Cancer Risks for Urban African-American Women Grow as Healthy Diets Become More Difficult to Maintain, Study Shows

29/11/07 Women living in the inner city have difficulty meeting dietary goals that could help prevent cancer, according to a report from Johns Hopkins University researchers. In a study of African-American women living in public housing within Washington, D.C., the researchers found that the majority met one - or none - of five dietary goals suggested to reduce the risk of developing cancer. In particular, these women were unlikely to eat a healthy diet that included the recommended amount of fresh fruits and vegetables.

Their analysis also linked high risk dietary behaviors with younger age, depression, smoking and being born within the District of Columbia. The researchers present their findings today in Atlanta at the American Association for Cancer Research conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, being held November 27-30.

"African-American women, in general, face a worse cancer incidence and mortality rate than most other ethnic groups, and poor African-American women are at an even greater disadvantage," said Ann C. Klassen, Ph.D., associate professor in the Department of Health, Behavior, and Society at Johns Hopkins University's Bloomberg School of Public Health. "Improving diet is one effective way to help these women lower their risk for developing cancer."

Since diet and behavior are intertwined, Klassen says, the researchers needed to get a better understanding of the lifestyle of African-American women in the District of Columbia's low resource neighborhoods in order to assess the needs of the community.

Klassen and her colleagues analyzed data from 156 African-American female residents of 11 public housing communities across Washington. The women participants gave information regarding what they ate and drank - as well as other behaviors - over several 24 hour periods, providing 468 such diet-related recalls to researchers.

In particular, the researchers examined the diet recalls to see if the researchers met the ideal goals of five characteristics of a cancer-preventing diet: adequate consumption of fruits and vegetables; low percentage of fat intake; moderate caloric intake, no alcohol consumption; and adherence to the USDA's "Healthy Eating Index," a measure of the overall quality of diet. They also looked at when and where these women ate, as well as with whom they were eating. "We were looking to take a holistic approach to the women's diet, one that not only looks at food consumed, but also their general behavior and circumstances, which can impact how they make dietary choices," Klassen said.

The majority of women, about 61 percent, failed to meet the goals for more than one of these characteristics, with many meeting none. Less than one percent met all the ideal standards in each of the five categories. Only 15 percent of women reported eating at least five servings of fruits or vegetables, Klassen says, however 64 percent reported no alcohol consumption during the recall days. "Many women drank soda, and ate convenience and prepared foods, even when they sat down with their families for a meal," Klassen said. "Younger adults, especially, seem to lack the skills to build a well-balanced diet - skills that our survey shows that older generations of women still possess."

Where they lived among the public housing communities also made a difference in whether the women reported eating a cancer-preventing diet. "We see that women who can take advantage of community vegetable gardens - which are often missing in inner-city neighborhoods - are more likely to eat a healthier diet than women who do not have those amenities in their neighborhoods," Klassen said. Klassen and her colleagues also demonstrated a positive relationship between the average education level in neighborhoods, namely the proportion of residents holding high school diplomas, and dietary behaviors in African-American women.

However, their analysis also uncovered traits that negatively affected cancer risk, including smoking, depressive symptoms and youth. They also found that women who were born in Washington, D.C., reported far worse dietary behaviors than women who had moved to the city from elsewhere. "Overall, we are getting a clear depiction of the role of diet as a connection between social status and health," Klassen said. "Women in poverty, in particular, suffer from the lack of good dietary information as well as a variety of healthy foods, which can compound other problems in their lives."

With this information, Klassen says it will be easier to craft new educational interventions to help African-American women and their families lower the cancer risk and improve their overall health.
This study was funded by the American Cancer Society and the Maryland Cigarette Restitution Fund. Researchers in this study include Katherine Smith, Ph.D., and Laura Caulfield, Ph.D., of Johns Hopkins Bloomberg School of Public Health, and Maureen Black, Ph.D., from the University of Maryland School of Medicine.