JOURNAL OF ADOLESCENT HEALTH 1997;20:27-37
ORIGINAL ARTICLE
A Longitudinal Study of the Dietary Practices of
Black and White Girls 9 and 10 Years Old
at Enrollment: The NHLBI Growth and Health Study
SUZANNE W. MCNUTT, M.S., R.D. YUANRENG HU, PH.D. GEORGE B. SCHREIBER, D.SC.
PATRICIA B. CRAWFORD, DR.P.H., R.D., EVA OBARZANEK, PH.D., R.D. AND
LAUREL MELLIN, M.A., R.D.
Purpose: To determine whether there are racial differ-
ences in the frequency with which black and white girls
engaged in eating practices commonly targeted for mod-
ification in weight reduction programs.
Methods: This is part of the NHLBI Growth and Health
Study, a longitudinal study of preadolescent girls
designed to examine the factors associated with develop-
ment of obesity, and its later effects on cardiovascular
risk factors. Black and white girls ages 9-10 years at entry
(n = 2,379) were recruited at three clinical sites. Racial
differences were examined in 11 "weight-related" eating
practices such as eating with TV, eating while doing
homework, and skipping meals. Multiple logistic regres-
sion analyses were then conducted for each of the depen-
dent variables.
Results: Black girls were more than twice as likely as
white girls to frequently engage in the targeted weight-
related eating practices. The odds of a study girl fre-
quently engaging in most of these eating practices de-
creased with an increase in parents' income and
education level. However, even when controlling for
socioeconomic and demographic effects, black girls re-
mained more likely to engage in these eating practices
than white girls. For most of the behaviors, girls who
frequently practiced a behavior had higher energy in-
takes compared to those who practiced it infrequently.
From Westat Inc. (S.W.M., Y.H., C.B.S.), Rockville, Maryland,
USA; University of California, Berkeley (P.B.C.), California, USA;
National Heart, Lung, and Blood Institute (E.O.), Bethesda, Maryland,
USA; and Family and Community Medicine (L.M.), Center for Adoles-
cent Obesity, University of California, San Francisco, California, USA.
Address reprint requests to: Suzanne McNutt, Westat, Inc., 1650
Research Blvd, WB 376, Rockville, MD 20850.
Manuscript accepted February 26, 1996.
© Societyfor AdolescentMedicine, 1997
Published by ElsevierScienceInc.,655 Avenue of the Americas,New York,NY 10010
Conclusions: The finding that black girls at an early
age more frequently engage in eating practices associated
with weight gain may have significant implications for
obesity development. For both young black and white
girls, early education efforts may be necessary in helping
develop good eating habits. Since it appears that black
girls have a higher risk of developing adverse weight-
related eating practices, culturally appropriate education
materials may be required. © Society for Adolescent
Medicine, 1997
KEY W O R D S :
Adolescent females
Dietary intake
Eating practices
Obesity
Socioeconomic status
Racial differences
Introduction
Black w o m e n are at a greater risk for d e v e l o p i n g
obesity than white w o m e n . The p e r c e n t a g e of black
w o m e n classified as o v e r w e i g h t is 1.5 times that of
white w o m e n (1). While black w o m e n are m o r e often
o v e r w e i g h t than w h i t e w o m e n in a d u l t h o o d , the
prevalence of o v e r w e i g h t in black girls in infancy
a n d early childhood has been r e p o r t e d to be less than
or equal to that a m o n g their white c o u n t e r p a r t s (2,3).
This suggests that it is d u r i n g the preadolescent and
adolescent years that racial differences in the p r e v a -
lence of obesity emerge. N e w l y released data f r o m
1054-139X/97/$17.00
PII $1054-139X(96)00176-3
28 McNUTFET AL.
the 3rd National Health and Nutrition Examination
Survey (NHANES) supports this view (4). The study
reported that 29.9% of black adolescent girls (12-17
years of age) are overweight (based on a BMI - 85th
percentile) compared to 20.3% of white adolescent
girls. Furthermore, the data indicate that the preva-
lence of overweight for black girls has dramatically
increased 64.3% (as compared to 33.6% for white
girls) over the decade since NHANES II 1976-80.
Because obese children have a higher risk of becom-
ing obese adults and developing premature cardio-
vascular disease in adulthood, this dramatic increase
in the prevalence of overweight underscores the
importance of finding factors contributing to exces-
sive weight gain.
The development of obesity and the racial differ-
ences in its prevalence may stem from a variety of
factors, including eating practices. While black fe-
male adolescents appear to be weight conscious,
Kumanyika suggests that they are less inclined to
engage in behaviors likely to control weight gain
than their white counterparts (5-7). Few studies have
examined racial differences in adolescent female
eating practices (8-9).
This study was designed to further investigate
whether there are racial differences in the frequency
with which black and white girls, in preadolescent
and adolescent years, engage in eating practices that
could lead to obesity. "Weight-related" eating prac-
tices are defined in this study as behaviors targeted
for modification in weight reduction programs. Ex-
amples of targeted behaviors include excessive fast-
food consumption (10), irregular eating schedule and
meal-skipping (10-17), situational eating such as
eating while watching TV or eating alone (10-13,15-
17), consuming large food portions (11,13-17), and
snacking when not hungry (14-17).
Control of these behaviors reflects clinical advice
commonly given to children and adults to prevent
excessive accumulation of fat. While the link to
weight gain is theoretical for some behaviors, there is
evidence that they are characteristics of obese sub-
jects. For example, Coll and colleagues (18) found
that obese subjects tended to eat more frequently in
fast-food restaurants than nonobese subjects. Since a
Big Mac with a large order of fries contains 900
kilocalories, 48% of which come from fat (19), limit-
ing the frequency of fast-food consumption may help
control weight gain. Obese adolescent girls skip
breakfast more frequently compared to their leaner
counterparts (8), suggesting that modifying behavior
to maintain a regular meal pattern may impact on
weight accumulation. Situational eating has also
JOURNALOF ADOLESCENTHEALTHVol. 20, No. 1
been shown to be more of a problem for obese
subjects than for their leaner counterparts (20). Obese
subjects eat less in response to hunger and more in
response to external cues like watching television
and reading books, suggesting decreasing environ-
mental stimuli may reduce the saliency of food cues to
control weight. And finally, Striegel-Moore reported
that binge eating, characterized by eating a large
amount of food in a limited time period with a
feeling of lack of control, appears to be a conse-
quence of prolonged efforts to control weight (21).
Because binge eaters are frequently characterized as
people who eat alone and when not physically
hungry, limiting these behaviors may help control
binge eating, thereby minimizing the resultant
weight gain.
Overall, there are few data bearing on the
association between eating behaviors and obesity,
as well as about racial differences in eating behav-
iors, especially in adolescents. To better under-
stand the prevalence and racial patterns of eating
practices in adolescent females, it is necessary to
examine a wide range of these behaviors in a
population with a broad socioeconomic represen-
tation. The National Heart, Lung, and Blood Insti-
tute Growth and Health Study (NGHS) provides
that opportunity. NGHS, a longitudinal study, was
designed to examine the factors associated with
the onset and development of obesity and obesity's
effects on cardiovascular disease risk factors in
preadolescent girls as they mature. It is an ongoing
study of 2,379 black and white girls who were 9
years old and 10 years old at time of enrollment in
1987. Details about recruitment and study design
were reported earlier (22).
The objective of this analysis was to determine
whether there were racial differences in the fre-
quency of engaging in eating practices targeted in
weight control programs. Eleven eating practice
questions were identified for examination based on
targeted practices in behavior modification weight
reduction programs. Racial differences in eating
practices were examined over a 4-year period while
controlling for household income, parental educa-
tion level, and the number of parents (or guardians)
in the household.
Materials and Methods
Sample
Participants in the study were recruited by three
clinical centers: the University of California at Berke-
January 1997 DIETARYPRACTICESOF BLACKAND WHITEGIRLS 29

Table 1. Distribution of NGHS Girls at Baseline by Race, Age, Household Income,

Maximum Parental Education, and Number of Parents
White Black
N % N %
Age at entry
9 years 616 52.8 539 44.4
10 years 550 47.2 674 55.6
Household income
Under $20,000 193 17.4 535 47.1
$20,000-$39,999 359 32.3 335 29.5
$40,000 or more 558 50.3 265 23.4
Maximumparental
education
High school (HS) or 236 20.2 382 31.5
less
Post-HS-4 yr. college 510 43.8 679 56.0
5 yr. collegeor higher 419 36.0 151 12.5
Number of parents
Two 946 81.1 683 56.3
One 220 18.9 530 43.7

ley, the University of Cincinnati/Cincinnati Chil-
dren's Hospital Medical Center, and Westat/Group
Health Association (GHA) (currently Humana
Group Health Plan) in the Washington, DC, area.
Berkeley and Cincinnati recruited participants from
public and parochial schools, and Westat recruited
subjects from GHA, an HMO in Washington, DC. A
total of 2,379 girls (49% white and 51% black) were
recruited from the ages of 9-10 years.
Table 1 represents the racial distribution of study
girls and their parents' income and education levels.
The data on race were obtained from questionnaires
completed by both the girl and her parents or guard-
ians. Only girls who classified themselves as either
black or white were eligible for the study. In addi-
tion, the race of the parents or guardians had to agree
with that of the girl before she was eligible for
participation.
Total household income was defined as wages,
salaries, social security payments, Aid to Families
with Dependent Children, interest, unemployment
compensation, and rental income and was obtained
from a self-administered demographic questionnaire
completed by each girl's parent or guardian. Income
was reported as within one of nine categories rang-
ing from less than $5,000 up to $75,000 or more per
year. For analysis, the income data were collapsed to
three categories: < $20,000, $20,000-39,999, and
$40,000 or more.
Parental education attainment was obtained from
the demographic questionnaire and was divided into
11 categories: 0 - 6 years; 7-9 years; 10-12 years; high
school diploma or equivalency; post-high school
education; 1, 2, 3, 4, or 5 years of college; and
graduate school. Parents were asked to choose the
category that included the highest level of school
completed for each parent or guardian. In two-
parent households, the maximum parental education
level for a family was determined by selecting the
highest education level reported for either parent or
guardian. For analysis, education levels were col-
lapsed to three categories: high school or less, post-
high school through 4 years of college, and 5 years or
more of college.
Data C o l l e c t i o n
The data were collected on an annual basis. Dietary
intake data were obtained from a three-day food
record that had been previously validated (23). The
girls were instructed in keeping this record using
age-appropriate materials and were supplied with
measuring cups and spoons to use in determining
portion sizes. Nutritionists were trained to review
the intake record with the girls using the University
of Minnesota Nutrition Coordinating Center (NCC)
certification guidelines. Trained interviewers col-
lected eating practices data using the Nutrition Pat-
terns Questionnaire, which contained questions
regarding nutrition patterns and practices, including
parental influence on food selection and preparation,
parental concern about weight, moods related to
eating, and weight-related practices. For this analysis
we chose 11 weight-related practices commonly tar-
30 McNUTTET AL. JOURNAL OF ADOLESCENTHEALTHVol. 20, No. 1

geted in weight reduction programs. The detailed three remaining variables, the binary values of 0 and
data collection methodology is described in previous 1 were assigned to frequency values as shown below.
publications (22,24).
The weight-related eating practices are:
1. eat while doing (always = 1;otherwise = 0)
homework
1. I eat while I do h o m e w o r k (always = 1;otherwise = 0)
2. eat in bedroom
2. I eat food in my b e d r o o m 3. eat with TV (always = 1;otherwise = 0)
3. I eat while ! watch TV 4. eat alone (always = 1;otherwise = 0)
4. I eat alone 5. eat big (always = 1;otherwise = 0)
5. I eat big helpings of food helpings
6. I eat between meals even w h e n I am not h u n g r y 6. eat w h e n not (always = 1;otherwise = 0)
7. I buy snack food hungry
8. I sneak food w h e n no one is looking 7. buy snack food (always = 1;otherwise = 0)
9. N u m b e r of daily snack occasions 8. sneak food (always = 1;otherwise = 0)
10. N u m b e r of times eat fast food per week 9. eat snacks (3 times = 1, < 3 times = 0)
11. N u m b e r of meals skipped 10. eat fast food (--- 4 times = 1, < 4 times = 0)
11. skip meals (skipped 1 meal = 1, skipped
Answers to questions 1-8 consisted of "never or no meals = 0)
almost never," "sometimes," or "usually or always," 12. eating practices (score -> 4 = 1, score < 4 = 0)
score
and were coded 1, 2, or 3, respectively. The answer to
practice 9, "number of daily snack occasions," was An additional dependent variable, "eating practices
derived from three separate questions about whether score" (#12), was created by s u m m i n g the 11 binary
snacks were usually eaten in the morning, afternoon, dependent variables. This variable reflects a compos-
a n d / o r evening, with a corresponding value range of ite pattern of weight-related practices. The weight-
0-3. Answers to question 10, " n u m b e r of times fast related "eating practices score" value had a range of
food is eaten per week," were collapsed into three 0-11 and for analysis was assigned a binary value of
groups: "less than once a week," "one to three times 0 for "always" participating in fewer than four eating
a week," and "four or more times a week," and practices and 1 for "always" participating in four or
coded 1, 2, or 3, respectively. Answers to practice 11, more practices.
" n u m b e r of meals skipped," were also derived from Since the longitudinal data included information
three separate questions about the combined fre- from five annual visits, individuals had up to five
quency of skipping breakfast, lunch, and d i n n e r / repeated responses to each of the eating practices
supper. Since no one reported skipping two or more questions. To account for the correlations among
meals a day, practice 11 had a binary value of 0 (no repeated records for the same participant, the gener-
meals skipped) and 1. alized estimating equation (GEE) method of Zeger
and Liang (25) was used. Specifically, the GEE pro-
gram written in SAS/IML (26) was used to run the
logistic regression model for the 5-year longitudinal
Statistical M e t h o d s
data. The GEE model was run for each of the
This analysis employed the first 5 years of longitu- dependent eating practice variables. In the model,
dinal data collected in the period from 1987-92. the logit of the probability of a child giving the
Eleven dependent variables corresponding to the positive response was assumed to be a linear func-
eating practices listed above were included. Initially, tion of her race, age, household income, and maxi-
principal components analysis was performed in an m u m parental education, and took the following
attempt to identify a few c o m m o n factors that might general form:
effectively summarize all 11 variables. The results of logit(p) = intercept + race + age + income +
the analysis, however, indicated that intercorrela- education + interaction terms
tions among the variables were low and no scoring where:
factors could be identified. Therefore, the 11 depen-
dent variables were analyzed separately. • p = Probability of positive response (response =
All the variables were assigned a binary value of 0 1) for any one of the 12 binary response eating
and 1. For variables 1-8 the answer of "always" was practice variables;
coded as 1 and other answers coded as 0. For the • race is an indicator variable (white = 0, black = 1);
January 1997 DIETARY PRACTICESOF BLACK AND WHITE GIRLS 31

Table 2. Mean Total Calories by Frequency of the Selected Eating Practices in the NGHS Year 1 and Year 5, by Race
with P-Value from Student's t-Test
White Girls Black Girls
Year 1 Year 5 Year 1 Year 5
Eating Practices Freq. Infr. Diff. Freq. Infr. Diff. Freq. Infr. Diff. Freq. Infr. Diff.
Eat with homework 1935 1790 145"* 1838 1769 69 1913 1847 66 2111 1924 187"
Eat in bedroom 1887 1798 89 1797 1772 25 1953 1848 105 2031 1933 98
Eat withTV 1861 1789 72* 1920 1751 169'* 1938 1813 125"* 2017 1919 98
Eat alone 1691 1803 -112 1590 1782 -192" 1786 1862 -76 1854 1956 -102
Eat big helpings 1796 1802 -6 2093 1756 337** 1957 1844 113" 2224 1921 303**
Eat not hungry 1953 1794 159" 1642 1779 -137 1839 1861 -22 2018 1945 73
Buy snacks 1810 1801 9 1892 1760 132" 1935 1838 97* 2060 1894 166"*
Eat snacks 1849 1798 51 1912 1759 153" 1898 1846 52 2049 1897 152"*
Sneak food 1771 1806 -35 2131 1768 363** 1998 1844 154" 1883 1951 -68
Eat fastfood 1795 1803 -8 2023 1761 262** 1892 1854 38 2115 1930 185"
Skip meals 1670 1823 -153"* 1653 1873 -220** 1820 1876 -56 1896 2072 -176"*
Eating summary score 1778 1803 -25 1817 1770 47 1975 1835 140" 2062 1913 149"*
* p = .05.
**p ~ .01.

• age is a set of indicator variables c o r r e s p o n d i n g to parents or g u a r d i a n s living in the household, be-

the subject's age at last b i r t h d a y on successive
visits, and includes age 10, age 11, age 12, age 13,
a n d age 14 years;
• education is a set of indicator variables including:
e d u c l ( p o s t - h i g h - 4 years college = 1, other-
wise = 0)
educ2 (5+ years college = 1, otherwise = 0);
• income is a set of indicator variables including:
i n c m l ($20,000-$39,999 = 1, otherwise = 0)
incm2 ($40,000+ = 1, otherwise = 0);
• interaction t e r m s include a n y significant first-
o r d e r (or t w o - w a y ) interactions (race* age, race*
education, race*income, age*income, age*educa-
tion, and income*education).
It should be noted that the n u m b e r of parents in the
h o u s e h o l d w a s initially in the model. H o w e v e r , w e
decided to exclude it f r o m our regression analysis
because it w a s only m a r g i n a l l y significant for one
eating practice. In fitting the m o d e l for each of the
eating practices, the m a i n effect t e r m s w e r e a l w a y s
retained in the model. The interaction t e r m s w e r e
tested using f o r w a r d m o d e l selection procedures.
The global Chi-square test w a s u s e d to evaluate the
significance of each set of the multilevel interactions
(e.g., race*incml, race*incm2). The final m o d e l s
include the m a i n effects a n d the interactions for
which p < 0.05.
Results
There w e r e substantial differences in h o u s e h o l d
income, parental education levels, a n d n u m b e r of
t w e e n the t w o racial groups. The m e d i a n income
category w a s $20,000-$39,999 for black h o u s e h o l d s
a n d $40,000-$49,999 for white households. A b o u t
47% of the black h o u s e h o l d s reported incomes u n d e r
$20,000 c o m p a r e d to fewer than 18% of the white
households. Conversely, a b o u t 50% of the white
h o u s e h o l d s r e p o r t e d a n n u a l incomes of $40,000 or
m o r e while f e w e r than 24% of the black h o u s e h o l d s
reported that level. A similar pattern w a s seen w i t h
parental education levels. The m e d i a n e d u c a t i o n
level w a s 1 year of college for black p a r e n t s a n d 3
years for w h i t e parents. A b o u t 31% of the parents of
black girls r e p o r t e d no further education after high
school c o m p a r e d to less than 21% of the parents of
w h i t e girls. A b o u t 36% of the parents of white girls
r e p o r t e d c o m p l e t i n g 5 years or m o r e of college
c o m p a r e d to less than 13% of the parents of black
girls. Black girls w e r e m o r e likely to live in a one-
parent h o u s e h o l d than white girls, a b o u t 44% a n d
19%, respectively.
Table 2 indicates the relationship of the eating
practices w i t h m e a n e n e r g y intakes for black a n d
white girls w h o practiced these behaviors frequently
or infrequently. Both black a n d w h i t e girls w h o
frequently e n g a g e d in a practice (i.e., a n s w e r e d "al-
w a y s " ) t e n d e d to h a v e higher e n e r g y intakes t h a n
those w h o did not. This w a s especially true for black
girls. In b o t h years 1 a n d 5, eight of the 11 practices
w e r e associated with higher e n e r g y intakes for black
girls w h o frequently practiced the behavior. The
differences w e r e statistically significant in y e a r 1 for
four of the practices a n d in year 5 for five of the
32 McNUTT ET AL. JOURNAL OF ADOLESCENT HEALTH Vol. 20, No. 1

Table 3. Percent of Girls Who Report Frequently Engaging in Selected Eating Practices in Years 1 and 5, by Race
Year 1 Year 5
White Black White Black
(n = 1166) 01 = 1213) p* (n = 970) (n = 1,092) p*
Eat while doing homework (always) 8.71 17.17 0.001 7.41 14.08 0.001
Eat in bedroom (always) 5.37 9.88 0.001 8.98 17.01 0.001
Eat with TV (always) 19.95 34.60 0.001 13.78 31.73 0.001
Eat alone (always) 2.03 6.05 0.001 3.76 5.67 0.04
Eat big helpings (always) 5.74 12.74 0.001 5.64 10.21 0.001
Eat when not hungry (always) 5.63 11.49 0.001 3.03 6.89 0.001
Buy snack food (always) 9.60 21.94 0,001 10.75 34.84 0.001
Sneak food (always) 4.96 10.02 0.001 1.77 2.65 0.19
Eat snacks (> 3 times/day) 10.46 19.78 0.001 9.61 34.63 0.001
Eat fast food (-> 4 times/wk.) 4.14 13.51 0.001 4.60 11.81 0.001
Skip meals (yes) 13.64 33.02 0.001 45.41 69.89 0.001
Eating practices score (-> 4) 5.07 14.80 0.001 5.45 24.45 0.001
* p-values from Chi-square test.

practices. For white girls, frequently practicing a
behavior was associated with an increased energy
intake for six of the 11 practices in year 1 and eight of
the practices in year 5. Significant differences were
seen in year 1 for three practices and in year 5 for six
practices. Skipping meals in both years for black and
white girls was associated with lower energy intakes.
These differences were statistically significant in all
instances except for year 1 for black girls. Frequently
"eating alone" was also associated with lower energy
intakes for both years for black and white girls.
When examining the entire group of girls (results
not shown), for all of the eating practices except
"skip meals" and "eat alone," mean energy intake of
girls who frequently practiced a behavior was higher
than for those who did not. This was true for both
years 1 and 5, and for 10 of the 12 practices the
differences were greater in year 5. Girls who re-
ported frequently skipping meals had lower mean
intakes than those who infrequently skipped meals.
Table 3 compares the frequency in year 1 (com-
posed of 9-year old and 10-year old subjects) and
year 5 (13-year old and 14-year old subjects) for the
11 eating practices and the "eating practices score"
for black and white girls. With the exception of the
practice "sneak food," a significantly greater percent-
age of black girls reported frequently engaging in all
of the weight-related eating practices in both years 1
and 5 (p ( 0.001 for nine practices).
In a comparison of the eating practices between
years 1 and 5 within each race (p-value not shown in
Table 3), both black and white girls significantly
increased their frequency of "skip meals" and "eat in
bedroom" (p < 0.001) and decreased their frequency
of "eat when not hungry" and "sneak food" (p
0.001). Additionally, the black girls significantly
increased their frequency of both "buy snack food"
and "eat snacks" (p (0.001) between year I and year
5, and also had an overall increase in the "eating
practices score" (p ( 0 . 0 0 1 ) . However, their fre-
quency of "eat while doing homework" decreased in
the same period (p = 0.04). In contrast, the white girls
reported an increased frequency of the practice "eat
alone" (p = 0.02) and a decreased frequency of "eat
with TV" (p ( 0 . 0 0 1 ) in year 5 compared to year 1.
Tables 4 and 5 present the final models for which
the main effects and interaction terms for each
behavior are listed below.
Eat while doing homework--main effects only
Eat big helpings--main effects only
Eat when not hungry--main effects only
Sneak food--main effects only
Buy snack food--main effects and race-age interac-
tion
Eat snacks--main effects and race-age interaction
Eat alone • main effects and race-age interaction
Eat with TV--main effects and race-education inter-
action
Eat in bedroom--main effects and race-education
interaction
Eating practice score--main effects and race-educa-
tion interaction
Skip meals--main effects and race-income interac-
tion
Eat fast foods--main effects and race-education and
income-age interactions
January 1997 DIETARY PRACTICES OF BLACK AND WHITE GIRLS 33

Table 4. Logistic Regression Odds Ratios for Effects of Age* (years) on Selected Eating Practices, with Significant
Interactions
Age 10 Age 11 Age 12 Age 13 Age 14
Eating Practices O.R. 95% C.I. O.R. 95% C.I. O.R. 95% C.I. O.R. 95% C.I. O.R. 95% C.I.
Eat while doing homework 0.96 0.78-1.18 0.69 0.56-0.87 0.78 0.62-0.98 0.74 0.59-0.92 0.78 0,59-1.02
Eat big helpings 0.86 0.66-1.11 0.67 0.52-0.87 0.68 0.52-0.89 0.71 0.55-0.93 1.10 0.81-1.48
Eat when not hungry 0.81 0.62-1.06 0.70 0.53-0.92 0.60 0.45-0.80 0.63 0.48-0.84 0.53 0.37-0.76
Sneak food 0.66 0.50-0.87 0.55 0.41-0.73 0.44 0.32-0.60 0.25 0.18-0.36 0.25 0.16-0.41
Eat with TV 0.83 0.71-0.98 0.74 0.62-0.87 0.81 0.68-0.95 0.72 0.61-0.85 0.76 0.62-0.94
Eat in bedroom 1.15 0.88-1.51 1.56 1.20-2.04 1.61 1.23-2.10 1.84 1.42-2.38 2.08 1.54-2.80
Eating practices score 0.91 0.71-1.17 0.94 0.74-1.20 1.16 0.90-1.49 1.44 1.13-1.83 1.74 1.32-2.29
Skip meals 1.09 0.92-1.29 1.68 1.43-1.98 2.85 2.42-3.36 4.77 4.03-5.65 5.80 4.73-7.11
Buy snack food
White 0.66 0.48-0.92 0.67 0.48-0.93 0,84 0.60-1.16 0.97 0.70-1.34 0.95 0.63-1.42
Black 1.00 0.78-1.29 1.30 1.01-1.68 1.19 0.92-1.54 1.91 1.49-2.45 1.99 1.50-2.64
Eat snacks
White 0.83 0.62-1.12 0.85 0.62-1.16 0.81 0.59-1.11 0.83 0.60-1.14 0.91 0.61-1.37
Black 1.22 0.94-1.59 1.70 1.31-2.19 2.12 1.64-2.75 2.35 1.81-3.04 2.39 1.78-3.21
Eat alone
White 0.57 0.28-1.16 0.88 0.45-1.71 1.04 0.53-2.03 1.33 0.71-2.50 2.95 1.54-5.66
Black 0.79 0.51-1.23 0.57 0.36-0.90 0.83 0.54-1.28 0.78 0.50-1.21 0.75 0.44-1.28
Eat fast food
Under $20,000 0.94 0.66-1.32 0.74 0.51-1.06 0.98 0.69-1.39 0.79 0.54-1.16 0.90 0.57-1.40
$20,000-$39,999 0.46 0.30-0.70 0.44 0.28-0.68 0.29 0.18-0.47 0.39 0.24-0.62 0.67 0.40-1.14
$40,000 or more 0.86 0.46-1.60 0.91 0.49-1.67 0.85 0.45-1.58 0.51 0.26-1.00 1.41 0.74-2.67
* 9-year olds as reference group (OR ~ 1).

Table 4 presents the odds ratios calculated from the
logistic regression analysis for the effects of age on
the selected eating practices. Age had no consistent
effect on the eating practices. An increased likelihood
for practicing the behavior was seen with increasing
age in the variables "eat in bedroom," "skip meals,"
and the "eating practices score;" while a decreased
likelihood was seen for the variables "eat when not
hungry" and "sneak food." The most dramatically
large odds ratio was found with the practice "skip
meals," for which the odds of skipping one meal a
day were more than five times greater as the girls
aged from 9 to 14 years of age (OR = 5.8).
The effect of age on the practices "buy snack
food," "eat snacks," and "eat alone," varied depend-
ing on race. It is of note that for the two practices
"buy snack food" and "eat snacks" there was no
clear age trend in odds ratios for the white girls from
age 9 to 14 years while the odds ratios for the black
girls were characterized by a generally monotonic
increase, leading to an approximately two-fold
increase in the odds at age 14 years compared to age
9 years. Conversely, for the practice "eat alone," the
odds ratio for the black girls remained relatively
constant from age 9 to 14 years, while for the white
girls it increased almost three times (OR = 2.95).
There was also an interaction between age and
income for the practice "eat fast food," but no clear
trends with age were apparent.
Odds ratios from logistic models for associations
between eating practices and income are presented
in Table 5. These results indicate that the frequency
of a girl engaging in most of these eating practices
decreased with an increase in parents' income. This
reduction in frequency was significant for the vari-
ables "eat while doing homework," "eat big help-
ings," "eat when not hungry," '%uy snack food,"
"eat snacks," "eat with TV," and the "eating practices
score;" and was substantial for several of these
practices. For example, for those girls whose parents
had incomes of $40,000 or more there was about a
35% reduction in the odds of frequently "buying
snack food" (OR = 0.64) and the "eating practices
score" (OR = 0.63), as compared to those girls whose
parents had incomes under $20,000.
An interaction was seen between income and race
for the practice "skip meals." For the white girls
there was about a 50% decrease in odds ratio for
those girls whose parents' income was above $20,000
(OR = 0.48). However, in the black group there was
actually an increase in the odds ratio for those girls
whose parents' incomes were $20,000 or more as
compared to those girls whose parents' income was
under $20,000. The odds increased by about 32% for
34 McNUTT ET AL. JOURNAL OF ADOLESCENT HEALTH Vol. 20, No. 1

T a b l e 5. Logistic R e g r e s s i o n O d d s Ratios for Effects of I n c o m e a n d E d u c a t i o n * o n Selected E a t i n g Practices, w i t h

Significant Interactions
Income 1 Income 2 Education 1 Education 2
($20-39,999) ($40,000+) (post-H.S.-4 yrs. college) (5+ yrs. college)
Eating Practices O.R. 95% C.I. O.R. 95% C.I. O.R. 95% C.L O.R. 95% C.I.
Eat while doing homework 0.85 0.70-1.04 0.70 0.56-0.88 0.85 0.70-1.03 0.72 0.55-0.95
Eat big helpings 0.78 0.62-0.98 0.67 0.52-0.87 0.90 0.72-1.12 0.82 0.60-1.14
Eat when not hungry 0.80 0.62-1.01 0.68 0.52-0.88 0.96 0.77-1.20 0.71 0.50 -1.01
Sneak food 0.80 0.60-1.06 0.83 0.62-1.12 0.96 0.74-1.25 0.78 0.53-1.13
Buy snack food 0.76 0.65-0.90 0.64 0.54-0.77 0.90 0.77-1.05 0.70 0.56-0.87
Eat snacks 0.85 0.72-1.01 0.69 0.57-0.83 0.90 0.77-1.06 0.67 0.53-0.84
Eat alone 0.82 0.61-1.12 0.73 0.51-1.04 1.04 0~78-1.39 0.97 0.64-1.45
Eat with TV 0.82 0.70-0.96 0.79 0.66-0.94
White 0.83 0.64-1.08 0.46 0.33-0.64
Black 1.06 0.89-1.27 1.15 0.86-1.53
Eat in bedroom 0.82 0.66-1.02 0.80 0.64-1.01
White 0.81 0.58-1.14 0.42 0.28-0.64
Black 1.18 0.92-1.52 0.87 0.59 -1.28
Eating practices score 0.82 0.66-1.00 0.63 0.50-0.79
White 0.72 0.49-1.06 0.41 0.25-0.67
Black 0.94 0.76-1.18 0.85 0.61-1.20
Skip meals 1.02 0.87-1.19 0.59 0,47-0.73
White 0.49 0.37-0.65 0.48 0.37-0.63
Black 1.32 1.09-1.60 1.11 0.88-1.38
Eat fast food (age in years)
9 1.07 0.67-1.70 0.53 0.29-0.97
10 0.52 0.35-0.76 0.49 0.32-0.75
11 0.63 0.42-0.95 0.66 0.42-1.02
12 0.32 0.20-0.50 0.46 0.30-0.71
13 0.52 0.34-0.80 0.34 0.20-0.58
14 0.80 0.47-1.35 0.94 0.56-1.61
White 0.51 0.33-0.80 0.17 0.09-0.32
Black 0.87 0.69-1.10 0.66 0.43-1.02
* Reference level (OR = 1): income--- <: $20,000; education--H.S, or less.

those girls whose parents' incomes were from
$20,000-$39,999 and the increase in the odds
dropped to 11% for black girls whose parents'
incomes were $40,000 or more.
The relationships between the eating practices and
the parents' education level are also presented in
Table 5. As with the income level, there was a
downward trend in odds ratio with an increase in
education level in almost all of the eating practices.
This decreased risk was significant for the practices
"eat while doing homework," "buy snack food," "eat
snacks," and "skip meals." For example, those girls
whose parents' education level was 5 years of college
or more had about a 40% reduction in the risk of
skipping one meal a day compared to those whose
parents had a high school degree or less (OR = 0.59).
The education effect also varied by race for the
variables "eat with TV," "eat in bedroom," "eat fast
food," and the "eating practices score." For the
variables "eat in bedroom," "eat fast food," and the
"eating practices score" there was a decreased odds
ratio with increased education for both black and
white girls, which was, however, significant only for
the white girls. For instance, for white girls whose
parents had 5 or more years of college, the odds of
"eat fast food" decreased by 83%, while for the black
girls it decreased by 34%. For the practice "eat with
TV," a significant decrease in the odds ratio was seen
with an increase in education for the white girls
(OR = 0.46), while only a nonsignificant increase in
the odds with an increase in education was seen for
the black girls (OR = 1.15).
Table 6 presents the odds ratios for the race effect
on the selected eating practices. The most consequen-
tial finding of the study was the considerable racial
differences in all of the eating practices analyzed.
The estimated odds ratios associated with race for
those practices with no interaction terms ranged
from 1.73 for "eat big helpings" to 2.09 for "sneak
food." On average, the black girls were nearly twice
as likely to frequently engage in these eating prac-
tices as the corresponding white girls.
January 1997 DIETARY PRACTICES OF BLACK AND WHITE GIRLS 35

Table 6. Logistic Regression Odds Ratios* for Race Effect more times a week compared to white girls (OR =
on Selected Eating Practices, with Significant Interactions 1.89), those black girls whose parents had 5 or more
Eating Practices O.R. 95% C.I. years of college were more than seven times as likely
Eat while doing homework 1.80 1.50-2.15 than their white counterparts to eat fast food four or
Eat big helpings 1.73 1.41-2.13 more times a week (OR = 7.39). White girls' risk
Eat when not hungry 2.07 1.66-2.58 decreased substantially with their parents' educa-
Sneak food 2.09 1.61-2.72 tion, while the black girls' risk did not change with
Eat with TV
HS or less 1.60 1.23-2.08
parental education.
Post-HS-4 yr. college 2.05 1.71-2.45 An interaction was seen between race and income
5+ yr. college 4.00 2.89-5.53 for the practice "skip meals." Black girls whose
Eat in bedroom parents' household income was less than $20,000 had
HS or less 1.21 0.86-1.70 about a 20% greater risk of skipping meals than
Post-HS-4 yr. college 1.75 1.37-2.25
5+ yr. college 2.50 1.62-3.86
white girls of the same income (OR = 1.21); but for
Eating practices score those whose income was $40,000 or more, the risk
HS or less 2.48 1.74-3,53 was almost three times higher than their white
Post-HS--4 yr. college 3.27 2.48-4.30 counterparts (OR = 2.79).
5+ yr. college 5.16 3.24-8.21 There was also an interaction between race and
Eat fast food
HS or less 1.89 1.31-2.73
age for the eating practices "buy snack food," "eat
Post-HS-4 yr. college 3.20 2.31-4.44 snacks," and "eat alone." For two of the practices,
5+ yr. college 7.39 4.00-13.64 "buy snack food" and "eat snacks," black girls were
Skip meals not only nearly twice as likely to participate in the
Under $20,000 1.21 0.96-1.53 eating practices as whites at age 9 years, but their
$20,000-$39,999 3.27 2.59-4.12
$40,000+ 2.79 2.19-3.54
relative risk also more than doubled from age 9 to 14
Buy snack food (age in years) years. Conversely, while black girls were more than
9 1.74 1.23-2.45 twice as likely to "eat alone" at age 9 years compared
10 2.62 2.00-3.42 to white girls, by age 14 years their risk of engaging
11 3.40 2.59-4.47 in that practice was actually lower than the white
12 2.48 1.91-3.21
13 3.44 2.69-4.40
girls by 38%.
14 3.64 2.54-5.23
Eat snacks (age in years)
9 1.47 1.04-2.10
10 2.17 1.68-2.80 Discussion
11 2.95 2.30-3.80
12 3.88 3.01-5.00
NGHS is the first study to examine a wide range of
13 4.20 3.25-5.42 weight-related eating practices of young black and
14 3.87 2.69 -5.58 white females, while controlling for socioeconomic
Eat alone (age in years) status. Moreover, these practices were examined
9 2.44 1.26-4.74 longitudinally over a 5-year period with a large
10 3.40 1.90-6.07
11 1.57 0,91-2.71
sample of girls covering a broad distribution of
12 1.95 1.20-3.17 parental household income and education. This
13 1.43 0.89-2.29 study focuses on a crucial age span when racial
14 0,62 0.36-1.08 differences in the prevalence of obesity become pro-
* White girls as reference group (OR = 1). nounced.
Our analyses show that as a group, the more
frequently the girls participated in a targeted eating
An interaction between race and education was practices other than eating alone or skipping meals,
seen for four eating practices. Black girls were not the higher the energy intakes. Over the age span of 9
only more likely to engage in the practices "eat with to 14 years, black girls more frequently engage in
TV," "eat in bedroom," "eat fast food," and the eating practices that are believed to be associated
eating practices score than white girls, but their odds with weight gain than do whites, even when control-
ratios also increased with increasing parental educa- ling for parental income, education, and number of
tion levels. For example, while black girls whose parents or guardians in the household. These data
parents had no more than a high school education confirm the results of earlier studies that examined a
were almost twice as likely to eat fast food four or very small number of practices (8,9). The racial
36 McNUTFET AL.
differences for some eating practices varied by
parental income, education, or subject age, but over-
all, not many interactions between race and socio-
economic status variables were seen. These socio-
economic differences in eating behaviors may reflect
other lifestyle variables that we did not assess, such
as food availability, degree of responsibility for food
purchasing and preparation, and the amount of
parental supervision of eating habits.
The fact that racial differences in these eating
practices remain after controlling for socioeconomic
factors is not surprising in light of findings from
studies that have examined overweight status in
black and white women. These studies indicate that
socioeconomic factors alone cannot fully explain the
black-white differences in the prevalence of over-
weight (2,27,28). We suggest that our findings are
also influenced by race-related cultural factors. Sev-
eral investigators, for example, have reported that
black women appear to be less concerned about their
weight and less influenced by social pressure to be
thin. Maddox and colleagues (29) found that not only
were adult black females less concerned about their
own weight and weight reduction, they also
appeared more tolerant of obese individuals com-
pared to black males, white males, and white fe-
males. In a California study of 1,000 teenagers,
conducted in the early 1960s, Huenemann et al. (30)
found that black girls had a higher desired weight,
were more concerned about being underweight, and
generally seemed more satisfied with their figures
than white girls. In a recent South Carolina study of
black and white female adolescents, Wilson et al.
reported that a larger body size may be more accept-
able among the black than white females studied
(31). Kumanyika (5,6) suggests that in the black
culture there is a greater tolerance, and perhaps
acceptance, of obesity. For example, she found in a
survey of 1,009 black women that only 36% of
severely overweight women reported their husband
or boyfriend thought they were very overweight (5).
Studies have also shown that black women dem-
onstrate fewer obesity-inhibiting attitudes or behav-
iors than whites. For instance, several investigators
have reported that weight control and weight loss
efforts of black women are less successful than those
of their white counterparts (7,28,32); and that more
black women and adolescents prefer high-calorie
foods, such as desserts, meats, and fats (33-36). Other
analyses of NGHS data have shown a positive asso-
ciation between some of the weight-related eating
practices and fat and sugar in the diet (34). Therefore,
the finding of a higher frequency of weight-related
JOURNALOF ADOLESCENTHEALTHVol. 20, No. 1
eating practices expected to be detrimental to weight
control among black girls is not unexpected.
A limitation of this study was the fact that the
possible response categories of the instrument were
restricted. Eight of 11 eating practice questions had
only three response levels ("never," "sometimes,"
and "always") and two practices had summed yes or
no responses for three time periods. Because of the
distribution of responses, they were dichotomized
for the analysis. Despite this limitation, significant
differences in the frequency with which black and
white girls participate in these practices were de-
tected. We expect that had we been able to more
accurately quantify the girls' participation in these
practices, we may have found stronger associations.
Caution must be exercised in interpreting these find-
ings. They do not necessarily mean that the racial
differences in the practice of these behaviors is a
major cause of the racial difference in obesity devel-
opment.
We speculate that these racial differences in eating
practices have significant implications for obesity
control. The eating practices we have examined have
been identified by practitioners as contributing to
weight gain and are targeted for modification in
weight reduction programs (10-17). Our data indi-
cate that these practices are associated with increased
energy intake and are more common in black girls
than white girls. The extent to which these practices
impact the health status and obesity prevalence of
girls is not clear, yet these data lend support to the
clinical goals of deemphasizing these behaviors in
preadolescent and adolescent girls. Because of their
more frequent practice by black girls, preventive and
therapeutic programs that stress modification of
these behaviors appear appropriate and might help
slow the rapid increase in adolescent obesity.
We gratefully acknowledge the investigators and staff of the
NGHS clinical centers at the University of California, Berkeley
(Z.I. Sabry, Ph.D., principal investigator), the Children's Hospital
Medical Center, Cincinnati (J.A. Morrison, Ph.D., principal inves-
tigator), and Westat, Inc./Group Health Association, Rockville,
MD (G. Schreiber, D.Sc., principal investigator); the NGHS coor-
dinating center at Maryland MedicalResearchInstitute, Baltimore
(B.A. Barton, Ph.D., principal investigator), and the National
Heart, Lung, and Blood Institute project office, Bethesda (D.G.
Payne, M.D., and E. Obarzanek, Ph.D., project officers).
This research was supported by the National Heart, Lung, and
Blood Institute contracts HC-55023, HC-55024, HC-55025, and
HC-55026.
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