Evidence from epidemiological studies shows a link between food insecurity and diet intake or quality. However, the moderating effect of race in this relation has not yet been studied. Food insecurity (USDA Food Security Module) and diet quality (Healthy Eating Index-2010; HEI) were measured in 1741 participants from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Data were collected from 2004 to 2009 and analyzed in 2014. Multivariable regression assessed the interaction of race and food insecurity on HEI scores, adjusting for age, sex, poverty status, single parent status, drug, alcohol and cigarette use, and comorbid diseases. The interaction of food insecurity and race was significantly associated with diet quality (p = 0.001). In the absence of food insecurity, HEI scores were similar across race. However, with each food insecurity item endorsed, HEI scores were substantially lower for Whites compared to Blacks. An ad hoc analysis revealed that Blacks were more likely than Whites to participate in SNAP (p < 0.05). Further, race stratified analyses revealed that Blacks participating in SNAP showed diminished associations of food insecurity with diet quality. Study findings provide the first evidence that the influence of food insecurity on diet quality may be potentiated for Whites, but not Blacks. Additionally, results show that Blacks are more likely to participate in SNAP and show attendant buffering of the effects of food insecurity on diet quality. These findings may have important implications for understanding how food insecurity affects diet quality differentially by race. Alternative pathways linking SES to DQ, DS, and CA were tested and models compared, stratified by race and sex. Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (baseline age: 30-64 y; 2 visits; mean follow-up: 4.9 y), 12 structural equation models (SM) were conducted and compared. Time-dependent factors included the Center for Epidemiologic Studies-Depression CES-D total score, baseline or visit 1 (v1), follow-up or visit 2 (v2), mean across visits (m), and annual rate of change (Delta), 2010 Healthy Eating Index (HEI), and central adiposity principal components' analysis score of waist circumference and trunk fat (kg) (Adipcent) (same notation). Sample sizes were white women (WW, n = 236), white men (WM, n = 159), African American women (AAW, n = 395), and African American men (AAM, n = 274), and a multigroup analysis within the SM framework was also conducted. In the best-fitting model, overall, approximately 31% of the total effect of SES-->Adipcent(v2) (alpha +/- SE: -0.10 +/- 0.03, P < 0.05) was mediated through a combination of CES-D(v1) and DeltaHEI. Two dominant pathways contributed to the indirect effect: SES-->(-)CES-D(v1)-->(+)Adipcent(v2) (-0.015) and SES-->(+) DeltaHEI-->(-)Adipcent(v2) (-0.017), with a total indirect effect of -0.031 (P < 0.05). We examined interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults. Participants were 2,270 AAs and Whites (57 % AA; 57 % female; ages 30-64 years) who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. CVD risk factors assessed included body mass index (BMI), waist circumference (WC), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides (TG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (CRP), and systolic, diastolic, and pulse pressure (SBP, DBP, PP). Significant interactions of race and poverty status (p's < .05) indicated that AAs living in poverty had lower BMI and WC and higher HDL-C than non-poverty AAs, whereas Whites living in poverty had higher BMI and WC and lower HDL-C than non-poverty Whites. Main effects of race revealed that AAs had higher levels of HbA1c, SBP, and PP, and Whites had higher levels of TC, LDL-C and TG (p's < .05). Poverty status moderated race differences for BMI, WC, and HDL-C, conveying increased risk among Whites living in poverty, but reduced risk in their AA counterparts. Mortality rates in the United States vary based on race, individual economic status and neighborhood. Correlations among these variables in most urban areas have limited what conclusions can be drawn from existing research. Our study employs a unique factorial design of race, sex, age and individual poverty status, measuring time to death as an objective measure of health, and including both neighborhood economic status and income inequality for a sample of middle-aged urban-dwelling adults (N = 3675). At enrollment, African American and White participants lived in 46 unique census tracts in Baltimore, Maryland, which varied in neighborhood economic status and degree of income inequality. A Cox regression model for 9-year mortality identified a three-way interaction among sex, race and individual poverty status (p = 0.03), with African American men living below poverty having the highest mortality. Neighborhood economic status, whether measured by a composite index or simply median household income, was negatively associated with overall mortality (p<0.001). Neighborhood income inequality was associated with mortality through an interaction with individual poverty status (p = 0.04). While racial and economic disparities in mortality are well known, this study suggests that several social conditions associated with health may unequally affect African American men in poverty in the United States. Beyond these individual factors are the influences of neighborhood economic status and income inequality, which may be affected by a history of residential segregation. The significant association of neighborhood economic status and income inequality with mortality beyond the synergistic combination of sex, race and individual poverty status suggests the long-term importance of small area influence on overall mortality. In a 9-year follow-up study of a representative sample of African American (AA) and white adults from Baltimore City, we found that AA men with household incomes below 125% of the Federal poverty level were at particular risk for overall mortality. Our study, Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS), recruited socioeconomically diverse groups of AA and white women and men who were initially 30-64 years old. From a sample of 3,720 participants, we found 328 deaths or nearly 9% over just 9 years. There's ample evidence from a wide variety of sources that AA men are feared. AA men are also marginalized in our society: they are sometimes excluded from the mainstream of American society in a variety of ways, including their contact with healthcare professionals. For this, and a variety of other reasons, AA, particularly AA men, distrust medical institutions in which they are often treated as 2nd class patients. Added to difficulties in accessing health care, availability of specialists, and health insurance, AA men are left on margins of the healthcare system and this has had a profound effect on their overall mortality compared with other groups. Recent data highlighted the association between income and longevity in the United States, particularly the increasing differences during 2001 through 2014 in life expectancies for people in the top 5% range of household income compared with those in the bottom 5%. However, these results depend on removing potential effects of race on mortality, especially the consequences of segregation, discrimination, and unequal resource distribution.
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