Trends in gestational weight gain: the Pregnancy Risk Assessment Monitoring System, 2000-2009.

OBJECTIVE: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. We estimate current population-based trends of GWG. STUDY DESIGN: We analyzed data from the Pregnancy Risk Assessment Monitoring System for 124,348 women who delivered live infants in 14 states during 2000 through 2009. We examined prevalence and trends in GWG in pounds as a continuous variable, and within 1990 Institute of Medicine (IOM) recommendations (yes/no) as a dichotomous variable. We examined adjusted trends in mean GWG using multivariable linear regression and GWG within recommendations using multivariable multinomial logistic regression. RESULTS: During 2000 through 2009, 35.8% of women gained within IOM GWG recommendations, 44.4% gained above, and 19.8% gained below. From 2000 through 2009, there was a biennial 1.0 percentage point decrease in women gaining within IOM GWG recommendations (P trend < .01) and a biennial 0.8 percentage point increase in women gaining above IOM recommendations (P trend < .01). The percentage of women gaining weight below IOM recommendations remained relatively constant from 2000 through 2009 (P trend = .14). The adjusted odds of gaining within IOM recommendations were lower in 2006 through 2007 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) and 2008 through 2009 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) relative to 2000 through 2001. CONCLUSION: Overall, from 2000 through 2009 the percentage of women gaining within IOM recommendations slightly decreased while mean GWG slightly increased. Efforts are needed to develop and implement strategies to ensure that women achieve GWG within recommendations.

Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk?

OBJECTIVE: To examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community. METHODS: Multilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. INDEPENDENT VARIABLES: neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: neighborhood and individual demographics, health-related behaviors. RESULTS: Observed and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR. CONCLUSIONS: Findings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR.

Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways.

OBJECTIVES: We examined relationships between neighborhood poverty and allostatic load in a low- to moderate-income multiracial urban community. We tested the hypothesis that neighborhood poverty is associated with allostatic load, controlling for household poverty. We also examined the hypotheses that this association was mediated by psychosocial stress and health-related behaviors. METHODS: We conducted multilevel analyses using cross-sectional data from a probability sample survey in Detroit, Michigan (n = 919) and the 2000 US Census. The outcome measure was allostatic load. Independent variables included neighborhood and household poverty, psychosocial stress, and health-related behaviors. Covariates included neighborhood and individual demographic characteristics. RESULTS: Neighborhood poverty was positively associated with allostatic load (P < .05), independent of household poverty and controlling for potential confounders. Relationships between neighborhood poverty were mediated by self-reported neighborhood environment stress but not by health-related behaviors. CONCLUSIONS: Neighborhood poverty is associated with wear and tear on physiological systems, and this relationship is mediated through psychosocial stress. These relationships are evident after accounting for household poverty levels. Efforts to promote health equity should focus on neighborhood poverty, associated stressful environmental conditions, and household poverty.

Ethnicity, nativity, and the health of American Blacks.

There have been few empirical studies of ethnic differences in health within the American Black population. Logistic regressions were used to examine the relationships among ethnicity, nativity, depressive symptoms, and physical health in the two largest ethnic groups of American Blacks, African Americans and Caribbean Blacks. The data were from the National Survey of American Life, a national household survey representative of the non-institutionalized U.S. Black population. We found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition: Caribbean-born Blacks had the best health outcomes and U.S.-born Caribbean Blacks had the worst. This finding remained significant even after considering self-reported depressive symptoms. This study highlights the importance of considering ethnic diversity, nativity and immigration as independent sources of variation in health status within the American Black population.

Cultural context and a critical approach to eliminating health disparities.

The science of eliminating racial health disparities requires a clear understanding of the underlying social processes that drive persistent differences in health outcomes by self-identified race. Understanding these social processes requires analysis of cultural notions of race as these are instantiated in institutional policies and practices that ultimately contribute to health disparities. Racism provides a useful framework for understanding how social, political and economic factors directly and indirectly influence health outcomes. While it is important to capture how individuals are influenced by their psychological experience of prejudice and discrimination, racism is more than an intrapersonal or interpersonal variable. Considerable attention has focused on race-based residential segregation and other forms of institutional racism but less focus has been placed on how cultural values, frameworks and meanings shape institutional policies and practices. In this article, we highlight the intersection of cultural and institutional racism as a critical mechanism through which racial inequities in social determinants of health not only develop but persist. This distinction highlights and helps to explain processes and structures that contribute to racial disparities persisting across time and outcomes. Using two historical examples, the National Negro Health Movement and hospital desegregation during the Civil Rights Era, we identify key questions that an analysis of cultural racism might add to the more common focus on overt policy decisions and practices.

Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students.

BACKGROUND: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States. METHODS: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2). RESULTS: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not. CONCLUSION: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Using national data sets to improve the health and mental health of Black Americans: challenges and opportunities.

National datasets provide a unique opportunity to examine racial and ethnic disparities in health and mental health. In this article, the authors discuss some of the ways in which national datasets can facilitate our understanding of key pathways and mechanisms that explain racial and ethnic disparities and some of the conceptual and measurement issues that continue to hinder disparities research. Utilizing infant mortality and major depression as examples, the authors illustrate the complexity of studying racial and ethnic health and mental health disparities and argue that more thought and precision be utilized to study and explain these differences. Specifically, the authors argue that it is critical to disentangle population-level factors and individual-level characteristics to advance our understanding of disparities. The authors also contend that it is important for researchers to recognize the reciprocal relationship between the theoretical foundations and methodological innovations that must be integrated to effectively examine disparities. The authors conclude by discussing some of the benefits of researchers utilizing national databases that hold particular promise for addressing racial and ethnic disparities.