565811
research-article2015
JMHXXX10.1177/1557988314565811American Journal of Men’s HealthKelley et al.
Article
Geography, Race/Ethnicity, and Obesity Among Men in the United States
American Journal of Men’s Health 1–9 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314565811 ajmh.sagepub.com
Elizabeth A. Kelley, BA1, Janice V. Bowie, PhD, MPH1, Derek M. Griffith, PhD2, Marino Bruce, PhD3,4, Sarah Hill1,5, and Roland J. Thorpe Jr., PhD1
Abstract The prevalence of obesity in the United States has increased significantly and is a particular concern for minority men. Studies focused at the community and national levels have reported that geography can play a substantial role in contributing to obesity, but little is known about how regional influences contribute to obesity among men. The objective of this study is to examine the association between geographic region and obesity among men in the United States and to determine if there are racial/ethnic differences in obesity within these geographic regions. Data from men, aged 18 years and older, from the National Health Interview Survey were combined for the years 2000 to 2010. Obesity was defined as body mass index (BMI) ≥30 kg/m2. Logistic regression models were specified to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between geographic region and obesity and for race and obesity within geographic regions. Compared to men living in the Northeast, men living in the Midwest had significantly greater odds of being obese (OR = 1.09, 95% CI [1.02, 1.17]), and men living in the West had lower odds of being obese (OR = 0.82, 95% CI [0.76, 0.89]). Racial/ethnic differences were also observed within geographic region. Black men have greater odds of obesity than White men in the South, West, and Midwest. In the South and West, Hispanic men also have greater odds of obesity than White men. In all regions, Asian men have lower odds of obesity than White men. Keywords social determinants of health, psychosocial and cultural issues, health inequality/disparity, health care issues
Introduction Over the past few decades, obesity has been identified as a major risk factor for multiple chronic conditions, including hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease (Griffith, Johnson-Lawrence, Gunter, & Neighbors, 2011; Malnick & Knobler, 2006). Flegal and colleagues reported that the prevalence of obesity among men increased significantly between 1999 and 2010, while the corresponding prevalence among women remained stable during this period (Flegal, Carroll, Ogden, & Curtin, 2010; Kumanyika et al., 2008; Ogden, Carroll, Kit, & Flegal, 2012). This pattern highlights the importance of considering gender in research on obesity. Obesity has also been reported to have an adverse effect on male hormones and prostate health and has been linked to a variety of male-specific comorbidities, including lower testosterone (Du Plessis, Cabler, McAlister, Sabanegh, & Agarwal, 2010), altered sperm (Hammoud et al., 2008), and prostate cancer aggressiveness and mortality, demonstrating the need to examine how obesity affects men (Hsing, Sakoda, & Chua, 2007).
The small but growing body of research examining obesity among men indicates that the prevalence and impact of obesity among men of different races/ethnicities vary considerably. Obesity has been reported to be a particular concern for minority men, as over 40% of Latino men and 37% of African American men are obese (Ogden, Carroll, Kit, & Flegal, 2013). Furthermore, minority men have higher rates of developing and dying from conditions and diseases associated with obesity than 1
Program for Research on Men’s Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2 Institute for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA 3 Center for Health of Minority Males, University of Mississippi Medical Center, Jackson, MS, USA 4 Jackson State University, Jackson, MS, USA 5 Johns Hopkins University, Baltimore, MD, USA Corresponding Author: Elizabeth Kelley, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. Email: [email protected]
Downloaded from jmh.sagepub.com at UNIVERSITE LAVAL on November 16, 2015
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American Journal of Men’s Health
other groups of men (Warner & Hayward, 2006). These group differences have been thought to be a function of individual-level risk factors, such as socioeconomic status, genetics, lifestyle, and behavioral characteristics (Bruce, Sims, Miller, Elliott, & Ladipo, 2007; Seo & Torabi, 2006). However, social science and social epidemiologic research has also reported that the social, environmental, and geographic conditions in which people live are associated with health disparities (Bleich, Thorpe, Sharif-Harris, Fesahazion, & Laveist, 2010; Fang, Madhavan, Bosworth, & Alderman, 1998; Gaskin, Price, Brandon, & Laveist, 2009; LaVeist et al., 2008; LaVeist, Thorpe, Galarraga, Bower, & Gary-Webb, 2009; Robert, 1998; Roux et al., 2001; Thorpe, Brandon, & LaVeist, 2008; Thorpe et al., 2013; Thorpe et al., 2014). For example, Thorpe et al. (2014) reported that race differences in obesity between Black and White men were not observed when accounting for the social and environmental conditions in which these men live. Findings from this study underscore the importance of place in understanding disparities in obesity among men. Factors influencing obesity in men should be examined more closely, as the relationship between these conditions and prevalence of obesity may function differently between people of different races/ethnicities. Understanding regional variation in obesity between men of different races/ethnicities can provide a better understanding of the extent to which population reductions in obesity can be achieved (Singh, Kogan, & van Dyck, 2008). Regional variation in lifestyle factors, environmental/geographical factors, quality of health care, socioeconomic status, infectious processes, and gene prevalence has been reported to influence variation in risk factors and comorbidities associated with obesity (Gillum, 1994; Howard, 1999; Howard et al., 2006; Voeks et al., 2008). Research exploring the degree to which levels of obesity among men can vary by race and region is scarce. The objective of this study is to examine the association between geographic region and racial/ethnic disparities in obesity using data drawn from a nationally representative sample of men in the United States.
Method Data Description This study used cross-sectional data from the National Health Interview Survey (NHIS). This annual survey was conducted by the National Center for Health Statistics using a nationally representative sample of the U.S. noninstitutionalized population from all 50 states and the District of Columbia. Participants were surveyed regarding their demographic characteristics, health behaviors and conditions, functional limitations, cancer screening,
and health care access and utilization. Individuals aged 17 years and older were eligible to participate in the survey, and NHIS oversampled Blacks, Hispanics, and Asians. The use of sampling weights yielded representative population estimates and adjusts for nonresponse. Detailed information regarding NHIS is reported elsewhere (Pleis & Lucas, 2009; Pleis, Schiller, & Benson, 2003). For this study, data from the 2000-2010 NHIS were combined. Men aged 18 years and older who responded to questions regarding their race/ethnicity, geographic region in which they lived, height, and weight were included in these analyses. This resulted in an analytic sample size of 327,556 male adults.
Measures The primary outcome in this study was obesity. BMI values were calculated by dividing participants’ self-reported weight in kilograms by their self-reported height in meters squared. A binary variable for obesity was created to identify those men whose BMI was greater than or equal to 30 kg/m2 versus those men whose BMI was less than 30 kg/m2 (1 = yes, 0 = no). The primary independent variables were race/ethnicity and geographic region. Men reported the state in which they lived, which was then categorized into one of the following regions (Northeast, Midwest, South, and West) as determined by NHIS. Table 1 displays the classification of states into regions. Men also reported their race as White, Black/African American, Asian and their ethnicity as Hispanic or not Hispanic. A variable was created to identify the following different racial/ethnic groups: non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic variables included age (years), married (1 = yes, 0 = no), income level (
research-article2015
JMHXXX10.1177/1557988314565811American Journal of Men’s HealthKelley et al.
Article
Geography, Race/Ethnicity, and Obesity Among Men in the United States
American Journal of Men’s Health 1–9 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314565811 ajmh.sagepub.com
Elizabeth A. Kelley, BA1, Janice V. Bowie, PhD, MPH1, Derek M. Griffith, PhD2, Marino Bruce, PhD3,4, Sarah Hill1,5, and Roland J. Thorpe Jr., PhD1
Abstract The prevalence of obesity in the United States has increased significantly and is a particular concern for minority men. Studies focused at the community and national levels have reported that geography can play a substantial role in contributing to obesity, but little is known about how regional influences contribute to obesity among men. The objective of this study is to examine the association between geographic region and obesity among men in the United States and to determine if there are racial/ethnic differences in obesity within these geographic regions. Data from men, aged 18 years and older, from the National Health Interview Survey were combined for the years 2000 to 2010. Obesity was defined as body mass index (BMI) ≥30 kg/m2. Logistic regression models were specified to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between geographic region and obesity and for race and obesity within geographic regions. Compared to men living in the Northeast, men living in the Midwest had significantly greater odds of being obese (OR = 1.09, 95% CI [1.02, 1.17]), and men living in the West had lower odds of being obese (OR = 0.82, 95% CI [0.76, 0.89]). Racial/ethnic differences were also observed within geographic region. Black men have greater odds of obesity than White men in the South, West, and Midwest. In the South and West, Hispanic men also have greater odds of obesity than White men. In all regions, Asian men have lower odds of obesity than White men. Keywords social determinants of health, psychosocial and cultural issues, health inequality/disparity, health care issues
Introduction Over the past few decades, obesity has been identified as a major risk factor for multiple chronic conditions, including hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease (Griffith, Johnson-Lawrence, Gunter, & Neighbors, 2011; Malnick & Knobler, 2006). Flegal and colleagues reported that the prevalence of obesity among men increased significantly between 1999 and 2010, while the corresponding prevalence among women remained stable during this period (Flegal, Carroll, Ogden, & Curtin, 2010; Kumanyika et al., 2008; Ogden, Carroll, Kit, & Flegal, 2012). This pattern highlights the importance of considering gender in research on obesity. Obesity has also been reported to have an adverse effect on male hormones and prostate health and has been linked to a variety of male-specific comorbidities, including lower testosterone (Du Plessis, Cabler, McAlister, Sabanegh, & Agarwal, 2010), altered sperm (Hammoud et al., 2008), and prostate cancer aggressiveness and mortality, demonstrating the need to examine how obesity affects men (Hsing, Sakoda, & Chua, 2007).
The small but growing body of research examining obesity among men indicates that the prevalence and impact of obesity among men of different races/ethnicities vary considerably. Obesity has been reported to be a particular concern for minority men, as over 40% of Latino men and 37% of African American men are obese (Ogden, Carroll, Kit, & Flegal, 2013). Furthermore, minority men have higher rates of developing and dying from conditions and diseases associated with obesity than 1
Program for Research on Men’s Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2 Institute for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA 3 Center for Health of Minority Males, University of Mississippi Medical Center, Jackson, MS, USA 4 Jackson State University, Jackson, MS, USA 5 Johns Hopkins University, Baltimore, MD, USA Corresponding Author: Elizabeth Kelley, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. Email: [email protected]
Downloaded from jmh.sagepub.com at UNIVERSITE LAVAL on November 16, 2015
2
American Journal of Men’s Health
other groups of men (Warner & Hayward, 2006). These group differences have been thought to be a function of individual-level risk factors, such as socioeconomic status, genetics, lifestyle, and behavioral characteristics (Bruce, Sims, Miller, Elliott, & Ladipo, 2007; Seo & Torabi, 2006). However, social science and social epidemiologic research has also reported that the social, environmental, and geographic conditions in which people live are associated with health disparities (Bleich, Thorpe, Sharif-Harris, Fesahazion, & Laveist, 2010; Fang, Madhavan, Bosworth, & Alderman, 1998; Gaskin, Price, Brandon, & Laveist, 2009; LaVeist et al., 2008; LaVeist, Thorpe, Galarraga, Bower, & Gary-Webb, 2009; Robert, 1998; Roux et al., 2001; Thorpe, Brandon, & LaVeist, 2008; Thorpe et al., 2013; Thorpe et al., 2014). For example, Thorpe et al. (2014) reported that race differences in obesity between Black and White men were not observed when accounting for the social and environmental conditions in which these men live. Findings from this study underscore the importance of place in understanding disparities in obesity among men. Factors influencing obesity in men should be examined more closely, as the relationship between these conditions and prevalence of obesity may function differently between people of different races/ethnicities. Understanding regional variation in obesity between men of different races/ethnicities can provide a better understanding of the extent to which population reductions in obesity can be achieved (Singh, Kogan, & van Dyck, 2008). Regional variation in lifestyle factors, environmental/geographical factors, quality of health care, socioeconomic status, infectious processes, and gene prevalence has been reported to influence variation in risk factors and comorbidities associated with obesity (Gillum, 1994; Howard, 1999; Howard et al., 2006; Voeks et al., 2008). Research exploring the degree to which levels of obesity among men can vary by race and region is scarce. The objective of this study is to examine the association between geographic region and racial/ethnic disparities in obesity using data drawn from a nationally representative sample of men in the United States.
Method Data Description This study used cross-sectional data from the National Health Interview Survey (NHIS). This annual survey was conducted by the National Center for Health Statistics using a nationally representative sample of the U.S. noninstitutionalized population from all 50 states and the District of Columbia. Participants were surveyed regarding their demographic characteristics, health behaviors and conditions, functional limitations, cancer screening,
and health care access and utilization. Individuals aged 17 years and older were eligible to participate in the survey, and NHIS oversampled Blacks, Hispanics, and Asians. The use of sampling weights yielded representative population estimates and adjusts for nonresponse. Detailed information regarding NHIS is reported elsewhere (Pleis & Lucas, 2009; Pleis, Schiller, & Benson, 2003). For this study, data from the 2000-2010 NHIS were combined. Men aged 18 years and older who responded to questions regarding their race/ethnicity, geographic region in which they lived, height, and weight were included in these analyses. This resulted in an analytic sample size of 327,556 male adults.
Measures The primary outcome in this study was obesity. BMI values were calculated by dividing participants’ self-reported weight in kilograms by their self-reported height in meters squared. A binary variable for obesity was created to identify those men whose BMI was greater than or equal to 30 kg/m2 versus those men whose BMI was less than 30 kg/m2 (1 = yes, 0 = no). The primary independent variables were race/ethnicity and geographic region. Men reported the state in which they lived, which was then categorized into one of the following regions (Northeast, Midwest, South, and West) as determined by NHIS. Table 1 displays the classification of states into regions. Men also reported their race as White, Black/African American, Asian and their ethnicity as Hispanic or not Hispanic. A variable was created to identify the following different racial/ethnic groups: non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic variables included age (years), married (1 = yes, 0 = no), income level (
