Introduction:
There are known racial differences in cardiovascular health behaviors, including smoking, physical activity, and diet quality. A better understanding of factors that explain these differences may suggest novel intervention targets for reducing disparities in cardiovascular disease.
Objective:
To examine whether socioeconomic, psychosocial and environmental factors mediate racial differences in health behaviors.
Methods:
We studied 3,028 Black or White CARDIA participants who were enrolled at age 18-30 years in 1985-86 and completed the 30 year follow-up visit in 2015-2016. Health behaviors included smoking (current, former ≤ 12 months, never smoker/quit >12 months), physical activity (inactive, active but not meeting guidelines, meeting guidelines), and a surrogate for healthy eating using fast food and sugar-sweetened beverage consumption (frequency per week ≥ 2, some but < 2, none). Each behavior was assigned a value of 0 for poor, 1 for intermediate or 2 for ideal and summed to calculate an overall health behavior score for each participant (range 0-6). The race difference (β) in health behavior score was estimated using linear regression. Formal mediation analyses computed the proportion of the total effect of race on health behavior score explained by socioeconomic, psychosocial, and environmental factors (see
Table
footnote).
Results:
Blacks had a lower health behavior score than Whites in crude analyses (mean difference: -1.04, p<0.001). After adjustment for sex, age and field center, socioeconomic factors mediated 50.5% of the association between race and the health behavior score, psychosocial factors 26.8% and environmental factors 9.0% (p<0.05 for all). Joint associations mediated 58.1% of the race-health behavior score association.
Conclusions:
Observed racial differences in the health behavior score are predominately mediated by socioeconomic factors, which appear to play a stronger explanatory role than psychosocial and environmental factors.
Epigenetic signatures underlying inflammation: an interplay of nutrition, physical activity, metabolic diseases, and environmental factors for personalized nutrition
