Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
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12 Racial/Ethnic Disparities in Health Behaviors: A Challenge to Current Assumptions
12 Racial/Ethnic Disparities in Health Behaviors: A Challenge to Current Assumptions
Pages 450-491
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We focus on the following health behaviors and risk factors, all of which are related to chronic diseases: smoking, obesity, physical inactivity, 450
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We base our main observations on data from two national data sets, the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES III) and the 2000 Behavioral Risk Factor Surveillance System (BRFSS)
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evaluate the importance of considering socioeconomic status, residential environments, and acculturation in studies on racial/ethnic disparities in health behaviors. In the second section of this chapter, we present new findings from analyses of racial/ethnic disparities in health behaviors and practices across a broad range of age groups using data from a national sample of white, black, and Hispanic women and men.
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Black women and men have higher age-standardized death rates from cardiovascular disease (CVD) than white women and men, regardless of income (Singh, Kochanek, and McDonan, 1996)
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, used data for black and white adults from the NHANES Epidemiologic Follow-Up Survey to evaluate whether black-white differences in all-cause mortality (of which chronic diseases are major contributors) were explained by differences in health behaviors and risk factors (cigarette smoking, systolic blood pressure, cholesterol level, body mass index, alcohol intake, and diabetes mellitus)
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From page 455... ...
. In contrast to studies on smoking, other studies consistently show that black women have higher prevalences of excess weight and physical inactivity and poorer diets than white women; differences between black and white men are less consistent and generally of lower magnitude (Burke et al., 1992; DiPietro, Williamson, Caspersen, and Eaker, 1993; Duelberg, 1992; Folsom et al., 1991; Gidding et al., 1996; Kumanyika, Wilson, Guilford-Davenport, 1993)
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The results showed that race/ethnicity was independently associated with health behaviors after adjustment for educational attainment and family income divided by family size. Black and Mexican-American women had significantly higher odds of obesity and physical inactivity than white women (odds ratios 1.5 to 2.3, p values <0.01)
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older white women and men are more likely to have ever smoked, but are also more likely to have quit smoking than older black women and men; and (2) older black women and men are more obese and physically inactive, but are less likely to have high alcohol consumption than older white women and men (National Research Council, 1997)
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From page 458... ...
Therefore, people in this age cohort who survived to 1988 to 1994 may represent those with healthier behaviors. Underestimation may be especially true for the black-white differences because of the substantially higher rates of early death from chronic diseases and injuries for black compared with white women and men (Corti et al., 1999; Ventura, Peters, Martin, and Maurer, 1997)
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From page 459... ...
Furthermore, the same level of educational attainment does not convey the same meaning when examining differences in health behaviors across age groups; for example, a high school degree for an elderly population may confer the same status and prestige as a college degree for a younger population. Finally, the measurement of education is difficult to interpret when sample populations include people who have been educated in countries outside the United States.
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A growing body of research supports the independent association of neighborhood socioeconomic characteristics on chronic disease morbidity and mortality, risk factors, and health behaviors. Residence in a socioeconomically disadvantaged area has been found to be independently associated with heart disease morbidity (Diez-Roux et al., 1997, 2001; Jones, 2000; Smith et al., 1998)
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. We examined differences in four health behaviors and risk factors related to chronic disease: · Cigarette smoking (smoked at least 100 cigarettes in entire life and currently smoking cigarettes everyday)
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Born in U.S. Obesity Low vegatable and/or fruit consumption High alchohol consumption FIGURE 12-2 Unhealthy behaviors among Mexican-American women and men, ages 18-74, by country of birth and age group, adjusted for education and family income.
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, and 13,088 Hispanic women and men aged 18 to 74 years who were interviewed for the 2000 BRFSS and were not missing information on educational attainment or household income. Data were not collected for separate groups of Hispanics in the 2000 BRFSS.
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. The independent variables in the adjusted models were race/ethnicity (black and Hispanic women and men compared separately to white women and men)
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Odds ratios are presented for each health behavior for black and Hispanic women and men, with white women and men as the reference group. Odds ratios greater than 1.00 indicate higher odds of unhealthy behaviors for black and/or Hispanic
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To assess the extent to which racial/ethnic disparities in health behaviors were accounted for by differences in SES, the odds ratios are first presented unadjusted, and then adjusted for two indicators of SES -- educational attainment and household income. Black and Hispanic women and men had substantially lower odds of smoking than white women and men in nearly every age group
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. After adjustment, black and Hispanic women had approximately a quarter to half the odds of smoking than white women.
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468 Group, Age Adjusted 1.00 0.53*
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and and/or 25-44 family black women Un- adjusted 1.00 1.54*
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Black and Hispanic women aged 18 to 24, and black women and men aged 25 to 44, had significantly lower odds of alcohol consumption than white women or men in the same age groups after adjustment for education and income. Black women aged 25-64 were more likely to report having a recent Pap test than white women after adjustment for education and income.
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The differences were apparent for all of the seven health behaviors and risk factors and two cancer screening tests, with the exception of alcohol consumption. The differences by education for Hispanic women and men were generally much weaker or not apparent, except for obesity for both women and men, and cancer screening for women.
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Hispanic FIGURE 12-3 Prevalence of cigarette smoking at each age group by level of education for white, black, and Hispanic women and men, ages 18-74. SOURCE: Behavioral Risk Factor Surveillance System (2000)
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30 Units 30 > 20 BMI 10 0 18-24 25-34 35-44 45-54 5-64 65-74 Age 60 Men 50 40 (percent) Units 30 30 > BMI 20 10 0 18-24 25-34 35-44 45-54 5-64 65-74 <$25,000 white <$25,000 black <$25,000 Hispanic >$25,000 white >$25,000 black >$25,000 Hispanic FIGURE 12-4 Prevalence of obesity at each age group by household income for white, black, and Hispanic women and men, ages 18-74.
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Although black women and Hispanic women and men in the NHIS were less likely to smoke than their white counterparts, they also showed a gradient in smoking by SES. Smoking is a particularly important health behavior because it is the leading cause of preventable death and disability in the United States and is a risk factor for heart disease, lung cancer, and other chronic diseases.
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had significantly higher odds of obesity and physical inactivity than white women after adjustment for education and income. Black women also showed lower vegetable and/or fruit intake than white women at every age group, although these findings were not statistically significant, except for women aged 25 to 44.
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There was one notable exception: younger black women and men and younger Hispanic women had a 60 to 80 percent lower likelihood of high alcohol consumption than younger white women and men. The higher heavy alcohol consumption in younger white women and men points to the need for special outreach programs to address their high alcohol intake and/or binge drinking because this health behavior is linked to
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. Racial/Ethnic Disparities in Cervical Cancer and Breast Cancer Screening We found that white women aged 25 to 64 were less likely to have received recent Pap screening than black women after adjustment for education and income and that Hispanic women aged 18 to 24 were less likely to have received recent Pap screening than white women.
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. The Influence of SES Our results confirm the importance of considering socioeconomic factors when assessing racial/ethnic disparities in health behaviors related to chronic diseases.
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A serious limitation of the BRFSS is the aggregation of persons of Hispanic origin into one group, making it impossible to distinguish among different Hispanic subgroups such as Mexican Americans, Puerto Ricans, and Cubans. This is important because of the large differences in prevalences of health behaviors within the Hispanic population (e.g., smoking in Mexican-American versus Cuban men)
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spoken at home, and length of time lived in the United States. The Next Generation of Chronic Disease Prevention Chronic diseases, with heart disease ranking first, cancer ranking second, and stroke ranking third, will remain the leading causes of death in the United States for the next 50 years for all major racial/ethnic groups (Cooper et al., 2000)
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We focused on smoking, obesity, physical inactivity, poor diet, high alcohol consumption, and cancer screening practices, all of which are related to chronic diseases. Our findings highlight many disparities in health behaviors, none of which are restricted to any gender or age group.
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This is apparent for smoking, secondhand smoke exposure, physical inactivity, high alcohol consumption, and inadequate mammography screening. · Both white and black adults with lower SES (as measured by either educational attainment or household income)
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. Association between multiple cardiovascular risk factors and athero sclerosis in children and young adults.
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. The prevalence of selected chronic diseases among the Mexican-American elderly: Data from the 1982-1984 Hispanic Health and Nutrition Examination Survey.
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. People, places and coronary heart disease risk factors: A multilevel analysis of the Scottish Heart Health Study archive.
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. Do cardio vascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, and acute myocardial infarction?
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. Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites: The San Antonio Heart Study.
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. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: The Renfrew and Paisley Study.
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. Cardiovascular disease risk factors among older black, Mexican American, and white women and men: An analysis of NHANES III, 1988-1994.
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. Ethnic and socioeco nomic differences in cardiovascular disease risk factors: Findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994.
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