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Abstract
Background: Obesity is a complex public health problem and is a risk factor for chronic diseases such as diabetes, cardiovascular disease, and cancer. Hispanic population is growing in the United States, and obesity affects Hispanic women more than non-Hispanic White (NHW) women. Stress may shift dietary behaviors towards higher consumption of sugary and fatty foods (e.g. soft drink and fast food consumption) and promote distracted eating (e.g. eating while doing other activities such as watching TV). However, stress may affect obesogenic behaviors differently in Hispanics and NHW women because of cultural differences, which may influence experience of stress as well as dietary behaviors and practices. The overall goal of this dissertation is to evaluate the effects of perceived stress on three obesogenic behaviors and weight status among NHW and Hispanic women. This dissertation evaluates the difference in three obesogenic behaviors (i.e. soft drink consumption, fast food consumption, and distracted eating) by ethnicity and acculturation (chapter 1), whether ethnicity or acculturation moderates the association between stress and obesogenic behaviors (Chapter 2). The mediating roles of three obesogenic behaviors in the association between stress and measures of obesity risk are examined separately among Hispanics and NHW women (Chapter 3).
Methods: For this dissertation, the data from socioeconomic status obesity (SESO) study was used. SESO is a population-based cohort of 1,040 women (NHW and Hispanic) in South King County who were followed for two years. Baseline data were used in chapter1 and 2, and for chapter 3, perceived stress at baseline, average of baseline and year-two follow-up obesogenic behaviors, and measures of obesity risk at year-two follow-up were used. The associations were evaluated using multivariable linear regression models. Mediation was tested by product-of-coefficients methods.
Results: Chapter 1 showed that Hispanic women consumed more soft drink compared to NHW women and showed less distracted eating behavior. Less acculturation was associated with less distracted eating among Hispanics. Chapter 2 showed that perceived stress was significantly lower in Hispanics compared to NHW and in less acculturated Hispanic women compared to more acculturated Hispanic women. Ethnicity only moderated the association between perceived stress and fast food consumption. Chapter 3 showed that three behaviors combined mediated 33% of the association between perceived stress and BMI among NHW women.
Conclusions: These studies contribute to the understanding of the relationship of ethnicity/acculturation with three obesogenic behaviors, perceived stress, and measures of obesity risk. There is not much data on distracted eating, specifically among the Hispanic population. Since less distracted eating was associated with less acculturation, more studies on this behavior are needed. The results suggest stress control techniques may be helpful to reduce obesity and obesogenic behaviors specifically among NHW women. Weight loss interventions for NHW women may also benefit from targeting three obesogenic dietary behaviors.
