Between-group differences in nutrition- and health-related psychosocial factors among US adults and their associations with diet, exercise, and weight status

Abstract

Background: Large disparities exist across ethnic and socioeconomic status groups regarding obesity and other chronic diseases. Eliminating health disparities is a national priority in the United States.

Objective: To test between-group differences in nutrition- and health-related psychosocial factors (NHRPF) and their associations with US adults' diet, exercise, and weight status. DESIGN AND PARTICIPANTS/SETTING: Nationally representative data from the Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey 1994-96 from 4,356 US adults aged 20 to 65 years were used. Diet was assessed using 24-hour recalls, NHRPF was assessed by 25 questions, and weight status was determined by self-reported weight and height. Index scores were created to measure NHRPF. Diet quality was assessed using the US Department of Agriculture 2005 Healthy Eating Index (HEI).

Statistical analyses: Multivariate linear and logistic regression models were conducted to examine the associations.

Results: Some ethnic differences in NHRPF existed but were small. There were statistically significant (P<0.05) and large ethnic differences in diet (blacks had the worst average HEI and whites the best at 47.6 vs 52.3, respectively). Groups with higher socioeconomic status had better NHRPF (ie, had better nutrition knowledge and beliefs, made better food choices, and had better awareness of nutrition-related health risks) and HEI score. Subjects with high school education had higher NHRPF score (37.2 vs 35.7) and HEI score (54.5 vs 49.5) than those with less than a high school education.

Conclusions: Ethnic differences among American adults' NHRPF were small, but socioeconomic status differences were greater. More efforts are needed to study the influences of the complex interactions between individual and social environmental factors that affect Americans' diet and weight status and to explain related ethnic disparities.

Figure 1

Associations (OR and 95% CI) between nutrition- and health-related psychological factors and high diet quality (HEI≥80^th percentile) in US men and women NKB: nutrition knowledge and beliefs; HEI: healthy eating index; NHRPF: nutrition- and health-related psychological factors. Separate multivariable logistic regression models were fit for individual NHRPF measures and NHRPF index and for men and women, respectively. Each model adjusted for survey year, age, education, poverty income ratio, region, urbanization, comorbidity, and self-rated health.