Healthy Lifestyle Index and Social Determinants amongst Older Underserved African American Adults

Keywords: African American older adults; Healthy Lifestyle Index; weight loss plan high quality; Healthy Eating Index-2015; monetary pressure; meals insecurity; meals entry; social determinants of well being; bodily exercise.

Introduction

Older African American adults expertise a disproportionate burden of power circumstances, together with hypertension, diabetes, weight problems, and heart problems, all of that are strongly influenced by modifiable well being behaviors similar to weight loss plan, bodily exercise, smoking, and alcohol use [1-3]. Yet older adults usually face boundaries to sustaining wholesome behaviors, together with monetary pressure, restricted meals sources, bodily limitations, and competing well being calls for [4, 5]. These challenges could also be particularly pronounced amongst older African American adults dwelling in underserved city communities, the place structural inequities form entry to sources that help well being [6-8].

A Healthy Lifestyle Index (HLI) presents a helpful method to look at the clustering of a number of well being behaviors inside a single measure. Rather than contemplating weight loss plan, bodily exercise, smoking, or physique weight in isolation, composite indices can present a broader image of way of life patterns and their relationships to well being and social context [9, 10]. This strategy could also be particularly related in populations the place behaviors are usually not unbiased of each other, however as a substitute replicate the cumulative affect of particular person, family, and neighborhood circumstances [11]. Prior analysis in older adults has proven that more healthy life are related to larger socioeconomic circumstances, self-perceived well being, and different contextual elements, suggesting that way of life patterns are formed by greater than particular person selection alone [12-14].

Among older adults, meals insecurity and associated financial hardship are more and more acknowledged as vital social determinants of well being [8]. Food insecurity has been related to a number of power circumstances, poorer self-rated well being, decrease weight loss plan high quality, and weight problems threat in nationally consultant samples of older U.S. adults [15, 16]. In African American communities, broader community-based analysis has additionally highlighted the significance of social and structural influences on wholesome consuming and weight-related behaviors, whereas emphasizing the necessity for extra rigorous research that look at a number of ranges of affect concurrently [17]. In our prior analyses of older African Americans, total weight loss plan high quality was suboptimal, and meals insecurity was related to poorer weight loss plan high quality, whereas perceived neighborhood meals setting was not [18]. These findings counsel that financial and food-related constraints could form way of life behaviors in methods that aren’t totally captured by illness standing alone.

Despite rising recognition of the function of social determinants in shaping well being behaviors, much less is understood about how an total wholesome way of life sample pertains to monetary pressure, food-related sources, and power illness burden amongst older African American adults. Most prior work on this inhabitants has examined particular person behaviors or single domains similar to weight loss plan high quality somewhat than a composite way of life profile. To deal with this hole, the current examine examined the distribution of the Healthy Lifestyle Index and its affiliation with sociodemographic, social, and health-related elements amongst older African American adults in an underserved city neighborhood. We hypothesized that more healthy way of life patterns could be related to favorable social and financial circumstances, notably decrease monetary pressure and higher food-related sources, and with decrease burden of power illness.

Methods

Design and Participants

This was a secondary evaluation of information from the C-FED examine, the design of which has been described beforehand [2]. Briefly, members have been enrolled from a cohort of African Americans recruited by means of two church buildings in South Los Angeles [19]. Participants have been eligible in the event that they recognized as African American and have been 65 years or older, or a minimum of 55 years with a power situation. 108 members accomplished surveys between October 2021 and July 2022 through a web-based hyperlink, phone interview, or in-person interview. Those with energy outdoors reasonable vary have been excluded from the dataset, leading to an evaluation dataset of 100 members. The examine protocol was authorized by the Institutional Review Board of Charles R. Drew University of Medicine and Science and all members gave knowledgeable consent to take part.

Data Collection and Measures

A variety of demographic, socioeconomic, well being, way of life, and dietary variables was collected to characterize the examine inhabitants and look at associations with wholesome way of life behaviors.

Demographic Factors

Participants reported their age, intercourse, dwelling association, and academic attainment. Age was handled as a steady variable (imply ± SD). Sex was categorized as male or feminine. Living association was assessed as a binary variable indicating whether or not members lived alone (sure/no). Educational attainment was grouped into 5 classes: (1) no highschool diploma, (2) highschool diploma, (3) some school, (4) bachelor’s diploma, and (5) grasp’s or doctoral diploma.

Socioeconomic Factors

Socioeconomic standing was assessed utilizing indicators of economic and food-related sources. Financial pressure was measured utilizing a composite scale reflecting problem in assembly fundamental wants, with larger scores indicating higher monetary pressure. Food entry was assessed utilizing a categorical variable reflecting entry to enough meals sources (low, average, excessive). Food insecurity was assessed as a binary variable (meals safe vs. meals insecure). Adequacy of cash for meals was assessed utilizing a steady measure reflecting members’ perceived capacity to afford enough meals, with larger scores indicating higher monetary problem. Annual family revenue was collected however excluded from the first analyses because of conceptual overlap with monetary pressure.

Health Status and Comorbidities

Participants self-reported their normal bodily well being, categorized as Excellent/Very Good, Good, or Fair/Poor. Information on physician-diagnosed power circumstances was collected, together with hypertension, diabetes, bronchial asthma, most cancers, power obstructive pulmonary illness (COPD), kidney illness, HIV, and tuberculosis. A abstract variable representing the variety of power circumstances was created. Body mass index (BMI) was calculated from self-reported peak and weight and handled as a steady variable.

Lifestyle and Behavioral Factors

Key way of life behaviors have been assessed, together with smoking standing and bodily exercise. Smoking standing was categorized as a binary variable (present/former smoker vs. non-smoker). Physical exercise was measured as minutes per week of average and/or vigorous exercise.

Dietary Assessment

Dietary consumption was assessed utilizing the Diet History Questionnaire III (DHQ III), a validated meals frequency questionnaire capturing standard consumption of 135 meals and drinks over the previous yr. DHQ III information have been used to estimate every day consumption of macronutrients (e.g., vitality, protein, carbohydrates, complete and saturated fats, and fiber) and micronutrients (e.g., calcium, iron, sodium, potassium, magnesium, and nutritional vitamins), in addition to different dietary elements similar to alcohol and caffeine.

Healthy Eating Index (HEI-2015)

Diet high quality was evaluated utilizing the Healthy Eating Index-2015 (HEI-2015), which measures adherence to the Dietary Guidelines for Americans throughout 13 elements. Total HEI scores vary from 0 to 100, with larger scores indicating higher weight loss plan high quality.

Healthy Lifestyle Index (HLI)

A composite Healthy Lifestyle Index (HLI) was constructed based mostly on established behavioral elements, together with smoking standing, bodily exercise, weight loss plan high quality, alcohol use, and physique mass index (BMI). Each element was scored and mixed to generate an total index reflecting adherence to wholesome way of life behaviors. A rating of 1 was earned for not smoking, for participating in bodily exercise for ≥150 minutes/week, for an HEI-2015 rating ≥69.72, for consuming no alcohol, and for having a BMI <25; a rating of 0 was earned when the response didn’t meet the criterion for a 1.

The HLI was handled as a steady variable (scaled 0–5), with larger scores indicating more healthy way of life patterns. For descriptive analyses, HLI was additionally categorized into tertiles representing low, average, and excessive adherence.

Statistical Analysis

Our evaluation comprised three phases. First, we performed descriptive analyses to summarize participant traits, together with demographic, socioeconomic, well being, way of life, and dietary variables. Continuous variables have been reported as means and commonplace deviations (SD), whereas categorical variables have been summarized utilizing frequencies and percentages.

Second, we examined associations between the Healthy Lifestyle Index (HLI), handled as a steady variable (scaled 0–5), and chosen sociodemographic, social, and health-related elements. Pearson correlation coefficients have been used to evaluate relationships between HLI and steady variables (e.g., age, physique mass index, monetary pressure, bodily exercise, and variety of power circumstances). For categorical variables, variations in imply HLI scores have been evaluated utilizing unbiased samples t-tests for binary variables (e.g., intercourse, dwelling association, meals insecurity) and one-way evaluation of variance (ANOVA) for variables with three or extra classes (e.g., training degree, meals entry classes, and self-rated bodily well being).

Third, we performed exploratory analyses to guage the connection between HLI and particular person power circumstances (e.g., diabetes, hypertension, bronchial asthma, most cancers, COPD, and melancholy) in addition to total power illness burden. These analyses have been primarily descriptive and aimed to determine potential patterns somewhat than take a look at particular hypotheses, given the restricted pattern dimension.

All statistical exams have been two-sided, and statistical significance was outlined as p < .05. Analyses have been performed utilizing R statistical software program.

Results

Table 1 presents the demographic, well being, and way of life traits of the examine pattern stratified by Healthy Lifestyle Index (HLI) tertiles. The examine included 100 African American adults aged 55 years and older, with a imply age of 68.64 years (SD = 8.61). Age was comparable throughout HLI teams, with no significant variations noticed.

Overall, the pattern was predominantly feminine (71.0%), with a smaller proportion of males (29.0%). Educational attainment various, with 15.6% of members reporting no highschool diploma, 22.9% having a highschool diploma, 39.6% having some school training, and 21.9% holding a bachelor’s diploma or larger. Most members weren’t at present married (58.3%), whereas 35.4% have been married or dwelling with a companion.

Health and way of life traits differed throughout HLI tertiles. Mean Healthy Eating Index (HEI-2015) scores elevated throughout tertiles, from 61.70 (SD = 6.46) within the low HLI group to 74.57 (SD = 4.46) within the excessive HLI group. Similarly, bodily exercise ranges have been considerably larger within the excessive HLI group in comparison with the low HLI group (484.07 vs. 11.83 minutes/week). The proportion of non-smokers additionally elevated throughout tertiles (80.0% in low, 95.0% in average, and 96.7% in excessive HLI teams). However, bodily exercise was extremely skewed, with median values of zero within the low and average HLI teams, indicating that many members reported no exercise.

Socioeconomic and social elements additionally various by HLI. Financial pressure and meals insecurity have been extra prevalent amongst members within the low HLI group, whereas these in larger HLI tertiles have been extra prone to report decrease monetary pressure and higher meals entry. For instance, 43.3% of members within the low HLI group reported low monetary pressure in comparison with 72.5% and 66.7% within the average and excessive HLI teams, respectively. Similarly, entry to meals sources improved throughout HLI tertiles.

Living association confirmed the same sample, with the next proportion of members dwelling alone within the low HLI group (40.0%) in comparison with the average (27.5%) and excessive (26.7%) HLI teams.

Self-rated bodily well being didn’t differ considerably throughout HLI tertiles. Although a higher proportion of members within the excessive HLI group reported truthful or poor well being, this descriptive sample was not statistically vital and ought to be interpreted with warning. Specifically, 53.3% of members within the low HLI group reported glorious or superb well being, whereas 41.4% of these within the excessive HLI group reported truthful or poor well being.

Overall, these findings point out that larger HLI is related to extra favorable way of life behaviors and improved socioeconomic circumstances, notably in relation to monetary pressure and meals entry, though patterns for self-rated well being have been much less constant.

Table 1: Participant Characteristics by Healthy Lifestyle Index (HLI) Tertiles

Healthy Lifestyle Index Distribution

Table 2 presents the distribution of the Healthy Lifestyle Index (HLI) tertiles and element indicators. Participants have been roughly evenly distributed throughout HLI tertiles, as anticipated based mostly on tertile classification, with 30.0% labeled as low, 40.0% as average, and 30.0% as excessive HLI.

Examination of particular person HLI elements indicated that the majority members reported not utilizing alcohol (99.0%) and non-smoker standing (91.0%). Nearly all members reported wholesome alcohol use, leading to minimal variability throughout HLI tertiles. In distinction, a smaller proportion of members met standards for a nutritious diet (50.0%), bodily exercise (31.0%), and wholesome physique mass index (24.0%), suggesting that these elements contributed most to variability in total HLI.

Table 2: Distribution of Healthy Lifestyle Index (HLI) and Component Indicators (N = 100)

Associations between Participant Characteristics and HLI

Associations between participant traits and HLI are offered in (Table 3). Among steady variables, larger HLI scores have been considerably related to decrease monetary pressure (r = –.28, p = .006), decrease problem affording meals (r = –.27, p = .008), larger ranges of bodily exercise (r = .26, p = .008), and better weight loss plan high quality as measured by the Healthy Eating Index (r = .55, p < .001). No vital associations have been noticed for age, entry to meals, or variety of power circumstances.

Among categorical variables, intercourse was considerably related to HLI, with females having larger HLI scores than males (p = .010). Smoking standing was additionally considerably related to HLI (p = .037), with non-smokers demonstrating larger HLI scores than people who smoke. No vital variations have been noticed throughout classes of dwelling association, revenue, training, meals entry, or self-rated well being. A marginal affiliation was noticed for meals insecurity (p = .062), with food-insecure members exhibiting decrease HLI scores.

Variable	Category	Statistic	Test / Effect	p
Age (years)	–	M (SD)	r = .05	.653
Sex	Female (n = 71): M = 3.10 (0.81)  Male (n = 29): M = 2.64 (0.77)	Group means	t(98) = 2.64	.010
Education	No HS diploma (n = 15): M = 2.87 (0.83)  HS diploma (n = 24): M = 2.81 (0.84)  Some school (n = 40): M = 2.96 (0.86)  Bachelor (n = 10): M = 3.20 (0.79)  Master/Doctorate (n = 11): M = 3.27 (0.65)	Group means	F(4,95) = 0.85	.499
Do you reside alone?	No (n = 69): M = 3.02 (0.81)  Yes (n = 31): M = 2.85 (0.85)	Group means	t(98) = 0.92	.361
Difficulty affording meals	–	M (SD)	r = –.27**	.008
Financial pressure	–	M (SD)	r = –.28**	.006
Food insecurity	Not meals insecure (n = 70): M = 3.07 (0.79)  Food insecure (n = 30): M = 2.73 (0.87)	Group means	t(98) = 1.89	.062
Food entry	Low (n = 39): M = 2.94 (0.85)  Moderate (n = 5): M = 3.00 (1.22)  High (n = 9): M = 3.33 (0.71)	Group means	F(2,50) = 0.75	.479
Self-rated bodily well being	Excellent/Very good (n = 35): M = 3.06 (0.82)  Good (n = 37): M = 2.95 (0.86)  Fair/Poor (n = 27): M = 2.89 (0.85)	Group means	F(2,96) = 0.35	.705
Number of power circumstances	M = 2.07 (1.45)	Correlation	r = –.09	.389
Smoking standing	Non-smoker (n = 91): M = 3.04 (0.81)  Smoker (n = 9): M = 2.22 (0.83)	Group means	t(9.03) = 2.45	.037
Physical exercise (min/week)	–	M (SD)	r = .26**	.008
Diet high quality (HEI-2015)	–	M (SD)	r = .55***	< .001
BMI (kg/m²)	–	M (SD)	r = –.15	.158
Note. HLI was handled as a steady variable. Continuous variables have been analyzed utilizing Pearson correlation coefficients, and categorical variables utilizing unbiased samples t-tests or one-way ANOVA. p < .05, ** p < .01. Alcohol use was not included in affiliation analyses as a result of almost all members met the wholesome alcohol criterion (99%), leading to inadequate variability.

Table 3: Associations between Participant Characteristics and Healthy Lifestyle Index (HLI)

Discussion

In this pattern of older African American adults dwelling in an underserved city neighborhood, more healthy way of life patterns gave the impression to be extra carefully associated to social and financial circumstances than to power illness burden. In specific, larger HLI scores have been related to decrease monetary pressure and higher food-related sources, whereas no clear affiliation was noticed with the general variety of power circumstances. Taken collectively, these findings counsel that way of life behaviors in later life could also be formed as a lot by social context and entry to sources as by illness standing. This is vital as a result of many well being interventions focus totally on particular person habits change though monetary and structural boundaries may restrict an individual’s capacity to observe wholesome suggestions.

This sample is per a rising physique of literature displaying that wholesome behaviors are usually not merely the results of particular person data or motivation, however are influenced by the broader circumstances wherein folks dwell. Prior work in older adults has proven that more healthy life are related to socioeconomic circumstances and self-perceived well being [12]. More broadly, meals insecurity and different materials hardships have been linked to poorer weight loss plan high quality, poorer self-rated well being, weight problems, and the next burden of power circumstances amongst older adults within the United States [4, 5, 15]. Our findings lengthen this literature by suggesting that, on this inhabitants, these social and financial constraints could also be mirrored not solely in weight loss plan high quality alone, however in broader way of life patterns.

The findings additionally align with our earlier work from this cohort. In a previous evaluation, we discovered that meals insecurity was related to poorer total weight loss plan high quality, whereas perceived neighborhood meals setting was not [18]. Viewed alongside the current findings, that earlier work means that monetary and household-level constraints could also be extra vital than perceived neighborhood availability alone in shaping wholesome habits. This distinction issues. It is feasible for wholesome meals to be current in a neighborhood and nonetheless stay out of attain due to price, competing family calls for, transportation boundaries, or different sensible limitations. In that sense, the more healthy way of life patterns noticed on this examine could replicate variations within the capacity to behave on wholesome intentions, not merely variations in data or desire.

One notable discovering was the dearth of affiliation between HLI and power illness burden. It is predicted that people with extra power circumstances would have much less wholesome way of life patterns. However, that was not the case on this pattern. There are a number of doable explanations. First, power circumstances are extremely prevalent in older adults, notably in underserved populations, and should not meaningfully distinguish these with more healthy versus much less wholesome habits patterns. Second, the connection could also be extra advanced, with some people adopting more healthy behaviors after analysis whereas others proceed to face boundaries that restrict habits change. Third, a cross-sectional design can’t seize timing. Current way of life patterns could replicate current variations, whereas power circumstances usually develop over a few years. For these causes, the absence of an noticed affiliation shouldn’t be interpreted to imply that way of life is unimportant for power illness, however somewhat that on this pattern, power illness burden didn’t clarify way of life variation as clearly as social and financial elements did.

Implications

These findings have sensible implications for intervention design. Efforts to enhance wholesome behaviors amongst older African American adults mustn’t focus solely on training or particular person counseling. While these methods stay vital, they might have restricted influence if they don’t additionally deal with the fabric circumstances that form day-to-day decisions. This could assist clarify why training alone typically produces solely modest enhancements in long-term way of life behaviors inside underserved communities [17]. Community-based interventions that incorporate meals help, navigation of native sources, monetary and social help, and culturally responsive way of life counseling could also be simpler than approaches that focus narrowly on particular person habits change. Prior community-based work in African American populations helps the worth of multilevel methods that deal with wholesome consuming and associated behaviors in real-world social contexts [17, 20]. Similarly, work on wholesome getting old in Black/African American older adults has highlighted the significance of addressing meals insecurity, neighborhood circumstances, and different social determinants as a part of a broader strategy to well being and well-being [21].

Limitations

This examine also needs to be interpreted in mild of its limitations. The pattern dimension was modest, and the analyses have been cross-sectional, which limits causal inference. The examine was performed in a selected underserved city inhabitants, and the findings could not generalize to all older African American adults. Several measures, together with power circumstances and way of life behaviors, have been based mostly on self-report and are due to this fact topic to recall and social desirability bias. In addition, a number of the relationships examined right here could also be interrelated in methods which are troublesome to disentangle in a comparatively small pattern. At the identical time, the examine additionally has vital strengths. It focuses on an understudied, high-risk inhabitants, makes use of a composite way of life measure somewhat than inspecting particular person behaviors in isolation, and builds on a well-characterized cohort with detailed information on weight loss plan, train, meals entry, and health-related elements (Kibe et al., 2024).

Conclusion

In conclusion, this examine means that amongst older African American adults in an underserved city neighborhood, more healthy way of life patterns could also be extra strongly related to social and financial circumstances than with power illness burden. These findings reinforce the significance of addressing monetary and food-related boundaries as a part of efforts to help wholesome getting old. The examine provides to rising proof that bettering well being behaviors in underserved populations could require each individual-level training and broader help for the social and financial realities that affect every day decision-making. In populations going through longstanding structural inequities, more healthy life could rely not solely on what people know or intend to do, but additionally on the sources they’ve accessible to make wholesome decisions doable.

Declaration Statements

Abbreviations: CDU; Charles R Drew University of Medicine and Science

Grant Support

This work was supported by Accelerating Excellence in Translational Science (AXIS) Center at Charles R. Drew

University of Medicine and Science [grant number NIMHD/NIH U54MD007598], and the Clinical Research Education and Career Development (CRECD) Program at Charles R. Drew University of Medicine and Science [NIMHD/NIHR25MD007610] Author Lucy W. Kibe has acquired analysis help from these two businesses.

Competing Interests Declaration

The authors declare that they don’t have any competing pursuits concerning this manuscript. In specific, they state that they don’t have any monetary, private, or skilled pursuits that will have influenced the evaluation or interpretation of the info offered on this manuscript.

Ethics Approval and Consent to Participate: Not relevant

Statement of Author Contributions

LK: Conceptualization, Data curation, Methodology, Writing- Reviewing and Editing, Software

EY: Data curation, Methodology, Writing- Reviewing and Editing, Software.

KS: Data curation, Methodology, Writing- Reviewing and Editing, Software.

YK: Methodology, Writing- Reviewing and Editing.

MB: Conceptualization, Data curation, Methodology, Writing- Reviewing and Editing, Software.

Data Availability Statement

The information units used and analyzed within the present examine can be found from the corresponding writer for collaborative research. Personal identification particulars of the members have been separated from the finished questionnaires. The information have been saved in a locked room on the Charles R. Drew University of Medicine and Science (CDU). No data referring to identifiable people was disseminated in any respect. The information units used and analyzed within the present examine can be found from the corresponding writer for collaborative research. Code availability: N/A.

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