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How Much of Racial/Ethnic Disparities in Dietary Intakes, Exercise, and Weight Status Can Be Explained by Nutrition- and Health-Related Psychosocial Factors and Socioeconomic Status among US Adults?

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Abstract

Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States.

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Study Design and Subjects

A nationally representative multistage stratified sample of 16,103 noninstitutionalized persons aged 0 to 90 years residing in the United States participated in the US Department of Agriculture (USDA) Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996 (14). Of the 16,103 CSFII 1994-1996 participants, 9,872 adults aged 20 years and older provided 1 to 2 days of dietary intake information in 24-hour recalls conducted 3 to 10 days apart. The 24-hour recalls utilized an automated

Results and Discussion

Table 1 shows that women, older Americans, those with higher SES (high education or high income), and people with comorbidities had better NHRPF and HEI (all P<0.001). There were some but small racial/ethnic differences in NHRPF. Non-Hispanic whites reported better awareness of nutrition-related health risks (score 6.04±0.04) than non-Hispanic blacks (5.58±0.10), Hispanics (5.49±0.11), and other racial/ethnic group members (5.78±0.15) (P<0.001). Overall, these NHRPF factors showed desirable

Conclusions

These US national survey data show that few of racial/ethnic differences in diet, exercise, and weight status were explained by health- and nutrition-related psychosocial factors, which is different from what we have expected, but SES explained considerable proportion; for example, 30% of the black–white difference in dietary quality and about 40% in overweight and obesity prevalence. However, the reduction in the white–black disparity for exercise participation was small (10%). The underlying

Y. Wang is an associate professor of international health and epidemiology, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

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Y. Wang is an associate professor of international health and epidemiology, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

X. Chen is an assistant scientist, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

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