Stroke is the third leading cause of death in the United States, and a leading cause of long-term disability. The risk for stroke varies by race/ethnicity; stroke incidence is greater among African Americans at younger ages, contributing to a mortality rate 80 percent greater than that of Caucasians (Keppel et al 2002; DHHS 2000; Stroke Progress Review Group, NINDS 2002). Limited understanding exists concerning the etiology and variations of subtypes of stroke incidence in different populations and geographic locations over time (Stroke Progress Review Group, NINDS 2002). Obesity, which results in part from a complex pathway of numerous lifestyle precursors, is a strong predictor of cerebrovascular disease such as stroke and other cardiovascular disease (WHO, 2000). Moreover, dietary intake and physical activity contribute to energy imbalances that result in obesity and independently predict stroke (AICR 1997; USDA/USDHHS 2000; USDHHS 1996; 2000; Krebs-Smith SM. 2001). Few studies consider both biological and social determinants of intermediate outcomes of cerebrovascular disease from a multileveled perspective. This application considers longitudinal measures of social and biological variables to investigate the independent effect of social disparities to the development of obesity among low-income multi-ethnic postpartum women at increased risk of stroke and other comorbidities. As women face particular biological and social transition during the postpartum period, the proposed research seeks to measure social determinants of pregnancy-related weight gain over time, adjusting for diet, physical and biological predictors of obesity and stroke. Research findings from the proposed work can inform the design of future interventions to reduce risk of stroke in women of reproductive age in low income, racial/ethnic subpopulations at highest risk of obesity and its sequelae.
Specific aims i nclude examination of: (1) individual and household social determinants pregnancy-related weight change and obesity; (2) social disparity in dietary intake and nutritional status and its relation to pregnancy-related weight change and obesity; and (3) neighborhood characteristics that influence the development of obesity.
| Dubowitz, Tamara; Subramanian, S V; Acevedo-Garcia, Dolores et al. (2008) Individual and neighborhood differences in diet among low-income foreign and U.S.-born women. Womens Health Issues 18:181-90 |
