Person:

Jackson, Chandra L.

Objective: To compare body-mass index (BMI)-related mortality risk in US Blacks vs. Whites as the relationship appears to differ across race/ethnicity groups. Design and Methods We pooled cross-sectional surveys of nationally representative samples of 11,934 Blacks and 59,741 Whites aged 35–75 in the National Health Interview Survey from 1997–2002 with no history of cardiovascular disease or cancer. Mortality follow-up was available through 2006. BMI was calculated from self-reported height and weight. We used adjusted Cox regression analysis to adjust for potential confounders. Results: Over 9 years of follow-up, there were 4,303 deaths (1,205 among never smokers). Age-adjusted mortality rates were higher in Blacks compared to Whites at BMI < 25 kg/m2 and showed no increase at higher levels of BMI. In men, adjusted hazard ratios for all-cause death rose in a similar fashion across upper BMI quintiles in Blacks and Whites; in women, however, BMI was positively associated with mortality risk in Whites, but inversely associated in Blacks (p interaction = 0.01). Racial disparities were amplified in subsidiary analyses that introduced a 12-month lag for mortality or focused on CVD mortality. Conclusions: The relationship of elevated BMI to mortality appears weaker in US Blacks than in Whites, especially among women.

OBJECTIVE To examine racial differences in sleep duration and its relationship with diabetes. RESEARCH DESIGN AND METHODS We used data from a nationally representative sample of U.S. adults (n = 130,943) participating in the National Health Interview Survey from 2004 to 2011. Usual sleep duration was self-reported and categorized as <7 h (short), 7 h (optimal), and >7 h (long). Diabetes status was based on self-reported diagnosis from a health professional. RESULTS Participants’ mean age was 50.6 years, 49% were men, and 13% were black. Compared with whites, blacks were more likely to report short sleep (37 vs. 28%) and less likely to get 7 h of sleep (24 vs. 33%). Diabetes (9,643 cases [9%] in whites and 3,612 cases [15%] in blacks) had a U-shaped distribution with sleep in whites (10, 7, and 9%, for short, optimal, and long sleep, respectively) and blacks (16, 13, and 15%). Suboptimal sleep duration was more strongly associated with diabetes in whites than in blacks among short (prevalence ratio 1.49 [95% CI 1.40–1.58] vs. 1.21 [1.09–1.34]) and long (1.32 [1.25–1.40] vs. 1.11 [1.00–1.23]) sleepers on the relative scale. Adjustment for socioeconomic status (SES) attenuated the short sleep–diabetes association in blacks (1.15 [1.02–1.29]), and the racial/ethnic difference in the short sleep–diabetes association became nonsignificant after SES adjustments. CONCLUSIONS Suboptimal sleep duration was positively associated with diabetes in blacks and whites, although diabetes prevalence was higher at any level of sleep in blacks. Socioeconomic factors appear to partly explain the association for short sleep in blacks as well as disparity between racial groups.

Background: Although short sleep is associated with an increased risk of morbidity as well as mortality and has been shown to vary by industry of employment and occupation, little is known about the relationship between work and sleep among Asian Americans. Methods: Using a nationally representative sample of US adults (n = 125,610) in the National Health Interview Survey from 2004–2011, we estimated prevalence ratios for self-reported short sleep duration (<7 hours) in Asians compared to Whites by industry of employment and occupation using adjusted Poisson regression models with robust variance. Results: Asians were more likely to report short sleep duration than Whites (33 vs. 28%, p < 0.001), and the Asian-White disparity was widest in finance/information and healthcare industries. Compared to Whites after adjustments, short sleep was also more prevalent among Asians employed in Public administration (PR = 1.35 [95% CI: 1.17,1.56]), Education (PR = 1.29 [95% CI: 1.08,1.53]), and Professional/Management (PR = 1.18 [95% CI: 1.03,1.36]). Short sleep, however, was lower among Asians in Accommodation/Food (PR = 0.81 [95% CI: 0.66, 0.99]) with no difference in Retail. In professional and support-service occupations, short sleep was higher among Asians, but was not different among laborers. Conclusions: U.S. Asian-White disparities in short sleep varied by industries, suggesting a need to consider both race and occupational characteristics to identify high-risk individuals.

Background:. Few studies have examined racial and educational disparities in recent population-based trends. Methods:. We analyzed data of a nationally representative sample of 174,228 US-born adults in the National Health Interview Survey from 1997 to 2008. We determined mean BMI trends by educational attainment and race and black-white prevalence ratios (PRs) for overweight/obesity (BMI > 25 kg/m2) using adjusted Poisson regression with robust variance. Results:. From 1997 to 2008, BMI increased by ≥1 kg/m2 in all race-sex groups, and appeared to increase faster among whites. Blacks with greater than a high school education (GHSE) had a consistently higher BMI over time than whites in both women (28.3 ± 0.14 to 29.7 ± 0.18 kg/m2 versus 25.8 ± 0.58 to 26.5 ± 0.08 kg/m2) and men (28.1 ± 0.17 kg/m2 to 29.0 ± 0.20 versus 27.1 ± 0.04 kg/m2 to 28.1 ± 0.06 kg/m2). For participants of all educational attainment levels, age-adjusted overweight/obesity was greater by 44% (95% CI: 1.42–1.46) in black versus white women and 2% (1.01–1.04) in men. Among those with GHSE, overweight/obesity prevalence was greater (PR: 1.52; 1.49–1.55) in black versus white women, but greater (1.07; 1.05–1.09) in men. Conclusions:. BMI increased steadily in all race-sex and education groups from 1997 to 2008, and blacks (particularly women) had a consistently higher BMI than their white counterparts. Overweight/obesity trends and racial disparities were more prominent among individuals with higher education levels, compared to their counterparts with lower education levels.

Background: The relation between body weight and mortality among persons with type 2 diabetes remains unresolved, with some studies suggesting decreased mortality among overweight or obese persons as compared with normal-weight persons (an “obesity paradox”). Methods: We studied participants with incident diabetes from the Nurses’ Health Study (8970 participants) and Health Professionals Follow-up Study (2457 participants) who were free of cardiovascular disease and cancer at the time of a diagnosis of diabetes. Body weight shortly before diagnosis and height were used to calculate the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters). Multivariable Cox models were used to estimate the hazard ratios and 95% confidence intervals for mortality across BMI categories. Results: There were 3083 deaths during a mean period of 15.8 years of follow-up. A J-shaped association was observed across BMI categories (18.5 to 22.4, 22.5 to 24.9 [reference], 25.0 to 27.4, 27.5 to 29.9, 30.0 to 34.9, and ≥35.0) for all-cause mortality (hazard ratio, 1.29 [95% confidence interval {CI}, 1.05 to 1.59]; 1.00; 1.12 [95% CI, 0.98 to 1.29]; 1.09 [95% CI, 0.94 to 1.26]; 1.24 [95% CI, 1.08 to 1.42]; and 1.33 [95% CI, 1.14 to 1.55], respectively). This relationship was linear among participants who had never smoked (hazard ratios across BMI categories: 1.12, 1.00, 1.16, 1.21, 1.36, and 1.56, respectively) but was nonlinear among participants who had ever smoked (hazard ratios across BMI categories: 1.32, 1.00, 1.09, 1.04, 1.14, and 1.21) (P=0.04 for interaction). A direct linear trend was observed among participants younger than 65 years of age at the time of a diabetes diagnosis but not among those 65 years of age or older at the time of diagnosis (P<0.001 for interaction). Conclusions: We observed a J-shaped association between BMI and mortality among all partici- pants and among those who had ever smoked and a direct linear relationship among those who had never smoked. We found no evidence of lower mortality among patients with diabetes who were overweight or obese at diagnosis, as com- pared with their normal-weight counterparts, or of an obesity paradox.

Background: Obesity is associated with increased morbidity, occupational injuries, and premature mortality. Obesity also disproportionately affects blacks and socioeconomically disadvantaged workers. However, few studies have evaluated national trends of obesity by employment industry overall and especially by race. Methods: To investigate national trends of obesity by employment industry overall and by race, we estimated the age-standardized obesity prevalence from 2004 to 2011. We used direct age-standardization with the 2000 US Census population as the standard among 136,923 adults in the US National Health Interview Survey. We also estimated prevalence ratios (PRs) for obesity in black women and men compared to their white counterparts for each employment industry using adjusted Poisson regression models with robust variance. Results: Obesity prevalence increased for men and women over the study period across all employment industry categories, and the healthcare industry had the highest overall age-standardized prevalence (30 %). Black women had a significantly higher obesity prevalence than white women across all employment industry categories, ranging from 33 % (95 % confidence interval (CI): 1.16,1.52) in Professional/Management to 74 % in Education (95 % CI: 1.56,1.93). Obesity prevalence was higher among black than white men for Healthcare (PR = 1.39 [1.15,1.69]), Education (PR = 1.39 [1.17,1.67]), Public Administration (PR = 1.34 [1.20,1.49]), and Manufacturing (PR = 1.19 [1.11,1.27]). Differences in obesity prevalence by race were generally widest in professional/management occupations. Conclusions: Obesity trends varied substantially overall as well as within and between race-gender groups across employment industries. These findings demonstrate the need for further investigation of racial and sociocultural disparities in the work-obesity relationship to employ strategies designed to address these disparities while improving health among all US workers. Further research and interventions among workers in industries with an increasing or high prevalence of obesity should be prioritized. Electronic supplementary material The online version of this article (doi:10.1186/s40608-016-0100-x) contains supplementary material, which is available to authorized users.

Background: Personal care products (PCPs) are an important source of endocrine disrupting chemicals (EDCs) linked to adverse reproductive health outcomes. Objective: We evaluated EDC-associated PCP use and acculturation among Asian women. Methods: Our study included 227 foreign-born Chinese women ages 18-45 seeking obstetrics-gynecology care at community health centers (Boston, MA). Acculturation was measured by English-language use, length of US residence, and age at US entry. Self-reported use of PCPs (crème rinse/conditioner, shampoo, perfume/cologne, bar soap/body wash, liquid hand soap, moisturizer/lotion, colored cosmetics, sunscreen, and nail polish) in the last 48 hours was collected. Latent class analysis was used to identify usage patterns. We also conducted multivariable logistic to determine the cross-sectional associations of acculturation measures and the use of individual PCP types. Results: Those who used more PCP types, overall and by each type, tended to be more acculturated. Women who could speak English had 2.77 (95% CI: 1.10-7.76) times the odds of being high PCP users compared to their non-English speaking counterparts. English-language use was associated with higher odds of using perfume/cologne and nail polish. Significance: Our findings give insight about EDC-associated PCP use based on acculturation status, which can contribute to changes in immigrant health and health disparities.