ARTICLE

An Examination of Eating
Behaviors, Physical Activity,
and Obesity in African
American Adolescents:
Gender, Socioeconomic
Status, and Residential Status
Differences
Nutrena H. Tate, PhD, RN, CPNP-PC, Heather E. Dillaway, PhD,
Hossein N. Yarandi, PhD, Lenette M. Jones, PhD, RN, ACNS-BC,
& Feleta L. Wilson, PhD, RN, FAAN

ABSTRACT
Nutrena H. Tate, Clinical Assistant Professor, College of Nursing,
Wayne State University, Detroit, MI.
Heather E. Dillaway, Associate Professor, Department of
Sociology, Wayne State University, Detroit, MI.
Hossein N. Yarandi, Professor, College of Nursing, Wayne State
University, Detroit, MI.
Lenette M. Jones, Mellen Postdoctoral Fellow, Frances Payne
Bolton School of Nursing, Case Western Reserve University,
Cleveland, OH.
Feleta L. Wilson, Associate Professor, College of Nursing, Wayne
State University, Detroit, MI.
Conflicts of interest: None to report.
Correspondence: Nutrena H. Tate, PhD, RN, CPNP-PC, 5557
Cass, Detroit, MI 48202; e-mail: nutrena.tate@wayne.edu.
0891-5245/$36.00
Copyright Q 2015 by the National Association of Pediatric
Nurse Practitioners. Published by Elsevier Inc. All rights
reserved.
Published online January 9, 2015.
http://dx.doi.org/10.1016/j.pedhc.2014.11.005

www.jpedhc.org

Background: African American adolescents experience

higher rates of obesity and have an increased risk of
obesity-related diseases than do White American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African
American adolescent population. Current obesity interventions do not usually address the heterogeneity (e.g., socioeconomic status [SES], gender, and residential status
differences) within the African American adolescent community that can affect the efficacy of these interventions.
Purpose: To examine the gender, SES, and residential status
differences related to obesity and weight behaviors in African
American adolescents.
Methods: A descriptive correlational study was conducted
with 15- to 17-year-old African American adolescents (n =
145) from community clinics, youth organizations, churches,
and social networks in metropolitan and inner-city Detroit.
Data were collected through use of survey methods
and analyzed with use of descriptive statistics, independent
sample t tests, and multiple regression equations.
Results: Female adolescents consumed foods higher in fat
and calories (t =
2.36, p = .019) and had more body
fat (t =
9.37, p = .000) than did males. Adolescents of lower
SES consumed food higher in fat and calories (t =
2.23,

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243

p = .027) and had higher body mass (t =
2.57, p = .011) than

did adolescents of higher SES. Inner-city African American
adolescents had higher levels of physical activity (t =

2.39, p = .018) and higher body mass (t = 2.24, p = .027)
than did suburban African American adolescent counterparts. Gender, SES, and residential status were statistically
significant predictors of eating behaviors, physical activity,
body mass index, and body fat.
Conclusions: The initial findings from the study will assist in
better understanding the obesity epidemic that affects African American adolescents in disparate proportions.
Implications: Further examination of the study variables is
essential to serve as a basis for developmentally appropriate
and culturally relevant targeted interventions with this population. Health care providers and obesity researchers who
work with youth can use the initial findings from this study
to advocate for healthy lifestyles while reducing the obesity
disparity within the African American adolescent population.
J Pediatr Health Care. (2015) 29, 243-254.

KEY WORDS
Obesity, African American, health disparities, eating, physical
activity

Obesity is a major health problem for African American adolescents in the United States. The existence of
this problem is well documented in the literature. For
example, the Centers for Disease Control and
Prevention (CDC; 2014) reported that in 2011, the
obesity rate among African American adolescents
(20.2%) was second only to the rate for Hispanic youth
(22.4%) and much higher than the rate for White youth
(14.1%). The prevalence of obesity among African
American teens has been attributed to a low level of
physical activity and unhealthy eating behaviors
(Haas et al., 2003; Singh, Kogan, Van Dyck, &
Siahpush, 2008; Zhang & Wang, 2004). In addition to
intergroup disparities, the literature indicates that
obesity among African American adolescents may be
associated with intragroup differences that include
gender, socioeconomic status (SES), and residential
status (urban and suburban; Schulz et al., 2000).
Researchers have found that females within the African American population have a higher incidence of
obesity than do males, and African American adolescents from families with low SES are more obese than
those from families with middle and high SES (Martin,
2008; Miech et al., 2006; Neumark-Sztainer, Story,
Hannan, & Croll, 2002; Wang & Zhang, 2006; Zhang &
Wang, 2004). Alm et al. (2008) found that African American adolescents who live in urban neighborhoods
were more likely to be obese than those living in suburban locations. Thus, not only are there obvious disparities in obesity between African American and White
adolescents, but notable disparities also exist within
the African American adolescent community. The range
of disparities that has been associated with obesity rates
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Volume 29  Number 3

among African American teens is of special concern,

given the increased incidence in this population of
obesity-related adult-onset diseases such as hypertension, type 2 diabetes, and hypercholesterolemia
(Skinner, Mayer, Flower, Perrin, & Weinberger, 2009).
Trends data from National Health and Nutrition
Examination Surveys (NHANES) conducted between
1999 and 2010 showed that the odds of being obese
remained significantly higher for non-Hispanic
Black and Mexican American males and females aged
12 to 19 years than for other ethnic samples of
this age group (Ogden, Carroll, Kit, & Flegal, 2012).
Further, the 2009-2010 NHANES indicated that
non-Hispanic Black children and adolescents had
higher rates of obesity (24.3%) than did Hispanic
(21.2%)
or
nonHispanic White (14%)
The prevalence of
children and adolesAfrican American
cents. The prevalence
adolescent obesity
of African American
adolescent obesity has
has remained
remained
relatively
relatively high
high despite culturally
despite culturally
sensitive health interventions, suggesting
sensitive health
that these interveninterventions,
tions may still not take
suggesting that
into account the African American teens
these interventions
unique developmental
may still not take
and sociocultural charinto account the
acteristics. Therefore,
the purpose of this
African American
study was to examine
teens unique
the intragroup differdevelopmental and
ences of gender, SES,
and residential status
sociocultural charin relation to eating beacteristics.
haviors and physical
activity among African
American adolescents. Examination of these intragroup
characteristics could address the limitations of previous
studies and potentially enhance health interventions to
reduce the prevalence of obesity in this population.
The current literature reports gender differences in
weight-related behaviors and obesity between male
and female African American adolescents. In a study
by Neumark-Sztainer and colleagues (2002, N =
4,746), African American females at an urban high
school in Minnesota reported fewer weight-related
concerns and weight-conscious behaviors such as
physical activity than did White females. On the other
hand, weight-related concerns and weight-conscious
behaviors were more prevalent among the African
American males compared with the White males.
Downs, DiNallo, Savage, and Davison (2007), in a study
of 646 adolescents (mean age = 14.28 years), also
Journal of Pediatric Health Care

reported that African American males scored higher on

measures of physical activity and lower on negative attitudes about eating than did their female counterparts.
Current research documenting the relationship between adolescent obesity and SES tends to focus on participants from low-income families, and few studies
have compared obesity prevalence between adolescents from lower and higher SES families. In a study
that explored adolescent activity outside of school,
McMurray and colleagues (2000) found a relationship
between African American ethnicity, low SES, and
adolescent obesity. Wang and colleagues (2006) reported a high prevalence of obesity among African
American adolescents from families with low SES in
their overview of a school-based intervention in Chicago public schools. Additionally, Lutfiyya, Garcia,
Dankwa, Young, and Lipsky (2008) found that overweight African American adolescents were more likely
to live in households with lower incomes. Lastly, using
data from the 2005-2008 NHANES, Ogden, Lamb,
Carroll, and Flegal (2010) also discovered that adolescents from low-income households were more likely
to be obese compared with adolescents from higher income households, although this finding was not consistent across racial and ethnic groups.
Few findings are present in the literature regarding the
residential status of teens in the United States and
obesity, specifically studies comparing eating behaviors
and physical activity between African American adolescents in urban or suburban communities. Most of the
literature exploring U.S. residential settings and teen/
child obesity focuses on neighborhood risks such as
reduced walkability, local food environments, built environments, and food deserts. Indeed, using data from
NHANES, Rossen (2014) noted that residential area
deprivation, which is most often seen in urban locales,
was associated with a higher incidence of obesity. Area
deprivation has been defined as decreased neighborhood walkability due to a decreased number of parks
and opportunities for recreation, increased crime,
absence of walking trails, a decreased number of local
area supermarkets with fresh fruit and vegetables, and
an increased availability of fast food restaurants (Kipke
et al. 2007; Lovasi, Hutson, Guerra, & Neckerman, 2009).
Studies not focused specifically on U.S. urban locales
have explored the relationship between region and
obesity. Morland and Evenson (2009) discovered that
obesity was lower in areas with large supermarkets
and higher in areas with plentiful fast food restaurants
and small grocery stores. Other researchers found that
residents with accessible healthy foods tend to have
improved eating behaviors (Smoyer-Tomic et al.,
2008; Walker, Keane, & Burke, 2010). Furthermore,
residents of neighborhoods considered to be safe
communities with safe parks are more likely to be
physically active and less likely to be obese (Black &
Macinko, 2008; Sallis & Glanz, 2009).
www.jpedhc.org

In general, the literature offers studies of adolescent

obesity that include samples from different racial/
ethnic groups, whereas the unique focus of the current
study is the examination of the variables of gender, SES,
and residential status in an allAfrican American adolescent sample, thus investigating their intragroup characteristics. Another unique aspect of the present study is
that it fills a gap in the literature on obesity differences
among African American adolescents who live in suburban and urban communities in the United States.
HYPOTHESES
To better understand intragroup characteristics of African American adolescents in regard to eating behaviors,
physical activity, and obesity, the following hypotheses
were tested, using an independent sample t test at a significance level of p < .05 for each.
Hypothesis 1
Obesity differences will be found between African
American adolescent females and males; specifically,
African American adolescent females will (a) weigh
more in pounds, (b) exhibit a higher amount of body
fat, (c) have a higher body mass index (BMI), (d) have
a greater waist circumference, (e) be less physically
active, and (f) consume diets higher in fat and calories
than African American adolescent males.
Hypothesis 2
Obesity differences will be found between African
American adolescents with lower and higher SES; specifically, those with lower SES will (a) weigh more in
pounds, (b) exhibit a higher amount of body fat, (c)
have a higher BMI, (d) have a greater waist circumference, (e) be less physically active, and (f) consume diets
higher in fat than the African American adolescents with
a higher SES.
Hypothesis 3
African American adolescents who reside in an urban
area will (a) weigh more in pounds, (b) exhibit a higher
amount of body fat, (c) have a higher BMI, (d) have a
greater waist circumference, (e) be less physically active,
and (f) consume diets higher in fat and calories than African American adolescents who live in a suburban area.
METHOD
Study Design
Based on Allen and Allens Social Ecological
Framework (1986), the study utilized a descriptive,
correlational design to describe the intragroup differences of gender, SES, and residential status as they
relate to the variables of eating behaviors, physical activity, and obesity of the study participants. The social
ecological approach to investigation differs from an
exclusive focus on the individual; rather, the focus is
on the individual within his or her sociocultural
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245

environment. The study design was appropriate for the

current study because it allowed the investigators to
describe a phenomenon while examining relationships
among variables.
Sample and Selection
The study participants consisted of a nonrandom convenience sample of 145 African American adolescents
aged 15 to 17 years who were recruited through various
community groups in the greater Detroit urban and
suburban areas during the first half of 2011. For study
purposes, urban was defined as within the city limits
of Detroit, Michigan, and suburban was defined as
outside Detroit, but within a 30-mile radius of the citys
geographic limits. A power analysis was conducted and
a sample size of 144 was determined adequate, with a
power of 0.80, an alpha of 0.05, and a critical effect
size of 0.50 (Faul, Erdfelder, Lang, & Buchner, 2007).
Setting
The African American adolescents were recruited from
community outreach clinics, community organizations,
and churches both within and outside the city of Detroit, as well as through social networks (e.g., sorority
and professional organizations). In the community
outreach clinics, individual patients were approached
about participation in the current study by the principal
investigator (PI) or trained research assistants while
they waited to be seen by a health care provider. Flyers
were also posted around the clinic describing the current study along with the PIs contact information. In
addition to recruitment at community outreach clinics,
the study synopsis was presented to prospective participants at various community organization meetings
(parentyouth meetings), and flyers were posted
around the headquarters of community organizations.
Recruitment at various churches was implemented by
attending youth group meetings. Upon visiting these
meetings, the current study was discussed and contact
information was obtained. Social networking was
used by the PI through the advertisement of the current
study and the need for participants during professional
and sorority meetings.
Prior to data collection and after obtaining Institutional Review Board approval from the PIs affiliated
university, the adolescents were instructed to return
the informed consent form completed by their parent
or legal guardian along with their own assent form.
The PI and trained assistants collected the data in a
setting familiar to each participant; this setting was
dependent on the location of solicitation. For the adolescents recruited from a primary care clinic (i.e.,
outreach clinic), data collection was completed in an
area designated by the office manager. In the church
setting, data collection was conducted in the fellowship
hall or other designated area. For the adolescents recruited from a community organization, data collection
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was conducted in a classroom of the organizations central building or other designated area. For the participants obtained through social networks, data were
collected at a physical location that was mutually
agreed upon by the participant and PI. Data were
collected from January 2011 through May 2011, and
participants received a $10 gift card upon completion
of their individual sessions.
Measures
The variables of gender, SES, and residential status were
assessed using a demographic form that included
gender, age, ZIP code, and nearest neighborhood
crossroads (to indicate residence), self-reported race/
ethnicity, and qualifications for free or reduced lunch
(to indicate SES).
The participants eating behaviors were assessed
with use of the Eating Behaviors Pattern Questionnaire
developed by Schlundt, Hargreaves, and Buchowski
(2003). Its psychometric properties had been determined in a sample of 310 African American adult and
adolescent females from diverse socioeconomic backgrounds and ages. Reliability measures for each subscale of the overall instrument were determined, and
item examples for the subscales included low-fat eating
(a = 0.88), for example, I buy snacks from vending machines; snacking and convenience (a = 0.86), for
example, I eat cookies, candy bars, or ice cream in
place of dinner; emotional eating (a = 0.80), for
example, I eat when I am upset; planning ahead (a
= 0.71), for example, I eat at a fast food restaurant at
least three times a week; meal skipping (a = 0.70),
for example, I rarely eat breakfast; and cultural/lifestyle behaviors (a = 0.78), for example, On Sunday, I
eat a large meal with my family. Psychometric properties were determined in the current sample for the
Eating Behaviors Pattern Questionnaire as Cronbachs
a = 0.777 and test-retest reliability (r = .802, p =
.0001), which was acceptable.
Physical activity levels were measured using the
Physical Activity QuestionnaireAdolescent version
(PAQ-A) developed by Kowalski, Crocker, and Donen
(2004). In previous studies, the psychometric properties of the PAQ-A had been determined in a sample of
85 Canadian high school students (41 males and
44 females), grades 8 to 12, ages 13 to 20 years
(Kowalski, Crocker, & Kowalski, 1997). Convergent
validity was determined with use of other measures:
activity rating (r = 0.73), Leisure Time Exercise Questionnaire (r = 0.57), and Physical Activity Readiness
(r = 0.59). Additionally, internal consistency was determined to be 0.68 in a sample of 63 adolescents in a Midwestern U.S. community (Paxton, Estabrooks, &
Dzewaltowski, 2004). Psychometric properties were
determined in the current sample for the PAQ-A: Cronbachs a = 0.889 and test-retest reliability (r = .736, p =
.0001), which was acceptable. To the best of our
Journal of Pediatric Health Care

knowledge, the current study is the first to use the PAQA in a sample population of African American adolescents.
After the participants completed the questionnaires,
their body measurements and weight were recorded
by the PI or trained research assistants. BMI was assessed
by height and weight. Height was measured using a Seca
217 stadiometer (Seca, Hanover, MD; www.seca.com).
Weight was assessed using a Tanita HD351 standing digital scale (Tanita, Arlington Heights, IL; www.tanita.
com). Each participants weight and height were entered
into a CDC computerized program (accessed from
http://apps.nccd.cdc.gov/dnpabmi/) to determine the
adolescents BMI based on her or his age and gender.
Once the BMI was obtained, the value was graphed on
a chart to determine if the adolescent was overweight
or obese based on age and gender. Overweight status
was indicated if the adolescents BMI was between the
85th and 94th percentile, and obese status was defined
as a BMI $95th percentile (Barlow, Bobra, Elliott,
Brownson, & Haire-Joshu, 2007; CDC, 2010).
Waist circumference was measured using a MyoTape
Vinyl Body Tape measure manufactured by AccuFitness (Greenwood Village, CO; www.accufitness.
com). When obtaining the participants waist circumference with a measuring tape, they were asked to point
to their umbilicus. The measurement tape was then
placed snugly around the area surrounding the waist
at the level of the umbilicus and inches were recorded.
The most frequently recommended site for waist
circumference measurement is the narrowest part of
the waist at the umbilicus. Waist circumference is an indicator of central adiposity, which is a good predictor of
abdominal fat (Katzmarzyk et al., 2004). Abdominal fat
is related to the development of type 2 diabetes, cardiovascular diseases, and premature death. African American males 15 to 17 years old with a waist circumference
larger than 29.1 inches and African American females 15
to 17 years old with waist circumference larger than 28.1
inches are considered at risk for obesity-related diseases (Katzmarzyk et al., 2004).
Body fat composition was measured using the Slim
Guide Skinfold Caliper (Unique Fitness Concepts, Mundelin, IL, www.uniquefit1.com; Lohman, Roche, &
Martorell, 1988). With all study participants, the skinfold was lifted by placing the thumb and index finger
about 3 inches apart on a line perpendicular to the
long axis of the skin. The skinfold was grasped firmly
between the thumb and index finger of the investigators left hand. The fold was lifted 1 cm above the site
to be measured. The jaws of the caliper were placed
perpendicular to the fold, approximately 1 cm below
the thumb and index finger.
The measuring sites for the males, specifically,
included the chest, abdomen, and thigh. For the male
chest site, the direction of the fold is diagonal and was
taken half the distance between the anterior axillary
www.jpedhc.org

line and the nipple. The male abdominal site is a vertical

fold taken 2 cm to the side of the umbilicus. Both male
and female thigh measuring sites are the same, where
the vertical fold is taken on the anterior aspect of the
thigh midway between the inguinal crease and proximal border of the patella. In addition to the thigh, the
measuring sites for the females included the triceps
and waist. For the female triceps measuring site, the direction of the fold is vertical and is taken midway between the shoulder and elbow joint, on the center of
the back of the arm. The female waist side is diagonal
above the iliac crest along the anterior axillary line.
All three measurements were added and then
compared with a table published by Unique Fitness
Concepts (www.uniquefit1.com). All body fat measurements were taken on the right side of the participants body.
Data Analysis
Data were analyzed using the Statistical Package for the
Social Sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY). To understand and summarize the data,
sample characteristics of gender, SES, residential status,
and weight status were described using descriptive statistics, which included frequencies along with measures of central tendency (mean, median, and mode).
In addition, t-tests to determine gender, SES, and residential status differences in eating behaviors, physical
activity, and obesity were obtained within the sample.
Multiple regression equations were also used to evaluate the potential impact of gender, SES, and residential
status on eating behaviors, physical activity, and obesity.
Crude (unadjusted) regression coefficients were estimated, along with adjusted regression coefficients based
on multivariate modeling of multiple factors. Residual
analysis was conducted to identify sources of model misspecification, outliers, and possible influential observations. Sensitivity analysis was performed to discern the
impact of influential cases on the results. In predicting
African American adolescents eating behaviors and
physical activity, step type regression analysis was
used to obtain the optimal model.
RESULTS
Demographics of the Sample
Of the 145 respondents who completed the study, 88
(60.7%) were female and 57 (39.3%) were male. The respondents ages ranged from 15 to 17 years; 48 were
aged 15 years (33.1%), 53 were aged 16 years (36.3%),
and 44 were aged 17 years (30.3%). One hundred
sixteen (79.5%) of the respondents lived within the
city of Detroit, and 28 (19.2%) lived in suburban Detroit.
Ninety-two respondents (63.4%) qualified for free
lunch, whereas 53 (36.6%) did not qualify for free
lunch. The majority of participants were recruited
from community youth groups (n = 81); the remaining
participants were from the PIs social network (n = 32)
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247

FIGURE. Weight status of study participants

according to body mass index classification.

Obese (20%) = $ 95th percentile; overweight (24%)

= 85th to 95th percentile; normal weight (54%) = 5th
to 84th percentile; and underweight (2%) = < 5th
percentile. This figure appears in color online at
www.jpedhc.org.
or from charter schools (n = 20) and church youth
groups (n = 11).
Weight Measurements and Indicators
All 145 respondents completed weight measurements after answering the questionnaires; 142 respondents
completed body fat measurements. The mean body fat
of the respondents was 23.65 mm (SD = 10.56), and the
mean BMI was 25.79 kg/m2 (SD = 6.46). The mean waist
circumference was 34.77 cm (SD = 10.97), and the mean
weight was 160.52 lb (SD = 44.08). The Figure describes
the overall weight status of the sample according to BMI
classification. Twenty-four percent of the sample was
overweight (85th-94th percentile), 20% was obese
($95th percentile), 54% was normal weight (5th-84th
percentile), and 2% was underweight (<5th percentile).
Hypothesis 1: Gender Differences
Table 1 presents the gender differences in weight measurements. A significant difference occurred between
the males and females in regard to weight (t = 2.00, p =
.047) and amount of body fat (t =
9.37, p < .0001);
however, there was no significant difference in BMI
(t = 0.96, p = .339) or waist circumference (t =
0.55,
p = .585).

Table 2 presents the gender differences in eating behaviors and physical activity. There was a significant
difference between African American females and
males in regard to eating behaviors (t =
2.36, p =
.019) but no significant differences in physical activity
(t = 1.36, p = .175).
Hypothesis 2: SES Differences
Table 3 presents the socioeconomic differences in
weight measurements. There was a significant difference between the participants based on lower or higher
SES in regard to BMI (t =
2.57, p = .011), but there was
no significant difference in weight (t =
1.49, p = .139),
amount of body fat (t =
1.65, p = .102), or waist circumference (t =
0.81, p = .42).
Table 4 presents the socioeconomic differences in
eating behaviors and physical activity. There was a significant difference between the participants based on
lower or higher SES in regard to eating behaviors (t =

2.23, p = .027), but there was no significant difference
in physical activity (t =
1.56, p = .121).
Hypothesis 3: Residential Status Differences
Table 5 presents the residential differences in weight
measurements. There was a significant difference between the urban and suburban African American participants in regard to weight (t = 2.07, p = .040) and BMI (t =
2.24, p = .027), but there was no significant difference in
body fat composition (t =
0.13, p = .900) or waist
circumference (t = 0.22, p = .830).
Table 6 presents the residential status differences in
eating behaviors and physical activity. There was a significant difference between the urban and suburban
participants in regard to physical activity (t =
2.39, p
= .018), but there were no significant differences in
eating behaviors (t = 0.44, p = .658).
Tables 7 and 8 present the residential and SES
differences in eating behaviors, physical activity, and
anthropometric measure differences in African
American females and males. There was a significant
difference between the female, urban low SES and
female, suburban high SES participants in regard to
the anthropometric measures of body mass index (t =
2.67, p = .01), body fat composition (t = 2.17, p = .03),
and waist circumference (t = 2.17, p = .03), but there

TABLE 1. Gender differences in weight measurement

Weight measurement
Weight (lb)
Body mass index (kg/m2)
Body fat composition (mm)
Waist circumference (inches)

Male
M (SD)
169.23 (47.97)
25.07 (6.27)
15.20 (8.22)
35.37 (12.08)

Female
M (SD)
154.33 (40.45)
26.13
28.62 (8.44)
34.34 (10.31)

Mean difference
14.90

1.06 (6.53)

13.42
1.03

t (p value)
2.00 (.047)*

0.96 (.339)

9.37 (.001)**
0.55 (.585)

Note. SD, standard deviation.

*p < .05.
**p < .01.

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Journal of Pediatric Health Care

TABLE 2. Gender differences in eating behaviors and physical activity

Major variable
Eating behaviors
Physical activity

Male
M (SD)
142.30 (21.80)
35.98 (17.82)

Female
M (SD)

Mean difference

t (p value)

150.70 (0.34)
31.86 (17.76)

8.40
4.12

2.36 (.019)*
1.36 (.175)

Note. SD, standard deviation.

*p < .05.

were no significant differences in eating behaviors

(t = 1.54, p = .13) or physical activity (t = 0.41, p = .69).
There were no significant residential and SES
differences in eating behaviors, physical activity, and
anthropometric measures in urban low SES or
suburban high SES males.
Table 9 shows the predictors of obesity, eating behaviors, and physical activity using gender, SES, and residential status. In relation to obesity and weight-related
measures, approximately 27% (R2 = 0.266, F(3, 142) =
3.519, p = .017) of variance in BMI could be explained
by the predictor variables. Approximately 63% (R2 =
0.629, F(3, 140) = 29.846, p = .000) of variance in body
fat could be explained by the predictor variables. Lastly,
approximately less than 1% (R2 = .084, F(3, 142) = .333, p =
.802) of variance in waist circumference could be explained by the predictor variables. Approximately 27%
(R2 = .266, F(3, 143) = 3.551, p = .016) of variance in eating
behaviors could be explained by the predictor variable.
Approximately 30% (R2 = .296, F(3, 143) = 4.474, p = .005)
of variance in physical activity could be explained by the
predictor variables.
DISCUSSION
The following discussion describes the findings of the
hypotheses in relation to physical activity, eating behaviors, and weight. Support of the present literature
by the findings is noted where applicable.
The females in the current study were less physically
active than the males, although the differences did not
approach significance. The current study findings
were similar to those of Downs and colleagues
(2007), who found that males were more physically
active than females in an African American sample. A
qualitative study of overweight African American

adolescent females revealed their concern about

damaging expensive hair and nail treatments if they
are physically active (Boyington et al., 2008). In the current study, the lower SES adolescents were more physically active than those with a higher SES, whereas
urban participants were less physically active than their
suburban counterparts. One possible reason for higher
physical activity level in the lower SES adolescents may
be because they walk long distances on a daily basis
instead of driving a car because of transportation issues.
On the other hand, urban African American adolescents
may have unsafe neighborhoods, as well as fewer recreational parks and walking trails, reducing opportunities to be physically active (Black & Macinko, 2008;
Sallis & Glanz, 2009). This study was one of the first to
examine physical activity among African American
adolescents within the context of both residential
neighborhood and SES, so there were no studies for
comparison with these different outcomes.
The females in this study consumed diets that were
higher in fat and calories than those of their male counterparts, consistent with the findings of Downs and
colleagues (2007) that adolescent males and females
are comparatively different in regard to eating behaviors. African American adolescent females may eat
foods higher in fat and calories than their male counterparts as a result of cultural norms surrounding body
size. Larger body sizes are coveted and accepted within
the African American community, which is a possible
rationale for the African American adolescent females
weight status and eating behaviors (Befort, Thomas,
Daley, Rhode, & Ahluwalia, 2008). Lower SES participants in the current study consumed diets higher in
fat and calories than the diets of higher SES participants,
whereas urban participants consumed diets higher in

TABLE 3. Socioeconomic status differences in weight measurement

SES

No free lunch (higher SES)

M (SD)

Free lunch (lower SES)

M (SD)

Mean difference

t (p value)

Weight (lb)
Body mass index (kg/m2)
Body fat composition (mm)
Waist circumference (inches)

152.90 (37.93)
23.92 (4.82)
21.42 (10.20)
33.76 (10.69)

164.21 (46.75)
26.74 (6.98)
24.45 (10.73)
35.30 (11.20)

11.31
2.82
3.03
1.54

1.49 (.139)

2.57 (.011)*

1.65 (.102)

0.81 (.422)

Note. SD, standard deviation; SES, socioeconomic status.

*p < .05.

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TABLE 4. Socioeconomic status differences in eating behaviors and physical activity

Major variable

No free lunch (higher SES)

M (SD)

Free lunch (lower SES)

M (SD)

Mean difference

t (p value)

Eating behaviors
Physical activity

142.28 (20.14)
30.45 (17.64)

150.35 (21.42)
35.22 (17.81)

8.07
4.77

2.23 (.027)*

1.56 (.121)

Note. SD, standard deviation; SES, socioeconomic status.

*p < .05.

fat and calories than the diets of suburban participants.

This phenomenon may be explained by modern-day
circumstances such as parents who do not have time
to cook; neighborhood stores lacking affordable,
healthy meal choices; or living in unsafe environments
that make it difficult to enjoy outdoor physical activity.
In the current study, the participants weight status
was obtained through the following measurements:
(a) waist circumference, (b) BMI, and (c) body fat
composition. In general, the sample was classified as
overweight per BMI with a high body fat percentage.
The average of the waist circumferences of the participants was inconclusive in comparison to other work
on this population, because standards for weight
circumference have not been developed for adolescents (Camhi, Kuo, & Young, 2008; Krebs et al., 2007).
The findings of the current study related to BMI were
similar to those of others in the literature (Bhuiyan,
Gustat, Srinivasan, & Berenson, 2003; Wang &
Beydoun, 2007).
The finding that African American females were more
overweight than their male counterparts in terms of
BMI and body fat composition is consistent with the
literature, specifically regarding BMI. In particular, the
findings closely match the landmark Bogalusa Heart
Study, in which African American female adolescents
possessed the highest BMI compared with other groups
(Bhuiyan et al., 2003; Brambilla, Bedogni, Heo, &
Pietrobelli, 2013; Hirschler, Aranda, Calcagno,
Maccalini, & Jadzinsky, 2005; Janssen et al., 2005).
The African American adolescents in this study from
families with a lower SES were more overweight than
those from families with a higher SES as measured by
their BMI, body fat composition, weight, and waist
circumference. This finding supports other research
indicating that African Americans with a lower SES are

more overweight than their higher SES counterparts

(Miech et al., 2006; Neumark-Sztainer et al., 2002;
Wang et al., 2006; Zhang & Wang, 2004). The
overweight status of these studies was based solely on
BMI, noninclusive of body fat composition and waist
circumference, and thus different from the methods
used in the present study.
The urban participants in this study were classified as
overweight compared with their suburban counterparts as measured by weight, BMI, and waist circumference. These findings are similar to those of other
studies. Based on BMI values, Alm and colleagues
(2008) found that urban African American adolescents
were more obese than suburban African American adolescents in their assessment of barriers and facilitators
for achieving weight behavior goals in urban adolescents.
Studying male and female African American adolescents from varying SES and recruited from different
community sites in urban and suburban areas may
have increased the generalizability of the results to
other African American adolescents. In contrast,
limiting the age range of the sample to between 15
and 17 years of age to represent middle adolescence
may have limited the generalizability of the findings
to other age groups.
Other limitations can be noted. Some of the adolescents needed their parents to assist with physical activity recall when answering the questionnaires,
especially related to sports practice dates and various
physical activities through the week. Despite the fact
that weight control behavior research commonly uses
self-report as well as other measures, self-report can
introduce a source of bias, especially if parents are
needed to assist with the adolescents recall. However,
racial-ethnic concordance between the participants

TABLE 5. Residential status differences in weight measurement

Weight measurement
Weight (lb)
Body mass index (kg/m2)
Body fat composition (mm)
Waist circumference (inches)

Urban
M (SD)
163.74 (46.80)
26.31 (6.87)
23.39 (10.98)
34.86 (9.70)

Suburban
M (SD)

Mean difference

t (p value)

144.68 (26.07)
23.31 (3.54)
23.68 (9.01)
34.36 (15.61)

19.06
3.00
0.29
0.50

2.07 (.040)*
2.24 (.027)*

0.13 (.900)
0.22 (.830)

Note. SD, standard deviation.

*p < .05.

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TABLE 6. Residential status differences in eating behaviors and physical activity

Major variable
Eating behaviors
Physical activity

Urban
M (SD)
147.82 (21.49)
31.50 (16.92)

Suburban
M (SD)

Mean difference

t (p value)

145.82 (20.93)
40.21 (18.68)

2.00

8.71

0.44 (.658)

2.39 (.018)*

Note. SD, standard deviation.

*p < .05.

and the research team may have assisted the selfreporting, specifically when the participants were
asked to assess eating behaviors related to their
ethnicity or race.
Another concern was the use of skinfold calipers for
measuring the participants body fat composition.
Although this method of measurement was inexpensive, portable, and fairly noninvasive, the values were
subject to the precision of the calipers, the skill level
of the technicians, and the weight status of the participants. In future research of this nature, other body fat
measurement methods need to be considered.
CLINICAL PRACTICE AND RESEARCH
IMPLICATIONS
The initial findings from this study contribute to
health care practices and social advancement by
beginning to address the gaps in the literature,
research, and clinical guidelines on eating behaviors,
physical activity, and obesity among African American adolescents. Specifically, the study findings
reveal some of the differences in gender, SES, and
residential status of this population that affect their
weight-related behavior and put them at risk of
obesity and related diseases.
Clinical Practice
Health care practices can benefit as the findings inform
nurses, advanced practice nurses, and other health care
providers regarding culturally appropriate ways to
educate and intervene with African American adolescents about their eating behaviors, physical activity,

and obesity status. Both nurses and advanced practice

nurses are well positioned to address the concerns of
this population. Nurses have excellent assessment skills
and can identify specific issues that African American
adolescents may be facing related to healthy food
choices or neighborhood challenges. In addition,
advanced practice nurses can develop an individualized plan of care that targets issues identified upon
assessment.
All nurses are trained to provide patient education
and help patients
problem
solve.
Providing
Providing education
education on
on obesity prevention
and helping African
obesity prevention
American adolescents
and helping African
solve
individual
American
concerns will help
mitigate
the
adolescents solve
disparities in obesity
individual concerns
that affect African
will help mitigate
American
youth.
Finally, both nurses
the disparities in
and advanced practice
obesity that affect
nurses can advocate
African American
on behalf of African
American adolescents
youth.
by being politically
activefor example,
contacting political leaders and petitioning for safer
neighborhoods, additional green space for walking,
and healthier options for school lunches.

TABLE 7. Residential and socioeconomic status differences in eating behaviors, physical activity,
and anthropometric measures in African American females

Major variable
Eating behaviors
Physical activity
Body mass index (kg/m2)
Body fat composition (mm)
Waist circumference (inches)

Urban
Low SES
N = 48
M (SD)
153.90 (20.84)
32.60 (16.86)
27.85 (7.25)
30.44 (8.63)
34.40 (6.28)

Suburban
High SES
N = 40
M (SD)

Mean difference

t (p value)

147.30 (19.23)
31.07 (18.73)
24.33 (5.12)
26.61 (7.77)
31.74 (5.08)

6.60
1.53
3.52
3.83
2.66

1.54 (.13)
0.41 (.69)
2.67 (.01)**
2.17 (.03)*
2.17 (.03)*

Note. SD, standard deviation; SES, socioeconomic status.

*p < .05.
**p < .01.

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251

TABLE 8. Residential and socioeconomic status differences in eating behaviors, physical activity,
and anthropometric measures in African American males
Urban
Low SES
N = 36
M (SD)

Major variable
Eating behaviors
Physical activity
Body mass index (kg/m2)
Body fat composition (mm)
Waist circumference (inches)

145.80 (21.70)
36.08 (18.07)
26.31 (7.20)
15.88 (8.14)
33.46 (6.43)

Suburban
High SES
N = 21
M (SD)

Mean difference

t (p value)

137.60 (21.46)
35.77 (17.39)
23.44 (4.14)
14.99 (9.45)
31.93 (4.68)

8.19
0.31
2.87
0.89
1.53

1.40 (.17)
0.06 (.95)
1.91 (.06)
0.38 (.70)
0.95 (.35)

Note. SD, standard deviation; SES, socioeconomic status.

Research
These findings can serve as a basis for developing interventions suitable for this age and ethnicity according to
gender, SES, and residential status to mitigate the effects
of factors that contribute to their weight gain and risk of
obesity. Additionally, the study results can serve as a
starting point to discuss methods of weight measurement other than BMI in health care settings. Each of

the three main variables in this study (gender, SES,

and residence), for instance, were associated with varying measurements of weight and physical activity,
which suggests that scholars and health care providers
need to be cautious in selecting the measurements they
use for determining obesity among adolescents.
The current study was only the first step in exploring
and describing the separate yet intertwined

TABLE 9. Prediction of eating behaviors, physical activity, and obesity using gender, socioeconomic
status, and residential status
B

Standard error

Significance

145.364

8.358
7.986
0.350

4.285
3.574
3.743
4.585

0.192
0.181
0.007

33.926

2.339
2.129
0.076

.000
.021*
.035*
.939

36.403
4.491
7.079

11.704

3.496
2.916
3.053
3.741

0.125
0.195

0.265

10.414
1.540
2.319

3.129

.000
.126
.022*
.002*

27.579

1.247
2.277

2.361

2.146
1.087
1.142
1.391

0.094
0.170

0.146

12.852

1.148
1.995

1.697

.000
.253
.048*
.092

27.816

13.259
2.976

0.901

2.864
1.450
1.512
1.861

0.613
0.136

0.034

9.712

9.145
1.968

0.484

.000
.000*
.051
.629

33.066
1.110
1.623
0.199

3.794
1.922
2.018
2.459

0.049
0.071
0.007

8.715
0.578
0.804
0.081

Predictor variables
Eating behaviors**
(Constant)
Gender
SES
Residential status
Physical activity
(Constant)
Gender
SES
Residential status
Body mass index
(Constant)
Gender
SES
Residential status
Body fatx
(Constant)
Gender
SES
Residential status
Waist circumference{
(Constant)
Gender
SES
Residential status

.000
.564
.423
.936

Note. SES, socioeconomic status.

*p < .05.
**R2 = 0.27, F(3, 143) = 3.551, p = .016.
R2 = 0.30, F(3, 143) = 4.474, p = .005.
R2 = 0.27, F (3, 142) = 3.519, p = .017.
xR2 = .63, F (3, 140) = 29.846, p = .000.
{R2 = .084, F(3, 142) = .333, p = .802.

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Journal of Pediatric Health Care

phenomena of gender, SES, and residential status and

how these variables are associated with physical activity and eating behavior patterns in African American adolescents in urban and suburban settings. To explore
the transmission of norms for desirable weight-related
behaviors and enhance cognition of eating behaviors
and physical activity, a qualitative study may be useful
to achieve an in-depth understanding of the causes of
disproportionate obesity in African American adolescents. Additionally, there is a need for further examination of neighborhood walkability and food access
related to the unique characteristics of the urban/suburban African American adolescent.
This study was the first of its kind to examine the relationship between eating behavior patterns, physical activity, and obesity in African American adolescents
residing in a metropolitan urban/suburban area.
Already during their teenage years, a large percentage
of the sample was classified as overweight, which could
lead to a lifetime of obesity and health challenges, as
well as an increase in health care costs for themselves
and society. Furthermore, differences in gender, SES,
and residential status were found to relate to the samples weight status, physical activity, and eating
behavior patterns. These variables are essential components to include in developmentally appropriate and
culturally relevant targeted interventions for this population. Health care providers and researchers need to
look at obesity among African American adolescents
in a much more complicated and complex way, considering both eating behavior and physical activity when
exploring obesity, and also looking at how gender,
SES, and residence have common and different effects
or associations with the eating behavior, physical activity, and obesity of adolescents. Unless we look at all of
these factors together, we cannot understand the larger
story of why this population continues to have higher
rates of obesity that contribute to long-term adult health
problems. Future research can include an intersectional
analysis where the intersecting/interacting and combined effects of gender, SES, and residence on eating
behavior, physical activity, and obesity measures are
examined. Health care providers who work with youth
can use the initial findings from this study to promote a
healthy lifestyle for African American adolescents while
helping to reduce the obesity disparity within this population.
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Journal of Pediatric Health Care