Health & Culture Project: Cultural Factors Underlying Obesity in African-American Adolescents
Condition: Pediatric Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Observational

Summary: 
      The overall goal of this study is to examine the relationships between cultural identity and
      identity-based motivation, physical activity, diet and obesity risk in African-American
      adolescents. It was hypothesized that African-American youth who self-report a bicultural
      identity maintain health promotion beliefs and behaviors that reduce obesity risk compared to
      minority youth who only identify with one culture or neither culture. It was also
      hypothesized that African-American youth who self report a bicultural identity are more
      likely to hold beliefs about health promotion behaviors that are congruent with their
      cultural identity than compared to youth who only identify with one culture or neither
      culture.
    

Detailed description: 
      Obesity is a significant problem in African-American adolescents in the United States (US).
      The most recent data suggests a doubling of overweight (BMI percentile > 85th for age and
      gender) and obesity (BMI percentile >95th for age and gender) among these racial/ethnic
      minority youth in the last 10 years. In 2007-8, 39.5% of African-Americans a ages 12-19 were
      overweight and 24.4% were obese. These obesity rates were approximately double that of
      non-Latino whites. Until now, most of our efforts to reduce pediatric obesity have targeted
      at-risk youth who are physically inactive and over-consume energy dense foods. More recently,
      however, that focus has broadened as a result of new understanding about how cultural factors
      also shape physical activity behaviors and dietary patterns. With the rapid increase in
      cultural diversity of the US, Black culture is quickly becoming a part of mainstream American
      culture, evolving within the US, while simultaneously integrating aspects of different
      African and Black American cultures. Consequently, African- American youth who come of age in
      the US, a multicultural society, interact with people from different cultural backgrounds
      that can lead to an interchange of cultural attitudes, beliefs and behaviors. Specifically,
      these youth may adopt one of four general cultural identities: (a) bicultural
      identity-combining aspects of their family's culture with aspects of mainstream American
      culture; (b) US cultural identity- replacing their family's culture with mainstream American
      culture; (c) traditional cultural identity- retaining their family's culture while rejecting
      mainstream American culture; or (d) marginalized cultural identity- becoming alienated from
      both cultures. Biculturalism is considered the most adaptive process allowing individuals to
      function effectively in a multicultural society while still maintaining supportive
      connections to their own family's culture. Hence, it was hypothesized that racial/ethnic
      minority youth who self-report a bicultural identity maintain health promotion beliefs and
      behaviors that reduce obesity risk compared to minority youth who only identify with one
      culture or neither culture.

      Empirical investigations assessing the impact of cultural identity on health promotion
      behaviors in African-American adults have reported a positive identification with
      African-American culture and a self- perception of being successful in both the "black" and
      "white" ways of life were associated with health promotion behaviors including reduced fat
      consumption and more participation in leisure-time physical activity. Less is known about the
      impact of cultural identity on physical activity behavior and dietary patterns in
      African-American youth. One important mechanism underlying the link between cultural
      identity, physical activity and diet likely involves identity-based motivation the process by
      which individuals see health behaviors as being congruent or incongruent with their cultural
      identity. According to the identity-based motivation model, health promotion behaviors (e.g.,
      exercising, restraining eating, reducing fat and sugar intake) are not simply personal
      choices made in the moment but rather are identity-infused habits. Hence, ethnic minorities
      who view health promotion behaviors as White and middle-class and unhealthy behaviors (e.g.,
      high-fat, high-sugar diet, sedentary behaviors) as a defining characteristic of their own
      cultural identity are less likely to engage in health promotion behaviors. Oyserman et al
      argues that even though physical activity and diet have important consequences for health,
      these identity-infused behaviors are engaged in less for their health consequences than for
      their identity consequences. Hence, identity-based motivation may serve as a novel mechanism
      explaining the link between cultural identity, physical activity and diet, ultimately
      influencing obesity risk in African-American youth. It was hypothesized that racial/ethnic
      minority youth who self report a bicultural identity are more likely to hold beliefs about
      health promotion behaviors that are congruent with their cultural identity than compared to
      youth who only identify with one culture or neither culture.

        1. Test whether a bicultural identity among African-American adolescents is associated with
           obesity risk and related health behaviors.

           H1: African-American adolescents who self-report a bicultural identity will report lower
           BMIs, increased physical activity and lower fat and sugar intake compared to adolescents
           who maintain an alternate cultural identity.

        2. Test whether a bicultural identity is associated with identity-based motivation in
           African-American adolescents.

           H2: African-American adolescents who self-report a bicultural identity view health
           promotion behaviors as identity-congruent compared to adolescents who maintain an
           alternate cultural identity.

        3. To evaluate whether identity-based motivation mediates the associations between a
           bicultural identity, obesity risk and related health behaviors in African-American
           adolescents. H3: Identity-congruent health promotion beliefs mediate associations
           between biculturalism, BMI, physical activity and diet in African-American adolescents.

      The Health & Culture project represents the convergence of two rapidly expanding areas of
      pediatric obesity research; the role of cultural identity and identity-based motivation in
      shaping health promotion behaviors. The investigators recently submitted several papers for
      publication examining associations between cultural identity, physical activity, diet and
      diabetes-related metabolic risk factors in obese African- American adolescents. Results
      demonstrate that for obese African-American adolescents, biculturalism was negatively
      associated with diabetes risk (via increased pancreatic beta-cell function assessed during a
      frequently-sampled intravenous glucose tolerance test). These relationships remained
      significant after controlling for household socioeconomic status, sex, pubertal maturation,
      fat/fat-free mass, physical activity and diet. These exciting findings peeked our interest in
      the area of cultural psychology, particularly as it relates to racial/ethnic disparities in
      pediatric obesity. Moreover, these preliminary data extend the findings of others who have
      pointed to the important role of cultural identity in shaping health and health behaviors.
      The researchers are advancing this area of research further by examining the influence of
      identity-based motivation in the context of cultural identity. Because identity-based
      motivation is a modifiable psychosocial mechanism, a richer and more in depth understanding
      of how identity-based motivation may help to inform culturally-tailored interventions could
      have a large public health impact by improving health promotion behaviors in racial/ethnic
      minority youth and reducing the economic burden of pediatric obesity.
    

Intervention name(s): Questionnaires and Measurements
Intervention type(s): Behavioral
Intervention description(s): Participants completed anthropometric measurements and questionnaires assessing psychosocial stress, habitual dietary intake and physical activity as well as cultural identity, identity-based motivation and socioeconomic status. At home, participants recorded their habitual physical activity and food intake. Participants then returned to the laboratory to complete an assessment of identity-based motivation and received personalized information regarding their habitual physical activity and dietary patterns.
Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        African American children and adolescents were recruited to participate in this study. The
        study included both genders aged 12-18 years. Adolescents were chosen because pubertal
        youth are at increased risk for obesity than pre-pubertal children.