Karen Winters

Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem

This paper provides an overview of the evidence on the current epidemic of obesity in the United States. The prevalence of overweight and obesity now exceeds 60% among US adults, and the rate is rapidly increasing among children and adolescents. Dismal medical, social, and economic consequences are already apparent and likely to worsen without multipronged intervention. Increased rates of hypertension, diabetes, and dyslipidemia, among other medical conditions, threaten to shorten the longevity of the American populace by as much as 5 years. The incidence of depression is increasing and experts suggest this is linked with the increased prevalence of obesity. The cost of obesity-related medical care has increased astronomically since 1987, in addition to lost productivity and income. Novel multidisciplinary, preventive, and therapeutic approaches, and social changes are needed that address the complex interplay of biologic, genetic, and social factors that have created the current obesity epidemic.

Racism and cardiovascular disease in African Americans.

&NA; This article provides an overview of the evidence on the ways racism can affect the disproportionate rates of cardiovascular disease (CVD) in African Americans. It describes the significant health disparities in CVD for blacks and whites and suggests that racial disparities should be understood within the context of persistent inequities in societal institutions and relations. Evidence and potential pathways for exploring effects of 3 levels of racism on cardiovascular health risk factors and outcomes are reviewed. First, institutional racism can lead to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions that can adversely affect cardiovascular health. Second, perceived/personally mediated racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. Third, in race‐conscious societies, such as the United States, the negative self‐evaluations of accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health. Few population‐based studies have examined the relationship between racism and CVD. The findings, though suggestive of a positive association, are neither consistent nor clear. The research agenda of the Jackson Heart Study in addressing the role of racism in CVD is presented.

Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem.

This review considers a variety of perspectives on overweight and obesity (OW/obesity), including measurement and classification; prevalence and changes in prevalence in recent years; genetic, biological, medical, individual, and social correlates of OW/obesity; and treatment approaches. Despite increased attention, OW/obesity is escalating in prevalence worldwide, and the causes are exceedingly complex. A range of innovative studies, including basic research on gut microflora, dietary composition, pharmacologic interventions, and surgical procedures, is generating findings with potential for future prevention and treatment of OW/obesity. Social system changes such as school programs and the awareness of the roles of personal, family, health provider, and cultural experiences related to OW/obesity have also gained traction for vital prevention and treatment efforts over the past decade.

Framing body size among African American women and girls

Obesity continues to affect African Americans in epidemic proportions, particularly among women and adolescent females. Perceptions, beliefs, behaviors, and body sizes of adolescents are associated with those of their mothers, yet little is known about the transgenerational meanings and experiences of obese African American adolescent girls and their mothers. An interpretive phenomenological study was conducted with seven African American adolescents between the ages of 11 and 17, and their adult female caregivers. Audio-taped interviews were transcribed and analyzed by a multicultural interpretive team. Two constitutive patterns and associated themes were identified. One pattern, ‘Framing: sizing it up; sizing it down’, with its three associated themes is presented. Mothers and daughters are engaged in multiple common practices in which they self-define body size, while protecting their self-esteem and self-image. This pattern illustrates how the women and girls created an image of their bodies as they confronted and acknowledged their self-perceptions, compared themselves to others in their environment, and evaluated themselves against specific parameters of acceptable size.

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

OBJECTIVES 1) To examine the association of multiple dimensions of discrimination with reported trust and satisfaction with providers; 2) to report within-group differences among African Americans (AAs). MAIN MEASURES Measures of perceived discrimination included everyday, lifetime, burden from lifetime discrimination, and stress from discrimination. Outcomes included trust and satisfaction with providers. METHODS Descriptive cross sectional study. The study population included AAs aged 35 to 84 years from the Jackson Heart Study (JHS) (N=5,301). Poisson regression (PR) was used to quantify the association between perceived discrimination and reported trust and satisfaction with providers before and after controlling for selected characteristics. RESULTS The mean everyday discrimination score was 2.11 (SD±1.02), and the mean lifetime discrimination score was 2.92 (SD±2.12). High (vs low) levels of everyday discrimination were associated with a 3% reduction in the prevalence of trust in providers (PR .97, 95% CI .96, .99) in all models. In fully-adjusted models, high (vs low) lifetime discrimination was associated with a 4% reduction in the prevalence of trust and satisfaction (PR .96, 95% CI .95, .98). Burden of discrimination was not associated with trust or satisfaction, but stress from discrimination was inversely associated with satisfaction. CONCLUSIONS The significant association between discrimination and mistrust and dissatisfaction suggests that health care providers should be made aware of AA perceptions of discrimination, which likely affects their levels of trust and satisfaction.

Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study

Background: Non‐adherence to medications is common and leads to suboptimal outcomes. Non‐adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non‐adherence could inform the development of effective interventions. Methods and Results: We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient‐reported adherence with non‐adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non‐adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non‐adherence with 754 (35.3%) reporting only unintentional non‐adherence, 263 (12.3%) only intentional non‐adherence, and 1121 (52.4%) both. Factors independently associated with intentional non‐adherence included female sex and depressive symptoms while factors associated with unintentional non‐adherence included younger age and separated relationship status. Unintentional and intentional non‐adherence was more common among participants taking anti‐arrhythmic and anti‐asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non‐adherence. The adjusted models for intentional and unintentional non‐adherence had c‐statistics of 0.65 and 0.66, respectively, indicating modest discrimination. Conclusion: Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non‐adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non‐adherence and provide rationale to assess whether personalized interventions can improve adherence.

Cardiovascular Disease Burden and Socioeconomic Correlates: Findings From the Jackson Heart Study

Background Black persons have an excess burden of cardiovascular disease (CVD) compared with white persons. This burden persists after adjustment for socioeconomic status and other known CVD risk factors. This study evaluated the CVD burden and the socioeconomic gradient of CVD among black participants in the JHS (Jackson Heart Study). Methods and Results CVD burden was evaluated by comparing the observed prevalence of myocardial infarction, stroke, and hypertension in the JHS at baseline (2000–2004) with the expected prevalence according to US national surveys during a similar time period. The socioeconomic gradient of CVD was evaluated using logistic regression models. Compared with the national data, the JHS age‐ and sex‐standardized prevalence ratios for myocardial infarction, stroke, and hypertension were 1.07 (95% CI, 0.90–1.27), 1.46 (95% CI, 1.18–1.78), and 1.51 (95% CI, 1.42–1.60), respectively, in men and 1.50 (95% CI, 1.27–1.76), 1.33 (95% CI, 1.12–1.57), and 1.43 (95% CI, 1.37–1.50), respectively, in women. A significant and inverse relationship was observed between socioeconomic status and CVD within the JHS cohort. The strongest and most consistent socioeconomic correlate after adjusting for age and sex was income for myocardial infarction (odds ratio: 3.53; 95% CI, 2.31–5.40) and stroke (odds ratio: 3.73; 95% CI, 2.32–5.97), comparing the poor and affluent income categories. Conclusions Except for myocardial infarction in men, CVD burden in the JHS cohort was higher than expected. A strong inverse socioeconomic gradient of CVD was also observed within the JHS cohort.