Scharoun-Lee Melissa, Adair Linda S, Kaufman Jay S, Gordon-Larsen Penny
Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin Street, Chapel Hill, NC 27516, USA.
Soc Sci Med. 2009 Feb;68(4):708-16. doi: 10.1016/j.socscimed.2008.12.009. Epub 2009 Jan 10.
Racial/ethnic disparities in obesity widen dramatically during young adulthood in the US. Understanding racial/ethnic differences in the association between socioeconomic status (SES) and obesity can provide insight on these disparities. However, the delay and complexity of the transition to adulthood create challenges for defining SES using traditional, single indicators, such as income or years of education. Our objective was to define a multidimensional measure of young adult SES using exploratory factor analysis and to investigate whether distinct SES dimensions differentially predicted obesity across race/ethnicity in 11,250 young adults (mean age=21.9 years) from the National Longitudinal Study of Adolescent Health (Wave III: 2000-2001). Four factors (social advantage; schooling; employment; and economic hardship) extracted from a principal factor analysis on 38 SES indicators comprised our multidimensional measure of young adult SES. The respondents' scores on each factor were entered into gender-stratified Poisson regression models to estimate the relative risk of young adult obesity for a contrast of approximately one standard deviation in score. The association of the "Social advantage" and "Economic hardship" factors with obesity differed by race/ethnicity (p<0.05 for Wald test of interaction) in females; high "Social advantage" scores were inversely associated with obesity in white and Hispanic females (9-20% lower) while high scores on "Economic hardship" were positively associated with obesity (7-76% higher) in white and Asian females. In contrast, no significant racial/ethnic differences were detected in young adult males. The "Schooling" factor was significantly protective (RR=0.91; 95% CI: 0.85, 0.98) for females of all racial/ethnic groups. These results facilitate understanding of the impact of multiple, distinct SES dimensions during the complex transition to adulthood and thus provide salient information for reducing racial/ethnic disparities in obesity during this important period for obesity development.
在美国，肥胖方面的种族/族裔差异在青年期会急剧扩大。了解社会经济地位（SES）与肥胖之间关联中的种族/族裔差异，有助于洞察这些差异。然而，向成年期过渡的延迟和复杂性，给使用传统单一指标（如收入或受教育年限）来界定SES带来了挑战。我们的目标是通过探索性因素分析来界定青年期SES的多维指标，并调查在来自青少年健康全国纵向研究（第三波：2000 - 2001年）的11250名青年（平均年龄 = 21.9岁）中，不同的SES维度是否对不同种族/族裔的肥胖情况有不同的预测作用。从对38个SES指标进行的主因素分析中提取的四个因素（社会优势、教育、就业和经济困难）构成了我们对青年期SES的多维指标。将受访者在每个因素上的得分纳入按性别分层的泊松回归模型，以估计得分相差约一个标准差时青年肥胖的相对风险。在女性中，“社会优势”和“经济困难”因素与肥胖的关联因种族/族裔而异（交互作用的Wald检验p < 0.05）；白人及西班牙裔女性中，高“社会优势”得分与肥胖呈负相关（低9 - 20%），而在白人和亚裔女性中，高“经济困难”得分与肥胖呈正相关（高7 - 76%）。相比之下，在青年男性中未检测到显著的种族/族裔差异。“教育”因素对所有种族/族裔的女性都有显著的保护作用（RR = 0.91；95% CI：0.85，0.98）。这些结果有助于理解在向成年期的复杂过渡过程中多个不同SES维度的影响，从而为在肥胖发展的这一重要时期减少肥胖方面的种族/族裔差异提供重要信息。
