"Body composition is clearly associated with higher blood pressure (Sowers et al. 2002), but differences in body composition do not explain health disparities. National Center for Health Statistics (NCHS) (Cent. Dis. Control Prev. 2004c) data show that in 1999-2000, 67.3% of white American men would be considered overweight (a body mass index >25.0), compared with 60.3% of African American men. This discrepancy therefore could not account for the differences in hypertension prevalence between black and white men. Fifty-seven percent of white women are overweight compared with 77.7% of black women. Although this seemingly could account for prevalence differences between black and white women, it apparently does not. Bell and associates (2004) recently analyzed data from the NHANES (National Health and Nutrition Examination Survey) for women, and black women remained twice as likely to have high blood pressure after controlling for obesity. Furthermore, virtually every study of blood pressure routinely uses a measure of body composition (e.g., the body mass index) as a control variable, with little effect on black-white disparities.

"With respect to birth weight, heavier women tend to have heavier babies (Inst. Med. 1990), so the higher prevalence of overweight among black women cannot explain the higher prevalence of low birth weight.

"Physical activity levels affect both weight and overall risk of disease, and there is evidence of differences among racial and ethnic groups in levels of physical activity. Nationally, 34.4% of white men and 38.3% of white women report being physically inactive compared with 45.1% of black men and 55.1% of black women (Schoenborn et al. 2004, p. 42). Bell et al. (2004) found that controlling for reported levels of physical activity made no difference in the differential risk of hypertension between black and white women. With respect to low birth weight, strenuous occupational activity (such as standing for long periods) does not alter differences in low birth weight between black and white women (Homer et al. 1990, Teitelman et al. 1990).

"Smoking is a risk factor that has been directly implicated in low birth weight (McCormick et al. 1990) but only tangentially, if at all, in association with blood pressure (Janzon et al. 2004). Again, smoking is not a factor likely to account for health disparities because there are virtually no differences in rates of smoking between black and white men (27.1% versus 25.2%) or between black and white women (19.5% versus 22.2%) (Schoenborn et al. 2004, p. 21).

"Alcohol intake is discouraged during pregnancy because it contributes to low birth weight, whereas when considering blood pressure there appears to be a J-shaped relationship between alcohol consumption and blood pressure; nondrinkers and mild drinkers (≤3 drinks/day) had comparably low blood pressures, and heavy drinkers had higher blood pressures (Estruch et al. 2004). According to NCHS survey data, 70.8% of white men versus 55.8% of black men report being drinkers; corresponding ?gures for white versus black women are 60.4% versus 39.4%. Rates of heavy drinking, de?ned as 14 or more drinks per week, are very similar across groups, ranging from 2.2% among African American women to 5.6% among white men (Schoenborn et al. 2004, p. 7)." (Dressler et al 2005:236-238)

Do health behaviors (e.g., diet and exercise) affect health? Do you think they are a likely source of health disparities? Why or why not? What are the most compelling examples to support your argument?

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