scholarly journals Racial Differences in Weight Loss Mediated by Engagement and Behavior Change

2018 ◽  
Vol 28 (1) ◽  
pp. 43 ◽  
Author(s):  
Loneke T. Blackman Carr ◽  
Carmen Samuel-Hodge ◽  
Dianne Stanton Ward ◽  
Kelly R. Evenson ◽  
Shrikant I. Bangdiwala ◽  
...  

<strong></strong><p class="Pa7"><strong>Objective: </strong>We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differ­ential weight loss in African American and non-Hispanic White women, and to identify possible mediators.</p><p class="Pa7"><strong>Design: </strong>Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months.</p><p class="Pa7"><strong>Setting: </strong>The intervention included monthly face-to-face group sessions and an Internet component that participants were recom­mended to use at least once weekly.</p><p class="Pa7"><strong>Participants: </strong>We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions.</p><p class="Pa7"><strong>Intervention: </strong>Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitor­ing tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards.</p><p class="Pa7"><strong>Main outcome measure: </strong>Multiple linear regression was used to evaluate race group differences in weight change.</p><p class="Pa7"><strong>Results: </strong>Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship.</p><p class="Default"><strong>Conclusions: </strong>The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors. <em></em></p><p class="Default"><em>Ethn Dis. </em>2018;28(1):43-48; doi:10.18865/ed.28.1.43.</p>

2016 ◽  
Vol 26 (1) ◽  
pp. 61 ◽  
Author(s):  
Andrea E Cassidy-Bushrow ◽  
Ganesa Wegienka ◽  
Suzanne Havstad ◽  
Albert M. Levin ◽  
Susan V. Lynch ◽  
...  

<p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Objectives:</span></strong><span style="font-size: medium;"> African American children are at higher risk of obesity than White children and African American women are more likely to undergo caesarean-section (CS) delivery than White women.</span><span style="font-size: medium;">  </span><span style="font-size: medium;">CS is associated with childhood obesity, however, little is known whether this relationship varies by race.</span><span style="font-size: medium;">We examined if the association of CS with obesity at age 2 years varied by race.</span><span style="font-size: medium;">  </span></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Design: </span></strong><span style="font-size: medium;">Longitudinal birth cohort.</span><strong></strong></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Setting:</span></strong><span style="font-size: medium;"> Birth cohort conducted in a health care system in metropolitan Detroit, Michigan with follow-up at age 2 years.</span></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Participants:</span></strong><span style="font-size: medium;"> 639 birth cohort participants; 367 children (57.4%) were born to African American mothers and 230 (36.0%) children were born via CS.</span></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Main Outcome Measure: </span></strong><span style="font-size: medium;">Obesity defined as body mass index </span><strong></strong><span style="font-size: medium;">≥95</span><sup><span style="font-size: small;">th</span></sup><span style="font-size: medium;"> percentile at age 2 years.</span></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Results:</span></strong><span style="font-size: medium;"> Slightly more children of African American (n=37; 10.1%) than non-African American mothers (n=18; 6.6%) were obese (</span><span style="font-size: medium;">P</span><span style="font-size: medium;">=.12). There was evidence of effect modification between race and delivery mode with obesity at age 2 years (interaction<em> </em></span><span style="font-size: medium;">P</span><span style="font-size: medium;">=.020).</span><span style="font-size: medium;">  </span><span style="font-size: medium;">In children of African-American mothers, CS compared to vaginal birth was associated with a significantly higher odds of obesity (aOR=2.35 (95% CI: 1.16, 4.77), </span><em><span style="font-size: medium;">P</span></em><span style="font-size: medium;">=.017).</span><span style="font-size: medium;">  </span><span style="font-size: medium;">In contrast, delivery mode was not associated with obesity at age 2 years in children of non-African-American mothers (aOR=.47 (95% CI: .13, 1.71), </span><span style="font-size: medium;">P</span><span style="font-size: medium;">=.25).</span><span style="font-size: medium;">    </span></span></p><p><span style="font-family: Times New Roman;"><strong><span style="font-size: medium;">Conclusions:</span></strong><span style="font-size: medium;"> There is evidence for a race-specific effect of CS on obesity at age 2 years; potential underlying mechanisms may be racial differences in the developing gut microbiome or in epigenetic programming.</span><span style="font-size: medium;">  </span><span style="font-size: medium;">Future research is needed to determine if this racial difference persists into later childhood. <em>Ethn Dis.</em> 2016;26(1):61-68; doi:10.18865/ed.26.1.61<br /></span></span></p><p> </p>


2020 ◽  
Author(s):  
Justin Xavier Moore ◽  
Yunan Han ◽  
Catherine Appleton ◽  
Graham Colditz ◽  
Adetunji T Toriola

Abstract BACKGROUND Due to mixed reports from smaller studies, we examined associations of race with mammographic breast density and evaluated racial differences in the determinants of breast density. METHODS Participants included 37,839 women (23,166 non-Hispanic White, and 14,673 African American women) receiving screening mammograms at the Joanne Knight Breast Health Center at Washington University School of Medicine, St. Louis, Missouri from June 2010 to December 2015. Mammographic breast density was assessed using Breast Imaging Reporting and Data System (5th edition). To determine the association of race and participant characteristics with mammographic breast density, we used multivariable polytomous logistic regression models (reference group: almost entirely fatty). RESULTS African American women had increased odds of extremely dense (adjusted odds ratio (AOR) = 1.31, 95% CI = 1.13–1.52) and reduced odds of heterogeneously dense breasts (AOR= 0.91, 95% CI = 0.84 – 0.99) compared to non-Hispanic White women. Altogether, race, parity and age at first birth, age, current body mass index (BMI), BMI at age 18, menarche, family history of breast cancer, oral contraceptive use, alcohol, and menopausal status explained 33% of the variation in mammographic breast density. Among African American and non-Hispanic White women these factors explained nearly 28.6% and 33.6% of the variation in mammographic density, respectively. Current BMI provided the greatest explanation of breast density (26.2% overall, 22.2% in African American, and 26.2% in non-Hispanic White women). CONCLUSIONS The determinants of mammographic breast density were generally similar between African-American women and non-Hispanic white women. After adjustments for confounders, African Americans had higher likelihood of extremely dense breast but lower likelihood of heterogeneously dense breast. The greatest explanation of breast density was provided by BMI, regardless of race.


2003 ◽  
Vol 21 (22) ◽  
pp. 4200-4206 ◽  
Author(s):  
Thomas C. Randall ◽  
Katrina Armstrong

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.


2015 ◽  
Vol 72 (6) ◽  
pp. 576 ◽  
Author(s):  
Addie Weaver ◽  
Joseph A. Himle ◽  
Robert Joseph Taylor ◽  
Niki N. Matusko ◽  
Jamie M. Abelson

2018 ◽  
Vol 21 (8) ◽  
pp. 1072-1078 ◽  
Author(s):  
Raina D Pang ◽  
Mariel S Bello ◽  
Madalyn M Liautaud ◽  
Andrea H Weinberger ◽  
Adam M Leventhal

Abstract Introduction Prior studies have found heightened negative affect following tobacco abstinence in women compared to men. However, experimental work addressing whether these findings generalize across racial groups is scarce. This study investigated whether race (non-Hispanic White vs. non-Hispanic African American) moderated gender differences in abstinence-induced negative affect and smoking behavior. Methods Data were collected from 2010 to 2017 from two separate laboratory studies investigating experimentally manipulated tobacco abstinence. Following a baseline session, adult daily smokers (≥10 cigarettes/day; women: n = 297, 83.8% non-Hispanic African American; men: n = 492, 86.2% non-Hispanic African American) attended two counterbalanced lab sessions (16 hours abstinent vs. non-abstinent) and completed self-report measures of negative affect followed by a laboratory analogue smoking reinstatement task. Results We found a gender × race interaction for several negative affect states and composite negative affect (βs = −.12 to −.16, Ps &lt; .05). Analyses stratified by race showed that non-Hispanic White women compared to non-Hispanic White men exhibited greater abstinence-induced increases in anger, anxiety, and composite negative affect (βs = −.20 to −.29, Ps &lt; .05). No significant gender differences in abstinence-induced negative affect were found for non-Hispanic African American smokers (βs = .00 to − .04, Ps &gt; .05). Conclusion These findings suggest that negative affect during acute tobacco abstinence may be a clinically important and intervenable factor that can inform cessation interventions specifically for non-Hispanic White women smokers. Further empirical exploration of mechanisms underlying interactions of gender and race in tobacco addiction may benefit smoking cessation efforts in non-Hispanic African American women smokers. Implications This study contributes to a scant body of research examining the intersectional influence of race and gender on abstinence-induced negative affect—a central, motivationally prepotent feature of tobacco withdrawal. Using a laboratory-based design to experimentally manipulate abstinence, we provide evidence of a gender × race interaction on negative affect–related withdrawal. Our findings suggest that gender differences in abstinence-induced negative affect observed among non-Hispanic White smokers may not generalize to non-Hispanic African American smokers, highlighting the need for future work to address potential mechanisms underlying the racially discrepant impact of gender on affective tobacco withdrawal.


2005 ◽  
Vol 23 (24) ◽  
pp. 5526-5533 ◽  
Author(s):  
Steven J. Katz ◽  
Paula M. Lantz ◽  
Nancy K. Janz ◽  
Angela Fagerlin ◽  
Kendra Schwartz ◽  
...  

Purpose High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer. Methods All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844). Results Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041). Conclusion Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.


2012 ◽  
Vol 302 (2) ◽  
pp. E218-E225 ◽  
Author(s):  
Ranganath Muniyappa ◽  
Vandana Sachdev ◽  
Stanislav Sidenko ◽  
Madia Ricks ◽  
Darleen C. Castillo ◽  
...  

Insulin resistance is associated with endothelial dysfunction. Because African-American women are more insulin-resistant than white women, it is assumed that African-American women have impaired endothelial function. However, racial differences in postprandial endothelial function have not been examined. In this study, we test the hypothesis that African-American women have impaired postprandial endothelial function compared with white women. Postprandial endothelial function following a breakfast (20% protein, 40% fat, and 40% carbohydrate) was evaluated in 36 (18 African-American women, 18 white women) age- and body mass index (BMI)-matched (age: 37 ± 11 yr; BMI: 30 ± 6 kg/m2) women. Endothelial function, defined by percent change in brachial artery flow-mediated dilation (FMD), was measured at 0, 2, 4, and 6 h following a meal. There were no significant differences between the groups in baseline FMD, total body fat, abdominal visceral fat, and fasting levels of glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, or serum estradiol. Although African-American women were less insulin-sensitive [insulin sensitivity index (mean ± SD): 3.6 ± 1.5 vs. 5.2 ± 2.6, P = 0.02], both fasting triglyceride (TG: 56 ± 37 vs. 97 ± 49 mg/dl, P = 0.007) and incremental TG area under the curve (AUC0–6hr: 279 ± 190 vs. 492 ± 255 mg·dl−1·min−1·10−2, P = 0.008) were lower in African-American than white women. Breakfast was associated with a significant increase in FMD in whites and African-Americans, and there was no significant difference in postprandial FMD between the groups ( P > 0.1 for group × time interactions). Despite being insulin-resistant, postprandial endothelial function in African-American women was comparable to white women. These results imply that insulin sensitivity may not be an important determinant of racial differences in endothelial function.


2014 ◽  
Vol 26 (8) ◽  
pp. 1261-1279 ◽  
Author(s):  
Roland J. Thorpe ◽  
Rachael McCleary ◽  
Jenny R. Smolen ◽  
Keith E. Whitfield ◽  
Eleanor M. Simonsick ◽  
...  

Objective: Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. Method: We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities–Southwest Baltimore, Maryland Study (EHDIC-SWB). Results: Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. Conclusion: These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.


1999 ◽  
Vol 8 (2) ◽  
pp. 101-104 ◽  
Author(s):  
DH Griffiths ◽  
ME Pokorny ◽  
JM Bowman

BACKGROUND: Despite overall declining death rates from cardiovascular disease, the number of women dying of cardiovascular disease increases each year, with substantially higher rates in African American women than in white women. OBJECTIVE: To investigate differences in presentation, diagnostic method, and type of infarction between African American and white women with myocardial infarction. METHODS: Chart review of all women with discharge diagnosis of myocardial infarction. RESULTS: No significant differences were found between African American and white women in admitting diagnosis, diagnostic methods, or type of infarction. At the time of admission, 2 medical history variables, stroke and hypertension, differed significantly between African American and white women (P = .027 and P = .002, respectively). CONCLUSIONS: Healthcare professionals must be aware of possible racial differences in medical history, signs and symptoms, and prognosis when assessing patients and planning interventions. Studies with larger samples are needed to confirm these findings on African American and white women with myocardial infarction.


2015 ◽  
Vol 25 (4) ◽  
pp. 391 ◽  
Author(s):  
Meghan Baruth ◽  
Patricia A Sharpe ◽  
Gayenell Magwood ◽  
Sara Wilcox ◽  
Rebecca A Schlaff

<p class="Pa7"><strong>Objectives: </strong>Understanding body size percep­tions and discrepancies among African Ameri­can women may have implications for effec­tive weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women.</p><p class="Pa7"><strong>Design: </strong>Cross-sectional using baseline data from a randomized controlled trial.</p><p class="Pa7"><strong>Setting: </strong>18 census tracts in a central South Carolina city where ≥25% of residents were below poverty income.</p><p class="Pa7"><strong>Participants: </strong>147 economically disad­vantaged, overweight and obese African American women.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>Using Pulvers’ figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women.</p><p class="Pa7"><strong>Results: </strong>Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m2 larger, <em>P</em>&lt;.0001) than those established in the sample of White women.</p><p><strong>Conclusions: </strong>Although women desired a smaller body size, there nonetheless were misperceptions of body size and the as­sociated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss. <em>Ethn Dis</em>. 2015;25(4):391-398; doi:10.18865/ ed.25.4.391</p>


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