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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
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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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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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OVERWEIGHT AMONG AFRICAN AMERICAN COLLEGE STUDENTS
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
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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
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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.
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(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
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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
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(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.
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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.
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