Race and ethnic differences in physical activity, osteopenia, and osteoporosis: results from NHANES 2009-2010, 2013-2014, 2017-2018.

This study aimed to determine current physical activity trends association with bone density in a racial and ethnically diverse sample of older adults. We found that those engaged in no and some physical activity had lower femoral BMD when compared to those that met the physical activity recommendation. PURPOSE: Most older adults do not engage in the recommended levels of physical activity to improve health, and there are racial and ethnic differences in physical activity participation. This study aims to evaluate whether meeting the physical activity recommendation is related to osteopenia and osteoporosis in a racially and ethnically diverse sample of older adults. METHODS: Femoral neck bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES 2009-2010, 2013-2014, 2017-2018) was obtained from 5252adults 60-80 years old. Self-reported physical activity was categorized into met recommendation, some physical activity, and no physical activity. We used linear regression models to examine the association between physical activity and BMD for each race and ethnic group adjusting for sociodemographics and other selected variables. RESULTS: Non-Latino Blacks (NLB) and Latinos reported the lowest prevalence of meeting the physical activity recommendation, compared with Non-Latino Whites (NLW) (40.0%, 44.0%, and 51.4%, respectively; p < 0.0001). Further, NLB and Latinos had a lower prevalence of osteoporosis when compared to NLW (5.4%, 7.3%, and 9.1% respectively; p < 0.0001). There was a 0.03 g/cm2 difference in BMD between those who met the physical activity recommendation when compared to the no physical activity group; however, this decreased after adjusting for selected covariates. CONCLUSION: Considering the prevalence and burden of osteopenia and osteoporosis, and projected increases in the racial and ethnic diversity of the older population, more research is needed to further understand the association between meeting the physical activity recommendation and bone health among racial and ethnic diverse older adults.

Evaluation of the Role of Leisure Time Physical Activity and Sedentary Behavior Simultaneously on the Income-Overweight/Obesity Relationship.

In the United States, overweight/obesity is more prevalent among those with low-income; higher income is related to greater leisure time physical activity (LTPA) and sedentary behavior (SB), which are inversely related to overweight/obesity. This study aimed to evaluate the role of LTPA and SB simultaneously in the income-overweight/obesity relationship. Cross-sectional data from the National Health and Nutrition Examination Survey (2007-2014) were utilized (n = 10,348 non-older adults (aged 20-59 years)). A multiple mediator structural equation model was conducted to evaluate the indirect effects from income to overweight/obesity (Body Mass Index ≥25 kg/m2) through LTPA and SB simultaneously, controlling for confounding variables, including diet, smoking, and alcohol consumption. As expected, greater income was negatively associated with overweight/obesity. Income indirectly influenced overweight/obesity through LTPA (Indirect effect: B = -0.005; CI = -0.01, -0.003), and through SB (Indirect effect: B = 0.008; CI = 0.005, 0.01), in opposing directions. The direct effect from income to overweight/obesity remained statistically significant. LTPA partially accounted for the negative relationship between income and overweight/obesity; SB reduced the strength of the negative relationship between income and overweight/obesity. Targeted behavior approaches for weight management may be beneficial. Increasing LTPA among adults with lower income and decreasing SB among adults with higher income may provide some overweight/obesity protection.

Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans.

Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

The Association Between Family Social Network Size and Healthy Lifestyle Factors: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

We examined associations of central family (i.e., children, parents, in-laws) social network size with healthy lifestyle factors (i.e., favorable body mass index, physical activity, diet, alcohol use, smoking). Using data on 15,511 Hispanics/Latinos 18-74 years old from the Hispanic Community Health Study/Study of Latinos, multivariable adjusted survey logistic regression was used to compute associations of social network size with healthy lifestyle factors. A one-unit higher total of central family size was associated with lower odds of healthy body mass index (OR 0.90; 95% CI 0.86-0.93) and having all five healthy lifestyle factors (OR 0.90; 95% CI 0.85-0.96). Findings suggest familial structural social support may contribute to healthy lifestyle factors and differ based on the type of relationship among Hispanics/Latinos.

Physical activity and sleep problems in homeless adults.

BACKGROUND: For the estimated 554,000 homeless individuals on any given night in the United States, obtaining quality sleep is often challenging. This group is known to have multiple health disparities, potentially affected by sleep problems; therefore, identifying lifestyle factors-such as physical activity-that are associated with improving both quality and quantity of sleep has important implications for public health. Here, we examine associations of physical activity with subjective sleep problems within a large sample of homeless adults. METHODS: Participants were homeless adults recruited from Dallas and Oklahoma (N = 747; 66.1% men, Mage = 43.7±12.1). Participants self-reported insufficient sleep (number of days without sufficient rest/sleep in the last month; categorized as 0, 1-13, 14-29, or ≥30 days), sleep duration (over average 24 hours; categorized as ≤6 [short sleeper], 7-9 [optimal sleeper], or ≥10 hours [long sleeper]), and unintentional daytime sleep (number of days with unintentional sleep in the last month; categorized as 0 vs ≥30 days). Physical activity was assessed subjectively using the BRFSS Physical Activity Questionnaire. Regression analyses were performed to examine the associations between physical activity and sleep problems, controlling for age, sex, race, education, body mass, months homeless, at-risk drinking, self-rated health, serious mental illness, smoking status, and recruitment city. RESULTS: Failure to meet/exceed physical activity guidelines was associated with higher likelihood of being a long sleeper (OR = 2.64, 95% CI: 1.46, 4.78) but a lower likelihood of having ≥30 days of insufficient rest/sleep (OR = 0.52, 95% CI: 0.29, 0.93). CONCLUSIONS: Findings suggest that physical activity promotion may hold promise for addressing the problem of too much sleep, but not other manifestations of sleep problems among this vulnerable group.

Diabetes Prevalence by Leisure-, Transportation-, and Occupation-Based Physical Activity Among Racially/Ethnically Diverse U.S. Adults.

OBJECTIVE: Leisure-time physical activity (LTPA) has been shown to prevent or delay the development of diabetes. However, little research exists examining how other domains of PA (e.g., occupation based [OPA] and transportation based [TPA]) are associated with diabetes prevalence across diverse racial/ethnic groups. We examined associations between OPA, TPA, and LTPA and diabetes prevalence and whether associations differed by race/ethnicity. RESEARCH DESIGN AND METHODS: Participants in the 2011-2016 National Health and Nutrition Examination Survey (NHANES) self-reported domain-specific PA. Diabetes status was determined by self-reported doctor/health professional-diagnosis of diabetes or a glycosylated hemoglobin (HbA1c) measurement of ≥6.5% (48 mmol/mol). Multivariable log binomial models examined differences in diabetes prevalence by PA level in each domain and total PA among Latinos (n = 3,931), non-Latino whites (n = 6,079), and non-Latino blacks (n = 3,659). RESULTS: Whites reported the highest prevalence of achieving PA guidelines (64.9%), followed by Latinos (61.6%) and non-Latino blacks (60.9%; P < 0.0009). Participants achieving PA guidelines were 19-32% less likely to have diabetes depending on PA domain in adjusted models. Diabetes prevalence was consistently higher among non-Latino blacks (17.1%) and Latinos (14.1%) compared with non-Latino whites (10.7%; P < 0.0001), but interaction results showed the protective effect of PA was similar across PA domain and race/ethnicity-except within TPA, where the protective effect was 4% greater among non-Latino whites compared with Latinos (adjusted difference in risk differences 0.04, P = 0.01). CONCLUSIONS: PA policies and programs, beyond LTPA, can be leveraged to reduce diabetes prevalence among all population groups. Future studies are needed to confirm potentially differential effects of transportation-based active living on diabetes prevalence across race/ethnicity.

Nativity and Occupational Determinants of Physical Activity Participation Among Latinos.

INTRODUCTION: Latinos in the U.S. bear a disproportionate burden of cardiovascular risk factors, including physical inactivity. Previous research among Latinos has focused on leisure-time physical activity, limiting understanding of the different ways in which populations, particularly working-class groups, achieve recommended levels of physical activity. This study examined associations of race/ethnicity; nativity; and leisure-time, transportation, and occupation-related physical activity among Latino and non-Latino white adults. METHODS: Participants sampled in the 2007-2012 waves of the National Health and Nutrition Examination Survey self-reported domain-specific physical activity. Data were analyzed in 2016-2017 using multivariable log binomial regression models to examine differences in meeting guidelines for each physical activity domain separately and as total physical activity among Latinos (n=4,692) and non-Latino whites (n=7,788). Models were adjusted for sociodemographic characteristics and health status and tested interactions between nativity and occupational categories. RESULTS: In adjusted models, foreign-born Latinos (prevalence ratio=0.70, 95% CI=0.63, 0.77) and U.S.-born Latinos (prevalence ratio=0.85, 95% CI=0.76, 0.95) were least likely to meet physical activity guidelines through occupation-related and leisure time physical activity, when compared with non-Latino whites. By contrast, foreign-born Latinos were more likely to meet physical activity guidelines through transportation physical activity than non-Latino whites (prevalence ratio=1.26, 95% CI=1.01, 1.56) and were proportionately more likely to participate in vigorous modes of physical activity. Interaction results indicated that foreign-born Latinos were the least likely to meet physical activity guidelines compared with U.S.-born Latinos and non-Latino whites if they worked in non-manual occupational categories. All racial/ethnic groups working in manual occupations saw the largest increase (40%-50%) in meeting physical activity guidelines when occupation-related physical activity was combined with leisure-time and transportation physical activity. CONCLUSIONS: These findings suggest variability in the relationship between nativity and the physical activity domain Latinos engage in compared with non-Latino whites, with occupation contributing substantially to meeting physical activity recommendations for all population groups.

The Association of Prediabetes and Diabetes Risk Perception With Leisure-Time Physical Activity and Weight Loss.

PURPOSE: To examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and determine whether the association of risk perception with LTPA and weight loss varies by race/ethnicity. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 2011-2014. SUBJECTS: Non-Latino white, non-Latino black, and Latino nondiabetic and nonprediabetic NHANES participants ≥18 years of age who were not underweight (n = 9550). MEASURES: Demographic characteristics, LTPA, attempted weight loss, and perceived risk of prediabetes or diabetes. ANALYSIS: Log-binomial regression models were fit to assess the association of perceived risk with meeting LTPA recommendations and having attempted to lose weight, overall and by race/ethnicity. RESULTS: Individuals reporting that they perceived they could be at risk for diabetes/prediabetes were less likely to meet LTPA recommendations (adjusted prevalence ratio [aPR]: 0.87; 95% confidence interval [CI]: 0.79-0.95), but significantly more likely to report attempting weight loss in the past year (aPR: 1.14; 95%CI: 1.04-1.25), compared with those reporting no risk perception. Latino and non-Latino blacks who perceived they could be at risk for diabetes/prediabetes were 25% and 35% more likely to report trying to lose weight in the past year (aPR: 1.25; 95% CI: 1.08-1.44 and aPR: 1.35; 95% CI: 1.19-1.54, respectively), compared with Latino and non-Latino blacks that did not perceive being at risk. In contrast, non-Latino whites who perceived they were at risk were 20% less likely to report meeting LTPA recommendations (aPR: 0.80; 95% CI: 0.72-0.89), compared with non-Latino whites reporting no risk perception. CONCLUSION: Findings highlight the role of perceived risk for prediabetes and diabetes in LTPA and weight loss, with findings varying by race/ethnicity. Awareness of prediabetes and diabetes risk could contribute to efforts aimed at improving LTPA and weight loss.

Racial/Ethnic Differences in the Associations Between Physical Activity and Sleep Duration: A Population-Based Study.

BACKGROUND: This study examined associations between physical activity (recreational, nonrecreational) and sleep duration among a nationally representative diverse sample of U.S. adults. METHODS: We used cross-sectional data from 9,205 National Health and Nutrition Examination Survey 2007 to 2012 participants aged 20 to 65 years who identified as White, Black, or Hispanic. Activity (ie, recreation, occupation, and transportation activity) was categorized into quartiles. Sleep duration was categorized as short (≤6 hours/night) or normal (>6 to ≤9 hours/night). Logistic regression was used to estimate associations of activity with sleep duration. RESULTS: Recommended levels of recreation activity and moderate levels of transportation activity were associated with normal sleep duration [Odds Ratio (OR): = 1.33, 95% Confidence Interval (CI) = 1.08, 1.65; OR = 1.28, 95% CI = 1.02, 1.62, respectively]. High occupation physical activity was associated with shorter sleep duration (OR = 0.59, 95% CI = 0.49, 0.71). Differences were observed by race/ethnicity in associations of recreation and occupation activity with sleep duration. CONCLUSIONS: White individuals who engaged in some recreation activity, relative to being inactive, had more favorable sleep duration; whereas, high levels of occupation activity were associated with worse sleep duration among White and Black individuals. Physical activity was not associated with sleep duration among Hispanics.

Association of self-reported physical activity with obstructive sleep apnea: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

We examined associations of mild and moderate to severe obstructive sleep apnea (OSA; apnea-hypopnea index ≥5 and ≥15, respectively) with recommended amounts of moderate-vigorous physical activity (MVPA) or vigorous physical activity (VPA) and by type of activity (i.e., recreational, transportation, and work activity). The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter population-based study, enrolled individuals from 2008 to 2011 from four U.S. metropolitan areas (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California). Participants in this study included 14,087 self-identified Hispanic/Latino ages 18 to 74years from the HCHS/SOL. Survey logistic regression analysis was used to compute odds ratios [OR] and 95% confidence intervals [CI], adjusting for sociodemographics, smoking status, and body mass index (BMI). Relative to being inactive, performing some MVPA (>0 to <150min/week) or meeting the recommended MVPA (≥150min/week) were associated with lower odds of mild OSA (ORs and 95% CIs 0.70 [0.61-0.82] and 0.76 [0.63-0.91], respectively), as well as moderate to severe OSA (ORs and 95% CIs 0.76 [0.62-0.93] and 0.76 [0.59-0.98], respectively). Associations of VPA with OSA were not significant. Engaging in medium or high levels of transportation activity was associated with lower odds of mild OSA (OR: 0.84, 95% CI: 0.74-0.96; OR: 0.64, 95% CI: 0.43-0.95, respectively). Performing some recreational MVPA was associated with lower likelihood of mild and moderate to severe OSA (OR: 0.82, 95% CI: 0.71-0.93; OR: 0.79, 95% CI: 0.64-0.97, respectively). Health promotion and OSA prevention efforts should encourage individuals to engage in at least some MVPA.

Activity and Weight Misperception among Overweight and Obese US Adults.

OBJECTIVES: Engaging in some exercise is associated with weight misperception (ie, overweight and obese participants self-reporting being normal weight or underweight) among adults. Less is known about associations between various types of activity with weight misperception. We examined associations between activity (moderate-vigorous leisure-time, work- and transportation-related physical activity, and sedentary activity) and weight misperception. METHODS: We used cross-sectional data from 7992 National Health and Nutrition Examination Survey 2007-2010 participants aged 20+ years with a ≥ 25 body mass index. Logistic regression models were used to estimate activity-weight misperception associations. RESULTS: Individuals who performed some activity, versus none, were less likely to misperceive their weight (Odds Ratio [OR]: 0.78; 95% Confidence Interval [CI]: 0.66, 0.93). Those who engaged in high levels of transportation activity were more likely to misperceive their weight (OR: 1.29; 95% CI: 1.09, 1.54). Individuals who engaged in medium and high levels of sedentary activity, versus low, were less likely to misperceive their weight (OR: 0.65; 95% CI: 0.57, 0.75 and OR: 0.51; 95% CI: 0.43, 0.61, respectively). Associations varied by sex. CONCLUSIONS: Variation in associations of various types of activity with weight misperception should be considered when developing health promotion programs.

Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health.

The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal.

The Role of Physical Activity and Sedentary Behaviors in Explaining the Association Between Acculturation and Obesity Among Mexican-American Adults.

PURPOSE: We investigated associations of acculturation with various types of activity (moderate-vigorous leisure-time physical activity [LTPA], moderate-vigorous work- and transportation-related physical activity, and sedentary activity), and whether these activities mediated the acculturation-obesity association among Mexican-Americans. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 2007-2010. SUBJECTS: Mexican-American NHANES participants aged ≥20 years (n = 1902). MEASURES: Demographic characteristics, physical activity, sedentary behavior, acculturation, and body mass index. ANALYSIS: Multinomial logistic regression was used to estimate associations of acculturation with categories of self-reported activity. Path analysis was used to test whether the activity measures mediated acculturation-obesity associations. RESULTS: In adjusted models, compared to U.S.-born Mexican-Americans, foreign-born Mexican-Americans living in the United States for less than 10 years were significantly less likely to be in the highest LTPA and sedentary activity categories, and more likely to be in the highest total and transportation activity categories. Foreign-born Mexican-Americans living in the United States for 10 years or more were significantly less likely to engage in high sedentary activity but more likely to engage in high transportation activity. Sedentary behavior was the strongest mediator of the acculturation-obesity association, accounting for 40.7% and 57.1% of the total effect of acculturation on obesity among foreign-born Mexican-Americans living in the United States for less than 10 years and for 10 years or more, respectively, compared to U.S.-born Mexican-Americans. CONCLUSION: Reducing sedentary behavior may lower the negative impact of acculturation on obesity.

Persistent disparities in cholesterol screening among immigrants to the United States.

BACKGROUND: This study compared differences in cholesterol screening among immigrant populations and US born race/ethnic groups and whether improving access to health care reduced differences in screening. METHODS: Self-reported cholesterol screening for adults was calculated from multivariate logistic regression analysis of the 1988-2008 National Health and Nutrition Examination Surveys (N = 17,118). Immigrant populations were classified by place of birth and length of residency. RESULTS: After adjusting for individual characteristics and access to health care, the multivariate adjusted probability of cholesterol screening is significantly lower for persons originating from Mexico (70.9%) compared to persons born in the US (80.1%) or compared to US born Hispanic persons (77.8%). Adjustment for access to care did significantly reduce the difference in screening rates between immigrants and natives because the rate for natives remained the same, but the rate for immigrants improved. For example, the difference in screening between US born persons and persons born in Mexico was reduced by nearly 10% after adjustment for access to care. CONCLUSIONS: There are persistent disparities in cholesterol screening for immigrants, particularly recent immigrants from Mexico, but improved access to health care may be a viable policy intervention to reduce disparities.