School influence
The Epidemiology of Overweight and Related Lifestyle Behaviors: Racial/Ethnic and Socioeconomic Status Differences Among American Youth

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Background

Differences in the prevalence of youth at or above the 85th percentile of age- and gender-adjusted body mass index (BMI) by race/ethnicity and socioeconomic status were examined among youth in 8th and 10th grades. The possible role of a number of lifestyle behaviors and family/parenting factors in explaining these differences was then explored.

Methods

Cross-sectional survey data were used from nationally representative samples in the Monitoring the Future study from 1998 to 2003 (N=39,011 students). Data were analyzed in 2006.

Results

Minority, low-income males, and male youth were more likely have a BMI at or above the 85th percentile. Frequency of eating breakfast, eating fruits and vegetables, and exercising regularly were inversely associated with being at or above the 85th percentile. The number of hours youth spend per week watching television was positively associated with being at or above the 85th percentile. These lifestyle behaviors proved more important than the family/parenting variables examined.

Conclusions

The overrepresentation of youth at risk of overweight or overweight among racial/ethnic minority and low-income populations mimics the excess morbidity of overweight and obesity-related health conditions in these same populations. Differences in lifestyle behaviors and family characteristics might help to explain these subgroup differences starting at an early age. While there is growing need to modify these behaviors in the population at large, the need is greatest among minorities and low-socioeconomic status youth.

Introduction

Recent trends in overweight and obesity and related lifestyle behaviors indicate that more youth have become overweight and at risk for overweight and that many more engage in detrimental behaviors that are potentially linked to the current overweight and obesity epidemic.1, 2, 3, 4, 5 Being overweight substantially and negatively impacts the present and future health of American youth.6, 7, 8, 9, 10, 11 Regrettably, the burden of disease is likely to fall more heavily on racial/ethnic minority youth and low-income populations because of the overrepresentation of being overweight in these populations.12, 13, 14, 15

To enhance an understanding of the epidemiology of overweight among American youth, the present study investigates differences in the prevalence of overweight and of being at risk for overweight among white, black, and Hispanic youth by socioeconomic status (SES). The extent to which the associations among overweight, race/ethnicity, and SES are accounted for by differences in lifestyle behaviors that may be associated with obesity are also examined.16, 17, 18, 19 Prior research has found, for example, that youth from low-income families tend to eat fewer fruits and vegetables,16 and that African-American youth spend more time watching television than white youth.19 Also, in light of prior research documenting the importance of family-related factors in relation to risk of overweight,5 it is also hypothesized that reduced parental supervision, as measured by the number of hours youth spend alone after school, is associated with increased risk of overweight. For example, less parental supervision after school may result in youth spending more time watching television or playing video games, snacking on foods high in fat and calories, not being provided with transportation to participate in after-school sports programs, and overall being more sedentary.20 In turn, these differences in parental supervision may account for overweight differences between racial/ethnic groups and SES.21

Among minors, overweight is defined as being at or above the 95th percentile based on an age- and gender-adjusted body mass index (BMI), while being at risk for overweight is defined as being between the 85th and 95th percentile on the same scales. The current study examines whether the percentage of students who are at or above the 85th percentile (that is being at risk of overweight or overweight) differs by race/ethnicity and SES, controlling for population density, region, and the frequency with which students eat breakfast, fruits, and vegetables; get seven hours of sleep each night; exercise vigorously; and watch television; hereafter referred to as lifestyle behaviors. Whether the percentage of youth at or above the 85th percentile differs by race/ethnicity and SES is also examined controlling for the number of hours they spend after school each day at home with no adult present, whether or not they live with both parents, and whether the students’ mothers have paid jobs, hereafter referred to as family/parenting variables. The study is based on large national representative samples of 8th and 10th graders living in the United States.

Section snippets

Sample

Data are utilized from 1998–2003 for 8th- and 10th-grade students who participated in the University of Michigan’s Monitoring the Future project. Data for 12th-grade youth are not included in this study because several variables under investigation are not asked in the same format of a multiple-forms questionnaire, precluding multivariate analyses with all relevant variables. Data were analyzed in 2006.

The design and methods are summarized briefly below; a detailed description is available

Sample Characteristics

Table 1 provides the numbers of cases for the demographic variables separately for each gender and the percentage of youth in the various categories who are at or above the 85th percentile. Across the 6 years, 1998–2003, there were a total of 39,011 participants completing the relevant questionnaire forms, 20,913 girls and 18,098 boys. The sample of youth was approximately 75% white, 13% black, and 12% Hispanic. The percent of students who are of low, mid, and high SES was approximately 15%,

Discussion

A consistent pattern of more black and Hispanic youth being at or above the 85th percentile than white youth was found at every SES level, with only one exception (a slightly lower percentage of black boys of low SES at or above the 85th percentile than white boys of low SES at or above the 85th percentile). These findings are consistent with prior research that has found some health outcomes of educated African Americans to be of lower quality than that of equally educated whites, and to be

Conclusion

These findings provide evidence of racial/ethnic and SES differences in becoming at risk of overweight or overweight by early adolescence. It also demonstrates that those differences are explainable in part by group differences in dietary and exercise behaviors. The results also show that children in certain family situations are at greater risk of becoming at risk of overweight or overweight.

The prevention of obesity and eventual elimination of racial/ethnic and socioeconomic disparities is

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