Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls

Social and Behavioral Factors Associated with BMI and Waist Circumference among Adolescents: The Jackson Heart KIDS Pilot Study

Background

African American children and adolescents make up a disproportionately large segment of those classified as overweight and obese. The purpose of this study was to examine social and behavioral factors associated with accelerated accumulation of weight and adiposity among this group.

Methods

The data for this cross-sectional study were drawn from the Jackson Heart KIDS Pilot Study - an offspring cohort study comprising 12- to 19-year-old descendants of Jackson Heart Study participants (N=212). Body mass index (BMI) and waist circumference were the outcomes of interest. Daily hassles, fruit and vegetable consumption, physical activity, television watching, parent/grandparent weight status and participant birth weight, age and sex were the independent variables included in the analyses.

Results

Males and females were equally represented in the study and the mean BMI and waist circumference for adolescents in the study was 25.81±7.78 kg/m² and 83.91 ± 19.81 cm, respectively. Fully adjusted linear regression models for the total sample produced results indicating that age, television viewing, weight control, and parental weight status were positively associated with BMI and waist circumference, respectively. Findings from sex-stratified models for BMI and waist circumference indicated that the significance of coefficients for age, television viewing, and parent/grandparent weight status varied by sex.

Conclusions

Knowledge is limited about how sex or gender interact with social and behavioral factors to influence African Americans' health and additional studies are needed to specify how these factors interact to accelerate weight gain and adipose tissue accumulation over the life course.

Downward spirals of body surveillance and weight/shape concern among African American and Caucasian college women

Within dominant American culture, females often learn to view themselves from an observer's perspective and to treat themselves as objects to be looked at (i.e., self-objectification), which can result in negative outcomes. Body surveillance (the indicator of self-objectification) has been found to predict concern with weight/shape in predominantly Caucasian samples, but research has not yet examined the potential reciprocal relations between body surveillance and weight/shape concern. Participants were 226 women attending a Midwestern university (70 self-identified as African American and 156 as Caucasian) who provided data at two time points, spaced about 5 months apart. Results revealed that downward spirals of body surveillance and weight/shape concern were apparent for the Caucasian but not the African American women. However, there was evidence that body surveillance helped account for change in weight/shape concern for the African American women.

A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS

OBJECTIVE

To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies).

DESIGN

Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months.

SETTING

Low-income areas of Oakland, California.

PARTICIPANTS

African American girls aged 8 to 10 years (N=261) and their parents or guardians.

INTERVENTIONS

Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education.

MAIN OUTCOME MEASURE

Changes in body mass index (BMI).

RESULTS

Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01).

CONCLUSIONS

A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.

Household income, maternal acculturation, maternal education level and health behaviors of Chinese-American children and mothers

OBJECTIVE

A cross-sectional study was conducted to examine factors associated with health behaviors, including physical activity and dietary intake, of Chinese women who have immigrated to the United States and their children.

PARTICIPANTS

Using convenience sampling, a total of 65 Chinese-American children and their mothers in the San Francisco Bay Area participated in the study.

MEASURES

Information related to children's weight, height, level of physical activity (Caltrac accelerometer), and dietary intake (Kids' food frequency questionnaire) was collected using standardized instruments. Mothers completed questionnaires regarding household income, their levels of education and acculturation (Suinn-Lew Asian Self-Identity Acculturation Scale), dietary intake (SWAN Food Frequency Questionnaire), and level of physical activity (Seven-day physical activity recall).

RESULTS

36.9% (n = 24) of the children were overweight (body mass index higher than the 85th percentile). A high household income was related to low maternal body mass index (R(2) = .08, P = .04), high maternal fat intake (R(2) = .21, P = .0001), and high maternal intake of sweets (R(2) = .08, P = .033), and a high level of maternal acculturation was related to low body mass index in children (R(2) = .07, P = .034).

CONCLUSIONS

The results suggest that an intervention aimed at reducing obesity and promoting health behaviors must be appropriate for different ethnic groups with various incomes and levels of acculturation.

Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: design and sample baseline characteristics

OBJECTIVE

African-American girls and women are at high risk of obesity and its associated morbidities. Few studies have tested obesity prevention strategies specifically designed for African-American girls. This report describes the design and baseline findings of the Stanford GEMS (Girls health Enrichment Multi-site Studies) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income, pre-adolescent African-American girls.

DESIGN

Randomized controlled trial with measurements scheduled in girls' homes at baseline, 6, 12, 18 and 24 month post-randomization.

SETTING

Low-income areas of Oakland, CA.

PARTICIPANTS

Eight, nine and ten year old African-American girls and their parents/caregivers.

INTERVENTIONS

Girls are randomized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention. Interventions last for 2 years for each participant.

MAIN OUTCOME MEASURE

Change in body mass index over the two-year study.

RESULTS

Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample. Two-hundred sixty one (261) families were randomized. One girl per family is randomly chosen for the analysis sample. Randomization produced comparable experimental groups with only a few statistically significant differences. The sample had a mean body mass index (BMI) at the 74 th percentile on the 2000 CDC BMI reference, and one-third of the analysis sample had a BMI at the 95th percentile or above. Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications. Girls averaged low levels of moderate to vigorous physical activity, more than 3 h per day of screen media use, and diets high in energy from fat.

CONCLUSIONS

The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income, pre-adolescent African-American girls.

Perceptions and beliefs about body size, weight, and weight loss among obese African American women: a qualitative inquiry

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 +/- 9.2 kg/m(2). Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables

PURPOSE

Accelerometers are recognized as a valid and objective tool to assess free-living physical activity. Despite the widespread use of accelerometers, there is no standardized way to process and summarize data from them, which limits our ability to compare results across studies. This paper a) reviews decision rules researchers have used in the past, b) compares the impact of using different decision rules on a common data set, and c) identifies issues to consider for accelerometer data reduction.

METHODS

The methods sections of studies published in 2003 and 2004 were reviewed to determine what decision rules previous researchers have used to identify wearing period, minimal wear requirement for a valid day, spurious data, number of days used to calculate the outcome variables, and extract bouts of moderate to vigorous physical activity (MVPA). For this study, four data reduction algorithms that employ different decision rules were used to analyze the same data set.

RESULTS

The review showed that among studies that reported their decision rules, much variability was observed. Overall, the analyses suggested that using different algorithms impacted several important outcome variables. The most stringent algorithm yielded significantly lower wearing time, the lowest activity counts per minute and counts per day, and fewer minutes of MVPA per day. An exploratory sensitivity analysis revealed that the most stringent inclusion criterion had an impact on sample size and wearing time, which in turn affected many outcome variables.

CONCLUSIONS

These findings suggest that the decision rules employed to process accelerometer data have a significant impact on important outcome variables. Until guidelines are developed, it will remain difficult to compare findings across studies.