Rosenda Murillo

Gender Disparities in the Food Insecurity–Overweight and Food Insecurity–Obesity Paradox among Low-Income Older Adults

BACKGROUND Obesity and obesity-related comorbidities are increasing among older adults. Food insecurity is a nutrition-related factor that coexists with obesity among low-income individuals. The majority of the research on the food insecurity-obesity paradox has been conducted on low-income mothers and children, with research lacking on large diverse samples of older adults. OBJECTIVE The purpose of this study was to assess gender disparities in the association between food insecurity and overweight and obesity among low-income older adults. STUDY DESIGN Cross-sectional 2011 and 2012 National Health Interview Survey data were used. Food insecurity status was determined by ≥3 affirmative responses on the 10-item US Department of Agriculture Food Security Scale (FSS). Body mass index (BMI) was calculated as outlined by the Centers for Disease Control and Prevention based on self-reported height and weight. PARTICIPANTS/SETTINGS Adults included were low-income (≤1.99 federal poverty level [FPL]), older (aged ≥60 years), with a normal BMI (18.5) or greater who had complete data on FSS, BMI, and the following covariates: age, race or ethnicity, marital status, income, nativity status, physical activity, poor health status, health insurance coverage, problems paying medical bills or for medicine, and region of residency (N=5,506). STATISTICAL ANALYSES PERFORMED Multivariate logistic regression models were stratified by gender to estimate the association between food insecurity and higher weight status. All models included covariates. RESULTS In covariate-adjusted models, compared with low-income, food secure men, low-income, food-insecure men had 42% and 41% lower odds of being overweight and overweight or obese, respectively. Despite the high prevalence rate of obesity among low-income, food-insecure women, food insecurity was not significantly related to overweight, obesity, or overweight or obesity for older adult women in adjusted models. CONCLUSIONS Food insecurity-overweight and -obesity paradox appears not to be present in older men. However, food insecurity and obesity coexist among low-income, older women.

Association of self-reported physical activity with obstructive sleep apnea: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

We examined associations of mild and moderate to severe obstructive sleep apnea (OSA; apnea-hypopnea index ≥5 and ≥15, respectively) with recommended amounts of moderate-vigorous physical activity (MVPA) or vigorous physical activity (VPA) and by type of activity (i.e., recreational, transportation, and work activity). The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter population-based study, enrolled individuals from 2008 to 2011 from four U.S. metropolitan areas (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California). Participants in this study included 14,087 self-identified Hispanic/Latino ages 18 to 74years from the HCHS/SOL. Survey logistic regression analysis was used to compute odds ratios [OR] and 95% confidence intervals [CI], adjusting for sociodemographics, smoking status, and body mass index (BMI). Relative to being inactive, performing some MVPA (>0 to <150min/week) or meeting the recommended MVPA (≥150min/week) were associated with lower odds of mild OSA (ORs and 95% CIs 0.70 [0.61-0.82] and 0.76 [0.63-0.91], respectively), as well as moderate to severe OSA (ORs and 95% CIs 0.76 [0.62-0.93] and 0.76 [0.59-0.98], respectively). Associations of VPA with OSA were not significant. Engaging in medium or high levels of transportation activity was associated with lower odds of mild OSA (OR: 0.84, 95% CI: 0.74-0.96; OR: 0.64, 95% CI: 0.43-0.95, respectively). Performing some recreational MVPA was associated with lower likelihood of mild and moderate to severe OSA (OR: 0.82, 95% CI: 0.71-0.93; OR: 0.79, 95% CI: 0.64-0.97, respectively). Health promotion and OSA prevention efforts should encourage individuals to engage in at least some MVPA.

The Role of Stress in Understanding Differences in Sedentary Behavior in Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

BACKGROUND Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. METHODS Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders. RESULTS Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant. CONCLUSION Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.

Activity and Weight Misperception among Overweight and Obese US Adults.

OBJECTIVES Engaging in some exercise is associated with weight misperception (ie, overweight and obese participants self-reporting being normal weight or underweight) among adults. Less is known about associations between various types of activity with weight misperception. We examined associations between activity (moderate-vigorous leisure-time, work- and transportation-related physical activity, and sedentary activity) and weight misperception. METHODS We used cross-sectional data from 7992 National Health and Nutrition Examination Survey 2007-2010 participants aged 20+ years with a ≥ 25 body mass index. Logistic regression models were used to estimate activity-weight misperception associations. RESULTS Individuals who performed some activity, versus none, were less likely to misperceive their weight (Odds Ratio [OR]: 0.78; 95% Confidence Interval [CI]: 0.66, 0.93). Those who engaged in high levels of transportation activity were more likely to misperceive their weight (OR: 1.29; 95% CI: 1.09, 1.54). Individuals who engaged in medium and high levels of sedentary activity, versus low, were less likely to misperceive their weight (OR: 0.65; 95% CI: 0.57, 0.75 and OR: 0.51; 95% CI: 0.43, 0.61, respectively). Associations varied by sex. CONCLUSIONS Variation in associations of various types of activity with weight misperception should be considered when developing health promotion programs.

Differences in neighborhood social cohesion and aerobic physical activity by Latino subgroup

Previous research has examined the role of neighborhood social cohesion in physical activity outcomes; however, less is known about this relationship across Latino subgroups. The purpose of our study was to examine the association between neighborhood social cohesion and aerobic leisure-time physical activity (LTPA) among Latino adults and to determine whether these associations differ by Latino subgroup. We used cross-sectional 2013–2014 National Health Interview Survey (NHIS) data on Latinos originating from 5 countries/regions (i.e., Latinos of Puerto Rican, Mexican/Mexican-American, Cuban/Cuban-American, Dominican and Central or South American origin) aged ≥18 years (n=11,126). Multivariable logistic regression models were used to estimate associations between self-reported neighborhood social cohesion and meeting aerobic LTPA guidelines. Models were adjusted for age, sex, education, and acculturation. We also investigated whether associations varied by Latino subgroup. In adjusted models for all Latino adults, compared with those reporting low social cohesion, individuals who reported high social cohesion (Odds Ratio [OR]: 1.33; 95% Confidence Interval [CI]: 1.17–1.52) were significantly more likely to meet the aerobic physical activity guideline. When stratified by Latino subgroups, among Mexican/Mexicans-Americans (OR: 1.39; 95% CI: 1.16, 1.66) and Cuban/Cuban Americans (OR: 1.73; 95% CI: 1.00, 2.97) high social cohesion was associated with meeting the aerobic activity guideline. Among Dominicans, those who reported medium social cohesion (OR: 0.52, 95% CI: 0.29, 0.93) were less likely to meet the aerobic activity guideline. When examining aerobic physical activity outcomes in the Latino population, the role of neighborhood social cohesion and the variability among Latino subgroups should be considered.

25-Year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Objective To evaluate 25‐year physical activity (PA) trajectories from young to middle age and assess associations with the prevalence of coronary artery calcification (CAC). Patients and Methods This study includes 3175 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who self‐reported PA by questionnaire at 8 follow‐up examinations over 25 years (from March 1985‐June 1986 through June 2010‐May 2011). The presence of CAC (CAC>0) at year 25 was measured using computed tomography. Group‐based trajectory modeling was used to identify PA trajectories with increasing age. Results We identified 3 distinct PA trajectories: trajectory 1, below PA guidelines (n=1813; 57.1%); trajectory 2, meeting PA guidelines (n=1094; 34.5%); and trajectory 3, 3 times PA guidelines (n=268; 8.4%). Trajectory 3 participants had higher adjusted odds of CAC>0 (adjusted odds ratio [OR], 1.27; 95% CI, 0.95‐1.70) vs those in trajectory 1. Stratification by race showed that white participants who engaged in PA 3 times the guidelines had higher odds of developing CAC>0 (OR, 1.80; 95% CI, 1.21‐2.67). Further stratification by sex showed higher odds for white males (OR, 1.86; 95% CI, 1.16‐2.98), and similar but nonsignificant trends were noted for white females (OR, 1.71; 95% CI, 0.79‐3.71). However, no such higher odds of CAC>0 for trajectory 3 were observed for black participants. Conclusion White individuals who participated in 3 times the recommended PA guidelines over 25 years had higher odds of developing coronary subclinical atherosclerosis by middle age. These findings warrant further exploration, especially by race, into possible biological mechanisms for CAC risk at very high levels of PA.

Racial/Ethnic Differences in the Associations between Physical Activity and Sleep Duration: A Population-Based Study.

BACKGROUND This study examined associations between physical activity (recreational, nonrecreational) and sleep duration among a nationally representative diverse sample of U.S. adults. METHODS We used cross-sectional data from 9,205 National Health and Nutrition Examination Survey 2007 to 2012 participants aged 20 to 65 years who identified as White, Black, or Hispanic. Activity (ie, recreation, occupation, and transportation activity) was categorized into quartiles. Sleep duration was categorized as short (≤6 hours/night) or normal (>6 to ≤9 hours/night). Logistic regression was used to estimate associations of activity with sleep duration. RESULTS Recommended levels of recreation activity and moderate levels of transportation activity were associated with normal sleep duration [Odds Ratio (OR): = 1.33, 95% Confidence Interval (CI) = 1.08, 1.65; OR = 1.28, 95% CI = 1.02, 1.62, respectively]. High occupation physical activity was associated with shorter sleep duration (OR = 0.59, 95% CI = 0.49, 0.71). Differences were observed by race/ethnicity in associations of recreation and occupation activity with sleep duration. CONCLUSIONS White individuals who engaged in some recreation activity, relative to being inactive, had more favorable sleep duration; whereas, high levels of occupation activity were associated with worse sleep duration among White and Black individuals. Physical activity was not associated with sleep duration among Hispanics.

Susto, Coraje, y Fatalismo: Cultural-Bound Beliefs and the Treatment of Diabetes Among Socioeconomically Disadvantaged Hispanics

Hispanics are disparately affected by diabetes. Treating socioeconomically disadvantaged Hispanics is challenging due to economic and cultural barriers. Health care providers must understand that cultural beliefs about medicine and disease may have an impact on how diabetes treatment is viewed. Concepts such as susto (fright), coraje (anger), and fatalismo (fatalism) are common cultural beliefs. If these beliefs are not well understood by the health care provider, recommendations for treatment are likely to be discarded. To dismantle cultural barriers between the patient and the health care provider, there are several strategies that a health care provider can implement. For instance, a health care provider must develop trust with the patient. The health care provider could also engage a family member or promotora or promotor (community health worker) in the conversation. Furthermore, if the cultural barriers are significant, the patient may be best served by receiving treatment from someone with a better understanding of his or her background. Thus, a referral may be appropriate.

Gender Differences in the Association Between Alcohol Use and Sedentary Behavior Among Adults

Purpose: We examined differences in the association between alcohol use and sedentary behavior by gender among adults. Design: Cross-sectional study that employs a complex, multistage stratified probability cluster sample design. Setting: National Health and Nutrition Examination Survey (NHANES) 2007 to 2014. Participants: NHANES participants aged ≥20 years and identifying as Hispanic, white, or black (N = 18 441). Measures: Demographic characteristics, sedentary behavior, and alcohol consumption. Sedentary behavior was measured based on the number of minutes of sedentary activity per week. Alcohol consumption in the last year was measured based on responses to items assessing whether the participant consumes alcoholic beverages and the number of alcoholic beverages consumed on average. Analysis: Multinomial logistic regression analysis was used to estimate associations of alcohol use with categories of sedentary behavior by gender. Results: Compared to women who reported not consuming alcohol, women who were heavy drinkers were significantly more likely to engage in high sedentary activity (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.16-1.87), relative to low levels of sedentary activity. Similarly, women who were binge drinkers were more likely to engage in moderate levels of sedentary activity (OR: 1.39; 95% CI: 1.05-1.85). There were no significant associations between alcohol use and sedentary activity among men. Conclusion: Findings suggest that alcohol consumption should be considered in health promotion efforts targeting sedentary behavior among women.

The Association of Prediabetes and Diabetes Risk Perception With Leisure-Time Physical Activity and Weight Loss

Purpose: To examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and determine whether the association of risk perception with LTPA and weight loss varies by race/ethnicity. Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey (NHANES) 2011-2014. Subjects: Non-Latino white, non-Latino black, and Latino nondiabetic and nonprediabetic NHANES participants ≥18 years of age who were not underweight (n = 9550). Measures: Demographic characteristics, LTPA, attempted weight loss, and perceived risk of prediabetes or diabetes. Analysis: Log-binomial regression models were fit to assess the association of perceived risk with meeting LTPA recommendations and having attempted to lose weight, overall and by race/ethnicity. Results: Individuals reporting that they perceived they could be at risk for diabetes/prediabetes were less likely to meet LTPA recommendations (adjusted prevalence ratio [aPR]: 0.87; 95% confidence interval [CI]: 0.79-0.95), but significantly more likely to report attempting weight loss in the past year (aPR: 1.14; 95%CI: 1.04-1.25), compared with those reporting no risk perception. Latino and non-Latino blacks who perceived they could be at risk for diabetes/prediabetes were 25% and 35% more likely to report trying to lose weight in the past year (aPR: 1.25; 95% CI: 1.08-1.44 and aPR: 1.35; 95% CI: 1.19-1.54, respectively), compared with Latino and non-Latino blacks that did not perceive being at risk. In contrast, non-Latino whites who perceived they were at risk were 20% less likely to report meeting LTPA recommendations (aPR: 0.80; 95% CI: 0.72-0.89), compared with non-Latino whites reporting no risk perception. Conclusion: Findings highlight the role of perceived risk for prediabetes and diabetes in LTPA and weight loss, with findings varying by race/ethnicity. Awareness of prediabetes and diabetes risk could contribute to efforts aimed at improving LTPA and weight loss.