Racial Differences in Association between Deleterious Health Behaviors and Intra-Peritoneal Fat

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.

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Chronic Kidney Disease Awareness and Longitudinal Health Outcomes: Results from the REasons for Geographic And Racial Differences in Stroke Study

American Journal of Nephrology ◽

10.1159/000507774 ◽

2020 ◽

Vol 51 (6) ◽

pp. 463-472 ◽

Cited By ~ 1

Author(s):

Sri Lekha Tummalapalli ◽

Eric Vittinghoff ◽

Deidra C. Crews ◽

Mary Cushman ◽

Orlando M. Gutiérrez ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health Behaviors ◽

Health Outcomes ◽

Racial Differences ◽

Fasting Blood Glucose ◽

Management Indicators ◽

Stroke Study ◽

Increased Risk ◽

Ckd Stage

Background: The majority of people with chronic kidney disease (CKD) are unaware of their kidney disease. Assessing the clinical significance of increasing CKD awareness has critical public health and healthcare delivery implications. Whether CKD awareness among persons with CKD is associated with longitudinal health behaviors, disease management, and health outcomes is unknown. Methods: We analyzed data from participants with CKD in the REasons for Geographic And Racial Differences in Stroke study, a national, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were (1) health behaviors (smoking avoidance, exercise, and nonsteroidal anti-inflammatory drug use); (2) CKD management indicators (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, statin use, systolic blood pressure, fasting blood glucose, and body mass index); (3) change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR); and (4) health outcomes (incident end-stage kidney disease [ESKD], coronary heart disease [CHD], stroke, and death). Logistic and linear regressions were used to examine the association of baseline CKD awareness with outcomes of interest, adjusted for CKD stage and participant demographic and clinical factors. Results: Of 6,529 participants with baseline CKD, 285 (4.4%) were aware of their CKD. Among the 3,586 participants who survived until follow-up (median 9.5 years), baseline awareness was not associated with subsequent odds of health behaviors, CKD management indicators, or changes in eGFR and UACR in adjusted analyses. Baseline CKD awareness was associated with increased risk of ESKD (adjusted hazard ratio [aHR] 1.44; 95% CI 1.08–1.92) and death (aHR 1.18; 95% CI 1.00–1.39), but not with subsequent CHD or stroke, in adjusted models. Conclusions: Individuals aware of their CKD were more likely to experience ESKD and death, suggesting that CKD awareness reflects disease severity. Most persons with CKD, including those that are high-risk, remain unaware of their CKD. There was no evidence of associations between baseline CKD awareness and longitudinal health behaviors, CKD management indicators, or eGFR decline and albuminuria.

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Informal and Formal Social Integration Shape Eating and Drinking of Older Black and White Americans

Journal of Aging and Health ◽

10.1177/0898264319893486 ◽

2019 ◽

Vol 32 (9) ◽

pp. 1145-1155

Author(s):

Katrina Hauschildt ◽

Sarah A. Burgard

Keyword(s):

Alcohol Use ◽

Health Behaviors ◽

Health Outcomes ◽

Social Integration ◽

Racial Differences ◽

Dietary Behaviors ◽

White Americans ◽

Black And White ◽

Objective Health ◽

Important Health

Objective: Health behaviors are seen as one possible pathway linking race to health outcomes. Social integration has also been consistently linked to important health outcomes but has not been examined as a mechanism accounting for racial differences in health behaviors among older U.S. adults. Method: We use data from the American’s Changing Lives (ACL) Study to explore racial differences in measures of social integration and whether they help account for racial differences in several dietary behaviors and alcohol use. Results: We find differences by race and social integration measures in dietary behaviors and alcohol use. Net of socioeconomic status, health status, and reported discrimination, variation in social integration helps to account for racial differences in some health behaviors. Discussion: Our results highlight the nuanced role of social integration in understanding group differences in health behaviors. Interventions should consider such complexities when including aspects of social integration in their design.

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Abstract P156: Health Literacy and Health Behaviors Associated with Racial Disparities in Blood Pressure

Circulation ◽

10.1161/circ.129.suppl_1.p156 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Jia Pu ◽

Dave Vanness ◽

David Kreling ◽

Betty Chewning

Keyword(s):

Blood Pressure ◽

Health Literacy ◽

Health Behavior ◽

Health Behaviors ◽

Racial Disparities ◽

Racial Differences ◽

Risk Behaviors ◽

Cardiovascular Health ◽

Baseline Health

Introduction: Racial disparity in cardiovascular disease has prompted efforts to improve cardiovascular outcomes through patient education and health behavior promotion. However, little is known about the long-term effects of health literacy and health behaviors on cardiovascular disease outcomes. Hypothesis: This study aims to explore whether racial differences in long-term blood pressure outcomes are associated with baseline levels of health literacy, mediated through longitudinal patterns of health behaviors. Methods: This study used a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) project, funded by NHLBI. Blood pressure was measured by trained CARDIA researchers at seven examinations between 1985 and 2005. Self-reported health behaviors (including smoking, binge drinking, overweight and sedentary lifestyle) were obtained at each examination. Cardiovascular health literacy was assessed as part of the 1990 observation. We used growth curve modeling to explore racial disparities in blood pressure and to examine if blood pressure outcomes could be explained by participants’ health literacy and their health behavior change. This study included 3,546 CARDIA study participants who remained in the most recent examination at year 2005, with 47% African Americans and 43% males. Results: Racial disparities were observed in participants’ initial blood pressure, blood pressure progression rate, health literacy and health behaviors. African Americans had higher blood pressure at baseline (systolic: 109 vs. 105; diastolic: 70 vs. 67 P<0.0001) and greater increases over time. Caucasians had a higher health literacy score (4 vs. 3.5 P<0.0001) and reported fewer risk behaviors on average. There was a positive relationship between health literacy, education attainment, parents’ education attainment, family income, having health insurance and having fewer risk behaviors. Participants with fewer risk behaviors had lower blood pressure. Blood pressure improved in years with fewer risk behaviors. Higher baseline health literacy was associated with having fewer risk behaviors in the following fifteen years. Overall, the results indicated that blood pressure outcomes were indirectly influenced by baseline health literacy through longitudinal patterns of risk behaviors. This relationship was stronger in Caucasians. Conclusions: This study suggests that racial differences in blood pressure are associated with both health literacy and health behaviors. In response to these findings, important gaps in hypertension preventive care and health behavior promotion should be identified and addressed through efforts to improve cardiovascular health literacy. For minority and high risk populations, multifaceted approaches in addition to patient education may be needed to initiate behavior change.

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Racial Differences in Maintaining Optimal Health Behaviors Into Middle Age

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2018.10.020 ◽

2019 ◽

Vol 56 (3) ◽

pp. 368-375 ◽

Cited By ~ 1

Author(s):

John N. Booth ◽

Norrina B. Allen ◽

David Calhoun ◽

April P. Carson ◽

Luqin Deng ◽

...

Keyword(s):

Health Behaviors ◽

Racial Differences ◽

Middle Age ◽

Optimal Health

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Racial Differences in Health Status and Health Behaviors of Older Adults

Nursing Research ◽

10.1097/00006199-199807000-00010 ◽

1998 ◽

Vol 47 (4) ◽

pp. 243-250 ◽

Cited By ~ 28

Author(s):

Jin-Sun Kim ◽

Martha H. Bramlett ◽

Lore K. Wright ◽

Leonard W. Poon

Keyword(s):

Older Adults ◽

Health Status ◽

Health Behaviors ◽

Racial Differences

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SOCIAL INTEGRATION, DISCRIMINATION, AND RACIAL DIFFERENCES IN HEALTH BEHAVIORS AMONG U.S. ADULTS

Innovation in Aging ◽

10.1093/geroni/igy023.066 ◽

2018 ◽

Vol 2 (suppl_1) ◽

pp. 18-18 ◽

Cited By ~ 1

Author(s):

S Burgard ◽

K Hauschildt

Keyword(s):

Health Behaviors ◽

Social Integration ◽

Racial Differences

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Which social measures relate to cancer screening & healthy behaviors?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18142 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18142-e18142

Author(s):

Kezhen Fei ◽

Daliz Cruz ◽

Jenny J. Lin ◽

Radhi Yagnik ◽

Emily Gallagher ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Health Behaviors ◽

Cancer Patients ◽

Racial Differences ◽

College Education ◽

Breast Cancer Patients ◽

Healthy Behaviors ◽

Pap Screening ◽

Cancer Screenings

e18142 Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of > $100,000/yr. The median sSES = 8; 20% had high sSES ( > 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income > $100K/yr (62% vs 36%, p < .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]

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Baseline Obesity Increases 25-Year Risk of Mortality due to Cerebrovascular Disease: Role of Race

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193705 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3705 ◽

Cited By ~ 1

Author(s):

Shervin Assari ◽

Mohsen Bazargan

Keyword(s):

Health Behaviors ◽

Cerebrovascular Disease ◽

Racial Differences ◽

Black People ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Predictive Role

Background: Although obesity may have a role as a risk factor for cerebrovascular mortality, less is known about how demographic and social groups differ in this regard. Aims: This study had two aims: first to investigate the predictive role of baseline obesity on long-term risk of mortality due to cerebrovascular disease, and second, to test racial variation in this effect. Methods: the Americans’ Changing Lives Study (ACL) 1986–2011 is a state of the art 25-year longitudinal cohort study. ACL followed a nationally representative sample of Blacks (n = 1156) and Whites (n = 2205) for up to 25 years. Baseline obesity was the main predictor of interest, time to cerebrovascular death was the main outcome of interest. Demographic characteristics, socioeconomic status (educational attainment and household income), health behaviors (exercise and smoking), and health (hypertension and depressive symptoms) at baseline were covariates. Cox proportional hazards models were used to test additive and multiplicative effects of obesity and race on the outcome. Results: From the total 3,361 individuals, 177 people died due to cerebrovascular causes (Whites and Blacks). In the pooled sample, baseline obesity did not predict cerebrovascular mortality (hazard ratio (HR) = 0.86, 0.49–1.51), independent of demographic, socioeconomic, health behaviors, and health factors at baseline. Race also interacted with baseline obesity on outcome (HR = 3.17, 1.09–9.21), suggesting a stronger predictive role of baseline obesity on cerebrovascular deaths for Black people compared to White individuals. According to the models that were run specific to each race, obesity predicted risk of cerebrovascular mortality for Blacks (HR = 2.51, 1.43–4.39) but not Whites (HR = 0.69, 0.31–1.53). Conclusions: Baseline obesity better predicts long-term risk of cerebrovascular death in Black individuals compared to White people. More research should explore factors that explain why racial differences exist in the effects of obesity on cerebrovascular outcome. Findings also have implications for personalized medicine.

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