Virginia W Chang
Virginia W Chang
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Associate Professor of Social and Behavioral Sciences
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Professional overview
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Virginia W. Chang, MD, PhD is Associate Professor of Global Public Health at NYU School of Global Public Health, Associate Professor of Population Health at NYU School of Medicine, and Affiliated Associate Professor in the Department of Sociology at NYU. Dr. Chang is a graduate of the Inteflex Program at the University of Michigan, where she received her BS and MD degrees. She then completed a residency in internal medicine, fellowship training with the Robert Wood Johnson Foundation Clinical Scholars Program, and a PhD in sociology, all at the University of Chicago. Prior to joining NYU, Dr. Chang was in the Division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania and a staff physician at the Philadelphia Veterans Administration Medical Center.
As a physician and sociologist, Dr. Chang integrates perspectives from medicine, epidemiology, sociology, and demography in her research. Much of her work has focused on obesity and health disparities, engaging topics such as the influence of socially structured context (e.g., racial segregation, income inequality, neighborhood social/physical disorder) on obesity; the relationship of obesity to mortality and disability; the influence of weight status on the quality of medical care; socioeconomic disparities in health and mortality; and the inter-relationships between health, medical technologies, and stratification.
Her research program has been funded by the NICHD, NHLBI, and NIA of the National Institutes of Health, the Veterans Health Administration, the Robert Wood Johnson Foundation, the Measy Foundation, the American Diabetes Association, and the Russell Sage Foundation. She is the recipient of numerous awards, including the Society of General Internal Medicine Award for Outstanding Junior Investigator of the Year and the Marjorie A. Bowman Award from the University of Pennsylvania School of Medicine for achievement in the health evaluation sciences. Dr. Chang is also a Diplomate of the American Board of Internal Medicine.
Dr. Chang’s publications span a variety of disciplines, including journals such as JAMA, Annals of Internal Medicine, JAMA Internal Medicine, Health Affairs, American Journal of Public Health, American Journal of Epidemiology, Journal of Health & Social Behavior, Social Science & Medicine, Demography, and Social Forces. She was recently an Associate Editor of the Journal of Health & Social Behavior.
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Education
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BS, Biomedical Sciences and Philosophy, University of Michigan, Ann Arbor, MIMD, Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MIMA, Sociology, University of Chicago, Chicago, ILPhD, Sociology, University of Chicago, Chicago, IL-Fellow, Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, ILResident, Department of Medicine, University of Chicago, Chicago, ILIntern, Department of Medicine, University of Chicago, Chicago, IL-Diplomate, American Board of Internal MedicineLicensed Medical Physician, Commonwealth of Pennsylvania
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Honors and awards
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Majorie A. Bowman Research Award, University of Pennsylvania School of Medicine (2010)Outstanding Junior Investigator of the Year, Society of General Internal Medicine (2008)Robert Austrian Faculty Award for Health Evaluation Reserach, Department of Medicine, University of Pennsylvania School of Medicine (2008)Physician Faculty Scholars Award, Robert Wood Johnson Foundation (2007)Finalist, Hamolsky Junior Facutly Award, Society of General Internal Medicine (2004)Finalist, Richard Saller Prize for Best Dissertation in the Division of the Social Sciences, University of Chicago (2003)Graduate University Fellowship, University of Chicago (2001)Eli G. Rochelson Memorial Award for Excellence in Pulmonary and Critical Care Medicine, University of Michigan Medical School (1994)Biomedical Research Program Scholarship, University of Michigan Medical School (1991)James B. Angell Scholar, University of Michigan (1988)William J. Branstrom Freshman Prize, University of Michigan (1986)
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Areas of research and study
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Global HealthHealth DisparitiesInternal MedicineObesityPopulation HealthSocial Behaviors
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Publications
Publications
Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death
AbstractMyrskylä, M., Mehta, N. K., & Chang, V. W. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
7Page(s)
e83-e90AbstractObjectives. We sought to analyze how early exposure to the 1918 influenza pandemic is associated with old-age mortality by cause of death. Methods. We analyzed the National Health Interview Survey (n = 81 571; follow-up 1989-2006; 43 808 deaths) and used year and quarter of birth to assess timing of pandemic exposure. We used Cox proportional and Fine-Gray competing hazard models for all-cause and cause-specific mortality, respectively. Results. Cohorts born during pandemic peaks had excess all-cause mortality attributed to increased noncancer mortality. We found evidence for a trade-off between noncancer and cancer causes: cohorts with high noncancer mortality had low cancer mortality, and vice versa. Conclusions. Early disease exposure increases old-age mortality through noncancer causes, which include respiratory and cardiovascular diseases, and may trigger a trade-off in the risk of cancer and noncancer causes. Potential mechanisms include inflammation or apoptosis. The findings contribute to our understanding of the causes of death behind the early disease exposure-latermortality association. The cancer-noncancer trade-off is potentially important for understanding the mechanisms behind these associations.Obesity and Mortality
AbstractMehta, N. K., & Chang, V. W. (n.d.). In The Oxford Handbook of the Social Science of Obesity (1–).Publication year
2012AbstractThis chapter reports that the mortality penalty linked with obesity has been falling in recent decades. It describes how, in current data, the relationship between obesity and mortality is complex; although class II and III obesity are associated with elevated mortality risk, overweight and class I obesity are generally not associated with higher mortality. Studies that measure body mass index (BMI) when respondents are middle aged and model mortality into later life can give a better sense of the BMI and mortality relationship at the older ages. A high BMI is a small source of excess deaths in the United States, although this topic continues to be controversial. Studies that measure BMI in middle age and model subsequent mortality may give a better sense of the effect of BMI on mortality for those over the age of 50.Gender equality, development, and cross-national sex gaps in life expectancy
AbstractMedalia, C., & Chang, V. W. (n.d.).Publication year
2011Journal title
International Journal of Comparative SociologyVolume
52Issue
5Page(s)
371-389AbstractFemale life expectancy exceeds male life expectancy in almost every country throughout the world. Nevertheless, cross-national variation in the sex gap suggests that social factors, such as gender equality, may directly affect or mediate an underlying biological component. In this article, we examine the association between gender equality and the sex gap in mortality. Previous research has not addressed this question from an international perspective with countries at different levels of development. We examine 131 countries using a broad measure of national gender equality that is applicable in both Less Developed Countries (LDCs) and Highly Developed Countries (HDCs). We find that the influence of gender equality is conditional on level of development. While gender equality is associated with divergence between female and male life expectancies in LDCs, it is associated with convergence in HDCs. The relationship between gender equality and the sex gap in mortality in HDCs strongly relates to, but is not explained by, sex differences in lung cancer mortality. Finally, we find that divergence in LDCs is primarily driven by a strong positive association between gender equality and female life expectancy. In HDCs, convergence is potentially related to a weak negative association between gender equality and female life expectancy, though findings are not statistically significant.Race/ethnic differences in adult mortality: The role of perceived stress and health behaviors
AbstractKrueger, P. M., Saint Onge, J. M., & Chang, V. W. (n.d.).Publication year
2011Journal title
Social Science and MedicineVolume
73Issue
9Page(s)
1312-1322AbstractWe examine the role of perceived stress and health behaviors (i.e., cigarette smoking, alcohol consumption, physical inactivity, sleep duration) in shaping differential mortality among whites, blacks, and Hispanics. We use data from the 1990 National Health Interview Survey (N = 38,891), a nationally representative sample of United States adults, to model prospective mortality through 2006. Our first aim examines whether unhealthy behaviors and perceived stress mediate race/ethnic disparities in mortality. The black disadvantage in mortality, relative to whites, closes after adjusting for socioeconomic status (SES), but re-emerges after adjusting for the lower smoking levels among blacks. After adjusting for SES, Hispanics have slightly lower mortality than whites; that advantage increases after adjusting for the greater physical inactivity among Hispanics, but closes after adjusting for their lower smoking levels. Perceived stress, sleep duration, and alcohol consumption do not mediate race/ethnic disparities in mortality. Our second aim tests competing hypotheses about race/ethnic differences in the relationships among unhealthy behaviors, perceived stress, and mortality. The social vulnerability hypothesis predicts that unhealthy behaviors and high stress levels will be more harmful for race/ethnic minorities. In contrast, the Blaxter (1990) hypothesis predicts that unhealthy lifestyles will be less harmful for disadvantaged groups. Consistent with the social vulnerability perspective, smoking is more harmful for blacks than for whites. But consistent with the Blaxter hypothesis, compared to whites, current smoking has a weaker relationship with mortality for Hispanics, and low or high levels of alcohol consumption, high levels of physical inactivity, and short or long sleep hours have weaker relationships with mortality for blacks.Secular declines in the association between obesity and mortality in the United States
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2011Journal title
Population and Development ReviewVolume
37Issue
3Page(s)
435-451AbstractRecent research suggests that rising obesity will restrain future gains in US life expectancy and that obesity is an important contributor to the current shortfall in us longevity compared to other high-income countries. Estimates of the contribution of obesity to current and future national-level mortality patterns are sensitive to estimates of the magnitude of the association between obesity and mortality at the individual level. We assessed secular trends in the obesity/mortality association among cohorts of middle-aged adults between 1948 and 2006 using three long-running US data sources: the Framingham Heart Study, the National Health and Nutrition Examination Survey, and the National Health Interview Survey. We find substantial declines over time in the magnitude of the association between obesity and overall mortality and, in certain instances, cardiovascular-specific mortality. We conclude that estimates of the contribution of obesity to current national-level mortality patterns should take into account recent reductions in the magnitude of the obesity and mortality association.Metabolic syndrome and weight gain in adulthood
AbstractAlley, D. E., & Chang, V. W. (n.d.).Publication year
2010Journal title
Journals of Gerontology - Series A Biological Sciences and Medical SciencesVolume
65Issue
1Page(s)
111-117AbstractBackgroundThe influence of long-term adult weight history on metabolic risk independent of attained body mass index (BMI) is unknown.MethodsUsing nationally representative data on adults aged 50-64 years from the 1999-2006 National Health and Nutrition Examination Surveys, we examined weight change for two periods of adulthood: prime age (age 25-10 years ago) and midlife (the last 10 years). Weight changes in each period were categorized as stable (gain <10 kg) or gain (gain ≥10 kg) to create weight history comparison groups: stable-stable, gain-stable (prime age gain), stable-gain (midlife gain), and gain-gain (continuous gain). Persons who lost weight were excluded. Logistic regression predicted odds of metabolic syndrome and its subcomponents based on weight history, adjusting for current BMI and covariates.ResultsParticipants in the gain-stable group had 89% elevated odds of metabolic syndrome (odds ratio = 1.89, 95% CI: 1.19-3.01) relative to the stable-stable group, even after adjustment for current BMI. All weight gain groups had increased odds of low HDL and high triglycerides relative to participants with continuously stable weights. No significant associations were found between weight history and hypertension or high glucose.ConclusionsWeight history confers information about metabolic risk factors above and beyond attained weight status. In particular, adult weight gain is related to risk of low HDL and high triglycerides. Weight history may contribute to our understanding of why some obese older persons are metabolically healthy but others are not.Quality of care among obese patients
AbstractChang, V. W., Asch, D. A., & Werner, R. M. (n.d.).Publication year
2010Journal title
JAMAVolume
303Issue
13Page(s)
1274-1281AbstractContext Clinicians often have negative attitudes toward obesity and express dissatisfaction in caring for obese patients. Moreover, obese patients often feel that clinicians are biased or disrespectful because of their weight. These observations raise the concern that obese patients may receive lower quality of care. Objective To determine whether performance on common outpatient quality measures differs by patient weight status. Design, Setting, and Participants Eight different performance measures were examined in 2 national-level patient populations: (1) Medicare beneficiaries (n=36122) using data from the Medicare Beneficiary Survey (1994-2006); and (2) recipients of care from the Veterans Health Administration (VHA) (n=33550) using data from an ongoing performance-evaluation program (2003-2004). Main Outcome Measures Performance measures among eligible patients for diabetes care (eye examination, glycated hemoglobin [HbA 1c] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening. Measures were based on a combination of administrative claims, survey, and chart review data. Results We found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients. Moreover, success rates were marginally higher for obese and/or overweight patients on several measures. The most notable differentials were observed for recommended diabetes care among Medicare beneficiaries: comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%; odds ratio, 1.37 [95% confidence interval, 1.09-1.73]) and HbA 1c testing (74% vs 62%; odds ratio, 1.73 [95% confidence interval, 1.41-2.11]). All analyses were adjusted for sociodemographic factors, health status, clinical complexity, and visit frequency. Conclusions Amongsamplesofpatients from theMedicareandVHApopulations, there was no evidence across 8 performance measures that obese or overweight patients received inferior care when compared with normal-weight patients. Being obese or overweight was associated with a marginally higher rate of recommended care on several measures.Social capital and glucose control
AbstractLong, J. A., Field, S., Armstrong, K., Chang, V. W., & Metlay, J. P. (n.d.).Publication year
2010Journal title
Journal of Community HealthVolume
35Issue
5Page(s)
519-526AbstractThere is a growing diabetes epidemic in the United States and if we are to halt its progress we need to better understand the social determinants of this disease and its control. Social capital, which has been associated with general health and mortality, may be one important mediator of glucose control. In this study we determine if neighborhood social capital is associated with glucose control, independent of individual factors. We performed a cross-sectional study of Black veterans with diabetes living in Philadelphia. We merged individual-level data from surveys and charts with six area-level social capital descriptors. Holding all other variables constant, patients who lived in neighborhoods that scored near the 5th percentile of working together to improve the neighborhood were estimated to have glycosylated hemoglobin (HbA1c) values that were at least one point above a conservative clinical definition of "diabetes control" (HbA1c B 8%). If these same patients were to live in neighborhoods in the 95th percentile, their expected HbA1c would be over a point below the cut-off value 8%. No other measure of social capital was associated with HbA1c. In this study of black veterans with diabetes we observed that living in neighborhoods where people work together is associated with better glucose control.Fundamental cause theory, technological innovation, and health disparities: The case of cholesterol in the era of statins
AbstractChang, V. W., & Lauderdale, D. S. (n.d.).Publication year
2009Journal title
Journal of health and social behaviorVolume
50Issue
3Page(s)
245-260AbstractAlthough fundamental cause theory has been highly influential in shaping the research literature on health disparities, there have been few empirical demonstrations of the theory, particularly in dynamic perspective. In this study, we examine how income disparities in cholesterol levels have changed with the emergence of statins, an expensive and potent new drug technology. Using nationally representative data from 1976 to 2004, we find that income gradients for cholesterol were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were previously more likely to have high levels of cholesterol, they are now less likely. We consider our case study against a broader theoretical framework outlining the relationship between technology innovation and health disparities. We find that the influence of technologies on socioeconomic disparities is subject to two important modifiers: (1) the nature of the technological change and (2) the extent of its diffusion and adoption.Mortality attributable to obesity among middle-aged adults in the United States
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2009Journal title
DemographyVolume
46Issue
4Page(s)
851-872AbstractObesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI ≥ 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI ≥ 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.Neighborhood racial isolation, disorder and obesity
AbstractChang, V. W., Hillier, A. E., & Mehta, N. K. (n.d.).Publication year
2009Journal title
Social ForcesVolume
87Issue
4Page(s)
2063-2092AbstractRecent research suggests that racial residential segregation may be detrimental to health. This study investigates the influence of neighborhood racial isolation on obesity and considers the role of neighborhood disorder as a mediator in this relationship. For the city of Philadelphia, we find that residence in a neighborhood with high black racial isolation is associated with a higher body mass index and higher odds of obesity among women, but not men, highlighting important sex differences in the influence of neighborhood structure on health. Furthermore, the influence of high racial isolation on women's weight status is mediated, in part, by the physically disordered nature of such neighborhoods. Disorder of a more social nature (as measured by incident crime) is not associated with weight status.Racial differences in the impact of comorbidities on survival among elderly men with prostate cancer
AbstractPutt, M., Long, J. A., Montagnet, C., Silber, J. H., Chang, V. W., Liao, K., Schwartz, J. S., Pollack, C. E., Wong, Y. N., & Armstrong, K. (n.d.).Publication year
2009Journal title
Medical Care Research and ReviewVolume
66Issue
4Page(s)
409-435AbstractThis study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ĝ‰¥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels.Weight change, initial bmi, and mortality among middle- and older-aged adults
AbstractMyrskyla, M., & Chang, V. W. (n.d.).Publication year
2009Journal title
EpidemiologyVolume
20Issue
6Page(s)
840-848AbstractBackground: It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change. Methods: We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units. Results: Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m2 (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders. Conclusions: Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.Affect and heart disease
Chang, V. W. (n.d.).Publication year
2008Journal title
BMJVolume
337Issue
7660Page(s)
3-4Being poor and coping with stress: Health behaviors and the risk of death
AbstractKrueger, P. M., & Chang, V. W. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
5Page(s)
889-896AbstractObjectives. Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Methods. Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n=40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. Results. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. Conclusions. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.The relationship between measured performance and satisfaction with care among clinically complex patients
AbstractWerner, R. M., & Chang, V. W. (n.d.).Publication year
2008Journal title
Journal of general internal medicineVolume
23Issue
11Page(s)
1729-1735AbstractBACKGROUND: Recent work has shown that clinically complex patients are more likely to receive recommended care, but it is unknown whether higher achievement on individual performance goals results in improved care for complex patients or detracts from other important but unmeasured aspects of care, resulting in unmet needs and lower satisfaction with care. OBJECTIVE: To examine the relationship between measured performance and satisfaction with care among clinically complex patients DESIGN AND PARTICIPANTS: An observational analysis of a national sample of 35,927 veterans included in the External Peer Review Program in fiscal years 2003 and 2004. MEASUREMENTS: First, compliance with individual performance measures (breast cancer screening with mammography, colorectal cancer screening, influenza vaccination, pneumococcal vaccination, lipid monitoring, use of ACE inhibitor in heart failure, and diabetic eye examination), as well as overall receipt of recommended care, was estimated as a function of each patient's clinical complexity. Second, global satisfaction with care was estimated as a function of clinical complexity and compliance with performance measures. MAIN RESULTS: Higher clinical complexity was predictive of slightly higher overall performance (OR 1.13, 95% CI 1.09 to 1.18) and higher performance on most individual performance measures, an effect that was mediated by increased visit frequency. High measured performance was associated with higher satisfaction with care among patients with high clinical complexity. In fact, as complexity increased, the effect of achieving high performance on the odds of being satisfied with care also increased CONCLUSIONS: Not only was measured performance higher in clinically complex patients, but satisfaction with care was also higher among clinically complex patients with high measured performance, suggesting that compliance with performance measures in clinically complex patients does not crowd out unmeasured care.The shape of things to come: obesity, aging, and disability.
AbstractAlley, D. E., Chang, V. W., & Doshi, J. (n.d.).Publication year
2008Journal title
LDI issue briefVolume
13Issue
3Page(s)
1-4AbstractRising obesity represents one of the most disturbing health trends in the U.S. and elsewhere. Obese people are at greater risk for diabetes, cardiovascular disease, disability, and mortality. However, recent studies also suggest that the obese population has grown "healthier" since the 1960s, probably due to improved medical care for cardiovascular disease. It is unclear whether these improvements have resulted in more or less disability in obese people as they age. This issue Brief summarizes two studies that examine the prevalence of obesity over time in the elderly and disabled, and the changing relationship of obesity and disability.Weight Status and Restaurant Availability. A Multilevel Analysis
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2008Journal title
American journal of preventive medicineVolume
34Issue
2Page(s)
127-133AbstractBackground: Empiric studies find that contextual factors affect individual weight status over and above individual socioeconomic characteristics. Given increasing levels of obesity, researchers are examining how the food environment contributes to unhealthy weight status. An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants. Methods: This study analyzed the relationship between the restaurant environment and weight status across counties in the United States. Individual data from the 2002-2006 Behavioral Risk Factor Surveillance System (N=714,054) were linked with restaurant data from the 2002 U.S. Economic Census. Fast-food and full-service restaurant density, along with restaurant mix (the ratio of fast-food to full-service restaurants), were assessed. Results: Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status (BMI and the risk of being obese). In contrast, a higher density of full-service restaurants was associated with lower weight status. Conclusions: Area-level restaurant mix emerged as an important correlate of weight status, with components of the restaurant environment exhibiting differential associations. Hence, it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes. Areas with a high density of full-service restaurants were indicative of a more healthful eating environment, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. Future prospective studies are required to delineate causal pathways.The changing relationship of obesity and disability, 1988-2004
AbstractAlley, D. E., & Chang, V. W. (n.d.).Publication year
2007Journal title
Journal of the American Medical AssociationVolume
298Issue
17Page(s)
2020-2027AbstractContext: Recent studies suggest that the obese population may have been growing healthier since the 1960s, as indicated by a decrease in mortality and cardiovascular risk factors. However, whether these improvements have conferred decreased risk for disability is unknown. The obese population may be living longer with better-controlled risk factors but paradoxically experiencing more disability. Objective: To determine whether the association between obesity and disability has changed over time. Design, Setting, and Participants: Adults aged 60 years and older (N=9928) with measured body mass index from 2 waves of the nationally representative National Health and Nutrition Examination Surveys (NHANES III [1988-1994] and NHANES 1999-2004). Main Outcome Measures: Reports of much difficulty or inability to perform tasks in 2 disability domains: functional limitations (walking one-fourth mile, walking up 10 steps, stooping, lifting 10 lb, walking between rooms, and standing from an armless chair) and activities of daily living (ADL) limitations (transferring, eating, and dressing). Results: Among obese individuals, the prevalence of functional impairment increased 5.4% (from 36.8%-42.2%; P=.03) between the 2 surveys, and ADL impairment did not change. At time 1 (1988-1994), the odds of functional impairment for obese individuals were 1.78 times greater than for normal-weight individuals (95% confidence interval [CI], 1.47-2.16). At time 2 (1999-2004), this odds ratio increased to 2.75 (95% CI, 2.39-3.17), because the odds of functional impairment increased by 43% (OR 1.43; 95% CI, 1.18-1.75) among obese individuals during this period, but did not change among nonobese individuals. With respect to ADL impairment, odds for obese individuals were not significantly greater than for individuals with normal weight (OR, 1.31; 95% CI, 0.92-1.88) at time 1, but increased to 2.05 (95% CI, 1.45-2.88) at time 2. This was because the odds of ADL impairment did not change for obese individuals but decreased by 34% among nonobese individuals (OR, 0.66; 95% CI, 0.50-0.88). Conclusions: Recent cardiovascular improvements have not been accompanied by reduced disability within the obese older population. Rather, obese participants surveyed during 1999-2004 were more likely to report functional impairments than obese participants surveyed during 1988-1994, and reductions in ADL impairment observed for nonobese older individuals did not occur in those who were obese. Over time, declines in obesity-related mortality, along with a younger age at onset of obesity, could lead to an increased burden of disability within the obese older population.Trends: Prevalence and trends in obesity among aged and disabled U.S. medicare beneficiaries, 1997-2002
AbstractDoshi, J. A., Polsky, D., & Chang, V. W. (n.d.).Publication year
2007Journal title
Health AffairsVolume
26Issue
4Page(s)
1111-1117AbstractGiven Medicare's recent national coverage decision on bariatric surgery, as well as potential coverage expansions for other obesity-related treatments, data on obesity in the Medicare population have great relevance. Using nationally representative data, we estimate that between 1997 and 2002, the prevalence of obesity in the Medicare population increased by 5.6 percentage points, or about 2.7 million beneficiaries. By 2002, 21.4 percent of aged beneficiaries and 39.3 percent of disabled beneficiaries were obese, compared with 16.4 percent and 32.5 percent, respectively, in 1997. Using 2002 data, we estimate that three million beneficiaries would be eligible for bariatric surgery coverage under current Medicare policy.Racial residential segregation and weight status among US adults
AbstractChang, V. W. (n.d.).Publication year
2006Journal title
Social Science and MedicineVolume
63Issue
5Page(s)
1289-1303AbstractWhile the segmentation of residential areas by race is well known to affect the social and economic well-being of the segregated minority group in the United States, the relationship between segregation and health has received less attention. This study examines the association between racial residential segregation, as measured by the isolation index, and individual weight status in US metropolitan areas. Multi-level, nationally representative data are used to consider the central hypothesis that segregation is positively associated with weight status among African Americans, a group that is hyper-segregated and disproportionately affected by unhealthy weight outcomes. Results show that among non-Hispanic blacks, higher racial isolation is positively associated with both a higher body mass index (BMI) and greater odds of being overweight, adjusting for multiple covariates, including measures of individual socioeconomic status. An increase of one standard deviation in the isolation index is associated with a 0.423 unit increase in BMI (p < 0.01), and a 14% increase in the odds of being overweight (p < 0.01). Among whites, there is no significant association between the isolation index and weight status. These findings suggest that in addition to differences among people, differences among places and, in particular, differences in the spatial organization of persons may be relevant to health policy and promotion efforts.Trends in the association of poverty with overweight among US adolescents, 1971-2004
AbstractMiech, R. A., Kumanyika, S. K., Stettler, N., Link, B. G., Phelan, J. C., & Chang, V. W. (n.d.).Publication year
2006Journal title
JAMAVolume
295Issue
20Page(s)
2385-2393AbstractContext: Prevalence of adolescent overweight in the United States has increased substantially during the past 3 decades. Whether socioeconomic disparities in adolescent overweight increased, decreased, or remained constant during this period is not known. Objective: To examine trends in adolescent overweight from 1971 to 2004 by family poverty status, as well as trends in potentially relevant eating and physical activity behaviors. Design, Setting, and Participants: Four cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES] of 1971-1974, 1976-1980, 1988-1994, and 1999-2004) were examined for trends in the prevalence of overweight among adolescents aged 12 to 17 years by family poverty status. Main Outcome Measures: Prevalence of adolescent overweight, defined as body mass index at or above the 95th percentile for age and sex in the 2000 Centers for Disease Control and Prevention growth charts. Intermediate outcomes were physical inactivity in the past 30 days, proportion of caloric intake from sweetened beverages (24-hour recall), and whether respondent skipped breakfast (24-hour recall). Results: Trends in the association of adolescent overweight with family poverty differed by age stratum (P=.01). In 12- to 14-year-old adolescents, prevalence did not significantly differ by family poverty status in any of the surveys; however, among non-Hispanic black adolescents, overweight prevalence increased faster in nonpoor vs poor families. In contrast, a widening disparity that disfavored adolescents from poor families was present in the 15- to 17-year-old adolescents. This trend was similar among male, female, non-Hispanic white, and non-Hispanic black adolescents, resulting in an overall prevalence of overweight in 1999-2004 more than 50% higher among adolescents in poor vs nonpoor families (23.3% vs 14.4%, respectively; P<.001). Additional analyses suggest that physical inactivity, sweetened beverage consumption, and skipping breakfast may contribute to these disparities. Conclusions: Trends of increasing overweight showed a greater impact in families living below the poverty line vs not living below the poverty line among older (15-17 years) but not younger (12-14 years) adolescents. Furthermore, physical inactivity, high consumption of sweetened beverages, and breakfast skipping may be candidate targets for prevention programs aimed at reducing this recently emerged disparity.Income disparities in body mass index and obesity in the United States, 1971-2002
AbstractChang, V. W., & Lauderdale, D. S. (n.d.).Publication year
2005Journal title
Archives of Internal MedicineVolume
165Issue
18Page(s)
2122-2128AbstractBackground: Although obesity is frequently associated with poverty, recent increases in obesity may not occur disproportionately among the poor. Furthermore, the relationship between income and weight status may be changing with time. Methods: We use nationally representative data from the National Health and Nutrition Examination Surveys (1971-2002) to examine (1) income differentials in body mass index (calculated as weight in kilograms divided by the square of height in meters) and (2) change over time in the prevalence of obesity (body mass index, ≥30) at different levels of income. Results: Over the course of 3 decades, obesity has increased at all levels of income. Moreover, it is typically not the poor who have experienced the largest gains. For example, among black women, the absolute increase in obesity is 27.0% (1.05% per year) for those at middle incomes, but only 14.5% (0.54% per year) for the poor. Among black men, the increase in obesity is 21.1% (0.77% per year) for those at the highest level of income, but only 4.5% (0.06% per year) for the near poor and 5.4% (0.50% per year) for the poor. Furthermore, all race-sex groups show income differentials on body mass index, but patterns show substantial variation between groups and consistency and change within groups over time. For example, white women consistently show a strong inverse gradient, while a positive gradient emerges in later waves for black and Mexican American men. Conclusion: The persistence and emergence of income gradients suggests that disparities in weight status are only partially attributable to poverty and that efforts aimed at reducing disparities need to consider a much broader array of contributing factors.Income inequality and weight status in US metropolitan areas
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2005Journal title
Social Science and MedicineVolume
61Issue
1Page(s)
83-96AbstractPrior empirical studies have demonstrated an association between income inequality and general health endpoints such as mortality and self-rated health, and findings have been taken as support for the hypothesis that inequality is detrimental to individual health. Unhealthy weight statuses may function as an intermediary link between inequality and more general heath endpoints. Using individual-level data from the 1996-98 Behavioral Risk Factor Surveillance System, we examine the relationship between individual weight status and income inequality in US metropolitan areas. Income inequality is calculated with data from the 1990 US Census 5% Public Use Microsample. In analyses stratified by race-sex groups, we do not find a positive association between income inequality and weight outcomes such as body mass index, the odds of being overweight, and the odds of being obese. Among white women, however, we do find a statistically significant inverse association between inequality and each of these weight outcomes, despite adjustments for individual-level covariates, metropolitan-level covariates, and census region. We also find that greater inequality is associated with higher odds for trying to lose weight among white women, even adjusting for current weight status. Although our findings are suggestive of a contextual effect of metropolitan area income inequality, we do not find an increased risk for unhealthy weight outcomes, adding to recent debates surrounding this topic.U.S. obesity, weight gain, and socioeconomic status
Chang, V. W. (n.d.).Publication year
2005Journal title
CHERP Policy BriefVolume
3Issue
1Page(s)
1-4