kumanyika expanding the paradigm cornell 4 21 08edit.ppt ... · • (may 2006) new u.s. census...
TRANSCRIPT
1
Addressing Obesity in African American Communities: Expanding
the Paradigm
www.aacorn.org
Shiriki KumanyikaUniversity of Pennsylvania School of MedicineCornell University Community Nutrition Seminar April 21, 2008
OverviewAudio will start with the next slide
• Context • Expanded causal paradigm• AACORN’s expanded paradigm• Follow up
– Linking AACORN’s paradigm to broader community issues
– Linking AACORN’s paradigm to mainstream obesity research
– Using paradigm to drive research design and implementation
In the News: U.S. Population Is Now One-Third Minority
• (May 2006) New U.S. Census Bureau estimates for 2005 show that 98 million people in the United States —about 33 percent of the total U.S. population of 296.4 million—are part of a racial or ethnic minority group. In addition, 45 percent of children under age 5 are minorities.
Population reference bureau www.prb.org
% of U.S. Non-Hispanic Black Men And Women Above Overweight And Obesity Cutoffs: 1999-2002
BMI 40 +
BMI 30 +
BMI 25 +
BMI 40 +
BMI 30 +
BMI 25 +
50.3
50.6
46.6
49.0
82.2
81.5
70.3
77.2
Women
3.0
2.9
4.1
3.4
14.030.572.260 y +
15.129.765.040-59 y
11.824.755.420-39 y
13.527.962.920 y +
Men
Source: Hedley et al, JAMA 2004;2847-2850 (June 16)BMI 25+= overweight or obese BMI 30+= obese (Class I, II, or III)BMI 40+= Class III or extremely obese
% of U.S. Non-Hispanic Black Boys and Girls Above Overweight and Obesity Cutoffs: 1999-2002
GirlsBoys
41.9
37.9
25.6
40.1
BMI > 85th
percentile
23.618.732.112-19 y
22.817.029.76-11 y
9.68.020.92-5 y
23.217.931.06-19 y
BMI > 95th
percentileBMI > 95th
percentileBMI >85th
percentile
Source: Hedley et al, JAMA 2004;2847-2850 (June 16)
BMI 85th percentile and over = at risk of overweight BMI 95th percentile and over = overweight
Trends in Adult Obesity
0
10
20
30
40
50
60
0
10
20
30
40
50
60Black Male Mexican American MaleWhite Female Black FemaleMexican American Female White Male
Percent
1960-62 1971-74 1976-80 1988-94 1999-2000
Obj. 19-2
Note: Data are for ages 20 years and over, age adjusted to the 2000 standard population. Obesity is defined as BMI >= 30.0. Source: National Health Examination Survey, National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC..
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Trends in the prevalence (%) of overweight in American children and adolescents during 1976-2002, by sex and ethnicity (Younger Children)
6.1
10.7
14.0
6.8
12.3
17.0
13.3
17.5
26.5
0
5
10
15
20
25
30
1976-80 1988-94 1999-02
Prev
alen
ce (%
)
White, non-Hispanic
Black, non-Hispanic
Mexican Am
5.2
9.8
13.1
11.2
17.0
22.8
9.8
15.3
17.1
0
5
10
15
20
25
30
1976-80 1988-94 1999-02
Prev
alen
ce (%
)
White, non-Hispanic Black, non-Hispanic Mexican Am
Boys (6-11 y) Girls (6-11 y)
Data sources: CDC, 2003; Hedley et al, 2004 Wang & Kumanyika, 2007
3.8
11.6
14.6
6.1
10.6
18.7
7.7
14.1
24.7
0
5
10
15
20
25
1976-80 1988-94 1999-02
Prev
alen
ce (%
)
White, non-Hispanic Black, non-Hispanic Mexican Am
4.6
8.9
12.7
10.7
16.3
23.6
8.8
13.4
19.9
0
5
10
15
20
25
1976-80 1988-94 1999-02
Prev
alen
ce (%
)
White, non-Hispanic Black, non-Hispanic Mexican Am
Adolescent boys (12-19 y) Adolescent girls (12-19 y)
Wang & Kumanyika in press
Trends in the prevalence (%) of overweight in American children and adolescents during 1976-2002, by sex and ethnicity (Adolescents)
The shifting distributions of BMI of five population groups of men and women aged 20-59 years derived from 52 surveys in 32 countries.
14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 440.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14Probability density
Body Mass index (kg/m )2Source: Rose, G. (1991) .
Population BMI Change Schematic Representations of BMI Distribution Models
Body mass index
Perc
ent of popula
tion
Body mass index
Perc
ent of popula
tion
U.S. children & youth U.S. adults
Source: Flegal KM, Troiano RP. 2000. Int J Obes Relat Metab Disord24:807-818.
Global Prevalence of Overweight in GirlsPrior to 1990
< 5 %
≥30%
Self Reported data
25-29.9%
20-24.9%
15-19.9%
10-14.9%
5-9.9%
% Overweight
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Global Prevalence of Overweight in Girls2000-2006
< 5 %
≥30%
Self Reported data
25-29.9%
20-24.9%
15-19.9%
10-14.9%
5-9.9%
% Overweight
Global Prevalence of Overweight in BoysPrior to 1990
< 5 %
≥30%
Self Reported data
25-29.9%
20-24.9%
15-19.9%
10-14.9%
5-9.9%
% Overweight
Global Prevalence of Overweight in Boys2000-2006
< 5 %
≥30%
Self Reported data
25-29.9%
20-24.9%
15-19.9%
10-14.9%
5-9.9%
% Overweight
Paradigm shift• Obesity levels reflect changes in
society– Economic development– Modernization and technology– Urbanization– Food production and marketing – Patterns of media use– Women’s roles
FACTORSINTERNATIONAL
Development
Globalizationof
markets
SchoolFood &Activity
WORK/SCHOOL/
HOME
Infections
Labour
Worksite Food & Activity
LeisureActivity/Facilities
Agriculture/Gardens/Local markets
COMMUNITY/LOCALITY
Health Care
System
PublicSafety
PublicTransport
Manufactured/ImportedFood
Sanitation
NATIONAL/REGIONAL
Food & Nutrition
Urbanization
Education
Health O
ITY
PREVALE
INDIVIDUAL
EnergyExpenditure
POPULATION
%OBESE
OR
UNDERWTSocial Security
Transport
Family &Home
Nationalperspective
Media &Culture
Food intake :
Nutrient density
Media programs
& advertising
Source: International Obesity Task Force [www.iotf.org]see Kumanyika S et al International Journal of Obesity 2002;26:425-36
OBESITY
PREVALENCE
Causal Web of Societal Processes influencing the population prevalence of obesity
Excess environmental risk in communities of color: Access
• Targeted marketing• Excess fast food outlets• Few supermarkets• Limited shelf choices in groceries• Availability of high-fat food• Less private transportation• Poorer public transportation
Yancey AK, Kumanyika SK, et al. review. Preventing Chronic Disease Available from: URL: http://www.cdc.gov/pcd/issues/2004/jan/03_0012.htm
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Excess environmental risk in communities of color: Economics
• Low neighborhood demand for low cal/low fat foods
• Low family incomes and cash flow• Other household expenses• Little home-grown food• Financial incentives offered to under-
resourced schools by commercial cafeteria vendors
Yancey AK, Kumanyika SK, et al. review. Preventing Chronic Disease Available from: URL: http://www.cdc.gov/pcd/issues/2004/jan/03_0012.htm www.aacorn.org
AACORN’s Purpose and Rationale
To improve the quality, quantity, and effective translation of research to address weight issues in African American communities
Extremely low representation of African American issues in the obesity and related literatures, coupled with extremely high need for attention to obesity and related issues in the African American community
Potential benefits of a cross-mentoring model for African American scholars with relevant interests
Need for an expanded obesity research paradigm
www.aacorn.org
African American Collaborative Obesity Research Network (AACORN)
Researchers across the US with diverse interests and expertise related to African American health, especially food, nutrition, weight, weight related health problems and women’s health
African American and selected other scholars
Early career scholars, established scholars, and scholars in training
Community research partners
AFRICAN AMERICANCOLLABORATIVE OBESITY RESEARCH NETWORK
Achieving Healthy Weight in African American Communities:Interdisciplinary Research Directions
Second Annual Scientific Meeting & Workshop
Sponsored by the Division of Nutrition and Physical ActivityCenters for Disease Control and Prevention
August 9 – 10, 2004Wyndham Hotel Downtown
www.aacorn.org
Research Focus: What is the Question?
Interventions on eating, physical
activity, andweight in African
Americans
www.aacorn.org Joanne Banks-Wallace, RN, PhD
“In order to gain the most out of this session, I encourage each of you to lay aside the usual framework that you use to take in information at scientific meetings and imagine that you have awakened, like Dorothy and Toto, and found yourself in Oz, where all that you know no longer governs all that is…”
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www.aacorn.org
Expanded Knowledge Domains
*Focus of traditional obesity research
Balance of
Calorie Intake
and Output*
Historical & Social
Contexts
Physical & Economic
Environments
Cultural & Psychosocial
Processes
• Aesthetic, moral, religious, and social values
• Collective psychology• Literary expressions
• Historical legacy• Social processes
in families andcommunities • Media and
marketing• Built environment • Food costs
Balance of
Calorie Intake
and Output*
www.aacorn.org
Research Lenses: Who is Looking? Listening?
African Americansin researched communities
African American researchers
Researchers in general
and researchsponsors
www.aacorn.org
• Community and family life (content)
• Historical legacy and core values (content)
• Ethnographic and literary content analysis (methods)
• Engaging communities(methods)
• Leveraging insider status (methods)
Research Contentand Methods
Expanded Knowledge Domains
Balance ofCalorie Intakeand Output*
*Focus of traditional obesity research
Balance of
Calorie Intake
and Output*
Cultural & Psychosocial
Processes
Historical & Social
Contexts
Physical & Economic
Environments
Where does this lead us?
www.aacorn.org
Community and Family Life
Community-specific environmental influencesCommunity structure and organizationWomen as a central focusHeterogeneity
www.aacorn.org
Jarrett… Qualitative sociological research, Chicago South Side
Gaining a sense of contexts, routines, and rhythmsAll types of family structures and family dynamicsFamilies “subsidizing” communitiesResource pools, daily routinesStrong normative support for self-sacrificing mothers
www.aacorn.org
Sheftall…literary works cited
Becky W. Thompson, Black Female, Hungry and HurtingRetha Powers, Fat is a Black Woman’s Issue (Essence, 1989)bell hooks, Sisters of the YamGloria Naylor, Linden HillsAlice Walker, MeridianGayle Pemberton, The Hottest Water in ChicagoToni Morrison, The Bluest EyeJune Jordan, Free Flight (in Passion, New Poems)
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One response
Is America ready for African Americans to be healthy?
www.aacorn.org
Historical Legacy and Core Values
Historical importance of trustCollective trauma
www.aacorn.org
McGary…spiritual and philosophical underpinning
What can we learn from the methods and teaching of philosophy?Recognize three important African American community values—
Loyalty (rationale and empirically validated)TrustworthinessJustice
Framed as rights of individuals and groups(“non-consequentialist” view), not justice in terms of the good of society as a whole (consequentialistview)
www.aacorn.org
James Myers…Collective Psyche
Importance of cultureUniqueness of African American experienceEmphasis on achieving optimal healthCollective and individual adaptationsChanges across generations
www.aacorn.org
Ethnographic and literary content analysis
Ethnographic research methodsLiterary representations of African American life
www.aacorn.org
Engaging Communities
Community members as equal research partnersCommunity strengthsBenefits to researched communities
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Leveraging Insider Status
Trust and credibilityConnections to communities of referenceObjectivity and expectationsSocial and professional support
www.aacorn.org
• Community and family life (content)
• Historical legacy and core values (content)
• Ethnographic and literary content analysis (methods)
• Engaging communities(methods)
• Leveraging insider status (methods)
Research Content& Methods
Expanded Knowledge Domains
Focus of traditional obesity research
Balance ofCalorie Intakeand Output*
Cultural & Psychosocial Processes
Historical & Social Contexts
Physical & Economic
Environments
Interventions on eating, physical
activity, andweight in African
Americans
ResearchFocus
ResearchLenses
African Americansin researchedcommunities
African American researchers
Researchersin general
andresearch sponsors
Progression toward more effective research to improve weight and quality of life in African American communities
Energy Balance
AACORN’S Expanded Obesity Research Paradigm
© African American Collaborative Obesity Research Network
Outline
• Context • Expanded causal paradigm• AACORN’s expanded paradigm• Follow up
– Linking AACORN’s paradigm to broader community issues
– Linking AACORN’s paradigm to mainstream obesity research
– Using paradigm to drive research design and implementation
Participatory Research on African American Community Weight Issues: Defining the State of the Art
• 2nd National Invited Workshop: August 2006– CBPR concepts and principles and potential
implementation regarding weight interventions– What constitutes a successful research project
to community residents? – What is involved in conducting research in
communities?
Participatory Research on African American Community Weight Issues: Defining the State of the Art
– Community priorities other than obesity (e.g., housing, violence and incarceration) that may be more immediate than those related to obesity and how these interface with efforts to address obesity; and
– Model CBPR programs (on any topic)– Views of funders and scientific journal editors
Linking to obesity research mainstream (examples)
• Cultural and psychosocial processes
• Historical and social contexts
• Physical and economic environments
• Overeating and stress
• Information• Health services
• Built environment
• Price• Marketing
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Research Design and Implementation
• Commitment to CBPR• Think Tanks• Broader Literature Reviews• Consultant Pool• Visibility and Critical Mass
www.aacorn.org