Maternal Birthplace is Associated with Low Birth Weight Within Racial/Ethnic Groups

Introduction While disparities in low birth weight (LBW) incidence by racial/ethnic group are well known, differences in LBW incidence by maternal birthplace within racial/ethnic groups, and particularly, differences after adjustment for pregnancy complications, are less clear. Methods We conducted a population-based study of LBW using 113,760 singleton, live birth records from King County, Washington (2008–2012), a region in the Pacific Northwest with a large immigrant population. Study participants were Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander (NHOPI), and non-Hispanic white women. Using multivariable logistic regression models, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) to estimate relative risk of LBW (<2500 g) related to maternal race/ethnicity and birthplace (defined by the Millennium Development Goals Regional Groupings). Results Compared with non-Hispanic white women, non-Hispanic black, Asian Indian, Filipino, Japanese, and Vietnamese women had 1.57–2.23-fold higher, statistically significant, risk of having a LBW infant, and NHOPI and Mexican women had 1.30–1.33-fold, statistically significant, higher risk. LBW risk was lower for Asian women from Eastern Asia (OR 0.68, 95% CI 0.55–0.85), non-Hispanic black women from Sub-Saharan Africa (OR 0.58, 95% CI 0.47–0.73), and non-Hispanic white women from other developed countries (OR 0.83, 95% CI 0.69–1.00), as compared with their US-born racial/ethnic counterparts. Results were, in general, similar after adjustment for pregnancy complications. Conclusions Compared with most other racial/ethnic groups, non-Hispanic whites had lower risk of LBW. Foreign-born women had lower risk of LBW compared with their US-born counterparts in the majority of racial/ethnic groups. Pregnancy complications had minimal effect on the associations.     

Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003

OBJECTIVE: We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors. METHODS: Using the National Health Interview Survey 2000-2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents). RESULTS: The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03). CONCLUSIONS: This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.     

Child health in the United States: Recent trends in racial/ethnic disparities

In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black–white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.     

Prematurity as a predictor of childhood asthma among low-income children

PURPOSE: The purpose of this study was to evaluate the association among birth weight, prematurity, and the prevalence of asthma later in childhood and to assess the degree to which this association may differ between black and white children. METHODS: Michigan Medicaid claims data from 2001 through 2003 were analyzed to determine asthma prevalence for 150,204 children between ages 5 and 18 years. Asthma cases were identified using Healthcare Effectiveness Data and Information Set persistent asthma criteria and included children having claims for any of the following services within a calendar year: at least one inpatient or one emergency department (ED) claim with an asthma primary diagnosis; at least four asthma medication-dispensing events; or at least four outpatient visits with an asthma diagnosis, and at least two asthma medication-dispensing events. Birth weight and gestational age from birth certificate data were matched with Medicaid files to determine size-for-gestational-age criteria. RESULTS: Overall, 8.3% of children had persistent asthma; black children had slightly higher asthma prevalence (8.6%) than white children (7.8%; odds ratio [OR]=1.11, 95% confidence interval [CI]: 1.07-1.15). Children born very preterm (相似文献   

Contribution of weight status to asthma prevalence racial disparities, 2–19 year olds, 1988–2014

PurposeRacial disparities in childhood asthma prevalence increased after the 1990s. Obesity, which also varies by race/ethnicity, is an asthma risk factor but its contribution to asthma prevalence disparities is unknown.MethodsWe analyzed nationally representative National Health Examination and Nutrition Survey data for 2–19 year olds with logistic regression and decomposition analyses to assess the contributions of weight status to racial disparities in asthma prevalence, controlling for sex, age, and income status.ResultsFrom 1988–1994 to 2011–2014, asthma prevalence increased more among non-Hispanic black (NHB) (8.4% to 18.0%) than non-Hispanic white (NHW) youth (7.2% to 10.3%). Logistic regression showed that obesity was an asthma risk factor for all groups but that a three-way “weight status-race/ethnicity-time” interaction was not significant. That is, weight status did not modify the race/ethnicity association with asthma over time. In decomposition analyses, weight status had a small contribution to NHB/NHW asthma prevalence disparities but most of the disparity remained unexplained by weight status or other asthma risk factors (sex, age and income status).ConclusionsNHB youth had a greater asthma prevalence increase from 1988–1994 to 2011–2014 than NHW youth. Most of the racial disparity in asthma prevalence remained unexplained after considering weight status and other characteristics.     

Serum retinol distributions in residents of the United States: third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND: Inadequate vitamin A status has been a potential nutritional problem for some segments of the US population, particularly children and the poor. OBJECTIVE: We evaluated serum retinol concentration by using population-representative data from 16058 participants aged 4 to >/=90 y in the third National Health and Nutrition Examination Survey, 1988-1994. DESIGN: We used multivariate regression to examine the simultaneous associations of sociodemographic, biologic, and behavioral factors with serum retinol concentration. RESULTS: In children, serum retinol concentrations were greater with greater age, body mass index, serum lipids, and the use of supplements containing vitamin A. In adults, male sex, serum lipids, alcohol consumption, and age were positively associated with serum retinol concentration in most racial/ethnic strata. Household income was not associated with serum retinol concentration in children; associations were inconsistent in adults. The prevalence of serum retinol <0.70 micromol/L was very low in all strata; the prevalence of serum retinol <1.05 micromol/L was 16.7-33.9% in children aged 4-8 y and 3.6-14.2% in children aged 9-13 y, depending on sex and racial/ethnic group. The prevalence of serum retinol<1.05 micromol/L was higher in non-Hispanic black and Mexican American children than in non-Hispanic white children; these differences remained significant (P < 0.0001) after covariates were controlled for. Among adults, nonwhite women were significantly (P < 0.0001) more likely than white women to have serum retinol <1.05 micromol/L after covariates were controlled for. CONCLUSIONS: Clinically low serum retinol concentration is uncommon in US residents aged > or = 4 y, although racial/ethnic and socioeconomic differences in serum retinol concentration still exist.     

Birth characteristics and brain cancers in young children

BACKGROUND: High birthweight is a potential risk factor for childhood brain tumours, particularly astrocytomas. We investigated several birth characteristics in relationship to brain cancers in young children. METHODS: We obtained 849 invasive central nervous system (CNS) cancer cases, ages 0-4 years, from California's population-based cancer registry for 1988-1997. We matched 746 (88%) of these cases to a California live birth certificate. We randomly selected two control birth certificates for each case, matched on date of birth and gender. We used conditional logistic regression to obtain odds ratios (OR) and 95% CI. The birth characteristics examined included birthweight, gestational age, race, parental age, and parental education. RESULTS: Analysing all CNS tumours combined, we found that children of other racial/ ethnic groups had OR below one compared with non-Hispanic white children. When adjusted for gestational age, race/ethnicity, and mother's place of birth, the OR for high birthweight (>/=4000 g) was 1.05 (95% CI: 0.79-1.38) compared with children with birthweights of 2500-3999 g. For astrocytomas (313 cases), the adjusted OR for high birthweight was 1.40 (95% CI: 0.90-2.18). When parental education was included in the model (available for only a subset of the birth years), the adjusted OR was 1.71 (95% CI: 1.01-2.90). High birthweight did not appear to be a risk factor for primitive neuroectodermal tumours (PNET). CONCLUSIONS: We found high birthweight associated with increased risk of astrocytomas, but not PNET, in young children.     

Neighborhood crime, deprivation, and preterm birth

PURPOSE: Significant racial disparity in preterm birth (PTB; birth at <37 weeks' gestation) exists, poorly explained by Individual-level factors. This research explores whether neighborhood crime contributes to the racial disparity in PTB. METHODS: Geocoded Wake County, NC, birth records and crime-report data for 1999 to 2001 were merged with US Census data (2000). Race-stratified logistic and multilevel logistic models produced odds ratios (ORs) and 95% confidence intervals (CIs) for block-group violent, theft, property, and vice crime rates and singleton PTB. RESULTS: A total of 13,960 women resided in a 114-block-group crime area. Non-Hispanic black women were more likely than non-Hispanic white women to deliver preterm (12.8% versus 6.7%), live in economically deprived block groups (42.2% versus 19.3% in the highest deprivation quartile), and experience more crime (32.0% versus 3.8% in the highest violent-crime-rate quartile). Quartiles of violent, theft, property, and vice crimes were associated with PTB in unadjusted models. Living in very high violent-crime-rate block-group quartiles was suggestive of increased odds of PTB for white and black non-Hispanic women (OR = 1.5; 95% CI, 0.9-2.6; and OR = 1.4; 95% CI, 1.0-2.1, respectively) in adjusted models. Other crime effects were attenuated after adjustment. CONCLUSIONS: Differential neighborhood exposures may contribute to racial disparity in PTB.     

Self-Rated Health and Race Among Hispanic and Non-Hispanic Adults

Objective To investigate the association between race and self-rated health among Hispanics and non-Hispanics using data from the National Health Interview Survey 2000–2003. Methods This analysis was limited to Hispanic and non-Hispanic whites and blacks ≥18 years of age. The outcome was self-rated health. The main independent variable was race/ethnicity, and potential confounders included sociodemographic characteristics, access to care, health behaviors, and comorbidities. Results Non-Hispanic blacks exhibited the highest prevalence of fair/poor self-rated health compared to their white counterparts. In the adjusted analyses, compared to non-Hispanic whites, non-Hispanic blacks (OR: 1.21; 95% CI: 1.16–1.43), Hispanic whites (OR: 1.32; 95% CI: 1.14–1.52) and blacks (OR: 2.19; 95% CI: 1.07–4.49) were more likely to rate their health as fair/poor. There was no difference in self-rated health between Hispanic and non-Hispanic blacks. Discussion This study underscores the importance of accounting for the racial heterogeneity among Hispanics when presenting health data. Ignoring race could mask health variations among Hispanics.     

Racial and socioeconomic disparities in breastfeeding--United States, 2004

The American Academy of Pediatrics recommends breastfeeding for at least the first year of life, and beyond for as long as mutually desired by mother and child. Not breastfeeding is associated with increased health risks for children, including otitis media, respiratory tract infections, diarrhea, and necrotizing enterocolitis. In addition, breastfeeding duration is inversely associated with risk for childhood overweight. Breastfeeding also is associated with health benefits for mothers, including reduced risk for ovarian cancer and premenopausal breast cancer. Breastfeeding rates differ substantially by race, socioeconomic level, and other demographic factors. For example, among children born during 1982-1993, non-Hispanic black children were less likely than non-Hispanic white children to be breastfed at birth and at age 6 months, even when comparisons were among children in the same socioeconomic or other demographic subgroup. To obtain current estimates of racial and economic disparities in breastfeeding among U.S. children, CDC analyzed data from the 2004 National Immunization Survey (NIS). This report describes the results of that analysis, which indicated that 71.5% of non-Hispanic white children were ever breastfed compared with 50.1% of non-Hispanic black children. Among those ever breastfed, 53.9% of non-Hispanic white and 43.2% of non-Hispanic black children continued breastfeeding until at least age 6 months. Disparities between black and white children existed within most socioeconomic subgroups studied. Public health programs should continue to promote breastfeeding initiation and increase support of breastfeeding continuation, especially among subgroups with the lowest rates (i.e., black, poor, and young mothers; mothers with less than a high school education; and mothers residing in rural areas).     

Maternal ethnicity and pre-eclampsia in New York City, 1995-2003

Studies on ethnic differences in the risk of pre-eclampsia are limited. We linked birth records for 902,460 singleton births for the period 1995-2003 in New York City with hospital discharge data to evaluate the association between ethnicity and the risk of pre-eclampsia and compare risks between US-born and foreign-born women. Logistic regression models adjusted for maternal age, maternal education, parity, self-reported pre-pregnancy maternal weight, smoking during pregnancy and year of delivery were used to compare each ethnic group with non-Hispanic White women. The prevalence of pre-eclampsia in this study population was 3.2%. Among the major ethnic groups considered in our study, East Asian women had the lowest risk of pre-eclampsia (1.4%) and Mexican women had the highest risk (5.0%). Compared with non-Hispanic White women, there was a slightly decreased risk for East Asian women (adjusted OR = 0.8, [95% CI 0.7, 0.8]), similar risk for North African women (adjusted OR = 1.1, [95% CI 0.9, 1.3]), and increased risk for all other major ethnic groups (adjusted ORs: 1.3, 2.9), with the highest risk for Mexican women (adjusted OR = 2.9, [95% CI 2.7, 3.1]). No difference in risks was observed for US- vs. foreign-born women with the exception that foreign-born South-East Asian and Pacific Islanders had an increased risk of pre-eclampsia (adjusted OR = 1.8, [95% CI 1.0, 3.1]) relative to those born in the US. We concluded that there was ethnic heterogeneity in the development of pre-eclampsia among women in New York City and that Asian subgroups should be examined separately in future studies on ethnicity. Our results should contribute to screening for pre-eclampsia taking ethnic variation into account, and may help to suggest leads for the study of the aetiology of the condition.     

Racial and ethnic differences in adjuvant hormonal therapy use

Abstract Background: In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18-64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time. Methods: Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995-September 1998, phase II, diagnosed October 1998-April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled. Results: Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06-0.60; OR 0.40, CI 0.17-0.94, respectively). No racial/ethnic differences in use were observed among women with 1+ susceptibility indicators from either recruitment phase. Conclusions: Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.     

Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children

BackgroundIncome and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population.ObjectiveTo examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity.DesignData from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004.Participants/settingPersons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American).Statistical analyses performedThe National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations.ResultsHigher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk—15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity.ConclusionsThe diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.     

Socioeconomic Gradients in Infant Health Across Race and Ethnicity

The objective of this study was to examine socioeconomic (SES) gradients in infant health across a number of racial and ethnic groups in the United States. The study was based on data from a new nationally representative sample of children born in the US in 2001 (N = 8,650). The data include oversamples of several minority groups and a rich set of socioeconomic indicators, as well as demographic, health, and health behavior characteristics. Proportion of low birth weight (LBW) and small for gestational age (SGA) (and 95% CIs) across categories of several indicators of SES (maternal education, income, income adjusted for family size, and wealth) was presented for the full sample of children and disaggregated by race/ethnicity: non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN). A graded relationship was found between all measures of SES and infant health for white mothers, and between adjusted income and LBW for Asian and Hispanic mothers. There was no relationship between any indicator of SES and either LBW or SGA for either black or AI/AN mothers. The finding that some minority racial/ethnic groups do not reap the same health benefits from higher levels of SES as do whites suggests that approaches to reducing health disparities must address not only the structural barriers that lead some minority groups to have fewer resources but also barriers that prevent these groups from taking advantage of those resources to improve the health of their families.     

Prevalence of intellectual disability among eight-year-old children from selected communities in the United States, 2014

BackgroundChildren with intellectual disability (ID), characterized by impairments in intellectual functioning and adaptive behavior, benefit from early identification and access to services. Previous U.S. estimates used administrative data or parent report with limited information for demographic subgroups.ObjectiveUsing empiric measures we examined ID characteristics among 8-year-old children and estimated prevalence by sex, race/ethnicity, geographic area and socioeconomic status (SES) area indicators.MethodsWe analyzed data for 8-year-old children in 9 geographic areas participating in the 2014 Autism and Developmental Disabilities Monitoring Network. Children with ID were identified through record review of IQ test data. Census and American Community Survey data were used to estimate the denominator.ResultsOverall, 11.8 per 1,000 (1.2%) had ID (IQ ≤ 70), of whom 39% (n = 998) also had autism spectrum disorder. Among children with ID, 1,823 had adaptive behavior test scores for which 64% were characterized as impaired. ID prevalence per 1,000 was 15.8 (95% confidence interval [95% CI], 15.0–16.5) among males and 7.7 (95% CI, 7.2–8.2) among females. ID prevalence was 17.7 (95% CI, 16.6–18.9) among children who were non-Hispanic black; 12.0 (95% CI, 11.1–13.0), among Hispanic; 8.6 (95% CI, 7.1–10.4), among non-Hispanic Asian; and 8.0 (95% CI, 7.5–8.6), among non-Hispanic white. Prevalence varied across geographic areas and was inversely associated with SES.ConclusionsID prevalence varied substantively among racial, ethnic, geographic, and SES groups. Results can inform strategies to enhance identification and improve access to services particularly for children who are minorities or living in areas with lower SES.     

Excess type 2 diabetes in African-American women and men aged 40-74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey

OBJECTIVE: To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men. DESIGN: Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview. SETTING: Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres. PARTICIPANTS: 961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994. MAIN RESULTS: Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences. CONCLUSIONS: Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

One Size Does Not Fit All: An Examination of Low Birthweight Disparities Among a Diverse Set of Racial/Ethnic Groups

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.     

Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis

Existing evidence demonstrating a relationship between racial residential segregation and health has been based on aggregate analysis. Using a multilevel analytical framework, we assess the extent of geographic variation in black/white disparities in self-rated health across US metropolitan areas, and whether racial residential segregation accounts for such variation. We estimated multilevel regression models of poor self-rated health among 51,316 non-Hispanic white and non-Hispanic black adults nested within 207 metropolitan areas to assess the multilevel relationship between segregation and racial disparities in health. We found statistically significant variation in the black/white disparity in poor self-rated health across metropolitan areas, after controlling for individual level factors (age, sex, marital status, education and income) and residential segregation. High black isolation was associated with increased odds of reporting poor health among blacks (p<0.05). While a similar pattern was observed for white/black dissimilarity and white isolation, they were not statistically significant. Our multilevel analysis only partially supports the previously reported aggregate findings linking segregation to health. Additional multilevel statistical investigations across different health outcomes are required to draw firmer conclusions regarding the adverse effects of segregation on health.     

The Beneficial Effect of Family Meals on Obesity Differs by Race, Sex, and Household Education: The National Survey of Children's Health, 2003-2004

Studies have indicated that family meals may be a protective factor for childhood obesity; however, limited evidence is available in children with different racial, socioeconomic, and individual characteristics. The purpose of this study was to examine family meal frequency as a protective factor for obesity in a US–based sample of non-Hispanic white, non-Hispanic black, and Hispanic children age 6 to 11 years, and to identify individual, familial, and socioeconomic factors that moderate this association. Data were from the 2003 National Survey of Children's Health (n=16,770). Multinomial logistic regression analyses were used to test the association between family meal frequency and weight status, and the moderating effects of household structure, education, poverty level, and sex, by racial group. Non-Hispanic white children who consumed family meals every day were less likely to be obese than those eating family meals zero or a few days per week. A moderating effect for sex was observed in non-Hispanic black children such that family meal frequency was marginally protective in boys but not in girls. Higher family meal frequency was a marginal risk factor for obesity in Hispanic boys from low-education households, but not in girls from similar households. In conclusion, family meals seem to be protective of obesity in non-Hispanic white children and non-Hispanic black boys, whereas they may put Hispanic boys living in low-education households at risk. Greater emphasis is needed in future research on assessing why this association differs among different race/ethnic groups, and evaluating the influence of the quality and quantity of family meals on child obesity.