Serum leptin concentrations and body adipose measures in older black and white adults

BACKGROUND: Among US adults, serum leptin concentrations are higher in women than in men and are higher in blacks than in whites independent of anthropometric measures of body fatness. OBJECTIVE: Using radiographic measures of body fat, we determined the best correlates of leptin and whether adiposity can explain sex and race differences in leptin concentrations in older adults. DESIGN: This was a cross-sectional analysis of fasting serum leptin concentrations and body fat measured by dual-energy X-ray absorptiometry (DXA), abdominal computed tomography, and standard anthropometry in 3026 well-functioning 70-79-y-old participants (42% black, 51% women) of the Health, Aging, and Body Composition Study. RESULTS: Geometric mean (+/-SE) leptin concentrations (ng/mL) were higher in the women than in the men (16.5 +/- 0.3 and 5.7 +/- 0.1, respectively) and in the black women than in the white women (20.2 +/- 0.6 and 13.9 +/- 0.4, respectively), but did not differ significantly between the white and black men (5.8 +/- 0.2 and 5.5 +/- 0.2, respectively). Percentage fat estimated from DXA showed the highest correlation with leptin (R(2) = 0.56 for both sexes). Addition of abdominal visceral fat minimally increased the correlation. In the multivariate analysis, the association with sex was eliminated after adjustment for percentage fat and visceral fat in both whites (P = 0.051) and blacks (P = 0.34). Among women, higher leptin concentrations in blacks remained after adjustment for percentage fat and visceral fat (mean race difference = 4.95 ng/mL; P < 0.001). Among men, an association with black race emerged after adjustment for these factors (mean race difference = 1.42 ng/mL; P < 0.001). CONCLUSIONS: Among older adults, higher serum leptin concentrations in women are explained by a greater percentage of body fat. Higher leptin concentrations in blacks are not explained by percentage of body fat.     

Neighborhood socioeconomic conditions are associated with psychosocial functioning in older black and white adults

We examined neighborhood socioeconomic status (NSES) in relation to depressive symptoms, perceived stress, and hostility in 5770 community-dwelling older black and white adults (mean age=73 years; 62% female) from 3 contiguous neighborhoods covering 82 census block groups in Chicago, IL. NSES was an average of z-scores of four Census 2000 block-group variables: % public assistance, % households earning <$25,000 annually, % with >college degree, and % owner-occupied dwellings valued >$200,000. NSES was inversely related to hostility (beta=-0.305), stress (beta=-0.333), and depressive symptoms (beta=-0.223) (p<0.001) in multi-level mixed-effects regression models adjusted for age, sex, race, and the number of years in the neighborhood. With further adjustment for education, income, marital status, and health conditions, NSES remained associated with depressive symptoms (beta=-0.078) and hostility (beta=-0.133) (p<0.05); the association with hostility was strongest in non-black neighborhoods. Neighborhood social conditions contribute to the psychosocial well-being of older residents; research is needed to investigate pathways through which neighborhoods influence health outcomes in an aging population.     

Obesity and all-cause mortality among black adults and white adults

In recent pooled analyses among whites and Asians, mortality was shown to rise markedly with increasing body mass index (BMI; weight (kg)/height (m)(2)), but much less is known about this association among blacks. This study prospectively examined all-cause mortality in relation to BMI among 22,014 black males, 9,343 white males, 30,810 black females, and 14,447 white females, aged 40-79 years, from the Southern Community Cohort Study, an epidemiologic cohort of largely low-income participants in 12 southeastern US states. Participants enrolled in the cohort from 2002 to 2009 and were followed up to 8.9 years. Hazard ratios and 95% confidence intervals for mortality were obtained from sex- and race-stratified Cox proportional hazards models in association with BMI at cohort entry, adjusting for age, education, income, cigarette smoking, and alcohol consumption. Elevated BMI was associated with increased mortality among whites (hazard ratios for BMI >40 vs. 20-24.9 = 1.37 (95% confidence interval (CI): 1.02, 1.84) and 1.47 (95% CI: 1.15, 1.89) for white males and white females, respectively) but not significantly among blacks (hazard ratios = 1.13 (95% CI: 0.89, 1.43) and 0.87 (95% CI: 0.72, 1.04) for black males and black females, respectively). In this large cohort, obesity in mid-to-late adulthood among blacks was not associated with the same excess mortality risk seen among whites.     

Trust in the health care system and the use of preventive health services by older black and white adults

Objectives. We sought to find racial differences in the effects of trust in the health care system on preventive health service use among older adults.Methods. We conducted a telephone survey with 1681 Black and White older adults. Survey questions explored respondents'' trust in physicians, medical research, and health information sources. We used logistic regression and controlled for covariates to assess effects of race and trust on the use of preventive health services.Results. We identified 4 types of trust through factor analysis: trust in one''s own personal physician, trust in the competence of physicians'' care, and trust in formal and informal health information sources. Blacks had significantly less trust in their own physicians and greater trust in informal health information sources than did Whites. Greater trust in one''s own physician was associated with utilization of routine checkups, prostate-specific antigen tests, and mammograms, but not with flu shots. Greater trust in informal information sources was associated with utilization of mammograms.Conclusions. Trust in one''s own personal physician is associated with utilization of preventive health services. Blacks'' relatively high distrust of their physicians likely contributes to health disparities by causing reduced utilization of preventive services. Health information disseminated to Blacks through informal means is likely to increase Blacks'' utilization of preventive health services.There is strong empirical evidence of health care disparities between Black and White Americans. Blacks are less likely than are Whites to receive many needed services, including routine preventive care.^1–5 The causes of disparities in health care are complex and have been the subject of considerable research; socioeconomic differences and structural characteristics (such as lack of access to care) are important sources of care disparities, and there is significant evidence that racial bias in the health care system is also a major factor in disparities in care between Blacks and Whites.¹Blacks'' distrust of physicians and the health care system may also contribute to health care disparities. Studies have demonstrated that Blacks exhibit less trust in the health care system.^6–9 There are a variety of mechanisms through which this distrust may occur, including Blacks'' personal experiences with racism, their knowledge of a history of racism in the health care system—including circumstances in which Blacks were victimized, such as the Tuskegee Syphilis Study^10–12—and social and cultural distance between Black patients and White physicians.¹³ Taken together, these individual experiences constitute a broader cultural memory of abuse that may contribute to belief in conspiracy theories among Blacks.^14,15 Goertzel reported that belief in conspiracies was correlated with lack of interpersonal trust and that Blacks were more likely to believe in conspiracy theories than were Whites.¹⁶Trust plays a central role in all medical relationships and is an important contributor to positive therapeutic outcomes.^17–20 Lack of patient trust is associated with less doctor–patient interaction, poor clinical relationships that exhibit less continuity, reduced adherence to recommendations, worse self-reported health, and reduced utilization of health care services^17–22; thus, Blacks'' relatively lower trust in the health care system puts them at greater risk of all these negative outcomes. When O''Malley et al.²² evaluated respondents'' answers to a global question assessing overall trust in personal physicians, they found that greater trust was associated with higher overall use of a number of preventive services among low-income Black women 41 years and older.However, little is known about whether distrust affects use of specific preventive services differently. Because trust in the health care system is conceived as consisting of a number of types and dimensions,^17,19,20 it is also possible that different aspects of trust may affect service use differently, thus warranting more detailed study of how the dimensions of trust may affect use of preventive services among various populations. Because of its likely origins in racial bias, Blacks'' health care–related distrust may have somewhat different effects from that of Whites, perhaps manifesting as institutional distrust as opposed to interpersonal distrust.We explored these issues by examining the association of different aspects of health care–related trust with receipt of preventive health services among older Blacks and Whites. We focused on older adults because preventive services such as immunizations, routine physical examinations, and screening for cancer and other diseases can greatly reduce premature mortality and morbidity among this population and are critical to sustaining older adults'' health.²³ Thus, disparities in receipt of preventive services are an especially strong contributor to disparities in health outcomes for older adults.     

Research in black and white

The authors consider the methodological, interpretative, and practical issues that arise when there is a difference in ethnicity between researcher and informant in qualitative research by drawing on the academic literature and their fieldwork experiences as White researchers undertaking studies with individuals of African/Caribbean and South Asian descent. Some contemporary issues raised by "researching the other" in the context of pragmatic health services research are highlighted, including access to same-ethnicity researchers, the involvement of interpreters, and the potential for ethnocentric interpretation. The authors believe that qualitative research should be judged by the plausibility of the findings and by a critical evaluation of the way in which the research was conducted and the reflexivity of the researcher.     

Functional limitations and religious service attendance among African American and white older adults

Church attendance is associated with improved health and well-being among older adults, but older adults with functional limitations may have difficulty attending church services. This article examines differences in the association between functional limitations and church attendance in a sample of 987 elderly African American and white individuals. African American and white elderly people without limitations attended church at virtually the same rate (69 percent). Despite their higher scores on religiousness measures, elderly African Americans with one or more limitations were significantly less likely to attend church regularly than were white counterparts. Health status measures did not help explain older African Americans' lower attendance rates. Differences in attendance were associated primarily with educational attainment and cognitive functioning. The article recommends social work intervention to reduce barriers to church attendance for older adults who want to attend services.     

Relation between vegetarian/nonvegetarian diets and blood pressure in black and white adults.

We examined the possible interaction of race and diet on blood pressure (BP) in volunteer Black Seventh Day Adventists compared to volunteer White church members. Height, weight, waist and hip circumference, and resting seated BP were recorded in Black vegetarians (n = 55; age: 54.7 +/- 16.9 yrs), Black nonvegetarians (n = 59; 56.1 +/- 14.1 yrs), White vegetarians (n = 164; 52.2 +/- 16.7 yrs), and White nonvegetarians (n = 100; 52.6 +/- 15.6 yrs) attending a regional conference. Forty-four percent of the Black nonvegetarians were medicated hypertensives, compared to only 18 percent of the Black vegetarians, 7 percent of the White vegetarians, and 22 percent of the White nonvegetarians. Black vegetarians exhibited lower age and sex-adjusted systolic BP (means = 122.9/74.4 mm Hg) than Black nonvegetarians (means = 132.2/75.9 mm Hg). After further adjusting BP for body mass index and waist/hip ratio, the systolic BP among Black vegetarians remained lower (122.8) than Black nonvegetarians (129.7) but higher than that of the Whites who showed no diet-related BP differences.     

Reasonable estimates of serum vitamin E, vitamin C, and beta-cryptoxanthin are obtained with a food frequency questionnaire in older black and white adults

Few studies provide correlations between different indicators of the dietary intakes of older (>or= 65 y) black and white adults. This study compared the usual intakes of vitamin E, vitamin C, and selected carotenoids estimated by a modified Harvard food frequency questionnaire (FFQ) to those estimated by multiple 24-h recalls, and to blood concentrations of components in a randomly selected sample of participants in the Chicago Health and Aging Project (CHAP). Subjects (n = 59) were interviewed to complete multiple 24-h recalls over a year's time, then completed an FFQ and subsequently provided a fasting blood specimen within 2 mo. Dietary estimates were energy-adjusted separately for men and women. Significant (P < 0.05) correlations between total (diet and supplement) FFQ estimates and serum measures of vitamin E and vitamin C were as follows: 0.49 and 0.39 for blacks, and 0.42 and 0.29 for whites, respectively. The highest correlations between serum and FFQ indicators were for dietary beta-cryptoxanthin (0.46), total alpha-tocopherol (0.46) and total beta-carotene (0.44) among whites; among blacks, the highest correlations were for dietary alpha-carotene (0.81), total alpha-tocopherol (0.53) and total beta-cryptoxanthin (0.50); all were significant (P < 0.05). Further adjustment for age, gender, BMI, and educational level minimally altered these coefficients. These findings indicate that the modified Harvard FFQ provides reasonable estimates of serum levels of vitamin E, vitamin C and beta-cryptoxanthin among CHAP participants.     

The prevalence of major depression in black and white adults in five United States communities

There have been inconsistent findings on race differences in the rates and nature of depression, which are probably due to methodological differences between studies. Data are presented on the prevalence of major depression in white and black adults from the Epidemiologic Catchment Area Study, which examined a large community sample of five United States sites using diagnostic criteria based on the American Psychiatric Association Diagnostic and Statistical Manual, Third Edition. A total of 16,436 adults living in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), the Piedmont area of North Carolina, and Los Angeles (California) were surveyed in 1980-1983. In the five sites, age-adjusted analyses by site and sex did not show any consistent black excess in lifetime prevalence or six-month prevalence; white men as compared with black men in particular tended to have slightly higher prevalence of major depression. At all sites, in the 18-24 years age group, black women as compared with white women showed a trend for higher six-month prevalence. White men in the 18-24 years age group showed a trend for higher six-month prevalence than black men. In New Haven, Baltimore, and the Piedmont area of North Carolina, logistic regression analyses of lifetime prevalence (by site and sex) showed no significant or consistent interaction of race with household income or age. Controlling for age and household income, whites tended to have higher lifetime prevalence than black at each of these three sites, regardless of sex.     

Shared conceptualizations and divergent experiences of counseling among African American and white older adults

Research findings suggest that older adults prefer counseling for depression treatment; however, few older adults use counseling services. In this article we present the results of our analysis of semistructured interviews with 102 older adults to explore conceptualizations of counseling and impediments to use among African American and White older adults. We found that older adults believe counseling is beneficial; however, use was hindered in multiple ways. Older adults were skeptical about establishing a caring relationship with a professional. African American older adults did not mention social relationships to facilitate depression care, whereas White older adults described using personal relationships to navigate counseling services. African American older men were least familiar with counseling. Our findings suggest that African American and White older adults share a strong cultural model of counseling as beneficial; however, significant impediments exist and affect older adults differentially based on ethnicity.     

The association of near poverty status with cancer incidence among black and white adults

This cumulative incidence study was accomplished among adults in Upstate New York metropolitan areas (Buffalo, Rochester, Syracuse and Albany—1979–1986). It used a new ecological socioeconomic status measure—near poverty status (i.e., below 200% of the federally established poverty criterion, including the poor and near poor)-and observed its association with site-specific cancer incidence (lung, stomach, cervix uteri, prostate, colon, rectum and breast). Findings were: 1) near poverty status is directly associated with each cancer site's incidence and the strength of the associations are similar among blacks and whites for each one and 2) the prevalence of exposure, of living in high near impoverishment areas, is nearly seven-fold greater among blacks; prevalence ratio [PR]=6.74 (95% confidence interval [CI]:5.07,8.99).     

Physical activity and incident hypertension in black and white adults: the Atherosclerosis Risk in Communities Study

BACKGROUND: The epidemiologic observation that physical activity reduces the risk for hypertension has only been made for white men who self-reported hypertension. This study examined physical activity and clinically determined incident hypertension in black and white men and women of the Atherosclerosis Risk in Communities (ARIC) Study. METHODS: ARIC is a population-based prospective study with four U.S. clinic centers. The present analyses included 7,459 black and white adults 45-65 years of age. Hypertension (systolic/diastolic blood pressure >/= 140/90 mm Hg) was defined by blood pressure measured by a random-zero device or medication use. Physical activity was assessed with the Baecke questionnaire. RESULTS: After adjustment for age, baseline blood pressure, ARIC center, education, body mass index, waist-hip ratio, parental history of hypertension, cigarette smoking, alcohol consumption, and diet, white men in the highest quartile of leisure activity (primarily cycling and walking) had a 34% lower odds of developing hypertension over 6 years compared to the least active (OR = 0.66, 95% CI = 0.47-0.94; P for quartile trend = 0.01). Baseline activity was not associated with incident hypertension in white women or blacks. CONCLUSIONS: Leisure-time physical activity reduces the odds of hypertension in middle-aged white men. Additional studies in women and blacks are needed.     

Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment

Using data from the 1995 Detroit Area Study (N=1106) this paper finds that black adults report significantly worse self-rated health when compared to whites with similar levels of self-reported morbidity. This relationship, called health pessimism, persists despite statistical controls for age, gender, socioeconomic status, health care access, and health related behaviors. Interpersonal maltreatment is found to be positively associated with health pessimism and more importantly, when comparing adults who perceive similar levels of maltreatment, white and black adults do not differ with respect to health pessimism. This suggests that the increased risk of health pessimism among black adults is due in part to race differences in the perception of interpersonal maltreatment.     

Trends of abdominal adiposity in white,black, and Mexican-American adults, 1988 to 2000

OBJECTIVE: To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican-American adults from 1988 through 2000. RESEARCH METHODS AND PROCEDURES: Nationally representative cross-sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC > or =102 cm in men and > or 88 cm in women. RESULTS: There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican-American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks. DISCUSSION: Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence-based programs that show promise for long-term health behavior changes to facilitate the prevention of AO and related comorbidities.     

Gender differences in education effects on all-cause mortality for white and black adults in the United States

The existence of education differentials in adult mortality has been well established. The issue of gender differences in the education-mortality association, however, remains an open question, despite its importance for understanding of causal pathways through which education affects health outcomes. The goal of this paper is to analyze gender differences in education gradients in mortality among non-Hispanic white and black U.S. adults born between 1906 and 1965. The analysis is based on data from the 1986–2000 National Health Interview Surveys linked to the National Death Index through 2002 (NHIS-LMF) with over 700,000 respondents. Full-sample and cohort-stratified Cox proportional hazard models of all-cause mortality were estimated. Results indicate a great deal of similarity between men and women in the education-mortality association, with some exceptions. The most notable difference is the steeper educational gradient at high schooling levels for white men compared to white women. This difference was fully explained by marital status. No systematic gender differences in the relationship between education and adult mortality were observed among black adults in any birth cohorts. The findings suggest that men do not benefit from educational attainment uniformly more than women.