Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Factors Afecting Body Mass Index Levels in African American Women Living in North Carolina Padmini Shanti Kirpalani Walden University Follow this and additional works at: htps://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons Tis Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact Walden University College of Health Sciences This is to certify that the doctoral dissertation by Padmini Kirpalani has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Scott McDoniel, Committee Chairperson, Public Health Faculty Dr. Vasileios Margaritis, Committee Member, Public Health Faculty Dr. Daniel Okenu, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Factors Affecting Body Mass Index Levels in African American Women Living in North Carolina by Padmini Kirpalani Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Abstract The prevalence of obesity has doubled over the past 25 years in the United States, particularly in North Carolina. Obesity is influenced by biological, social, and environmental factors; its prevalence has been found to be higher among African American women and other racial ethnic minorities. Guided by the social ecological model, the purpose of this cross sectional study was to examine the relationship of the psycho-social, psycho-behavioral factors, and body mass index levels (BMI) in African American women living in North Carolina versus their Hispanic American and European American counterparts. A logistic regression model using secondary data from the Behavioral Risk Factor Surveillance System revealed a significant association in income levels, house hold size, dietary intake, physical activity, and increased BMI levels in African American women. African American women were significantly more likely to be obese (r = 0.93 p > 0.05) compared to European American and Hispanic American women. The association of each variable to BMI assessed for African American women was as follows: income (r = 0.46, p = 0.001), dietary intake (r = 0.-17, p = 0.04), household size (r = 0.57, p = 0.001), physical activity (r = -0.16, p = 0.05), depression (r = 0.37, p = 0.001), and alcohol consumption (r = 0.39, p = 0.001). A culturally sensitive weight loss model addressing the psycho-behavioral and psychosocial risk factors that negatively influence BMI and subsequently obesity is warranted for African American women living in North Carolina to promote social change and decrease the incidence of obesity in this ethnic group. Factors Affecting Body Mass Index Levels in African American Women Living in North Carolina by Padmini Kirpalani Dissertation Submitted in Partial Fulfillment Of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Dedication Dedicated to my parents Kamla and Shamdas Kirpalani; with profound gratitude, for all the sacrifices they made and values instilled in me that have made my journey successful. For my son, Tarun Karnani, endeavoring to leave him a legacy of excellence and in gratitude to all the support and assistance he provided through this process of my becoming a scholar-practitioner. Acknowledgments With deep gratitude and appreciation to my chair and content expert; Dr. Scott McDoniel PhD for his time and support throughout this process, and Dr. Vasileios Margaritis, Committee Member and methodology expert. Thank you both for your rigorous mentorship and encouragement which has made it possible for me to successfully complete the most academically challenging milestone in my journey. Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Problem Statement .........................................................................................................3 Purpose of the Study ......................................................................................................5 Nature of the Study ........................................................................................................7 Research Questions ........................................................................................................8 Theoretical Framework ..................................................................................................9 Definition of Terms......................................................................................................10 Assumptions .................................................................................................................11 Limitations ...................................................................................................................12 Delimitations ................................................................................................................13 Significance of the Study .............................................................................................13 Summary ......................................................................................................................14 Chapter 2: Literature Review .............................................................................................16 Introduction ..................................................................................................................16 Literature Research Strategy ........................................................................................19 Theoretical Framework ................................................................................................20 Overview of Obesity in the United States ....................................................................20 Obesity Trends ...................................................................................................... 22 Ethnicity and Obesity ............................................................................................ 25 i Obesity in North Carolina ..................................................................................... 27 Psycho-Social Factors and Obesity ..............................................................................29 Food Insecurity & Obesity .................................................................................... 30 Income and Obesity .............................................................................................. 31 Diet and Obesity ................................................................................................... 32 Household Size and Ethnicity ............................................................................... 35 Psycho-Behavioral Factors ..........................................................................................36 Depression and Obesity ........................................................................................ 38 Depression and Ethnicity ...................................................................................... 44 Dietary Intake & Obesity ...................................................................................... 46 Alcohol Intake and Obesity .................................................................................. 49 Physical Activity and Obesity ............................................................................... 51 Physical Activity & Ethnicity ............................................................................... 56 Summary of Literature Review ....................................................................................58 Chapter 3: Research Method ..............................................................................................60 Introduction ..................................................................................................................60 Research Design and Approach ...................................................................................62 Research Questions ......................................................................................................63 Setting and Sampling ...................................................................................................65 Target Population .................................................................................................. 65 Sampling Method .................................................................................................. 66 Sample Size ........................................................................................................... 67 ii Power Analysis ..................................................................................................... 68 Study Participants Eligibility Criteria ................................................................... 69 Instrumentation and Materials .....................................................................................69 Study Variables ............................................................................................................71 Dependent Variable .............................................................................................. 71 Independent Variables .......................................................................................... 72 Measurement of Variables .................................................................................... 72 Data Recoding ..............................................................................................................74 Data Analysis ...............................................................................................................76 Threats to Validity .......................................................................................................80 Research Design and Approach ...................................................................................83 Ethical Concerns ..........................................................................................................84 Summary ......................................................................................................................85 Chapter 4: Results ..............................................................................................................87 Limitations of the Data ................................................................................................88 Summary ....................................................................................................................104 Chapter 5: Discussion, Conclusions, and Recommendations ..........................................106 Introduction ................................................................................................................106 Interpretation of the Findings.....................................................................................106 Implications for Future Research ...............................................................................115 Social Change Implications .......................................................................................118 Summary ....................................................................................................................121 iii