity in diverse populations will require greater attention to minority groups in research in the future.

Reporting More but Moving Less? The Complex Relationship between Acculturation and Physical Activity Among US Adults

PURPOSE

To investigate the association between acculturation and physical activity (PA).

DESIGN

Cross sectional.

SETTING

The National Health and Nutrition Examination Surveys (NHANES) 2003 to 2006.

SUBJECTS

A total of 4029 adults (aged 20-64), including 2063 men and 1966 women.

MEASURES

The outcome measures included both self-reported PA and device-assessed PA. The acculturation measure was constructed based on nativity, language use at home, and length of residence in the United States.

ANALYSIS

Regressions with domain analysis were conducted to adjust for the influence of confounding factors and complex survey design.

RESULTS

For men, self-reported PA increased with acculturation, especially leisure-time PA. However, device-assessed PA decreased with acculturation. For women, the results were more mixed.

CONCLUSION

All evidence considered, we concluded that PA decreased with acculturation for US men.

Rural-Urban Disparities in Obesity Prevalence Among Working Age Adults in the United States: Exploring the Mechanisms

PURPOSE

Higher prevalence rates of overweight and obesity in rural America have been consistently reported, but sources of these disparities are not well known. This study presented patterns and mechanisms of these disparities among working age Americans.

DESIGN

Cross-sectional study.

SETTING

United States of America.

PARTICIPANTS

The study included 10 302 participants of the 2003-2008 National Health and Nutrition Examination Survey (NHANES) who were 20 to 64 years old, not pregnant, and with a body mass index ranging from 18.5 to 60.

MEASURES

Individual-level data were from NHANES including age, gender, race/ethnicity, immigrant status, education, and family income. The outcomes were prevalence of obesity and prevalence of overweight and obesity combined. Neighborhood data were constructed from the 2000 US Census providing tract-level information on family median income and built environmental features and from the 2006 ESRI ArcGIS 9.3 Data DVD providing tract-level park location information.

ANALYSIS

Geographic information system (GIS) methods were used to create a measure of spatial distance to local parks capturing park accessibility. Random intercept logistic and ordinal logit regression analyses were performed.

FINDINGS

Multivariate regression results showed that the odds of obesity was higher in rural areas compared to urban areas (odds ratio = 1.358, P < .001) net of demographic controls and that this gap was largely attributable to individual educational attainment and neighborhood median household income and neighborhood built environmental features. After controlling for these hypothesized mediators, the elevated odds associated with rural residence was reduced by nearly 94% and rendered statistically insignificant.

CONCLUSIONS

In this nationally representative cross-sectional sample, rural-urban obesity disparities were large and explained by rural-urban educational differences at the individual level and economic and built environmental differences at the neighborhood level.

Culturally based health assumptions in Sub-Saharan African immigrants: Body mass index predicting self-reported health status

This study examined whether Sub-Saharan African adult immigrants maintained cultural preferences for curvier/higher body size post-migration to the United States. Linear and multiple regression analyses were utilized to discern the predicting effects of Sub-Saharan African immigrants' body mass index score on their self-reported health status at two post-migration data collection points. The initial assessment reveals that Sub-Saharan African immigrants' overweight body mass index score predicted better self-reported health status. Four to six years later, higher body mass index score predicted a better self-reported health status and lower dietary acculturation moderated the predicting effect of body mass index on self-reported health status. Limitations of the study and implications for research and practice are explored.

Differences in Obesity Among Men of Diverse Racial and Ethnic Background

Racial/ethnic disparities exist in obesity prevalence among men, with Hispanic men exhibiting the highest prevalence compared with non-Hispanic White and non-Hispanic Black men. Most studies do not parse out Hispanic groups; therefore, it is unclear whether the increases in obesity rates among Hispanic men applies to all groups or if there are particular groups of Hispanic men that are driving the increase. The goal of this study is to examine the variations in obesity among men of diverse racial/ethnic backgrounds and determine if obesity is affected by nativity. The data used in this study were from 11 years (2002-2012) of the National Health Interview Survey. Logistic regression was used to examine the relationship between race/ethnicity, obesity, and nativity. After adjusting for covariates, there are differences in obesity prevalence, with the largest prevalence among Puerto Rican men and Mexican American men. Consistent with previous literature, it has been suggested that men born in the United States are more likely to be obese than men born outside the United States. This study underscores the importance of distinguishing Hispanic groups when examining obesity, and provides information for future, targeted intervention strategies related to obesity among high-risk groups.

Ethnic disparities in general and abdominal adiposity at school age: a multiethnic population-based cohort study in the Netherlands

BACKGROUND/AIMS

Ethnic differences in obesity prevalence have been reported. We examined ethnic differences in general and abdominal fat distribution in school-age children and the influence of parental prepregnancy, pregnancy, and childhood factors on these differences.

METHODS

We performed a multiethnic population-based prospective cohort study among 5,244 children with information about prepregnancy factors, pregnancy, and childhood factors. At the age of 6 years, the BMI, total fat mass, android/gynoid fat mass ratio, and preperitoneal fat mass were assessed via dual-energy X-ray absorptiometry and abdominal ultrasound.

RESULTS

The overweight and obesity prevalences among Dutch children were 10.0 and 2.1%, respectively. Higher prevalences were observed among Cape Verdean (21.0 and 10.3%), Dutch Antillean (18.4 and 13.8%), Moroccan (20.6 and 7.7%), Surinamese-Creole (13.4 and 7.7%), Surinamese-Hindustani (12.3 and 6.2%), and Turkish (23.8 and 12.0%) children. In the models adjusted for age and sex only, Moroccan, Surinamese-Hindustani, and Turkish children had a higher total fat mass than Dutch children, whereas Surinamese-Creole children had a lower total fat mass. Compared to Dutch children, the android/gynoid fat mass ratio was higher in Moroccan, Surinamese-Hindustani, and Turkish children, whereas the preperitoneal fat mass was higher among Dutch Antillean, Moroccan, Surinamese-Hindustani, and Turkish children (all p < 0.05). Prepregnancy factors explained up to 73% of these differences. In addition to prepregnancy factors, pregnancy factors explained up to 34% of the differences. Childhood factors did not significantly explain these associations.

CONCLUSIONS

All ethnic minority groups had higher risks of overweight and obesity than Dutch children. Moroccan, Surinamese-Hindustani, and Turkish children also had an adverse body fat profile. Prepregnancy and pregnancy might be critical periods for preventive strategies focused on the reduction of ethnic disparities in childhood adiposity.

Walking or dancing: patterns of physical activity by cross-sectional age among U.S. women

OBJECTIVES

To identify age differences in physical activity (PA) participation for women.

METHODS

Data from 3,952 women 25+ from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) were used to analyze participation patterns for 17 PA types.

RESULTS

The top five leisure PAs by participation rate for all ages were walking (42%), dancing (20%), treadmill (15%), biking (11%), and yoga (10%). Participation in running, dancing, treadmill, and team sports declined around ages 35 to 44, and participation in household PA, walking, weightlifting, and hiking declined around ages 55 to 64. At age 75+ further substantial decline in most activities occurred. Nativity status was the most important moderator for age-related PA decline.

CONCLUSIONS

Total PA declines with age but significant decline does not occur until ages 55 to 64. Major decline in leisure PA participation starts earlier at ages 35 to 44. While age-related declining patterns differ for different activities, the top five most popular leisure activities are similar for all age groups.