Spiritual influences on ability to engage in self-care activities among older African Americans.

The influence of spiritual factors on the ability of African-American elders to carry out instrumental activities of daily living (IADL) independent of age, gender, education, and self-rated health is explored using the religion-health explanatory model in a cross-sectional sample of 96 African-American community dwelling adults 62 to 93 years of age. The Reed spiritual perspective (SPS) and self-transcendence (STS) scales are used to study spiritual factors (Reed, 1991). The typical respondent was 75 years of age, female, widowed with 10.4 years of education. Self-rated health and age are strongly related to IADL in models that include the other variables (R2 = 0.41, p < 0.01). Those who are younger and those who self-report better health have higher IADL scores than those without these characteristics. Spiritual factors are significantly related to IADL in a model that includes an interaction of STS with education (R2= 0.50). Among the least educated, STS is associated with higher scores of IADL. Addition of the interaction to the model resulted in a significant positive association of both STS and education with IADL. SPS was unrelated to IADL. Caregivers concerned with functional ability may want to consider interventions based on increasing a sense of self-transcendence, and to consider educational level as a potential moderator of this relationship. Criticism of the religion-health literature has suggested that putative health effects of religion may be exaggerated, because of failure to take confounding variables into account (Sloan, Bagiella, & Powell, 1999). However, this study and a recent survey by Musick, House, and Williams (2004) are evidence that it is just as likely that health benefits of religion would be hidden by confounders as that they would be exaggerated by them.

Developmental, gender, and ethnic group differences in moods and ambulatory blood pressure in adolescents.

BACKGROUND: Adolescence is characterized by profound changes in physical, psychological, and social functioning thought to be accompanied by intense and varying moods. PURPOSE: Within a psychophysiological framework, this study examined the prevalence of 12 self-reported mood states of adolescents; investigated associations between specific mood states and ambulatory blood pressure readings; and explored effects of interactions among moods, gender, ethnic group, and maturation on ambulatory blood pressures. METHODS: The sample included 371 African American, European American, and Hispanic American adolescents 11 to 16 years old. Systolic (SBP) and diastolic (DBP) blood pressures were measured every 30 min with an ambulatory monitor and were synchronized with electronic activity monitoring and moods self-recorded during waking hours in a checklist diary. RESULTS: Moods differed significantly by gender, ethnic group, and maturation. Controlling for height, maturation, gender, ethnic group, mother's education, position, location, activity, other moods, and interactions of moods with other variables in a multilevel, random coefficients regression model, both positive and negative mood states were associated with higher levels of SBP and DBP; being relaxed or bored, or having a feeling of accomplishing things were associated with lower SBP and DBP. There were significant interaction effects of moods with physical maturity, gender, and ethnic group on ambulatory SBP and DBP. CONCLUSIONS: Further study of the modifying effects of gender, ethnic group, and stage of development on reports of moods, and their associations with cardiovascular responses is recommended.

Percentiles of body composition from bioelectrical impedance and body measurements in U.S. adolescents 8-17 years old: Project HeartBeat!

Reference percentiles (5th, 10th, 50th, 85th, 90th, and 95th) of black and nonblack children ages 8-17 years from Project HeartBeat! (n = 678) are presented for body mass index (BMI), percent body fat (PBF), fat-free mass (FFM), and fat mass (FM) derived from bioelectrical impedance. Project HeartBeat! is a mixed longitudinal study in which three cohorts of children (seen initially at age 8, 11, or 14 years) were followed for 4 years and measured thrice-yearly from 1991 through 1995. Weight, height, and BMI of Project HeartBeat! children are similar in central tendency and variability to those of nationally representative samples for nonblack children but not black children, for whom there is an excess of children at or above the 95th percentile for weight and BMI. Values of PBF above which cardiovascular risk variables increase (as suggested in the literature) are located at the 85th percentile of the Project HeartBeat! distributions. This percentile of PBF may be tentatively considered as a cutoff point with epidemiological significance for children.

Migration history, health behaviors, and cardiovascular disease risk factors in overweight Mexican-American women.

PURPOSE: This research examined whether the migration history of overweight Mexican-American women had an independent effect on cardiovascular risk factors, or whether it was mediated by health behavior changes. DATA AND METHODS: Cross-sectional data from 390 overweight, non-diabetic Mexican-American women (aged 18 to 65 years), all recruited from Starr County, Texas, were used for this analysis. Migration history was inferred from birthplaces of subjects and relatives, and length of residence in the United States. Health behaviors included tobacco and alcohol use, sleeping, exercise, and dietary practices. The cardiovascular disease risk factor variables (CDRFVs) studied were plasma glucose, abdominal obesity, blood pressures, and blood lipids. A migration history score (MHS) was developed from factor analysis, almost equally contributed to by the 9 migration history variables. Healthy habits were defined by 6 variables, and 3 factors (blood pressures, lipids/glucose, and body fat/glucose) were used for the CDRFVs. FINDINGS AND CONCLUSION: MHS was correlated positively with socioeconomic status, and negatively with family stress. Older women had healthier drinking and sleeping habits. Women with a higher migration history score exhibited poorer exercise habits, and increased blood pressures. After adjusting for the effect of healthy exercise habits on blood pressures, the impact of migration history on blood pressures became non-significant (P>.05), leading to the conclusion that healthy exercise behaviors mediated the negative relationship of MHS with blood pressures. Age was independently positively correlated with all CDRFVs. Age also weakly moderated the negative relationship of MHS and healthy exercise habits.

Anger in adolescents: sex, ethnicity, age differences, and psychometric properties.

BACKGROUND: The State-Trait Anger Expression Inventory (STAXI), a self-report questionnaire, is designed to measure the experience and expression of anger. Reliability and validity of the STAXI have been well established among African and European Americans aged 13 years and older. However, little is known of the use of this instrument among adolescents younger than 13 years and Hispanic American adolescents. OBJECTIVES: Objectives were (a) to test ethnic, sex, and age group differences in STAXI scores in a sample of 11-to-16-year-old African, Hispanic, and European American adolescents; and (b) to assess the psychometric properties of the STAXI among these same adolescents with special emphasis on Hispanic youths, for whom no data are available. METHODS: A cross-sectional design was used with stratified quota sampling techniques. Participants (N = 394) were African, Hispanic, and European Americans aged 11-16 years and were drawn from one public middle school and two public high schools in Houston, Texas. RESULTS: Internal consistency reliability for the anger scales (STAXI) ranged from 0.61 (anger-in) to 0.91 (state-anger) for the younger group (aged 11-13 years), and 0.68 (anger-in) to 0.88 (state-anger) for the older Hispanic Americans (aged 14-16). No notable differences were seen among the three ethnic groups in regards to internal consistency. Results of factor analyses of the five anger scales were similar to those reported originally by the scale author. Ethnicity and age had statistically significant main effects on the anger scales, and there was only one interaction. DISCUSSION: The use of the STAXI among a tri-ethnic adolescent population is warranted. The anger-in scale may be less reliable, especially among younger adolescents.

Healthy Growth: project description and baseline findings.

OBJECTIVES: The purpose of the study was to describe the physical activity, blood pressure, and body fat patterns of sixth-grade, African-American girls (N = 82), who participated in the Healthy Growth Study. The purpose of the primary study questions was to determine which sets of variables best predict blood pressure, physical activity, and body fat. DESIGN AND METHODS: This paper is a cross sectional analysis of the first assessment of a 5-year longitudinal project. Standard procedures were used to assess height, weight, skinfolds, blood pressure, physical activity, predictors of physical activity, maturation, dietary intake, fitness level, and health behaviors. RESULTS: The average age of the subjects was 12.3 years; almost two-thirds of the girls had reached menarche. Fifty-two percent of the 13-year-olds had body mass index (BMI) values greater than the 85th percentile for their age and sex compared to 32% of the 12-year-olds. None of the variables were significantly related to diastolic or systolic blood pressure. Physical activity was significantly and negatively related to total percent of calories from fat and to breast stages and positively related to waist/thigh ratio. Body mass index (BMI) was significantly and positively related to breast stages. CONCLUSIONS: Important developmental differences between 12- and 1 3-year-olds were evident. Body mass index (BMI) was mainly dependent on physical maturity. No relationship was found between BMI and blood pressure. The relationship between physical activity and waist/thigh ratio merits further study. The importance of BMI and physical inactivity as potential indicators of cardiovascular risk in adolescent girls is discussed. Developmentally appropriate and culturally competent interventions are recommended to increase physical activity and healthy eating behaviors among adolescents.

Longitudinal analysis of changes in indices of obesity from age 8 years to age 18 years. Project HeartBeat!

To compare growth patterns of obesity indices derived from body composition and anthropometric measures, the authors analyzed data from Project HeartBeat!, a longitudinal study of cardiovascular disease risk factors in childhood and adolescence. A total of 678 children initially aged 8, 11, and 14 years in The Woodlands and Conroe, Texas, were enrolled and followed with 4-monthly examinations between October 1991 and August 1995. Trajectories of change from age 8 years to age 18 years were estimated for body mass index, percent body fat, abdominal circumference, the sum of two skinfolds, and the sum of six skinfolds. All indices varied importantly with age. Percent body fat, sum of two skinfolds, and sum of six skinfolds shared similar growth patterns, with strong divergence between males and females. Males' body fat decreased with age and females' increased or remained nearly constant with age. In contrast, both body mass index and abdominal circumference increased monotonically with age in both sexes, exhibiting little sex difference as children reached late adolescence. Sex differences were more striking among Blacks than among non-Blacks. The authors conclude that growth patterns of adiposity differ according to the measure chosen. Furthermore, changes in different obesity indices may not relate in the same way to changes in blood pressure or blood lipid concentrations.

Is obesity associated with poor sleep quality in adolescents?

Obesity has reached epidemic proportions in the U.S. and more developed countries, particularly so among adolescents. A substantial impact on public health could be achieved if other factors causing obesity besides the conventional ones of diet and physical activity could be identified and acted upon. The present study investigates whether there is a link between low sleep quality and obesity in a tri-ethnic, cross-sectional sample (n = 383) of male and female adolescents ages 11-16 years old (Heartfelt Study). Sleep quality was expressed as two variables, total sleep time and sleep disturbance time obtained by 24-hour wrist actigraphy. Percent body fat and body mass index (BMI) were used together to define obesity. The potential influence of demographic and behavioral confounders were considered in models that described the relation of sleep to obesity occurrence. Obese adolescents experienced less sleep than nonobese adolescents (P < 0.01). For each hour of lost sleep, the odds of obesity increased by 80%. Sleep disturbance was not directly related to obesity in the sample, but influenced physical activity level (P < 0.01). Daytime physical activity diminished by 3% for every hour increase in sleep disturbance. The above observations were independent of potential confounding variables. Inadequate and poor sleep quality in adolescents may be important factors to consider in the prevention of childhood obesity.

Body measurement variability, fatness, and fat-free mass in children 8, 11, and 14 years of age: Project HeartBeat!

Project HeartBeat! is a four year mixed-longitudinal study of the development of cardiovascular risk factors in White and African American children who at baseline comprised three age cohorts 8, 11, and 14 years. This paper focuses on the anthropometric variables which were chosen to reflect body fat and fat-free mass. Selected anthropometric dimensions are compared with those of samples from the combined National Health and Nutrition Examination Surveys I and II to explore the similarities of the samples in terms of central tendencies and variances. The measurements were then explored in terms of their ability to estimate the two compartment model of body composition: fat-free mass (FFM) and body fat (BF) from bioelectrical impedance (BIA). Project HeartBeat! children are slightly larger than NHANES children and have variances that are generally comparable to the national surveys. Over seven percent (7.7%) of children were overweight (BMI) and 25% had 'mild obesity' by %BF. Three different factor analytic methods (incomplete principal components, alpha and maximum likelihood) produced two latent variables from 17 anthropometric dimensions which together accounted for 76-83% of the variation: (1) A body mass factor (F1) which was weighted highly on six circumferences, weight and six skinfolds, and (2) a linear growth factor (F2) which was strongly associated with height, arm length, and sitting height. Triceps, subscapular and midaxillary skinfolds were consistently highly loaded on the body mass factor and their sum was highly correlated to %BF and fat mass (0.90-0.99). This suggests that this sum could be used to estimate fatness in children in studies where the BIA or other body composition techniques are unavailable. FFM and %BF were predicted from the anthropometric factors. Both factors contributed to the estimate of FFM (R(2) = 0.81-0.93), although F2 contributed proportionately more. The 'body mass' factor (F1) was the main predictor of %BF (R(2) = 0.86-0.93), though at some ages the linear factor (F2) was significantly and negatively related to %BF. This set of anthropometric dimensions, taken for the purpose of estimating body composition and summarized as two latent vectors by factor analysis, strongly reflects body fat and FFM in children and adolescents. Am. J. Hum. Biol. 11:69-78, 1999. Copyright 1999 Wiley-Liss, Inc.

Role of infant feeding practice, sex, and age on fatness and subcutaneous fat distribution in infancy: Longitudinal analysis of multiple skinfold measurements.

The aim of this study was to determine whether subcutaneous fatness and fat distribution differ on the basis of feeding practice and sex during the first 6 months of life. Longitudinal principal components analysis (PCA) was done on skinfolds measured at five sites in 45 breast-fed and 41 formula-fed infants. The first component represented fatness, the second component change in fatness, and the third component upper body/lower body fat distribution. Analysis of the components indicated that fatness and the proportion of lower body fat were greater in breast-fed than in formula-fed infants; however, when race was included as a predictor, the differences in lower body fat did not persist. The interpretation of components and the group differences were confirmed by repeated measures analysis of variance (ANOVA) on the sum of skinfolds (fatness) or simple skinfold ratios (fat distribution). Group differences for fatness and upper body/lower body fat persisted when race was included as a predictor. Longitudinal PCA of another indicator, the Rohrer index, suggested that fatness was greater in formula-fed than breast-fed infants. Collectively, these findings suggest that formula-fed infants have less subcutaneous fat than breast-fed infants; however, formula-fed infants may have either more internal fat or more lean body mass. Am. J. Hum. Biol. 9:179-190, 1997. © 1997 Wiley-Liss, Inc.

Conicity: A new index of body fat distribution-what does it tell us?

"Conicity" (C) is an index of body fat distribution which expresses an individuals waist circumference relative to the circumference of a cylinder generated with that persons weight and height assuming a constant for body density (Valdez [1991] J. Clin. Epidemiol. 44:955-956). The more central a person is in fat distribution, the higher the value of C. In a pilot study of cardiovascular reactivity and dimensions of anger and hostility in 60 African-, Anglo-, and Hispanic-American adolescents, anthropometry and sexual maturation were determined to assess their mediating influence on the relation between anger and cardiovascular risk. The concurrent validity of three indices of body fat distribution was explored: conicity(C), waist/hip ratio (WHR), and central/peripheral skinfold ratio (C/P) by assessing their association with cardiovascular variables (CV) and other anthropometrics. Anthropometry included height, weight, fat mass estimated from bioelectrical impedance, four circumferences, and skinfolds. Maturation variables included menarche in girls, testes size in boys, and pubic hair in both sexes. Cardiovascular variables included resting diastolic and systolic blood pressures and heart rate, and the same three variables after recovery from a step test. The boys and girls were 15-16 years of age, and there were equal numbers in each sex/ethnic group. Partial correlations accounting for height (which was affected by ethnicity) and maturation stratified by gender are reported. C was more strongly related to CV risk in boys and girls than the other indices or the body mass index. Least related to CV risk was C/P, correlated only weakly to central skinfold fat. C and WHR are highly related (0.85) yet differ in important respects in both sexes: C is more closely related to body fat (0.62-0.66) and fat mass (0.53-0.77) than the WHR (respective correlations: 0.54-0.55 and 0.43-0.66). Thus, C relates not only to body shape but also to body fat. Indices of central fat such as circumference and skinfold ratios, may "over-correct" for total fatness and thus miss important aspects of risk prediction. Conicity may be a useful indicator of body fat distribution in studies of adolescents. © 1996 Wiley-Liss, Inc.

Precision of measuring body fat distribution in adolescent African American girls from the 'healthy growth study'.

Precision estimates are given for anthropometric assessment of body fat distribution in participants (n = 86) of the Healthy Growth Study (total n = 154). This five year longitudinal study explored the psychosocial and biologic influences on activity levels in urban adolescent African American girls. The basic anthropometric data include height, weight, four body and limb circumferences, and five skinfold measurements. It is proposed that ratio indices of body fat distribution are likely to have poorer precisions than the single variables which they comprise, and that ratios based on skinfolds may be particularly sensitive to this problem. The precision of the body mass index (BMI) and principal components of skinfold fatness and fat distribution are also considered. Precisions were greater than 0.95 (intraclass correlation from a random-effects analysis of variance) for most anthropometric dimensions and indices, including the BMI and the first principal component of fatness. However, three of the five skinfolds had lower precisions (0.84-0.93). In contrast, the precisions of all indices of body fat distribution were 0.90 or less (range: 0.57-0.87 skinfold ratios; 0.83-0.90 circumference ratios). Of the ratios, conicity was most stable at 0.90 for repeated measures by both the same and different observers. A second principal component of central fat did not have precisions noticeably better than skinfold ratios (0.79-0.82). Indices of fat distribution may have lower reliabilities than the single variables that they comprise, because errors may be compounded when dividing one variable by another or in linear combinations of measurements other than the first principal component. This problem should be taken into account in clinical and epidemiologic investigations of body fat distribution. © 1996 Wiley-Liss, Inc.

Precision of the one- versus two-handed method of skinfold measurement in the obese.

Skinfolds at five anatomic sites were measured on 47 subjects in a study of gallbladder disease in Starr County, Texas, by two methods, one and two handed. A comparison was made of the two methods as to bias and precision. There were statistically significant but biologically unimportant differences (on the order of 1-2 mm) at four of the five sites. At three of these, the two-handed method gave larger values (lower thigh, triceps, and subscapular), and at the other site (medial calf) this method produced smaller values on average. Measurement precision was improved using the two-handed method at three of the five sites, significantly so for the triceps skinfold. Measuring skinfolds with two hands improves the precision of measurement for some skinfold sites in obese individuals. It does not introduce important and systematic biases across skinfold sites. Adoption of this technique should be used when circumstances outweigh the cost of involving an extra observer in the measurement of skinfold thickness, such as when precision is very important and when subjects are obese. © 1995 Wiley-Liss, Inc.

Obesity and upper body fat distribution in Mexican American children from families with a diabetic proband.

Upper and centralized body fat distribution is associated with non-insulin dependent diabetes mellitus (NIDDM). Few studies have focused on anthropometric characteristics of preadults from families in which there is a diabetic (NIDDM) proband. This study explores the prevalence of upper and centralized body fatness in Mexican American children from the Diabetes Alert study (1981-1983) in Starr County, Texas. Anthropometric data on 165 males and 224 females 9-19 years include measures of adiposity such as skinfold thicknesses and the body mass index (BMI), a measure of overweight. They show rates of obesity two to three times that of White children of comparable age and sex from National Health Surveys. In comparison with U.S. White subjects, Mexican American adults are shorter, have more adiposity and arm muscle mass and have sitting heights and body breadths at the mean of these dimensions for the U.S. POPULATION: Children from Diabetes Alert families show only marginal excess of severe obesity (> 95th percentile of BMI) when compared to the general population of children surveyed in Starr County schools. Girls from these families, but not boys, have excess fatness in the BMI compared to Mexican American children from the Hispanic Health and Nutrition Examination Survey (HHANES); suprailiac skinfold thicknesses are also greater in children of the Diabetes Alert study than in HHANES children. From 1972 through 1982, Mexican American children in South Texas showed an increase in average stature, weight, and the BMI. These data together suggest that excessive obesity exists and may be increasing in children in populations at risk for NIDDM. The prevention of NIDDM in the Mexican American population may be more effective if educational and promotional interventions include the school aged population. © 1993 Wiley-Liss, Inc.

Body fat distribution and job stress in Mexican-American men of the hispanic health and nutrition examination survey.

A positive relationship between psychosocial stress and central body fat distribution has been hypothesized. To test this hypothesis, two indices derived from principal components analysis of four skinfold measurements were studied in relation to imputed job stress characteristics (decision latitude, skill discretion, decision authority, and psychological demands) in Mexican-American men of the U.S. Hispanic Health and Nutrition Examination Survey (HHANES). The two indices were fatness and central body fat distribution. Fatness was not significantly associated with any of the job stress characteristics before controlling for education. Once education was included in the equations, however, the relationship between fatness and two of the four job stress variables (decision authority and psychological demands) became statistically significant. Thus, for a given level of education, increasing job stress was associated with increasing fatness. Three of the four job stress characteristics were significantly associated with central body fat distribution before controlling for education. However, after education was entered into the regression equations as a proxy for social class, the relationships between central body fat distribution and the job stress variables were no longer significant. It thus appears that aspects of social class other than job stress are of equal or greater importance in predicting body fat distribution. © 1992 Wiley-Liss, Inc.

Body fat distribution: Associations with socioeconomic status in the Hispanic health and nutrition examination survey.

Three indices derived from principal components analysis of four skinfold measurements were studied in relation to socioeconomic status (SES; income and education) in men and women of the U.S. Hispanic Health and Nutrition Examination Survey (HHANES). The three indices were fatness (PC1), central body fat distribution (PC2), and "centralized obesity" (PC1 + PC2). The well-known inverse relation of fatness (PC1) with SES was demonstrated in women. This relationship tended to be positive in men, but not consistently so within the three Hispanic groups (Puerto Rican, Cuban, Mexican-Americans) studied. A negative association of central body fat distribution (PC2) was also evident in both sexes and in all three groups except in Puerto Rican men, in whom the relationship was no longer significant after age adjustments. The third index combined information on both fatness level and central distribution. It was strongly related to SES in women but not in men.

Body circumferences as measures of body fat distribution in 10-14-year-old schoolchildren.

In this paper the hypothesis is tested that circumferences are as useful as skinfolds in children aged 10-14 years to detect variation in regional fat distribution. This would be confirmed by the appearance of a significant canonical correlation between a vector of appropriately selected circumferences and an analogous vector of skinfolds, producing a weighted pattern suggestive of centralized obesity (that is a series of mathematical weights of different signs for central versus peripheral regions of the body). The hypothesis is confirmed (P < 0.01) in this sample of 378 children of both sexes. The association occurs in the second canonical correlation after a strong first canonical correlation providing information about fatness level (0.83-0.87). The canonical correlations are low (0.29 in boys, 0.36 in girls), lower than has previously been reported in a similar study of adults. The circumferences most heavily weighted in opposite directions are the waist and thigh. These results are in accord with adult studies. This study did not support the use of the waist-hip circumference combination, the measures currently used in most epidemiologic studies of body fat distribution.