Winkleby Lab In the Prevention Research Center

Interactions of Ethnicity and Socioeconomic Status on Women's Cardiovascular Health: Implications from NHANES III Data


     This comparative study focuses on three population subgroups that are among the most underrepresented in cardiovascular disease (CVD) epidemiologic research: women, ethnic minority  groups (Mexican-American and African-American), and low socioeconomic status (SES) groups. The proposal has two main aims. Aim #1 will elucidate ethnic differences in a comprehensive set of major CVD risk factors by using a matched-pairs design to analyze data on approximately 5,000 Mexican-American, African-American, and white women from the Third National Health and Nutrition Examination Survey (NHANES III).  Aim #2 will build on the quantitative data findings from Aim #1 and collect new qualitative data from focus groups and community-based organization interviews to advance knowledge about tailored CVD prevention models for low SES ethnic minority and white women. The focus groups and interviews will generate further hypotheses that will be tested using the NHANES III data, thus initiating a feedback loop between data analyses and program planning.

     Aim #1:  Assess ethnic differences in CVD risk factors for Mexican-American, African-American, and white women, matched on SES and age. We hypothesize that: a) ethnic differences in CVD risk factors will exist at each level of SES and will be most pronounced for women at the lowest levels of SES (i.e., interactive effect between ethnicity and SES), and b) strong SES differences in CVD risk factors will exist for women from all ethnic groups. The CVD risk factors that will be analyzed from the NHANES III sample include: 1) physiologic data on body mass index, mean blood pressure, insulin glucose levels, and lipid and lipoprotein measurements (e.g., total cholesterol, HDL, LDL, triglycerides, Lp(a), and apolipoproteins A1, B); 2) behavioral data on smoking, physical activity, and dietary patterns; and 3) sociocultural and health care utilization data (e.g., education, family income, occupation, language spoken, immigration status, perceived health status, medical insurance).

     Aim #2-a:  Conduct focus groups with low income Mexican-American, African-American, and white women to: 1) gather in-depth information about psychosocial, family, sociocultural, and environmental factors that influence CVD risk factors and behavior change and, 2) develop a tailored CVD intervention model that takes into account the needs of low SES and ethnic  minority women. 

     Aim #2-b:  Conduct interviews with representatives from community-based organizations to reconfirm focus group findings and assess the feasibility of the tailored community-based CVD intervention model.

This collaborative effort joins investigators and resources from the Stanford Center for Research in Disease Prevention (with expertise in community-based CVD intervention programs and women's health issues) and the Stanford Center for Excellence in Minority Health (with ethnic minority researchers with strong backgrounds in Hispanic and African-American health issues).

The knowledge gained from this work will: 1) increase our basic understanding of underlying mechanisms associated with ethnic differences in CVD risk factors, and 2) guide public policy recommendations about community-based CVD intervention programs that are tailored to underserved women who have high prevalences of CVD risk factors and disease


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