Race/ethnicity, socioeconomic status and obesity across the transition from adolescence to adulthood

Although racial/ethnic minorities in the U.S. have higher rates of obesity than whites throughout the life course, these disparities increase dramatically during the transition from adolescence to adulthood, a period of complex changes in schooling, employment, residence and social roles. Minority adolescents have higher obesity at all levels of parental income and education, and further, these disparities widen at higher parental socioeconomic status (SES). Such findings provoked our desire to go beyond simple measures of parental SES to better capture important facets of SES exposure for obesity development in minorities, and to investigate whether the association between better conceptualized measures of SES and obesity truly differ by race/ethnicity, i.e. do racial/ethnic minorities receive fewer health benefits from higher SES? We explored these issues using a rich set of parental and young adult socioeconomic data from the National Longitudinal Study of Adolescent Health, a nationally representative, racial/ethnically-diverse study following U.S. adolescents with multiple interview waves into adulthood. Using factor analysis to identify SES dimensions of unique relevance to the young adult context, we found that the high status milieu of "social capital" was associated with reduced young adult obesity for white and Hispanic females only, while "schooling" reduced obesity risk in all females. We then used latent class analysis to characterize the heterogeneity of combinations of parental and young adult SES, revealing detailed subtypes of life course SES exposure to "disadvantage." Although we demonstrated important gender differences in the association of these SES exposure groups with longitudinal patterns of obesity across the transition to adulthood, these relationships did not differ substantially by race/ethnicity. Further, obesity trends remained higher in racial/ethnic minorities across life course SES groups, underscoring the need to identify social forces beyond SES that shape these disparities earlier in life. Overall, these findings highlight several dimensions of young adult SES that present opportunities for efforts to reduce racial/ethnic disparities in young adult obesity, as well as groupings of life course SES from the parent to young adult that may provide important avenues to reduce obesity for all racial/ethnic and gender groups during this complicated stage of the life course

Obesity, race/ethnicity and the multiple dimensions of socioeconomic status during the transition to adulthood: A factor analysis approach

Racial/ethnic disparities in obesity widen dramatically during young adulthood in the US. Understanding racial/ethnic differences in the association between socioeconomic status (SES) and obesity can provide insight on these disparities. However, the delay and complexity of the transition to adulthood creates challenges for defining SES using traditional, single indicators, such as income or years of education. Our objective was to define a multidimensional measure of young adult SES using exploratory factor analysis and to investigate whether distinct SES dimensions differentially predicted obesity across race/ethnicity in 11,250 young adults (mean age = 21.9 years) from the National Longitudinal Study of Adolescent Health (Wave III: 2000–2001). Four factors (social advantage; schooling; employment; and economic hardship) extracted from a principal factor analysis on 38 SES indicators comprised our multidimensional measure of young adult SES. The respondents’ scores on each factor were entered into gender-stratified Poisson regression models to estimate the relative risk of young adult obesity for a contrast of approximately one standard deviation in score. The association of the “Social advantage” and “Economic hardship” factors with obesity differed by race/ethnicity (p<0.05 for Wald test of interaction) in females; high “Social advantage” scores were inversely associated with obesity in white and Hispanic females (9–20% lower) while high scores on “Economic hardship” were positively associated with obesity (7–76% higher) in white and Asian females. In contrast, no significant racial/ethnic differences were detected in young adult males. The “Schooling” factor was significantly protective (RR=0.91; 95% CI: 0.85, 0.98) for females of all racial/ethnic groups. These results facilitate understanding of the impact of multiple, distinct SES dimensions during the complex transition to adulthood and thus provide salient information for reducing racial/ethnic disparities in obesity during this important period for obesity development

Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults

<p>Abstract</p> <p>Background</p> <p>Weight misperception might preclude the adoption of healthful weight-related attitudes and behaviors among overweight and obese individuals, yet limited research exists in this area. We examined associations between weight misperception and several weight-related attitudes and behaviors among a nationally representative sample of overweight and obese US adults.</p> <p>Methods</p> <p>Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used. Analyses included non-pregnant, overweight and obese (measured body mass index ≥ 25) adults aged 20 and older. Weight misperception was identified among those who reported themselves as "underweight" or "about the right weight". Outcome variables and sample sizes were: weight-loss attitudes/behaviors (wanting to weigh less and having tried to lose weight; n = 4,784); dietary intake (total energy intake; n = 4,894); and physical activity (meets 2008 US physical activity recommendations, insufficiently active, and sedentary; n = 5,401). Multivariable regression models were stratified by gender and race/ethnicity. Analyses were conducted in 2009-2010.</p> <p>Results</p> <p>These overweight/obese men and women who misperceived their weight were 71% (RR 0.29, 95% CI 0.25-0.34) and 65% (RR 0.35, 95% CI 0.29-0.42) less likely to report that they want to lose weight and 60% (RR 0.40, 95% CI 0.30-0.52) and 56% (RR 0.44, 95% CI 0.32-0.59) less likely to have tried to lose weight within the past year, respectively, compared to those who accurately perceived themselves as overweight. Blacks were particularly less likely to have tried to lose weight. Weight misperception was not a significant predictor of total energy intake among most subgroups, but was associated with lower total energy intake among Hispanic women (change -252.72, 95% CI -433.25, -72.18). Men who misperceived their weight were less likely (RR 0.68, 95% CI 0.52-0.89) to be insufficiently active (the strongest results were among Black men) and women who misperceived their weight were less likely (RR 0.74, 95% CI 0.54, 1.00, <it>p </it>= 0.047) to meet activity recommendations compared to being sedentary.</p> <p>Conclusion</p> <p>Overall, weight misperception among overweight and obese adults was associated with less likelihood of interest in or attempts at weight loss and less physical activity. These associations varied by gender and race/ethnicity. This study highlights the importance of focusing on inaccurate weight perceptions in targeted weight loss efforts.</p

Intergenerational Profiles of Socioeconomic (Dis)advantage and Obesity During the Transition to Adulthood

Investigations of socioeconomic status (SES) and health during the transition to adulthood in the United States are complicated by the later and more varied transitions in residence, employment, schooling, and social roles compared with previous generations. Parental SES is an important influence during adolescence but cannot sufficiently capture the SES of the independent young adult. Typical, single SES indicators based on income or education likely misclassify the SES of young adults who have not yet completed their education or other training, or who have entered the labor force early with ultimately lower status attainment. We use a latent class analysis (LCA) framework to characterize five intergenerational SES groups, combining multidimensional SES information from two time points—that is, adolescent (parental) and young adult (self) SES data. Associations of these groups with obesity, a high-risk health outcome in young adults, revealed nuanced relationships not seen using traditional intergenerational SES measures. In males, for example, a middle-class upbringing in adolescence and continued material advantage into adulthood was associated with nearly as high obesity as a working poor upbringing and early, detrimental transitions. This intergenerational typology of early SES exposure facilitates understanding of SES and health during young adulthood

Will the Public's Health Fall Victim to the Home Foreclosure Epidemic?

Gary Bennett and colleagues discuss the ways in which the dramatic rise in home foreclosures, particularly in the US, may have health consequences

Obesity, race/ethnicity and the multiple dimensions of socioeconomic status during the transition to adulthood: A factor analysis approach

Racial/ethnic disparities in obesity widen dramatically during young adulthood in the US. Understanding racial/ethnic differences in the association between socioeconomic status (SES) and obesity can provide insight on these disparities. However, the delay and complexity of the transition to adulthood create challenges for defining SES using traditional, single indicators, such as income or years of education. Our objective was to define a multidimensional measure of young adult SES using exploratory factor analysis and to investigate whether distinct SES dimensions differentially predicted obesity across race/ethnicity in 11,250 young adults (mean age = 21.9 years) from the National Longitudinal Study of Adolescent Health (Wave III: 2000-2001). Four factors (social advantage; schooling; employment; and economic hardship) extracted from a principal factor analysis on 38 SES indicators comprised our multidimensional measure of young adult SES. The respondents' scores on each factor were entered into gender-stratified Poisson regression models to estimate the relative risk of young adult obesity for a contrast of approximately one standard deviation in score. The association of the "Social advantage" and "Economic hardship" factors with obesity differed by race/ethnicity (p USA Social class Minority groups Obesity Young adults US Factor analysis Socioeconomic status (SES)