Abstract and Introduction

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Journal of Pediatric Health Care

An Examination of Eating Behaviors, Physical Activity, and Obesity in African American Adolescents

• Add "Obesity"

Abstract and Introduction

Abstract

Background African American adolescents experience higher rates of obesity and have an increased risk of obesity-related diseases than do White American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African American adolescent population. Current obesity interventions do not usually address the heterogeneity (e.g., socioeconomic status [SES], gender, and residential status differences) within the African American adolescent community that can affect the efficacy of these interventions.
Purpose To examine the gender, SES, and residential status differences related to obesity and weight behaviors in African American adolescents.
Methods A descriptive correlational study was conducted with 15- to 17-year-old African American adolescents (n = 145) from community clinics, youth organizations, churches, and social networks in metropolitan and inner-city Detroit. Data were collected through use of survey methods and analyzed with use of descriptive statistics, independent sample t tests, and multiple regression equations.
Results Female adolescents consumed foods higher in fat and calories (t = −2.36, p = .019) and had more body fat (t = −9.37, p = .000) than did males. Adolescents of lower SES consumed food higher in fat and calories (t = −2.23, p = .027) and had higher body mass (t = −2.57, p = .011) than did adolescents of higher SES. Inner-city African American adolescents had higher levels of physical activity (t = −2.39, p = .018) and higher body mass (t = 2.24, p = .027) than did suburban African American adolescent counterparts. Gender, SES, and residential status were statistically significant predictors of eating behaviors, physical activity, body mass index, and body fat.
Conclusions The initial findings from the study will assist in better understanding the obesity epidemic that affects African American adolescents in disparate proportions.
Implications Further examination of the study variables is essential to serve as a basis for developmentally appropriate and culturally relevant targeted interventions with this population. Health care providers and obesity researchers who work with youth can use the initial findings from this study to advocate for healthy lifestyles while reducing the obesity disparity within the African American adolescent population.

Introduction

Obesity is a major health problem for African American adolescents in the United States. The existence of this problem is well documented in the literature. For example, the Centers for Disease Control and Prevention (CDC; 2014)) reported that in 2011, the obesity rate among African American adolescents (20.2%) was second only to the rate for Hispanic youth (22.4%) and much higher than the rate for White youth (14.1%). The prevalence of obesity among African American teens has been attributed to a low level of physical activity and unhealthy eating behaviors (Haas et al., 2003, Singh et al., 2008, Zhang and Wang, 2004). In addition to intergroup disparities, the literature indicates that obesity among African American adolescents may be associated with intragroup differences that include gender, socioeconomic status (SES), and residential status (urban and suburban; Schulz et al., 2000).
Researchers have found that females within the African American population have a higher incidence of obesity than do males, and African American adolescents from families with low SES are more obese than those from families with middle and high SES (Martin, 2008, Miech et al., 2006, Neumark-Sztainer et al., 2002, Wang and Zhang, 2006, Zhang and Wang, 2004). Alm et al. (2008)) found that African American adolescents who live in urban neighborhoods were more likely to be obese than those living in suburban locations. Thus, not only are there obvious disparities in obesity between African American and White adolescents, but notable disparities also exist within the African American adolescent community. The range of disparities that has been associated with obesity rates among African American teens is of special concern, given the increased incidence in this population of obesity-related adult-onset diseases such as hypertension, type 2 diabetes, and hypercholesterolemia (Skinner, Mayer, Flower, Perrin, & Weinberger, 2009).
Trends data from National Health and Nutrition Examination Surveys (NHANES) conducted between 1999 and 2010 showed that the odds of being obese remained significantly higher for non-Hispanic Black and Mexican American males and females aged 12 to 19 years than for other ethnic samples of this age group (Ogden, Carroll, Kit, & Flegal, 2012). Further, the 2009–2010 NHANES indicated that non-Hispanic Black children and adolescents had higher rates of obesity (24.3%) than did Hispanic (21.2%) or non-Hispanic White (14%) children and adolescents. The prevalence of African American adolescent obesity has remained relatively high despite "culturally sensitive" health interventions, suggesting that these interventions may still not take into account the African American teen's unique developmental and sociocultural characteristics. Therefore, the purpose of this study was to examine the intragroup differences of gender, SES, and residential status in relation to eating behaviors and physical activity among African American adolescents. Examination of these intragroup characteristics could address the limitations of previous studies and potentially enhance health interventions to reduce the prevalence of obesity in this population.
The current literature reports gender differences in weight-related behaviors and obesity between male and female African American adolescents. In a study by Neumark-Sztainer and colleagues (2002, N = 4,746), African American females at an urban high school in Minnesota reported fewer weight-related concerns and weight-conscious behaviors such as physical activity than did White females. On the other hand, weight-related concerns and weight-conscious behaviors were more prevalent among the African American males compared with the White males. Downs, DiNallo, Savage, and Davison (2007)), in a study of 646 adolescents (mean age = 14.28 years), also reported that African American males scored higher on measures of physical activity and lower on negative attitudes about eating than did their female counterparts.
Current research documenting the relationship between adolescent obesity and SES tends to focus on participants from low-income families, and few studies have compared obesity prevalence between adolescents from lower and higher SES families. In a study that explored adolescent activity outside of school, McMurray and colleagues (2000)) found a relationship between African American ethnicity, low SES, and adolescent obesity. Wang and colleagues (2006)) reported a high prevalence of obesity among African American adolescents from families with low SES in their overview of a school-based intervention in Chicago public schools. Additionally, Lutfiyya, Garcia, Dankwa, Young, and Lipsky (2008)) found that overweight African American adolescents were more likely to live in households with lower incomes. Lastly, using data from the 2005–2008 NHANES, Ogden, Lamb, Carroll, and Flegal (2010)) also discovered that adolescents from low-income households were more likely to be obese compared with adolescents from higher income households, although this finding was not consistent across racial and ethnic groups.
Few findings are present in the literature regarding the residential status of teens in the United States and obesity, specifically studies comparing eating behaviors and physical activity between African American adolescents in urban or suburban communities. Most of the literature exploring U.S. residential settings and teen/child obesity focuses on neighborhood risks such as reduced walkability, local food environments, built environments, and food deserts. Indeed, using data from NHANES, Rossen (2014)) noted that residential area deprivation, which is most often seen in urban locales, was associated with a higher incidence of obesity. Area deprivation has been defined as decreased neighborhood walkability due to a decreased number of parks and opportunities for recreation, increased crime, absence of walking trails, a decreased number of local area supermarkets with fresh fruit and vegetables, and an increased availability of fast food restaurants (Kipke et al., 2007, Lovasi et al., 2009).
Studies not focused specifically on U.S. urban locales have explored the relationship between region and obesity. Morland and Evenson (2009)) discovered that obesity was lower in areas with large supermarkets and higher in areas with plentiful fast food restaurants and small grocery stores. Other researchers found that residents with accessible healthy foods tend to have improved eating behaviors (Smoyer-Tomic et al., 2008, Walker et al., 2010). Furthermore, residents of neighborhoods considered to be safe communities with safe parks are more likely to be physically active and less likely to be obese (Black and Macinko, 2008, Sallis and Glanz, 2009).
In general, the literature offers studies of adolescent obesity that include samples from different racial/ethnic groups, whereas the unique focus of the current study is the examination of the variables of gender, SES, and residential status in an all–African American adolescent sample, thus investigating their intragroup characteristics. Another unique aspect of the present study is that it fills a gap in the literature on obesity differences among African American adolescents who live in suburban and urban communities in the United States.