How Can Healthy Eating Become a Higher Priority for Men?

DEREK GRIFFITH ANSWERS: "We find that men in general tend to eat less healthily than women, and men of color tend to eat less healthily than white men. So in the struggle to change those norms, you need to ask who controls what men eat, as well as their access to food. What’s the social and cultural significance of the food they eat? And what are the social situations in which men eat? For example, when African-American men get together they often drink beer and eat French fries and chicken wings. It’s difficult to change that norm to salads and water.

"Portion size is another issue. The media aggressively markets unhealthy foods in large portion sizes to men. This is particularly problematic as men get older and their metabolism slows. Older men should eat less, but many don’t, because they’ve become accustomed to big portions. Access is also an issue. Many urban areas lack a full-service grocery store with a good produce section, or they have fewer of these stores than the suburbs do.

"These are all reasons why African-American men have higher incidences and death rates from a variety of cancers and other diseases associated with and exacerbated by being overweight or obese.

"Through a project called Men 4 Health, funded by the American Cancer Society, my colleagues and I are working to improve the quality of food that African-American men eat and the amount of physical activity they get. We’re examining how partners and families can support efforts to make healthier food choices in the home, and as a core component of our project, we’re trying to get fraternal organizations, men’s lodges, sports teams, motorcycle clubs, men’s church groups, and other organizations to encourage men to engage in healthy behaviors. We’re also working to change the culture of some of these organizations so that they prepare and provide healthy foods for events and activities and promote physical activity among their constituents.

"Through focus groups we’ve conducted, we know that African-American men tend not to change their behavior until they’ve been diagnosed with a chronic disease. We’re seeking ways to speed up that process so that men adopt healthy behaviors earlier in life, rather than in response to a medical diagnosis or life-threatening illness. But it’s a challenge: how do you get men to re-order their priorities to make health more important?” Derek Griffith, an assistant professor of health behavior and health education, studies the mechanisms by which social, economic, physical, and health environments promote and hinder health. He is particularly interested in the unique health needs of African-American men and how these can be addressed by changing aspects of their social environment.

Menopause and Diet

Could a change in diet reduce a woman’s risk of heart disease or cancer? That’s the question—and hope—behind research that epidemiologist MaryFran Sowers has been conducting for the past decade. As women enter menopause they experience changes in estrogen metabolism, and these changes may affect their risk for heart disease and cancers, especially hormone-sensitive cancers, says Sowers, the John G. Searle Professor of Public Health at SPH.

Diet may be of increased importance during this period because naturally occurring compounds in foods, such as isoflavones, which are found in soy products, and hydroxybenzoic acid, found in berries, may influence the pathways by which estrogens get broken down or used by the body by binding with estrogen receptors. Through the nationwide Study of Women’s Health Across the Nation (SWAN), Sowers, who directs the study’s Michigan center, is trying to determine whether these and other compounds change the circulating estrogen metabolytes in women during menopause. “Because if they do,” she says, “then we can look to see if they are related to other outcomes, such as hot flashes, cognition, heart disease, and cancers.”

What’s already clear is that a diet rich in variety increases the likelihood that a woman will take in nutrients beneficial to her health. “The idea down the line would be to describe the optimal diet, relatively speaking, for better outcomes,” Sowers says. “It’s real. This isn’t ‘pie in the sky.’”

Tailored Nutritional Messages

When it comes to nutritional advice, some people want to be told what and how to eat, and others want to share in the decision-making process. If a clinician or public health educator takes the wrong approach, an intervention designed to promote healthy eating could backfire. So HBHE Professor Ken Resnicow is using functional magnetic resonance imaging (FMRI) to try to identify the physiological and neurological differ-ences between individuals. He hopes his findings will help physicians and public health educators be able to tailor behavioral-change interventions according to personality type—“one type being highly directive, one being far more autonomous.”

In a related study, Resnicow is examining the efficacy of tailoring nutritional messages according to ethnicity. A newsletter designed to promote healthy eating in Afrocentric African Americans, for instance, might talk about African foods and spiritual practices. The approach seems to work: Resnicow has found a statistically significant difference in self-reported fruit and vegetable intake among study participants who scored high on the study’s measure of Afrocentricity and who received the Afrocentric version of the newsletter. Both studies were done in collaboration with the Henry Ford Health System.

Obesity in South Africa: Obesity is on the rise not just in the U.S. but overseas. In South Africa, both white and so-called coloured segments of the population have started to become overweight, says Ken Resnicow of HBHE, and now blacks—who comprise 85 percent of the population—are gaining weight, too. The underlying reasons?

A shift from rural to urban life—and its attendant woes, such as fast food—and an increase in wealth. Resnicow anticipates a “massive increase” in obesity and diabetes in the country, and is seeking funding to develop both a surveillance system and a public health initiative to try to stem the tide.

Can Residents of Detroit Improve Their Access to Healthy Foods?

AMY SCHULZ ANSWERS: “Two years ago, as part of the Healthy Environments Partnership, an affiliated project of the Detroit Community–Academic Urban Research Center, we had an extensive community-planning process in eastside, southwest, and northwest Detroit, looking at characteristics of neighborhoods that might contribute to an excess risk of cardiovascular disease and figuring out what interventions we could design. Food access was a major part of that process. People had a lot of really creative ideas about ways to work with food store owners and managers to help increase the availability of healthy foods in their neighborhoods. There are a lot of community gardens in Detroit, for example, and one idea was to work with people who run corner grocery stores to create spaces where produce from these gardens can be sold. Detroit has an active urban agriculture movement, and community groups throughout the city are pushing forward with ideas like this. The Healthy Environments Partnership is also seeking funding to implement some of these creative ideas. ”
Amy Schulz, MPH ’81, is an associate professor of health behavior and health education at SPH and associate director of the Center for Research on Ethnicity, Culture and Health. Her research focuses on social factors that contribute to health, with a particular focus on health disparities and urban communities.

Mapping Detroit: As part of her doctoral dissertation at SPH, Shannon Zenk, Ph.D. ’04, mapped supermarkets in metropolitan Detroit. She found that the city had few supermarkets overall, and that supermarkets were farther away from African-American neighborhoods with the highest levels of poverty than they were from white neighborhoods with the highest levels of poverty. Zenk also compared fresh fruit and vegetable availability, prices, and quality across diverse Detroit-area communities. Maps such as this, showing supermarket locations relative to neighborhood racial composition, were an integral part of her research. Zenk is an assistant professor of health systems science at the University of Illinois, Chicago.

Where You Live Matters

“If you want people to change their behavior, and they live in an area where there is not much available in terms of healthy food, it’s going to be very difficult for them to change,” says Ana Diez-Roux, professor of epidemiology and director of the Michigan Center for Integrative Approaches to Health Disparities.

In a multiethnic study covering six American cities, Diez-Roux found that the physical and social characteristics of neighborhood environments—and not just personal behavior and genetics—affect people’s health.

Not surprisingly, residents of neighborhoods with greater street connectivity, walkable sidewalks, mixed land use, and a higher density of parks and recreational facilities have better cardiovascular health and lower rates of diabetes and hypertension. The availability of healthy food options improves the health of communities, too.

The study also looked longitudinally at the effects of the physical environment. Over time, Diez-Roux found, people living in neighborhoods with better physical activity and food resources have overall healthier outcomes and are less likely to become diabetic. Her findings suggest that urban planning and community development are crucial elements of public health.

The study showed further that people who live in neighborhoods where community members are willing to help and support each other have better health outcomes. As Diez-Roux points out, stressful environments with poor social-support systems in fact physically degrade health. Higher levels of the stress hormone cortisol were found in residents of more stressful, and oftentimes poorer, neighborhoods with greater violence, traffic, litter, vandalism, and drug use, and a low availability of social services. Cortisol causes the body to improperly regulate blood pressure, insulin levels, metabolism, and the immune system.

Because different ethnic groups often live in very different environments, the study also indicated “that environmental differences may contribute to some of the race differences that we see in health,” she says.
Written by Valentina Stackl, M.P.H. candidate, SPH class of 2010

Cancer Prevention and the Mediterranean Diet

Zora Djuric first became interested in the link between diet and cancer about 20 years ago when she was asked to collaborate on a study that looked at diet and cancer prevention. She was intrigued to discover that women who followed a low-fat diet had lower levels of oxidative DNA damage to their blood—which in turn meant they may have had a lower chance of developing cancer.

“Ever since then I’ve been looking at what aspects of diet could be useful for cancer preven-tion,” says Djuric, an SPH alumna (M.S. ’80, Ph.D.’83) who holds joint appointments in the Department of Environmental Health Sciences and the UM Department of Family Medicine.

During the natural process of energy production, humans produce toxic molecules called “free radicals” that can damage cells and DNA. When we’re younger, free radicals are generally “mopped up” by antioxidants before they cause damage, but as we age, that process becomes less efficient. Oxidative damage has been linked to a number of age-associated diseases, including cancer.

Because nutrients can affect oxidative-DNA damage and other kinds of cellular damage, what we eat may play an important role in cancer prevention, Djuric says. But it’s not simply a matter of reducing fats or eating any one thing—it’s about eating the right combination of foods in order to achieve the most helpful nutrient intakes.

Djuric is now conducting a study to see whether a Mediterranean diet—low in Western fats and refined carbohydrates and high in fish, fruits, vegetables, whole grains, and mono-unsaturated fats—may help prevent cancer. The randomized study looks at the effects of two different diets—the Mediterranean and the Healthy People 2010 diet—in a group of people at elevated risk for colon cancer. The Healthy People 2010 diet also reduces total- and saturated-fat intake but is less rigorous in its specific requirements for fruits and vegetables.

Djuric hypothesizes that the Mediterranean diet can help reduce inflammation in the colon and thus lower the risk of colon cancer. Findings are expected in 2010. The study is still in need of healthy volunteer participants. For more information on the Healthy Eating for Colon Cancer Prevention Study visit umclinicalstudies.org/ or call the Cancer Answer Line at 1-800-865-1125.