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Overweight and Physical Inactivity Among African American Students at a Historically Black University Jaesin Sa, Ph.D., James Heimdal, Ph.D., Tracy Sbrocco, Ph.D., Dong-Chul Seo, Ph.D., Beatrice Nelson, M.S.

Databases utilized to create bibliography: MEDLINE, CINAHL, Academic Search Premier, and PsycArticles Financial Disclosure: This project was funded by the U.S. National Institute on Minority Health and Health Disparities (Grant Number P20 MD00505). The views expressed in this paper do not necessarily reflect the official policies of the Department of Health and Human Services. Abstract: Background: Little is known about correlates of overweight, obesity, and physical inactivity among African American students at historically Black colleges and universities. Objective: To assess overweight, obesity, and physical inactivity among African American college students at a historically Black university in Maryland in the USA. Methods: Data were collected from 268 African American college students in 2013. Data were analyzed with percentage difference z-tests, chi-square tests, and multiple logistic regression. Design: Cross-sectional survey (student response rate ¼ 49.9%). Results: The overweight/obesity rate of participants was 47.5%, which was higher than that of the U.S. college student population overall (34.1%) and a representative sample of African American college students (38.3%). When age and sex were controlled, a family history of obesity, skipping breakfast, drinking caffeinated drinks, lower family income, and smoking a pipe, cigars, or cigarettes daily were significant correlates of overweight (obesity included). The percentage of physical inactivity was 68.3, and physical inactivity was higher among women and overweight or obese students. Conclusion: Given the high overweight and obesity prevalence among African American college students, historically Black colleges and universities in the USA should increase health promotion efforts targeting weight-related behaviors, particularly physical activity. Keywords: Overweight-physical inactivity-African American-college students-historically Black university

Author affiliations: Jaesin Sa, Touro University, Vallejo, California, USA; James Heimdal, Tennessee State University, Nashville, Tennessee, USA; Tracy Sbrocco, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Dong-Chul Seo, Ewha Womans University, Seoul, South Korea; Beatrice Nelson, University of Maryland Eastern Shore, Princess Anne, Maryland, USA Corresponding Author: Dong-Chul Seo, Ph.D., FAAHB, Professor, College of Health Sciences, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 120-750, South Korea, tel: 82-2-3277-2578, fax: 82-2-3277-2867, email: [email protected] Copyright ª 2016 by the National Medical Association

http://dx.doi.org/10.1016/j.jnma.2015.12.010

INTRODUCTION

T

he prevalence of overweight in the USA, defined as a body mass index (BMI) 25.0-29.9 kg/m2, has increased gradually over the last 3 decades

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION

regardless of sex, age, race/ethnicity, and educational levels.1,2 From 2009 to 2010, an estimated 69.2% of U.S. adults aged 20 years or older were overweight or obese.3 Overweight has been a serious public health problem because it increases the risk of diabetes, cardiovascular disease, and most forms of cancer.4 In addition to the major chronic diseases, overweight during adolescence is related to low academic performance5 and low self-esteem.6 While people of all racial/ethnic origins are affected by the epidemic, disparities in overweight are pronounced among racial/ethnic minority populations, particularly among African Americans. According to the results from the latest U.S. National Health and Nutrition Examination Survey,1 76.6% of African American adults were overweight or obese compared with only 68.0% of Whites. Data from the American College Health Association showed that 21.6% and 12.5% of U.S. college students (N ¼ 80,121) were overweight and obese, respectively.7 Disparities in overweight exist among U.S. college students.8 Although a large proportion of college students, irrespective of race/ethnicity, is at risk for poor health habits,9,10 African American college students are significantly heavier and gain more weight during college than other racial/ethnic groups.8-10 In a U.S. national study of 24,613 students from 119 four-year colleges,8 overweight (obesity included) was more prevalent among African American college students (38.3%) compared with their White (26.7%), Asian (16.4%), Native American (30.6%), and Hispanic (30.2%) counterparts. Although overweight among college students results from a variety of factors, such as TV viewing8 and “allyou-can-eat” dining halls on campus,11 physical inactivity is a main determinant of overweight and is most amendable to change.12 Despite the benefits of physical activity (PA),13 most college students do not meet the PA guidelines14 [i.e., 150 minutes of moderate-intensity aerobic activity (e.g., brisk walking) and muscle-strengthening activities on 2 or more days per week or 75 minutes of vigorous-intensity aerobic activity (e.g., jogging) and

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OVERWEIGHT AMONG AFRICAN AMERICAN COLLEGE STUDENTS

muscle-strengthening activities on 2 or more days per week] recommended by the Centers for Disease Control and Prevention (CDC). In a study of college students (N ¼ 903),15 a substantial proportion (42%) did not engage in moderate PA for at least 30 minutes on 3 or more days a week. Disparities were also found in physical inactivity among U.S. college students. A study16 reported that African American college students showed higher rates of physical inactivity (23.5%) than their White (17.4%) and Hispanic (20.3%) counterparts. The transition from high school to college may be a stage of particular risk of overweight and excessive weight gain.17 College students start making decisions about their PA and eating behaviors8 during this transition period establishing health habits are established.18 Studies found that this transition period is a time for engaging in unhealthy behaviors, including low PA17 and poor diet.10,17 Colleges and universities are considered an important setting for impacting this early stage of behavior change8 because they have resources (e.g. fitness centers, swimming pools, and student wellness programs) to promote health for their students.16 However, most research on overweight and obesity has been focused on primary and secondary schools rather than colleges and universities.8 Furthermore, few studies regarding correlates of overweight and obesity have been conducted at historically Black colleges and universities19 and little is known about PA among African American college students.19 The purpose of this study was to examine overweight, obesity, and physical inactivity among African American college students at a historically Black university in the USA.

behaviors (e.g. PA, drinking, and smoking). Students who were not African Americans were excluded from this study. The study protocol was approved by the Institutional Review Board of the lead author’s institution.

Measures

METHODS

Using a Detecto scale with height rod (Detecto Scale Company), participants’ actual weights and heights were measured with participants wearing light clothing without shoes. To remove inter-observer error in anthropometry, the same researcher measured weights. The scale was recalibrated by returning the scale to the zero position before each participant was weighed. BMI (calculated as kg/m2) was categorized into six groups: underweight (BMI < 18.5), normal (18.5 BMI < 25.0), overweight (25.0 BMI < 30.0), class I obesity (30.0 BMI < 35.0), class II obesity (35.0 BMI < 40.0), and class III obesity (BMI 40.0). Physical inactivity was measured by two questions: (1) asking on how many days per week participants engaged in aerobic exercise (e.g. brisk walking) of at least 20 to 30 minutes in duration and (2) asking participants to select one of the four responses that best described their current PA levels (see Table 2). Participants who selected the last response [i.e., I participate regularly in more active physical exercise (e.g., jogging and swimming)] were asked to indicate how much time they spend participating in more active physical exercise each week. Based on the PA guidelines from the CDC,21 physical inactivity was defined as engaging in either 0-4 days of moderateintensity aerobic exercise (e.g., brisk walking) of 20-30 minutes and 0-1 day of muscle-strengthening activities per week or 0-1 hour of more active physical exercise (e.g., jogging) and 0-1 day of muscle-strengthening activities per week.21

Data Collection

Data Analysis

Participants in this study were from a purposive sample of African American students at a historically Black university located in a rural area on the eastern shore of Maryland in the USA. The study protocol was approved by the institutional review board from the authors’ institutions. A Personal Wellness Profile, a 75-item questionnaire, was administered to 537 students who were enrolled in health courses, and it was completed by 268 students (response rate: 49.9%) from January to March 2013. A study20 reported that the Personal Wellness Profile is a valid and reliable tool that can be used to help eliminate health disparities among African Americans. To reduce response bias, voluntary participation in the survey was emphasized several times. All participants provided written informed consent. The questionnaire included a variety of questions about demographics (e.g., sex, age, and race) and health

Statistical analyses were performed using SPSS Windows version 20.0. Percentage difference z-tests and chi-square tests were employed to examine proportional differences in demographics and PA between men and women. Multiple logistic regressions were conducted to compute odds ratios and 95% confidence intervals (CIs) of correlates of overweight (obesity included). Two control variables (i.e., age and sex) were selected based on prior research.22 Chisquare significance tests were performed to find potential correlates that are significantly associated with overweight (obesity included), and nine correlates were identified. Each correlate was tested separately with the two control variables in the multiple logistic regression models. The Hosmer-Lemeshow test c2 value ranged from 0.16 (p ¼ .98) to 6.47 (p ¼ .60), indicating the good model fit of each of the logistic regression models.

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RESULTS As shown in Table 1, women comprised 61.6% of participants; 54.1% were freshmen; 22.8% were overweight (25.0 BMI < 30.0); 24.7% were obese (BMI 30.0); and 48.1%

reported that their family income was under $40,000. The mean age was 19.3 (SD ¼ 1.7, range ¼ 18-25). More women than men (23.0% vs. 8.7%; p < .01) had a family history of obesity, whereas more men than women

Table 1. Demographic characteristics of participants

Characteristic

Total (N [ 268)

Men (n [ 103)

Women (n [ 165)

Age 18-21

242 (90.3%)

93 (90.3%)

149 (90.3%)

22-25

26 (9.7%)

10 (9.7%)

16 (9.7%)

Academic classification Freshman

144 (54.1%)

52 (50.5%)

92 (56.4%)

Sophomore

66 (24.8%)

27 (26.2%)

39 (23.9%)

Junior

36 (13.5%)

16 (15.5%)

20 (12.3%)

Senior

20 (7.5%)

8 (7.8%)

12 (7.4%)

Yes

225 (92.6%)

82 (88.2%)

143 (95.3%)

No

18 (7.4%)

11 (11.8%)*

7 (4.7%)*

11 (4.1%)

0 (0%)**

11 (6.7%)**

130 (48.5%)

55 (53.4%)

75 (45.5%)

Overweight

61 (22.8%)

25 (24.3%)

36 (21.8%)

Class I obesity

39 (14.6%)

14 (13.6%)

25 (15.2%)

Class II obesity

14 (5.2%)

5 (4.9%)

9 (5.5%)

Class III obesity

13 (4.9%)

4 (3.9%)

9 (5.5%)

Yes

47 (17.5%)

9 (8.7%)**

38 (23.0%)**

No

221 (82.5%)

94 (91.3%)**

127 (77.0%)**

Health insurance

BMI Underweight Normal weight

Family history of obesity

Perceived overall health Excellent

58 (22.7%)

27 (27.8%)

31 (19.5%)

Very good

60 (23.4%)

34 (35.1%)***

26 (16.4%)***

Good

91 (35.5%)

23 (23.7%)*

68 (42.8%)*

Fair

40 (15.6%)

11 (11.3%)

29 (18.2%)

Poor

7 (2.7%)

2 (2.1%)

5 (3.1%)

Under $20,000

28 (21.7%)

9 (20.0%)

19 (22.6%)

$20,000-$39,999

34 (26.4%)

9 (20.0%)

25 (29.8%)

$40,000-$59,999

26 (20.2%)

11 (24.4%)

15 (17.9%)

$60,000-$79,999

20 (15.5%)

9 (20.0%)

11(13.1%)

> $79,999

21 (16.3%)

7 (15.6%)

14 (16.7%)

Family income

Note: Significant differences between men and women are denoted using asterisk marks. The percentages may not add to 100 because of rounding errors. *p < .05, **p < .01, ***p < .001.


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Table 2. Comparison of physical activity between male students and female students (N ¼ 268)

Men (n [ 103)

Characteristic Frequency of engaging in aerobic exercise of at least 20 to 30 minutes in duration 0 days/week

Women (n [ 165)

c2

p

7.59

.022

27.00

.001

40.75

.001

17 (17%)

52 (32%)

1-3 days/week

50 (49%)

63 (38%)

4 days/week

36 (35%)

50 (30%)

I have no regular exercise program, generally avoid walking and exertion when possible

13 (14%)

38 (24%)

I occasionally walk for pleasure or exercise sufficiently to cause heavy breathing or perspiration (sweat)

16 (17%)

59 (37%)

I get regular exercise in work or recreation requiring modest physical activity (e.g. golf, yard work) up to 1 hour per week

44 (46%)

30 (19%)

I participate regularly in more active physical exercise (e.g. jogging, swimming)

22 (23%)

32 (20%)

Physical activity status

Times of engaging in strength building exercise (sit-ups, push-ups) None

19 (19%)

89 (55%)

1 time/week

15 (15%)

27 (17%)

2 times/week

68 (67%)

47 (29%)

Note: The percentages may not add to 100 because of rounding errors.

(35.1% vs. 16.4%; p < .001) perceived their overall health as very good. More men than women (67% vs. 29%; p < .001) did strength exercises (e.g., push-ups) twice or more per week, whereas about twice as many women (32%) as men (17%) engaged in no days of aerobic exercise of at least 20 to 30 minutes per week (p ¼ .022), and more women than men (24% vs. 14%; p < .001) had no regular exercise program, generally avoided walking and exertion when possible (see Table 2). The overall physical inactivity prevalence was 68.3%. The physical inactivity rate was significantly higher among (1) women, (2) overweight or obese students, (3) students with a family history of obesity, (4) those who perceived their overall health as fair or poor, (5) those who were somewhat or not very confident in being physically active, and (6) those who were somewhat or not very confident in achieving and maintaining a healthy weight (see Table 3). Controlling for age and sex, multiple logistic regressions of overweight (obesity included) were conducted (see Table 4). Participants who seldom or never ate snacks

80


between meals (adjusted odds ratio [AOR] ¼ 3.30, 95% CI ¼ 1.11, 9.86) or ate snacks a few times per week (AOR ¼ 1.72, 95% CI ¼ 1.02, 2.92) were more likely to be overweight or obese than those who ate 1-3 or more times per day. Participants who did not take a calcium supplement were more likely to be overweight or obese than those who did (AOR ¼ 2.31, 95% CI ¼ 1.12, 4.79). A family history of obesity, skipping breakfast, drinking caffeinated drinks (e.g. cola), lower family income, and smoking a pipe, cigars, or cigarettes daily were significantly associated with overweight (obesity included) (p < .05). However, drinking alcohol and wearing a seat belt when driving or riding in a car were not related to overweight (obesity included).

DISCUSSION This study examined overweight, obesity, and physical inactivity in a sample of African American college students at a historically Black university in the USA and affirmed disparities in overweight and obesity. The current study found that 47.5% of participants were overweight



continued. Table 3. Number and percentage of physical inactivity (n ¼ 183)

Correlate

Number

%

c2

p

Age 18-21

164

67.8

22-25

19

73.1

144

54.1

Sophomore

66

24.8

Junior

36

13.5

Senior

20

7.5

62

60.2

121

73.3

0.31 .580

3.80 .284

Female

13

86.7

None

93

69.9

1-3 drinks

73

64.6

4 drinks

17

77.3

115

63.9

56

80.0

7

77.8

Currently smoke cigarettes daily

Very confident 5.06 .025

5

Somewhat confident Not very confident

BMI Under weight

%

c2

p

1.69 .429

Confidence in being physically active

Sex Male

Number

Number of drinks in the past 2 weeks

Academic classification Freshman

Correlate

45.5 26.41 .001

6.44 .040

Confidence in achieving and maintaining a healthy weight

Normal weight

74

56.9

Overweight

44

72.1

Very confident

90.9

Somewhat confident

62

81.6

Not very confident

10

90.9

Excellent

14

50.0 21.65 .001

Very good

42

53.2

Good

80

76.2

Fair

37

84.1

Poor

9

81.8

< $40,000

41

66.1

$40,000-$59,999

19

73.1

$60,000-$79,999

15

75.0

$80,000

13

61.9

Obese

60

Family history of obesity Yes

38

80.9

No

145

65.6

4.16 .041

Frequency of eating breakfast Every day or most mornings

43

59.7

2-3 times/week

57

77.0

Seldom or never

81

67.5

5.06 .080

104

65.0

2-4 times/month

57

73.1

Seldom or never

19

73.1

1.90 .388

134

68.0

1-3 times/month

27

69.2

Seldom or never

19

67.9

Have never smoked or quit smoking

151

66.5

Smoke a pipe or cigars only

12

85.7

Perceived overall health

1.22 .749

Note: The percentages may not add to 100 because of rounding errors.

Frequency of eating dark leafy green vegetables 1-4 or 5 times/week

61.4 12.60 .002

Family income

Frequency of eating fast foods 2-3 or 4 times/week

105

0.02 .988

Smoking status 4.64 .098

continued.


(obesity included), which was higher than the overweight (obesity included) rate (38.3%) of a representative sample of African American college students.8 Specially, the class I, II and III obesity rates (14.6%, 5.2%, and 4.9%, respectively) of participants are about twice as high as those (7.6%, 3.0%, and 1.9%, respectively) of the American college students who participated in the 2011 American College Health AssociationeNational College Health Assessment (ACHA-NCHA).7

VOL 108, NO 1, SPRING 2016 81


continued. Table 4. Multiple logistic regression of overweight (obesity included) among African American college students (n ¼ 127)

Correlate

AORa (95% CI)

Family obesity history Yes

3.94 (1.95, 7.94)***

No (ref) Frequency of eating breakfast Every day or most mornings (ref)

Correlate

AORa (95% CI)

Less than half the time

0.69 (0.16, 3.00)

Seldom or never

3.47 (0.35, 34.38)

Family income < $40,000

3.01 (1.40, 4.57)*

$40,000-$59,999

2.52 (1.86, 4.47)*

$60,000-$79,999

2.42 (1.46, 4.38)*

> $79,999 (ref)

2-3 times per week

1.89 (1.47, 5.69)*

Seldom or never

2.86 (1.49, 5.52)**

Frequency of snacking

AOR: adjusted odds ratio; CI: confidence interval; ref: reference group. a Adjusted for sex and age. *p < .05; **p < .01; ***p < .001.

1-3 or more times per day (ref) Few times per week

1.72 (1.02, 2.92)*

Seldom or never

3.30 (1.11, 9.86)*

Calcium supplement intake Yes (ref) No

2.31 (1.12, 4.79)*

Number of drinks (beer, wine) in the past two weeks Never drink or none (ref) 1-3 drinks

0.68 (0.41, 1.13)

> 3 drinks

0.50 (0.22, 1.16)

Times of drinking caffeinated drinks (cola) per day None (ref) 1-2 times

1.51 (0.90, 2.51)

> 2 times

2.46 (1.11, 5.45)*

Smoking status Never smoked or quit smoking (ref) Currently smoke a pipe, cigars, or cigarettes daily

2.80 (1.13, 6.89)*

Frequency of wearing a seat belt when driving or riding in a car Always (ref) Most of the time

0.87 (0.50, 1.50)

continued.

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Despite the fact that African Americans were found to be heavier than other racial/ethnic groups,1,2 little research attention so far has been focused on overweight-related behaviors among students at historically Black colleges and universities.19,23 Future studies should investigate other determinants of overweight and obesity, such as college grade point average, life satisfaction at school, body image satisfaction, and self-perceived body image,24 because these potential determinants could be antecedents to energy consuming or expending behaviors among African American students. Until historically Black colleges and universities implement effective interventions and increased health promotion efforts to prevent or treat overweight and obesity among African American students, disparities in overweight and obesity between them and their counterparts will not be reduced, and these disparities will continue beyond their college years. Although there may be other possible explanations for disparities in overweight and obesity, the high rates of overweight and obesity among participants might be due to physical inactivity. More female students than male students (73.3% vs. 60.2%; p ¼ .025) were physically inactive. Over one fourth of participants did not participate in any aerobic exercise (e.g. brisk walking) per week compared with 21.6% of U.S. college students who participated in the 2012 ACHA-NCHA25 although the survey question used to measure PA in this study is not identical to the ACHA-NCHA question.25 This study found discrepancies between participants’ physical inactivity status and their confidence in being physically active and achieving and maintaining a healthy weight. Approximately two-thirds of physically inactive participants were very confident in being physically active



(63.9%) and achieving and maintaining a healthy weight (61.4%). A denial of their physical activity status might be a possible explanation for the distorted confidence. Educational efforts helping African American college students manage overconfidence in physical activity are needed, especially for overweight and obese students. Given that (1) most overweight-related health problems (e.g. diabetes and heart disease) are improved by increasing PA12 and (2) colleges and universities can play an important role in promoting healthy lifestyles for young adults,26 administrators at historically Black colleges and universities should consider providing more fitness classes and facilities and hosting more PA events (e.g., tennis leagues and basketball tournaments) for their students, particularly for female students.12 Furthermore, historically Black colleges and universities may consider mandatory PA classes to increase the likelihood of PA. Despite the urgent need to reduce or eliminate disparities in overweight and obesity, there is a paucity of research on PA among African American college students.12 Thus, more research is needed to develop interventions that focus on increasing PA in this high risk population. In particular, longitudinal research designs are needed to identify longitudinal changes in PA during the college years given that college students may become more sedentary as they age.10 Understanding changes in PA as students become older may provide information necessary to identify target populations with low levels of PA. No significant association was found between overweight (obesity included) and alcohol consumption, whereas other studies found a positive27,28 and a negative correlation.29 However, these studies did not examine racial/ethnic differences in the relationship although Whites and African Americans have the highest rates of drinking30 and overweight,1 respectively. The contradictory findings warrant replications of previous studies, with a particular focus on racial/ethnic differences. Given disparities in overweight among college students,8 it is recommended for researchers to report overweight rates by race/ethnicity rather than overall rates, helping other researchers to effectively address and eliminate disparities in overweight for African Americans in the future. The finding that the frequency of snacking was inversely associated with overweight (obesity included) is consistent with a previous study31 that used nationally representative data; however, the opposite relationship was found in a study of 68 college freshmen.11 Because the findings are contradictory and evidence regarding the mechanisms through which snacking may cause overweight is scarce,31 more studies are needed to further investigate the role of snacking in overweight and racial/ ethnic differences in the relationship.


An inverse relationship was found between family income and overweight (obesity included), a finding that is consistent with results from the U.S. National Health and Nutrition Examination Survey, which found that adolescents in poor families showed a higher rate of overweight compared with those in non-poor families.32 Although overweight has increased at all levels of income in the past 30 years,33 more health promotion efforts are needed for the low-income population. This study has limitations. Selection bias may have occurred because recruitment was not random. The use of self-report questionnaires is subject to response bias although voluntary participation in the survey was emphasized several times. Causality cannot be inferred from the present findings because this study used a cross-sectional survey design. The survey was conducted at only one historically Black university. Thus, the findings from this study cannot be generalizable to African American students at other historically Black colleges and universities.

CONCLUSION This study contributes to the literature by (1) revealing the current status of overweight and obesity among African American college students at a historically Black university, (2) affirming disparities in overweight and obesity among U.S. college students, and (3) providing important information about the need for PA promotion programs for African American college students at historically Black colleges and universities. The rates of overweight, obesity, and physical inactivity among participants will help develop interventions that substantially reduce disparities in overweight and obesity during the college years and beyond.34 At historically Black colleges and universities, these rates may be particularly useful for health personnel who play a key role in promoting healthy campuses. Given that a substantial proportion (47.5%) of participants was overweight (obesity included), efforts to implement or improve PA programs and interventions preventing or treating overweight and obesity are needed to help counteract overweight and obesity among African American college students.

REFERENCES 1. Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (Feb 1 2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA, 307(5), 491e497. 2. Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (Apr 5 2006). Prevalence of overweight and obesity in the United States, 1999-2004. JAMA, 295(13), 1549e1555.

VOL 108, NO 1, SPRING 2016 83

OVERWEIGHT AMONG AFRICAN AMERICAN COLLEGE STUDENTS 3. Centers for Disease Control and Prevention. (2013). Obesity and

Overweight.

http://www.cdc.gov/nchs/fastats/overwt.

htm Accessed 29 June 2013.

18. Sparling, P. B. (Fall 2003). College physical education: an unrecognized agent of change in combating inactivity-related diseases. Perspect Biol Med, 46(4), 579e587.

4. National Center for Health Statistics. (2007). Health, United States,

19. Gary, T. L., Gross, S. M., Browne, D. C., & LaVeist, T. A. (Mar 2006).

2007, with Chartbook on Trends in the Health of Americans. http:// www.cdc.gov/nchs/data/hus/hus07.pdf#listfigures Accessed 29

The College Health and Wellness Study: baseline correlates of overweight among African Americans. Journal of urban health :

June, 2013.

bulletin of the New York Academy of Medicine, 83(2), 253e265.

5. Judge, S., & Jahns, L. (Dec 2007). Association of overweight

20. Brown, S. C., Geiselman, P. J., Copeland, A. L., Gordon, C., &

with academic performance and social and behavioral

Richard-Eaglin, A. (Winter 2008). Reliability and validity of the

problems: an update from the early childhood longitudinal study. J Sch Health, 77(10), 672e678.

Personal Wellness Profile (PWP) Questionnaire in African American college women. J Cult Divers, 15(4), 163e167.

6. Tiggemann, M. (Jun 2005). Body dissatisfaction and adolescent

21. Center for Disease Control and Prevention. (2011). How much

self-esteem: prospective findings. Body Image, 2(2), 129e135. 7. American College Health Association. (2011). American College Health Association-National College Health Assessment. http://www.acha-ncha.org/reports_ACHA-NCHAII.html Accessed 9 July, 2013. 8. Nelson, T. F., Gortmaker, S. L., Subramanian, S. V., Cheung, L., & Wechsler, H. (Jul-Aug 2007). Disparities in overweight and obesity among US college students. American journal of health behavior, 31(4), 363e373. 9. Debate, R. D., Topping, M., & Sargent, R. G. (Winter 2001). Racial and gender differences in weight status and dietary practices among college students. Adolescence, 36(144), 819e833. 10. Huang, T. T., Harris, K. J., Lee, R. E., Nazir, N., Born, W., & Kaur, H.

physical activity do adults need?. http://www.cdc.gov/ physicalactivity/everyone/guidelines/adults.html Accessed 11 July, 2013. 22. Savva, S. C., Kourides, Y., Epiphaniou-Savva, M., Tornaritis, M., & Kafatos, A. (Mar 2004). Short-term predictors of overweight in early adolescence. International Journal of Obesity, 28(3), 451e458. 23. Owens, C. S. (Nov 2008). Diabetes and obesity risks in African American young adult freshmen attending a historically black college/university. J Health Care Poor Underserved, 19(4), 1096e1118. 24. Gillen, M. M., & Lefkowitz, E. S. (Dec 2011). The ’freshman 15’: trends and predictors in a sample of multiethnic men and women. Eat Behav, 12(4), 261e266.

(Sep-Oct 2003). Assessing overweight, obesity, diet, and physical activity in college students. J Am Coll Health, 52(2), 83e86.

25. American College Health Association. (2012). American

11. Levitsky, D. A., Halbmaier, C. A., & Mrdjenovic, G. (Nov 2004).

ment. http://www.acha-ncha.org/reports_ACHA-NCHAII.html Accessed 9 July, 2013.

The freshman weight gain: a model for the study of the epidemic of obesity. Int J Obes, 28(11), 1435e1442.

College Health Association-National College Health Assess-

26. Racette, S. B., Deusinger, S. S., Strube, M. J., Highstein, G. R., &

12. Ajibade, P. B. (2011). Physical activity patterns by campus

Deusinger, R. H. (May-Jun 2005). Weight changes, exercise,

housing status among African American female college stu-

and dietary patterns during freshman and sophomore years of

dents. J Black Stud, 42(4), 548e560.

college. J Am Coll Health, 53(6), 245e251.

13. Franco, O. H., de Laet, C., Peeters, A., Jonker, J., Mackenbach,

27. Breslow, R. A., & Smothers, B. A. (Feb 15 2005). Drinking

J., & Nusselder, W. (Nov 14 2005). Effects of physical activity on

patterns and body mass index in never smokers: National

life expectancy with cardiovascular disease. Arch Intern Med,

Health Interview Survey, 1997-2001. Am J Epidemiol, 161(4),

165(20), 2355e2360.

368e376.

14. Suminski, R. R., & Petosa, R. (Jan-Feb 2006). Web-assisted instruction for changing social cognitive variables related to physical activity. J Am Coll Health, 54(4), 219e225. 15. Miller, K., Staten, R., Rayens, M., & Noland, M. (2005). Levels and characteristics of physical activity among a college student cohort. American Journal of Health Education, 36, 215e221. 16. Suminski, R. R., Petosa, R., Utter, A. C., & Zhang, J. J. (Sep 2002). Physical activity among ethnically diverse college students. J Am Coll Health, 51(2), 75e80. 17. Wengreen, H. J., & Moncur, C. (2009). Change in diet, physical activity, and body weight among young-adults during the transition from high school to college. Nutr J, 8, 1e7.

84


28. Lukasiewicz, E., Mennen, L. I., Bertrais, S., et al. (May 2005). Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage. Public Health Nutr, 8(3), 315e320. 29. Wilsgaard, T., Jacobsen, B. K., & Arnesen, E. (Dec 15 2005). Determining lifestyle correlates of body mass index using multilevel analyses: the Tromso Study, 1979-2001. Am J Epidemiol, 162(12), 1179e1188. 30. Chartier, K., & Caetano, R. (2010). Ethnicity and Health Disparities in Alcohol Research. Alcohol Res Health, 33(1-2), 152e160. 31. Keast, D. R., Nicklas, T. A., & O’Neil, C. E. (Aug 2010). Snacking is associated with reduced risk of overweight and reduced


OVERWEIGHT AMONG AFRICAN AMERICAN COLLEGE STUDENTS abdominal obesity in adolescents: National Health and Nutrition

33. Chang, V. W., & Lauderdale, D. S. (Oct 10 2005). Income

Examination Survey (NHANES) 1999-2004. Am J Clin Nutr, 92(2),

disparities in body mass index and obesity in the United

428e435. 32. Miech, R. A., Kumanyika, S. K., Stettler, N., Link, B. G., Phelan, J. C., & Chang, V. W. (May 24 2006). Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA, 295(20), 2385e2393.


States, 1971-2002. Archives of Internal Medicine, 165(18), 2122e2128. 34. Kemper, K. A., & Welsh, R. S. (Jan-Feb 2010). Physical activity behaviors of students of a rural historically black college. J Am Coll Health, 58(4), 327e334.

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