Trends in body weight among American Indians: findings from a telephone survey, 1985 through 1996

Assessing health status, behavioral risks, and health disparities in American Indians living on the northern plains of the U.S

OBJECTIVE

We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities.

METHODS

AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews.

RESULTS

AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease.

CONCLUSIONS

Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

Health behaviors among American Indian/Alaska Native women, 1998-2000 BRFSS

BACKGROUND AND OBJECTIVE

Minority populations, including American Indians and Alaska Natives (AI/AN), in the United States generally experience a disproportionate share of adverse health outcomes compared with whites. The prevalence of risk behaviors associated with these adverse health outcomes among AI/AN women is not well documented, especially for those who live outside areas serviced by Indian Health Service. We sought to describe the prevalence of selected health risk behaviors among AI/AN women, document the disparities between AI/AN women and all U.S. women, and demonstrate the efforts needed for AI/AN women to reach Healthy People 2010 goals.

METHODS

Age-adjusted prevalence estimates for selected sociodemographic characteristics, current smoking, obesity, lack of leisure time physical activity, and binge drinking were calculated using Behavioral Risk Factor Surveillance System (BRFSS) data from 1998 to 2000, combined. Comparisons were made between prevalence estimates for AI/AN women and all women who participated in the BRFSS and Healthy People 2010 goals.

RESULTS

The prevalences of current smoking (27.8%) and obesity (26.8%) were significantly higher among AI/AN women than among all U.S. women. AI/AN women did not meet Healthy People 2010 goals for current smoking, obesity, leisure time physical activity, or binge drinking.

CONCLUSIONS

These data highlight both disparities in health risk behaviors between AI/AN women and all U.S. women and improvements needed for AI/AN women to meet Healthy People 2010 goals. This project demonstrates the overwhelming need for culturally appropriate and accessible prevention programs to address health risk behaviors associated with the leading causes of death among urbanized AI/AN women.

The nutrition transition in American Indians

The purpose of this article was to examine whether a nutritional transition has occurred among American Indians (AI) by evaluating related articles and government health statistics. Findings indicate that although the primary health risk for the AI population around 1970 was undernutrition, now there is an obesity epidemic among all age groups that is associated with a loss of traditional food practices and reduced physical activity. Deaths caused by cardiovascular disease, diabetes mellitus, and cancer have outpaced death from infectious disease. With abundant high-energy foods and limited physical activity, the acculturated environment has resulted in obesity and increased mortality from chronic diseases. To improve AI health and survival, the obesity epidemic must be approached in a concerted, culturally appropriate manner with encouragement of traditional foods and safe opportunities for physical activity.

Psychosocial determinants of food purchasing and preparation in American Indian households

OBJECTIVE

Obesity and other diet-related chronic diseases affect American Indians at high rates, yet little is known about food use behaviors in this population, or of psychosocial factors that influence these behaviors. The study objective was to address this gap.

DESIGN

Cross-sectional; part of baseline collection for an intervention trial.

SETTING

White Mountain and San Carlos Apache reservations, Arizona.

PARTICIPANTS

Main household food shoppers and preparers of 270 randomly selected households on two American Indian reservations.

ANALYSIS

Multivariate linear regression.

VARIABLES MEASURED

Primary independent variables were healthy food knowledge, self-efficacy and intentions, assessed using multi-question scales. Dependent variables were frequency of purchasing healthy foods and a healthiness of cooking methods score.

RESULTS

Higher-fat and/or higher-sugar items were commonly purchased, with limited purchasing of healthier alternatives. Pre-prepared foods are a substantial component of the diet. Cooking methods which add or have little impact on the fat content of foods were more commonly employed than methods which reduce fat. Food acquisition and use behaviors were predicted by food use intentions. Food intention scores were predicted by food self-efficacy; food self-efficacy by food knowledge.

CONCLUSIONS AND IMPLICATIONS

These findings support the use of food knowledge, self-efficacy, and intentions in understanding food-related behavior in this setting.

Overweight and obesity in Italian adults 2004, and an overview of trends since 1983

OBJECTIVE

Overweight has been increasing in several developed countries over the last few decades. No update information on the issue is available for Italy.

DESIGN AND SETTING

We conducted a computer assisted personal in-house interview survey in March-April 2004, on a sample of 2932 Italian individuals (1407 men and 1525 women) aged 18 years or over, representative of the general adult Italian population. Information on weight and height was self-reported.

RESULTS

Overall, 3.4% of the Italian adult population were underweight (< 18.5 kg/m2, 0.9% of men and 5.8% of women), 31.3% were overweight (25.0-29.9 kg/m2, 38.4% of men, 24.7% of women), and 8.2% were obese (> or = 30.0 kg/m2, 7.4% of men and 8.9% of women). Overweight or obesity was reported by 14.2% of subjects aged 18-24 years (20.6% of men and 7.6% of women). The highest proportions of overweight and obese subjects were in the 45-64 year age group for men (51.4% overweight, 10.0% obese) and in the > or = 65 year age group for women (38.8% overweight, 13.8% obese). Age- and sex-standardised prevalence of overweight or obesity was 36.0% for more educated subjects, and 54.0% for less educated ones. It was 32.3% in northern, 44.3% in central and 47.0% in southern Italy. Overweight increased from 1983 to the early 1990s, and levelled off thereafter. Prevalence of obesity remained around 8-9% across the last 20 years.

CONCLUSIONS

Trends of overweight and obesity in Italy are more favourable than in several developed countries. Still, approximately 15 million of Italian adults are overweight and 4 million obese.

Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in Native Americans and whites in the Hemochromatosis and Iron Overload Screening Study

We compared initial screening transferrin saturation (TfSat) and serum ferritin (SF) phenotypes and HFE C282Y and H63D genotypes of 645 Native American and 43,453 white Hemochromatosis and Iron Overload Screening Study participants who did not report a previous diagnosis of hemochromatosis or iron overload. Elevated measurements were defined as TfSat >50% in men and >45% in women and SF >300 ng/ml in men and >200 ng/ml in women. Mean TfSat was 31% in Native American men and 32% in white men (p = 0.0337) and 25% in Native American women and 27% in white women (p < 0.0001). Mean SF was 153 microg/l in Native American and 151 microg/l in white men (p = 0.8256); mean SF was 55 microg/l in Native American women and 63 microg/l in white women (p = 0.0015). The C282Y allele frequency was 0.0340 in Native Americans and 0.0683 in whites (p < 0.0001). The H63D allele frequency was 0.1150 in Native Americans and 0.1532 in whites (p = 0.0001). We conclude that the screening TfSat and SF phenotypes of Native Americans are similar to those of whites. The allele frequencies of HFE C282Y and H63D are significantly lower in Native Americans than in whites.

Process evaluation of a store-based environmental obesity intervention on two American Indian Reservations

Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.

The freshman weight gain: a model for the study of the epidemic of obesity

OBJECTIVE

The objective of this study was to quantify the weight gain of freshmen during their first 12 weeks at Cornell University. In addition, students completed questionnaires that revealed particular behaviors and activities that were associated with weight gain.

DESIGN

Serial, correlational study.

SUBJECTS

A total of 68 freshmen from Cornell University.

MEASUREMENT

A total of 60 students were weighed during the first week of the semester, then again 12 weeks later. They were also given a questionnaire to complete concerning their behavior during the previous 12 weeks.

RESULTS

After adjusting for clothing weights, the mean weight gain of the freshmen was 1.9+/-2.4 kg, a value significantly different from 0. Two regression models generated from the questionnaire were fitted to the weight gain. The first linear regression model (Model 1) accounted for 58% of the variance and indicated that eating in the 'all-you-can-eat' dining halls accounted for 20% of the variance in weight gain. Snacking and eating high-fat 'junk food' accounted for anther 20%. When initial weight was used as a covariate (Model 2), the consumption of junk foods, meal frequency and number of snacks accounted for 47% of the variance.

CONCLUSION

The study clearly demonstrated that significant weight gain during first semester college is a real phenomenon and can be attributed to tangible environmental stimuli. The weight gain is considerably greater than that observed in the population and may be useful as a model to test various techniques that may reduce or reverse the 'epidemic' of obesity observed in the general population.

Obesity in American-Indian children: prevalence, consequences, and prevention

BACKGROUND

American Indians of all ages and both sexes have a high prevalence of obesity. The health risks associated with obesity are numerous and include Type 2 diabetes mellitus, hypertension, dyslipidemia, and respiratory problems. Obesity has become a major health problem in American Indians only in the past few generations and it is believed to be associated with the relative abundance of high-fat, high-calorie foods and the rapid change from active to sedentary lifestyles.

METHODS

The authors reviewed selected literature on prevalence of obesity in American-Indian children, and health consequences of obesity.

RESULTS

Obesity is now one of the most serious public health problems facing American-Indian children, and it has grave implications for the immediate and long-term health of American-Indian youth. Unless this pattern is reversed, American-Indian populations will be burdened by an increased incidence of chronic diseases. Intervention studies are urgently needed in American-Indian communities to develop and test effective strategies for obesity prevention and treatment.

CONCLUSIONS

To be effective, educational and environmental interventions must be developed with full participation of the American-Indian communities.

Associations between energy balance and body mass index and risk of breast carcinoma in women from diverse racial and ethnic backgrounds in the U.S

There is increasing epidemiologic evidence of an association between body mass index and energy expenditure and the risk of breast carcinoma. Women who are overweight or obese, especially women who gain weight throughout adulthood, are at an increased risk for developing breast carcinoma after menopause. Conversely, overweight women are at a reduced risk for developing breast carcinoma in the premenopausal years. The association between body mass index and breast carcinoma risk has been observed in women from several racial and ethnic backgrounds. Many studies have found an association between increased physical activity and reduced risk for breast cancer. Studies regarding physical activity and breast carcinoma risk have been conducted primarily with white women; therefore, the cross-racial/ethnic patterns with this risk factor are unknown. This article reviews data regarding the associations between body mass index, physical activity, and breast carcinoma risk and presents potential mechanisms for the observed associations, such as sex hormones, reproduction, growth hormones, insulin, and immune function. It outlines challenges in measuring physical activity and body mass index across populations. Finally, the current study discusses limitations of the available data and suggests future research priorities. Obesity and a sedentary lifestyle may be two important risk factors for breast carcinoma that can be modified and thus may have significant public health impact in women from various racial and ethnic backgrounds.