546 Cultural Aspects of Health Psychology
RACE/ETHNICITY
There are similarities and differences across ethnic groups in
relation to the prevalence of health, disease, and health be-
haviors. To this end, we review reports on mortality and mor-
bidity, major behavioral risk factors, and major biobehavioral
risk factors among African Americans, Asian Americans,
Latinos, and Native Americans separately. We conclude this
section with a brief review of behavioral treatment and
prevention programs.
African Americans
Morbidity and Mortality
One of the most striking demographic characteristics in health
statistics continues to be the difference between African
Americans and Caucasians. The age- and gender-adjusted
death rate from all causes is 60% higher in African Americans
than in Caucasians (U.S. Department of Health and Human
Services [DHHS], 1995a). This difference in death rates for
African Americans persists until age 85 (DHHS, 1995b),
resulting in a life expectancy gap of 8.2 years for men and
5.9 years for women (DHHS, 1995a).
One of the major factors in this life expectancy gap is mor-
tality from circulatory diseases. For example, heart disease
continues to be the leading cause of death in the United States
(Gardner, Rosenberg, & Wilson, 1996; National Heart Lung
and Blood Institute [NHLBI], 1985; Peters, Kochanek,
Murphy, 1998). Trends suggest that while heart disease is de-
creasing among Caucasian men, it may be increasing in
African American men (Hames & Greenlund, 1996). Simi-
larly, African Americans experience higher age-adjusted
morbidity and mortality rates than Caucasians not only for
coronary heart disease but also for stroke (NHLBI, 1985).
For example, the NHLBI examined the 1980 age-adjusted
stroke mortality rates by state and found 11 states with stroke
death rates that were more than 10% higher than the U.S.
average. These states included Alabama, Arkansas, Georgia,
Indiana, Kentucky, Louisiana, Mississippi, North Carolina,
South Carolina, Tennessee, and Virginia. The NHLBI and
others have designated these 11 states as the •Stroke Belt.Ž
These •Stroke BeltŽ states also correspond with some of the
highest populations of older African American adults.
Deaths associated with CVD arise from a myriad of risk
factors including elevated blood pressure, cigarette smoking,
hypercholesterolimia, excess body weight, sedentary life-
style, and diabetes, all of which are in”uenced to varying
degrees by behavioral factors (e.g., Manson et al., 1991;
Powell, Thompson, Caspersen, Kendrick, 1987; Stamler,
Stamler, & Neaton, 1993; Willet et al., 1995; Winkleby,
Kraemer, Ahn, & Varady, 1998). The clustering (comorbidity)
of coronary heart disease risk factors in African Americans
appears to play an important role in excess mortality from
coronary heart disease observed in African Americans (Potts
& Thomas, 1999).Major Behavioral Risk and Protective FactorsTobacco Use. In the general population, tobacco con-
sumption slowed down when the deleterious health effects of
cigarette smoking were made public in the 1950s. Cigarette
smoking prevalence reaches a peak between the ages of 20
and 40 years among both men and women and then decreases
in later adulthood; but across all ages, smoking prevalence is
higher among males than among females. Smoking is more
prevalent among African Americans than Caucasians
(Escobedo, & Peddicord, 1996; Gar“nkel, 1997). Even
among minority groups, African Americans experience the
most signi“cant health burden (Mortality and Morbidity
Weekly Report [MMWR],1998; •Response to Increases,Ž
1998).Diet. The age-adjusted prevalence of overweight adults
continues to be higher for African American women (53%)
than for Caucasian women (34%; National Center for Health
Statistics [NCHS], 2000). The prevalence of obesity among
African American women has reached epidemic proportions
(Flynn & Fitzgibbon, 1998). A number of studies attribute the
high rate of obesity in women in part to differences in body
images, suggesting that African American women subscribe
to the belief that overweight bodies are more attractive, but
the results are still not completely clear because of divergent
methodologies (see Flynn & Fitzgibbon, 1998). Nutritional
status, which contributes to obesity, among minority popula-
tions may be adversely affected by a number of factors asso-
ciated either directly or indirectly with aging (Buchowski &
Sun, 1996).PhysicalActivity. In minority samples, physical activity
has been linked to decreased risk for diabetes (D. Clark, 1997;
Manson, Rimm, and Stamp”er, et al., 1991; Ransdell &
Wells, 1998), CVD (Yanek et al., 1998), and blood pressure
regulation (e.g., Agurs-Collins, Kumanyika, Ten Have, &
Adams-Campbell, 1997). Conversely, there is evidence to
suggest that African Americans do not exercise at the same
rates as Caucasians (Sallis, Zakarian, Hovell, & Hofstetter,
1996; Young, Miller, Wilder, Yanek, Becker, 1998). Women
of color, women over 40, and women without a college edu-
cation have been shown to participate the least in a study of