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Risk factors for obesity and high blood pressure in Chinese American children: maternal acculturation and children's food choices.
No full textThe objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children's weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and self-efficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children's unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children
A Nationwide Analysis of US Racial/Ethnic Disparities in Smoking Behaviors, Smoking Cessation, and Cessation-Related Factors
No full textObjectives. We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults.
Methods. We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data.
Results. Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy.
Conclusions. Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers
Tobacco Use among Rural African American Young Adult Males.
No full textObjective. Tobacco-related disease is a primary source of mortality for African American men. Recent studies suggest that alternative tobacco products may have supplanted cigarettes as the most common products used by young African Americans. Effective cessation strategies require community-specific prevalence data. This project measures the prevalence of 9 tobacco products among young African American men in rural Alabama. Study Design. Principles of community-based participatory research were used to design a verbally administered tobacco product survey to measure the prevalence and behavioral factors influencing use. Setting. Black Belt counties of rural Alabama. Subjects and Methods. African American men aged 19 to 30 years were recruited from the target counties. Participants were stratified by income and education level. Prevalence rates for 9 products were determined, and logistic regression analysis was performed. Results. A total of 415 participants completed surveys. Cigarettes were the most common product ever (54%) and currently (39.9%) used. Participants who attended school for more than 12 years or attended religious services were less likely to use cigarettes. Marijuana and blunts were used next most commonly. Only 35 respondents (8.9%) currently used mini-cigars. Other products, bidis/kreteks, smokeless tobacco, and pipes were used uncommonly in this sample. Conclusions. Cigarettes remain the dominant tobacco product used by young African American men in rural Alabama. Cigarette prevalence far exceeds that measured statewide for African American men of the same age. Alternative products were not commonly used in this study population. Effective community-based intervention must target cigarette initiation and cessation in this vulnerable population
The Relation of Diabetes, Impaired Fasting Blood Glucose, and Insulin Resistance to Left Ventricular Structure and Function in African Americans: The Jackson Heart Study
No full textOBJECTIVE We assessed the relation of diabetes and insulin resistance (IR) on left ventricular (LV) structure and function in African Americans.
RESEARCH DESIGN AND METHODS Among those receiving echocardiograms in cycle 1 of the Jackson Heart Study, we assessed the sex-specific relation of fasting blood glucose (FBG), diabetes, and IR to LV structure and function, adjusting for age, systolic blood pressure, antihypertensive medications, and BMI.
RESULTS Among 2,399 participants, LV mass index (Pwomen = 0.0002 and Pmen = 0.02), posterior wall thickness (Pwomen = 0.01 and Pmen = 0.05), and interventricular septal wall thickness (Pwomen = 0.01) were related to FBG categories. Among those with normal FBG and no diabetes, concentric remodeling and low ejection fraction in women and LV mass index and posterior wall thickness in men were related to IR.
CONCLUSIONS In the largest study of its kind in a community-based cohort of African Americans, we found a relation of FBG category and IR to LV structure and function
Associations of Fast Food Restaurant Availability With Dietary Intake and Weight Among African Americans in the Jackson Heart Study, 2000-2004.
No full textObjectives. We examined the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the southeastern United States. Methods. We investigated cross-sectional associations of FFR availability with dietary intake and body mass index (BMI) and waist circumference in 4740 African American Jackson Heart Study participants (55.2 612.6 years, 63.3% women). We estimated FFR availability using circular buffers with differing radii centered at each participant's geocoded residential location. Results. We observed no consistent associations between FFR availability and BMI or waist circumference. Greater FFR availability was associated with higher energy intake among men and women younger than 55 years, even after adjustment for individual socioeconomic status. For each standard deviation increase in 5-mile FFR availability, the energy intake increased by 138 kilocalories (confidence interval [CI]=70.53, 204.75) for men and 58 kilocalories (CI=8.55,105.97) for women. We observed similar associations for the 2-mile FFR availability, especially in men. FFR availability was also unexpectedly positively associated with total fiber intake. Conclusions. FFR availability may contribute to greater energy intake in younger African Americans who are also more likely to consume fast food. (Am J Public Health. Published online ahead of print May 5, 2011: e1-e9. doi:10.2105/AJPH.2010.300006)
Consensus recommendations for advancing breast cancer: risk identification and screening in ethnically diverse younger women.
No full textA need exists for a breast cancer risk identification paradigm that utilizes relevant demographic, clinical, and other readily obtainable patient-specific data in order to provide individualized cancer risk assessment, direct screening efforts, and detect breast cancer at an early disease stage in historically underserved populations, such as younger women (under age 40) and minority populations, who represent a disproportionate number of military beneficiaries. Recognizing this unique need for military beneficiaries, a consensus panel was convened by the USA TATRC to review available evidence for individualized breast cancer risk assessment and screening in young (< 40), ethnically diverse women with an overall goal of improving care for military beneficiaries. In the process of review and discussion, it was determined to publish our findings as the panel believes that our recommendations have the potential to reduce health disparities in risk assessment, health promotion, disease prevention, and early cancer detection within and in other underserved populations outside of the military. This paper aims to provide clinicians with an overview of the clinical factors, evidence and recommendations that are being used to advance risk assessment and screening for breast cancer in the military
Eliminating Disparities in Hypertension Care for Hispanics and Blacks Using a Heart Failure Disease Management Program
No full textObjectives: This study assessed if patients enrolled in a heart failure disease management program (HFDMP) reach the JNC VII target goals for blood pressure (BP) control, eliminate disparities in hypertension control by race/ethnicity and the impact BP control has on survival.
Methods: Patients (N = 898) with an ejection fraction <40% were enrolled into two HFDMPs and screened for hypertension, defined as BP > 130/80.
Results: Mean baseline systolic BP (SBP) 132 +/- 25.5 mm Hg and diastolic BP (DBP) 79 +/- 16.8 mm Hg. Final mean SBP decreased to 129.6 mm Hg, DBP 77.6 mm Hg. Whites had the highest rate of achieving BP goals. Mortality reduction was associated with minority race, history of hypertension, increase ejection fraction and statin use.
Conclusion: HFDMPs are an effective way to reduce BP in hypertensive patients. Disparities by race and ethnicity were not seen after adjustment for disease modifiers. There was no mortality difference in those who reached BP goal
Health Behaviors and Racial Disparity in Blood Pressure Control in the National Health and Nutrition Examination Survey
No full textMinorities have a higher prevalence of hypertension, a major risk factor for cardiovascular disease, which contributes to racial/ethnic disparities in morbidity and mortality in the United States. Many modifiable health behaviors have been associated with improved blood pressure control, but it is unclear how racial/ethnic differences in these behaviors are related to the observed disparities in blood pressure control. Cross-sectional analyses were conducted among 21 489 US adults aged >20 years participating in the National Health and Nutrition Examination Survey from 2001 to 2006. Secondary analyses were conducted among those with a self-reported diagnosis of hypertension. Blood pressure control was defined as systolic values <140 mm Hg and diastolic values <90 mm Hg (or <130 mm Hg and <80 mm Hg among diabetics, respectively). In primary analyses, non-Hispanic blacks had 90% higher odds of poorly controlled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). In secondary analyses among hypertensive subjects, non-Hispanic blacks and Mexican Americans had 40% higher odds of uncontrolled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). For both analyses, the racial/ethnic differences in blood pressure control persisted even after further adjustment for modifiable health behaviors, which included medication adherence in secondary analyses (P<0.001 for both analyses). Although population-level adoption of healthy behaviors may contribute to reduction of the societal burden of cardiovascular disease in general, these findings suggest that racial/ethnic differences in some health behaviors do not explain the disparities in hypertension prevalence and control.
Manifesting Empowerment: How a Family Health Program Can Address Racism
No full textRacism has been conducive to ostensible health disparities, with African Americans being gravely affected. The lack of cultural responsiveness within the health care system is one reason among others for the persistence of such discrepancies. Family is an integral factor in the culture and history of the African American community, making the inclusion of this variable in health care a potentially ancillary response to culture. The present study endeavored to ascertain the views of African American parents/guardians and health care professionals on how a family health program could address racism and the subsequent ill effects. Applying qualitative methods, various themes on addressing racism emerged, including the following: (1) enhancing self-esteem, increasing cultural pride and knowledge, and enhancing conduct; (2) increasing intraracial community cohesion; and (3) bolstering inter-racial community connection
Ethnic/racial differences in the self-reported physical and mental health correlates of adolescent obesity.
No full textAdolescent obesity has increased significantly during the past 20 years disproportionately affecting African-Americans. We tested the cultural hypothesis which suggests that the acceptance of a larger body size among African-Americans serves as a protective factor against negative physical and mental health consequences. Secondary analyses of data from a subsample of 5158 Black and White participants in the 2009 Youth Risk Behavior Survey were conducted to assess the relationship between weight status and global self-reports of physical and psychological health. Planned comparisons revealed support of our hypotheses for some outcomes but not others. Implications for interventions targeting adolescent obesity are discussed