Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children’s positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers’ support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers’ support for prevention initiatives. Methods A convenience sample of maternal caregivers (N?=?129, ages 22–65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers’ support for prevention strategies. Results Caregivers’ perceptions of childhood obesity risk factors were moderate (M?=?3.4; SD?=?0.64), as were their perceptions of obesity-related health complications (M?=?3.3; SD?=?0.75); however, they perceived a high level of support for prevention strategies (M?=?4.2; SD?=?0.74). In the regression model, only health complications were significantly associated with caregiver support (β?=?0.348; p?<?0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.     

Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?

Objective To examine the association between gestational weight gain and adverse maternal and infant outcomes among overweight women [body mass index (BMI) 26.0–29.0 kg/m²]. Methods A population-based cohort study using birth certificate data (1990–2004) from 34,143 singleton, full-term deliveries to nulliparous, Missouri residents ages 18–35. Gestational weight gain was divided into three categories: below Institute of Medicine (IOM) recommendations (<15 lbs), within IOM recommendations (15–25 lbs), and above IOM recommendations (>25 lbs). Categories of 10-lb increments were also evaluated. The primary outcomes were preeclampsia, cesarean section, macrosomia, low birth weight (LBW), and perinatal death. Adjusted relative risks and 95% confidence intervals (CI) were calculated using Mantel–Haenszel pooled estimator. Results Compared to women who gained 15–25 lbs, women who gained <15 lbs were 0.8 (95% CI 0.6–1.0), 0.9 (0.8–1.0), 0.6 (0.5–0.8), and 1.7 (1.4–2.2) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. Conversely, women who gained >25 lbs were 1.7 (1.5–1.9), 1.3 (1.2–1.4), 2.1 (1.9–2.3), and 0.6 (0.5–0.7) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. The lowest risk of adverse outcomes was for women who gained in the 6–14 and 15–24 lb categories. There was no association between gestational weight gain and perinatal death. Conclusions Increasing gestational weight gain appears to decrease the risk of LBW but elevates the risks of preeclampsia, cesarean section, and macrosomia. Overweight women should gain within current IOM recommendations.     

Suburban Migration and the Birth Outcome of Chicago-Born White and African–American Women: The Merit of the Healthy Migrant Theory?

The healthy migrant theory posits that women who migrate before pregnancy are intrinsically healthier and therefore have better birth outcomes than those who don’t move. Objective. To determine whether migration to the suburbs is associated with lower rates of preterm (<37 weeks) birth among Chicago-born White and African–American mothers. We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational dataset of non-Latino White and African–American infants (1989–1991) and their mothers (1956–1976) with appended US census income information. Forty percent of Chicago-born White mothers (N = 45,135) migrated to Suburban Cook County and 30 % migrated to the more geographically distant collar counties. In contrast, 10 % of Chicago-born African–American mothers (N = 41,221) migrated to Suburban Cook and only two percent migrated to the collar counties. Chicago-born White and African–American migrant mothers to Suburban Cook County had lower preterm birth rates than their non-migrant counterparts; RR = 0.8 (0.8–0.9) and 0.8 (0.7–0.8), respectively. When neighborhood income was singularly taken into account, the protective association of suburban migration and preterm birth disappeared among Chicago-born Whites. In race-specific multilevel multivariate regression models which included neighborhood income, the adjusted odds ratio of preterm birth, low birth weight, and small for gestational-age for Chicago-born White and African–American migrant (compared to non-migrant) mothers approximated unity. Neighborhood income underlies the protective association of suburban migration and birth outcome among Chicago-born White and African–American mothers. These findings do not support the healthy migrant hypothesis of reproductive outcome.     

How Does Acculturation Affect the Use of Complementary and Alternative Medicine Providers Among Mexican- and Asian- Americans?

Researchers have found that immigrants in the United States gradually relinquish cultural practices and adopt health behaviors similar to native born individuals as they acculturate. Few studies have looked at acculturation and Complementary and Alternative Medicine (CAM) use, particularly ethnic forms of CAM. This study uses data from the 2001 California Health Interview Survey—Complementary and Alternative Medicine (CHIS-CAM) supplement to estimate the prevalence of CAM provider use among Mexican- and Asian- Americans and examine the relationship of acculturation on use. Multinomial logistic regression models were used to predict the probability of provider use based on socio-demographic variables, health status and acculturation. Mexican- and Asian- Americans who have spent more time in the US were more likely to use chiropractors or massage therapists compared to no CAM provider. Both groups were less likely to use ethnic-specific CAM providers with more time in the US compared to chiropractors or massage therapists.     

Is percentage body fat differentially related to body mass index in Hispanic Americans,African Americans,and European Americans?

BACKGROUND: Limited research has been done to explore differences between ethnic groups, including Hispanic Americans (HAs), in the association between percentage body fat (PBF) and body mass index (BMI; in kg/m(2)); the numbers of HAs are increasing in the US population. OBJECTIVE: We investigated whether the relation between PBF and BMI in adult HAs differed from that of African Americans (AAs) and European Americans (EAs). DESIGN: We used a multiple regression model in which PBF measured with dual energy X-ray absorptiometry was predicted by the reciprocal of BMI (1/BMI; in m(2)/kg) in a sample of 487 men (n(EA) = 192, n(AA) = 148, and n(HA) = 147) and 933 women (n(EA) = 448, n(AA) = 304, and n(HA) = 181). RESULTS: For men, our results showed no significant differences between HAs and EAs, AAs and EAs, or HAs and AAs in the slope of the line relating 1/BMI to PBF. In women, there were significant differences in PBF as predicted by BMI between HAs and EAs (P < 0.002) and AAs and HAs (P = 0.020), but not between AAs and EAs. When PBF was estimated on the basis of predicting equations, the trend of the predicted PBF value in women differed according to ethnic group and BMI category. At a BMI < 30, HAs tended to have more body fat than did EAs and AAs, and at a BMI > 35, EAs tended to have more body fat than did the other groups. CONCLUSIONS: Our results show that the relation between PBF and BMI in HA women differs from that of EA and AA women.     

Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer’s disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D₃ supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.     

Does Paid Maternity Leave Affect Infant Development and Second‐Birth Intentions?

Given the economic implications of a low‐fertility rate, many countries have implemented paid maternity leave to promote births. However, the efficacy of this policy is mostly unknown. We examined whether paid maternity leave in South Korea, which has a fertility rate among the lowest in the world, is directly related to infant development and employed mothers' second‐birth intentions, and indirectly associated with these outcomes via parenting stress. Participants included 315 married and employed Korean mothers in the months after giving birth to their first child. Paid maternity leave was beneficial for infant development but was not a solution for promoting second‐birth intentions among employed mothers in Korea. Parenting stress adversely affected both infant development and employed mothers' second‐birth intentions, and it may therefore need to be considered as work–family policies, fertility issues, and infant development in families are addressed. Implications considering cultural and familial contexts are discussed.     

AIDS in Black and White: The Influence of Newspaper Coverage of HIV/AIDS on HIV/AIDS Testing Among African Americans and White Americans, 1993–2007

This study examined the effect of newspaper coverage of HIV/AIDS on HIV testing behavior in a U.S. population. HIV testing data were taken from the Center for Disease Control and Prevention's National Behavioral Risk Factor Surveillance System from 1993 to 2007 (N = 265,557). The authors content-analyzed news stories from 24 daily newspapers and 1 wire service during the same time period. The authors used distributed lagged regression models to estimate how well HIV/AIDS newspaper coverage predicted later HIV testing behavior. Increases in HIV/AIDS newspaper coverage were associated with declines in population-level HIV testing. Each additional 100 HIV/AIDS-related newspaper stories published each month was associated with a 1.7% decline in HIV testing levels in the subsequent month. This effect differed by race, with African Americans exhibiting greater declines in HIV testing subsequent to increased news coverage than did Whites. These results suggest that mainstream newspaper coverage of HIV/AIDS may have a particularly deleterious effect on African Americans, one of the groups most affected by the disease. The mechanisms driving the negative effect deserve further investigation to improve reporting on HIV/AIDS in the media.     

How do urban African Americans and Latinos view the influence of diet on hypertension?

Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension. Participants generally agreed that certain foods and food additives play an important role in the cause and treatment of hypertension. However, they found clinician-recommended diets difficult to follow in the context of their family lives, social situations, and cultures. These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications. These findings suggest the importance of culturally sensitive approaches to dietary improvements.     

Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?

Objectives In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae. Methods Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30–35, delivering at Sheba Medical Center from 2008 through 2013.Results VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45–49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. Conclusions Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.     

Pregnant Women’s Infant Oral Health Knowledge and Beliefs: Influence of Having Given Birth and of Having a Child in the Home

Introduction Prenatal oral health interventions can positively impact maternal and child oral health, yet limited information exists concerning how to best educate pregnant women about infant oral health. Our objective was to examine the influence of having given birth on pregnant women’s infant oral health knowledge and beliefs. Methods We conducted a secondary analysis of data collected from a cross-sectional survey of pregnant women ≥18 years old attending UNC’s Ultrasound Clinic. Four binomial items were categorized as infant knowledge (IK) and five rated on a Likert scale (1–5) as infant belief (IB). Overall IK and IB scores were calculated, averaging the items within each construct. Respondents were categorized into two groups: multiparous (N = 268), women having at least one previous live birth and a child between 2 and 6 years old, or nulliparous (N = 186), women with no previous live births or a child between 2 and 6 years old. Regression models for IK and IB were conducted using SAS 9.2 with maternal demographic characteristics, dental utilization, and birth history as explanatory variables (p ≤ 0.05). Results IK was affected by race (p = 0.04), mother’s oral health self-rating (p = 0.0002), and birth history (p < 0.0001). On average, IK was 0.12 units higher in subjects with a history of giving birth, adjusting for explanatory variables. IB was influenced by maternal oral health beliefs (p = 0.002) and history of access to dental care (p = 0.0002). IB did not differ based on birth history (p = 0.17). Discussion The influence of birth history on pregnant women’s infant oral health knowledge and beliefs can be considered in future intervention designs to maximize available resources.     

Inclusion of African Americans in genetic studies: what is the barrier?

To facilitate an increase in the amount of data on minority subjects collected for genetic databases, the authors attempted to clarify barriers to African-American participation in genetic studies. They randomly sampled 78,072 subjects from the community (Missouri Family Registry, 2002-2007). Of these, 28,658 participated in a telephone screening interview, 3,179 were eligible to participate in the genetic study, and 1,919 participated in the genetic study. Response rates were examined in relation to the proportion of subjects in the area who were African-American according to US Census 2000 zip code demographic data. Compared with zip codes with fewer than 5% African Americans (average = 2% African-American), zip codes with at least 60% African Americans (average = 87% African-American) had higher proportions of subjects with an incorrect address or telephone number but lower proportions of subjects who did not answer the telephone and subjects who refused the telephone interview (P < 0.0001). Based on reported race from the telephone screening, 71% of eligible African Americans and 57% of eligible European Americans participated in the genetic study (P < 0.0001). The results of this study suggest that increasing the number of African Americans in genetic databases may be achieved by increasing efforts to locate and contact them.     

Does vitamin D deficiency contribute to increased rates of cardiovascular disease and type 2 diabetes in African Americans?

African Americans have higher rates of type 2 diabetes (T2D) and some forms of cardiovascular disease (CVD) than do European Americans. African Americans also have much higher rates of vitamin D deficiency. There is emerging evidence that vitamin D deficiency may be a risk factor for hypertension, T2D, and CVD, but the extent to which racial disparities in disease rates are explained by racial differences in vitamin D status is uncertain. Despite a large number of observational studies and a limited number of clinical trials that examined 25-hydroxyvitamin D [25(OH)D] concentrations as a potential determinant of CVD and T2D or its precursors, it remains uncertain whether improving vitamin D status would reduce risk of these conditions in the general US population or in African Americans specifically. However, if the associations reported from the observational studies are of the estimated magnitudes and causal, vitamin D supplementation could potentially have a strong preventive effect on some of these conditions and could reduce race-related disparities in their prevalence. Because of the low 25(OH)D concentrations of many, if not most, African Americans, and the low risk associated with vitamin D supplementation, it is important to obtain more definitive answers to these questions.     

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

A discrete-choice logit model was applied to study the determinants of mental health provider choice using data from a large urban county in the Northeast US. The study subjects were 9,544 adult Medicaid recipients who received outpatient treatment from the 20 Community Mental Health Center (CMHC) programs in 2001. In addition to a conventional set of variables representing client and provider characteristics, the regression model included several interaction terms to examine whether racial concordance level among patients influences the choice of an outpatient program. The results revealed that racial concordance among the clients seems to be a factor in choosing a program. In particular, Caucasian clients are much more likely to select a program with a higher percentage of Caucasian clients, even though they have to travel further. More generally, our results suggest that program choice may be driven more by the racial composition of the clients served than by spatial proximity to the program.     

State-Specific Trends in Preterm Delivery: Are Rates Really Declining Among Non-Hispanic African Americans Across the United States?

Objectives: This study sought to examine state-specific trends in preterm delivery rates among non-Hispanic African Americans and to assess whether these rates are influenced by misclassification of gestational age. Methods: The sample population consisted of singleton non-Hispanic White and non-Hispanic African–American infants born in 1991 and 2001 to U.S. resident mothers. For both time periods, state-specific and national preterm delivery rates were calculated for all infants, stratified by infant race/ethnicity. Next, birth-weight distributions within strata of gestational age were studied to explore possible misclassifications of gestational age. Lastly, state-specific and national preterm delivery rates among infants who weighed less than 2,500 g were separately computed. Results: National analyses showed that the frequency of preterm delivery increased by 15.8% among non-Hispanic Whites but declined by 10.3% among non-Hispanic African Americans over the same period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28–31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1991 than in 2001. After excluding preterm infants who weighed 2,500 g or more, the national trends persisted. State-specific analyses showed that preterm delivery rates increased for both subgroups in 13 states during this period. Of these 13, 6 states had a number of non-Hispanic African–American births classified as preterm that were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1991 than in 2001 and inflated 1991 rates. Conclusion: There is heterogeneity in state-specific preterm delivery rates. Such differences are often overlooked when aggregate results are presented.     

Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature

It is well established that obese women are at increased risk of delayed lactogenesis and short breastfeeding duration, but the underlying causal contributors remain unclear. This review summarizes the literature examining the role of insulin in lactation outcomes. Maternal obesity is a strong risk factor for insulin resistance and prediabetes, but until recently a direct role for insulin in milk production had not been elucidated. Over the past 6 y, studies in both animal models and humans have shown insulin-sensitive gene expression to be dramatically upregulated specifically during the lactation cycle. Insulin is now considered to play a direct role in lactation, including essential roles in secretory differentiation, secretory activation, and mature milk production. At the same time, emerging clinical research suggests an important association between suboptimal glucose tolerance and lactation difficulty. To develop effective interventions to support lactation success in obese women further research is needed to identify how, when, and for whom maternal insulin secretion and sensitivity affect lactation ability.