Kathryn M. Cardarelli

Visceral fat, waist circumference, and BMI: impact of race/ethnicity.

Objective: BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)‐determined VAT or subcutaneous adipose tissue (SAT).

Gender-specific disparities in obesity.

Little prior research has investigated whether the correlates of obesity differ between men and women. The objective of this study was to examine gender-specific disparities in obesity by rurality of residence, race/ethnicity, and socioeconomic status. Particular emphasis was devoted to examining potential differences between residents of urban, suburban, and rural areas. Data from the adult version of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Texas were used to model the crude and adjusted odds of being obese as compared to normal weight. The findings showed that males of other race/ethnicity had lower adjusted odds of obesity than non-Hispanic whites, but other race/ethnicity was insignificant for females. Females who were Hispanic or black/African American had higher adjusted odds of obesity than non-Hispanic whites, but Hispanic ethnicity and black/African American race were insignificant for males. Men and women residing in non-metropolitan areas had higher adjusted odds of obesity than their counterparts in metropolitan areas. No economic disparities were revealed among men, but females with high household income had lower odds of obesity than those with low income. Educational status was insignificant for men and women. The findings suggest that programs and policies aimed at curbing obesity should target males and females residing in non-metropolitan localities. Other initiatives should focus on particular groups of women, including those who are Hispanic or black/African American and have low household income.

Acculturation and self-reported health among Hispanics using a socio-behavioral model: the North Texas Healthy Heart Study

BackgroundAcculturation is a continuous, firsthand contact with other cultures functioning at both group and individual levels and is reflected in our culturally diverse society, calling for a greater understanding of the environmental and cultural impact on health. Self-reported health (SRH), a robust and well validated predictor of future mortality for all racial/ethnic groups, has been differentially reported by Hispanics compared to whites, especially based on their acculturation status. This study investigated the relationship between acculturation and SRH among Hispanics. An adapted Andersen framework was used to develop logistic regression models to assess for an association between acculturation and general health status.MethodsHispanic participants (n = 135), as part of the North Texas Healthy Heart Study, were administered standardized questionnaires on acculturation, psychosocial measures which included sense of control, stress, depression and social support and a single item SRH measure. In addition, physiological measurements and demographic characteristics including age, gender, body mass index, medical history, and socioeconomic status were also obtained.ResultsBivariate analyses found Mexican-oriented participants 3.16 times more likely to report fair/poor SRH compared to Anglo-oriented Hispanics. Acculturation was also associated with SRH in multiple regression models controlling for enabling, need, and predisposing factors together (OR: 3.53, 95% CI: 1.04, 11.97).ConclusionsAcculturation status was associated with SRH after accounting for other underlying factors. Medical and public health professionals should promote the use of acculturation measures in order to better understand its role in Hispanic behaviors, health outcomes and health care use. Such research findings will contribute to the design of culturally sensitive prevention and treatment strategies for diverse and immigrant populations.

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of

Brief report: the modifying effects of education and income on Hispanics reporting perceived discrimination

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Self-reported racial discrimination, response to unfair treatment, and coronary calcification in asymptomatic adults - the North Texas Healthy Heart study

214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.

Sense of control and diabetes mellitus among U.S. adults: A cross-sectional analysis

Research has shown that experiences of discrimination negatively affect health. However, little is known about whether socioeconomic position modifies the reporting of perceived discrimination. This cross-sectional study of 69 participants investigated the modifying effects of education and income on the reporting of perceived discrimination among Hispanics and Whites. Hispanics, compared to non-Hispanic Whites, of higher education (more than high school) and income (

Parental risk perception and influenza vaccination of children in daycare centres.

30,000 or more per year) status are more than 4 times more likely to report perceived discrimination (odds ratio [OR] = 4.09, 95% confidence interval [CI] = 1.31-12.72; OR = 4.43, 95% CI = 1.41-13.93, respectively). However, this difference was nonsignificant among those with lower education and income levels (OR = 1.71, 95% CI = 0.27-10.92; OR = 1.71, 95% CI = 0.20-15.02, respectively). These results may affect future study sample and effect sizes.

Critical review of the evidence for the connection between education and health: A guide for exploration of the causal pathways

BackgroundAccruing evidence supports the hypothesis that psychosocial factors are related to cardiovascular disease. However, a limited number of studies have investigated the pathophysiologic pathways through which these associations occur. The purpose of this study was to assess whether experiences of self-reported racial discrimination and reactions to unfair treatment were associated with coronary artery calcification (CAC), an indicator of subclinical coronary heart disease (CHD).MethodsThis cross-sectional study recruited 571 subjects (45 years and older) who were asymptomatic of CHD from Fort Worth, Texas from 2006 to 2008. Subjects completed a questionnaire, a multi-slice computed tomography scan to assess for CAC presence (measured as Agatston score >0), and serum chemistries. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between self-reported discrimination and CAC. Results were stratified by response to unfair treatment as it was found to significantly modify the relationship between discrimination and CAC.ResultsAmong those who passively responded to unfair treatment, the odds of having CAC present were approximately 3 times higher for those experiencing discrimination (OR, 2.95; 95% CI, 1.19-7.32) after adjusting for age, gender, race/ethnicity, education, body mass index, hyperlipidemia, smoking status, hypertension, diabetes, and first degree relative with heart disease.ConclusionsThis is the first multi-racial/ethnic study to find racial discrimination associated with CAC, which differs based on how one responds to unfair treatment.

Abstract B2: Educational intervention to reduce breast cancer disparities: The Dallas Cancer Disparities Community Research Coalition

BackgroundLittle is known about the influence of psychosocial factors on diabetes mellitus. The aim of this study was to improve understanding of the association between two psychosocial factors- sense of control and social support- and diabetes mellitus.MethodsThe authors analyzed data from 2,592 U.S. households in the 1995 survey of the Aging, Status, and the Sense of Control study. Logistic regression analyses were conducted to examine whether sense of personal control and social support were associated with DM and whether gender, race, and Hispanic ethnicity modified these associations.ResultsAfter adjusting for age, obesity, and socioeconomic position, a one point increase in sense of control (i.e., a stronger sense of control) was associated a significant reduction in risk of diabetes mellitus (odds ratio = 0.67, 95% confidence interval: 0.47, 0.95). A weak social support system was associated with a non-significant risk of diabetes (odds ratio = 1.32, 95% confidence interval: 0.93, 1.89). No effect modification was detected.ConclusionSense of control deserves greater attention as a predictor of diabetes mellitus. Further studies of the contribution of psychosocial factors to diabetes mellitus should assess the temporal nature of this relationship.