SOCIOCULTURAL RISK FACTORS OF NON-INSULIN DEPENDENT DIABETES MELLITUS AMONG MIDDLE CLASS AFRICAN AMERICANS IN CENTRAL

OHIO

DISSERTATION

Presented in Partial Fulfillment of the Requirements

for the Degree of Doctor of Philosophy in the Graduate

School of The Ohio State University

By

Jacquelyn Patricia Price Robinson, M.A.

*****

The Ohio State University

2003

Dissertation Committee: Dr. Douglas E. Crews, Advisor Approved by Dr. Patrick Mullen _______________________ Department of Anthropology Dr.William Hicks

Copyright© by

Jacquelyn Patricia Price Robinson

2003

ABSTRACT

Slavery, as an innovation in human cultural development, not only caused disequilibria

in culture, ecology and biology, but also produced by-products that affect health and

mortality and stimulated selection for metabolic adjustment to health and environmental

imbalances. That the adjustment may have programmed slaves' descendants to the

present type II diabetes epidemic, forms the basis for this dissertation. Its purpose is to

develop an etiology of diabetes that uses a global structural analysis of folklore,

biohistory, and socio-political hegemony for interpreting anthropometry and sociocultural

variables that may contribute to type II diabetes.

Statistical analyses suggested: obesity and anthropometry predict plasma glucose; the

influence of sociocultural risk factors on the dependent variable is minimal; and the

relationship between total dietary cholesterol and post-load glucose is highly significant.

The cholesterol/post-load glucose relationship has important implications. Global

structural analysis provides confirmatory evidence that "master's" manipulation of slaves'

diets by adding fats to increase energy for maximum labor output, has impacted the

dietary habits and soul food cuisine of slaves' descendants today as social inheritance.

Analysis of data from the Central Ohio Study of Diabetes and Aging (COSDA) and

global structure resulted in development of a diabetes profile, the Anabolic-Catabolic-

Homeostasis Etiology of Diabetes Mellitus (ACHED). It focuses on energy metabolism

under-cum-deficient nutrition, excesses in energy dissipation, morbidity, life stresses, and

and selection of "high-performance genotypes", those adjusted to prolonged catabolism,

ii

fat consumption. Analysis of environmental disequilibria experienced by slaves and their

descendants show two periods of intergenerational food scarcity, one was prolonged and

followed by another shorter and more severe. These periods occurred with excessive

morbidity, life stresses, energy output and fat consumption as precursors to type II

and overweight but can’t maintain metabolic homeostasis following food scarcity

periods.

diabetes when obesity prone “high-performance genotypes” become physically inactive

iii

This Dissertation is dedicated to

My parents,

Mr. Arthur Paul and Mrs. Georgia Mae Price

Who did not live to see me complete the doctorate degree.

iv

ACKNOWLEDGMENTS

This dissertation could not have been completed without a support network of friends,

colleagues, professors, and family. I am deeply grateful to Drs. Esther J. Pressel, Robert

Theodoratus and James Hansen, all professors at Colorado State University whose

encouragement, support, friendship and love enabled me to endure and rise above the

turbulent desegregation there, and whose support continued through my doctoral studies.

I especially thank Esther for organizing the anthropology faculty there to help me locate

articles by Neel, Williams and others.

I am especially thankful to Dr. Ojo Arewa, my first advisor at The Ohio State

University, who delayed his retirement to advise me. He has been my lighthouse as I

sailed the seas of doctoral studies. Words will never express my gratitude for the

opportunity, kindness and support he bestowed upon me.

I am grateful to Dr. Patrick Mullen who taught me that folklore scholarship

exceeds the laughter of some folktales and jokes. Dr. Mullen is never too busy to help,

encourage and quickly respond to his students' needs. I thank him for his compassion,

I thank Dr. Douglas Crews, my second advisor, for his unwavering persistence.

His efforts resulted in me studying African Americans when I wanted to avoid the pain of

advise, guidance, encouragement, character qualities, professionalism, and altruism.

v

past atrocities. Because of him, I can address minority health disparities with confidence

and authority. I benefit tremendously from his editorial skills.

The conscious benefits by Dr. William Hicks resulted in the completion of this

work. His expression that findings of this study are logical and consistent with medical

knowledge and African American experiences were very encouraging. His compassion,

propriety, professionalism and scholarship took me over the top.

I could not have pursued the doctorate without a dependable network of social

support. I am deeply appreciative of Reverend Leroy “Poppy” and Mrs. Virginia Stills,

my dear friends, surrogate parents and my children’s surrogate grandparents, for their

encouragement, assistance, and love. Their Christian fellowship, Bible studies, and meals

provided the foundation for this dissertation. Dr. Alfred and Mrs. Mary Jenkins, my dear

friends, were always there to provide medical assistance and knowledge, to share social

activities, holidays and meals with my family. Dr. Charles and Mrs. Gwyneth Russell

helped me get through difficult times. Chuck took time from the Emergency Room to talk

to me and E-mailed jokes that made me laugh. Gwyneth sent floral arrangements with a

dozen orchids that focused my attention on God’s beauty and her kindness. Mr. Sean

Walton, my personal trainer, kept me “fit” and “laughing” during what would have been

physically inactive and obese doctoral studies. Dr. Evelyn Blanche-Payne, my dear friend

and colleague, gave academic and professional guidance, strength, deep faith and

Christian love. She kept saying, “In God’s time,” brought me to closure with this

assignment. The inspiration, and advice of Mrs. Bessie Johns, my long time and dearest

friend, fostered my hope throughout this work. I am especially indebted to Dr. Howard

and Mrs. Ethel Swonigan, my friends and my children’s surrogate grandparents. I cannot

vi

thank Ethel enough for the support she gave me and for the affection, attention, time, and

gifts she gave my children. Her wings of love lifted my sons above childhood illnesses

and brooded them with protection from the misfortunes of being black, adolescent, and

males in a “color line” society.

There are family members who also made this doctorate possible. Dr. Deborah

Jones, my cousin, took time from her psychiatric patients to share her medical books and

knowledge. Her parents, Lt. Col.(ret.) Meyer and Mrs. Delores Stansberry, shared their

home when I was too tired to drive home from Columbus. Dr. Jacinto and Mrs. Karen

Beard, Deborah's sister, also shared their home with me when I needed to rest before

driving to Dayton. Dr. Ames and Mrs. Burnice Chapman, my cousins, helped arrange the

Diabetes Screening at Zion Baptist Church, the church pastored by their son and my

cousin, Reverend Gary Chapman. I am thankful that, Mrs. Beverlyn Price Jorman, my

sister, and Burnice kept telling me, “Finish the Ph.D. degree!” I thank Mr. Brian and Mrs.

Rhonda Phillips-Guy of Atlanta, Georgia, my cousins, for sharing their home, love and

fellowship with my family when Gene, Louis and I visited Paul when he attended Rabun

Gap-Nacoochee School in Rabun Gap, Georgia. I thank them for floral arrangements

that marked each stage of the doctorate with congratulation cards that encouraged me to,

“Continue working with patience.”

My colleagues also help with this dissertation. The deep compassion of Drs. Sue

Mother, then my Father. Their help were soothing currents that lifted me up over

dissertation statistic. I am especially grateful for Dr. Morgan’s gentle urging that kept me

Kopel and Neville N. Morgan pushed me through overwhelming grief after I lost my

writing through tears of grief to complete this dissertation.

vii

I reserve distinct gratitude for my parents, husband and sons. I honor my parents

post-humously for my formal and informal education, Christian training, and

development of my "gifts" that culminated in this dissertation. Mother and Daddy

encouraged me to never give up, and that I could always seek their wisdom, love and

compassion. They are my model of high ethical conduct and esteem. I am deeply grateful

to Eugene Robinson, Esq., my loving husband, for his financial and domestic support in

every phase of this degree completion. To our sons, Louis A. and Paul D. Robinson, who

came to understand that goal achievement meant their Mother could no longer taxi them

to summer and extra curricular activities. I thank them and Eugene for understanding that

my love for them extends far beyond "book knowledge", anthropology, and computers. I

thank the three of you for patiently waiting on the joys and benefits of “life after the

doctorate degree.”

Again, to all with the utmost gratitude, love and appreciation,

“Thank you from the bottom of my heart.”

viii

VITA

November 9,1951 ………………………..Born, Brunswick, Georgia 1970 ………………………………………B.S. Sociology and Anthropology, The

Colorado State University

1972 ………………………………………M.A. Anthropology, The Colorado State University 1972 – 1973 ………………………………Instructor,

Denver Community College Denver, Colorado 1973 – 1979 ……………………………...Assistant Professor

Central State University, Wilberforce, Ohio

1990 – 1995 ……………………………...Assistant Professor Wilberforce University, Wilberforce, Ohio 2002 – present ……………………………Associate Professor Texas College, Tyler, Texas

FIELDS OF STUDY

Major Field: Anthropology

ix

PageAbstract…………………..………………………………………………………iv

Dedication………………………………………………………………….. vi

Acknowledgements………………………………………………………… vii

Vita…………………………………………………………………………. xi

List of Tables………………………………………………………………. xviiList of Figures……………………………………………………………… xxi

Chapters:

1. Introduction

1.1 Non-insulin Dependent Diabetes Mellitus (NIDDM) In African Americans……………………………………………. 1

1.2 Background of the Problem……………………………………… 81.3 Determnants of Adult Disease…………………………………… 8

1.3.1 Lifestyle and Disease……………………………………… 91.3.2 Racial/ethnic Minorities and Lifestyle…………………….. 101.3.3 Transition or Acculturation and Diabetes Mellitus……….. 13

(Type II)1.4 Objectives and Hypothesis……………………………………… 171.5 Statistics…………………………………………………………. 19

2. Sample and Methods

2.1 ResearchDesign………………………………………………….. 212.1.1 Recruitment……………………………………………….. 222.1.2 Study Population…………………………………………. 232.1.3 History of African Americans in Ohio……………………. 23

2.2 Study Samples2.2.1 Sample Selection…………………………………………… 27

292.2.2.1 Wilberforce (Township), Ohio…………………… 29

3234

TABLE OF CONTENTS

2.2.2 City and Township Description……………………………

2.2.2.2 Columbus, Ohio…………………………………..

x

2.2.2.3 Dayton, Ohio……………………………………..

2.3 Data Collection Techiniques……………………………………. 352.3.1 Difficulties Recruiting Participants………………………. 372.3.2 Recruitment………………………………………………. 402.3.3 The Process………………………………………………. 402.3.4 The Research Team………………………………………. 41

2.4 The Order of COSDA Procedures……………………………… 412.4.1 Procedures………………………………………………… 432.4.2 Anthropometry………………………...…………………. 432.4.3 Anthropometeric Indices…………………………………. 472.4.4 Phlebotomy and Glucose Measurements………………… 47

2.5 Sociocultural Assessment………………………………………. 482.6 Construction and Measurement of Sociocultural Risk Factors… 50

2.6.1 Sociocultural Risk Factors: Sociodemographics Index…… 512.6.2 Sociodemographics: Social Era/Age………………………. 512.6.3 Sociodemographics:Sex…………………………………… 512.6.4 Sociodemographics:Income………………………………. 512.6.5 Sociodemographics:Education……………………………. 522.6.6 Sociodemographics:Occupation………………………….. 522.6.7 Sociodemographics:Marital Status……………………….. 52

2.7 Sociocultural Risk Factors: Lifestyle/Stressor Index…………… 542.7.1 Lifestyle/Stressors:Chronic Stressors

or Assimilation Index…………………………………….. 542.7.2 Chronic Stressors or Assimilation Index:

Social Incongruity………………………………………… 552.7.3 Chronic Stressors or Assimilation Index:

Social Support……………………………………………. 572.7.4 Chronic Stressors or Assimilation Index:

Relaxation………………………………………………… 592.8 Lifestyle/Stressors: Acute Stressors……………………………. 60

2.8.1 Acute Stressors: Desegregation…………………………… 602.8.2 Acute Stressors:Victimization……………………………. 622.8.3 Acute Stressors:Reaction to Anger…….…………………. 632.8.4 Acute Stressors: Discrimination…………………….……. 65

2.9 Lifestyle/Stressors: Health Threatening Behavior………………. 662.9.1 Health Threatening Behavior: Tobacco Use………………. 662.9.2 Health Threatening Behavior: Alcoholic Use……………… 672.9.3 Health Threatening Behavior: Exercise or

Physical Activity………………………………………….. 672.10 Lifestyle/Stressors: Dietary Variables…………………………… 672.11 Statistical Analyses……………………………………………… 692.12 Construction of Biomedical Indices……………………………… 69

xi

3. History and Folklore

3.1 Africans and African Americans………………………….. 733.2 Hebrew Folklore………………………………………….. 763.3 Arab Folklore……………………………………………… 783.4 European Folklore………………………………………… 793.5 A Clash or Ethos, Meanings and Cultures………………… 803.6 Europe…………………………………………………….. 833.7 Africa……………………………………………………… 863.8 Sociocultural Factors……………………………………… 96

3.8.1 Lifestyle/Stressors………………………………….. 963.8.2 Acculturation: Acute Stressors……………………… 98

4. Results: Biological and Sociocultural Variables

4.1 Introduction……………………………………………….. 1004.1.1 Descriptive Statistics Summary……………………. 1004.1.2 Anthropometry Results……………………………. 116

4.2 Sociocultural Risk Factors………………………………… 1244.2.1 Introduction………………………………………… 1244.2.2 Sociodemographics…………………………………. 126

4.2.2.1 Sociodemographics: Age/Social Era……. 1264.2.2.2 Sociodemographics: Occupation………. 1284.2.2.3 Sociodemographics: Sex……………….. 1294.2.2.4 Sociodemographics: Marital Status……. 1304.2.2.5 Sociodemographics: Income…………… 130

4.2.3 Lifestyle/Stressors…………………………………. 1314.2.3.1 Desegregation………………………….. 1314.2.3.2 Discrimination…………………………. 1324.2.3.3 Victimization…………………………… 1334.2.3.4 Relaxation……………………………… 1334.2.3.5 Social Congruity……………………….. 1354.2.3.6 Social Support…………………………. 1364.2.3.7 Reaction to Anger……………………… 137

4.2.3 Health Threatening Behavior………………………. 1394.2.4 Dietary Factors…………………………………….. 139

4.3 Analysis of the Sociocultural Index………………………. 1434.4 Summary of Variables in Regression Analyses…………… 145

5. Model for Diabetes

5.1 Anthropometry & Sociocultural Variables…………….…. 147

xii

5.1.1 Anthropemetry…………………………………….. 1475.1.2 Sociocultural Factors……………………………….. 150

6. Discussion and Conclusion

6.1 Review of Results…………………………………………. 1566.2 Folklore, Literature and History………………………….. 1606.3 Sociocultural Index and Hypothesis………………………. 1616.4 Summary of Major Results and Comparison With Other

Studies…………………………………………………….. 1636.4.1 Major Findings……………………………………… 1756.4.2 Type II Diabetes in African Americans……………. 163

6.5 The Model for the Anabolic-Catabolic Homeostasis Etiology of Diabetes Mellitus (ACHED)…………………. 1686.5.1 Type II Diabetes and Obesity in African Americans………………………………………….. 172

6.5.1.1 Anabolism……………………………… 1726.5.1.2 Catabolism……………………………… 1736.5.1.3 Cutural Ecology and Type II Diabetes… 1756.5.1.4 Enviromental Ecology of Type II Diabetes………………………………… 1766.5.1.5 Homestasis…………………………….. 178

6.5.2 Confounders………………………………………… 1786.6 Significance………………………………………………… 1806.7 Conslusion………………………………………………… 185

Biobliography……………………………………………………………..

Appendix A…………………………………………………………….…… 186

Appendix B…………………………………………………………………. 188

xiii

206

Tables Page

2.1 City and Township Population of COSDA Participants…………. 24

2.2 Demographic factors of COSDA participants by organization…… 25

2.3 Distribution of sample by sociocultural factors and assignedvalues for sociodemographics (SD)…………………………………53

2.4 Diet and Health Risks…………………………………………… 70

2.5 Blood Pressure Value Box………………………………………….71

4.1 Descriptive Data for Age by Gender……………………………… 101

4.2 Descriptive Data for Lifestyle/Stessors by Gender………………. 101

4.3 Descriptive Data for Health Behaviors by Gender……………….. 102

4.4 Descriptive Data for Blood Pressure, GlucoseAnthropometry and Dietary Variables by Gender………………… 105

4.5 Descriptive Data for Age by Social Era…………………………… 105

4.6 Descriptive Data for Lifestyle & Anger by Social Era……………. 105

4.7 Descriptive Data for Lifestyle/Discrimination by Social Era……. 105

4.8 Descriptive Data for Acculturation by Social Era………………… 106

4.9 Descriptive Data for Health Behaviors by Social Era…………….. 106

4.10 Descriptive Data for Dietary Variables by Social Era…………….. 107

4.11 ANOVA Results by Age by Sample Source……………………… 109

LIST OF TABLES

xiv

4.12 ANOVA Results for Lifestyle/Stessors by Sample Source………. 110

4.13 ANOVA Results for Acculturation by Sample Source………… 111

4.14 ANOVA Results for Health Behavior by Sample Source……… 112

4.15 ANOVA Results for Dietary Variables by Sample Source…….. 113

4.16 Pearson Correlations Between Anthropometric MeasurementsGlucose and Blood Pressure……………………………………… 116

4.17 Association of Anthropometrics with Social Era and Participants; n 112COSDA Participants, 58 Apartheid, 54 Post Civil Rights.. 121

4.18 Summary of multiple regression ; Two Skinfold waist-hip ratio, and upper arm area to Post Load Glucose reading……………….. 122

4.19 Distribution of Sample by Sociocultural Factors and Assigned Values for Sociodemographics (SD)………………….. 125

4.20 Age, Social Era, and Sex Distribution of COSDA Participants…. 126

4.21 Fasting and Post-Load Glucose (mg/dl) by Social Eraand Age Categories in the COSDA Sample……………………… 127

4.22 Occupations of COSDA Participants…………………………… 128

4.23 Educational Attainment of COSDA Participants in Years……… 129

4.24 Marital Status of COSDA Participants…………………………. 130

4.25 COSDA Income…………………………………………………. 131

4.26 The Perception of Desegregation by COSDA Participants…….. 132

4.27 COSDA Participant' Evaluation of Equal Pay With Whites……. 133

4.28 COSDA Participants' Perception of Discriminationin Daily Life Beyond the Work Place…………………………… 134

xv

4.29 COSDA Participant's and Their Families Victimizationby Violent Crimes………………………………………………. 135

4.30 The Relationship of Victimization With Type II Diabetes…….. 135

4.31 COSDA Participants' Relaxation Index………………………… 135

4.32 Assessment of Social Incongruity Through MaterialPossessions Owned by COSDA Participants………………….. 136

4.33 Social Support or COSDA Participants byOrganization…………………………………………………….. 138

4.34 Descriptive Statistics for COSDA Participants'Reaction to Anger……………………………………………….. 139

4.35 Prediction of Threatening Behaviors and Post-Load Glucose……………………………………………………. 139

4.36 Prediction of Threatening Behaviors and Lifestyle……………… 140

4.37 Dietary Cholesterol and Total Fat for Post-Load Glucose……… 140

4.38 Regression of Food Nutrients and Post-Load Glucose Reading… 141

4.39 Predicator: (Constant), Health Threatening Behavior, Total Cholesterol, Total Lifestyle/Acculuration Index,Discrimination Index ffor Fasting Glucose……………………… 143

4.40 Health Threatening Behavior, Total Cholestrol,Total Lifestyle/Acculturation Index, and DiscriminationIndex as Predictors of Post-Load Glucose………………………. 144

4.41 Correlation Matrix for Variables in Regression Analyses………. 145

5.1 Sum of Two Skinfolds, Waist-Hip Ratio, and UpperArm Fat Area and Post-Load Glucose………………………….. 147

5.2 Body Mass Index, Arm Fat Index , Waist-Hip Ratio,Sum of Skinfolds for Post-Load Glucose……………………….. 147

xvi

5.3 Effects of the Sum of Two Skinfolds, Waist-Hip Ratio,and Upper Arm Muscle Area and Fasting Glucose…………….. 148

5.4 Sum of Two Skinfolds, Waist-Hip Ratio, Arm FatIndex, and Body Mass Index on Fasting Glucose………………. 149

5.5 Summary of Multiple Regression Analysis:Sociodemographic Predictor Variables for Post-Load Glucose……………………………………………… 150

5.6 Logistic Regression Prediction of the Likehood of > 140 from Sociodemographics…………………………………… 151

5.7 Prediction of Four Sociocultural Variable,Post-Load Glucose………………………………………………. 152

5.8 Summary of Multiple Regression Analysis: Biologicaland Sociocultural Predictor Variables for Post-Load Glucose………153

6.1 Comparisons of Typical Soul Food, European American,and Hypothesized Slave Diet……………………………………… 177

6.2 A Model of Anabolic-Catabolic Homeostasis Etiologyof Diabetes Mellitus in African Americans…………………………183

xvii

Figure Page

2.1 The Dissection Hall………………………………………………………………39

LIST OF FIGURES

xviii

1

CHAPTER 1

INTRODUCTION

1.1 Non-insulin Dependent Diabetes Mellitus (NIDDM) in African Americans

This study is designed to examine the etiology of NIDDM (type II) among middle

class African Americans1 in Central Ohio (Columbus, Dayton, Xenia and Wilberforce

Township). It represents Part II of the 1995 Central Ohio Study of Diabetes and Aging in

African Americans (COSDA): sociocultural risks for NIDDM. Phase I examined

biomedical and genetic risks for NIDDM in this sample (Crews and Moore in press). This

study examines sociocultural risks factors among these participants.

1 African Americans are a self-defined ethnic and sociopolitical population living in the United States. Many define themselves as descendants of Hamitic people who, before Biblical times, populated Africa and during Biblical times, also populated Southern Europe, the Middle East and Western Asia (Watts 1990). Others define themselves as descendants of West and Central African explorers, indentured servants, immigrants, or slaves who were illegally captured, detained, sold, and brought to the New World where they were held hostage in inherited bondage for sixteen generations (Franklin and Moss 1988, Holloway 1990, Bennett 1965, Asante 1996). Whether African Americans adopt the religious definition or the secular definition, they also define themselves as descendants of African people who inhabited the East African caves of Olduvai Gorge, built pyramids in the Nile Valley, used primitive abacuses in the Congo, and started civilization in the fertile crescent in the great river valleys of Africa and Asia (Bennett 1970 p, 4-5) before they left the land they called Whydah (Franklin and Moses 1988, p.1). Many admixed with Europeans, Asians and Native Americans after they came to the United States. There is also a general consensus that African Americans originated in Africa, not in the New World with the inception of American slavery. Regardless of which definition chosen, African Americans are an ethnic population with clear and substantial differences in health characteristics, morbidity, and mortality from other US subpopulations (Crews 1997). Researchers must group humans along some criterion; the criteria appropriate here is self-definition by participants.

`

2

Rapid increases in NIDDM among African Americans have been observed since

1960, when its prevalence was 33% higher than in 1940 (U.S, Department of Health and

Human Services 1986, p.193). Diabetes is defined as elevated levels of plasma glucose

(currently > 140 mg/dl fasting) (U.S, Department of Health and Human Services 1986).

Recently, NIDDM has been included as part of a constellation of symptoms labeled

Syndrome X, including obesity, insulin resistance, coronary heart disease (CHD), stroke,

and hypertension (Defronzo et. al 1997). Diabetes is a debilitating disease affecting over

3 million blacks (Harris 1984). Complications of diabetes include blindness, end-stage

renal disease, and limb amputations. Age-adjusted diabetes mortality rates are 50% higher

among non-whites than among whites in the United States (U.S. Department of Health

and Human Services 1986). One in four black men between ages 64 and 74 and one in

four black women over age 55 has diabetes, with a prevalence fifty to sixty percent above

whites (Auslander, Haire-Joshu, Houston and Fisher 1992).

Sociocultural factors predict type II diabetes among most populations, particularly

members of lower classes (Barker 1993; Bindon et al. 1991; Charkraborty et al. 1986;

Cowie et al. 1993; Crews and Gerber 1994; Dressler 1993; Hales and Barker 1992; Neel

1962, 1982; Ritenbaugh and Goodby 1989; Szathmary 1990, 1989;Weiss 1990). COSDA

participants are members of the middle class. It is expected that they should manifest

predictors of NIDDM associated with middle class life and health style rather than those

related to lower SES. These include better access to medical care, health knowledge,

physical activity and social support than lower SES samples

“Good health” is the ability to execute normal mental, emotional, physical, and

social activities that are performed by, and expected of, others in society (Mascie-Taylor

3

1993). Disease is a pathological condition with a group of clinical signs, symptoms and

laboratory findings that distinguish it as an impairment of health and well-being (Mascie-

Taylor 1993). Health is affected adversely and disease results when imbalances within the

ecosystem occur. Disequilibria in culture, behavior, technology, ecology, and biology

affect health, morbidity, and mortality in a mutual interaction system. Thus, aspects of

culture within variable ecosystems may create sociocultural risks that result in disease as

a by-product. Agriculture, a major innovation in human cultural development, led to

health imbalances and disease as agriculturalists disturbed their ecosystems when they

cleared fields to plant crops (Brown et. al 1966; Massie-Taylor 1993). A consequence of

ecosystem disturbance brought on by swidden agriculture in Africa was creation of

breeding grounds for malaria carrying Plasmodium mosquitoes and, subsequently a high

frequency of sickle cell alleles in many African populations.

Given this model, NIDDM and other diseases may result from systemic

adjustments associated with agriculture and cultural change. Metabolic adjustments to

agriculture by generations of laborers experiencing food scarcity and sociocultural

adversities, while producing a surplus for consumption and wealth accumulation by their

masters, would produce strong selective pressures. All activities from reproduction to

survival require energy. Human cultural development depended on the accumulation and

expenditure of energy. When cultures altered environments, they also triggered ecosystem

imbalances that continue to affect health and disease today.

Agriculture is associated with a variety of endemic, enteric, bacterial and parasitic

infections that modified ecological balances (Mascie-Taylor 1993). Human exposures to

these diseases represented a new phase in human adaptability that still affects human

4

health and illness (Foster and Anderson 1978). Although agriculture increases exposures

and susceptibility to infectious disease, it is the only way to produce sufficient food for

large populations. This need for energy to produce agricultural, handicraft, commercial,

and technological products precipitated in part the colonization and enslavement policies

of pre-industrial societies. Slavery was a major form of human cultural development.

Slaves transformed many simple societies into complex and powerful economic and

political systems (McKay, Hill and Buckler, 1992). Although mortality and morbidity

rates among slaves were always high, pre-industrial people exploited slaves for energy

until methods were developed to use fossil fuels. Excessive energy expenditure of slave

populations led to long-term disequilibria in their health. Slavery was immediately

followed by technological society, a new form of human cultural development. This study

focuses on links between reduced energy output and physical activity, rapid alterations in

food availability, from scarcity to excess, and obesity among one previously enslaved and

colonized population.

Enslavement and colonization result in high morbidity and mortality. Modern

genetic and epidemiological theories rely on multiple models: single-gene, chromosomal,

multifactorial with “high heritability,” multifactorial with “low heritability,” infectious,

and environmental, in the etiology of chronic degenerative disease (Crews and Gerber

1994, Gerber and Crews 1999). Unfortunately, sociocultural factors are seldom examined

in these models. Medical sociology and medical anthropology explicitly include

sociocultural factors in models of disease causation (Brown et al. 1966). No specific

metabolic agent for NIDDM has yet been identified. Morbidity and mortality rates for

NIDDM suggest that enslavement may have placed Africans at increased risk. Both

5

micro- and macrosociological alterations between culture and environment likely led to

the high rates of obesity and NIDDM among today’s African Americans.

Cultural contact alters microsociological and macrosociological patterns giving

rise to new diseases. European slave trading removed Africans from their primary

ecosystems, producing microsociological disequilibria. Slavers restricted slaves’ access to

food subjecting them to malnutrition, deficiency, metabolic and other diseases (Kipple

1984; Corruccini et. al 1982; and Corruccini et. al 1987).

In comparison with US whites, black men and women more often have low

income and education, along with obesity, and a family history of diabetes (Cowie et al.

1993). Both education and income are inversely correlated with NIDDM. NIDDM

exemplifies a biocultural difference in health status in its association with age, sex, body

fat distribution, family history, socioeconomic status, and obesity (Stern 1993, Auslander

et al. 1992).

Historical and cultural factors are of equal importance in understanding the etiology of

NIDDM in African Americans are biological factors. Health and disease in contemporary

populations also reflect historical, political, economic and cultural hegemony. Today,

these power differences are integrated with the global economy and associated social

forces (Brown, Inhorn and Smith 1996). Dressler (1993, Grim and Wilson 1992)

proposed a social structure model for studying ethnic health inequalities such as high

blood pressure in African Americans. Based upon “social closure” (Weber 1954), this

model shows how power preserves a hierarchical place in the social structure by

excluding certain classes from competing for social rewards or restricting their access to

socioeconomic opportunities (Dressler 1993). Skin color is a restriction criterion that

6

produced “color line” societies in the United States. Massey and Denton (1993) suggest

that segregation of blacks in Northern ghettos, along with the bombing and lynching of

blacks by whites following World War I trapped blacks in deteriorating and impoverished

inner cities. These activities created and maintained a “color line” through

institutionalized racism and discrimination.

Dressler’s social structure model is based upon national, rather than global

processes. Conversely, slave trading in the 16th through the 19th century was a global,

event that helped European and New World nations develop (Franklin and Moss 1994,

Clark et al. 2000). As an example, Great Britain fought against Spain in the War of

Spanish Succession or Queen Anne’s War (1701 - 1713) to gain the asiento—exclusive

rights to take slaves to Spanish colonies for thirty years (Franklin and Moss 1994). Such a

global structure model more aptly describes the mobilization of power and accumulation

of wealth that resulted from forced human production by Africans. This created a color

line and restricted non-Europeans from attaining basic needs, including food, security, a

livelihood, inheritance, education, civil rights, and liberty. Thus, a global model is

required to explain the problem of diabetes in African Americans. This model must

include African American history, folklore, global hegemony, sociocultural factors

supporting racial enslavement, economic and industrial growth as well as when and how

African slaves were exposed to disease through prolonged ecosystem disequilibria.

A global structure model incorporates an ecological view of health. That is, health

is seen as an index of adaptation to the environment reflecting adequate energy

acquisition and consumption (McElroy and Townsend 1979:3). Based upon this

perspective, selection pressures engendered by socioculturally constructed long-term food

7

scarcity and excessive dissipation of energy in labor created conditions in which NIDDM-

promoting alleles were advantaged. Etiological models for diabetes have focused on

reproductive efficiency, energy conservation, food intake, thrifty-pleiotropy alleles,

senescence, parity, low birth weight, growth retardation, obesity, physical inactivity and

undernutrition (Crews and Gerber 1994, Barker 1998, Crews 2003 [in press]). Except for

growth retardation (Barker 1998), these all fail to link global politico-economic systems

to Type II diabetes. Here both diabetogenic alleles and pathogenic politico-economic

systems are seen as producing Type II diabetes as a metabolic adjustment to adverse

conditions of low nutrition, hard labor, and high mortality rates in mid-adulthood.

The “environmental disequilibria” model for NIDDM explored here sees world

events and slavery as promoters of NIDDM in African Americans. Slavery—and its

counterpart, colonialization—were major and prolonged sociocultural phenomena that

limited food supplies to slaves on all continents. However, none of the major theories for

high Type II diabetes in African Americans acknowledges slavery as a contributing

factor. These include transition and acculturation theories (Neel 1962, Weiss 1999,

Ritenbaugh and Goodby 1989 and Weidman 1990), culture, perception and obesity

(Kumanyika et al. 1992, Dressler 1993), senescence (Williams 1951, Crews and Gerber

1994), life style (Kumanyika and Golden 1990, Dressler (1994), social support and social

incongruity (Tijhuis et al. 1995, Dressler et al. 1996), physiological theories (Dressler et

al. 1991, Garn 1994), and those incorporating development, social status and life style

(Barker 1992, Davison et al. 1992, Abel 1991, Dressler 1994). A global structure model

recognizes that Type II diabetes affects the descendants of slaves wherever they live,

8

whether in Europe, Africa, Asia, or the Americas. Food scarcity caused by enslavement

lasts longer, is more devastating, and is more widespread than naturally occurring famine.

1.2 Background of the Problem

This study focuses on physiological disequilibria among African Americans. It

examines historical, cultural, folklore, sociocultural, sociopolitical, ecological and

economic data. The premise is that agriculture, enslavement, and technology were major

phases in human development that produced disease profiles as latent by-products. The

focus here is enslavement, a major cultural experience that affected the ancestors of many

of today’s African Americans.

1.3 Determinants of Adult Disease

Structural and functional changes initiated during infancy affect adult disease

(Barker 1998). To some degree physical, biochemical and physiological insults in utero

program late-life diseases (Barker 1998). This occurs when insults acting at critical

periods in development produce permanent or long-term changes in physiological

structure or function (Lucus 1991, Barker 1998). Adult disease susceptibility is

influenced by interuterine, childhood and maternal nutrition (Barker 1998). Fetal

programming may be a major environmental contributor to late-life disease. For example,

among 370 men born in Hertfordshire, England, 40% of those with birth weights of 5.5 lb

or less (2500 g) showed diabetes, while only 14% with birth weights over 9.5 lb (4300 g)

did at age 50 plus; similar associations were observed for men whose weight at age 1 was

18 lb (8.8 kg) or less (43%) compared with those weighing over 27 lb (12.27 kg) (13%)

9

(Hales and Barker 1993). Intrauterine undernutrition apparently results in permanent and

generalized growth, developmental, and somatic disequilibria that manifest as disease in

late life (James and Coore 1970). Hales and Barker (1993) conclude that poor intrauterine

nutrition reduces the number and volume of differentiated pancreatic ß cells leading to

poor insulin secretion. Undernutrition may limit availability of amino acids while

hindering protein energy production, and, thereby altering ß cell growth. In addition,

insulin is a key regulator of general fetal growth (Hales and Barker 1993, Barker 1998).

Good nutrition of mothers and infants results in proper growth and reduced

incidence of diabetes in late life (Barker 1993). Hales and Barker (1993) propose a

“thrifty phenotype” hypothesis for the etiology of Type II, linking maternal nutrition to

low socioeconomic status and poor diets. In essence,

“. . .poor nutrition in fetal and early infant life are detrimental to the development and function of the ß cells of the islets of Langerhans. Defects of structure and function... predispose to the later development of non-insulin dependent diabetes. Existing evidence points to a key role for protein and amino acids in this process... The type and timing of nutritional defects in early life are suggested as underlying the pathogenesis described as syndrome X. Though early changes determine susceptibility... obesity, aging, physical inactivity, and possibly other processes leading to insulin resistance must also play a part in deciding the time of onset and severity of non-insulin dependent diabetes. . .” (Hales and Barker, 1993 p. 267, 269).

Since maternal and child malnutrition predispose individuals to NIDDM, any global or

national factors restricting access to food may permanently affect health and disease of

the undernourished.

10

1.3.1 Life style and Disease

Etiological studies show that health, diabetes, and chronic diseases are associated

with life style (Dressler 1993, McElroy and Townsend 1979). Health and the etiology of

chronic diseases are affected by social incongruity and life style (Dressler 1994, Dressler

1996). Social incongruity assesses the accumulation of consumer goods with respect to

income and education and adoption of leisure activities and behaviors that define social

identity (Dressler 1994, Dressler 1961). Dressler (1994) shows that life style incongruity

is associated with family health and discriminates between households with and without

chronically ill members. The status incongruity model for health differences includes

ethnicity, socioeconomic status, and skin color (Dressler 1993). Skin color is a criterion

of social class, health inequalities, and limited opportunity structures (Dressler 1993).

Dark skin color also may frustrate and block fulfillment of cultural ideals and aspirations

(Dressler 1993; Dressler et al. 1996). Unrealized aspirations, unwanted pregnancies,

criminal behavior, absent/dysfunctional fathers, many children, death of parents, and

addicted parents are all prevalent among darker-skinned blacks in color line societies

(Dressler 1993). Psychosocial frustrations result when social interactions are

incommensurate with social status or when individuals are unable to accumulate material

goods or adopt status-enhancing behaviors. Prolonged frustrations lead to repeated

autonomic arousal and sustained blood-pressure elevation (Dressler 1993). Health is thus

a measure of racism in color line societies and skin color is a key to understanding

differences in life style, social conditions, and disease.

11

1.3.2 Racial/ethnic Minorities and Life style

Racial/ethnic minorities show higher rates of cardiovascular diseases, type II

diabetes, and cancer (chronic degenerative conditions) [CDCs] than does the majority

population (Kumanyika and Golden 1991). Differences in health and life style likely are

related to attributes that increase risks for CSCs. Among disadvantaged members of most

societies, trauma, infectious diseases, asthma, and conditions resulting from osteoarthritis

of weight-bearing joints are higher than among the better off (Kumanyika and Golden

1991). Time trends in disease are related to how sociocultural processes affect health and

disease. Health disparities among racial/ethnic minorities are thought to reflect recent

exposures to western life-styles. In color line societies, health inequalities and life style

incongruity are correlated with the darkness of skin color. In these societies health

disparities between blacks and the white majority most likely reflect racism; lighter skin

color also is associated with higher SES and longer life (Dressler 1993).

Few Irish, Jews, Italians, Chinese, Puerto Ricans, and Mexicans arrived in the US

before the end of the 19th century (Sowell 1981). After the 19th century most immigrants

were poor white peasants (Sowell 1981). They and their descendants, cumulatively, have

less exposure to US life styles than do African Americans who arrived sixteen

generations before their emancipation in 1865. Some slaves already were in industrial and

urban settings before 1865, while runaway slaves began the 1810-20s urbanization

movement of America’s blacks that continued through the 1950s as segregation (Franklin

and Moss 1988). The Fair Housing Act of 1965 halted segregation policies in housing and

Title VII of the Civil Rights Act of 1964 led to 18.8% of US blacks relocating to

suburban areas, and 55% of all living in central cities by 1977 (Clarke 1979). Researchers

12

attributing African Americans’ health disparities to shorter exposure to western life styles

and urbanization failed to incorporate migration, settlement patterns, and social and

political policies into their models. They also may be unaware that market and trade

centers emerged during the 4th and 5th centuries throughout Africa, flourishing and

linking the continent’s cities as early as the 9th to 11th centuries (Davidson 1974).

Africans from these cities were slaves in the New World. Urbanization was not alien to

all slaves. Rather, the slave trade relocated African cities to coastal areas, drastically

depopulating interior cities and leaving many ghost towns, and relocated many Africans

to the rural US (Franklin and Moss 1988). That Africans maintained a pre-slave trade

urban society and had been exposed to unhealthy and unsanitary living conditions for

more than twenty-five generations suggests that the causes for health disparities are not

recent exposures. Kumanyika and Golden (1991) suggest that chronic diseases vary

inversely with infectious diseases while also varying with exposure to and adoption of

sociocultural attributes and expectations. Thus, US minorities have been sufficiently

exposed to modern life to express chronic diseases, but not to risk reduction and

treatment attributes (Kumanyika and Golden 1991).

Exposures to risks include many life style factors, poor eating habits, obesity,

limited access to medical care, and poverty (Veal 1996). Blacks in the US eat, cook and

buy foods that are high in calories, sugar and fats; and they also fry and bake in lard and

heavy oils or boil in “fat back” (Veal 1996). These calorie dense foods had a survival

advantage during periods of food scarcity, slavery, apartheid, and excessive physical

labor. Calorie dense foods no longer have these same advantages. Now that food is more

plentiful and physical labor is less demanding, these foods increase risks for death.

13

CDDs are characteristic of modern, affluent societies (Crews and Gerber 1994).

They are directly correlated with increased life expectancy, high-fat and refined

carbohydrate diets, and physically inactive life-styles (Crews 1992, Kumanyika and

Golden 1991, Crews 2003 [in press], Crews and Gerber 1994, Gerber and Crews 1999).

SES alterations following the civil rights acts likely precipitated an increasing prevalence

of CDDs among African Americans. Increased affluence did not alter biological

propensities selectively programmed during enslavement and apartheid. Desegregation

and equality legislation increased participation in the wider society and its rewards.

Racial/ethnic minorities in the US today show the same order of disease emergence as did

European Americans—surgical disease increased first followed by medical ones

(Kumanyika and Golden 1991).

1.3.3 Transition or Acculturation and Diabetes Mellitus (Type II)

Recent epidemics of NIDDM also occurred in Native, Mexican and Samoan

American. Hypotheses of thrifty genotypes (Neel 1962), antagonistic pleiotropy

(Williams (1957), thrifty-pleiotropic genes (Crews and Gerber 1994), multiparity

(Wiedman 1990), New World Syndrome (Weiss 1990), and centripetal fat and dietary

shift have been offered as explanations (Szathmary 1990). None included historical

enslavement/colonization of these populations, widespread conditions. Slavery was a

long-term risk, but all theories of type II in African Americans ignore the longitudinal

effects of this apartheid institution.

Neel (1962) hypothesized a “thrifty genotype” to explain the evolutionary and

physiological basis of NIDDM. Thrifty genotypes effectively and rapidly store excess

14

energy when it is available (Neel 1967). They likely increased in frequency when humans

were exposed to low caloric consumption and high-energy expenditure interspersed with

periods when calories were plentiful. Neel’s hypothesis was that hypoinsulinism initially

resulted during food shortage, but was later followed by a compensatory increase in beta

cell function during periods of food availability. Neel speculated that “thrifty genotypes”

could overproduce insulin leading to energy conservation in times of food surplus. Later

studies of energy conservation and diabetes did not confirm this theory. Neel (1982)

explained this by suggesting diabetes was advantageous during food shortages, but

became detrimental when food became constant.

Although Williams (1957) does not present a diabetogenic theory, his theory of

senescence due to pleiotropy is used as a model for NIDDM. His theories were used by

biologists and health care researchers to develop etiologies of non-insulin dependent

diabetes mellitus (type II). Williams (1957) suggested that genetics are favored if they

even slightly increase fitness and act during peak years of sexual maturation. If these

traits carry serious decreases in fitness they will be selected against; however, if these

deterrents arise late in life after reproduction they will be retained (Williams 1957). Based

on the concept that genes may have multiple effects, Medawar (1952) proposed the

concept of pleiotropy, that genes may have multiple functions and thus different effects

on fitness at different ages. Williams (1957) used this concept to suggest that tradeoffs

occur between reproduction and survival such that alleles with early life benefits are

retained, even if they lead to early death at ages beyond those of maximum effort (Harper

and Crews 2000, Crews 2003 [in press]). William’s ideas have been used to argue that

since onset of diabetes mellitus (type II) begins during middle age and peaks during the

15

latter decades of life, diabetes is a disease of senescence. Type II commonly occurs after

childbearing is complete. Diabetogenic genotypes may benefit from more vigor during

their reproductive years due to increased glucose and metabolic efficiency.

Crews and Gerber (1994) developed the thrifty-pleiotropic gene model by

combining both evolutionary models in their description of chronic diseases due to gene-

environment interactions. They hypothesized that several major chronic degenerative

diseases (CDDs) of senescence are secondary to risk factors arising from antagonistic

pleiotropy and thrifty genotypes (phenotypes). Many alleles may have selective value

during development and reproductive life, but be associated with debilitation during later

decades (Crews and Gerber 1994). They predict two types of CDDs: those arising due to

pleiotropic effects underlying thrifty genotypes, and those secondary to decreased

availability of once plentiful resources. Today, some CDDs arise secondary to excessive

accumulations of previously scarce but now abundant resources (e.g., calories,

cholesterol, salt) (Crews and Gerber 1994, Gerber and Crews 1999). Efficient use of such

resources still benefits some during early life but leads to deleterious outcomes during

later years. Conversely, resources such as calcium, iron, iodine, and fiber were more

abundant in prior ecological circumstances (Gerber and Crews 1999). Sociocultural

changes result in these resources being less available today although they remain

abundant in the environment (Gerber and Crews 1999). Lack of these over a life-time

may often lead to CDDs.

Dogrib Indians of Canada share multiple historical, sociopolitical, and economic

traits common with African Americans. Many are in the gene-environment etiology of

type II diabetes mellitus with African Americans. Europeans enslaved and/or colonized

16

both. Several generations ago diabetes was rare in both. Both are racial/ethnic minorities

of low socioeconomic status within Western nations. Most importantly, both American

Indian and African American populations suffered declines over several hundred years

following starvation and other atrocities through the mid 19th century. This was followed

by metabolic downshifting associated with continued discrimination and near extinction

of these ethnic groups. About the fourth decade of the twentieth century, a “metabolic

upshifting” occurred. Populations rebounded as food became more plentiful and social

conditions improved. Both experienced these metabolic shifts. In these populations, the

etiology of type II may reflect similar responses to such shifts and alterations in gent-

environment balances. Many indigenous populations with high type II rates, such as

Naruans, Hawaiians, and Pima Indians, may have experienced such metabolic shifts

(Crews 1990).

Szathmary’s (1990) criticism of Neel’s thrifty genotype supports the suggestion

that enslavement and colonization contribute to increased population susceptibility to

type II. The thrifty gene does not fit the Dogrib case. In the Arctic/sub-arctic setting

protein/fat intake is high, while carbohydrates are virtually nonexistent for most of the

year (Szathmary 1990, p.87). Also, hyperinsulinemia is integral to Neel’s thrifty gene

hypothesis. This also has been documented among the Dogrib. Obesity, particularly fat

distribution, was shown to be the most important diabetogenic factor among the Dogrib

(Szathmary 1990, p. 90). Weiss (1990) speculated that environmental change must be

involved in the emergence of hypertriglyceridemia, diabetes, gallstones and obesity

among Native American horticulturalists, constituting a “New World syndrome.”

17

Wiedman (1990) postulated a cultural-historical hypothesis of type II diabetes

attributing it to rapid shifts from subsistence agriculture to industrial technology,

excessive caloric intakes, and low energy expenditure. Obesity, hyperglycemia, and

diabetes are the consequence of techno-industrial developments which have led to a

nutritional shift from indigenous, natural, self-produced foods, to a diet of processed,

refined, high calorie, and high fat ones. Women with thrifty genes are also better at

gaining weight during pregnancy, maintaining sufficient fat for lactation, and have infants

of slightly greater birth weight with slightly higher probability of surviving childhood

(Weidman 1990).

1.4 Objectives and Hypotheses

History and political systems, along with economic and cultural hegemony,

provide a complex background from which to view type II diabetes in today’s African

Americans. Thus, the first step in this study is to review historical literature and African

American folklore to establish the sociocultural context for type II in African Americans.

Multiple social, environmental, and biological factors have contributed to the current

problem. The objective of this study is to explore environmental and social factors that

may program descendants of African slaves for type II diabetes. This study uses

biomedical indices examined in Part I of the Central Ohio Study on Diabetes and Aging

(COSDA) as dependent variables. Dependent variables are cases at risk for or with

fasting and 2-hr post-load plasma glucose scores > 140 mg/dl (the U.S. Department of

Health and Human Services 1986m P. 193). Independent variables are sociocultural and

18

anthropometry risk factors for type II diabetes. Anthropometry and sociocultural variables

will test the following hypotheses:

Hypothesis 1:HD1 - Body Mass Index and skinfold measurements are significantly associated with plasma glucose levels > 140 mg/dl among middle class African Americans in Central Ohio.

HDo – Body Mass Index and skinfold measurements are not significantly associated with plasma glucose levels > 140 mg/dl among middle class African Americans in Central Ohio.

The second step is to determine which of the variety of sociocultural factors may

contribute to the etiology of diabetes in African Americans. Among many populations

social class is directly associated with type II diabetes. Among African Americans it

seems reasonable to examine relationships between a variety of variables associated with

disadvantaged minorities and marginal social classes. However, it is expected that in this

middle-class sample sociocultural risk factors associated with slavery, discrimination and

SES will not be significantly associated with type II diabetes.

Hypothesis 2: H1- Sociodemographics (age/social era, sex, marital status, income, occupation, and education), life style/stressors (acute stressors such as victimization, anger reaction, unemployment/employment, discrimination, desegregation and desegregation, social congruity, social support, relaxation), health behaviors, and dietary variables are significantly associated with plasma glucose > 140 mg/dl among middle class African Americans in Central Ohio.

Ho - Sociodemographics (age/social era, sex, marital status, income, occupation, and education), life style/stressors (acute stressors such as victimization, anger reaction, unemployment/employment, discrimination,

19

desegregation and desegregation, social congruity, social support, relaxation), health behaviors, and dietary variables are not significantly associated with plasma glucose > 140 mg/dl among middle class African Americans in Central Ohio.

The recently emerging black middle class has suffered less discrimination and

desegregation and benefited from upward mobility and broader opportunity structures

Than did earlier generations. Blacks escaped the lower class once educational and

occupational restrictions were removed. Life style and health style changed; however,

many vestiges of social and dietary habits linger yet today. These provide social markers

identifying the black American ethnic group and are used to celebrate holidays and rites

of passages.

Hypothesis 3:

H1 - High consumption of “soul food”, particularly dietary cholesterol willbe significantly associated with plasma glucose above or equal to 140 mg/dl among middle class African Americans in Central Ohio.

Ho - High consumption of “soul food”, particularly dietary cholesterol will not be significantly associated with plasma glucose above or equal to 140 mg/dl among middle class African Americans in Central Ohio.

1.5 Statistics

Although this study examines physiological phenomena, it focuses on

sociocultural phenomena. Both type of variables are outcomes, cases are those with or at

risk for diabetes and control are those without or not currently at risk for diabetes. This

study compares cases with controls among COSDA participants for biological and

sociocultural risk factors identified at baseline and through follow-up to examine how

“life stresses” may serve as risk factors for type II diabetes. Independent variables are

20

biological risks and sociocultural risk factors indexed as demographic, health behaviors,

life style/stressors, and dietary variables.

The statistical software used for analysis is Statistical Packet for the Social

Sciences (SPSS). The Food Processor Nutrition and Fitness Software is used for

dietary analysis. Logistic Regression is used to determine whether particular

sociocultural or anthropometeric variables are associated with the dependent variable:

diabetic versus not diabetic. Multiple regression is used to determine whether qualitative

dependent variables explain a significant percentage of variance in plasma glucose

levels. Univariate statistics are used to determine frequencies, distributions, standard

deviations, and means. Pearson Correlation is used to determine association between

quantitative dependent and independent variables. ANOVA are used to compare means

among several groups, t tests to compare two groups.

21

CHAPTER 2SAMPLE AND METHODS

2.1 Research Design

A century ago, Erwin Ackernecht, physician-ethnologist and father of medical

anthropology, investigated biocultural relationships between past and present human

behavior, health, and disease (Foster and Anderson 1968). Today, medical

anthropologists investigate how health and disease determine human survival and

reproduction. This often requires study of clinical diagnosis, etiological inquiries, and

individual cases. Understanding of disease patterns, risk factors, and time trends provide

data to guide interventive and preventive measures. COSDA was designed to identify

unknown and known cases of NIDDM among African Americans, associated

physiological and sociocultural risk factors, and to construct a model of type II diabetes

among middle class African Americans in Central Ohio.

This research was completed with funding from American Diabetes Association

and The Ohio State University. It was designed to examine diabetes as a multi-system

pathological process affecting all physiological systems and organs (Crews 1992). As part

of COSDA, numerous molecular, physiological, social, cultural, and behavioral risk

factors for type II diabetes were examined in a sample of African Americans (Crews

1992). Blood samples were obtained and used to extract DNA and to determine serum

glucose (glycemia), insulin, lipids, blood chemistry, and glycation of glucose.

22

2.1.1 Recruitment

Because churches are social tools and agents of change in the African American

community, they were selected as primary recruitment sites for COSDA. Dr. Crews

(study PI) originally contacted and made arrangements with black ministers to recruit

COSDA participants from their congregations. However, his success was not satisfactory

and over the first half of the study only fourteen participants had volunteered for COSDA

research. At this point, the author teamed up with the study and was appointed the

Recruiter-in-Charge (RIC). As a recruiter, the author suggested black middle class

participants in Dayton would volunteer for a research project. Additionally, she advised

that she would have greater success soliciting middle class African American volunteers

than the PI because they could identify with her background and class. The author also

recommended recruiting additional participants from black social organizations. With

these measures in place, the author enrolled 133 volunteers within two and a half months,

about half the original projected sample size of 300, but sufficient for this study.

The author followed protocols common to African American culture, adhering to

traditions of the black Baptist Church and “worked the trust” of the black community.

She gained the trust of ministers and organization leaders by first establishing her

credentials and character as an African American health researcher before enlisting the

leader’s compliance. She was able to emotionally appeal to the unspoken and agreed upon

consensus that African Americans seek to overcome vestiges of the African Holocaust

through enhancement of individual, family and community uplift. Previous barriers to

research gradually gave way when the recruiter was able to remind leaders that their

influential positions in the black community made them filial trustees. Black posterity

relies on them to protect the health of the born and yet-to-be-born; thus they were

encouraged to promote research and intervention that might benefit African Americans.

The author also acquired the trust of the COSDA researchers. She not only

explained why African Americans mistrust European American researchers, but also what

23

the researchers should do to remove the mistrust. Black Americans’ distrust mean-

spiritedness in white Americans who disclaim guilt for past atrocities committed against

African slaves. Although they did not commit these atrocities, they benefit from the social

and financial gains these atrocities produced. Even when they refuse to acknowledge or

apologize for the immoralities of the African Holocaust, they still benefit from remnants

of the slavocracy ethos, apartheid and white supremacy. They also benefit from

institutional racism that maintains the secondary citizenship of African Americans.

Conversely, European American researchers build trust in African American research

participants when they consistently display compassion, acknowledge past atrocities,

admit their benefits, advocate justice and deal ethically with blacks. African Americans

are likely to participate in research led by European Americans that extracts body fluids

and genetic materials only when these researchers establish and maintain trust.

2.1.2 Study Population

2.1.3 History of African Americans in Ohio

Participants in this research are residents of Columbus, Dayton, Xenia, and the

rural township of Wilberforce in Central Ohio. The U.S. Department of Commerce

Bureau of Census 2000 released the following population statistics for Ohio cities.

24

_______________________________________________________________________

Total Black White PercentPopulation Population Population Black

_______________________________________________________________________

Columbus 711,470 174,965 483,332 24.46%

Dayton 166,179 71,668 88.676 43.12%

Xenia 24,264 3,265 20,128 13.46%

Wilberforce 1,579 1,329 177 84.17%________________________________________________________________________

Table 2.1City and Township Population of COSDA Participants________________________________________________________________________

In two of these towns, African Americans make up a sizable portion of the populations,

Wilberforce (84%) and Dayton (43%); but in Columbus and Xenia they are a minority.

Having a predominantly Black population likely influences politics, economics, and

sociocultural variability in health and life style. In particular, residents of Wilberforce,

surrounding two traditionally black universities, provide the economic base of

Wilberforce, Ohio. The African American centered economic and political system likely

provides residents an opportunity for structure, health care, and life style similar to those

of majority populations elsewhere in American society.

Ohio today continues to reflect a long series of treaties, ordinances, and

compromises on New World slavery that began with the Treaty of Tordesillas in 1494

(Strayer, Gatzke, and Harbison, 1974).

25

_________________________________________________________________Organizations Number of Percent

participants_________________________________________________________________

1 10 9%

2 25 23%

3 22 20%

4 26 23%

5 11 11%

6 14 13%__________________________________________________________________

2.2 Demographic factors for COSDA Participants by organization__________________________________________________________________

It started conditions that today affect health, diet, mortality, diseases and political affairs

of all Africans and particularly African Americans.

Ohioans continue to struggle against the vestiges of slavery. Slavery became legal

in Ohio in 1719, but never took intrinsic hold (Strayer, Gatzke, and Harbison, 1974).

Many Africans fled enslavement through Ohio because it was the shortest distance to

Canada (Elson 1949; Woodson 1970). The Ordinance of 1785 outlawed slavery east of

Mississippi and North of Ohio while opening the Northwest Territory to peaceful

settlement, although this conflicted with the US Constitution (Woodson, 1970).

Provisions required Ohioans to endorse slavery although most Ohioans generally opposed

slavery (United States Department of the Interior National Park Service, 1995). Some

Ohioans resisted abetting slavery and joined the underground escape movement (circa

1831). This was one of the most dramatic protest actions against slavery in United States

26

history (United States Department of the Interior National Park Service, 1995). Many

refugees from Kentucky and Tennessee escaped to and settled in Wilberforce, Caesar

Creek, New Lebanon, and Oberlin, Ohio between 1810 and 1850. It is estimated that the

South lost 100,000 slaves, 40,000 from Kentucky and Tennessee alone, valued at $30

million during this period (Franklin and Moss, 1988). The conflict culminated in the

Civil War causing Ohio to further restrict the influx of blacks. Legislation also prevented

white slave masters and Quakers from bringing freed slaves to Carthagena, a functioning,

successful, self-governing and self-sufficient black community in Mercer County, Ohio,

established by Augustus Wattles (Knepper 1997). Ohioans responded to federal measures

against slavery by enacting the Black Laws of 1804 and later restricting black emigration.

Black Laws restricted the movement, congregation, and activities of blacks. They

required blacks to register with the state, post a five hundred dollar bond within twenty

days of entering Ohio, and carry a certificate of free and legal status (Burk and Davidson,

1984). They also prevented blacks from receiving public assistance, public education, or

civil protection and security; they could not they serve on juries, testify against whites, or

vote. In 1851, Ohio legislators issued Article I, § 6 of the Constitution of the State of

Ohio stating, “There shall be no slavery in this state, nor involuntary servitude, unless for

the punishment of crime” (Burke and Davidson 1984). Enslavement of Africans remained

an issue until December 18, 1865 when the Thirteenth Amendment ended slavery.

Freedom did not ameliorate conditions. Black Laws still restricted African Americans in

Ohio throughout the Civil War period after which an apartheid system permitted the

vestiges of slavery to continue into the twentieth century. Blacks were segregated into

poor areas and barred from public accommodations, including hospitals. Children could

not live in orphanages nor could adults serve in the state militia, or be served at hotels,

restaurants, theaters, or barber shops. Blacks could not utilize public transportation

(Gerber 1976). Black Ohioans were constant victims of racial discrimination, segregation,

disenfranchisement, and hate crimes. Some cities prohibited black settlement, forbidding

27

residence within city limits. Ohio had multiple race riots during this period. From 1889 to

1922, two racially motivated lynchings a week were reported in the US totaling 3,436

murders in the country.

Northern migration of fugitive slaves started during the 1820s and 1830s,

culminating in the Negro Exodus (1890 to 1900). After World War II, blacks came to

Ohio to find jobs as unskilled, service and menial workers and to seek relief from

poverty, share cropping, and farm work in the South. However, Black Laws passed in the

1800’s continued to make life difficult, preventing blacks from finding jobs, receiving

charity, or living in orphanages. Some opened service businesses, saloons, restaurants,

and beauty and barbershops catering to blacks. With a steady livelihood these

entrepreneurs became the early black middle class. Eventually, white and black

abolitionists, philanthropists, and churches came together to build Central State

University (circa 1887), Payne Theological Seminary (circa 1866), and Wilberforce

University (Circa 1856) offering blacks social, educational, and economic opportunities.

A black middle class of professionals formed around this nexus of institutions in Central

Ohio. Although the Civil Rights Movement of the 1960s led to desegregating schools and

public facilities, many areas of Central Ohio still remain segregated. Most black children

continue to attend segregated and inferior schools and Central Ohio still boasts social

organizations such as the Bicycle Club of Dayton that do not permit black membership.

Eleven o’clock Sunday morning is the most segregated hour in Central Ohio when

religious edifices are attended by either black or white, but not mixed congregations.

2.2 Study Samples

2.2.1 Sample Selection

Columbus, Ohio and surrounding areas of Central Ohio were chosen as a research

area for COSD because the Principal Investigator was located at The Ohio State

University. The recruiter cautioned that common ethnicity would not automatically enable

28

her to access this African American community. This was in part because African

Americans are class conscious. Inner city African Americans have more of a “street

orientation,” and might view an upper middle class black as having a “bourgeois

orientation.” They might also reject her as having “sold out” on black culture. Recruiting

African Americans from Dayton, Xenia and Wilberforce Township, areas where the

recruiter had community support systems and family networks and friends was much

more feasible. There the recruiter could more effectively assuage the prevailing black

attitude that white researchers are unethical, untrustworthy, and they conduct research that

affects black Americans adversely. The study was already aimed at “middle-class,

married, church-going African Americans” and these would be more prevalent and

accessible in these areas. Churches and social groups were the sampling frame for this

study.

Even with the same ethnic identity, the recruiter’s sex required her to use gender-

specific and religious protocols to recruit this sample. The religious domain prevented the

recruiter from approaching the ministers directly concerning the research project.

Therefore, the ministers’ wives or mothers were used to initiate recruitment and become

visible in the church. Often it was difficult to gain ministerial support because of the

community mistrust of what white researchers might do with body fluids and genetic

materials from blacks. They saw their duty as protecting their congregation and people

from foul or demeaning research. One minister made it perfectly clear the only reason

COSDA recruitment was permitted at his church was his personal relationship to the

recruiter and her husband. In this case, the minister’s wife clearly stated her grave

reservations in encouraging her husband to permit COSDA research. Subsequently, both

she and the minister refused to participate in the COSDA research. She admonished the

recruiter to watch the Principal Investigator and researchers carefully because they were

unethical and could not be trusted.

29

Strong resistance was met at the second church sampled also, even though

several members of the recruiter’s family were members of the congregation. Two of her

family members participated because two relatives in that family line had succumbed to

diabetes (Additionally, they wanted the recruiter to obtain the doctorate degree). Another

Baptist Church in Dayton, Ohio, was selected as the third sampling site because it had a

large congregation. A smaller percentage of the congregation volunteered to participate in

COSDA research at this church than at the two smaller churches in Dayton.

Participants also were solicited from the Wilberforce Links, Inc., a national

women’s philanthropic organization that donates money to African Americans and other

charities. Recruiting Links for COSDA provided a means of alerting them to the diabetes

epidemic affecting African Americans. Links are upper middle class black women and

they expressed fewer misgivings concerning participation in COSDA. Approximately

forty percent of the membership participated, some to monitor their plasma glucose

levels, others to support the recruiter. Private physicians screened Links who didn’t

volunteer for COSDA research.

2.2.2 City and Township Description

2.2.2.1 Wilberforce (Township), Ohio

Approximately 201 families and 2,639 people live in predominantly African

American Wilberforce Township (Wilberforce, Ohio Resource Guide 1999). Wilberforce

Township has a distinct history of being one of Ohio’s several terminal stations on the

Underground Railroad, and part of the Southern Ohio area where emancipated slaves,

mainly from Virginia, settled on lands bought for them by former slave masters (Gerber

1976). Quakers and former slave owners assisted fugitive slaves and sponsored black

settlements in Brown and nearby counties (Woodson 1935). Some of those failed to

protect freed bondsmen from swindlers, vigilantes, and land speculators who cheated ex-

slaves out of thousands of acres of land. More astute slave masters and Quakers helped

30

ex-slaves settle into free life by buying farms, building houses, and maintaining freed

bondsmen for one year to establish them as economically independent farmers (Gerber,

1976).

White Ohioans did not want highly skilled and experienced freed bondsmen to

settle in Ohio. Since Africans were specialists in agriculture, crafts, trades, culinary arts,

and manufacturing, they would compete against less skilled and inexperienced

immigrants who left Europe because merchant and craft guilds were reserved for the

middle class (McKay, Buckler and Hill 1992). European immigrants sought opportunities

in America to gain personal privileges, economic security, and tax exemptions while laws

prevented free black laborers from attaining the same.

Black settlers in Ohio often were blood relatives of their masters, natural children

of slave masters and their slave mistresses (Gerber 1976). Before the Civil War, elite

Southern planters often brought their slave mistresses and mulatto children to vacation in

Tawawa Springs Resort, a recreation area in Wilberforce known for its medicinal and

mineral springs (Woodson 1935). Between 1844 and the Civil War, Tawawa Springs

became a center of Negro culture and education in Ohio (Gerber 1976). The education of

Africans began during the 1700s with abolitionists, statesmen, philanthropic

organizations, and black churches establishing “colored” schools for Africans. African

self-help was a means of convincing friendly whites that education is a fundamental right

for all mankind (McGinnis 1941). Three Negro institutions were founded in the Tawawa

Springs area: Union Seminary (1853), Ohio African University (1855), and Wilberforce

University (1856) (King 1979). Wilberforce University was the first African school in the

United States dedicated to collegiate, primary, and secondary education (Goggins 1987).

Tawawa Springs Resort was later renamed Wilberforce, Ohio to honor Samuel

Wilberforce, an English abolitionist who was the major force in securing passage of a bill

that abolished English slavery in 1807. Wilberforce was the driving force in the universal

31

abolition of African enslavement. He and Thomas Clarkson publicized the inhumane and

brutal mistreatment of African slaves in the New World (Everette 1988).

The legacy of anti-slavery, pro-African education and culture, African and

European admixture, African economic development, and intellectual achievement make

Wilberforce, Ohio, a unique community of mostly middle class African American

educators and professionals. Many members of the Wilberforce community are college

graduates with terminal degrees, and belong to professional, social, service, political, and

philanthropic organizations. Wilberforce is a community where club membership

validates social standing and where social inclusion is important. Organizations for

women include

national philanthropic organizations such as Links, Incorporated, sororities such as Alpha

Kappa Alpha, Delta Sigma Theta, Sigma Gamma Rho, and Zeta Phi Beta; service

organizations such as Top Ladies of Distinction, The Twentieth Century Club, and the

Moles, Leisurettes, Epicureans, Couples Clubs, the Partners, and national mother’s

organizations for children including Jack and Jill. Men belong to fraternities such as

Kappa Alpha Psi, Omega Psi Phi, Alpha Phi Alpha, and Phi Beta Sigma; philanthropic

organizations such as the G Men and the Boulé; and art and literary organizations, such as

the Pals (Promoters of the Arts, Literature and Science). Wilberforceians also are active

in political organizations such as the National Council of Negro Women, the Urban

League, National Association for the Advancement of Colored People, and the

Republican and Democratic Parties who control local politics and represent both internal

and external change agents. The active social life of Wilberforceians includes luncheons,

lectures and Brown Bag Series, Bridge Parties and Tournaments, formal dinner dances

and brunches, couples parties and fund raising activities.

Wilberforceians are family and education oriented. Education provides economic

stability for this predominantly black suburban township. Wilberforce has few social

problems such as miseducation, unemployment, institutionalized racism, or ghettoization.

32

Most senior residents of the community attended university operated laboratory schools

for pre-, primary and secondary education. Many are graduates of Central State

University, Wilberforce Universities, or other Historically Black Colleges and

Universities (HBCU). Many have graduate degrees from predominately white

universities. Most of the children who grow up in the Wilberforce community attend

college and earn bachelors, graduate and terminal degrees. Wilberforcians are community

leaders, entrepreneurs, professionals and politicians. Black families in Wilberforce

township are generally stable across generations. Matri-focality is virtually unknown.

When it occurs, it results from the death of a husband/father. Divorce after children and

out-of-wedlock births are virtually unknown among Wilberforcians.

Wilberforceians are also home and business owners who are proprietors of janitor

supplies and services companies, floral shops, law firms, doctor and dentist offices,

barber and beauty shops, Drive Thrus, service stations, day care centers, dry cleaning

outfits, grocery stores, fast food restaurants, and real estate companies. The 2002 fair

market value of the homes range from $90,000 and higher with most properties valued

around $175 to $200,000. Most Wilberforceians are heirs to maternal and paternal

inheritances, including usufruct properties in the South. Wilberforceians are also avid

travelers who expose their children to global excursions. Children travel with parents to

fraternity, sorority, social club, church, and professional conventions. Children attend

family vacations, golf and ski trips, bridge tournaments, ocean cruises, and travel

internationally.

2.2.2.2 Columbus, Ohio

Named for Christopher Columbus, Columbus, located between the Scioto and

Olentangy Rivers in central Ohio, is the capital city of Ohio. Columbus also is the largest

city in Ohio (population 632,000). The African American population in Columbus makes

up 22.6 percent of the city’s total (N= 120,000) (Knepper 1997). Black pioneers in

33

Columbus were victims of the same anti-slave laws and racist sentiments and Black Laws

seen elsewhere. They could not attend public schools with white children and districts

were required to educate black children only if there were more than thirty black children

in the district (Knepper 1997). Laws restricted blacks to living in areas with poor housing

and were designed to keep the city a “white man’s country” (Knepper 1997). Blacks in

Columbus experienced more racial resistance and progressed less than black

Wilberforceians where the HBCU’s stimulated upward mobility, career opportunities and

economic independence. By the early 1900’s, Klan membership grew to 50,000 in

Columbus and nearby counties.

Some blacks in Columbus practiced carpentry, barbering, black smithing, and

occasionally attained high status as captains of boats, and later as train conductors

(Knepper 1997). Others attended universities such as Oberlin College (1855), Ohio

University (1830s), Western Reserve (1820s), and Wilberforce University (1863) to earn

degrees in education, business, and later in medicine, dentistry, and law. A few

professionals and entrepreneurs amassed considerable real property. Whether menial

laborers, tradesmen or professionals, African Americans in Columbus joined other

African Americans throughout Ohio to celebrate enfranchisement and freedom. The

Public Accommodation Law of 1884 banned discrimination in the State of Ohio.

Segregation by race and denial of access to public accommodations, such as hotels,

restaurants, dance halls, roller-skating rinks, swimming pools, bowling alleys, cemeteries,

schools, and private clubs, were made illegal. By 1963, black advancement and social

progress increased in Columbus. Today thousands of black college students, teachers,

doctors, lawyers, businessmen and other professionals form a growing middle class.

Many attend desegregated schools and public facilities, have gained voting rights and

political power, and have suburbanized and Americanized.

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2.2.2.3 Dayton, Ohio

Tax records for 1798 indicate the first blacks were brought to Dayton to serve

whites (Peters 1995). Tax records identified William Maxwell and his Negro and the

community leader, Daniel Cooper, and a “colored girl” he brought to the city to serve his

family. As in other Ohio cities, Dayton did not want blacks to settle in the city for fear of

job competition with whites. Only blacks with certificates of freedom could settle in

Dayton after they paid a registration fee of twelve and a half cents for adults and children

(Peters 1995). By 1804, there were less than twenty free blacks and indentured servants

living in Dayton. The children of indentured servants were indentured to their parents’

masters. This applied to Harry, age two-and-one-half-years, and Polly, his nine-month-old

sister. Both children were freed, Harry at age twenty-one, and Polly at age eighteen. Both

were given a horse, clothing, and other gender specific items to start their lives as free

people (Peters 1995). Tax records do not contain information about these children’s

parents, only that the “colored girl” was “unjustly detained in slavery contrary to the laws

and Constitution of Ohio” (Peters 1995). Efforts of abolitionists who worked to aid

fugitives from slavery increased the black population to 141 in 1820 and to 548 by 1875.

The “Africa” section of Dayton grew from 1870 to 1920. Hallie Q. Brown became

principal of the first “colored” school in 1870 after the black community petitioned the

Board of Education to locate a school in “Africa” (Peters 1995). Many blacks came to

Dayton from 1915 to 1940, seeking refuge from Southern racism, oppression, violence,

discrimination, and crop destruction. They came to Dayton to find jobs, better education

and opportunities for themselves, children and families. Black professionals in Dayton

increased in 1912 to include ten physicians, an architect, contractors, a police officer,

several entrepreneurs, publishers, editors, morticians, attorneys, army officers, and a

podiatrist (Peters 1995). Dayton celebrities included Paul Laurence Dunbar and his

visiting friend, Frederick Douglass. From 1921 to 1940 many blacks participated in

philanthropic organizations such as the YMCA, YWCA, Linder Center, church

35

organizations, fraternities and sororities, and Garden Clubs (Peters 1995). The six top

career categories during this period were service work, laborers, beauticians, barbers,

craftsmen, clerical/sales, with blacks distributed equally in domestic, professional and

semiprofessional careers (Peters 1995). Many blacks lost their homes and jobs when the

stock market crashed in 1929, but survived the great depression by taking a variety of

jobs to support their families. Others such as C.J. McLin, Sr., C.J. McLin, Jr., and Ethel

Prear, became political leaders who fought for human rights and employment

opportunities. Some whites retaliated by bombing the home of C.J. McLin, Sr. in 1938.

Dayton’s black population increased to 57,288 in 1960 (Peters 1995). During this

period, black Daytonians attended the new Regal Theater, with “all colored employees”;

went to Cincinnati to see Jackie Robinson and the Dodgers; saw the emergence of new

local human rights leaders and groups, including Reverend Cody Bush, W.S. McIntosh,

Reverend David Gilbert, and the Southern Christian Leadership Conference (SCLC).

They witnessed the National Cash Register (NCR) open its apprenticeship program to

black people in 1958 (Peters 1995). According to the West Dayton Profile, ninety-five

percent of Dayton’s black population lived in West Dayton in 1960 (Peters 1995).

2.2.2.4 Xenia, Ohio

Colonel John Paul founded Xenia in 1830 at Trebein Station, an area three miles

west of the present location of the city. Colonel Paul selected Xenia, the Greek word

meaning, “a pledge of friendship” for the name of the town (King 1981). Xenia has not

been a true friend to African Americans. White Xenians dissuaded black fugitives and

free people from settling in the area. Owen Davis, a miller and pioneer, brought the first

free black man to Xenia in 1795 (King 1981). In 1810 the free black population increased

to nearly forty men, women, and children who migrated from the South to escape

competition with abundant slave labor for jobs, and break away from whites who forced

blacks to leave the state. Blacks also left the South to escape illegal capture and

36

enslavement. They also left because blacks were required to pay poll taxes and higher

property taxes than whites (King 1981). Those coming to Xenia came mainly from

Virginia, Kentucky, and North Carolina.

Many blacks who migrated to Xenia were of interracial parentage (Robinson

1966). White slave masters and Quakers brought them to the city, or they came as

passengers on the Underground Railroad. In 1830 twenty percent of the total black

population of Xenia had been freed through self-purchase, purchase by friends, or, more

often, purchase by kinsmen for $400 to $1200 (Peters 1995). Blacks usually paid for their

freedom around thirty years of age. They tended to be males, artisans, cooks, dining room

waiters, and barbers who had been allowed to save a small percentage of their earnings as

hired out slave workers (Robinson 1966).

Black Laws prevented blacks from attending public schools and universities. In

1885, Xenia had a black primary and secondary school and a nearby private university for

young adults. The Xenia-Wilberforce area became a center of education for blacks.

Abolitionists who relocated their movement to Xenia in 1841 were partially responsible

for bringing educational institutions to Xenia by way of private donations and volunteer

services. Thus, fugitives from slave states came to Xenia for work and education. They

settled in the “East End,” an area close to Wilberforce University and open to black

residents. The “East End” segregated blacks in poorer, decaying areas of town that were

without sewage, drainage, ventilation, chimneys, halls, staircases or adequate space (Du

Bois 1979 [1909]). Some lived in crowded conditions as boarders or in extended family

units (Robinson 1966).

Xenia developed into an Oasis for black intellectuals and a site of black social and

political development during the 1870s and 1880s. The “East End” had become a type of

black town (Gerber 1994). Black Baptist and Methodist Churches were centers of black

culture and political and social life. “Color line” segregation restricted poor and affluent

blacks to the “East End”. Over 63% of blacks living in the “East End” were homeowners

37

(Gerber 1994). Some houses were dilapidated, poorly insulated and without sanitary

facilities (Gerber 1994). Many “East End” blacks worked at Wilberforce University, the

local shoe factory, a cordage factory, a gunpowder factory, the Powder Mill, or Greene

County Soldiers and Sailors Orphanage Home (Gerber 1994). As early as 1887, Xenia

was the only place in the state that provided housing for black orphaned children.

The black population increased during the 1880s when the mulatto population

comprised 61.5% of the non-white population (King 1981). Most mulattos were children

of black females and Southern white fathers. Mulattos and full-blooded Africans who

remained in Xenia made steady socio-economic, educational, and political progress

because black men in Xenia were free of restrictions imposed on them by white men,

especially slave masters, who prevented black men from attaining an education and

becoming economically independent (King 1981). The progress of the black community

in Xenia was a direct result of black’s ability to construct black institutions and

communities free of institutional racism.

2.3 Data Collection Techniques

2.3.1 Difficulties Recruiting Participants:

It is difficult to recruit African Americans to participate in medical research

(Harris et al., 1995; Carter-Nolan et al., 1996; Veal, 1996). Their reluctance reflects long

held fears from the time when antebellum medical schools and physicians used blacks for

experimentation to test new operating procedures and for dissection (Savitt 1989). As

late as 1932, the Public Health Institute conducted the Tuskegee Study. Researchers

“withheld available medical cures from syphilitic men during a forty year syphilis

experiment on black men” (Roy 1995). The 1890 Oslo Norwegian study and the

Cooperative Clinic Study that used Bruusgaard data rendered the Tuskegee Study of

38

Syphilis completely unnecessary and racist (Roy 1995), since large numbers of blacks and

whites participated in each of these earlier syphilis studies. The medical community knew

the long term effects of syphilis and had achieved their stated research objectives for the

Tuskegee Study even before they started it.

Blacks’ fear of medical research is also justified by practices of racist southern

physicians and medical students who believed that blacks were inferior to whites.

Southern medical professors taught medical students that blacks and whites differed

anatomically, that blacks were “sub-humans,” whose corpses made good cadavers to

teach medical students human anatomy, and that live blacks were good for medical

experimentation (Blakely 1997). Antebellum blacks had little defense against medical

researchers. They educated one another about unethical medical experimentation by

spreading rumors about immoral practices of physicians that were detrimental to black

health, safety, and existence. Rumors warned both old and young blacks alike of unethical

“nightdoctors” who stole, killed, and dissected blacks (Savitt 1989). One warning

circulated as:

39

The Dissecting Hall

Yuh see dat house? Dat great brick house?Way yonder down de street?Dey used to take dead folks een darWrapped een a long white sheet.

An’ sometimes we’en a nigger’d stop,A-wondering who was dead, Dem stujdent men would take a clubAn’ bat ’em on de head.

An’ drag dat poor dead nigger chileRight een dat ’sectin hallTo vestigate ’is liver—lights—His gizzard an’ ’is gall.

Tek off dat nigger’s han’s an’ feet—His eyes, his head, an’ all,An’ w’en dem stujdent finishDey was nothin’ left at all.(After Savitt 1989:240).

Figure 2.1 The Dissecting Hall

Blacks warned one another through poems, personal narrations, legends, and

especially rumors. The Transylvania Journal of Medicine, Associates Science (1828-

1839) and Transylvania Medical Journal (1849-1851) in Kentucky reported that 80% of

all postmortem experimentations were performed on blacks (Blakely 1997). Southern

medical schools paid men to rob graves for bodies, mostly of black males, for dissection

in Southern and Northern medical schools. In 1987, construction workers renovating the

Medical College of Georgia dug up human bones from the basement floor. The forensic

team called in to excavate the discovery unearthed over 9000 human bones that had been

buried earlier in the century when dissecting human bodies was illegal. Over eighty

percent of the bones were of African American males who were subject to

40

experimentation and dissection. It is speculated that other Southern medical schools also

may have blacks buried in their basements (Blakely 1997).

Much medical experimentation and other practices on blacks were not only

unethical, but also brutal (Harris et al. 1996). African Americans have been

underrepresented in most recent clinical trials (Harris et al. 1996). Most African

Americans, including this writer, had misgivings and questions about participating in

COSDA research organized by white researchers who wanted samples from black bodies.

The perceived ethics and character of white COSDA researchers always posed a problem

for recruitment. No matter what their ethics and character truly were, they could never

overcome the historical evidence of unethical medical practices against blacks by whites.

Instead, the ethics, character, and community standing of the recruiter became the ethic

balance for COSDA participants.

2.3.2 Recruitment:

The principal COSDA recruiter contacted each volunteer by telephone to schedule

appointments for oral glucose and sociocultural testing, and spent up to two hours

preparing each participant for screening. Recruitment sessions included discussion of the

research project, analytical procedures, and, of course researchers’ ethics. Discussions

usually allayed participants’ screening anxieties. Misapprehensions were definitely

present, but were reduced during all procedures, and in reports to organizations and

churches whose members participated in COSDA research.

2.3.3 The Process:

Recruitment of participants was a threefold process. Phase One took place in

Columbus, Ohio at New Salem Baptist Church. Fourteen African Americans volunteered

for COSDA. Phase Two involved door-to-door canvassing of an African American

community to recruit participants. This failed to produce any participants. Recruitment in

41

Wilberforce, Xenia, and Dayton the third phase was productive. Recruitment methods

were based on religious and social protocols of the African American community.

2.3.4 The Research Team:

The research team was headed by D.E. Crews, Ph.D. and inculted his graduate

students. Those who participated in COSDA are: Hilton DaSilva MD, (MPH, Ph.D.) a

Brazilian physician; Lori Fitton (Ph.D.), a medical technologist; Mauren Gallager, DO,

(MPH) an osteopathic physician; Janise Gillespie, RN, (Ph.D.) a registered nurse, Greg

Zehnnera, anthropometrist, Wright Patterson Air Force Base; and Gillian Harper (Ph.D.),

Laura Severson ) Ph.D.), Jacquelyn Robinson (Ph.D.), Melissa Reece-Nelson (M.A.) and

Sharon Williams (ABD). These later individuals were all graduate students in Biological

Anthropology at the time of this research and have since completed higher degrees as

indicated in parentheses.

2.4 The Order of COSDA Procedures

This research followed a twelve-step procedure. It started with the participant

reading (or when required, the recruiter read and explained) the Statement of Participant

Information. Researchers answered participant’s questions about COSDA research, then

explained the screening should take approximately 2 hours and 30 minutes. The recruiter

(JR) then ascertained whether the participant ate, drank or smoked within the past twelve

hours. Those who ate or drank were excluded from participation. Those who had not were

asked to sign the Informed Consent Form. Participants proceeded to the next station

where pulse and blood pressure were measured using protocols of the Systolic

Hypertension in the Elderly Program (SHEP). Pulse and blood pressure measurements

were repeated after the participant relaxed for five minutes. Afterwards, a fasting blood

sample was obtained and participants drank a 75 g oral glucose load (Orangedex®, or

42

Koladex®). Participants then advanced to the anthropometeric technician for

anthropometeric measurements. Measurements were taken three times and then averaged.

An interviewer then completed a Biomedical Questionnaire and then participants

completed the Sociocultural Questionnaire while the interviewer determined whether the

anthropometeric form was complete. If the form was complete, the participant was passed

to the RIC (JR) who then double-checked data for completion, and scheduled

participants’ 2-hour post-load draw. If the form was not complete, the participant returned

to the required station to complete it. Participants attended Sunday School, Church

Service, the club meeting or simply waited 2 hours for their post-load draw. Ushers or

club members helped the recruiter, they collected participants from church or club

meetings ten minutes before the two hour post-load blood draw. After the post-load blood

draw participants were provided their blood pressure readings, glucose scores, a $40

honorarium and a continental breakfast. Participants signed receipts and listed social

security numbers before going to the breakfast station and returning to their own

activities.

Standards of the National Diabetes Data Group and the World Health

Organization were used to identify participants with fasting plasma glucose

concentrations (venous) of more than 7.8 mM (140 mg/dl). These participants were

considered with, or at risk for diabetes (Foster, 1989) and instructed to seek confirmation

with a private physician. Blood pressures ranging from 100 to 140 mmHg systolic and 60

to 90 mmHg diastolic were considered normal. Measurements of 140 mmHg to 160

mmHg systolic and 90 to 115 mmHg diastolic were considered abnormal. When either

the systolic pressure is 160 or more or the diastolic pressure is 115 or above, the elevation

is considered severe (Davis 1989). Participants were informed whether their blood

pressure was normal, abnormal or severe. Abnormal and severe blood pressure

measurements were considered hypertension, and participants were instructed to seek

43

medical attention from private physicians. Participants with excessively high plasma

glucose levels or severe blood pressure levels were advised to seek care immediately.

2.4.1 Procedures

2.4.2 Anthropometry

Anthropometeric measures followed protocols outlined by Lohman et al (1988).

Two anthropometry technicians were enlisted. One measured and the other recorded

measurements. The measurer positioned, measured and announced measurements of the

survey participant, while the recorder repeated and entered the numbers on the

participant’s form. The recorder also assisted in obtaining correct measurements by

verifying correct positioning of both participant and measuring device. The recorder also

was responsible to enter correct data on forms and note “gross” error in measurements.

Equipment included: 1 Health-o-Meter® scale, flat steel tape measure, GPM®

anthropometer, Lange® skinfold caliper, and sliding caliper.

Weight

All participants were weighed on a Health-o-Meter® spring-tension scale after the

scale was zero-adjusted. All heavy outer clothing, such as hats, coats, sweaters, and

shoes, etc., was removed. The weight of participants was recorded in pounds to the

nearest 0.1 pound. Weight was record as more than 300 pounds for participants who

weighed more than the 300 pound upper limit of the scale. The average of two

measurements was recorded.

Stature

Stature was measured to the nearest 0.1 centimeter (cm). Participants stood erect

with back straight, both heels together and toes slightly apart at a 60 degree angle. Arms

44

with palms facing forward hung free at the side of the trunk of the body to distribute the

body weight proportionately on both feet. The head was positioned in the Frankfort Plane

and the anthropometer was aligned with the spine. The measurer placed the sliding arm

on the crown of the head, compressing the hair. The value was announced to the recorder

who repeated it, before recording the value on the participant’s record form. Two

measurements were made and averaged.

Waist Circumference

Participants wore light clothing when waist circumference was measured. They

were standing erect, with arms at sides and feet slightly apart. The researcher stood in

front of participants, looped the tape measure around the participant’s torso and

positioned it at the level of the natural waist. The narrowest part of the torso viewed from

the anterior is the waist (Crews 1994, p. 8). Waist circumference for obese subjects was

the smallest circumference between the bottom of the rib cage and the iliac crest. Waist

circumference was measured to the nearest mm and was taken at minimal respiration after

it was determined that the tape was snug, but not indenting the skin. The measurement

was made, and repeated three times by the recorder, before being entered on the record

form.

Hip (Buttocks) Circumference

Hip circumference was measured with participants standing erect with feet

slightly apart. The anthropometrist looped the tape around the maximum protrusion of the

buttocks while stooping at the right side of the participant. The recorder stood on the left

side of the participant looking to insure the tape was in a horizontal plane. The tape was

pulled snug against any clothing to the zero end to below the measurement value. Values

45

were called out to the recorder who repeated them while entering them to the nearest mm

on the Report Form. Hip circumference was always measured a second time, and a third

time when any discrepancy of > 1 mm existed between the first and second values.

Upper Arm Circumference

Upper arm circumference (UAC) was measured while participants stood erect

with their feet slightly apart. The midpoint of the upper arm was located as participants

flexed their elbow to 90 degrees with the palm superior. The anthropometrist then located

the lateral tip of the right acromion (the outer extremity of the scapula) by palpating

laterally along the superior surface of the spinous process of the scapula and the most

distant point on the olecranion (the point of the ulna that projects beyond the elbow joint).

Then a mark was made midway between these two points for measurements of UAC and

triceps skinfold.

Triceps Skinfold

As described for the UAC, except that while standing behind the participant, the

anthropometrist used the thumb and index finger of his left hand to pick a double-fold of

skin and subcutaneous fat in the midline approximately 1 cm above the previous mark.

The tip of the large skinfold calipers were used to measure the fold to the nearest mm.

The triceps skinfold (TSF) was repeated three times with a 30 second pause between

each.

Subscapular Skinfold

Participants were standing erect. The scapula was palpated along the right

vertebral border to find the inferior angle. A double fold of skin was lifted on a diagonal

approximately 45 degrees to the horizontal plane in the natural cleavage line of the skin, 1

46

cm below the inferior angle of the scapula. For obese participants arms were placed

behind their back while the caliper jaws were applied 1 cm inferior-lateral to the thumb

and index finger. Subscapular skinfold (SS) was measured three times to the nearest mm.

There was a thirty-second pause between each measurement.

Suprailiac Skinfold

The participant was standing erect and relaxed with each arm hanging loose at the

side of his/her body. The measurer identified the iliac crest and a line superior to the mid-

axillary line. The measurer grasped an oblique double-fold of skin and subcutaneous fat

posterior to the mid-axillary line, then placed the caliper jaws 1 cm from the index finger

and thumb. This measurement was repeated three times with a thirty-second pause

between each measurement. It was measured to the nearest mm.

Medial Calf Skinfold

The participant sat with soles of his/her feet flat on the floor while flexing the

right knee at 90 degrees. The maximum calf circumference along the axis of the calf on

the medial aspect was located. About 1 cm above this maximum circumference the

medial calf skinfold (MC) was measured. Caliper jaws were parallel and placed about 1

cm below the left thumb and index. This was repeated 3 times with a thirty-second pause

between each.

Abdominal Depth

Participants were standing erect. Large spreading calipers were used to measure

abdominal depth (AD) at a point 1 cm superior to the umbilicus. One tip of the caliper

was placed at the midline point, and the other was placed on the spinous process of the

vertebra in the same horizontal plane. The anthropometrist stood to the left of participants

47

to maintain the caliper at level. AD was recorded to the nearest 1 mm and repeated three

times with a 30 second pause between each. The anthropmetrics were determined by two

individuals. One is a Certified anthropometrist posted at Wright Patterson Air Force Base,

Cockpit Design Group. The other is a physician and doctoral student in the Department of

Anthropology.

2.4.2 Anthropometeric Indices

Six indices determined from the anthropometric data are used as assessments of

overweight, obesity, and health risks among COSDA participants:

1. Body Mass Index (BMI) = weight (kg)/height (m2);

2. Arm Fat Index (AFI) = (upper arm fat area/total upper arm area) x 100

total upper arm area =upper arm circ2 /(4 x π);

3. Upper arm muscle area (UA Fat) = total upper arm area - upper arm muscle

area;

4. Upper arm fat area (UAF) = total upper arm area - upper arm muscle area;

5. Sum of two skinfolds (Sum SF) = tri SF + subscap sf;

6. Waist hip ratio (WHR) = waist circ / hip circ.

2.4.3 Phlebotomy and Glucose Measurement

Either the PI or a certified phlebotomist drew all blood samples by venipuncture.

These were used to determine fasting blood sugar levels. As discussed above, oral

glucose tolerance tests (OGTT) were performed on all participants who had fasted at least

eight hours and had a fasting glucose measurement below 200 mg/dl. Phlebotomists

cleaned the puncture site with antiseptic, tied a tourniquet around the upper arm to restrict

the blood flow, and inserted a needle into the vein to collect 7 ml EDTA blood in

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vacutainers®. After blood collection, the tourniquet and needle were removed and the site

covered with cotton and a bandaid.

Blood was used immediately to determine glucose levels using an Ames

Glucometer III®. Results were determined following the manufacturer’s directions.

Following the fasting blood draw, participants to be tolerance-tested ingested a standard

oral solution of 75 g oral glucose load (Orangedex® 75 of Koladex®). After 2 hours

blood was again drawn, and plasma glucose level was determined. Either fasting or 2-hr

post load plasma glucose concentrations (venous) above 7.8 mM (140 mg/dl) are

considered to indicate Type II diabetes following Foster (1989) and the WHO (1998).

Later in Dr. Crews’ laboratory at OSU, Glyc-Affin® columns were used to determine

glycated hemoglobin from preserved whole blood following manufacture’s directions.

Fingerstick blood samples were also performed to check plasma glucose level in

participants who had known diabetes. Participants also had fasted eight hours but were

not given glucose solutions to drink. The fingerstick and phlebotomy protocols were the

same as for other participants, except there was no glucose loading or 2-hour draw. Vials

containing blood were labeled and centrifuged, before being stored on ice for

transportation to The Ohio State University Biological Anthropology Laboratory for

further analysis. Participants were informed that their serum glucose levels were normal,

hyperglycemic (greater-than-normal level), or hypoglycemic (lower-than-normal level).

2.5 Sociocultural Assessment

The sociocultural assessment provides insights into the association of

socioculutral risk factors with “stylization of life,” diabetes, hypertension, and obesity.

Weber (1912) and Veblen (1889) suggested that social differentiation reflects life style

and that it is composed of personal choices and structural conditions of society that may

be termed “stylization of life.” Some social scientists agree that African Americans’ life

style and minority status result from personal choices (Crews 1995) or attribute life and

49

health style to vicissitudes of class rather than to black skin color that historically

determined enslavement and disenfranchisement (Bennett, Jr. 1964). Others explain black

life style as intercultural responses to institutionalized restrictions, economic under

development, social barriers, and racial disenfranchisement. That is “alternative levels of

creations within the confines of the black experience and differential behavioral

adaptation to racism, with its economic, social, and geographical restrictions” (Williams

1981). Rather than concentrating on either aspect of the stylization of life, this study

focuses on global structural conditions generating sociocultural processes that affect

disease incidence. Disease is a barometer of socioeconomic, histopolitical, and biological

processes that produce population-specific disease profiles whether infectious, chronic,

epidemic or pandemic.

Often scientific methodology and researchers have interpreted data from a racist

and dehumanizing perspective, especially on African Americans (Barker 1993). Over

time, data have been denied, rewritten, distorted and/or dismissed. This reflects Sir Karl

Popper’s axiom that “the criterion of the scientific status of a theory is that its falsibility,

refutability or testability has become so deeply embedded in the design of research that it

is often used without conscious awareness of its origins” (Popper, 1994:14). Biased and

racist methodologies and interpretations benefited global culture but also threatened the

cultural autonomy of tribal and state societies. Commercial interests used government and

political power to promote industrial technologies, acquire new energy sources, and

generate social power through economic growth. This displaced indigenous people from

resources and placed them in areas where food supplies were inadequate, undernutrition

common and prolonged, and workloads high. Some researchers view food disruption and

deficiencies among members of tribal societies as the consequences of “progress”

(Bodley 1999). These researchers are so deeply enmeshed in global scale capitalism and

profits that they view health indices and the disequilibria associated with

commercialization as indices of acculturation and lack of exposure to western life style.

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Instead of indices of minority status and life style, others see poor health as lack of power,

and the sign of malnutrition, starvation and genocide.

Poor health indicators also may reflect pathophysiological or metabolic

maladjustment to socioculturally induced adversity and/or nutritional deprivation,

programmed response to improper growth and development, or abnormal changes in

structure and function of organs and tissues due to previous deleterious conditions.

Global economies determine access to food and goods thereby causing and maintaining

patterns of undernutrition. Undernutrition affects fetuses, infants, children, and adults

adversely and subjects members of small-scale cultures to poor maternal nutrition,

deficient intrauterine environments, poor fetal, infant and childhood nutrition. Studies by

Hales and Barker (1992), James and Coore (1970), Dicke and Henderson (1988), Cohen,

Stern, Rusecki and Zedler (1988), and Dowse, Simmet, Finch and Collins (1991)

demonstrate how poor maternal nutrition leads to impaired glucose tolerance and

diabetes. Maternal malnutrition limits amino acids and reduces protein and energy

production (Hales and Barker 1992). Amino acids are major factors controlling ß cell

growth and development and insulin secretion until later fetal life (Hales and Barker

1992). Reduced ß cell function results in diabetes (Hales and Barker 1992). Multiple

sociocultural factors such as undernutrition and high workloads may lead to poor ß cell

function and diabetes in African Americans and other marginalized peoples. Structural

conditions led by governments such as the United States determined African American

life style and health styles, slavery, segregation, discrimination, access to jobs, and

education. All led to poor nutrition for many generations

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2.6 Construction and Measurement of Sociocultural Risk Factors All participants

completed the Sociocultural Questionnaire. Sociodemographic, life style/stressors,

threatening health behavior, and dietary variables were measured as separate indices

comprising the Sociocultural Risk Factors.

2.6.1 Sociocultural Risk Factors: Sociodemographics Index

Sociodemographics were obtained by self-report. Sociodemographic variables

included social era/age, sex, income, education, occupation, and marital status.

2.6.2 Sociodemographics: Social Era/Age

Age reflects social era, the social milieu or environmental setting, the overall

living, political and social conditions, and life experience of people living at specific time

periods. World War II demarcated two different social eras for African Americans, the

apartheid social era, and the civil rights social era (Dressler 1996). African Americans

born before World War II lived in an apartheid world where they were forced to adjust to

the restrictions of Black Codes and/or Black Laws and second class citizenship. The

apartheid era ended with the beginning of the civil rights movement in the 1940s and

culminated in the Brown vs. the Board of Education Supreme Court decision in 1954

resulting in desegregation and equal rights. This ruling ushered in wide scale social

changes and a new “stylization of life” for blacks growing up after this court decision

and World War II. Thus, COSDA participants were organized into these two social eras

to reflect their social milieu. Social era was recorded as 0 for those growing up during

apartheid and 1 for those following the civil rights. Age groups were scored 0 for 40 - 49,

1 for 50 - 59, 2 for 60 - 69, 3 for more than 70.

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2.6.3 Sociodemographics: Sex

There are two sexes of participants, men and women. Men are coded 0, women 1.

2.6.4 Sociodemographics: Income

Scores for income were assigned 0 for incomes under $4,000, 1 for incomes of

$4,000 - $7,999, 2 for $8,000 - $14,999, 3 for $15,000 - $24,000, 4 for $25,000 -

$49,999, and 5 for more than $50,000.

2.6.5 Sociodemographics: Education

A score of 0 was assigned for high school incompletion, 1 for high school/

technical/trade school graduation, 2 for 12 - 16 of college, 3 for graduate school, and 4 for

professional school graduation.

2.6.6 Sociodemographics: Occupation

A score 0 was assigned to unemployed, homemaker, student or retired, 1 for

unskilled or semi-skilled, 2 for lower professional or office worker, and 3 for

professional.

2.6.7 Sociodemographics: Marital Status

A score of 0 was given for never married or living as married, 1 for married, 2 for

divorced or single, and 3 for widowed.

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________________________________________________________________________Assigned N PercentValue

________________________________________________________________________

Social Era Apartheid 0 58 52%Civil Rights 1 54 48%

Age Group 26 - 40 0 25 22%41 - 50 1 28 25%51 - 60 2 24 21%> 61 3 35 32%

Sex Male 0 34 30%Female 1 78 70%

Education < than 12 years 0 0 8%high school, technical 1 25 22%trade school graduation1 - 4 years of college 2 49 44%complete graduate school 3 25 22%professional school graduate 4 4 4%

Occupation unemployment, homemaker 0 18 16%student or retired,unskilled or semi-skilled 1 34 30%lower professional, office 2 39 35%workerprofessional 3 21 19%

Marital never married 0 16 15%married 1 53 47%divorced/separated 2 9 9%widowed 3 33 29%

Income under $4,000 0 4 4%$4,000 - $7,999 1 6 5%$8,000 - $14,999 2 7 6%$15,000 - $24,000 3 24 22%$25,000 - $49,000 4 36 33%> $50,000 5 32 29%

_______________________________________________________________________Table 2.3 Distribution of the sample by sociocultural factors and assigned values for sociodemographics (SD)_______________________________________________________________________

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2.7 Sociocultural Risk Factors: Life style/Stressor Index

The life style/stressor index comprises two categories of sociocultural risk factors,

stressors and acculturation. Dressler (1996) described the African American life style as

consisting of two dominant types of stressors, chronic and acute stressors. Chronic

stressors are stressful events in daily life, while acute stressors are sudden, unpredictable

and cataclysmic life events (Dressler 1996). Chronic stressors include social incongruity,

social support, and relaxation, while acute stressors include desegregation adversities,

victimization, anger reaction, employment/unemployment and perceived discrimination.

Chronic stressors are also viewed as indicators of assimilation since they reflect the

degree to which a minority group has assimilated or has been absorbed into the prevailing

American culture.

2.7.1 Life style/Stressors: Chronic Stressors or Assimilation Index

COSDA participants completed a variety of questions that were based upon Likert

scales. Social incongruity measures life style and assimilation. Social incongruity was

determined by the type and number of material items people acquire. Material

possessions included microwaves, stereos, televisions, outfits, shoes, inheritance,

investments, and domestic and international travel. COSDA participants scored 1 point

for each item they owned. There was no maximum number of material possessions

obtainable. Social support was determined by various types of assistance, namely

financial advice and/or money participants received from family members, friends,

neighbors, pastors, and others to alleviate hardships. COSDA participants scored 1 point

for each type of assistance available to them. Thirty-seven points were possible.

Participants scored 1 point for each type of relaxation activity in which they engaged.

Relaxation activities included eating, meditating, praying, bathing, exercising, watching

TV, and having a warm drink.

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Questions concerning acute stressors assessed participants’ perceptions of

desegregation, victimization by nonviolent and violent crimes, imprisonment, and anger.

Passive responses to anger received a score of 0, aggression and destruction of property

received 1, harm against a person and other acts of violence received 2. Participants’

perceived employment discrimination was scored high to indicate more perceived job

unfairness. Lower points indicated less training, pay, raises, and fewer promotions, and

grievances.

2.7.2 Chronic Stressors or Assimilation Index: Social Incongruity

Health status and the onset of chronic diseases such as diabetes mellitus are often

affected by social incongruity or the degree to which life style (measured by the

accumulation of consumer goods and the adoption of specific leisure activities) exceeds

economic status as assessed by occupational class and educational credentials

(Dressler 1994). In addition to assessing social status, social incongruity also measures

acculturation. Acculturation is often called cultural or social assimilation or integration,

the fusion of institutions and social structure causing people with divergent customs to

come to share common modes of action, norms, language, and dress (Vander Zanden

1983). Social incongruity reflects behaviors that define social identity. These behaviors

develop from patterns of interaction associated with attempts to manage and make

personal choices. Social incongruity also reflects structural conditions of society called

“stylizations of life”. Some social scientists suggest stylizations of African American life

results from the vicissitudes of class rather than phenotypic inheritances. Other social

scientists explain social incongruity and social differentiation as “intercultural responses

to institutionalized restrictions, economic under development, social barriers, and racial

disenfranchisement. These are alternative levels of creations within Black experiences

and differential behavioral adaptation to racism, with its economic, social, and

geographical restrictions” . . . (Williams 1981).

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Instead of being a genetic trait, skin color is a criterion of social class and health

inequalities. Skin color is a chronic stressor that limits the opportunity structures for

African Americans. It indicates the frustration of darker-skinned people who receive

treatment incommensurate with their social status and education and who are unable to

accumulate material goods and adopt status-enhancing behaviors called life style. Life

style should be consistent with social status, education, economic and political

opportunities and health. Consistent life styles result in social congruity and reflect access

to status-enhancement in societies. Individuals who are barred from status-enhancement

behaviors experience frustration leading to repeated autonomic arousal and sustained

blood-pressure elevation (Dressler 1993). Such health conditions confirm the status

incongruity hypothesis developed by Dressler (1993). He argues discrepancies exist

between life style and occupational status or between life style and education, all of

which are based on skin color. This model not only exemplifies the significance of

ethnicity in a color-conscious society, but also redirects focus from the individual to the

social-relation structure.

William Dressler (1994) concluded social incongruity predicts family health as

locus of incongruity and social identity. It reflects life style yielding personal choices and

structural conditions of society. Life style is highly structured and widely shared across

sub communities indicating strategies members of subcultures use to overcome obstacles

and restrictions common to the black experience in the United States (Dressler 1996),

including adjustments to low status life styles that may be inconsistent with occupational

or educational achievements. Cultural models of life style are shaped by cultural sharing

and patterned behaviors.

Inconsistencies in education/occupation and income prevent the actualization of

shared aspirations, causing those deprived of goal attainment to engage in alternative

behaviors that impede goal attainment. Such behaviors include unwanted pregnancy,

criminal misconduct, victimization, absent/dysfunctional fathers, having too many

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children, and death or addiction of parents. These behaviors produce a variety of

economic, social, and psychological phenomena that may become stressors in alternative

cultural meaning systems among subgroups. Those who attain shared aspirations of the

cultural meaning system and escape behaviors that prevent shared aspirations gain status,

prestige and social distinction (Dressler et al. 1996). Whether the escape is determined by

internal and external loci of control, personality traits, or skin color, all influence life style

and socioeconomic status. Actualized or blocked aspirations influence material

acquisitions associated with physiological indices such as serum cholesterol, high density

lipoprotein cholesterol, and triglycerides (Dressler et al. 1991), and onset of multifactorial

diseases such as heart disease, hypertension, hyperlipidemia and diabetes (Dressler, Evans

and Gray 1992 a). Material possessions gauge life style, health, and acculturation.

2.7.3 Chronic Stressors or Assimilation Index: Social Support

Social support is the sum of social, (social interaction), emotional (feelings of

social connectedness and encouragement), instrumental (re-education and material

intervention), and companionship (associate, assistant, or mate) exchanges among

individuals. Social support measures perceived, instrumental or tangible assistance. It

assesses financial, illness, guidance, feedback, appraisal, and/or career matters. Social

support causes individuals to see themselves as objects of continuing value in the eyes of

significant others (Glass, et al. 1993; Glass et al. 1992; Berkman, et al. 1992). Social

support is the sum of all relationships making a person matter to the people who matter to

him (Gordy 1996). Social support speeds recovery from illness, helps prevent or delay

disease onset, buttresses financial stability, and solidifies families and relationships

(Martin and Martin 1987). Family, friends and associates give emotional and practical

support in the form of companionship, assistance, affection, information, and security.

Social support bestows protective effects on health and well-being (Communities Count

2000).

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Social support, however, is somewhat different among African Americans in that,

among slaves, it was a continuation of the African helping tradition, an informal self-help

network of mutually dependent relationships (Jewell 1988). Mutual-aid networks

involved communal cooking, childcare, sewing, and other cooperative activities occurring

in and around slave quarters. It creates on the plantation a type of ‘transresidential

cooperation’ (Jewell 1988). Then, survival was predicated upon assistance, a collective

interdependence of sharing networks among the community and family. Social assistance

was also provided directly or indirectly by the slave master and depended on his resources

and sense of moral obligation (Billingsley and Giovanni 1972). The mutual aids network

dispensed assistance according to need, the principle of the African helping tradition.

Social support changed after the emancipation of slaves. The federal government

through the Freedmen’s Bureau became the major social support agency providing food,

clothing, shelter, information, jobs, and other elements that established and maintained

black nuclear families. By1870, 90% of the black families were nuclear families

(Gutman 1976). The black community also continued its own informal social support

networks that provided basic needs and services for physical survival, child care,

counseling, and guidance (Jewell 1988). Black churches became the vanguard of mutual

aid networks providing goods, credit, job training, services, education, and other types of

mutual support to blacks, especially male household heads. Black churches worked with

Black philanthropic organizations to achieve social control, and establish and reinforce

values, beliefs and behavior.

The mutual-aid system declined after the federal government responded to the

social revolution of the 1960s by “mainstreaming” blacks and other economically

disadvantaged people into the Social Services system (Jewell 1988). Traditional Mutual

Aid Networks in black churches phased out in favor of governmental helping agencies.

Eligibility guidelines for receiving social support differed, though, from the Mutual Aid

Network and African helping tradition criteria. Supreme Court rulings in 1979 stipulated

59

that only mothers with dependent children, not unemployed fathers and their families,

were eligible for aid and services from formal social agencies. Thus, black families in

need responded to the loss of informal social support, but could not seek assistance from

the black community as black helping agencies deteriorated with the mainstreaming of

blacks into Social Service Agencies. Black males who were the last hired and first fired

left their children and wives to make them eligible for governmental social support.

Lower class black families further survived as financially dependent lineal networks of

multi-generational, matri-focal, nuclear and/or malleable family units. This response

stimulated the disruption of black nuclear families that reconstituted themselves by

finding loved ones and marrying after emancipation in 1865. Middle class black families,

however, survived as nuclear families as they escaped dependence on social support due

to job retention. COSDA participants, like other middle class black families, are nuclear,

financially independent and self-sufficient (Martin and Martin 1985).

2.7.4 Chronic Stressors or Assimilation Index: Relaxation

Stress is the physiological and emotional reaction to stressors that cause a change

in homeostatic systems, which if persistent, threatens an individual’s fitness and health

(Harrison 1980; James, Crews, and Pearson 1989; Zastrow and Kirst-Ashman 1995).

Stress triggers a physiological response that prepares individuals for “fight or flight” and

to cope with stressors by increasing outputs of catechoalimines (epinephrine and

norepinephrine) (James, Crews, and Pearson 1989). Catechoalimines are hormones that

alter tissue activity adapting the organism to environmental demands and stressors

(Johansson and Lundberg 1978). Stressors are demands, situations, or circumstances that

disrupt a person’s equilibrium and initiate stress. Stressors include job loss, loud noise,

toxic substances, retirement, arguments, death of a spouse or loved one, moving, heat,

cold, serious illness, and lack of purpose in life (Zastrow and Kirst-Ashman 1995). The

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body also releases adrenalin and other hormones to cope with demanding stimuli (Shapiro

et al 1979). Hormones increase breathing and heart rates, blood pressure, blood

coagulation, serum cholesterol and blood fat, divert blood from the skin to the brain,

heart, and muscles, decrease mobility of the gastrointestinal tract, and cause pupil dilation

(Zastrow and Kirst-Ashman 1995).

Selye (1956) studied stress and found that individuals undergo a three-stage

reaction to stress: (a) the alarm phase in which the body recognizes and responds to

stress; (b) the resistance phase in which the body returns to homeostasis, repairs damage

caused by stressors, or adapts to stressors; and (c) the exhaustion phase that occurs when

the body remains in high stress states for extended periods, and if the body is unable to

repair damage the person develops stress-related illnesses such as hypertension, heart

attacks, migraine headaches, arrhythmia, diabetes, cancer, colds, flu, insomnia, dermatitis,

infections, and enuresis (Zastrow and Kirst-Ashman 1995). Stress may be dissipated

through stress management or coping skills that change distress or harmful stress,

changing evaluation of distressful events, and thinking about pleasure rather than

participating in compulsive overeating, drug or alcohol abuse, and other destructive

behaviors. A stressed person can also relax by getting a massage, learning muscle

relaxation and biofeedback techniques, meditating, or treating one’s self with pleasurable

and enjoyment. The sociocultural questionnaire recorded number and types of relaxation

activities in which COSDA participants engaged.

2.8 Life style/Stressors:Acute Stressors

2.8.1 Acute Stressors: Desegregation

Segregation started with the capture of Africans for enslavement. Those who

spoke the same language were separated to lessen conspiracies, sabotage, escape, “gold-

bricking” and rebellion. African-born slaves were separated from other slaves because

they were defiantly rebellious often to death, and if they survived, encouraged other

61

tribesmen to escape (Hines et al., 2000). Repressive slave codes were implemented to

regulate and differentiate slaves from other humans, and to demote them to property for

subordination, discipline, and maximum work (Franklin and Moss 1988, 114). Slave

codes prevented bondsmen from leaving plantations without authorization; possessing

firearms; beating drums or blowing horns; hiring themselves out without permission;

conducting themselves as free people; buying or selling goods; visiting or entertaining

whites or Free Negroes; assembling in the absence of a white person; receiving,

possessing, or transmitting incendiary literature; having legal standing or testifying in

court, except against another Negro; being party to a law suit; swearing binding oaths or

making contracts, owning property, or striking a white person; and defending themselves

against sexual and physical transgressions (Franklin and Moss 1988).

No Northern state in the late 1700s disenfranchised blacks. Exclusionary

legislation was coined as Jim Crow Laws in 1841 in Massachusetts and started with

railroad cars. But these restrictions soon spread leading to segregation of free Blacks in

neighborhoods with unheated shacks, dirt-floors, and houses without doors or windows.

Jim Crow laws banned blacks from public lecture halls, art exhibits, religious revivals,

state-supported poorhouses and insane asylums, public transportation, and nearly all

public schools (Franklin and Moss 1988). Segregation policies were further solidified in

1857 by the Dread Scott v. Sanford decision in which the Supreme Court ruled Scott was

a slave although he was taken as a slave from the slave state of Missouri to the free state

of Illinois. This decision established African Negroes of the United States as inferior

beings unfit to associate socially or politically with whites, and denied them rights which

the white men were afforded (Asante, 1995). Robert Purvis, C.L. Redmond, and other

civil and human rights leaders protested against such legislations. However, this decision

enshrined segregation in the South before and after the Civil War. After the Civil War

Southern states unsuccessfully attempted to reinstate former forced servitude by passing

Black Codes to replace Slave Codes. These codes legalized racial separation in public and

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private life. The 1896 Supreme Court ruling of Plessy v. Ferguson (Selection 16)

mandated that racial segregation in public facilities did not violate the Thirteenth and

Fourteenth Amendments and “separate but equal” public accommodations since they

were evaluated as not denying blacks equal protection of the law (Rothenberg, 2000).

Exclusionary practices in employment made it especially difficult for black men

to find work. Job market restrictions increased antebellum and post-bellum single-parent

families. It also caused black families to take in boarders, move often in search of

employment, and family members to share dwelling places. Extended families increased

(Hines, 2000). Until the 1954 Brown v. Board of Education of Topeka decision by the

Supreme Court, exclusionary conditions nurtured disease, infant mortality, alcoholism,

and crime (Hines, 2000). This decision concluded “separate” could not be “equal”, and

that segregation should be abolished in public facilities, public schools, housing, and

employment (Hines, 2000). Many exclusionary policies and much of de jure segregation

ended with the desegregation that followed the civil rights movement led by Martin

Luther King, Jr. in the 1960s. However, inequalities and segregation still exist today as

de facto segregation in most neighborhoods, work places, private clubs and facilities, and

public schools. Health effects of such social conditions on type II onset for COSDA

participants are examined as sociocultural risk factors.

2.8.2 Acute Stressors: Victimization

This dissertation research documented numerous accounts of Africans, both

enslaved and free, American and African born, being harmed by those who enforced slave

and black codes, disenfranchisement and segregation, and punishments, mistreatments,

tricks, and swindles. African Americans suffered injury, loss and death from acts of

violence making them victims. Conflict theorists explain that oppression and exploitation

underlie violence. As a large force of laborers who do not own the means of production

and capital for investment money, African Americans are without a power base to make

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business, economic, and social decisions to buy food, clothing, utilities, mortgages, and

transportation (Henslin 1990). When confronted with adversities that affect their

livelihood, some strike out in violence. They became threatened and desperate when

access to culturally approved goals are blocked (Henslin 1990). African Americans are

disproportionately represented among abusers of alcohol, and drugs and among those

committing crimes against property and persons. Owners of production use power and

influence to protect their privileged position in society, causing workers to misdirect

anger and violence against one another. Thus, blacks are more likely to become victims of

crime, violence, racism, drugs, personal theft, rape, robbery, assault, drug and alcohol

abuse, and murder. They are also more likely than other ethnic groups to be statistically

over-represented as criminals (Wilson 1990). In 1988, 5.4% of black households

experienced violent crime, 7.6% were burglarized, 9.1% experienced theft, and Black

males had a 1 in 21 chance of being murdered (Williams (1990). The sociocultural

questionnaire enumerates violence perpetrated against COSDA participants, their

families, mates, and mates’ families.

2.8.3 Acute Stressors: Reaction to Anger

Anger is a physiological, social, or psychological response to emotive situations.

Anger expressions depend on culturally based learning and socialization. The limbic

system and frontal lobes play an important role in creating emotions. Increased heart rate

and fast, shallow breathing are phenotypic signs of arousal. These reflect sympathetic

nervous system responses dependent upon adrenalin, norepinephrine, and cortisol. These

hormones are secreted from the adrenal gland in response to stress perceived by the

hypothalamus (Huffman, Vernoy, and Vernoy 1994). The parasympathetic nervous

system returns the organism to its pre-arousal state following sympathetic arousal from

emotions and stressors.

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Modern evolutionary theorists contend that basic emotions such as anger, fear,

sexual desire, and aggression have survival and protective functions shaped by natural

selection (Huffman, Vernoy and Vernoy 1994). Anger, fear, joy and sadness are primary

emotions that combine to produce love, submission, awe, and disappointment, the

secondary emotions. Human conduct researchers view anger as the result of frustration, a

condition that exists when a person fails or is prevented from reaching goals (Gelinas

1983). This frustration-aggression hypothesis suggests when needs are not met frustration

and anger follow sometimes leading to violence or hatred. Individuals may either adjust

or control them. When unresolved, angry may be turned against people, objects, or

oneself (Gelinas 1983).

Pierce (1970) developed the micro-aggression concept. It helps explain the

continual assaults and insults African Americans encounter subtly or blatantly in

disadvantaged environments. Assaults and insults remind them of their low status and

mistreatment. Blacks, especially male youths, report being called stupid by teachers,

bypassed by available taxis, ethnically profiled, followed or ignored in stores, or denied

interviews for jobs for which they qualify (Gibbs 1988). African American males,

especially, must either learn to tolerate these micro-assaults against their dignity, react

with uncontrolled aggression that may invite counter violence, suppress their anger and

develop psychosomatic symptoms like hypertension and ulcers, or drown their

frustrations in alcohol and drugs and other health threatening behaviors (Gibbs 1988).

Society reinforces anger catharsis by admonishing black parents to teach their

children to ventilate anger without open expression of enjoyment of an aggressive

response, or to avoid directing damage and aggression on the target (Renfrew 1997). By

adulthood they learn to speak softly and avoid kicking furniture, throwing household

accessories, yelling or rebelling. Those who fail to heed admonishments and vent their

anger in socially unacceptable ways often find themselves victims of the criminal justice

system. In COSDA, relationships between anger management and plasma glucose were

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assessed (Appendix A). Questions reflecting self-control were scored 1; those vented on

inanimate objects 2, while violent actions toward others were scored 3. The maximum

possible score is 60.

2.8.4 Acute Stressors: Discrimination

Discrimination often accompanies segregation as a prejudging attitude. It is an

unfair action or treatment directed against someone (Henslin, 2001). The unfair treatment

may or may not be deliberate. Discrimination against blacks was legislated as federal and

state policies backed by Supreme Court decisions such as the Dread Scott Decision and

Article 1, Section II—the three fifths clause—of the Constitution of the United States.

Although elements of culture are shared, individual discrimination experiences depend on

personal characteristics, individual accomplishments, family background, shade of skin

color, education, style of dress, language patterns, and other factors upon which

discrimination and privilege are executed.

Discrimination is built into the country’s institutions, specifically the financial and

employment institutions (Henslin, 2001). Examination of 1910 economic opportunities

by Landale and Steward (1991) showed restriction of African Americans from

nonagricultural opportunities created a caste or southern tenancy system and a dual

economic system. These restrictions guaranteed black oppression, restricted upward

mobility, created debt penonage and precluded blacks from saving money, owning

property, inheritance, and other opportunities. Tenant households functioned as

autonomous units in which income for both the tenant family and the landlord depended

on tenant family labor. Tenancy encouraged early marriage and large families. Preventing

black males from pursuing economic opportunities resulted in barring them from

manufacturing and industrial employment in the South but less so in the North.

Employment restrictions to agriculture in the South, and to dangerous or low paying

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industrial jobs in the North resulted in black family instability and differential marriage

patterns for blacks and whites. Data from the 1910 Public Use Sample of the United

States census indicate 47% percent of black males and 47% of black females, and 37% of

white males and 22% of white females aged 18 were married (Strong et al. 1989). This

system guaranteed whites an opportunity structure where tenancy was a temporary status,

and farm ownership, entrepreneurship and savings were achievable goals for upward

mobility (Landale and Steward, 1991). Discrimination against blacks created

disadvantaged life styles and health styles for blacks and advantages and privileges for

whites (Strong et al. 1989). COSDA participants were asked questions to evaluate life

and health styles resulting from their perceptions of employment discrimination. This

assessment was used to determine the correlation between discrimination and plasma

glucose.

2.9 Life style/Stressors: Health Threatening Behavior

Health threatening behaviors included alcohol and tobacco use and physical

inactivity. Alcohol was scored as the number of drinks consumed per month. Tobacco

was scored as the number of packs participants smoked per day and for how many years.

Pack years or packs per day times years smoked were computed. Physical activity at work

and leisure along with type, frequency, and intensity of exercise were reported. Self-

reports scored physical activity as 0 for very light, 1 for moderate, 2 for heavy, and 3 for

very heavy.

2.9.1 Health Threatening Behavior: Tobacco Use

Questions included when tobacco use began, whether the participant presently

smokes, how many cigarettes per day the participant currently smokes, and how many

years the participant has smoked (Appendix A). The number of cigarettes that were

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smoked per day was divided by 20, and then 13 to determine the number of packs smoked

per year (pack years).

2.9.2 Health Threatening Behavior: Alcoholic Use

Amount of beer, ale, wine, wine coolers, liquor, cocktails and mixed drinks

containing liquor was determined for the past 12 months (Appendix A). Participants

reported the number of drinks they consumed per day. This figure was used to determine

number of drinks per week and included as a component of threatening health behavior.

2.9.3 Health Threatening Behavior: Exercise or Physical Activity

Level of physical activity was reported as very light, light, moderate, heavy and

very heavy, for work, leisure, and any exercise programs (Appendix A). Strenuous,

biking, running, dancing, basketball, and less strenuous exercises, like cricket, slow

walking, were also determined. A total score of 29 for physical activity was possible.

Tobacco and alcohol use along with physical activity was summed to estimate the

threatening health behaviors index.

2.10 Life style/Stressors: Dietary Variables

All participants completed a dietary recall for foods eaten the past year. The

dietary recall form included a wide variety of foods and asked participants to indicate

portion size and frequency (Appendix A). All items were measured in portions such as

slices, pieces, or cups and then converted into grams consumed per year. To evaluate

dietary deficiencies or excesses, all items were entered into the Food Processor®

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Nutrition and Fitness Software. The Food Processor® analyzes 114 nutrients and 29 other

factors. This study evaluated nutrition facts based on intake for age, weight, height,

gender, and activity level. They were compared to U.S. 1989 Recommended Daily

Allowances (RDA), Estimated Safe and Adequate Amounts, and Dietary Goals (Esha

Research 1999). Calories, total fats, saturated fats, cholesterol, sodium, total

carbohydrates, dietary fiber, sugars, proteins, vitamins A and C, calcium and iron were

evaluated for COSDA participants with and without diabetes and hyperglycemia.

Food and nutrient intakes influence the onset of NIDDM. In particular, intakes of

fat increase obesity during periods of physical inactivity since fat converts rapidly to

storage forms. Among US type II diabetics, 85-90% are obese (Editorial Diabetes Care

2000). Composition of dietary fat plays a significant role in type II diabetes. An inverse

relationship between vegetable fat and the incidence of NIDDM has been reported

(Meyers et. al 2001). Prolonged environmental, dietary and social assaults may express

themselves as increases in individual risk factor exposures. For example, social

incongruity and life style are associated with dietary, social, and psychosocial correlates

of serum lipids in an urban community sample. Life style incongruity also is a major risk

for high total serum cholesterol and low HDL cholesterol. Lower SES respondents have

lower cholesterol intakes than affluent ones (Dressler et al. 1991). Body mass mediates

relationships between sociocultural factors and serum cholesterol, suggesting that obesity

plays a role in elevating cholesterol and that total cholesterol is affected by SES or by

attempts to maintain general affluence in the context of lower SES.

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2.11 Statistical Analyses

For all quantitative variables means and standard deviations along with t - tests

comparing means between those with either fasting of 2-hour post load glucose levels

above 7.8 (140 mg/dl) and those below (non Type II, normal glycemia) are reported

(Table 3.2). For all qualitative variables, frequency distributions are presented for these

with and without Type II diabetes (Table 3.3). Multiple linear regression is used to

determine independent predictors of glucose level from the range of available covariates.

Logistic regression models are used to determine independent predictors of Type II from

the available array of sociodemographic life style and biophysiological variables.

2.12 Construction of Biomedical Indices:

All participants completed sociodemographic questionnaires (See Appendix A).

Diabetes/hyperglycemia as a dependent variable is examined with biological and

sociocultural risk factors as two categories of independent variables. The biological risk

factors are obesity, as measured by anthropometry and body mass index (BMI), and blood

pressure. Leibson et al. (2001) categorized BMI in the following ranges: BMI <18.5 =

underweight, 18.5 - 24.9 = normal weight, 25.0 - 29.9 = overweight, 30.0 - 39.9 = obese,

> 40 = extremely obese. Health risks are assessed according to the weight and health risk

chart below. A BMI less than 25 has a minimal health risk for a score of 1, 25 to less than

27 is low risk for a score of 3, 27 to less than 30 is moderate risk for a score of 3, 30 to

less than 35 is high risk for a score of 5, and over 40 is extremely high risk for a

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________________________________________________________________________

BMI Health Risk If combined with the other risks________________________________________________________________________Less that 25 1 Minimal Low25 – less than 27 2 Low Moderate27 – less than 30 3 Moderate High30 – less than 35 4 High Very High35 – less than 40 5 Very High Extremely HighOver 40 6 Extremely High Extremely High________________________________________________________________________

Treatment Recommendations________________________________________________________________________Minimum Moderate risk High and very Extremely high

Low risk________________________________________________________________________> Heathful eating > All of minimal High and very Extremely highand/or moderate and low risk and low and low moderate and deficit diet recommendations moderate risk high and very high > Increased plus low calorie recommendations recommendationsphysical activity diet plus drug therapy plus surgical > lifestyle change at very low calorie

diet________________________________________________________________________

Table 2.4 Diet and Health Risks________________________________________________________________________

score of 6 (See Table No. 2.3). BMI scores were calculated based on weight and height.

Participants with plasma glucose scores > 140 mg/dl were assessed as diabetic and

hyperglycemic (U.S., Department of Health and Human Services 1986).

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________________________________________________________________________

Diastolic________________________________________________________________________

Systolic > 85 85 – 89 90 – 104 105 – 114 > 115

Under 140 1 2 3 4 5________________________________________________________________________

140 – 159 3 3 3 4 5________________________________________________________________________

160 – 199 4 4 4 4 5________________________________________________________________________

> 200 4 4 4 4 5________________________________________________________________________

Table 2.5 Blood Pressure Value Box________________________________________________________________________

Participants with diabetes are given 1 point those without diabetes 0. The numerical value

for systolic and diastolic blood pressure risk was determined from the blood pressure

value box as presented in Table No. 2.

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CHAPTER 3

HISTORY AND FOLKLORE

3.1 Africans and African Americans

Folklore, literature, and historical reports provide a logical first step in unraveling

past and present environmental and ecological settings, laws, attitudes and behaviors that

may today predispose African Americans to type II diabetes. For example, the institution

of slavery was a global and long-term stressor. Still the effects of slavery, slave trading,

social disruption, apartheid, and desegregation on the health of today's African Americans

often are ignored. Previously, much of this ethnic group's population loss and disruption

were omitted from written history and distorted to justify enslavement, deny earlier

atrocities or escape restitution (Marketti 1990). The intent of this chapter is to examine

historical and cultural factors that may contribute to excessive risk for Type II in African

Americans today. My hypothesis is that enslavement led to major environmental

disequilibria that included inadequate nutrition, life-long psychosocial stresses, increase

disease risks, and arduous physical labor.

Using recorded information to examine the bio-history of Africans captured for

enslavement is problematic. Slavery records (e.g.: Bills of lading) were never widely

disseminated, although slavers were known to have kept extensive records. In addition,

narrative and folk knowledge that also recorded history through vernacular expression

and/or other genre of performances were often expressed in one social context and then

transported across categories, textures, texts, and/or other contexts. Most important is the

body of knowledge, thoughts, perceptions, behaviors and treatments redundantly

transmitted through time and space regardless of mode. Those circulated orally as

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folklore (Ben-Amos 1971), were written in prose or verse as literature, or chronicled in

thoughts, beliefs, and actions as history (McKay et al. 2000) and are equally important.

Folklore as a vehicle to examine the past of African Americans also is problematic

because nineteenth century folklorists reserved "folk" for Europeans who were illiterate,

rural, uncivilized, uneducated, and non-progressive peasants (Dundes 1980). It is

necessary to clarify matters regarding the interpretation, function, diffusion, and

limitations that might otherwise make it difficult to apply folklore to the epidemiology

and study of disease.

To interpret folklore correctly, the folklorist must evaluate the function, texture or

language features; the text or version of a tale, recitation, proverb, or folksong; the

context or specific social situation in which the item was employed; and the researcher's

statement of the use and purpose of the genre of folklore (Dundes 1980). Ben-Amos

explained that folklore is the sum total of knowledge shared by group members in a

society often as communal lore expressed in "collective actions of the multitude,

including public festivities, rituals, and ceremonies restricted to customs and

observances” (Ben-Amos 1971, p. 38). As a form of social interaction, folklore involves

stories, songs, music, painted pictures, and symbolic kinds of action that may be

classified as history and traditions. Symbolic modes of folklore include legends that often

signify chronological truth; myths that symbolize religious truth, and parables that imply

moral truth (Ben-Amos 1971).

Although folklore allows us to look at knowledge, behaviors and truth through

time and space as a communicative process, folklore has its social limitations that bind it

to a group for shared interaction among performer and audiences (Ben-Amos 1971).

Folklorists generally agree folklore that tradition forbearers produced folklore and carry it

through time and space to subsequent generations in "cultural baggage." Richard Bauman

(1971) described this as a "social matrix." This matrix is based in the ethnicity, traditions

and culture of "tradition bearers " who perform it, or tell it. These specifications of

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folklore caused controversy concerning whether the forbearers of African American

folklore were of European or African origin or both. Then an oppositional framework

developed that defined Europeans as folk, distinguished folk from elite, and separated

Europeans from the non-European "Other," often designated as "primitive." This

framework was based in ethnocentrism and European hegemony. Slavers established

paternity rights over African slaves and also claimed rights to the origins African

American folklore. Proslavery justified slavery as an institution that civilized the

"childlike primitives" by elevating their character, culture and vernacular expression to

European standards and levels of achievement (Roberts 2000, p. 81). This devolution of

African slaves, their history and vernacular expression contained blacks in a social matrix

that was created by whites. It allowed whites to produce, rewrite, and appropriate African

American history and erase African American history to facilitate the development of

African American folklore study within an Eurocentric discourse of folkness (Roberts

2000, p.84-85). Roberts explains this practice lasted until the politics of the late 19th

century made the inclusion of African Americans in a discourse of folkness necessary to

acculturate African Americans to Euroamerican cultural norms. Attaching African

American folklore to the African past during the apartheid era threatened Euroamerican

hegemony.

The vernacular expressivities of African Americans must not be approached as an

oppositional form of creative discourse if we are to discover how ideas, beliefs and

performances of African American vernacular expressions and performances record

knowledge as history and biohistory. As Roberts (2000) suggests, an African American-

centered approach to African American vernacular expressivities would eliminate the

Eurocentric bias that is inherent in culture-specific mode that is linked to the identity

formation peculiar to African people in the New World. He also explains that an African

centered approach would focus on the relationship between processes of vernacular

creativity and identity formation specific to African in America. It would also reveal how

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folklore incorporates history, biology, disease patterns, social conditions and political

processes as it circulates knowledge through time and space that is chronicled as legends,

myths, proverbs, tales, rumors and other genre of creative expressivity.

3.2 Hebrew Folklore

The legend of Noah-Ham-Canaan originated among ancient Hebrews and appears

in the Midrash, a book of Hebrew legends. It grants them divine authority to claim

ownership of the Promised Land or Canaanland. According to rabbis who circulated and

promoted this legend, Noah planted a vineyard after God judged and destroyed the world

with a cataclysmic flood. The transgressions of “falsehood” and “vexation” survived the

flood by entering the world through Noah. Accordingly, Noah became profaned through

the demon Shamdon or Satan (Bialik and Ravnitzky 1992:29). Supposedly, Noah allowed

Satan to drop the blood from a ewe, lion, and pig on the field before Noah planted

grapevines (Bialik and Ravnitzky 1992:29). The Bible says Noah made wine, got drunk

and

. . . was uncovered within his tent. And Ham, the father of Canaan, saw the nakedness of his father and told his two brethren without.

And Shem and Japheth took a garment, and laid it upon both their shoulders, and went backward, and covered the nakedness of their father; and their faces were backward, and they saw not their father’s nakedness.

And Noah awoke from his wine, and knew what his younger son had done unto him (Genesis 9:21-22).

No one knows exactly what Ham did to Noah, except that he looked at his naked

father. Breaking the privacy taboo was a transgression in tribal societies where people

lived in proximity without walls to separate them from others when they performed

personal and intimate acts. Rabbis amplified Ham’s transgressions with speculations in

the Babylonian Talmud that claimed Ham possibly practiced voyeurism (Drake 1987b),

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sodomy, bestiality (Drake 1987b), or “castrate[d] his father to prevent him from

increasing the number of progeny with whom they [Ham, Shem, and Japheth] would have

to share the inheritance” (Epstein et al. 1935-50 a). Rabbis explained penalties for these

sexual delinquencies as,

You have prevented me from begetting a young son to serve me, therefore that man [your son] will be a servant to his brethern!...Therefore I curse your fourth son. Your seed will be ugly and dark skinned... Therefore, Ham came forth black-skinned. . . (Ginzberg 1966).

This legend included Rabbis’ personal biases as the black-skin-color-curse appeared in

the legend after the sixth century enslavement of Jews with Africans in Babylon”

(Ginzberg 1966); Drake 1987). According to a Talmudic version of the Flood, Ham

became a black man because he also disregarded the injunction to separate from the

opposite sex in the ark ” (Rappaport 1968). Thus, rabbis also reported of Canaan’s

punishment that his children

“...shall be born ugly and black! Moreover, because you twisted your head around to see my nakedness, your grandchildren’s hair shall be twisted into kinks, and their eyes red; again, because your lips jested at my misfortune, theirs shall swell; and because you neglected my nakedness they shall go naked, and their male members shall be shamefully elongated.” Men of this race are called Negroes; their forefather Canaan commanded them to love theft and fornication, to be banded together in hatred of their masters and never to tell the truth (Ginzberb 1966, p. 45).

This legend loaded with derogatory stereotypes of Canaanites that continued until

the legend of ‘Alexander of Macedon’ became a part of the legend. The legend of

‘Alexander of Macedon’ explains how the curse of Canaan enabled ancient Hebrews to

claim Canaanland, moderns or Israel.

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“The Africans said, ‘The land claimed by Israel belongs to us, since it is described as ‘the land of Canaan with its various boundaries’ (Num. 34:2), and our forebear was Canaan. The Africans and Jews used the Torah to prove ownership of Canaanland. The Jews said, “ ‘Cursed be Canaan, the lowest of slaves shall he be to his brothers’ (Genesis. 9:25). Now, if a slave acquires property, since he is a slave, to whom does the property belong? Thus, the Jews proved ownership of Canaanland and the Canaanites fled, leaving behind their fields, which had been sown, and their vineyards, which had been planted” (Bailik and Ravnitzky 1992:166:29).

Hebrews mingled with, intermarried, and enslaved the Canaanites. Then they claimed

Canaanland and all its possessions and waged war against the Philistines who occupied

part of Canaanland (Mckay, Hill, Buckler and Ebery 2000), but were not Canaanites. The

Philistines were descendants of Mizriam, the second son of Ham and forbearer of the

Egyptians (Smith 1973). Including the Philistines, extended the original Biblical curse of

enslavement to non-Canaanite Africans on the basis that Ham’s black skin color applied

to all dark-skinned peoples. This, falsehood or myth set in motion a global folklore

pandemic of for all black skinned people were inferior and divinely appointed as slaves.

This led to the transfer of Africans’ physical energy, land, wealth, natural resources, and

lives to non-African peoples.

3.3 Arab Folklore

Long before slavery became a racial institution multicultural slavery was an

established Arab institution. Both customs and Islamic law required Arabs to obtain

slaves from non-Islamic groups including those of the Fertile Crescent, Africa, Central

Asia, India, China, the Byzantine Empire, and Europe (Lewis 1990). After the 5th century

collapse of Rome, the enslavement of Europeans in European countries was no longer

widespread (Everett 1988). Exceptions included German enslavement of Slavs during the

8th to 10th centuries and British enslavement by Anglo-Saxons, during the 10th to 11th

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centuries and the French 14 to 15th centuries. Reduced availability of European slaves,

the defeat of the Byzantine Christian Empire in 1453, the spread of Islam to Africa by

conquest, conversion, and/or enslavement, and the profitability of sugar and cotton

cultivation in the Iberian Peninsula revived Arabian needs for slaves and led them to seek

slaves elsewhere. In the 15th century, Europeans and Arabs converged on Africa to raid

for slaves, transforming multicultural slavery into racial slavery.

Arab cultures were infected by the Noah-Ham-Canaan folklore legend through

kinship with Ishmael and Abraham. Arabs raided Africa for slaves to use as miners,

domestics, soldiers, policemen, and harem guards (Lewis 1990). The Arab version of the

legend of Noah-Ham-Canaan explained the capture and enslavement of Africans.

“Ham the son of Noah was a white man, with a handsome face and a fine figure, and Almighty God changed his color and the color of his descendants in response to his father’s curse. He went away, followed by his sons, and they settled by the shore, where God increased and multiplied them. They are the blacks. Their food was fish, and they sharpened their teeth like needles, as the fish stuck to them. Some of the children went to West [Maghreb]. Ham begat Kush ibn Ham, Kan ‘am ibn Ham, and Fut ibn Ham. Fut settled in India and Sid and their inhabitants are the descendants. Kush and Kan‘an’s descendants are the various races of blacks: Nubians, Zanj, Qaran, Zaghawa, Ethiopians, Copts, and Berbers (Drake 1991 [1990], p 34).

Although chapters XXX:22 and XLIX:13 of the Qur’an are cited as proof that

Islam does not distinguish people by skin color, this legend reveals a pejorative view of

black skin color. Similarly, literature of the Aghrib al-‘Arag (black Arabs) expresses

resentment of the insults, inferior status, and discrimination they suffered. One tale

describes how Suhaym (“little blackie,” as Arabs called him) was burned to death by his

owner around 600 A.D. because he showed interested in Arabic women (Lewis 1979).

Arab lore also describes aggression and pejorative attitudes toward the Zanj, an East

African people. In Arab legends, the Zanj are “ugly, black, unintelligent, misshapen, and

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smelly people with kinky hair and sharpened teeth” (Lewis 1979, p.34); Lewis 1990);

Drake 1987b) who Arab men sexually exploited. Zanj slaves had little food, worked long

hours, could not marry, and were forbidden extramarital sex under Islamic law. Poor diet

and living conditions along with endemic and epidemic diseases caused high death rates

among the Zanj (Everett 1988). In 1776, the Zanj revolted, but were defeated by the

Arabs who ridiculed them as rebels, “rabbles,” “mobs of drunken slaves”, “good for

nothing” but to pillage, kill, ravage, loot and rape, and then raided Africa for more black

slaves (Lewis 1979, p. 11).

Additional folk sources of how African slaves circulated through Islamic society

are contained in Arab legends, history, and literature. These all repeat how Arabs

continually raided Africa to replenish their supply of slaves even as late as 1950 (Lewis

1990; Everett 1988). Although the legend of Noah-Ham-Canaan began among Hebrew

peoples it also justified enslavement of Africans in the Middle East, and then shifted

blame for the enslavement of black peoples to Christendom and Judaism (Lewis 1990).

3.4 European Folklore

Classical European folklore includes Osiris, a jet black Egyptian God. Osiris

brought civilization and turned into a man before civilizing Egypt. He then traveled to

India, Greece, and Rome to introduce cultivation, flood control, law and religion. The

Louvre Museum in Paris contains a statue of the god Osiris (Drake 1979). Before the Age

of Exploration many Europeans had heard of, but few had seen any black Africans. In

medieval Europe, folklore portrayed Africans mostly as folk and religious heroes. French

folk songs speak of Roland, an Ethiopian war hero, who led “fifty thousand blacker than

ink soldiers” with big noses, broad ears, and broad white teeth, alongside other Christians

in 8th and 9th-century campaigns against Muslims (Drake 1987). King Senapo of

Ethiopia (aka Prester John) also led troops who fought with other Christians and

Charlemagne. St. Maurice, an African knight, fought with the Holy Roman Empire army

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and Charles V of Germany to stop the advance of Ottoman Turks into Europe and North

Africa (Drake 1987). Africans helped preserve European and Catholic sovereignty and

pushed Muslims out of western Europe into Turkey (Drake 1987). Europeans honored

African folk heroes with shrines, cathedrals, statues, songs, tales, and legends. The most

honored Egyptian Emperor-Redeemer folk hero was the black Magus, a folk hero who

would save the world from imminent end (Psalms 68:31; Drake 1987) and then establish

a New Age (Kaplan 1984). The Magus was a dark-skinned offspring of the dark-skinned

Virgin Mary, the black Madonna to whom Europeans constructed over 250 shrines and

cathedrals (Drake 1987). “Tradition says that it was St. Luke who knew personally the

Mother of Christ and carved with his own hand the majority of these [statues of the]

black Virgins. If the Mother of Christ was not a Negro woman, how does it happen that

she is a black in France, Switzerland, Italy, and Spain?” (Rogers 1957)

The spread of Christianity introduced Europeans to the curse-on-Canaan legends

of Nimrod, grandson of Ham, and a political leader who built the first cities (Genesis

10:10-12). Church fathers such as Philo Judaeus associated the evil nature of Nimrod

with Ethiopians and equated black skin with sin, darkness and evil (Drake 1987). In the

3rd - 5th centuries, St. Augustine and the Church exposed a doctrine of racial prejudice

that through conversion to Christianity enslavement saved Africans from sin (Drake

1987). Although sin was seen as individual choice without ethnic boundaries, defining

black skin as evil made all Africans sinners, including righteous believers. The Church

used Paul’s New Testament statement supporting multicultural slavery to endorse the

enslavement of blacks. In actuality such racial slavery continued the policies of Rome and

Augustus Caesar who classified all Egyptians and Northern Africans dedicti (legal serfs),

legally segregated from the Greeks and Romans. In effect, early European interpretation

renewed Greek laws prohibiting intermarriage, preventing assimilation and relegating

African slaves to the lowest social strata. Because Africans then received inadequate

food, increased exposure to environmental hazards and stressful life style, they also

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suffered high suicide, morbidity and mortality rates and lowered life expectancies of 5 to

7 years (Littlefield 1991).

Diffusion of early Hebrew folklore throughout the Old World partly determined

acceptance of African enslavement. Although modern scientists reject the Ham legend,

classical and medieval folklore and literature promote Ham as the forefather of Africans.

Such religious, social, political, and cultural attitudes formed the foundations of 17th and

18th century polygenesis, monogenesis, cultural evolution, racial determinism, racism,

and the American School (Harris 1968). All of these advocated the philosophy that

Africans are inferior to Europeans. Only monogenesis believe that the races were created

separately. Followers of the American School including John Bachman supported the

prevailing Biblical justification of slavery:

“the Holy Scriptures tell how Noah blessed the descendants of Shem by making them ‘the parents of the Caucasian race—the progenitors of the Israelites and Our Savior. The Mongolians were the children of Japheth, and as the Bible predicted, many of them are still living in tents. Ham was the third of Noah’s son’s and the ancestors of the black “servant of servant” race. In slavery, the superior white race leads the inferior black race by the hand, protecting and improving them (Harris 1968, p. 80).

Racists today still quote Bachman’s version of the legend of Noah-Ham-Canaan to

advocate black inferiority and justify crimes against African Americans.

Negative connotations and denigration of Africans in folklore, history, science,

medicine and literature continued into 18th century in Europe. Once supplies of Native

Americans and Europeans became inadequate (Bennett, Jr. 1970) enslavement of

Africans replaced multiracial enslavement. Africans were more plentiful and better

resisted many Old World diseases (Mascie-Taylor 1993). They also produced four times

the labor of one Indian (Bennett 1970). Ultimately, Christian Europeans, Judaic

Hebrews, and Islamic Arabs all condoned enslavement of Africans before the 19th

century.

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3.5 A Clash of Ethos, Meanings and Cultures

This review has documented how folklore, history and literature illustrate how

past traditions and sociocultural conditions that contributed to physical hardships,

malnutrition, disease and death for Africans held in slavery. The next section surveys

European and African histories along with the ethos of their respective cultures to show

how cultural variables may have meanings and contributed to the recent epidemic of

Type II diabetes among descendants of African slaves. Both African and European

agrarian societies followed their own “little” and “great” traditions” (Bohannan 1968).

Little traditions are aspects of peasant culture. Great traditions include divine kingships,

centralized civilizations, and unilineal descent groups in Africa, and the Church and

anointed kings in Europe. Kings and nobility dominate while peasants perform duties,

produce goods, and support rulers, but benefit little from the great traditions. Both

African and European societies depended on the “manor’ (a city, village, church) as

central to their sociopolitical organization for survival.

3.6 Europe

Europeans had a major part in converting the institution of slavery from a

multicultural to a racial institution. European attitudes also laid the foundations of slavery

transfer to the United States and conditions of enslavement. Furthermore, the vestiges of

American slavery are all that are left on what created the environmental disequilibria that

led to the disease profile for African Americans today. The clash of European and African

ethos also impacted the effects slavery had on African American diet and disease profiles.

Slavery was an established aspect of European culture well before they entered the

New World. In classical Europe most slaves were Europeans. In the mid-5th century BC,

approximately 25% Greeks were slaves (Suzanne 1988). Slaves were essential to the

freedom, privilege, wealth and democracy of Greece. Most Greeks, including Aristotle

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and Plato, thought it was natural for some people to be slaves while others were masters

(Everett 1988). When slaves refused to accept their preordained fate, it also was

“naturally just” to hunt them down as “wild beasts” and force them into slavery

(Stavrianos 1975). Slaves’ refusal to submit to enslavement culminated in slave revolts

that spread throughout Greek colonies in Sparta, Egypt and the Punjab. These helped end

Greek slavery during the 3rd century B.C.

In the second century B.C., Rome built a military regime that depended on

territorial expansion and enslavement of populations it overthrew (Everette 1988). The

Roman Empire extended from England to the Black Sea and from Damascus into North

Africa. The Romans enslaved conquered people to work in mines, cities, and on

latifundias. In general, Roman slaves could not own property or enter into contracts such

as marriage, although they could enter contubernium (permitted cohabitation designed for

slaves under Roman Law). Slaves were killed if they failed to prevent the violent deaths

of their master and worked in grim conditions, ‘half naked . . . in chains, under lash and

soldiers’ guard (Everett 1988, p.19). Roman slaves frequently revolted to escape

starvation, beatings, brandings, insults and other forms of brutality. Spartacus led a revolt

of 90,000 runaway slaves who were defeated by 17,000 Roman soldiers. Roman soldiers

then crucified 6,000 rebel slaves along the Appian Way to dissuade other slaves from

rebelling or running away. Europe’s classical period of colonization and slavery began to

decline with the fall of the Western Roman Empire in 476 A.D. (Everett 1988).

The period between 476 A.D. and the discovery of the New World by Columbus

in 1492 is generally known as the Middle Ages or Dark Ages. Except for isolated

incidents already mentioned, the 5th century collapse of Rome ended widespread

enslavement of Europeans (Everett 1988). The mold was cast, however, and brutal

European slavery indifferent to humanity, human life, and living conditions had been

established. In addition to being detrimental to slaves, slavery also retarded European

technological development. Believing labor was beneath the dignity of freemen, owners

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selected manual labor over mechanical devices to keep their slave force active

(Stavrianos 1975). At the same time, European conquests and colonization continued as

a military ethos of rule and conquer led to warfare and disorder (McKay et al. 1992). This

military ethos led to the division of European society into three layers: 1) the privileged

nobility and the military class which were devoted to warfare; 2) peasants or serfs

performing manual labor, producing goods, paying royal taxes, church tithes, dues, and

set aside seeds for their lord; and 3) the monastery that produced the educated elite and

provided vital social services (McKay et al. 1998). Serfs in Eastern Europe were similar

to slaves. Peasants in Western Europe were free, but poor and bound to the land.

Agricultural and technological innovations of the Middle Ages improved life for

the European masses while epidemic diseases reduced population numbers. An open-field

agricultural system, a three-year crop rotation system, and introduction of the potato

increased food production and the population. However, death rates also soared during

famines, droughts or poor harvests (Buckler et al. 1992). The hungry succumbed to

influenza, smallpox, dysentery, and the plague. The Bubonic plague eliminated 30 to 75

percent of the 14th century population, and continued to devastate the population every

few decades until 1600 when brown rats which were poor hosts for the plague bacillus

replaced the black rats, the principal carriers of Yersina pestis (Mascie-Taylor 1993,

McKay et al. 1998). War also devastated the population. Wars were less destructive in the

17th century than between the 4th and 10th centuries when the Germans, Huns, Magyars,

Vikings and Moslems invaded Europe (Stavrianos 1975). From the 10th to the 14th

centuries Europe took the offensive on all fronts (Stavrianos 1975). Agricultural

production increased, but a cycle of poor harvests, bad weather, and wars during the 16th

and 17th centuries increased European death rates periodically. The overall effect of the

plague in Europe was the demise of the feudal system and the rise of the cottage industry

and middle class.

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By the 18th century, the food supply, social structure and economy were stressed.

Preindustrial Europeans developed a “put-out” system—a kind of capitalism in which

merchant-capitalists loaned raw materials to cottage workers who delivered finished

products such as textiles and other goods to the merchants for income (McKay et al.

1988). Extra income did not relieve economic or family pressures. Laws regulated

marriage and controlled public welfare by stipulating that men had to delay marriage until

they could support a wife usually by inheriting the family farm. Thus, premarital sex,

incest, and illegitimacy were common between 1750 and 1850 (McKay et al. 1988). By

the early 19th century, a third of all babies born in Paris, and 25,000 children a year in

other European cities were abandoned to foundling homes in a system of “legalized

infanticide.” Orphans were often victims of incest, or sired by married men, poor single

men, or poor husbands (McKay et al. 1988). Children of married women died from being

sent to wet or “killing” nurses who fed them (McKay et al. 1988). Other unwanted

children were victims of infanticide or aborticide. Children who were reared by their

parents were often victims of strict physical discipline, indifference, and brutality; they

were often sold to creditors or offered in oblation to monasteries. Eighteenth century

social and Christian activists encouraged parents to protect, love, nurse, and care for their

children. Philanthropists began donating money to monasteries to end “legalized

infanticide.”

3.7 Africa

The massive size of the continent makes it difficult to generalize about peoples

and cultures as diverse as Africa’s. “Africans have been frontiersmen who colonized

especially hostile regions on behalf of the entire human race.” Pioneering is the ethos of

Africans (Illiffe 1995, p. 1). The tradition of migrating to escape population pressures and

colonizing and surviving in harsh and inhospitable environments resulted in Africans

often struggling to establish equilibrium between environments and disease.

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African developments and innovations distinguish their versions of the little and

great traditions. The great tradition of divine kingship associates with the development of

metallurgy and everything that followed (Bohannan 1968, p. 99). Kings regulated the

distribution of wealth by accumulating gold from mining, collecting revenue from import

and export trading, and distributing gold dust as a medium of exchange. The great

tradition of divine kingship developed by solving three central problems facing all

societies’ infrastructures to support numerous large, self-contained, but distinct groups

(Davidson 1968), geographic and biological barriers to population movement, and

invention of new tools and techniques to improve the economic structure and master a

range of environments.

Africans solved population pressure by developing the extended family and

making the family a source of wealth, and sociopolitical power. The extended family

regulated morality and peace, along with political, social, religious and judicial

institutions (Davidson 1968). The family protected the young and old, free and enslaved.

It regulated motherhood and fatherhood with marriage, and promoted virginity. Elders

were sources of wisdom, respect and knowledge. When the family became too large, it

bifurcated around the extended family and migrated to available territories (Davidson

1968).

The second problem Africans overcame were obstacles restricting habitation of

certain African geographical areas. Africans resisted disease at molecular and

biochemical levels. One type of resistance provided Africans with hemoglobin and

enzymes to effectively exploit ecological niches in areas where malaria existed. Africans

also evolved high levels of resistance to certain parasites, bacteria, and infectious

diseases, including hookworm, anemia, and yaws in equatorial regions, endemic syphilis

in the savanna, and leprosy in equatorial regions and Iboland, and Trypanosomiasis in

West Africa (Illiffe 1995). The high prevalence of blood type O among Africans suggests

to historians that Africans south of the Sahara Desert may have also resisted the Bubonic

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Plague that devastated Eurasians in the 14 - 16th centuries (Illiffe 1995, McKay et al.

2000,Vol. B.).

Africans also mastered many environments, and improved economic structures

and invented new tools and techniques. They discovered and used metals, to fashion tools

and weapons. The discovery of metals stimulated sociocultural and agricultural

developments, population growth, craft manufacturing, and the production of gold

(McKay et al. 1988). Traders peddled goods to the world via trans-Saharan trade routes,

and along the East coast of Africa. By the 9th or 10th century, trade cities grew along

trade routes and developed into West and East African kingdoms and empires such as

Ghana, Hanem-Bornu, Mali, Songhay, and Axum. These states had effective

governments with civil servants and military forces that were funded with regular sources

of revenue (Davidson 1968).

The trans-Saharan trade affected West Africa in four ways. First, trans-Saharan

trade stimulated the development of Africa’s gold industry. By the twelfth century, gold

was West Africa’s major source of wealth and became the medium of exchange in

Europe and the Muslim world. The slave trade then developed as Africa’s second most

important export. Africans exported black slaves and imported European slaves from

slave markets in Venice and Genose (McKay et al. 1988). Europeans and Africans

perceived slaves were differently. Africans socialized their people to adhere to the

established social order by affiliating them into extended families with full family and

human rights or attached violators of the established order to family corporations as non-

kinsmen who had reduced family rights. Africans believed people were valuable, not

waste or “put out” products for destruction. Destruction signified social disharmony that

required discipline. Violators of the order were ignorant and needed education and

discipline to bring them into harmony with creation, righteousness, justice, and truth

(Asante 1990). Violators were regenerated and reintroduced into society. Prisoners of war

became slaves after their capture and social violators became slaves after their kinsmen

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“sold” them into slavery as a form of banishment for transgression. Slaves were kinless

members, of new extended families, and, like other family members they were wageless-

laborers who required the status and protection of the family. Although Paul Bohannan

and other Africanists characterize African slavery as a “benign” family-dominated

institution that enhanced family prestige as an institution of restitution, modern people

view slavery in any form as a transgression against inalienable rights. African slavery was

not practiced for subservience, servility or economic value (Bohannan 1964). Slaves

could earn high social status, marry, own property, own slaves, swear an oath, bear

witness, and inherit (Everett 1978).

Third, trans-Saharan trade stimulated the development of cities and empire

building around the beginning of the ninth century” (McKay et al. 1988). Between 1100

AD and 1400 AD African cities played a dynamic role in the commercial life of West

Africa and Europe, and became centers of intellectual creativity (McKay et al. 1988).

Fourth, trans-Saharan trade routes brought the intrusion of Arab culture that modified

African religions and cultural developments and destroyed indigenous African

civilizations and divine kingships (Bohannan 1964).

Intrusion of foreign cultures also brought diseases. Illiffe (1995) is uncertain

whether famines were devastating Africa before Europeans brought acute strains of

diseases. It is certain epidemics, wars, droughts, famine, pestilence, locusts, and cattle-

plagues followed the slave trade and became obstacles to economic development,

population growth and fertility. From 300 to 1000 A.D. West Africa received good

rainfall and was prosperous. Four centuries of dissication with an advancing Sahara

followed until 1630 before rainfall again increased. Most famines that followed were

localized. Although some crop failures and famines were consequences of deforestation

and environmental degradation, nearly all were due to war (Illiffe 1995).

Foreign intrusion also changed African slavery from Bohannan’s "benign"

institution to a cancerous pandemic that degraded African civilizations, social

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development, and health. Epidemics occurred among those clustering together for food

and water, when people moved into unfamiliar environments, or when wars and

oppression prevented people from exercising traditional survival skills (Illiffe 1995).

Epidemiological data mirror the record of the past and illustrate the effects of

pathogenic stressors in the slave trade and American slavocracy (King and Williams

1998). Todd Savitt said diseases that afflicted African slaves brought to the U.S. were in

most cases directly attributable to

“... lack of proper food, clothing, and shelter and to the occupational hazards and unsanitary conditions that abounded on plantations and in slave quarters. These abject conditions resulted in epidemic contagions of infectious diseases such as respiratory illnesses (tuberculosis, influenza, streptoccal disease, pneumonia, and the like), intestinal diseases (dysentery, typhoid fever) and other maladies, including malaria (1978 p. 49).

Instead of recognizing obvious pathogenic stressors of slaves’ environment,

physicians and proponents of scientific racism such as Samuel Cartwright and Josiah Nott

(1987) viewed slaves’ morbidity and mortality rates as evidence of blacks’ inherent

biological inferiority. These writers overlooked malnutrition, traumatic occlusion,

metabolic insults, and periodic near-starvation (Corruccini et al.1987, p. 179). Caribbean

slaves received 2,500 to 2,900 calories and 55 grams of protein per day. Strenuous

physical activity, with perspiration and stress, however, require between 3,200 and 4,000

calories daily and at least 100 to 125 grams of protein to maintain nitrogen balance (Kiple

1984). Slaves’ diets were low in fat content (20 grams of the 125 grams RDA) and

deficient in vitamins A, B1, B2, B3, C, D, K, iron, calcium, phosphorus, thiamine,

riboflavin, and niacin. Consequently slaves suffered greatly from deficiency diseases

including nytalopia or night blindness, sore eyes, scurvy, crib orbitalis, paraplegic dry and

wet beriberi, pellegra, iron deficiency, hypercementosis and other anemias, and scurvy

(Kiple 1984).

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Malnutrition, diets and diseases were similar among slaves in the United States.

Dietary deficiencies were reported among slaves in New Orleans (Owsley et al.1987),

Philadelphia (Angel et al. 1987), Virginia and Maryland (Blakley et al. 1994), South

Carolina (Rathbun (1987), and in Texas (Hutchinson 1987). Malnutrition caused “Harris

lines,” traverse lines, severe hypoplasias tooth root Hypercementosis, deaths and other

ailments (Rathbun 1984; Owsley 1987; Rathbun 1987; Corruccini et al. 1987).

Malnutrition in slaves typifies slaves’ led to the development of new foodways. Slaves

were fed “stock animal’ food that corresponded with their stock animal status they were

forces to assume. The stock animal food ultimately became known as “soul food” during

the twentieth century. Soul food, “food made with feeling and care,” is based in African

cookery (Helton 2002). However, slave masters modified the African diet in the United

States by adding “food waste” and “throwaway” foods that were often high-calorie, fat-

dense. Creative African cooks transformed undesirable foods into a “make do” cuisine

that incorporated foods from the Southern United States, West Indian, Caribbean, and

France. Blacks continued to modify their diet after emancipation. Food shortages then

caused African Americans to cook and eat together in large family groups. Soul food

became an occasion for mutual exchange and expression of love and care, assembly and

for renewal and renovation.

African slaves were not allowed to own necessities or personal possessions. Food

selection, quantities, and acquisition were limited and determined by slave masters,

seasons of the year, weather conditions, and crop production. Africans attained freedom

from some of these restrictions through distinct and creative cookery that infused regional

foods with African foods brought with them through the slave trade. African foods

integrated into slave diets included sorghum, yams, eggplants, cucumbers, garlic, onions,

(Soul Food 2002), lima beans and other legumes (Holloway 1990), sesame seeds, cow

peas or black eye peas, okra, watermelon, and peanuts (Helton 2002). Peanuts came from

Guinea via South America to North America (Helton 2002). Slaves boiled and steamed

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vegetables to make soups and stews. They also smoked foods for flavoring following

techniques used in Africa. They didn’t have African palm oil or vegetable shortening for

frying or groundnuts for thickening sauces and gravies. Instead, they used pork lard to fry

meats, pies, fishes, vegetables, and fruits to add nutrients and for easy transport of these

foods to work places (Soul Food 2002). Meat was sparser in the slave diet than it was in

the African diet (Soul Food 2002; Helton 2002). The average slave diet was similar to the

mostly vegetarian African diet that sometimes included rice, chicken, and milk, while the

poorest Africans ate a type of couscous with leafy vegetables (Soul Food). This same kind

of food, consisting of a small portion of rice and beans with occasional vegetables or a

piece of fruit during the transatlantic voyage, replaced the normally healthy diet (Soul

Food 2002). As a substitution for the more frequent stale bread and water during the

voyage to the New World, a “slabber” sauce, made from old beef and rotten fish and salt,

was poured over the rice and beans (Soul Food 2002).

Slaves' diets were frequently inadequate in quantity, seldom adequate in calories, and

usually lacking in sufficient protein and vitamins (Kiple and Ornelas 2000). A few

fortunate slaves had vegetable gardens. When in season, throwaway vegetables such as

turnips, beet and dandelion tops, collards, kale, cress, mustard, and pokeweed were

seasoned with lard and crackling from hog’s skin (Soul Food 2002). The use of fat rather

than lean pork for slaves was justified by slave masters’ conviction that fat provided

energy needed for hard physical labor (Kible and Ornelas 2000). Fat meats included

infrequent and inadequate portions of throwaway meats, also known as “juba”. These

included pigs’ and chicken’s feet, cow and pig head, pig ears, ham hocks, chitterlings

(also called “gut strut”), hog jowl, tripe, and crackling (Soul Food 2002). Most slaves

relied solely on rations their masters frequently dispensed as salt pork or salted fish, corn

meal, and sometimes molasses or sweet potatoes (Holloway 1990; Kiple and Ornelas

2000). Fluid loss from toiling in the hot sun was replenished with watermelon in the field,

the salt in salted meat and fish, and “pot likker,” seasoned cooking water from boiled

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vegetables (Helton 2002). Sugar obtained from sugar cane, molasses, and sorghum

provided quick and needed energy. Slaves made hoecakes and ashcakes, the forerunners

of corn bread.

Hoecakes are corn bread batter cooked in the field on spades or hoes held over an

open flame. Ashcakes are corn meal and water that were shaped into loaves and baked on

the ground in an open fire from sun up to the midmorning break. The ashes were brushed

or washed away before eating. Overall, slaves’ diet consisted largely of vegetables and no

alcoholic beverages.

African cookery and slaves’ creativity were combined with the Southern, West

Indian and French cuisines to produce innovative dishes. They combined rice and corn

with beans and peas to make Hoppin’ John (Helton 2002). Poke Salad, a combination of

dandelion and cresses, was a favorite. French-influenced Creole dishes such as Jambalaya

and okra in gumbo were created from a variety of spices, bay leaves, and hot pepper

sauces. The combinations of foods, forced eating habits, cooking techniques, and creative

cookery gave birth to soul food.

Foods that were once cooked in slave quarters, black homes, churches, and

businesses later became known as Soul food. Other foods were also popular among

African Americans and added to the soul food list. Black farmers added pork brains and

eggs, onions and eggs, slab bacon, home made sausage, cornbread and milk, biscuits and

sorghum, fried tomatoes, white beans with rice and hammocks, sugar cane, cornbread

pancakes and sorghum, and buttermilk. Northern city blacks cooked dinners of barbecued

pig’s feet, macaroni and cheese, sweet potato pie, fruit cobblers, pound cake, fried

potatoes, and fried steak. They had fritters, eggs cooked in cream of wheat, grits with

tomato gravy and fried chicken or fish and biscuits for breakfast. Later, poor inner city

blacks living on welfare added Spam, corn pudding, bean pies, and fried pies to this diet.

Nearly all soul foods are high in calories and animal fats since vegetables were boiled in

fat back or hammocks, and seasoned with bacon scraps and drippings, vegetable

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shortenings or lard. The meats were usually floured or breaded before frying in the same

fats. Desserts were made from large quantities of butter and sugar, and covered with very

sweet and buttery frostings or sauces. Beverages were usually red in color, and syrupy

sweet. Rolls, muffins, biscuits, and cornbread were served piping hot to melt sizable

dollops of butter and hefty portions of jams and jellies.

The emancipation of slaves in 1865 released them from plantations where food

was constant, but inadequate. Freed bondsmen were often without jobs to buy food. Freed

bondsmen had to increase their culinary innovation to prevent starvation. They used every

possible type of food to survive, including wild vegetables, nuts, berries, game, and stale

and rancid meats and breads. They hunted animals and fished. Opossum was the favorite

meat. They made bread pudding from raisins and/or apples and stale bread, and topped it

with a sugary lemon sauce. They mixed leftover fish with eggs, cornmeal and/or flour and

deep fried it to make croquettes (Soul Food 2002). They made biscuits from sour milk,

soup from left over vegetables, potato pancakes from leftover mashed potatoes, hash from

leftover meats and potatoes, and hush puppies from dredgings of catfish. They reused

cooking fats to fry other foods. In the beginning of the twentieth century, they made the

ever popular “wish sandwich” from two slices of bread spread with sugar, syrup,

sorghum, molasses, or mayonnaise, and, “Wished they had a piece of meat!” The 1960s

food stamp program provided Spam, government cheese, and peanut butter to fill and

displace wish sandwiches.

The high fat, salt and sugar content of soul food was retained by habit, social and

economic necessity, eating preference and desired flavoring although the Civil Rights

Movement and the Food Stamp Program gave blacks access to better quality and

abundant food supplies. Removal of education, job and opportunity restrictions and

entrance into low labor desk jobs in air conditioned and heated offices rendered high fat,

salt, and sugar foods no longer a survival necessity.

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A food developed and modified for survival, soul food of the twenty-first century,

is undergoing a major revolution that started during the enlightenment of the 1970s Afro-

centric Movement. Blacks became aware soul food was a vestige of slave culture that had

been forced on, and inadvertently passed on, to them. They learned how slave owners

increased their profits by depriving slaves of a healthy human diet and fed slaves like

stock animals. These blacks attended seminars and read national newspapers published by

the Nation of Islam and The Black Panthers that told how excessive fat, sugar, and salt

helped African Americans survive labor-intense adversities of enslavement. The slave

diet was no longer advantageous but hazardous to free people who lived and worked in

desegregated communities and engaged in reduced and normal physical activity.

Scientific research of the 1980s and 1990s documented the claims of the Afro-

centric Movements to reinforce the teachings of Dick Gregory and the Honorable Elijah

Muhammad and Louis Farrakan. They encouraged blacks to abandon the slave diet of

waste foods and high fat, sugar, salt. Educated blacks responded to the soul food diet by

substitution or abandonment. Those who altered their cooking and eating habits replaced

lards with Canola and olive oil (Soul Food 2002). Many blacks stopped frying foods and

began baking, boiling, grilling, smoking, and broiling meats. They trimmed fats and skin

from meats and had money to buy more expensive, leaner cuts of meat. They eliminated

oils, fat meats, and greases from cooked vegetables. Other blacks ate raw vegetables.

Many blacks stopped eating pork or substituted chicken for pork, oven frying for deep

frying and simple fresh fruit for sweet cobblers and bread puddings (Soul Food 2002).

Bean pies replaced pound cakes and other high fat and sugar desserts. Many blacks

adopted the vegetarian African diet of their ancestors. Other health cautious blacks

restricted their diets to fishes, organic vegetables, low fat foods, olive and other oils, and

low amounts of sugar and salt. The “Soul Food Revolution of the 21st Century” is

characterized by adoption of healthy eating habits, acquisition of health club

memberships, personal trainers, and dietitians. The goal is to lose weight through

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increased physical activity. Beauty standards are changing to conform to physical fitness.

The Soul Food Revolution of the 21st Century is the beginning of a new health and life

style for more knowledgeable middle class and educated blacks of all ages.

Nutritional conditions deteriorated after freedom in 1865 (Martin et al. 1987)

because most freed bondsmen could not find work or were paid insufficient

discriminatory wages. Near starvation conditions lasted until the 1940s (Martin,

Magennis and Rose 1987; Farley 1970; Holmes 1937). High mortality and morbidity

rates, gross pathologies and national population decline exceeded antebellum rates to

cause Farley (1970) to declare a “Biological Crisis” for post-Reconstruction blacks. In the

1930s, Holmes (1937) predicted the imminent disappearance of African Americans.

Pathogenic stressors during and after enslavement provide conclusive and indisputable

evidence of environmental disequilibria for Africans.

3.8 Sociocultural Factors

3.8.1 Life Style/Stressors

Human history is characterized by two major cultural transformations. First,

socioeconomic systems changed from simple to complex industrial and technological

production (McGarvey, Bindon, Crews and Schendel 1989:263). Second, labor activities

changed from intensive or extensive labor systems to sedentary labor systems with less

physical activity. These cultural transformations have been paralleled by a disease

transformation from “epidemics of acute and infectious diseases to our current epidemic

of chronic and multi-factorial disorders as the major causes of morbidity and mortality”

(Davidson, Frankel and Smith 1992:675). Approaches to disease eradication now include

treatment, intervention and prevention, and are expanded in spectrum to include

environmental factors in disease etiology relating to modern disease transformations.

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Likewise, studies of human culture must also expand to include research on the impact of

sociocultural risk factors and “life stresses” on humans.

A study of “life stresses” among African Americans and their associations with

diabetes, obesity and hypertension will improve understanding of social inequality and

cultural and disease transformations (Grim and Wilson 1992). “Life stresses” include “all

the usual external forces affecting any individual—inadequate diet, disease, occupation,

childbirth, accidents, violence, nutritional stresses (Blakely et al., 1994; Rathbun, 1985;

Corruccini, 1987; Owsley et al., 1987), occupational stresses, psychological stresses

(Seligman, 1975; Angel et al. 1987) and pathological stresses, (Kelley and Angel 1987;

1996). Life stresses yield consensus models of cultures or subcultures that represent

cultural constructs of life style producing characteristic differences in status, prestige,

social distinction, and health styles that are caused by differential role performance.

Obviously, “life style is highly structured and widely shared across sub-

communities” (Dressler 1996:350). African Americans are not a monolithic group whose

members have identical life styles, social identities, social values, ideas of success, social

patterns, personal choices, and health consequences. Instead, as members of a subculture,

African Americans use different strategies to overcome similar obstacles and restrictions,

have different abilities to adhere to cultural models, succumb to varying internal or

external loci of individual and social controls that predispose individuals to and influence

behavior, role performance, the realization of goal aspirations, and opportunities to

achieve cultural ideals of consumption. The examination of life style variables

demonstrates how exposure to suspect sociocultural risk factors creates intercultural life

style patterns associated with diabetes, hypertension (Grim and Wilson 1992) and obesity.

Culture specific stressors suspected of contributing to African American life style

examined here include those that cause sudden unpredictable and cataclysmic events in

the life of Blacks in color line societies. These acute stressors are examined first,

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followed by the examination of chronic stressors, then dietary factors that may contribute

to the onset of diabetes.

3.8.2 Acculturation: Acute Stressors

William Dressler’s (et al. 1996) study of life style in the color line society of

Brazil demonstrates that skin color is associated with life style variables and disease.

Skin color, underpinned by ethnicity, is a cultural key that generates cultural models

reflected by social classes, value systems and manifestation, ideals of success, social

patterns of behavior, and differential opportunity structures, all of which predict life style

and health styles, including the popular culture of prophylactic behaviors concerning diet,

leisure activities, drug use, health threatening and risky behaviors, and personal body

maintenance (Davison et al., 1992). Dressler’s research on family health (1994) also

shows that family health and social status not only predict health relative to social, dietary

and psychosocial stressors that affect physiological indices such as serum lipids, serum

cholesterol, high density lipoprotein cholesterol, and triglycerides, but also reflect

indicators of health and status that probably begin in utero and continue throughout life as

manifestations of chronic and multifactorial diseases.

Chronic diseases, whose prevalence previously was lower for blacks than for

whites, increased among black men and women during the 1960s. The low type II

diabetes prevalence among African Americans’ ancestors and the drastic disease increase

after rapid social and political changes, particularly the civil rights movement, suggest

sociocultural factors as triggers or causative factors in the onset of type II diabetes.

Humans have the biological capacity to adapt to rapid rates of contemporary change

(Thomas, Gage and Little 1989:296).

Researcher’s trepidation concerning elevated type II diabetes prevalence

recognizes the life-threatening nature of heightened type II diabetes prevalence among

African Americans. Epidemic diseases can trigger large-scale mortality or cause

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extinction (Haldane 1949:68-76). The life-threatening prevalence of type II diabetes

among African Americans prompted this study of diabetes causation and associated

disease risks targeting the identification of sociocultural risk factors that are suggestive of

environmental, social, and life style changes with consideration of ecosystem

disequilibria as a contribution to the current diabetes rate.

Most of today’s African Americans are descendants of slaves who were selected

generally because of their knowledge, skills, health, fitness, ethnicity, and specifically

from West Africans for their cultivation-technological skills and specifically from Central

Africa and Madagascar for their knowledge of rice farming (Holloway 1990:4). The

Central African Civilization of the Granaries and the West Africa Civilization of the

Cities developed intensive agriculture to support urban populations that emerged during

the 5th to 8th centuries. These intensive agriculturalists reformed their ecosystems with

intensive physical activity that created an artificial balance between high productivity

levels and a large population. Disturbance of the artificial balance by a decline in physical

activity would diminish productivity levels, create droughts, and increase silt, insects and

weeds (Plog, Jolly and Bates 1976). Extraction of 40 million Africans from Africa during

the African Holocaust disturbed the artificial balance, causing detrimental effects in these

early non-industrial farming communities where intensification was powered by human

energy.

Human energy produced more food per acre by investing more work per acre.

African agriculturalists were so successful that their agricultural surplus supported large

populations to support urban areas (Plog, Jolly and Bates 1976) such as Audaghost,

Timbuktu, Ife, Kumbi Saleh, Mali, Jeriba, Mani-Kura, Miani, Dura, Kano, Rano, Zaria,

Gober, Katsena, Biram, Ndjimi, El Fasher, Kumasi, Sao, Benin, Abome, Agni, Abomy,

and Nok, to name a few. From the 15th to the 18th centuries, Africans made rapid

adjustments as individuals were extracted for slavery. These systems went from intensive

agricultural with intensive physical activity and adequate food supplies to slavocracies

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that demanded systematic overloads characterized by excessive physical activity, gross

pathologies and scarce food supplies. In the late 19th and early 20th centuries they were

exposed to a “biological crisis” period that began with widespread starvation, increased

pathologies, overwhelming life stresses, and high rates of morbidity and mortality

(Holmes 1937) that began with emancipation and continued with the development of

American apartheid. The Reverend Martin Luther King, Jr. led a massive desegregation

movement that ushered in for African Americans throughout the US rapid and drastic

social changes that were followed by high prevalence of diabetes, obesity, hypertension,

and other Syndrome X diseases. Therefore, it is probably more bioculturally,

environmentally and historically accurate to examine sociocultural factors associated with

this prolonged period of environmental dissonance as contributing factors to today’s

African American health crisis than to attribute African Americans’ diabetes prevalence

simply to modernization, westernization, urbanization or industrialization.

100

CHAPTER 4

Results:

BIOLOGICAL AND SOCIOCULTURAL VARIABLES

4.1 Introduction

Means and standard deviations for the major variables, indexes, correlations

between dependent and independent variables and univariate analyses are examined for

all biological and sociocultural variables. Also, Hypothesis 1 is examined by statistical

analysis univariate relationships between sociocultural variables are examined to test

Hypothesis 2.

4.1.1 Descriptive Statistics Summary

This section provides a summary of the descriptive statistics for the study sample

detailing the socio-demographic, lifestyle/stressor, acculturation, health behaviors, and

dietary variables across gender, social era, and organization. It is important to note that

only variables measured on an interval or ratio scale are included here since comparisons

are made to test for significant differences between or among groups. It would be

inappropriate to include variables measured on an ordinal or nominal scale since variables

cannot be subjected to t tests or /ANOVA/. It must also be noted that the results of t tests

are given for differences between gender and social era groups (two levels for each

101

variable), and the results of ANOVA’s are given for the organization groups (seven

levels). Tables 4.1 – 4.15 are organized by gender, social era, and organization, and

contain the means, standard deviations, t or F values, and the probability level associated

with each test.

Tables 4.1 – 4.5 present results.

Men Women

Age N X SD N X SD t p

20 50.35 11.74 50 55.50 12.06 -1.63 .11

Table 4.1. Descriptive Data for Age by Gender

Male Female

Variable N M SD N M SD t p

Lifestyle score 14 164.54 49.83 37 272.89 240.86 -1.67 .10

Anger score 13 97.31 2.53 41 96.22 3.31 1.09 .28

Discrimination 13 11.00 5.47 36 7.10 5.13 2.31 .03index

Lifestyle Incong- 14 9.01 2.15 37 7.34 3.76 1.56 .12ruency index

Table 4.2. Descriptive Data for Lifestyle/Stressor by Gender

102

Male Female

Variable N M SD N M SD t p

Drinks per month 19 30.96 54.14 50 4.68 10.28 2.10 .05

Cigarettes per 19 8.89 11.76 50 8.09 11.08 .27 .79month

Health threat 18 54.67 61.13 50 27.93 18.36 2.79 .01index

Table 4. 3. Descriptive Data for Health Behaviors by Gender

Men Women

Variable N M SD N M SD t p

Systolic blood 19 133.18 13.65 50 130.53 19.60 .63 .53pressure

Diastolic blood 19 81.63 9.17 50 78.54 10.52 1.13 .26pressure

Fasting glucose 20 113.20 19.03 50 129.62 65.36 -1.10 .28reading

Post-load glucose 20 136.55 67.78 50 132.12 65.75 .25 .80reading

Average pulse 19 33.70 6.09 50 37.28 9.83 -1.48 .14

Body mass index 19 29.20 3.73 50 30.00 5.81 -.56 .58

Table 4.4. (Continued). Descriptive Data for Blood Pressure, Glucose, Anthropometry and Dietary Variables by Gender

103

Table 4.4. (Continued).

Male Female

Variable N M SD N M SD t p

Body mass 19 3.11 1.15 50 3.24 1.32 -.39 .70index risk

Calories per day 12 4743.16 3196.93 33 2442.70 1070.16 2.44 .03

Fat calories 12 1346.01 728.61 33 1006.59 514.95 1.74 .09per day

Saturated fats 12 68.26 36.00 33 46.43 24.86 2.30 .03per day

Proteins per day 12 160.03 105.52 33 249.93 883.28 -.35 .73in grams

Carbohydrates 12 616.81 535.00 33 273.19 112.36 2.20 .05per day

Sugar total 12 374.24 451.86 33 128.57 65.16 1.88 .09per day

Total fat in 12 178.27 95.51 33 111.37 58.03 2.85 .01in grams

Total cholesterol 12 559.89 355.07 33 328.83 212.30 2.12 .05in grams

Vitamin C in mg 12 345.18 278.14 33 245.60 162.65 1.17 .26

Vitamin A 12 12255.10 7474.99 33 13570.06 8394.98 -.48 .64

Calcium in mg 12 2504.04 3200.74 33 843.58 487.00 1.79 .10

Iron in mg 12 26.84 13.58 33 18.45 11.58 2.06 .05

Sodium in mg 12 5422.94 3114.12 33 3756.43 4486.56 1.18 .24

104

Several variables evidenced significant differences between the mean scores of

men and women. These were: discrimination, alcoholic drinks per month, health threat

index, calories/day, saturated fats/day, carbohydrates/day, total cholesterol/day, and

iron/day. In all cases, men had significantly higher scores than women. No significant

differences were noted for any of the other variables.

Tables 4.6 – 4.9 provide descriptive data and results of the t tests across the two

levels of social era.

Apartheid Civil Rights

Age N M SD N M SD t p

41 62.22 8.13 29 42.45 5.50 11.38 .00

Table 4.5. Descriptive Data for Age by Social Era

105

Apartheid Civil Rights

Variable N M SD N M SD t p

Lifestyle score 28 249.34 238.43 23 235.61 178.72 .23 .82

Anger score 29 97.41 1.59 25 95.40 4.08 2.45 .02

Discrimination 24 7.75 6.28 25 8.50 4.62 -.48 .64

index

Lifestyle incong- 28 6.97 2.15 23 8.80 4.43 -1.81 .08ruency index

Table 4. 6. Descriptive Data for Lifestyle/Stressor by Social Era

______________________________________________________________________Apartheid Civil Rights

Variable N M SD N M SD t p

Social support 41 16.24 8.61 28 15.96 7.61 .14 .29score

Relaxation index 28 9.79 4.58 24 7.63 4.56 1.70 .88

Table 4.7. Descriptive Data for Acculturation by Social Era

106

Apartheid Civil Rights

Variable N M SD N M SD t p

Drinks per month 41 8.10 21.53 28 17.54 41.92 -1.10 .28

Cigarettes per 41 8.72 11.65 28 7.71 10.67 .36 .72month

Health threat 40 31.17 28.40 28 40.49 45.80 -1.04 .31index

Table 4.8. Descriptive Data for Health Behaviors by Social Era

Apartheid Civil Rights

Variable N M SD N M SD t p

Systolic blood 41 138.16 14.30 28 121.17 18.56 4.29 .00pressure

Diastolic blood 41 79.70 9.59 28 78.94 11.18 .30 .77pressure

Fasting glucose 41 123.17 50.01 29 127.41 65.39 -.31 .76reading

Post-load glucose 41 137.46 59.36 29 127.62 78.84 .61 .54reading

Table 4. 9. (Continued). Descriptive Data for Dietary Variables by Social Era

107

Table 4. 9.(Continued).

Apartheid Civil Rights

Variable N M SD N M SD t p

Average pulse 41 35.76 7.92 28 37.08 10.62 -.59 .56

Body mass 41 29.93 4.11 28 29.58 6.76 .24 .81index

Body mass 41 3.37 .94 28 2.96 1.62 1.18 .24index risk

Calories per day 25 2709.50 1193.68 20 3489.47 2853.31 -1.24 .22

Fat calories 25 1109.93 564.62 20 1081.08 635.72 .16 .87per day

Saturated fats 25 45.92 21.95 20 60.16 35.84 -1.56 .13per day

Proteins per day 25 309.02 1012.44 20 122.11 94.78 .82 .42in grams

Carbohydrates 25 299.30 148.75 20 446.73 448.32 -1.55 .13per day

Sugar total 25 146.58 95.11 20 253.46 367.71 -1.27 .22per day

Total fat in 25 122.45 63.99 20 137.66 87.86 -.67 .51grams

Total cholesterol 25 373.09 252.67 20 412.13 303.47 -.47 .64in grams

(Continued).

108

Table 4. 9 (Continued).

Apartheid Civil Rights

Variable N M SD N M SD t p

Vitamin C in mg 25 269.30 229.44 20 275.73 165.58 -.11 .92

Vitamin A 25 12853.40 5985.55 20 13676.91 10305.06 -.34 .74

Calcium in mg 25 1351.73 2109.26 20 1204.66 1405.40 .27 .79

Iron in mg 25 21.37 12.72 20 19.82 12.64 .41 .69

Sodium in mg 25 3347.46 1458.22 20 5267.55 5996.72 -1.40 .18

An examination of the five tables above shows significant differences in only

three of the variables. The first one, age, was expected since the definition of social era

was to categorize participants by social and political conditions they were born into, and

the apartheid era group naturally was older. The apartheid era group, however, also had

significantly higher mean scores on the anger index and systolic blood pressure.

The next five tables (Tables 4.10 – 4. 14) present the descriptive data across

organizations samples for this study.

109

Organization

Age 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

9 16 15 6 19 1 257.78 49.44 56.73 41.83 58.95 55.00 42.00 2.90 .02

(15.16) (10.95) (12.09) (8.84) (9.61) ─ (2.83)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization. Table 4.10. ANOVA Results for Age by Sample Source

110

______________________________________________________________________

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Anger score 9 16 15 5 6 ─ 297.78 96.75 95.60 93.60 98.00 ─ 97.00 1.79 .13(1.86) (2.44) (3.96) (4.72) (1.55) ─ (1.41)

Discrimination 8 15 12 6 6 ─ 2index 7.56 7.90 4.79 13.08 10.25 ─ 11.00 2.56 .04

(4.80) (2.44) (3.96) (4.72) (1.55) ─ (1.41)

Lifestyle Incon- 9 16 12 6 6 ─ 2gruety index 6.11 7.85 7.96 7.29 9.53 ─ .10 .96 .45

(1.86) (2.44) (3.96) (4.72) (1.55) ─ (1.41)

Lifestyle score 9 16 12 6 6 ─ 2323.78 212.56 292.13 247.33 135.00 ─ 143.00 .85 .52

(168.88) (119.09) (361.08) (183.35) (27.05) ─ (24.04)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

Table 4.11. ANOVA Results for Lifestyle/Stressor by Sample Source

111

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Social support 9 16 15 6 19 1 213.89 15.13 12.60 14.67 20.32 32.00 14.00 2.40 .04

(7.18) (8.70) (8.14) (5.61) (7.33) ─ (5.66)

Relaxation 9 16 13 6 6 0 2index 9.67 11.91 7.08 6.33 7.33 ─ 8.50 1.52 .19

(4.80) (5.15) (3.28) (3.44) (4.97) ─ (4.95)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

Table 4.12. ANOVA Results for Acculturation by Sample Source

112

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Drinks 9 16 15 6 19 1 2per month 3.83 23.11 12.63 8.83 5.57 7.50 31.00 .67 .67

(3.74) (53.42) (31.92) (11.07) (13.83) ─ (43.84)

Cigarettes 9 16 15 6 19 1 2per month 3.94 7.38 10.32 9.27 8.81 11.00 15.50 .46 .84

(6.41) (10.71) (10.19) (10.60) (14.01) ─ (21.92)

Health threat 9 16 15 6 18 1 2index 21.00 44.53 39.29 35.93 28.88 40.50 53.00 .58 .75

(9.26) (57.09) (36.67) (22.77) (23.11) ─ (62.23)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

Table 4.13. ANOVA Results for Health Behaviors by Sample Source

113

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Systolic blood 9 16 14 6 19 1 2pressure 132.98 129.81 133.79 108.17 134.81 139.00 151.00 2.48 .03

(17.08) (16.66) (17.52) (13.15) (18.22) ─ (22.63)

Diastolic blood 9 16 14 6 19 1 2pressure 79.00 80.00 78.39 70.17 80.96 82.00 92.00 1.48 .03

(9.36) (12.46) (10.23) (9.35) (8.34) ─ (4.24)

Fasting glucose 9 16 15 6 19 1 2reading 138.00 115.44 136.00 157.83 108.42 126.00 139.00 .85 .54

(50.91) (12.19) (71.21) (140.10) (23.12) ─ (18.38)

Post-load glucose 9 16 15 6 19 1 2reading 126.56 135.88 125.47 92.67 141.53 189.00 227.50 1.31 .27

(75.05) (39.66) (79.49) (54.81) (63.19) ─ (125.16)

Average pulse 9 16 14 6 19 1 235.67 33.94 38.93 38.97 36.21 34.00 36.00 .45 .84(4.41) (10.88) (8.90) (8.96) (10.38) ─ (1.41)

Body mass 9 16 14 6 19 1 2index 30.77 29.51 28.66 27.72 30.88 34.00 29.00 .53 .79

(6.27) (7.23) (4.75) (4.25) (3.75) ─ (8.49)

Body mass 9 16 14 6 19 1 2index risk 3.44 3.00 2.93 2.50 3.63 4.00 3.00 .95 .47

(1.51) (1.55) (1.41) (1.22) (.83) ─ 2.83)

Calories per 7 15 10 6 5 0 2day 3870.20 2628.48 2420.99 3876.38 3085.63 ─ 3556.02 .52 .79

(4223.06) (863.34) (1820.30) (2476.62) (747.50) ─ (831.24)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

Table 4.14. (Continued). ANOVA Results for Dietary Variables by Sample Source

114

Table 4.14. (Continued).

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Fat calories 7 15 10 6 5 0 2per day 1240.40 1026.93 1055.21 970.29 1244.10 ─ 1344.31 .24 .96

(882.78) (334.14) (864.92) (517.87) (308.16) ─ (290.67)

Saturated fats 7 15 10 6 5 0 2per day 49.30 48.76 49.42 69.27 49.20 ─ 59.43 .39 .88

(38.37) (24.29) (37.50) (33.38) (12.78) ─ (6.55)

Proteins in grams 7 15 10 6 5 0 2per day 134.26 434.35 115.11 143.57 94.76 ─ 113.30 .26 .95

(118.77) (1306.30) (121.27) (111.03) (27.69) ─ (51.48)

Carbohydrates 7 15 10 6 5 0 2per day 527.24 314.66 238.38 475.38 384.74 ─ 423.40 .71 .64

(717.54) (142.28) (179.38) (287.54) (110.81) ─ (47.84)

Sugar total 7 15 10 6 5 0 2per day 345.31 160.29 139.63 222.70 144.13 ─ 229.58 .54 .78

(616.01) (111.25) (124.22) (126.33) (65.95) ─ (1.58)

Total fat 7 15 10 6 5 0 2in grams 138.57 114.18 115.98 163.65 138.23 ─ 149.37 .38 .89

(97.62) (37.11) (99.11) (112.08) (34.24) ─ (32.29)

Total cholesterol 7 15 10 6 5 0 2in grams 463.04 374.83 354.57 468.89 294.29 ─ 437.87 .28 .94

(426.36) (213.46) (333.13) (261.21) (135.55) ─ (125.82)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

(Continued).

115

Table 4.14 (Continued).

Organization

Variable 1 2 3 4 5 6 7

N N N N N N NM M M M M M M F p

(SD) (SD) (SD) (SD) (SD) (SD) (SD)

Vitamin C 7 15 10 6 5 0 2in mg 241.02 278.34 237.19 271.51 424.12 ─ 131.59 .69 .66

(113.57) (223.80) (207.36) (153.63) (286.36) ─ (13.32)

Vitamin A 7 15 10 6 5 0 210629.48 13779.30 14032.45 16143.94 11240.11 ─ 10194.33 .34 .91(5107.55)(10125.80) (8624.33) (9113.84) (3546.06) ─ (3257.28)

Calcium 7 15 10 6 5 0 2in mg 1121.63 1002.85 1197.79 1102.21 3068.18 ─ 530.09 .94 .48

(825.61) (565.16) (1855.14) (998.54) 4509.07) ─ (25.45)

Iron in mg 7 15 10 6 5 0 223.46 19.68 15.97 24.44 24.47 ─ 21.35 .44 .85

(11.63) (9.73) (15.57) (18.73) (10.25) ─ (3.54)

Sodium in mg 7 15 10 6 5 0 27795.08 3273.59 2682.89 4438.12 4553.43 ─ 4571.70 1.25 .30

(9286.68) (1422.76) (1879.92) (3560.88) (1262.70) ─ (518.50)

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another church; 7 = no church or organization.

As the above tables show, four of the analyses of variance performed on the

variables resulted in significant differences. Specifically, participants in organizations 4, 5,

and 7 were significantly younger than those in 1, 2, and 3. Participants in organizations 4, 5,

116

and 6 had higher mean discrimination scores than those in organizations 1, 2, 3, and 7.

Higher mean social support scores were also noted for groups 5 and 6 as compared to the

rest of the organizations.

4.1.2 COSDA Anthropometry Results

Pearson correlations between each of the anthropometric measurements, glycemia

and blood pressure are presented in Table 4.15. The entire matrix is not presented since

the correlations of interest are only with glycemia and blood pressure, and the

anthropometric measurements. Correlations between the measurements themselves are

not important to this study.

Fasting Post-load Systolic Diastolicglucose glucose blood bloodreading reading pressure pressure

Fasting glucose reading r 1.00pN 70

Post-load glucose reading r -.24 1.00p .05N 70 70

Systolic blood pressure r .16 .21 1.00p .18 .09N 69 69 69

Diastolic blood pressure r .02 .16 .55 1.00p .89 .20 .01N 69 69 69 69

Table 4.15. (Continued). Pearson Correlations Between Anthropometric Measurements, Glucose, and Blood Pressure

117

Table 4.15. (Continued).

Fasting Post-load Systolic Diastolicglucose glucose blood bloodreading reading pressure pressure

Body mass index r -.03 .20 .06 .02p .84 .10 .60 .88N 69 69 69 69

Weight in pounds r -.03 .24 .13 .20p .84 .05 .27 .10N 69 69 69 69

Stature in cm r -.03 .15 .14 .41p .84 .21 .24 .01N 69 69 69 69

Waist circumference r -.05 -.04 .04 -.23p .68 .75 .75 .06N 69 69 69 69

Hip circumference in cm r -.08 -.002 .10 -.07p .51 .99 .44 .59N 69 69 69 69

Upper arm circumference r -.13 .08 .10 .10in mm p .30 .50 .40 .41

N 69 69 69 69

Abdominal depth r -.09 .13 .07 .07p .46 .11 .57 .59N 69 69 69 69

Triceps skinfold in mm r .09 .06 -.13 -.08p .45 .63 .29 .53N 69 69 69 69

(Continued).

118

Table 4.15. (Continued).

Fasting Post-load Systolic Diastolicglucose glucose blood bloodreading reading pressure pressure

Suprascapular skinfold r .11 .22 -.09 -.01in mm p .36 .07 .47 .96

N 69 69 69 69

Suprailiac skinfold r .03 .17 .08 .15in mm p .86 .17 .50 .22

N 69 69 69 69

Medial calf skinfold r -.02 .09 -.09 -.01in mm p .91 .49 .48 .93

N 69 69 69 69

Total upper arm r -.12 .10 .08 .11p .32 .41 .53 .39N 69 69 69 69

Triceps x pi r .09 .06 -.13 -.08p .47 .63 .29 .53N 69 69 69 69

Upper arm muscle area r -.09 .13 .06 .17p .46 .28 .64 .17N 69 69 69 69

Upper arm fat area r -.13 .05 .09 .02p .29 .70 .49 .86N 69 69 69 69

Sum of 2 skinfolds r .12 .16 -.12 -.05p .35 .20 .32 .70N 69 69 69 69

(Continued).

119

Table 4.15. (Continued).

Fasting Post-load Systolic Diastolicglucose glucose blood bloodreading reading pressure pressure

Waist hip ratio r .06 -.04 -.03 -.17p .64 .77 .80 .17N 69 69 69 69

Arm fat index r .04 -.18 .01 .07p .77 .13 .92 .58

N 69 69 69 69

From Table 4.16 the sole statistically significant relationships are between stature,

diastolic blood pressure and weight and post-load glucose. Borderline relationships exist

between glucose and BMI, weight, stature, waist circumference and Suprascapular

skinfold measurements.

Mean measurements of BMI, weight, stature, circumferences, and skinfolds were

determined for each community organization sampled (See Table 4.16). Comparisons

show that the participants of the woman’s organization (group # 1) have higher average

BMI than other organizations examined, including samples with men (See Table 4.14).

Health risks associated with BMI are highest for participants of the woman’s social

organization (3.5) and lowest 2.92 for organization # 5 (Table 4.14 above). However,

participants from church # 2 were the heaviest (187.93) pounds, while organization # 5

120

had the lowest mean weight (170.57 pounds). Organization # 2 was the tallest (170.41

Cm), while organization # 5 shortest (162.25 cm).

Compared by social era, those of the apartheid era have larger mean BMI, weight,

waist circumference, hip circumferences, upper arm circumference, and abdominal depth.

Apartheid era participants, however, have smaller triceps skinfold scores. Except for

skinfolds, apartheid era participants are larger in circumference but shorter and heavier

than civil rights era participants. Apartheid era participants carry less subcutaneous

adipose tissue than do those of the civil rights area.

Using descriptive statistics, in cross sectional analyses COSDA participants are

larger at older ages (See Table 4.5). The group that is aged 51 - 60 years shows the

highest circumferences and skinfolds along with the highest BMI (30.95), BMI risk

(3.54), weight (186.14 pounds). Among the over sixty years old age group, weight and

skinfold scores are lower. These provide estimates of fat distribution, leanness, and

fatness. To estimate obesity among COSDA participants, anthropometeric indices

described in methods were examined. Relationships of anthropmetrics, social era and

glucose scores were also examined. These are presented in Table 14.16 and 4.17.

121

Anthropometry Social Era M t p

Body mass index Apartheid 30.33 1.77 .08Civil Rights 30.31

BMI risk Apartheid 3.45 2.34 *.02Civil Rights 2.87

Weight Apartheid 179.87 .12 .91Civil Rights 179.04

Stature Apartheid 164.85 -1.30 .20Civil Rights 168.48

Waist Apartheid 93.01 -1.28 .08Civil Rights 86.59

Hip Apartheid 113.90 1.83 .07Civil Rights 102.55

Upper arm circumference Apartheid 109.90 1.83 .70Civil Rights 48.42

Abdominal depth Apartheid 53.19 1.50 .14Civil Rights 34.64

Triceps skinfold Apartheid 29.54 1.92 .06Civil Rights 24.88

Suprascapular skinfold Apartheid 31.44 1.80 .07Civil Rights 27.30

Suprailiac skinfold Apartheid 35.16 2.56 *.04Civil Rights 29.93

Medial calf skinfold Apartheid 24.21 1.60 .11Civil Rights 20.81

Table 4.16. Association of Anthropometrics with Social Era of Participants; n 112 COSDA Participants, 58 Apartheid, 54 Post Civil Rights

122

The indices in Table 4.16 provide estimates of fat distribution, body leanness, and

fatness. To evaluate obesity among COSDA participants, the anthropometeric indices

described in methods were examined.

Model b B t pstandardized standardized coefficient coefficient

Sum of 2 Skinfolds .49 .17 1.39 .70

Waist-Hip-Ratio -19.49 -.04 -.33 .75

Upper Arm Fat Area -.51 .069 .55 .59

Constant 118.41N = 69R Square .03 Adjusted R -.01______________________________________________________________________*P < .05** P < .001

ANOVA

Model Sum of Squares df Mean Square F p

Regression 9291.90 3 3097.30 .71 .55Residual 283299.65 65 4256.93Total 292492.55 68

a. Predictor: (Constant) Upper Arm Fat Area, Sum of 2 Skinfolds, Waist-Hip-Ratiob. Dependent Variable: Post-load Glucose Reading

______________________________________________________________________

Table 4.17. Summary of Multiple Regression Analysis: Two Skinfolds, Waist-Hip-Ratio, and Upper Arm Fat Area to Post-load Glucose Reading______________________________________________________________________

In this sample, the sum of two skinfolds, waist-hip-ratio, and upper arm fat area poorly

predict plasma glucose (R square .03) (Table 4.17).

123

This portion of the study relied on anthropometry to test relationships of obesity

with NIDDM and the hypothesis that body mass index and skinfolds predict plasma

glucose in African Americans of Central Ohio. Four relationships of elevated plasma

glucose scores above 140 mg/dl are significant with obesity among COSDA participants:

1) post load glucose scores and body mass index of apartheid born are significantly

related, r = .048, n = 58, -< .02, two tail; 2) post load glucose scores and body mass index

of civil rights born are significantly related, r = .048, n = 54, p < .02, two tail; 3)

suprailiac skinfolds in mm are significantly related to post load glucose scores for

apartheid participants, r = .048, n = 58, two tail; and 4) suprailiac skinfolds in mm are

significantly related to post load glucose scores for civil rights born COSDA participants,

r= .048, n = 54, p < .04, two tail. Thus, post-load glucose and not fasting glucose is

equally related to elevated body mass index in both apartheid and civil rights COSDA

participants. Again, post load glucose elevated above 140 mg/dl is associated with

suprailiac skinfolds in both civil rights and apartheid-born COSDA participants.

However, several show borderline associations. Other measurements, circumferences,

and indices of adiposity, including degree, distribution and place of deposit, and thickness

of fat layers are not significantly related to plasma glucose in COSDA participants. The

strength of four significant relationships of adiposity and post load plasma glucose are

moderate at best. No skinfold measure associated with Type II diabetes. In combination

with other anthropometeric measures to assess the influence of obesity on plasma glucose

results, results were negligible. Acceptance of the positive relationship of elevated plasma

glucose and the suprailiac skinfold measurement only lends partial support to the

influence of obesity on plasma glucose levels. Since this result is negligible, the

hypothesis is accepted, but minimally. Thus, evaluation of the BMI and skinfolds

hypothesis with respect to anthropometry failed to reject the null hypothesis of no

relationship, but the relationship is not robust.

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4.2 Sociocultural Risk Factors

4.2.1 Introduction

The Research Objective was also to sociocultural variables as possible

contributors to type II diabetes in African Americans. Descriptive statistics for risk factors

will be presented before regression statistics. Sociocultural risk factors include the

demographic factors, congruity/incongruity, reaction to anger, social support, relaxation,

discrimination, health threatening behaviors, and total dietary cholesterol in grams.

Demographics include occupation, social era (age), sex, education and income.

Acculturation includes acute and chronic stressors African Americans experience in a

color line society.

125

Assigned Value N

Social era Apartheid 0 58Civil Rights 1 54

Age group 26 - 40 0 2541 - 50 1 2851 - 59 2 2460+ 3 35

Sex Male 0 34Female 1 78

Education < 12 years 0 8High school, technical 1 25Trade school graduation – –1 - 4 years college 2 49Complete graduate school 3 25Professional post graduate school 4 4

Occupation Unemployed, homemaker 0 15Student or retired – –Unskilled or semi-skilled 1 34Lower professional, office 2 38Worker – –Professional 3 14

Marital Never married 0 16Married 1 53Divorced/separated 01 9Widowed 001 33

Income Under $4,000 0 4$4,000 - $7, 999 1 6$8,000 - $14,999 2 7$15,000 - $24,000 3 24$25,000 - $49,000 4 36> $50,000 5 32

Table 4.18. Distribution of Sample by Sociocultural Factors and Assigned Values for Sociodemographics (SD)

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4.2.2 Sociodemographics:

4.2.2.1 Social Demographics: Age/Social Era

COSDA participants were divided into two age groups by social era. Age was

categorized to compare COSDA data with that of other research. Social era reflects

disenfranchisement and the process of discrimination in color line societies. Participants

aged 61 and over are the largest age group (n=37) and those 26 to 40 (n=26) the smallest.

The oldest age group had the highest mean post load glucose (170.6 mg/dl + 165.76) and

the second highest average fasting (146.91 mg/dl +). Those aged 41 - 50 had the lowest

fasting glucose. Average post load glucose of older participants place them well above

the cut point for type II diabetes. They also have a body mass index of 29.7 and a weight

that places them at high to moderate risk of vascular disease and type II diabetes. Those

51 to 60 years old show the highest body weight (186.1 pounds).

Age Social Era Sex

Category n % Era n % ---- n %

26 - 40 25 22 Apartheid 58 52 Male 35 31

41 - 50 28 25 Civil rights 55 49 Female 78 69

51 - 60 24 22

60 + 35 31

Table 4.19. Age, Social Era, and Sex Distribution of COSDA Participants

By social era, the mean fasting glucose score is 136.9 mg/dl and the post load

score 163.6 mg/dl for apartheid-born, but only 115.9 mg/dl and 121.4 mg/dl for civil

rights-born. Both concentrations are above hyperglycemic for the first group (Alberti et

127

al. 1999; Gabir et al. 2000), neither is hyperglycemic for the latter group. The association

with disenfranchisement (social era) is confounded because those born in the civil rights

era may not have expressed their propensities.

Fasting Post Load

Category n M SD M SD

Social eraApartheid 58 136.8 113.5 163.6 164.2

Civil rights 55 115.9 50.3 121.4 65.4

Age

26 - 40 26 118.5 67.8 116.1 57.6

41 - 50 28 111.7 25.0 119.1 62.3

51 - 60 24 146.9 163.2 159.9 165.5

61 + 35 130.8 59.6 170.6 165.7

Table 4.20. Fasting and Post-Load Glucose (mg/dl) by Social Era and Age Categories in the COSDA Sample

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4.2.2.2 Sociodemographics: Occupation

COSDA participants’ variables were distributed across all occupational

categories. Most frequent were professionals. Over half of retired workers also were

lower and higher level professionals. Professionals included participants with terminal

Occupation f %

No occupation 1 1

Homemaker/retired 18 16

Semi-skilled 34 3

Lower professional 39 34

Professional 22 19

Table 4.21. Occupations of COSDA Participants

degrees or certifications such as Certified Public Accountants, Engineers, Pharmacists,

Ministers, and Professors. Lower level professionals included other college graduates

with bachelor’s and master’s degrees. Ninety-one percent of COSDA participants

graduated high school. Seventy-nine (71%) attended college, 41 (37%) graduated college

and 29% attended graduate school or earned a Masters or Terminal Degree (Table 4.18

and 4.22; Figure 4.1).

129

4.2.2.3 Sociodemographics: Sex

In this sample there were 35 men (30.7%) and 78 women (68.4%). Fasting

(108.82 mg/dl) and post load (124.6 mg/dl) were both lower in men than in women

(134.7 mg/dl).

Years of education completed f %

8th grade 3 2.6

9th grade 1 .9

10th 2 1.8

11th 2 1.8

12th grade or high school grad. 25 21.9

1 year college or technical school grad. 20 17.5

2 years college 16 14.0

3 years college 2 1.8

4 years college 12 10.5

1 year of grad. school or M.S. degree 27 23.7

Professional school grad. 2 1.8

Missing 2 1.8____ _____

Total 113 100.0

Table 4.22. Educational Attainment of COSDA Participants in Years

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4.2.2.4 Sociodemographics: Marital Status

Among COSDA participants 53 (47%) are currently married and only 14 never

married (14%). Widows made up (28.9%) of the sample (Table 4.23). Marriages of

COSDA participants are stable. Fifty-five percent are married and thirty-three percent are

widowed resulting in eighty-eight percent of the participants being married, some until

the death of a spouse.

4.2.2.5 Sociodemographics: Income

Sixty-eight percent of COSDA participants have incomes over $25,000 with 28%

over $50,000, well above the $16,770 annual income for black women, and the $8500 to

$17,028 for black female heads of households. Table 4.25 provides the frequencies and

percentages of the various income categories.

Status f %

Married 55 47

Living as married 2 2

Widowed 33 30

Divorced 8 8

Separated 1 1

Never married 14 12

Table 4.23. Marital Status of COSDA Participants

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4.2.3 Life Style/Stressors:4.2.3.1 Life Style/Stressors: Desegregation

On the whole, participants of COSDA evaluated desegregation positively.

Seventy-five percent responded that desegregation had not affected them adversely; only

9% stated it had affected them adversely. Participants who were adversely affected by

desegregation stated their parents were entrepreneurs whose businesses or incomes

decreased once African Americans could patronize other businesses. Unrestricted

patronization was sometimes more convenient, was cheaper, of better quality, or the

services were better or faster (Table 4.25). Sixteen percent of COSDA participants failed

to respond to questions concerning desegregation. In all, about 11% indicated that

desegregation had negative effects on them. For several, their parents did not own

businesses or were not educators and, therefore, did not lose jobs to desegregation.

Others explained they worked with black employers or white employers who hired

African Americans. However, 21% did lose their jobs when desegregation occurred.

Income categories f %

< $4,000 4 4

$4,000 - $7,999 6 5

$8,000 - $14,000 7 7

$15,000 - $24,000 24 21

$25,000 - $49,999 36 32

> $50,000 32 28

Missing 3 3____ ____

Total 114 100

Table 4.24. COSDA Income

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Desegregation f %

Desegregation affected me adversely 10 9.0

Desegregation did not affect me adversely 76 69

I lost my job due to desegregation 24 21

I lost my business 1 1

My family business became less prosperous 1 1

Table 4.25. The Perception of Desegregation by COSDA Participants

4.2.3.2 Life Style/Stressors: Discrimination

All COSDA participants responded to questions concerning their individual work

experiences. Of the 114 respondents, 50% stated their incomes were commensurate with

their education. In addition, 36.8% stated their incomes are commensurate with those of

whites. A majority (62%), however, indicated that white workers with comparable

education and work experience received more pay (Table 4.26). Over half of the

respondents reported they were unfairly paid, compared to 47% reporting fairly paid.

Another 2% did not know. Additionally, 32% thought they were passed over for a

promotion and 30.7% denied a raise while, 23% filed complaints based on racism.

Finally, 22.8% reported their mates were passed over for a promotion. Twenty-seven

percent felt discriminated against sometimes, and 25.4% felt rarely or almost never

discriminated against in workplaces. Participants also responded to their perception of

discrimination beyond the work place in daily life (Table 4.27). Twenty-five percent felt

they were rarely or almost never discriminated against, while 27% felt they were

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discriminated against sometimes. Most participants lived in predominantly black

neighborhoods.

4.2.3.3 Life Style/Stressors: Victimization

Participants were asked whether they, their family members including in-laws had

been victims of murder, rape, violent crimes, stalking, robbery, muggings, fraud,

incarceration, or black on black crime. Ninety-nine of 114 participants responded. The

maximum number of incidents per participant was eleven. The average number of

incidents per participant is 2.4 (Table 4.28). Victimization is not significantly correlated

with fasting or post -load glucose (Table 4.29). Both p values are less than <.01.

f %

Whites are not paid more 43 38

$1,000 to $3,000 more 16 14

$3,001 to $7,5000 more 22 19

$7,501 to $25,000 more 9 8

More than $25,000 10 9

Missing 14 12____ ____

Total 114 100

Table 4.26. COSDA Participants' Evaluation of Equal Pay With Whites

4.2.3.4 Life Style/Stressors: Relaxation

COSDA participants reported how they reduced stress. This included engaging in

relaxation activities, such as burning incense, listening to soft music, meditating, reading

for pleasure, chewing gum, watching a wave tape, praying, singing, humming, repeating a

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Bible verse, bathing, doing muscle relaxing exercises, having sex, getting a massage, and

drinking a warm glass of milk, among others. The average number of relaxation activities

reported was 8.6. The highest number was twenty-three.

Discrimination f %

Rarely or almost never 29 25

Monthly 9 8

Sometimes 31 27

Weekly 9 8

Often 3 3

Daily 4 4

In my neighborhood 3 3

Total 88 77

Missing 26 23____ ____

Total 114 100

Table 4.27. COSDA Participants' Perception of Discrimination in Daily Life Beyond the Work Place

Relaxation was also evaluated by organization. Organization number six engaged

in the greatest number of relaxation activities while participants without church or

organization affiliation engaged in the fewest relaxation activities (Table 4.30).

135

Victimization question n Minimum Maximum X SD

My family and I 99 0 11 2.4 2.7were victimized

Table 4.28. COSDA Participants and Their Families Victimization by Violent Crimes

Glucose Readings

Victimization question Correlation Fasting Post Load

My family and I r -.10 -.09were victimized p (2-tailed) .32 -.40

Table 4.29. The Relationship of Victimization With Type II Diabetes

Organization n Minimum Maximum X SD

1 0 5 19 9 4.8

2 6 2 16 7.3 4.9

3 6 1 11 6.3 3.4

4 0 0 0 0 0

5 13 3 14 7.1 3.3

6 3 3 20 11.2 5.2

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another or no church or organization.Table 4.30. COSDA Participants' Relaxation Index

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4.2.3.5 Life Style/Stressors: Social Incongruity

The Sociocultural Questionnaire (Appendix A) accesses the number of material

possessions of COSDA participants to measure acculturation and social incongruity. The

mean number of material possessions COSDA participants owned is 25.06 (Table 4.31).

The maximum number of material possessions owned is 55, and the minimum number is

9 material possessions. The standard deviation is 8.93.

Total number of: n Minimum Maximun M SD

Material possessions 110 9 55 25.0 8.9

Whirlpools, Jacuzzis 94 0 2 .1 .4or swimming pools

Convection ovens 94 0 3 .4 .6

Bathrooms 93 1 4 1.7 .7

Pairs of shoes 94 2 450 25.1 48.9

Outfits 92 20 1600 148.1 212.3

Cars 90 0 8 1.3 1.3

Total lifestyle score 90 69 1791 238.7 248.9

Table 4.31. Assessment of Social Incongruity Through Material Possessions Owned by COSDA Participants

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4.2.3.6 Life Style/Stressors: Social Support

Social support scored the help available to COSDA participants during

adversities. Some of the individuals COSDA participants depended on belonged to

religious, educational, social, sports, political and professional associations and/or club.

Participants also depended on family, ministers and friends when they need assistance or

counsel. The mean number of points for social supports is 14.8 (Sd = 8.0). The

maximum score is 34. One hundred and eleven participants responded to the

questionnaire. The standard deviation is 8.0. The moderate range of social support

indicates self-reliance and independency among these middle class blacks.

4.2.3.7 Life Style/Stressors: Reaction to Anger

The next component of the lifestyle/stressor portion of the sociocultural index is

reaction to anger. Anger is an emotion. Analysis of reactions to anger reveals a total

adjusted R square of .44 (p <.00). This is indicative of a strong association.

There were significant associations of plasma glucose and the following

lifestyle/stressors: social support (p = .04) (Table 4.12), reaction to anger (p = .03) (Table

4.7), and the discrimination index (p = .03) (Tables 4.2, 4.11). Although these variables

associate significantly with plasma glucose, other lifestyle variables do not show a

significant association with plasma glucose. Therefore, Hypothesis 2 referring to lifestyle

stressors being significantly associated with plasma glucose is minimally supported at

best.

138

Organization n Minimum Maximum M SD

1 9 3 23 13.9 7.2

2 19 2 30 20.3 7.3

3 4 8 23 14.7 8.2

4 1 32 32 14.0 5.7

5 15 1 23 12.6 8.1

6 16 1 30 15.1 8.7

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another or no church or organization.Table 4.32. Social Support of COSDA Participants by Organization

Organization n Minimum Maximum M SD

1 9 94 100 98 1.9

2 6 95 99 98 1.5

3 5 88 98 98 4.7

4 2 96 98 97 1.4

5 15 86 99 96 4.0

6 16 91 100 97 2.4

Note. 1 = Links; 2 = Middle Run Baptist Church; 3 = Zion Baptist Church; 4 = Omega Baptist Church; 5 = New Salem Missionary Baptist Church; 6 = another or no church or organization.

Table 4.33. Descriptive Statistics for COSDA Participants' Reaction to Anger

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4.2.4 Health Threatening Behavior

Except drinks per month as analyzed by gender (p = .05) (Table 4.4), none of the

Health Behavior Index or specific items included in the index was significantly associated

with fasting or post-load glucose (Table 4.34, 4.35). Additionally, Logistic Regression

was used to examine associations with either fasting or post load glucose of 140 mg/dl or

more. The model failed to explain any significant variation (Chi square = 4.35, p > .36).

Examination of Wald statistics also failed to support any association between the Health

Threatening Behavior Index and glucose at/over 140 mg/dl (68.5%).

4.2.5 Dietary Factors

The final component of the sociocultural index is the dietary index. Regression

was used to estimate dietary influences on glucose. Only dietary cholesterol was

significantly associated with glycemia (Table 4.36). Other findings were insignificant.

The summary of dietary cholesterol and total fat appears below.

Unstandardized Standardized Coefficients Coefficients

Model B SE B β t p

Threatening health -8.5 .4 -.0 -.2 -.8behaviors

Note: Dependent variable = Post-load glucose.Table 4.34. Prediction of Threatening Behaviors and Post-Load Glucose

Multiple Regression was used to analyze the dietary recalls of COSDA

participants. Food components such as vitamins, minerals, fats, amino acids and other

food nutrients were analyzed. The nutritionists for Esha Research, the producers of the

Food Processor® Nutrition and Fitness Software used for this dietary analysis, suggested

140

restricting the dietary analysis to Nutrient Facts. A Pearson Correlation Matrix of

Nutrients Facts follows in Table 4.38.

UnstandardizedLifestyle Variable Coefficients Wald Odds Ratio

Threatening health behaviors -.01 .6 .9

-2 Log LR 89.5Model χ2 (df = 4) 4.4

PClassification %

Table 4.35. Prediction of Threatening Behaviors and Lifestyle

Unstandardized Standardized Coefficients Coefficients

Model B SE B β t p

Cholesterol 1.8 .00 .65 7.1 .00

Total fat .13 .17 .08 .75 .46

Table 4.36. Dietary Cholesterol and Total Fat for Post-Load Glucose

141

Total Vitamin C Vitamin A Calcium Iron Sodium Fat Saturated Proteins Carbo- Sugar Total Calories Fasting Post-loadcholesterol in mg in mg in mg in mg calories fats per per day hydrate total fats in per day glucose glucosein grams per day day in grams per day per day in grams reading reading

Total cholesterol r 1.000 .201 -.061 -.014 -.009 -.006 .012 .488** .016 -.034 -.021 -.059 -.011 -.033 .660**in grams p (2-tailed) .065 .578 .897 .935 .956 .911 .000 .888 .761 .848 .594 .917 .766 .000

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Vitamin C in mg r .201 1.000 .295 .090 -.006 .226* .260* .356** -.052 .259* .186 .301** .319** .008 .357p (2-tailed) .065 .006 .410 .954 .037 .016 .001 .633 .017 .088 .000 .003 .942 .357N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Vitamin A r -.061 .295** .1000 .080 .278** .461** .616** .452** .060 .340** .157 .652** .542** -.033 -.092p (2-tailed) .000 .765 .468 .010 .000 .000 .000 .587 .001 .157 .000 .000 .765 .402N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Calcium in mg r -.014 .090 .080 1.000 -.017 .175 .205 .183 .021 .223* .194 .215* .263 -.056 -.088p (2-tailed) .897 .410 .468 -.879 .110 .059 .093 .851 .040 .075 .048 .263 .609 .422N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Iron in mg r -.009 -.006 .278* -.017 1.000 .200 .274* .220 .004 .112 .034 .271 .182 -.030 -.48p (2-tailed) .935 .954 .010 .879 .066 .011 .043 .970 .308 .757 .012 .095 .786 .660N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Sodium in mg r -.006 .226 .461** .175 .200 1.000 .551** .425** .069 .000 .004 .000 .000 -.023 -.041p (2-tailed) .911 .016 .000 .059 .066 .000 .000 .531 .000 .004 .000 .000 .835 .708N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Fat calories r -.012 .260* .616** .205 .616** .205 .274 .551** .000 .123 .493 .764 -.051 -.025per day p (2-tailed) .911 .016 .001 .059 .011 .000 .000 .263 .000 .002 .001 .000 .643 .822

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Table 4.37. (Continued). Regression of Food Nutrients and Post-Load Glucose Reading

142

Table 4.37. (Continued).

Total Vitamin C Vitamin A Calcium Iron Sodium Fat Saturated Proteins Carbo- Sugar Total Calories Fasting Post-loadcholesterol in mg in mg in mg in mg calories fats per per day hydrate total fats in per day glucose glucosein grams per day day in grams per day per day in grams reading reading

Saturated fat r .481** .356** .452** .183 .220* .425** .724** 1.000 .112 .404** .284** .743** .639** -.023 .266in calories p (2-tailed) .000 .001 .000 .093 .043 .000 .000 .306 .000 .008 .000 .000 .835 .708

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Proteins per day r .016 -.052 .060 .021 .004 .069 .123 .112 1.000 .035 .025 .129 .090 -.014 .049in grams p (2-tailed) .888 .633 .587 .851 .970 .531 .263 .306 .753 .817 .238 .414 .898 .658

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Carbohydrates r -.034 .258* .340** .223* .112 .451** .493** .404** .035 1.000 .955** .540** .912** -.031 -.113per day p (2-tailed) .761 .017 .001 .040 .308 .000 .000 .000 .753 .000 .000 .000 .775 .302

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Sugar total per r -.021 .186 .154 .194 .034 .306** .336** .284** .025 .955** 1.000 .348** .798** -.030 -.107day p (2-tailed) .848 .088 .152 .075 .757 .004 .002 .008 .817 .000 .001 .000 .787 .332

N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Total fat in grams r -.059 .301** .652** .215* .271* .617** .919** .743** .129 .540** .348** 1.000 .825** .050 -.077p (2-tailed) .594 .005 .048 .011 .000 .000 .000 .000 .238 .000 .001 .000 .649 .430N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Calories per day r -.011 .317 .542** .263* .182 .588** .764** .639** .090 .912** .798** .825** 1.000 -.050 -.087p (2-tailed) .917 .003 .000 .015 .095 .000 .000 .000 .414 .000 .000 .000 .651 .430N 85 85 85 85 85 85 85 85 85 85 85 85 85 85 85

Fasting glucose r -.033 0..8 .033 -.056 -.030 -.023 -.051 -.025 -.014 -.031 -.030 -.050 -.050 1.000 .509**p (2-tailed) .766 .942 .765 .609 .786 .835 .643 .835 .898 .775 .787 .649 .651 .000N 85 85 85 85 85 85 85 85 85 85 85 85 85 129 129

Post-load glucose r .660** .101 -.092 -.088 -.048 -.041 -.025 .266* .049 -.113 -.107 -.077 -.087 .509 1.000p (2-tailed) .000 .357 .402 .422 .660 .708 .822 .-14 .658 .302 .332 .483 .430 .000N 85 85 85 85 85 85 85 85 85 85 85 85 85 129 129

143

4.3 Analysis of the Sociocultural Index

The regression analysis of the sociocultural indexes did not significantly predict

fasting glucose (Table 4.38).

Unstandardized Standardized Coefficients Coefficients

Model B SE B β t p

(Constant) 96.48 155.08 .62 .54

Total cholesterol in grams -6.32 .00 -.03 .26 .79

Discrimination index .57 2.21 -.03 .26 .80

Total lifestyle/accultur- .29 1.26 .02 .23 .82ation index

Health threatening index -.30 .41 -.09 -.73 .47

Dependent Variable: Fasting Glucose

Model Summary

Model R R2 Adjusted R2 SE of Estimate p

1 .06 .00 -.02 97.54 .85

Table 4.38. Predictors: (Constant), Health Threatening Behavior, Total Cholesterol, Total Lifestyle/Acculturation Index, Discrimination Index for Fasting Glucose

The regression analysis showed a highly significant association of post-load

glucose and total cholesterol in grams (p= <.00) (Table 4.36), and a significant

association of social support and fasting glucose readings (r = 42, n = 111, p <.02, two

tail). The regression analysis of all sociocultural indexes (Table 4.39) did not significantly

predict post-load glucose. The conclusion is that dietary variables in the sociocultural

index are strongly related to glycemia, specifically post-load glucose. This may indicate

144

that the middle class status of COSDA participants enables them to escape social factors

that correlate with hyperglycemia among lower class African Americans, but not the

social inheritance of food preferences for the high fat soul food diet.

Coefficients

Model B β t p

(Constant) 170.31 1.04 .30

Total cholesterol in grams 1.85 .69 7.64 .00

Discrimination index -.76 -.03 -.32 .75

Total lifestyle/acculturation index -.13 -.01 -.10 .92

Health threatening index -.47 -.10 .01.1 .29

Dependent Variable: Post-Load Glucose

Model Summary

Model R R2 Adjusted R2 SE of Estimate

1 .67 .47 .44 110.1

Table 4.39. Health Threatening Behavior, Total Cholesterol, Total Lifestyle/ Acculturation Index, and Discrimination Index as Predictors of Post-Load Glucose

4.4 Summary of Variables in Regression Analyses

Pearson correlations were calculated to examine relationships between each of the

variables used in multiple regression and logistic regression analyses. A matrix of these

correlations follows (Table 4.40).

145

Fasting Post-load Total Health Accultur-glucose glucose cholesterol threat ationreading reading in grams index score

Fasting glucose r 1.00reading p

N 70

Post-load glucose r -.24 1.00reading p .05

N 70 70

Total cholesterol r -.05 .15 1.00in grams p .74 .33

N 45 45 45

Health threat r -.06 .03 .07 1.00index p .64 .83 .65

N 68 68 45 68

Acculturation r -.20 -.17 .08 -.04 1.00score p .16 .24 .69 .77

N 50 50 42 50 50

Discrimination r -.15 -.05 .08 .21 -.03index p .31 .75 .62 .16 .84

N 49 49 40 49 46

Table 4. 40 Correlations Matrix for Variables in Regression Analyses

Table 4.40 shows that only one relationship was statistically significant. As

expected, the two glucose readings were related. None of the other variables, however,

were correlated.

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CHAPTER 5

MODEL FOR DIABETES

5.1 Anthropometry and Sociocultural Variables5.1.1 Anthropometry

According to the study hypothesis, anthropometry and sociocultural factors are

predictors of plasma glucose in African Americans. Examination of the effects of

anthropometeric indices on post load glucose reveal that the sum of two skinfolds, waist-

hip-ratio, and upper arm fat area failed to reach significance, (R square =.03) (See Table

5.1). A Multiple Regression analysis was conducted to test effects of anthropometeric

indices in the sample resulting in a R square =.03, adjusted R square = -.01, p=.55. In

essence, the contribution of these variables to the variance is negligible at 3% indicating

little contribution to post-load glucose. There is no significant relationship of

anthropometeric indices with post-load glucose scores (p = .70, .75, .59, p>.05 for sum

of 2 skinfolds, waist-hip-ratio, and upper arm fat area, respectively). Inclusion of body

mass index did not improve this model (Table 5.2). There are no significant relationships

of sum of 2 skinfolds, waist hip ratio, or upper arm fat area to post-load glucose. Sum of

2 skinfolds, waist-hip-ratio, and upper arm muscle area together explain only 2% of the

variance. There are no significant effects of anthropometeric indices on post-load glucose

147

readings (p = .39, .83, and .54, p>.05 for sum of 2 skinfolds, waist-hip-ratio, and upper

arm muscle area, respectively).

Model B β p

Sum of two skinfolds .49 .17 .70

Waist-hip ratio -19.79 -.04 .75

Upper arm fat area 2.51 .069 .59

Constant

R2 .03 Adjusted R2 -.01n = 69

*p < .05. **p < .001.

Table 5.1. Sum of Two Skinfolds, Waist-Hip Ratio, and Upper Arm Fat Area and Post-Load Glucose

Model B β p

Sum of two skinfolds 4.88 .02 .91

Waist-hip ratio -73.12 -.15 .25

Upper arm fat area -1.92 -.19 .13

Body mass index 2.75 .22 .16

Constant 107.00

R2 .09 Adjusted R 2 .03n = 69

*p < .05. **p < .001.Table 5.2. Body Mass Index, Upper Arm Area, Waist-Hip Ratio, Sum of Two Skinfolds for Post-Load Glucose

148

Model B β p

Sum of two skinfolds .26 .01 .39

Waist-hip ratio -11.9 .03 .83

Upper arm muscle area -2.7 .08 .54

Constant 101.9

R2 .02 Adjusted R2 -.02n = 69

*p < .05. **p < .001.Table 5.3. Effects of the Sum of Two Skinfolds, Waist-Hip Ratio, and Upper Arm Muscle Area and Fasting Glucose

Multiple regression analysis was used to determine relationships between the sum

of two skinfolds, waist hip ratio, arm fat index, and body mass index to fasting glucose

readings (See Table 5.3). Results show that these anthropometeric indices have little

predictive values on fasting glucose readings among COSDA participants (p = .39, .83,

.54 for the sum of 2 skinfolds, waist-hip-ratio, and upper arm muscle area, respectively.

These predictor variables explain only 2% of the variance for the dependent variable,

fasting glucose.

Addition of the BMI does little to improve the model, explaining only 3% of total

variation (Table 5.4). Anthropometry measure of body habitus are expected to reflect the

high risk of African Americans and be associated with Type II diabetes. However the

majority of African Americans are of lower SES and tending toward overweight like

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most members of the lower SES class (Mayer 1968; Mokdad et. al 1993)). This sample of

middle and upper SES African Americans is expected to show better body habitus as

indicated by lower body fat and BMI measures, as found among the middle class in

general (Dressler 1993).

Model B β p

Sum of two skinfolds .53 .22 .15

Waist-hip ratio 46.60 .11 .41

Arm fat index 6.05 .07 .60

BMI -2.01 -.19 .25

Constant 113.01

R2 .09 Adjusted R2 .03n = 69

*p < .05. **p < .001.

Table 5.4. Sum of Two Skinfolds, Waist-Hip Ratio, Arm Fat Index, and Body mass Index on Fasting Glucose

5.1.2 Sociocultural Factors

The only demographic measure significantly associated with post-load plasma

glucose in multivariate analysis is income (Table 5.5). Multivariate analysis was also

used to determine the relationship of other sociodemographic variables to plasma

glucose. No significant relationships of occupation, age or sex and post load glucose were

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observed (Table 5.5). Demographic factors also were examined for association with

fasting plasma glucose (Tables 5.6 and 5.7). The only demographic measure significantly

associated with fasting plasma glucose in multivariate analysis is age (Table 5.6).

Multivariate analysis was also used to

Model B β t p

Income -19.14 -.20 -2.19 *.04

Age/social era 1.28 .12 1.24 .22

Sex 7.88 .27 .27 .79

Unemployment -28.33 -.02 -.30 .83

Semiskilled -45.37 -.10 -.94 .35

Office worker 5.29 .02 .16 .87

Lower professional 2.52 .00 .04 .96

Higher professional -39.53 -.11 -.104 .30

Constant 169.77

R .28 R2 .08 Adjusted R2 .01N = 114

*p < .05. **p < .001.

Table 5.5. Summary of Multiple Regression Analysis: Sociodemographic Predictor Variables for Post-Load Glucose

determine relationship of sociodemographic variables to plasma glucose. There is a

significant relationship of age and post-load glucose. However, no other significant

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relationships of other demographic variables such as income, occupation, or sex and post-

load glucose were observed (Table 5.6). Overall, sociocultural factors explain only 8%

of the variance in post load glucose (Table 5.5). For this model only age increased the

odds of hyperglycemia, increasing the odds ratio by 3.6 (Table 5.6).

UnstandardizedPredictor Variables Coefficients Wald Odds Ratio

Stepa

Income -.09 .33 .56

Age .03 3.60 .05

Sex -.02 .00 .95

Unemployment 6.06 .07 .78

Semiskilled -.21 .06 .79

Office -.61 1.28 .25

Lower professional -1.95 .84 .35

Higher professional -.94 1.72 .18

Constant -1.72 1.71 .19

-2 Log LR 131.79Model χ2 (df = 1) 10.85P .21Overall rate of correct classification 68.5

Table 5.6. Logistic Regression Prediction of the Likelihood of > 140 mg/dl of Post-Load Plasma Glucose from Sociodemographics

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Predictor Variables B Odds Ratio 95% Odds CI Ratio

Cholesterol (diet) .00 1.00 0.61 1.61

Discrimination index -.03 .96

Acculturation index -.02 .97

Threatening health index -.01 .99

Constant 2.74 15.48

-2 Log LR 89.47Model χ2 (df = 4) 4.35P .36Overall rate of 65.8% correct classification

Table 5.7. Prediction of Four Sociocultural Variables and Post-load Glucose

Logistic regression was used to estimate the probability of a post-load glucose

reading of 140 or more using a set of four sociocultural variables: discrimination,

acculturation, health threatening behaviors, and diet. The overall prediction model failed

to reach .05 statistical level.

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ANOVA

Model SS df MS F p

1 Regression 728532.89 4 182133.22 14.64 .00a

Residual 920712.55 74 12442.06Total 1649245.40 78

2 Regression 737614.52 6 122935.75 9.71 .00b

Residual 911631.92 72 12661.54Total 1649245.40 78

a. Predictors: (Constant), total accumulation score-lifestyle, incongruity+anger+support+ relaxation, total cholesterol in grams, What is your health threatening index? What is your income?

b. Predictors: (Constant), total accumulation score-lifestyle, incongruity+anger+ relax, total cholesterol in grams, What is your health threatening index? What is your income?, BMI, total fat in grams.

c. Dependent variable: Post-load glucose reading

Coefficients

Model B β t p

1 (Constant) 203.785 1.301 .20Income -4.37 -.04 -.43 .67Cholesterol in grams 1.79 .65 7.14 .00Health threatening index -.11 -.23 -.29 .78Total acculturation -.38 -.03 -.29 .78

2 (Constant) 148.39 .86 .40Income -3.84 -.04 -.36 .72Cholesterol in grams 1.79 .65 7.09 .00Health threatening index -8.54 -.02 -.22 .83Total acculturation -.32 -.02 -.24 .81Total fat in grams -3.79 -.02 -.25 .80BMI 1.71 .07 .83 .41

a. Dependent variable: Post-load glucose reading

Table 5.8. Summary of Multiple Regression Analysis: Anthropometry and Sociocultural Predictor Variables for Post-Load Glucose

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Multiple Regression statistics in Table 5.8 show that the relationship of

anthropometery and sociocultural indexes to post load glucose are not significant. It is not

surprising though that total grams of dietary cholesterol is highly significantly related to

post load glucose scores of 140 ml/dl or above (p <.01 Table 5.8, Model 2.

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CHAPTER 6

Discussion and Conclusion

6.1 Review of Results

Forms of life survive best when they are in equilibrium with their ecosystems.

Humans are thought to be at equilibrium when they are able to perform normal activities

without socially determined or clinically defined symptoms resulting in morbidity,

mortality and impaired health. Conditions that lead to morbidity, impaired health or

mortality render humans unfit in their ecosystem. Humans use culture as the first line of

adjusting to their variable environment. Culture is man’s ecological adjustment. New

opportunities for the spread of parasites and disease emerge when major cultural

innovations result in environmental alterations or rapid population growth or decline.

This is particularly obvious in African agriculture. Agriculture produced surplus food,

and sustained large populations. Control of such surpluses is a prerequisite for the

mobilization of global resources providing wealth and power to those in control of food

supplies and human energy. Slavery helped transform many simple societies to complex

ones with powerful economic and political systems. Human energy allowed for slave and

colonial social systems to accumulate wealth based upon the labor of others. One way to

increase production and decrease expense was to feed fat to slaves. Calorically the

densest and monetarily the cheapest food source was an animal by-product.

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While building advanced civilizations on the surplus food they produced,

colonized slaves experienced long-term stresses, including food deprivation, exposures to

crowded conditions, associated endemic, enteric, bacterial and parasitic infections and

long-term deficiency diseases resulting from mono crop agriculture. Chronic

degenerative diseases (CDDs) including diabetes are multifactorial. Metabolic

adjustments associated with CDDs often allow humans to survive better in certain

environmental conditions. This study examined type II diabetes as a metabolic

maladjustment. The conclusion is that type II is a consequence of human adaptation to

prolonged food scarcity and undernutrition due to exploitation of human energy causing

environmental disequilibria among its victims.

We explore an environmental model of disequilibria for type II. Historical,

cultural, folklore, sociocultural, socio-political, and ecological data were used to

construct a model of environmental disequilibria for type II. According to Hypothesis 1 a

standard set of biophysical/clinical assessments could be significantly associated with

glycemia. This hypothesis was supported for blood pressure, cholesterol (Table 4.25) and

age (Table 4.20). Although other measures showed borderline associations, none were

strongly correlated with glycemia or glucose above 140 mg/dl (Table 4.3). Hypothesis 1

also addressed biological factors such as obesity and anthropometry. These measures

have predictive ability for plasma glucose levels > 140 mg/dl among middle class African

Americans in Central Ohio.

Hypothesis 2, on the other hand, examined culture specific sociocultural risk

factors that were expected to have minimal ability to predict plasma glucose > 140 mg/dl

among middle class African Americans in Central Ohio. The middle class status,

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educational attainment, and job stability of COSDA participants are atypical of most

African Americans. African Americans are predominantly lower class, have low levels of

educational attainment, and job instability. The expectation is that exposure to middle

class conditions results in middle class social and health indices.

Hypothesis 3 acknowledges African American food preferences and taste. The

expectation is that food choice is among the last elements of culture to change in an

acculturating population from which disenfranchisement restrictions have been lifted.

Thus, high levels of dietary fats that characterize soul foods are expected to predict

plasma glucose levels above or equal to 140 mg/dl among middle class African

Americans in Central Ohio. This general hypothesis was strongly supported.

Of BMI (r= 0.48, n=58 p < .02) and suprailiac skinfolds (r=.03, n= 58 p.86)

apartheid born ( r=.048, n=58 p < .04 ) and civil rights born (two tail, and r=.048, n=54 p

< .04, two tail ) participants with hyperglycemia were obtained (Table 6.1). Hip

circumferences also were sampled in the 1986 Body Composition Project (BCP). Mean

hip circumference of COSDA participants is 108.4 cm compared to 97.6, 96.1 cm, and

96.8 cm respectively for white, black, and Hispanic in the Body Composition Project (US

Army Research Institute, 1986). Hip circumferences of BCP men and women were 95.5

cm., 12.8 cm below COSDA participants. Waist circumference of COSDA participants

also was larger than that of Chinese men and women measured by Kapanrow et al.

(1996). Waist circumferences of COSDA participants were 89.9 cm compared to 80.7 for

Chinese men and women.

COSDA participants do, however, have smaller waist-to hip ratios than other

ethnic groups. Waist-to-hip ratios are 6.74% smaller than participants in a study by Croft

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et al (1993). Waist-to-hip ratios are 12.64% smaller than in whites and 13.55% smaller in

Mexican Americans (Roche 1995). These anthropometric differences suggest COSDA

blacks may exhibit adipose placement different from other ethnic groups. Such

differences may be due to their unique environment, opportunity structure, physical

activity, cultural history, biology, or other factors peculiar to their life style.

Affluence and the availability of surplus food make obesity a problem for all

Americans. In both sexes, African Americans between ages 20 and 74 are 69% and 58%

more likely to be overweight and severely more overweight than Europeans

(Kumananyika and Johnson 1991). Excessive weight gain generally results from low

energy expenditure and high food intake. Historical analysis suggests low physical

activity is the most probable explanation of overweight in African Americans.

Environmental disequilibria have led to high intakes of dietary fat. This significant

relationship between total cholesterol and post-load glucose (adjusted R2 = .42) is

presented in Table 4.38 and 4.39. High dietary cholesterol intake was once adaptive and

promoted survival of blacks during slavery and apartheid periods. Today these cultural

and biological contingencies conspire to produce an epidemic of type II diabetes in

African Americans. Other than dietary variables, most sociocultural phenomena assessed

in this study were poorly associated with glycemia.

The sociodemographic profile of COSDA participants reflects their uniqueness.

The apartheid era participants had the highest mean post load glucose score of 17.6

mg/dl, and the second highest fasting glucose score of 146.92 mg/dl while civil rights era

participants had the lowest mean fasting glucose score. Apartheid era participants also

had the highest mean systolic blood pressure of 141.51 mg/dl. COSDA participants are

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hypertensive, diabetic, and overweight; thus, demonstrating the prevalence of multiple

diseases of syndrome X constellation of diseases.

6.2 Folklore, Literature and History

Folklore, literature and history were surveyed to assess global attitudes and

behaviors towards African Americans in the genesis of the current environmental

disequilibria in the Americas. Sufficient materials were reviewed to indicate the etiology

of NIDDM among descendants of Africans who experienced slavery,

apartheid/segregation, desegregation and modern discrimination. Folklore and legend

justified Africans’ enslavement by Hebrews, Arabs and Europeans. In addition to legend,

the ability of African Americans to survive, produce, reproduce and endure the hardships

of slavery made them highly sought after (Mascie-Taylor 1993; Bennett 1970).

Furthermore, Christianity, Judaism and Islam condoned the enslavement of Africans.

This global attack on Africans resulted in prolonged undernutrition, exposure to endemic

and epidemic diseases, and high mortality rates in both the Old and New Worlds.

Transforming multicultural enslavement to racial enslavement established dark skin color

as a global marker for enslavement. Global denigration of black skin color began with the

legend of Noah and has continued through time, culminating in color line societies. This

furthered black environmental disequilibria and precipitated a biological crisis that almost

led to extinction of African Americans (Holmes 1937). By consuming a high fat diet

blacks were able to survive slavery, the following biological crisis and the apartheid

period.

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Among this sample high dietary cholesterol and a close association of cholesterol

with type II suggest the detrimental outcome of this diet. Although, COSDA participants

escaped many effects of oppression, their dietary preferences remain in black subculture.

Although no longer participating in physically demanding labor, they still eat the soul

food diet. One professional man explained, “I might as well be dead if I can’t eat the soul

foods I like, especially after I worked hard to acquire a high level education, entered a

high status career, and earned a high-income.” A woman said, “My favorite food is

cholesterol.” Another participant stated, “Cholesterol makes ‘soul food’ taste so good.”

Slaves had to consume a high fat diet to survive. This diet that continues as soul

food culminates today as a close association between dietary cholesterol and type II (r2 =

.42, t= .47, p=.005,) (Table 4.24). This association tends to support the Anabolic-

Catabolic-Homeostasis Model as contributing to the etiology of diabetes among at least

middle class African Americans in Central Ohio.

6.3 Sociocultural Index and Hypotheses

The lifestyle/stressor index indicates COSDA blacks escaped many of the culture

specific life stresses of African American life and culture including menial labor,

violence, discrimination, occupational stresses, and an inadequate diet. This sample

resides in a social milieu contrary to typical US blacks, but the prevalence of NIDDM is

lower. Desegregation was not a major issue in the lives of eighty-five (74.6%)

participants. Desegregation only affected ten (8.8%) adversely. In the Southern US where

school and economic systems were totally segregated, integration accompanied

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desegregation by closing black school and businesses. However, institutions of higher

learning such as Wilberforce University and Central State University remained

unaffected by desegregation, and their employees maintain control of these institutions

and their economic, social, and political lives. Thus, 50% stated their incomes are

commensurate with their education, but 63.2% felt white workers with comparable work

experience and education were paid more annually. Thirty-one (27.2%) of one hundred

and fourteen felt they were discriminated against sometimes, whereas 29 (25.4%) felt

they were rarely discriminated against. COSDA participants also escaped violence and

crime associated with many black communities in the United Stated. The mean of 2.4

victimizations they experienced was not significantly associated with elevated plasma

glucose levels. There is no significant relation of reaction to anger and post load and

fasting glucose.

The acculturation index composed the second category of the lifestyle stressor

index. This index measured the affect of contact situations between African Americans

with the majority culture by assessing the degree of African American social support,

social incongruity and relaxation. Only social support was significantly related to fasting

glucose readings > 140 mg/dl, r= .42, n = 111, p <. 02, two tail. Neither relaxation nor

social incongruity is significantly related to elevated plasma glucose. COSDA

participants engaged in a mean of 8.6 relaxation activities. COSDA participants

experience little social incongruity. They owned a mean of 25 material possessions with a

total lifestyle score of 238.91. Many material possessions of COSDA participants are

congruent with high educational attainment. Thus, social incongruity was not

significantly associated with plasma glucose levels > 140 mg/dl.

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The third major part of the sociocultural index is threatening health behaviors that

consisted of total alcohol and tobacco use, and total degree of physical activity/inactivity.

Logical regression was used to estimate the probability of plasma glucose levels > 140

mg/dl. The overall predictive model failed to reach the .05 statistical level to indicate that

disease prophylaxis activities in the prevention of disease does not associate with

individual COSDA participants.

6.4 Summary of Major Results and Comparison With Other Studies

6.4.1 Major Findings

Slaves ate limited meat such as salted fish or bacon, and, more occasionally,

animal products such as organs and fat. Some slaves managed to grow gardens. Gardens

helped to supplement slaves’ diets with African foods including watermelons, lima beans,

and black eye peas (Holloway 1990). This slave diet evolved today’s soul food one. All

animal products were of value in slave diets. Grease, lard and butter were added to

vegetables, cornbread, and greens to produce a more calorically dense and nutritional

adequate diet (Table 6.1).

High fat content foods remained beneficial during the second biological crisis for

African Americans when food supplies were scarce. High fat diets among emancipated

African Americans likely were an adaptive response. The soul food dinner listed below in

Table 6.1 would supply 62.19% more cholesterol and 53.61% more calories than the

American diet. During the Jim Crow era, a similar diet among bondsman performing

strenuous labor likely increased their reproductivity and survival. Adding fat became the

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basis for the American Soul food diet. This culturally-motivated dietary adaptation over

15 - 20 generations likely reset many aspects of African American metabolism. One way

this culturally-motivated diet manifests today may be by elevating blood glucose scores

and increasing body habitus, and hyperglycemia (> 140 mg/dl) and high BMI (> 27

kg/m2). Among the apartheid era participants, glycemia and BMI are significantly

associated (r= .048, n=58, p=< .02). High lifetime fat intake along with reduced physical

activity may have promoted their high body weight and BMI (Table 4.3). Among civil

rights era participants glycemia and BMI were not significantly correlated. The average

BMI for the apartheid era is 30.3 for age 56. The health risk is 3.5 (high). The BMI was

28.4 for aged 44.4 with a health risk of 2.9.

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Soul European American Slave

Mg cholesterol calories Mg cholesterol Calories Calories

Barbecued ribs 367.42 1562.71 254.55 815.44 none

Macaroni and cheese 119.36 603.20 18.31 334.00 none

Candied yams 30.38 368.07 0.00 146.52 none

Green beans 9.45 93.31 5.18 18.70 none

Corn bread 6.25 388.26 26.00 172.90 none

Dinner rolls 38.18 220.57 none

Butter (per pat) 10.00 33.33 10.00 33.33 none

Sweet potato pie 71.39 493.81 58.35 295.46 none

Vanilla ice cream 139.31 326.33 120.00 270.00 none791.78 3891.59 492.39 2086.35 none

Percent 62% more 54% more

Table 6.1. Comparisons of Typical Soul Food, European American, and Hypothesized Slave Diet

Multiple explanations could be provided for these results. Age alone may explain

all differences. However, controlling for era has a minor effect. Apartheid era

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participants’ mothers may have more frequently suffered malnutrition before and during

pregnancy. Thus, the maternal environment model as proposed by Barker (1998, 1992)

may also explain in part the variation across cohorts since the civil rights generation may

have gestated in more economically and nutritionally well-off mothers. Greater access to

health care, information, and life styles also might have altered morbidity/mortality

patterns and allowed those with less extreme body habitus to survive to adulthood to

maintain their weight and fatness at lower levels. Or perhaps, the diet affected members

of the apartheid era. Members of the apartheid era are most likely grandparents of the

civil rights era participants. Parents of civil rights era participants were, obviously, able to

provide food more consistently to their children. These children are the civil rights era

participants. Decreased employment restriction and better economic opportunities

following the gains of the civil rights movement also modified how overweight interacted

with prosperity.

Suprailiac skinfold also significantly associates with hyperglycemia in this sample

(r = .36, p = .04) (Table 4.19) but waist-hip ratio did not ( r=.06, p =.64) (Table 4.2).

Waist-hip ratio commonly is used to assess obesity (National Health and Nutrition

Examination Survey 1997-1999). The suprailiac skinfold measures gait and mobility

(National Health and Nutrition Examination Survey 1997-1999). In this sample of mainly

women (72%), skinfolds more may assess fatness in the lower body (buttocks, gynoid)

with that in the abdominal (android, upper) area and bias the association with BMI

generally found elsewhere (National Health and Nutrition Examination Survey 1997-

1999).

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COSDA participants weighed more than participants in the National Health

Survey (NHS) that was conducted by the National Center for Health Statistics at the U.S.

Department of Health, Education, and Welfare (1974). Men averaged 203 pounds

compared to a median weight of 169.6 pounds of all NHS men. Women were 169.2

pounds. They exceeded median weights for all (137.8 pounds) black (149.6 pounds) and

white (137.0 pounds) women in the NHS survey. Men also weighed more than median

weight of white (170.6 pounds) and black (166.1 pounds) men. In general COSDA

participants weigh more than the norm for blacks and whites sampled by the NHS.

6.4.2 Type II diabetes in African Americans

The multifactorial nature of chronic diseases makes disease etiology complex.

Involvement of multiple loci and environmental stressors produce a range of continuous

phenotypic variation (Crews and Gerber 1994:173). Such phenomena along with

sociocultural and cultural-historical factors produce ethnic differences in disease etiology

and type II diabetes. African Americans were examined for evidence of evolutionary,

cultural and environmental influences on the etiology of type II diabetes. Data examined

here contradict current explanations for type II diabetes in ethnic groups experiencing

transition, and suggests cultural-history may influence risk at least in African Americans.

The sociocultural level for diabetes type II in COSDA is on all fronts. It was possible to

construct a sociocultural etiology in this middle class sample of African Americans.

Overall adverse sociocultural encounters were not experienced by our sample. Poverty,

disease, adverse sociopolitical situations are encountered more often by lower SES

individuals, particularly minorities (Dressler 1993; Kumanyika and Golden 1991; and

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Greenberg 1981). The etiology of type II in African Americans likely is related to current

socioeconomic standing.

This research investigated evolutionary, cultural and environmental factors that

might contribute to type II diabetes mellitus causation in African Americans. It used

holistic, cultural-historical and biological models. In this section, an Anabolic-Catabolic-

Homeostasis model of type II diabetes is developed.

6.5 The Model for the Anabolic-Catabolic Homeostasis Etiology of Diabetes

Mellitus (ACHED)

Data examined here suggests SES, body habitus or discrimination factors did not

strongly predict type II among these middle class African Americans. The intake of

dietary fat, however, correlated significantly with type II. Some other genetic, cultural-

historical, or life style aspect shared by all African Americans must also account for their

similarities in rates of type II diabetes and obesity across SES. Neel (1962, 1982) offers

genetic adaptations to starvation as a possible model (McBeth 1993:64). Food scarcity is

but the second part of this tripartite hypothesis model. Individuals with high performance

genotypes also must differ in the genetic moderation of insulin (Knowler, Savage et al.

1982). Those able to maintain constant blood glucose during caloric restriction may more

efficiently utilize food energy. High performance genotypes survive because they are able

to gain more weight, and produce healthier offspring. Energy is the third leg this

hypothesis. Energy provides a key for understanding type II diabetes mellitus. Energy is

an important aspect of diabetes; without sufficient supplies the body will convert other

tissues to provide its needs. The etiology of type II focuses on energy production and

168

expenditure during food scarcity and African enslavement. This major lifestyle change

caused population-wide food scarcity and extreme labor demand for profit. Extraction of

labor was the fundamental purpose for African enslavement. Such extreme labor requires

glucose that diffuses through muscles during exercise without the benefit of insulin

(Ritenbaugh and Goodby 1989:230). Normally the body obtains glucose from exogenous

sources (food, anabolism). During energy scarcity, due to low intakes glucose is obtained

from endogenous sources beginning with catabolism, a limited source stored in liver and

muscle. Next the body’s protein, stored blood and muscle is catabolized (Ritenbaugh and

Goodby 1989:229). Labor or physical activity increases glucose requirements completing

the model.

When food is plentiful, glucose energy is produced normally allowing physical

activity and metabolic equilibrium (anabolism). When food is scarce, production

increases when combined with physical activity or labor, excessive metabolic

disequilibria (catabolism) may occur. Plentiful food with energy efficiency and low

physical activity may itself lead to hyperglycemia. This suggests hyperglycemia is not a

state of homeostasis but physical activity diminishes it. Physical activity burns energy,

maintaining glycemia at a constant level. This facilitates survival. Individuals adapting to

such stress may experience constant hunger due to prolonged food deprivation and

secondary nutritional deficiencies and disease. Complex carbohydrates and meat protein

may be beneficial. Fat is the most calorie dense food, supplying more calories than

carbohydrates or proteins. The common Southern slave diet that consisted of corn, yams,

and salt pork or fish with some occasionally salted beef or fish (Hines et al. 2000). Salt

169

pork is “fat back” or “bacon”. Corn and yam are starchy vegetables (Nelson et al. 1994).

Table 6.2 summarizes the probable disease profile.

Energy and its passage through African Americans’ bodies may be the key to

understanding type II diabetes. Worldwide, peoples have been enslaved and colonized for

their labor (energy). Most researchers associate type II diabetes with Westernization,

cosmopolitanization, diet, urbanization and modernization. These may be superficial

confounders. In addition to the enumerated sociocultural alternations, many populations

with high type II rates have been enslaved and/or colonialized. Slavery, and

disenfranchisement are major life style changes. They altered normal metabolic states

leading to disequilibria (Table 6.2). Hyperglycemia occurred with the eventual return to

anabolism and homeostasis with diminished physical activity. Reduced energy

expenditure in an environment with a sure fit of calories would put high-performance

genotypes at risk for obesity and type II diabetes.

170

Metabolic States

Preenslavement

EnvironmentalEquilibrium

Anabolism

Enslavement

EnvironmentalDisequilibria

Catabolism

Jim Crow

IntensifiedEnvironmentalDisequilibria

HeightenedCatabolism

Desegregation

EnvironmentalEquilibrium

Homeostasis

FoodPlenty Scarce

High dietaryCholesterol and fats

Intermittenthunger

HeightenedScarcity and“Biological Crisis”

High dietaryCholesterol and fats

Heightened hunger

Plenty of food

Normal andhigh dietarycholesterol

EnergyGlucose Normal Exuberant Exuberant Adequate

Conditions

PhysicalActivity Normal Excessive Excessive Normal

Outcomes Normo- glycemia

*"High-performance genotype"

Hyperglycemia

*"High- performance genotype"

Hyperglycemia

Normoglycemiaand *"High-performancegenotype"Hyperglycemia

* "High-performance genotypes" = individuals with exuberant metabolic systems that produce surplus glucose or excessive energy from food that is deficient in nutrients, quality, and quantity. Surplus glucose is required to perform excess and arduous physical labor in states of environmental disequilibria characterized by high life stresses, mortality, and morbidity.

Table 6.2. A Model of Anabolic-Catabolic Homeostasis Etiology of Diabetes Mellitus in African Americans

171

6.5.1 Type II Diabetes and Obesity in African Americans

6.5.1.1 AnabolismAfricans were enslaved for a single reason: labor. African labor generated wealth

for African, Arab, Jewish, and European slave owners. The ACHED model focuses on

fuel needed for labor. It recognizes explicitly the degrading and degenerating of the body

when fuel is undersupplied. This model views type II diabetes as a chronic degenerative

disease (Crews and Gerber 1994), a catabolic processes.

The etiology of type II diabetes in African Americans begins in Africa. There

were large populations with tremendous wealth and complex political organizations

throughout Africa well before Europeans arrived. Well-populated empires and cities are

strong circumstantial evidence that Africans who came to the Americas as slaves

generally were from societies with constant food supplies. One estimate is that

40,000,000 Africans died during the European slave trade (Bennet 1964). Mortuary

studies of Africans slaves’ Osteological remains in Barbados confirm that African-born

were healthy and better able to resist pathologies and nutritional diseases than American-

born (Corruccini et al. 1987, p. 183). Barbados and other Caribbean Islands were

seasoning ground or the first stop in the New World for Africans’ introduction and

adjustment to slavery. Risks for and predispositions to type II diabetes likely were low in

African slaves from such societies. They would probably fall into the anabolic

equilibrium heading of Table 6.2. The probable metabolic cycle for African born

Africans is anabolic.

African prehistory confirms the basic physiological fitness of Africans. Africans’

disease profiles likely paralleled their socio-cultural developments, most important being

172

agricultural and pastoral development. Slavers generally selected slaves from agricultural

and pastoral societies to benefit from skills and knowledge that would be appropriate for

European industries and agriculture (Holloway 1990). Settled agriculture with villages or

cities leave populations susceptible to enteric bacteria, respiratory and other infections,

measles, rubella and venereal diseases (Mascie-Taylor 1963, p. 6).

When energy needs are adequate, the body grows, functions normally, and stores

any excess energy as fat for later use (anabolism). Food producing societies with constant

food supplies are better equipped to meet energy needs. Neel also explains the converse

in societies with plentiful and scarce cycles of food availability. Disease became more

likely when resources are lower and body’s energy requirements are not met (Szathmary

1990, p. 87). When energy needs are not met by the diet, metabolism converts to

catabolism. Anabolism generally is found after food is sure fit. African American slaves

survived periods of food scarcity and catabolism that today contribute to their higher

risks for obesity and type II diabetes.

6.5.1.2 Catabolism

Slave diets and their and Osteological remains contribute to understanding

evolutionary etiology of type II diabetes in African Americans. These records show the

diet was calorie restricted and nutritionally poor. The diet was insufficient to sustain

normal metabolic processes. At the same time, energy expenditure was high. In

Barbados, slaves disembarking from Africa already showed malnutrition and traumatic

occlusion, along with various metabolic insults (Corruccini et al. 1987, p. 179). Some of

173

their skeletal features suggest periodic near-starvation, while infant slaves experienced

considerable weaning trauma, exceeding that of the prenatal or immediate postnatal

periods.

Plantation nutrition records from the Caribbean suggest slaves received 2,500 to

2,900 calories and 55 grams of protein per day (Kiple 1984). Strenuous physical activity

in the tropics causes perspiration and stress, requiring 3,200 to 4,000 calories daily and

100 to 125 grams of protein to maintain nitrogen balance. Slaves were also often fed

rancid foods of poorer nutritional value (Kiple 1984, p. 80). Diets also were deficient in

vitamins A, B1, B2, B3, C and minerals including iron, calcium, phosphorus, thiamine,

riboflavin, and niacin. Salted meats provided some proteins but few vitamins and

minerals. Slaves frequently suffered deficiency diseases such as night blindness, beriberi,

pellegra, iron deficiency and other anemias, dropsy, and scurvy.

Similar diets were provided US slaves. Dietary deficiencies were reported among

slaves in New Orleans (Owsley et al. 1987) in Philadelphia (Angel et al. 1987), Virginia

and Maryland (Blakley et al. 1994), Charleston, South Carolina (Rathbun 1989), Texas

(Hutchinson 1987). Malnutrition caused Harris lines, reflecting acute development arrest

and recovery period (Rathbun 1984, p. 245). Forty-five percent of the males and eighteen

percent of the females in the Charleston sample had Harris lines. Transverse lines were

found on the distal diaphusis, proximal femur and proximal tibia. Childhood growth was

compromised (Owsley 1987, p.193). Dentition showed frequent severe hypoplasias

(Rathbun 1987, p. 245; Corruccini et al. 1982, p. 445) and tooth hypercementosis

(Corruccini 1987, and 1982) caused by endocrine disorders, iron and protein deficiencies,

or malnutrition and vitamin C deficiencies (Corruccini et al. 1987, p. 180).

174

Nutritional conditions deteriorated further when slaves were emancipated in 1865

(Martin, Magennis and Rose 1987, p. 261). Slave masters fed slaves. However, most

freed bondsmen were often unemployed. When employed, employers paid freed

bondsmen insufficient wages to support themselves and families. Emancipated black men

and their families nearly starved. Deteriorating conditions for freed bondsmen continued

until the 1940s (Martin, Magennis and Rose 1987, p. 261; Farley 1970, p. 3; Holmes

1937; Martin, Magennis and Rose 1987, p. 255). High mortality and morbidity rates,

gross pathologies caused national population decline that led to a prediction of the

imminent disappearance of Afro-Americans (Farley 1970, p.3; Holmes 1937). Data on

diets of slaves and freed bondsmen suggest their metabolism was catabolic. Thus, the

model for the Anabolic-Catabolic-Homeostasis Etiology of Diabetes that relies on the

Global Structure Model provides conformity evidence supporting the predictive power of

cholesterol vis’-a’-vis’ Type II.

6.5.1.3 Cultural Ecology and Type II Diabetes

Forced labor and energy expenditure required to complete it provide the

ecological background for today’s African Americans. From 1878 to 1940 skilled blacks

were paid substandard wages and restricted to farm labor and dangerous menial jobs.

Catabolic metabolism continued through 1940 as mortality rates of freed blacks exceeded

each of those among slaves. High mortality and morbidity rates brought African

Americans to near extinction. Nutritional deficiencies increased for calcium, iron, and

proteins. Adults exhibited more frequent spinal osteophytosis and osteoarthritis of the

major joints, hands and feet due to the strenuous labor they performed (Martin, Magennis

175

and Rose 1987, p. 255). Records indicate post-Reconstruction black males worked but

nearly starved by yielding the small quantity of food to wives and children.

During the late nineteenth century, the southern caste system shaped all

institutions of southern society, from voting booths to the market place (Landale and

Talnay 1991, p. 35) as a “dual economy” replaced slavery. Upward mobility was

restricted by crop liens and debt peonage systems. Anti-enticement and vagrancy laws

legalized tenant exploitation. Except for strenuous and dangerous jobs in the turpentine

and timber industries, blacks were excluded from industrial jobs throughout the South”

(Landsdale and Talnay 1991, p. 38). Blacks also were excluded from skilled occupations,

dock labor and professional careers. Strenuous and dangerous jobs and high mortality and

morbidity rates further suggest high catabolism among Post-Reconstruction African

Americans.

6.5.1.4 Environmental Ecology of Type II Diabetes

Environmental conditions of African Americans also support a model of

metabolic disequilibria. This may have particularly affected reproduction and prenatal

environments among blacks. Multiparity hypothesis helps explain possible reproductive

benefits of high performance genotypes. These women are better able to gain weight

during pregnancy. This could lead to higher RS; however, in a setting with a sure fit of

calories high performance genes would be detrimental, resulting in obesity and

hyperglycemia (Weidman 1989, p.242).

Easy weight gain likely reflects efficient metabolism and high performance

genotypes. Among U.S. blacks, 72% of women and 29% of men aged over 25 are

176

overweight (Johnson 1996, p. 227). Infants born to thrifty overweight blacks would be

better able to survive. However, black women in Los Angeles deliver 59% of all

extremely premature infants but represented only 15% of total deliveries (Taeusch and

Supnet 1994), contradicting Weidman’s (1998) hypothesis.

However, very low birth weight black neonates may survive marginally better

than white neonates, particularly girls (Phelps et al. 1989, p. 9). Those with high

performance metabolisms differ from those without. From birth onward, women giving

birth to macro somatic infants often develop clinical diabetes about thirty years later

(Neel 1962, p. 353), although class and ethnicity coined this association. The high

percentage of low birth weight black neonates, overweight black women, and high

diabetes among African Americans suggest that adjustments enabling blacks to survive

enslavement and post-Reconstruction period may place them at a life span disadvantage

with respect to US whites. Adjustments enabling African Americans to reproduce

themselves and avoid extinction may also provide a diabetic phenotype.

Poor maternal nutrition also is linked to low birth weight infants (Hales and

Barker 1992). Malnourished children seem to exhibit permanent alterations in their

responses to glucose. Insulin secretion in protein/calorie malnutrition is severe. Islet

vascularisation appears altered lending to poor secretion due not only to fewer Beta cells

(Hales and Barker 1992, p. 598). Maternal malnutrition predisposes infants to type II

diabetes (Barker 1990). Evolutionary, cultural, and environmental conditions seem to

have predisposed most US blacks to type II diabetes. Circumstances among US blacks

may have been severe enough to predisposition people who were once healthy to type II

diabetes.

177

6.5.1.5 Homeostasis

Following the Civil Rights Movement of the early 1950s blacks gained access to

skilled, management and professional occupations. Such occupations required little

strenuous physical labor. These jobs allowed many to earn more than a survival income

and enter a new phase of homeostasis with adequate and even overadequate nutrition.

Given generation of maternal malnutrition, the hypothesis is that infants born following

these conditions are predisposed to type II diabetes. Barring rapid dietary changes in this

model, reduced energy expenditure and improved nutrition made the onset of type II

diabetes inevitable. A return to metabolic homeostasis accompanied by reduced physical

labor set the stage for the current epidemic of diabetes among African Americans.

6.5.1.6 Confounders

Most models of type II diabetes that fail to consider possible effects of worldwide

slavery and colonialization may bias models of important historic events. Without

consideration of these important historic events, researchers associated the onset of

diabetes mellitus type II with western diets, urbanization and industrialization. Middle

class and free African Americans have consumed a western style, high animal fat, and

high simple carbohydrate “soul food” diet since the 1700s (Helton 2002). Soul food

helped free blacks meet the physically taxing energy demands associated with

disenfranchisement, discrimination and arduous labor of the 19th and 20th centuries.

However, before the 1960s blacks ate soul food, but they did not experience a diabetes

epidemic (Dressler 1993).

178

Urbanization also appears to be a confounder. Before 1865 most free blacks lived

in Northern cities. Skilled slaves also lived in cities, bit in the South. Runaway slaves fled

to Northern cities in search of freedom and jobs. They started a large urban movement

during the late 1820s (Franklin and Moss 1988; Angel et al. 1987). Later, freed

bondsmen fled the South in a mass urban movement called the “Negro Exodus (1889).

The last urban wave was the “Great Folk Movement” that started after World War II

(Franklin and Moss 1988, Bennett 1964). Northern industries hired blacks to break strikes

and fight union demands for wage increases (Abrahamson 1981, p. 54). By 1980, 81% of

southern blacks had migrated to urban areas (Franklin and Moss 1988, p. 420).

Some slaves also lived in urban areas and were industrialized. Industrial slaves

lived in New Orleans from 1720 (Owsley et al. 1987, p. 190) and in Catoctin Furnace,

Maryland, as early as 1790 (Kelley and Angel 1987, p.222). Urban slaves lived in many

other cities. Those in New Orleans lived longer than the white population. Slaves at

Catoctin Furnace were healthier than nonindustrial slaves. Industrialization improved

living conditions, health, opportunity structures and lifestyles for African Americans

whether they were industrial slaves in the South or strikebreakers and industrial workers

in the North. For blacks, industrialization was a major techno-economic change and a

drastic life style improvement. Until recently, the diabetes epidemic was not a significant

factor for urban or industrial experiences of African Americans.

Again, the data suggest one must look elsewhere for the etiology of type II

diabetes in African Americans. Metabolic disequilibria is one common factor for all non-

Western people and Europeans enslaved and colonized by one another. Greeks, Romans,

and Germans enslaved and colonized hundreds of thousands of Europeans (Everett 1978).

179

Europeans stopped enslaving each other during the tenth century (Everett 1978). During

the fifteenth century Europeans gradually shifted their interest from European indentured

servitude to the enslavement of Native Americans, then to “more desirable” African

Negroes (Everett 1988, p. 31; Bennett 1970, p. 35; Franklin and Moss 1988, p. 32).

Europeans probably have a lower prevalence of type II because they have had longer

period of return to metabolic homeostasis compared to more recently enslaved and

colonized non-Westerners.

The Anabolic-Catabolic-Homeostasis model provides an ecological, cultural-

historical, biological and evolutionary explanation of type II diabetes in modern

populations. It focuses attention on human energy expenditures. Accumulation of wealth

requires expenditure of human energy. Those who controlled human energy accumulated

vast quantities of wealth and luxuries for themselves and their posterity. Those who were

captured and forced to expend their energy could only have enhanced their survival by

maintaining constant blood glucose during periods of low caloric restrictions and low

nutrition. In such settings high performance genotypes have a survival advantage

regardless of where they come from.

6.6 Significance

The significance of COSDA research is that its findings are consistent with other

research. Liebson et al. (2001) discussed how obesity is a risk factor for diabetes and

mortality among people with diabetes. Increasing obesity is accompanied by increasing

diabetes (Liebson et al. 2001). Other studies show a positive correlation between diabetes

and total dietary fat (Feskes et al. 1995). This is significant as the percent of energy from

180

fat predicted diabetes, and positively correlates to post load glucose levels after 20 years

of follow-up (Feskes et al. 1995). Post load glucose levels of COSDA participants were

strongly related to dietary fat.

Additionally, the location of adipose tissue may indicate the extent to which

obesity contributes to insulin resistance (Sumner et al 2001). Visceral adipose tissue

(VAT) is measured by abdominal skinfolds. White women have larger VAT

measurements and black women have larger suprailiac skinfold measurements (Sumner

et al (2001). Larger VAT also associates with insulin resistance in white women but not

in black women. COSDA women, like other black women, have larger suprailiac

skinfold measurements. Genetic predisposition for or against obesity does not preclude

overriding environmental influences of energy-dense foods in developing obesity.

Particularly African American women are more likely to be obese because they have

smaller rather than larger visceral fat stores in comparison to white women. Our results

also indicate that obesity is a growing problem in the United States. Twenty percent of

men and twenty-five percent of women aged 20 - 74 have BMI >30 kg/m2 (Looker et al.

2001). Seventy-two percent of the black females and twenty-nine percent of the black

males in a study by Johnson et al. (1996, p. 227) were overweight. African Americans of

both sexes aged 20 to 74 are 69% and 58% more than likely to be overweight and

severely overweight respectively than white Americans (Kumananyika and Johnson

1991). The mean BMI score for COSDA participants is 29.40, the overweight range with

scores from 25 to 29.9 kg.m2.

COSDA findings also reflect diabetes trends in the United States. The prevalence

of diabetes increased from 4.9% in 1990 to 6.5% in 1998, which, in the latter year,

181

equaled 12 million people in the 43 participating states and 13 million people in all 50

states and the District of Columbia (Mokdad et al. 2002). Additionally, the sex-age-race

standardized prevalence of diabetes increased from 4.9% in 1990 to 5.9% in 1998—a

20% increase the was also accompanied by a weight increase in both men and women

during this period, and observed across all age-groups, races, educational levels, levels of

smoking status, weight levels and nearly all states (Mokdad 2002). Data on the

prevalence of diabetes are not available for COSDA participants in 1990. The prevalence

of diabetes also increases among COSDA participants among the other older and better

educated as it did among Americans toward the end of the 1990s (Mokdad 2002).

Findings also show that folklore may contribute to the study of disease causation.

Folklore provided the foundation to develop and examine the global model. Theoretical

perspectives on type II diabetes may need to be revised to include a global structure

perspective and environmental equilibrium model. The impact of the circulation of

folklore indicates researchers should include middle class African Americans in diabetes

etiology.

Folklore has contributor to understanding the etiology of type II diabetes among

African Americans by showing how legends express the “collective actions of the

multitude” and culminate in customs and observances (Ben-Amos 1972 that gave rise to

modern global structure. Following the global circulation of Hebrew, Arab and European

legends, Africans were placed in prolonged states of diminished food supplies, high

morbidity and high mortality. Thus, folklore not only explained disease causation but also

its maintenance.

182

There are many theoretical perspectives of diabetes causation. One of the most

popular and most controversial is Neel’s “thrifty genotype.” This theory explains

diabetes mellitus type II as genetic adaptation to starvation during conditions of plentiful

nutrition (McBeth 1993, p. 64). Neel’s thrifty genotype attributes cycles of food plenty

and scarcity to various environmental, sociocultural, and technological changes.

However, he and other scientists fail to include major global forces of slavery and

colonization in their models. A global structure model goes beyond single-gene,

chromosomal, multifactorial with high heritability, or low heritability, infectious, and

environmental models of disease causation. A global perspective allows us to combine all

models of disease in the examination of actual metabolic adjustment to cyclic food

supplies and other pertinent factors that may have contributed to the etiology of type II.

Neel’s thrifty genotype emerges during fluctuating periods of low caloric consumption.

The Anabolic-Catabolic-Homeostasis Etiology of Diabetes Mellitus presented here is

based on factual historical and sociocultural phenomena. It suggests high performance

genotypes emerged as a result adjustments to prolonged food-scarcity and intensive labor

demands. These high performance genotypes are fueled by high fat consumption as an

adaptation to food scarcity in a setting of high-energy dissipation. The addition of fats

and cholesterol to a diet that is substandard in quality and quantity converts this diet into

one that can more adequately meet the demands for high-energy expenditure.

COSDA research is also significant in that it expands etiological methodology.

The Sociocultural Questionnaire used here provides a new index of culture specific risks

peculiar to African American experiences in the United States. It classifies risks into four

indexes: sociodemographics, lifestyle, health threatening behaviors, and dietary factors.

183

This demonstrates how global factors, folklore global political hegemony, and slavery

and colonization, are major forms of human cultural development that influence modern

sociocultural outcomes.

Previous social science research concerning African Americans generally focuses

on the lower class. These findings often are generalized to all African Americans. This is

a misapplication. Study of middle class African Americans will extend medical and

social science knowledge of health disparities. Research on middle class African

Americans will enable researchers to compare lifestyle, socioeconomic, educational and

other differences of an ethnic minority within a color line society. These differences will

aid social scientists engaged in applied research to develop social policies and implement

social programs to reduce health disparities among minorities regardless of class.

This research should continue to determine how class differences among African

Americans impact health differences and how social class and disenfranchisement affect

disease prevalence and the onset of chronic diseases. An expansion of COSDA research

should also include an assessment of family type and disease among African Americans.

Lastly and most importantly, further research is needed to develop strategies for

successful dietary modifications. African Americans must be informed how the “slave-

food/soul-food” diet is detrimental to health and longevity. African Americans must

developed strategies to alter their preferential food selection. Additionally, standards of

physical attractiveness must be modified so that standards of physical characteristics

promote overall health.

184

6.7 Conclusion

Rapidly increasing type II diabetes is a serious health care threat to African

Americans. Since 1960 its prevalence has increased from almost zero to 33%. Age-

adjusted rates are 50% higher among ethnic minorities, especially those of lower income

and education. Other than dietary cholesterol, sociocultural factors explained only 8% of

the variance in elevated post load glucose levels above 140 ml/dl. Careful examination of

medical, historical, and social phenomena showed the most significant sociocultural

factor in type II onset is prolonged environmental disequilibria culminating in high

dietary fat consumption. Enslavement and colonization led to health imbalances and

ecosystem disturbances on global scale. These major cultural developments forced slave

to alter their diets to their detriment. Analysis of COSDA participants’ diets show they

retain the high saturated fat and cholesterol soul food diet that enabled their ancestors to

survive the “biological crises” associated with slavery, emancipation and apartheid. A

high saturated fat and cholesterol diet is beneficial when excessive, arduous physical

labor accompany food and nutrition scarcity. COSDA participants carved out a middle

class community that enabled them to escape much of the environmental disequilibria

associated with the American color line society. However, the high saturated fat and

cholesterol “slave food/soul food” food way that was forced on their slave ancestor’s

subjects COSDA participants to the same environmental disequilibria of slaves.

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APPENDIX A

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