30- https://doi.org/10.1038/oby.2011.54
Body Image and Modifiable Weight Control Behaviors Among Black Females: A Review of the Literature
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Black women are at high risk for obesity and obesity-related health problems (1). Nearly 50% of black women compared to 30% of white women are obese (2,3). While many women who attempt to lose weight do so through caloric restriction and/or physical activity, smoking has been identified as an alternate strategy used for weight loss among black women with weight concerns or body image concerns (4). Nicotine's suppression of body weight facilitates initiation and maintenance of smoking among women (5,6,7). Despite the deadly health risks associated with tobacco use, 23.1% of women smoke (8). Female smokers are more likely to report smoking cigarettes to control weight (6,9) and less likely to quit smoking due to weight concern (10). Perkins et al. and Pirke and Laessle note that women tend to suffer more postcessation weight gain than men (as cited in Copeland) (11). Smoking cessation is less likely among women who fear postcessation weight gain or benefit from weight control when smoking. Additionally, women with the intention to control body weight by restrictive eating are more likely to smoke to control appetite and weight (12). Black women tend to have lower rates of smoking cessation and physical activity and higher dietary fat intake (13,14,15). Factors contributing to low prevalence of weight management among black women need to be identified for the development of appropriate interventions. Less reported social pressure to achieve thinness and greater perceived attractiveness at higher body weights may limit motivation for healthy weight management among many black women. The 2003–2008 National Health and Nutrition Examination Survey found weight control through physical activity or dietary change to be positively associated with weight perception (odds ratio women 3.74; 95% confidence interval 2.96, 4.73) (16). Several authors assert that historical black-white differences in ideal female body image (17) and acceptance of overweight (18) may contribute in part to explaining racial differences in weight loss efforts and modifiable weight management behaviors. It has been indicated that black women have a high prevalence of obesity partly because self-image is not strongly dependent on body size (19). Body shape perception often varies by race and gender with blacks generally perceiving their bodies as lighter than indicated by their BMI (20). An understanding of factors such as body image and their relationship to weight loss behaviors is necessary to promote healthier lifestyles. This review investigates the association between body image satisfaction and dietary behavior, physical activity, and smoking as tools for weight control among black women. Due to the paucity of literature focusing solely on black women, this article considers both the experiences of black women alone and with other groups. Studies were identified through computerized searches of biomedical and psychological databases, namely PubMed, CINAHL, Psych Abstracts, Science Direct, and Web of Science and manual searches of article bibliographies focusing on dietary behaviors, physical activity, and smoking/alternative weight control techniques since 1990. Searches were performed on recurring authors and in recurring journals for additional articles on the topics. Variations of the term "body image," including "body dissatisfaction," "satisfaction," and "esteem," as well as "size," "shape," and "weight" were sought. Searches included these terms in combination with the target health behaviors, namely diet, physical activity, and smoking. The search was limited to studies including black or African-American females. We did not restrict our search to only studies that investigated ethnic differences because it is our aim to understand body image as it relates to health behaviors among black women to determine whether it may be a factor to address in designing interventions. We were not specifically investigating racial differences in regards to body image. Additionally, we found that many studies did not distinguish results by race or ethnicity. Thirty-one articles have been cited in this article. The list may not be exhaustive. Some identified articles were excluded for several reasons. Studies investigating dietary disorders were omitted as well as those that did not evaluate body image in association with the health behaviors. Findings and critiques of the remaining articles follow. Over the last decade, several seminal papers have documented the positive association between components of body image dissatisfaction and dieting frequency or dieting status among US adults and adolescents. An accumulating body of research has directly evaluated the relationship between dimensions of body image and dieting behavior or dieting status specifically in black women (see Table 1). Two studies bear mentioning first as findings have acknowledged the importance of identifying potential within group variation among black women with respect to dieting and body image disturbance (see Table 1). Kumanyika and colleagues were among the first to begin to clarify the link between dieting and weight satisfaction in a large sample of black women from the Washington DC community (1). Results showed that less satisfaction with weight and a history of dieting were more likely among the overweight women. Similarly, among black female participants in the CARDIA multisite investigation, a positive relationship between dimensions of body dissatisfaction and dieting for weight reduction was evidenced across BMI tertiles despite women of greater BMI reporting poorer body image (19). It is unclear however, whether results varied by study site. A series of cross-sectional studies assessed body image (using diverse instrumentation) among multiethnic samples of self-identified dieters inclusive of appreciable numbers of black females (21,22,23,24,25,26). In both adults and adolescents few differences in body image disturbance were observed between black and white female dieters (Table 1). This parity was particularly evident when analyses were adjusted for covariates correlated with both dieting status and body image perceptions (e.g., age, BMI regardless of race (21,23,25). Only a few studies to date have examined these relationships including nondieting controls as a comparison (22,24). In one early report, adolescent dieters residing in the Midwest irrespective of race, gender, and actual overweight status typically endorsed more disturbed body image attitudes relative to nondieting peers (24). Similarly, in a more recent investigation conducted in Los Angeles, both black and white adult female chronic dieters exhibiting high dietary restraint reported greater distortions in aspects of body image than nondieting females and male chronic dieters (22). However, these results were not controlled for BMI, age, or socioeconomic status. Another series of cross-sectional investigations compared the relationship between dimensions of body image and dietary restraint/dieting in ethnically diverse groups of black and white adult and adolescent females. Again, it appears that in general, the correlations between these factors are robust independent of age and race in community (22,27,28,29,30) and in-patient (26) samples. Notable exceptions, however, were observed in a few instances where patterns of relationships between indicators of poor body image and dieting behavior differed between women of both racial groups (Table 1 and see refs. 26,28,29). Interestingly, the one investigation in which no significant relationship emerged between components of body dissatisfaction and dieting among black females was conducted in the southern US region (26). A few recent reports have begun to explore the association between measures of body image and various dietary consumption patterns among black females and others (Table 2; please see Ard et al., for a description of findings using qualitative methodology) (31). Dependent variables included frequency of skipping meals (32,33), fast food consumption (34), and composite measures of dietary weight control (35) in predominantly black or ethnically diverse samples spanning a spectrum of ages and US regions. Components of body image disturbance tended to covary positively with poorer nutritional content (35) and behavior patterns (36) and negatively correlated with healthy dietary intake (37) with some exceptions (38,39). However, BMI and other socioeconomic status variables were not consistently controlled in analyzing these relationships. There have been varied findings regarding the association between body satisfaction and participation in physical activity (see Table 3). One study identified body image as a motivating factor for engaging in physical activity (14). Taylor et al. (14) investigated reasons for adolescent girls' participating or not participating in physical activity. Focus groups of black and Latina girls revealed that concerns with body image facilitated physical activity. The girls reported that extra body fat and size affected how they felt about themselves. Some noted positive effects of exercise were "keeping your right size," "a flat stomach," and "losing weight" as well as the desire to be skinny like the people on the exercise programs on TV and to lift weights to give shape to your body. Although there is qualitative evidence of body image being a motivating factor for physical activity, several other studies have found that low body satisfaction is associated with low physical activity. In a 5-year longitudinal study of socioeconomically and ethnically diverse adolescents, Neumark-Sztainer and colleagues (40) found that lower body satisfaction predicted lower levels of physical activity among females. Separate findings for black and white females were not presented. However, results were weighted by ethnicity, race, and socioeconomic status of respondents. Similarly, Yancey et al. (41) found that overweight black women and men were less likely to perceive themselves to be overweight than overweight Latinos or whites. Average weight blacks and Latinos who perceived themselves as being overweight were more likely to be sedentary than their white counterparts. In subgroup analyses by race/ethnicity, black and Latina women were grouped together due to small numbers (41). In another study, adolescents who perceived themselves as overweight were less likely to engage in physical activity despite trying to lose weight. Exercising was the method more often reported by whites than by other racial and ethnic groups (32). Some studies support the notion of cultural acceptance of fatness suggesting that blacks are less likely to engage in weight loss behaviors due to acceptance of large body shapes (42,43). Kelly et al. (33,42) found that black girls were more likely than white girls to report high body satisfaction. Results suggested that adolescent girls with high body satisfaction were less likely to use healthy or unhealthy weight control behaviors, including exercise, eating more fruits and vegetables, and eating fewer sweets and high-fat foods (42). Similarly, Mabry and colleagues (43) found that black adolescent girls demonstrated more acceptance and self-esteem with regards to having a larger body size than their white peers. This acceptance was associated with less participation in physical activity (43). Although many investigators are concerned with the impact of body image satisfaction on engagement in physical activities, others have investigated the opposite relationship. Some studies have found participation in physical activity to lead to improved body image (20,44,45,46). In a convenience sample with 60% black women Smith and Michel found that pregnant women who participated in an aquatic aerobic program reported improved body image scores. While analyses were not stratified by race/ethnicity, the diversity of the sample suggested that this association was true across race and ethnic groups (44). Likewise, Miller and Levy found that female athletes exhibited significantly more positive body image self-concept than female nonathletes (45). Again, results were not stratified by race. In a biracial population of young adults aged 18.5–35 in Bogalusa, LA, physical activity was not found to be a significant predictor of body image perception (20). While both black women and white women expressed negative body image views that countered the cultural tolerance of fatness theory attributed to black women, these groups expressed differences in ideal weight-loss methods. White women emphasized physical activity whereas black women emphasized food characteristics with no mention of physical activity (46). Some studies investigated both body image and physical activity but did not assess the association between these two factors; however, racial/ethnic differences were noted. Studies suggest that there is no significant difference between blacks and whites over age 22, whereas white teens and college-aged women are more dissatisfied with their looks than black women at this age (47). Perry et al. found that white girls had greater physical activity whereas black girls had higher ideal body sizes and greater body satisfaction than white girls. There was no significant difference between black girls and Hispanic girls on body satisfaction or physical activity (48). Contrarily, another study found that black women had higher ideal body image and more sedentary behaviors than Latin-American women (49). While there is evidence of contrary findings of the relationship between body image and physical activity and differences by race/ethnicity, in general the association tends to vary by age. Several researchers have examined the relationship between body image and smoking among females. However, the sample sizes of many of these studies assessing the role of body image on decisions to start smoking or smoking cessation included few blacks. King (13) noted that researchers had not examined the role of tobacco use for weight management among black women. Several clinical trials regarding tobacco cessation have assessed the impact that body image or weight image has in influencing smoking patterns among females. The studies can be separated into two types—those examining smoking initiation or smoking cessation. Several cross-sectional studies examined whether perceptions of attractiveness influenced smoking behaviors (50,51,52). Findings suggest that women smokers felt less attractive and disliked their bodies more than nonsmokers (52) (Table 4). Women with weight concern were more likely to smoke to achieve a smaller figure. Knauss and colleagues (50) found that female smokers considered other smokers to be more attractive and rated smoking as appealing. Utilization of media (magazines and television) may encourage smoking among weight-concerned adolescents. Carson surveyed 967 12th graders to examine whether exposure to media and drive for thinness influenced smoking among this population. Teens who read fashion, entertainment, and gossip magazines were more likely to be current smokers. The authors asserted that smoking is used by these teens in order to maintain a thin figure (51). Among studies of smoking for weight management, few studies have assessed the use of smoking for weight management among black women (53). An earlier review of barriers to smoking cessation among minority women did not include weight control as a barrier to quitting smoking (13). Many prior studies included small numbers of blacks. However, four studies examined the relationships between smoking and weight concern among larger numbers of black females. Several clinical trials have assessed factors affecting smoking cessation among black females. One study examined smoking cessation among blacks with HIV/AIDS (54). Another examined smoking cessation among low-income blacks (55). Both found black females with less weight concern were more likely to smoke. Only one study has assessed the role of weight concerns in smoking initiation among black females (53). Whereas 5.6% of African-American women initiated smoking as a result of weight concern, 11.3% of white women felt that weight was an important factor in smoking initiation. Using data from the National Longitudinal Survey of Youth (NLSY97) Cawley and colleagues (56) found that adolescent females with a higher BMI who were trying to lose weight were more likely to initiate smoking than the females who did not consider themselves overweight. Results were not stratified by race. Several studies assessed whether weight concern reduced smoking cessation among black women. Pomerleau et al. (53) found that overweight black smokers were less willing to risk weight gain by quitting smoking and concluded that weight concerns may motivate black women as powerfully as white women to continue to smoke. Two studies found that the majority of black female smokers were not concerned about postcessation weight gain (54,57). Obese black females were least concerned about postcessation weight gain. In contrast, another study reported that black female smokers were concerned about postcessation weight gain (56). Concerns about body shapes or the fear of postcessation weight gain differ from those of white females, yet have influenced some black women's decisions about smoking cessation. Further efforts must be made to provide weight gain education and prevention among black females (57). Numerous studies have investigated the association between body image and modifiable weight-loss behaviors among black females. In general, body dissatisfaction was found to be associated with poorer health behaviors. Females who were dissatisfied with their bodies were more likely to practice poor nutritional behaviors and less likely to participate in physical activity or to stop smoking. There were variations in findings due to race, age, and overweight status. Notable aspects of some previous studies regarding body image and weight control measures were the use of diverse populations, longitudinal study designs, and the consideration of inverse relationships. Several studies of body image and dieting behavior are particularly noteworthy for their methodological rigor of executing prospective longitudinal study designs (34,57) and for strategically sampling from both traditionally underrepresented groups in health research (e.g., ethnically diverse female hospital workers in an urban locale: (55) and from large regional segments of the US adolescent population (36,58,59). With small numbers of black females generally included in body image studies, two studies on smoking cessation are also noteworthy for investigating large groups of black females (54,57). The women in these studies were low-income, and in one study, the black women were HIV-infected. The bidirectional association between components of body image and weight control behaviors was highlighted by physical activity studies which investigated the impact of body image satisfaction on participation in physical activity(14,40,41,42,43,60) as well as the inverse influence of physical activity on body satisfaction (38,39,40,42) to assess motivators and barriers to weight control. Contrary to the strengths of a few studies, many studies suffered from analytical, methodological, and inclusion deficiencies. Little is known about the bidirectional relationship between changes in specific weight control behaviors and shifts in how black females may perceive their bodies and whether these patterns correspond with those reported by white females in this country. Most studies were cross-sectional in nature and unable to infer a clear directional relationship. The variations in findings of the associations suggest the need for more longitudinal research to clarify the directionality of this association. Additionally, there was great variation in measures of body image and classifications for dieting and physical activity status and perception. Most studies utilized a measure of self-perceived body image or weight status. It has been found that black females tend to be more accepting of larger bodies and generally underestimate their actual weight status with those who are overweight less likely to perceive themselves as overweight compared to other races (41,61). Those who are overweight perceive themselves as normal weight, and the obese consider themselves overweight (61). This discrepancy suggests the need for more culturally tailored programs to increase self-awareness of weight status, health consequences, and healthy lifestyle changes. Many studies on body image were mainly conducted on white females. Unfortunately, only small percentages of black females were usually included in the studies, therefore making any efforts to test for the potential differential impact of race on the relationship between measures of body image and behaviors untenable. Most authors discussed general findings irrespective of race (59,62), used race simply as a sociodemographic control variable versus testing it as a possible effect modifier (35,58), or tended to prefer emphasizing differences observed due to gender (37,59) or to overweight status (58). Additionally, studies were performed on a broad range of age cohorts suggesting an influence of body image throughout the stages of development and the need for further studies at each age level. Further investigation into differences by race/ethnicity within various age groups is needed. To design appropriate interventions to reduce obesity among black females it is necessary to understand whether body image is gaining influence in promoting dietary, physical activity, and smoking changes within the context of weight control. Based on the review of the literature offered here, the current state of the evidence is insufficient to adequately address this question at present. There are several factors to consider in improving the quality of the research produced and therefore strengthening confidence in the validity and applicability of findings. Chief among these is the need for greater attention to designing prospective longitudinal studies that would provide a more robust test of how dimensions of body image may act as determinants of weight control behaviors among black females. Additionally, with perceived overweight as well as high satisfaction with body image both being associated with more sedentariness, this presents quite a challenge for identifying motivators for black females to engage in health-promoting activities. A central question to target in future efforts is: What factors may modify the impact of weight and body dissatisfaction on engaging in dieting, physical activity, and smoking cessation among black females? The current review has provided some preliminary clues that may be involved in further delineating important individual differences in this line of research. These include overweight status (1), level of acculturation to mainstream US culture (22), and likely regional variation in the value placed on weight loss and tuning into feelings about the body as a mechanism of change (35,39). It is our hope that this critique may serve as a preliminary roadmap for both existing and future qualitative and quantitative research in this area to be effectively translated into culturally attuned healthy weight management promotion efforts among ethnically diverse females. The authors declared no conflict of interest.
- Research Article
- 311
- 10.1161/01.cir.92.3.380
- Aug 1, 1995
- Circulation
The objective of this study was to describe the distribution of echo left ventricular (LV) mass and its association with demographic and cardiovascular risk factors in a large race- and sex-balanced cohort of young adults. Recent epidemiological data have suggested that M-mode echocardiographically determined LV hypertrophy is an independent predictor of mortality and morbidity from coronary heart disease (CHD) in older adults. Echocardiographic LV mass has been associated in middle-aged and older adults with multiple factors including age, arterial blood pressure, body mass, and sex. However, there are few data describing the distribution of echo LV mass among black and white young adult men and women and relating LV mass to cardiovascular disease risk factors within race-sex subgroups. CARDIA (Coronary Artery Risk Development in Young Adults) is a multicenter study of young adults, including approximately equal proportions of black and white men and women aged 23 to 35 years at the time of echo examination (1990 through 1991). Two-dimensionally guided M-mode echocardiograms were attempted in 4243 participants with recordings deemed acceptable for calculation of LV mass, that is, of at least fair quality score, obtained in 3840 (90.5% of the 1990-1991 cohort). M-mode LV mass was calculated from the formula of Devereux and Reicheck, adapted for use with measurements made according to the American Society of Echocardiography Standards. LV mass was greater in men than in women and greater in blacks than in whites (P < .001) (mean +/- SD): black men, 176 +/- 42 g; white men, 169 +/- 40 g; black women, 135 +/- 38 g; and white women, 125 +/- 33 g. In all race-sex groups, LV mass was positively correlated (P < .0001) in bivariate analyses with body weight, subcapular skinfold thickness, height, and systolic blood pressure. In multivariate analyses, LV mass remained independently and positively related to body weight and systolic blood pressure and, when body weight was not considered, with subcapular skinfold thickness and height. In addition, the multivariate models allowed us to infer a direct relation between LV mass and both fatness and lean body mass. Weaker positive associations were noted of LV mass with pulse pressure in white participants and with physical activity in men. After adjustment for subscapular skinfold thickness, height, systolic and diastolic blood pressures, alcohol consumption, pulmonary function, smoking history, physical activity, total serum cholesterol, and family history of hypertension, LV mass remained higher in men than in women (P < .0001), in black men (167 +/- 43 g) than in white men (156 +/- 50 g, P < .0001), and in black women (142 +/- 49 g) than in white women (137 +/- 43 g, P < .002). In the healthy young adults of the CARDIA cohort, LV mass was highly correlated with body weight, subscapular skinfold thickness, height, and systolic blood pressure across race and sex subgroups. Furthermore, after adjustment for anthropometric, blood pressure, and other covariates, LV mass remained higher in men than in women and in blacks than in whites. Longitudinal studies are necessary to delineate the possible roles of these factors in the genesis of LV hypertrophy.
- Conference Article
- 10.1136/jech-2020-ssmabstracts.175
- Aug 24, 2020
- Poster presentations
Background Disparities in chronic systemic inflammation among black and white women and men are well documented. However, while chronic stress domains such as discrimination and financial strain, as well as socioeconomic factors such as education, have all been linked to inflammation, more research is needed to clarify how these social determinants influence each other and contribute to inflammation. Guided by the Stress Process Model and Intersectionality, this present study assessed the mediating role of both discrimination and financial strain in the relationship between race-gender groups and inflammation (measured as elevated CRP levels). This research also examined if the potential indirect effects of discrimination and financial strain were contingent on the educational level of black and white men and women with the United States. Methods This secondary analysis focused on an analytic sample (ages 25–74) of black and white men and women (n=775) from the Midlife in the United States (MIDUS) Biomarkers Project (2004–2009). SPSS version 24 and PROCESS macro were used to test all mediation and moderated mediation analyses. Results Separate mediation analyses revealed that after adjusting for age and when compared to the reference category (white men), both financial strain and daily discrimination mediated the relationship between race-gender (black men, black women, and white women) and inflammation (CRP levels). That is, self-identifying as a black man, white woman, or black woman positively influenced perceptions of both everyday discrimination and financial strain, which in turn contributed to increased levels of CRP. However, when both mediators were included in the mediation model, discrimination was only significant among black men. Results of the first moderated mediation analysis indicated that the indirect effect among black men on inflammation through discrimination was significantly stronger for black men educated beyond high school. Findings from the second moderated mediation analysis findings suggested that education significantly moderated the indirect effect of race-gender on inflammation through financial strain. While this indirect effect was stronger for black men and white women with a high school degree or less; conversely, the effect was stronger for black women with educational levels that exceeded high school. Conclusion This study contributes to the literature on inflammation by further illuminating the social determinants and social patterning of inflammation among black and white women and men within the United States.
- Research Article
- 207
- 10.1542/peds.107.3.e34
- Mar 1, 2001
- Pediatrics
Black women are particularly vulnerable to obesity, with a prevalence rate of >50%. The higher mortality and morbidity from cardiovascular disease, stroke, and diabetes have been attributed, in part, to their obesity. In recent years, a particular public health concern is the increasing secular trend in obesity with an even greater racial disparity, especially in girls and women. Between the early 1960s and late 1980s, the prevalence of obesity tripled in young black girls 6 to 11 years of age, while it doubled in white girls. Similarly, both overweight and obesity in adolescent girls 12 to 17 years of age also increased, with a greater increase again seen in adolescent black girls. This secular trend in obesity with a greater increase in black girls signals a potentially grave future chronic disease burden on black women, which is already higher than in white women. The increasing occurrence in children and adolescents of noninsulin-dependent diabetes, traditionally viewed as an adult-onset condition, may be a consequence of the currently high prevalence of obesity in American youth. Not surprisingly, this condition is seen more frequently among black youths. Prepubescent black girls are generally leaner than age-comparable white girls, but by 20 years of age, black women are considerably heavier than are white women. Thus, it is assumed that the racial disparity in adiposity evolves during adolescence. However, the specific age at which this occurs and underlying factors are yet to be identified because of the current paucity of longitudinal cohort data. In 1985, the National Heart, Lung, and Blood Institute (NHLBI) initiated a 10-year longitudinal multicenter study (the NHLBI Growth and Health Study [NGHS]) to investigate the development of obesity in black and white girls during adolescence and its environmental, psychosocial, and cardiovascular disease risk factor correlates. The purpose of this report is to examine the natural history of adiposity and weight accretion during adolescence in a biracial cohort of girls to investigate the evolution of the racial divergence in adiposity and to examine the relationships between increases in adiposity and pubertal maturation, energy intake, and physical activity. A total of 2379 black (51%) and white (49%) girls, 9 to 10 years of age, were recruited from public and parochial schools in Richmond, California, and Cincinnati, Ohio, and from families enrolled in a large health maintenance organization in the Washington, DC area. Participant eligibility was limited to girls and their parents who declared themselves as being either black or white and who lived in racially concordant households. DESIGN AND STATISTICAL ANALYSIS: The NGHS is a multicenter prospective study of black and white girls with annual visits from 9 to 10 years of age through 18 to 19 years of age. The follow-up rate was 89% at the 10th annual visit. Skinfold measurements were obtained at the triceps, suprailiac, and subscapular sites with Holtain calipers. Sexual maturation was assessed by trained registered nurses. The onset of menarche was ascertained annually by questionnaire. All clinical assessments were conducted using a common protocol by centrally trained staff. Longitudinal regression (generalized estimating equations) models were used to examine the relationship between adiposity and race, age, pubertal maturation, daily energy intake, and physical activity. The main outcome measure was the sum of skinfolds (SSF) at the triceps, subscapular, and suprailiac sites as an index of adiposity for comparison between the 2 racial groups. Body mass index (BMI; weight in kilograms divided by height in meters, squared) distributions were examined by age and race. Racial differences in SSF, unadjusted for maturation, were evident at 10 years of age. For each chronological age, there was a higher proportion of black girls with more advanced pubertal maturation than white girls. The 15th percentiles for SSF were similar and remained thus throughout the study. The median for SSF for black girls, although similar to the median SSF of white girls at 9 years of age, became greater for black girls at 12 years of age (36 mm vs 32.5 mm) and at age 19 years the difference was 6 mm (49.5 mm vs 43.5 mm). In contrast, the difference in the 85th as well as the 95th percentile values for SSF were substantially higher in black girls at all ages (9 mm and 10 mm, or 18% and 15%, respectively, at age 9 years) and these racial differences widened with age (20 mm and 26 mm, or 25% and 24%, respectively, by age 19 years). The racial difference in the median BMI increased from 0.4 to 2.3 kg/m(2) between ages 9 and 19 years. Unlike SSF at the 15th percentile, the BMI for lean 9-year-old black girls was ~3% higher than whites. (ABSTRACT TRUNCATED)
- Research Article
- 10.14321/qed.9.issue-2.0156
- Jun 1, 2022
- QED: A Journal in GLBTQ Worldmaking
Jezebel Unhinged: Losing the Black Female Body in Religion & Culture
- Research Article
- 14
- 10.1016/j.jtcvs.2023.10.025
- Oct 18, 2023
- The Journal of thoracic and cardiovascular surgery
Persistent race- and sex-based disparities in lung cancer screening eligibility
- Research Article
- 19
- 10.13016/0haz-kwsj
- Dec 1, 2005
- Journal of the National Medical Association
Smoking cessation, obesity and weight concerns in black women: a call to action for culturally competent interventions.
- Research Article
- 15
- 10.1001/jamahealthforum.2023.1235
- Jun 9, 2023
- JAMA Health Forum
In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Monthly methadone-involved overdose deaths. From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.
- Research Article
- 58
- 10.1097/00006842-200107000-00014
- Jul 1, 2001
- Psychosomatic Medicine
These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores. The subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support. After controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate. We conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.
- Research Article
- 10.5406/23260947.10.1.02
- Apr 1, 2022
- Women, Gender, and Families of Color
Labor Organizer Nannie Helen Burroughs and Her National Training School for Women and Girls
- Research Article
- 256
- 10.1038/sj.jhh.1000740
- Jan 1, 1999
- Journal of Human Hypertension
Few prospective studies have examined associations of lifestyle factors or variables in the insulin resistance syndrome (syndrome X) with incidence of elevated blood pressure (BP) in black subjects and women. This report estimates the 10-year incidence of high blood pressure (HBP) and high normal blood pressure (HNBP) in the biracial cohort of the Coronary Artery Risk Development in (Young) Adults Study (CARDIA), and examines lifestyle factors and four syndrome X variables, measured at baseline, as predictors. CARDIA examined 5115 black and white men and women aged 18-30 years in 1985-1986, and re-examined them at 2, 5, 7, and 10 years. The 10-year incidence of HBP was 16.4% in black men, 7.8% in white men, 13.1% in black women, and 3.2% in white women, while the 10-year incidence of HBP or HNBP was 29.5%, 16.2%, 19.2%, and 6.3%, respectively, in the four sex-race subgroups. Predictors included body mass index, waist circumference, physical activity, alcohol intake, pulse rate, cigarette smoking, education, fasting insulin, triglycerides, uric acid, and high-density lipoprotein cholesterol, as well as age and systolic BP. In univariate analyses, each of these variables was significantly related to incidence in at least one of the four sex-race groups. In multivariate analyses that included control for age and systolic pressure, independent predictors included fasting insulin in white men and women, triglycerides in white men, uric acid and pulse rate in black men, waist circumference in white men and black women, and education (inverse) in white men and black and white women. These results suggest that lower socioeconomic status, as assessed by education level, and one or more syndrome X variables, ie, fasting insulin, triglycerides, uric acid, may be associated with development of elevated BP in young adults.
- Research Article
- 1
- 10.1353/csd.2023.0023
- Mar 1, 2023
- Journal of College Student Development
Reviewed by: Investing in the Educational Success of Black Women and Girls ed. by Lori D. Patton, Venus E. Evans-Winters, and Charlotte E. Jacobs Emerald Templeton Investing in the Educational Success of Black Women and Girls Lori D. Patton, Venus E. Evans-Winters, and Charlotte E. Jacobs (Editors) Sterling, VA: Stylus, 2022, 312 pages, $37.50 (softcover) In her seminal work, Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment, Hill Collins (2000) described the "hidden space of Black women's consciousness" (p. 98) that includes self-definition; self-determination; and resistance to racism, sexism, classism, and white supremacy. Lori D. Patton, Venus E. Evans-Winters, and Charlotte E. Jacobs's work is an embodiment of this consciousness. Much like how Hill Collins designed Black Feminist Thought, the editors of this volume created an accessible text grounded in Black women and girls' experiences, knowledges, and existence. As a Black woman scholar whose research underscores the experiences of Black women in higher education while uncovering the logics of valuing diversity, I recognize the authority of this work and find that it aligns with and informs my scholarly interests. As a former Black girl who has trudged through misogynoir throughout my educational experiences, I feel incredibly affirmed, seen, and celebrated through this work. Written from the vantage point of women and girls across the spectrum of Black womanhood and girlhood, the authors of this edited volume artfully describe how we navigate the American system of education while maintaining our meanings and intonating our expressions (Hill Collins, 2000). This text is organized into four sections: (a) Mattering for Black Women and Girls in Schooling Contexts, (b) Naming and Challenging the Violence and Criminalization of Black Women and Girls, (c) Navigating Politics and the Politicization of Black Women and Girls in Higher Education, and (d) Still We Rise: Black Women and Girls Lifting and Loving Black Women and Girls. The chapters in these sections provide the reader with context, discussion questions, further reading, and additional resources. These sections weave together narratives that illustrate the depth, breadth, and rigor of scholarship about Black women and girls. Each section sheds light on multiple experiences and voices, which I will describe below. In the first section, Mattering for Black Women and Girls in Schooling Contexts, Patton et al. set the tone for this volume and lay a foundation for understanding the ways of knowing (epistemologies), being (ontologies), and thinking (ideologies) that influence Black women and girls' efficacy in school. Chapter 1, "Mid-Twerk and Mid-Laugh," uncovers how Black girls' ability to express themselves through laughter and dancing in culturally situated ways is stifled and criminalized. Further, the author posits that this level of expressiveness provides an opportunity for learning that schools can engage for transformation. In Chapter 2, readers are presented with ways to enact the Black girls' literacy framework, which allows schools to expand learning and literacy beyond simply reading and writing to a nuanced practice that situates learning in sociopolitical, historical, and cultural contexts. Similarly, Chapters 3 and 4 discuss the ways myths and stereotypes depict Black girls as older than they are, disrespectful, and underachieving. Such myths must be dispelled so that Black girls can find belonging and safety in spaces that were not intended for them. Together, these chapters encompass why [End Page 250] Black girls matter and how schools can begin to embrace that fact. The second section, Naming and Challenging the Violence and Criminalization of Black Women and Girls, begins by situating the education of Black women and girls within a political context that surveils, polices, and arrests them. Chapters 5 and 6 detail the ways in which schools are failing Black girls—pushing them out and deeming them "nobodies"—by highlighting compelling cases and data related to their involvement with school discipline and the legal system. Further, the ways in which a lack of care and value for Black women and girls persist through higher education are explicated in Chapters 7 and 8. The authors herein urge educators and administrators to challenge their biases about gender and race and interrogate how the intersection of those identities reveals the ways they characterize and value Black women and girls...
- Research Article
- 36
- 10.1111/jch.13474
- Feb 1, 2019
- The Journal of Clinical Hypertension
Nocturnal hypertension and non-dipping blood pressure are each associated with increased risk of cardiovascular disease. We determined differences in nocturnal hypertension and non-dipping systolic/diastolic blood pressure among black and white men and women who underwent 24-hour ambulatory blood pressure monitoring at the Coronary Artery Risk Development in Young Adults study Year 30 Exam in 2015-2016. Asleep and awake periods were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as mean asleep systolic/diastolic blood pressure ≥120/70mmHg. Non-dipping systolic and diastolic blood pressure, separately, were defined as a decline in awake-to-asleep blood pressure <10%. Among 767 participants, the prevalence of nocturnal hypertension was 18.4% and 44.4% in white and black women, respectively, and 36.4% and 59.9% in white and black men, respectively. After multivariable adjustment and compared with white women, the prevalence ratio (95% confidence interval) for nocturnal hypertension was 1.65 (1.18-2.32) for black women, 1.63 (1.14-2.33) for white men, and 2.01 (1.43-2.82) for black men. The prevalence of non-dipping systolic blood pressure was 21.5% and 41.0% in white and black women, respectively, and 20.2% and 37.9% in white and black men, respectively. Compared with white women, the multivariable-adjusted prevalence ratio (95% confidence interval) for non-dipping systolic blood pressure was 1.66 (1.18-2.32), 0.91 (0.58-1.42) and 1.66 (1.15-2.39) among black women, white men, and black men, respectively. Non-dipping diastolic blood pressure did not differ by race-sex groups following multivariable adjustment. In conclusion, black women and men have a high prevalence of nocturnal hypertension and non-dipping systolic blood pressure.
- Research Article
- 10.1215/10418385-7861881
- Dec 1, 2019
- Qui Parle
The Third Revolution
- Research Article
- 84
- 10.1016/j.bodyim.2021.10.005
- Nov 5, 2021
- Body Image
Body image and internalization of appearance ideals in Black women: An update and call for culturally-sensitive research
- Research Article
- 10.1249/01.mss.0000537179.18700.03
- May 1, 2018
- Medicine & Science in Sports & Exercise
PURPOSE: Describe the 10-year race/sex specific changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort. METHODS: Data are from 881 Coronary Artery Risk Development in Young Adults (CARDIA) participants aged 18 to 30 years at baseline (1985-86) who wore the accelerometer and had valid wear (≥4 of 7 days, ≥10 hours per day) at the Year 20 (2005-06; ages 38-50) and Year 30 (2015-16; ages 48-60) exams. At Year 20, accelerometer measures were first collected using the ActiGraph 7164; at Year 30 the ActiGraph wGT3X-BT model was used. A calibration factor (counts divided by 1.088, based on a subset who simultaneously wore both devices at Year 30) was applied to Year 30 data to account for differences in models. All 10-year change estimates are expressed as median (25th, 75th percentiles). Wilcoxon Rank Sum tests were used to examine 10-year changes overall and within the four race/sex groups. RESULTS: Over 10 years, participants experienced significant reductions in average accelerometer counts [-46.7 (-122.7, 31.1 ct·min·d-1; p<0.001]. This reduction was shown within each race/sex group, with the greatest decline observed in black men (all p<0.001). Sedentary time significantly increased overall (32.9 min[BULLET OPERATOR]d-1), with the largest increases shown in black women (56.9 min[BULLET OPERATOR]d-1) followed by black men (50.2 min[BULLET OPERATOR]d-1), white women (28.9 min[BULLET OPERATOR]d-1) and men (19.0 min[BULLET OPERATOR]d-1); all p<0.001. Light intensity PA decreased (-29.2 min[BULLET OPERATOR]d-1), with black men having the greatest reductions (-38.3 min[BULLET OPERATOR]d-1), followed by white (-35.3 min[BULLET OPERATOR]d-1) and black (-26.6 min[BULLET OPERATOR]d-1) women, then white men (-25.6 min[BULLET OPERATOR]d-1); all p<0.001. Moderate to vigorous intensity PA (MVPA) also declined (-5.5 min[BULLET OPERATOR]d-1) with the largest reductions shown in black men (-7.3 min[BULLET OPERATOR]d-1), then white men (-6.9 min[BULLET OPERATOR]d-1), and white (-4.9 min[BULLET OPERATOR]d-1) and black (-4.3 min[BULLET OPERATOR]d-1) women; all p<0.001. Of note, black women had the lowest accumulated MVPA at Year 20. Finally, median time spent in MVPA bouts lasting ≥8 of 10 consecutive minutes slightly increased in white men and women (2.3 and 0.60 min[BULLET OPERATOR]d-1, respectively; both p<0.01), which was not shown in black participants. CONCLUSIONS: We found a decline in overall PA during the midlife transition. This reduction was largely attributable to increases in sedentary time and reductions in light intensity PA.
