Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.     

Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation

OBJECTIVES: This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS: Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS: Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS: Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.     

Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women

BACKGROUND: There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, we used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation. METHODS: Our study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. We calculated adjusted relative risks to assess the effect of sexual orientation on important health issues. RESULTS: Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and a clinical breast examination. CONCLUSIONS: In this first population-based study of lesbian and bisexual women's health, we found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support our hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care. Arch Fam Med. 2000;9:1043-1051     

Sexual orientation and health: comparisons in the women's health initiative sample

CONTEXT: Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. OBJECTIVE: To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. DESIGN: Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. SETTING: Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. PARTICIPANTS: Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation. MAIN OUTCOME MEASURES: Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire. RESULTS: Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups. CONCLUSIONS: This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.     

Weight Status and Sexual Orientation: Differences by Age and Within Racial and Ethnic Subgroups

Objectives. We determined differences in weight at age 18 years and at current age and weight change by sexual orientation within different racial/ethnic populations, stratifying by gender.Methods. We used 2001–2007 data from the California Health Interview Survey, resulting in an unweighted sample of 120 274 individuals aged 18 to 74 years. Using regression models, we examined overweight status and change in weight by sexual orientation, stratifying by race/ethnicity and gender.Results. Compared with heterosexual women of the same race/ethnicity, White and African American lesbians and bisexuals had increased likelihood of being overweight at age 18 years and maintaining overweight status during adulthood. Sexual minority status was unrelated to weight among Latinas and inconsistently linked to weight among Asian women compared with heterosexual women of the same race/ethnicity. Sexual minority status was protective against unhealthy weight among White, African American, Asian, and Latino men compared with heterosexual counterparts of the same race/ethnicity. This protective effect was seen after age 18 years except among African American bisexual men.Conclusions. Our findings indicate a need for age- and culture-sensitive interventions that reduce weight or prevent weight gain in sexual minority women and men.Obesity is among the most pressing public health issues facing the nation because of the numerous health risks associated with this condition.1 Despite public health efforts, the prevalence of obesity has continued to increase, rising to 68% in the general population.2 Obesity affects some population groups more than others, in that it has been linked to gender, race/ethnicity, and socioeconomic status.3–6 More women than men are obese. Among both genders, Asian individuals have the lowest prevalence of obesity (11.6% for both sexes), followed by non-Hispanic Whites (33% for women and 31% for men) and Mexican Americans (43% for women and 32% for men); non-Hispanic Blacks have the highest prevalence of obesity (51% in women and 37% in men).4,7 The prevalence of obesity among men is about the same for all income and educational levels; among women, those with higher income and greater educational attainment are less likely to be obese than women with less education and lower income.6Research has also linked obesity to sexual orientation. Compared with heterosexual men, gay and bisexual men have a lower body mass index (BMI; defined as weight in kilograms divided by the square of height in meters)8,9 and decreased odds of being overweight or obese.10,11 For women, the relationship between sexual orientation and weight is inverse: studies have consistently concluded that lesbian women have an increased likelihood of overweight and obesity compared with heterosexual women.12–19 Some evidence suggests that the weight disparity between sexual orientation groups may begin at an early age. In a group of predominantly White adolescents, sexual minority females had consistently increased BMI throughout adolescence compared with heterosexual females, whereas sexual minority males had decreased BMI in late adolescence compared with heterosexual males.20 Moreover, data from the Nurses’ Health Study II, a predominantly White cohort, showed that lesbian and bisexual women had significantly greater prevalence of overweight or obesity at age 18 years14 and had an adverse weight gain trajectory from ages 25 to 59 years21 compared with heterosexual women in this cohort.The available evidence establishes the existence of weight disparities by sexual orientation and a need for interventions for sexual minority women. However, there is insufficient information for the planning of targeted interventions, because we know little about the onset of the weight disparity by sexual orientation within a generalizable population of men and women. Furthermore, the racial/ethnic patterns of obesity are understudied in sexual minority populations. To assist program planners in the development of interventions for the most appropriate target groups, we sought to improve the knowledge on these 2 aspects.To generate information about the most appropriate age cohort to be targeted by interventions, we focused first on the relationship between sexual minority status and weight at age 18 years and subsequently assessed this relationship at current adult age. This approach identified whether adult lesbians’ greater likelihood, and gay and bisexual men’s lower likelihood, of overweight and obesity compared with heterosexual populations is already present at age 18 years or acquired during adulthood. Consistent with the recent Institute of Medicine report on lesbian, gay, bisexual, and transgender health, we sought to advance knowledge about obesity by focusing on the intersection of sexual minority status and race/ethnicity.22 This approach recognizes the diversity of sexual minorities, and that among both female and male sexual minorities, the prevalence of obesity may differ by race and ethnicity. To provide data on the intersection of sexual minority status and race/ethnicity for men and women, we examined weight differences by sexual orientation within each racial and ethnic group, focusing on the time periods age 18 years and current age.     

Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization

OBJECTIVES: This study compared the prevalence of cigarette smoking and alcohol use among lesbians and bisexual women with that among heterosexual women. METHODS: Logistic regression models were created with data from an extensive member health survey at a large health maintenance organization. Sexual orientation was the primary predictor, and alcohol consumption and cigarette smoking were outcomes. RESULTS: Lesbians and bisexual women younger than 50 years were more likely than heterosexual women to smoke cigarettes and drink heavily. Lesbians and bisexual women aged 20 to 34 reported higher weekly alcohol consumption and less abstinence compared with heterosexual women and older lesbians and bisexual women. CONCLUSIONS: Lesbians and bisexual women aged 20 to 34 years are at risk for alcohol use and cigarette smoking.     

Hispanic lesbians and bisexual women at heightened risk for [corrected] health disparities

Objectives. We investigated whether elevated risks of health disparities exist in Hispanic lesbians and bisexual women aged 18 years and older compared with non-Hispanic White lesbians and bisexual women and Hispanic heterosexual women.Methods. We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System (2003–2009) using adjusted logistic regressions.Results. Hispanic lesbians and bisexual women, compared with Hispanic heterosexual women, were at elevated risk for disparities in smoking, asthma, and disability. Hispanic bisexual women also showed higher odds of arthritis, acute drinking, poor general health, and frequent mental distress compared with Hispanic heterosexual women. In addition, Hispanic bisexual women were more likely to report frequent mental distress than were non-Hispanic White bisexual women. Hispanic lesbians were more likely to report asthma than were non-Hispanic White lesbians.Conclusions. The elevated risk of health disparities in Hispanic lesbians and bisexual women are primarily associated with sexual orientation. Yet, the elevated prevalence of mental distress for Hispanic bisexual women and asthma for Hispanic lesbians appears to result from the cumulative risk of doubly disadvantaged statuses. Efforts are needed to address unique health concerns of diverse lesbians and bisexual women.Equity in health and health care is of critical societal importance given its ethical and social justice implications. Despite tremendous advancements in medicine and improved health for many Americans, historically disadvantaged and underserved communities continue to bear higher levels of illness, disability, and premature death. The National Institutes of Health affirms a commitment to reducing and eliminating health disparities affecting disadvantaged populations across the country.1 In addition, Healthy People 2020 has specifically recognized racial/ethnic minorities and sexual minorities as primary targets of health disparity reduction.2A growing body of literature endorses such federal initiatives’ recognition of health disparities by race/ethnicity and sexual orientation. Health disparities among the Hispanic population, for example, have been well documented. Higher death rates from stroke, chronic liver disease, diabetes, and HIV/AIDS have been observed among Hispanics compared with non-Hispanic Whites, and Hispanics are more likely to be obese and less likely to participate in regular physical activities.3,4 Furthermore, the Hispanic population is at increased risk for limited health care access.5–7 The likelihood of Hispanics not having health insurance is almost twice as high as that of the general population.8The evidence of health disparities affecting sexual minority women is also growing. According to previous studies based on probability samples, sexual minority women, compared with heterosexual women, report experiencing higher levels of poor physical and general health,9–11 mental distress,9,11–13 and higher prevalence rates of asthma10,11,13 and disability.10,11 In terms of health risk behaviors, lesbians and bisexual women are more likely to smoke9–11,13,14 and to consume higher quantities of alcohol.9,11,13,14 Sexual minority women are also at increased risk for poor health care access.10,14,15 Emerging research has also found within-group differences among sexual minority women; for example, lesbians, but not bisexual women, are more likely to be obese10,16 and have arthritis12 than are heterosexual women, whereas bisexual women are more likely to report poor general health and mental distress than are lesbians.17Yet, the evidence of health disparities by race/ethnicity and sexual orientation might not be generalized to sexual minorities of color,18 and knowledge regarding health among Hispanic sexual minorities is still limited. Without better understanding the potential interplay between these marginalized statuses, it remains difficult, if not impossible, to develop culturally sensitive health services that are responsive to the needs of the Hispanic sexual minority population.19The possibility of cumulative risks resulting from multiple disadvantaged statuses affecting health among Hispanic sexual minorities has been raised in the literature. It has been suggested that Hispanic sexual minorities experience heightened risks of poor physical and mental health compared with non-Hispanic White sexual minorities and Hispanic heterosexuals. According to a comprehensive review on racial/ethnic disparities in health, racial discrimination and related stressors have an inverse relationship to physical and mental health and health care access.20 Previous studies also have emphasized that health disparities among sexual minorities likely result from exposure to life stressors, including stigmatization, victimization, and discrimination.21–23 The consequences of multiple stressors, such as racial/ethnic discrimination within sexual minority communities and antigay values within Hispanic communities, may lead to an increased risk of poor physical and mental health.18,24,25 Furthermore, Hispanic sexual minority women may experience additional stressors if they are perceived to violate conventional feminine norms in Hispanic communities.26A few studies have assessed health-related concerns among Hispanic sexual minority women. One study found that Hispanic sexual minority women had increased psychiatric morbidity risk compared with Hispanic heterosexual women.27 Another study found that among sexual minority women, Hispanic women were more likely than were non-Hispanic White women to report depressive symptoms.28 In terms of physical health status and behaviors, Hispanic lesbians and bisexual women have shown elevated risks and higher prevalences of obesity, smoking, and drinking than have Hispanic heterosexual women.29Yet, to identify the potentially cumulative impact of multiple disadvantaged statuses on health disparities, the prevalence of health indicators for Hispanic sexual minority women must be compared with Hispanic heterosexual women as well as non-Hispanic White lesbians and bisexual women within the same sample. Furthermore, because the patterns and extents of health disparities may be dissimilar between lesbians and bisexual women, the cumulative effects should be tested separately among lesbians and bisexual women. Disaggregating groups of sexual minorities is an important stage in developing tailored interventions to respond to the unique health-related needs of these subgroups.17The Washington State Behavioral Risk Factor Surveillance System (BRFSS) provides population-based data that allow us to examine indicators of health disparities. In this study, we compared the unadjusted and adjusted prevalence of health disparities including health status, health risk behaviors, health care access, and health outcomes by Hispanic lesbians (the reference group), non-Hispanic White lesbians, and Hispanic heterosexual women as well as by Hispanic bisexual women (the reference group), non-Hispanic White bisexual women, and Hispanic heterosexual women. We hypothesized that Hispanic lesbians and bisexual women would experience higher risks of health disparities than would non-Hispanic White lesbians and bisexual women as well as Hispanic heterosexual women.     

Disparities in Health-Related Quality of Life: A Comparison of Lesbians and Bisexual Women

Objectives. We investigated the association of health-related quality of life (HRQOL) with sexual orientation among lesbians and bisexual women and compared the predictors of HRQOL between the 2 groups.Methods. We used multivariate logistic regression to analyze Washington State Behavioral Risk Factor Surveillance System population-based data (2003 to 2007) in a sample of 1496 lesbians and bisexual women and examined determinants of HRQOL among lesbians and bisexual women.Results. For lesbians and bisexual women, frequent mental distress and poor general health were associated with poverty and lack of exercise; poor general health was associated with obesity and mental distress. Bisexual women showed a higher likelihood of frequent mental distress and poor general health than did lesbians. The odds of mental distress were higher for bisexual women living in urban areas as compared with nonurban areas. Lesbians had an elevated risk of poor general health and mental distress during midlife.Conclusions. Despite the standard practice of collapsing sexual minority women into a single group, lesbian and bisexual women in this study emerge as distinct groups that merit specific attention. Bisexual women are at elevated risk for poor HRQOL.Sexual minority women (SMW) were acknowledged as a health disparate population in Healthy People 2010.¹ Despite many recent advances in sociopolitical and cultural acceptance for sexual minorities in the United States, these women continue to live in a society in which their lives run counter to the dominant culture. Meyer''s² model of minority stress attributes health disparities to the greater exposure to life stressors that accompanies minority status among this population. Such stressors include victimization, discrimination, stigmatization, expectations of rejection, and vigilance and are well documented in some empirical studies.^2–4According to the minority stress model, disparities in health outcomes are expected between lesbians and bisexual women and heterosexual women. The inclusion of questions about sexual orientation on some epidemiological health surveys such as the National Comorbidity Survey, the National Health and Nutrition Examination Survey, the National Household Survey on Drug Abuse, and the Midlife in the United States Survey has allowed researchers interested in this population to conduct such between-group research.^5–9 Overall, these data suggest that SMW are at higher risk for mental health disorders, particularly depression and anxiety (see Cochran¹⁰ and Meyer² for reviews). Relative to mental health outcomes, less research has been published focusing on physical health outcomes among SMW. There is evidence, however, that SMW are more likely to be obese, which puts them at greater risk for major health problems such as cancer and heart disease.¹¹ Other studies have demonstrated higher rates of health risk behaviors such as alcohol and drug abuse¹⁰ and smoking¹² among SMW compared with their heterosexual counterparts. Differences in physical health outcomes may be confounded by mental health problems; for example, Cochran and Mays¹³ found that differences in physical health between SMW and heterosexual women were no longer significant when psychological distress was taken into account.Although some studies document differences between SMW and heterosexual women,^14–18 relatively few studies look within SMW subpopulations to examine determinants of health for these populations. Because of small numbers of participants, most studies combine lesbians and bisexual women into a single group for analysis, thereby obscuring potentially important differences. Yet, bisexual women may face additional stressors associated with lack of support from both lesbian and heterosexual communities. Indeed, studies that examine bisexuals as a separate group suggest that this group may have even greater health disparities relative to heterosexual women than do lesbians. For example, in Cochran and Mays''s study,¹³ bisexual women, but not lesbians, were significantly more likely to report a functional health limitation, poor overall physical health, and a greater number of physical health conditions than were heterosexual women. In a recent study, Dilley et al.¹⁹ suggested that bisexual women may have more health risks relative to both heterosexual women and lesbians, although heterosexual women again served as the referent group. Because these prior studies do not report statistically based comparisons of lesbians and bisexual women, we know little about how these 2 groups of women may differ in terms of health.Another limitation of the existing literature on SMW is the inconsistent use of measures across studies, making comparisons difficult. For example, although health-related quality of life (HRQOL) has received much attention in recent health research and has been used extensively to track population trends and assess health disparities,^20,21 HRQOL has not been used in studies of sexual minority health. Moreover, there is little research specifically examining determinants of health and HRQOL among lesbians and bisexual women. Such within-group analyses are the next step in advancing our understanding of minority stress² by highlighting the factors within a minority population that make individuals relatively more vulnerable to poor health outcomes. To date, little is known about whether and how such determinants of health and HRQOL are similar or different for lesbians versus for bisexual women. Hence, we have little information on how best to focus preventive intervention efforts for these groups.In this population-based study, we used Behavioral Risk Factor Surveillance System data from Washington State (WA-BRFSS) to examine the relationship between HRQOL and sociodemographic characteristics, access to health care, and health risk behaviors among lesbians and bisexual women. We hypothesized that compared with lesbians, bisexual women would have lower levels of HRQOL, after controlling for the other health-related factors. We also examined similarities and differences in the predictors of HRQOL between these 2 groups.     

Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities

BACKGROUND: Overweight and obesity have reached epidemic proportions in Latin America. OBJECTIVE: The purpose of this study was to explore social and behavioral factors associated with obesity in Peruvian cities. DESIGN: Between 1998 and 2000 health examination surveys were conducted among adults in 1176 families identified in six cities. Stratified by social class, multistaged random sampling was used. Using body mass index (weight (kg)/height (m)(2)), men and women were classified into normal weight (BMI <25), overweight (BMI 25-29), or obese (BMI > or =30); abdominal circumference (> or =94 cm in men and > or =84 cm in women) further identified morbidity risk. Several demographic, social, and behavioral variables were collected following standardized procedures. RESULTS: Adjusting for age, 37% of women were categorized as normal weight, 40% overweight, and 23% obese; corresponding figures for men were 40, 44, and 16%. More developed cities, e.g., Lima, Arequipa, and Ica, had the largest prevalence of overweight and obesity for both men and women. Adjusted logistic models showed that BMI > or =25 was positively correlated with age; whereas, education was negatively associated, only among women. Other significant associated factors of overweight included city of residence, television viewing > or =4 h daily in women, and underestimation of body weight status. CONCLUSIONS: The study showed elevated rates of overweight across the income level spectrum. Factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight and must be considered in designing future public health interventions. Underestimation of body weight status and sedentary behavior may also constitute specific areas of intervention.     

The Implications of Maternal Overweight and Obesity on the Course of Pregnancy and Birth Outcomes

The increasing prevalence of overweight and obesity among women of childbearing age is a growing public health concern in the United States. The average body mass index (BMI) is increasing among all age categories and women enter pregnancy at higher weights. Women are also more likely to retain gestational weight with each pregnancy. Women who are overweight (BMI 25–30) and obese (BMI ≥30) are at greater risk of adverse reproductive health outcomes compared to women of normal weight status (BMI 19.8–25). This article provides an overview of the complications associated with maternal overweight and obesity including diabetes, pre-eclampsia, c-sections, and birth defects. We present updated information on the weight trends among women. Finally, we present an overview of the prevention studies aimed at adolescents and women prior to pregnancy.

     

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.     

Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women

BACKGROUND: Study aims were to examine cervical cancer risk factors, screening patterns, and predictors of screening adherence in demographically similar samples of lesbian (N=550) and heterosexual women (N=279). METHODS: Data are from a multisite survey study of women's health conducted from 1994 to 1996. RESULTS: Differences in sexual behavior risk factors for cervical cancer were observed with lesbians reporting earlier onset of sexual activity (P<0.05), more sexual partners (P<0.001), and lower use of safer sex activities (P<0.01). Lesbian and heterosexual women were equally likely to have ever had a Pap test; however, lesbians were less likely to report annual (P<0.001) or routine (P<0.001) testing. Multivariate analyses were used to determine the associations between demographics, health care factors, health behaviors, and worry about health and screening behaviors. Individual predictors of never screening included younger age, lower income, and lack of annual medical visits. Independent predictors of both recent and annual screenings included history of an abnormal Pap test, being heterosexual, and annual medical visits. CONCLUSION: Data indicate that lesbians are at risk for cervical cancer, yet underutilize recommended screening tests. Findings have implications for research, education, and cancer control among lesbians.     

Relation of body mass index to depression and weighing frequency in overweight women

OBJECTIVE: Research suggests that overweight and obesity are associated with depressive symptoms, particularly among women. Evidence from weight control trials suggests that higher weighing frequency is associated with greater weight loss or less weight gain. As limited data exist on the effects of self-weighing on body mass index (BMI) among overweight adults with or without depression, this study seeks to examine this issue using data from a population-based epidemiologic survey. METHODS: Data from a large population-based survey of 4655 women ages 40-65 in the greater Seattle area, surveyed from November 2003 to February 2005, were used to examine associations of depression and weight self-monitoring with BMI. Sample-weighted regression models were used to examine associations of depression, self-weighing frequency, and BMI, with demographic factors (race/ethnicity, employment status, smoking status, age, martial status, educational attainment) entered as covariates. RESULTS: Regression models indicated that higher self-weighing frequency and negative depression status were independently associated with lower BMI, with no interaction observed between depression and self-weighing. CONCLUSION: Frequent self-weighing appears to be associated with lower BMI in both depressed and non-depressed overweight women.     

Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women

BACKGROUND: Observational studies suggest that a plant-based diet is inversely related to body mass index (BMI), overweight, and obesity. OBJECTIVE: Our objective was to examine the BMI (kg/m(2)) and risk of overweight and obesity of self-defined semivegetarian, lactovegetarian, and vegan women. DESIGN: Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores (n = 54257), semivegetarians (n = 960), lactovegetarians (n = 159), or vegans (n = 83), and this question was the main exposure variable in this study. In secondary analyses, we reclassified women as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire. RESULTS: The prevalence of overweight or obesity (BMI >/= 25) was 40% among omnivores, 29% among both semivegetarians and vegans, and 25% among lactovegetarians. In multivariate, adjusted logistic regression analyses, self-identified vegans had a significantly lower risk of overweight or obesity [odds ratio (OR) = 0.35; 95% CI: 0.18, 0.69] than did omnivores, as did lactovegetarians (OR = 0.54; 95% CI: 0.35, 0.85) and semivegetarians (OR = 0.52; 95% CI: 0.43, 0.62). Risk of overweight or obesity remained significantly lower among lactovegetarians classified on the basis of the food-frequency questionnaire (OR = 0.48; 95% CI: 0.30, 0.78). CONCLUSIONS: Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.     

The relation of body mass index,cardiorespiratory fitness,and all-cause mortality in women

OBJECTIVE: To examine the relation of body mass index (BMI), cardiorespiratory fitness (CRF), and all-cause mortality in women. RESEARCH METHODS AND PROCEDURES: A cohort of women (42.9 +/- 10.4 years) was assessed for CRF, height, and weight. Participants were divided into three BMI categories (normal, overweight, and obese) and three CRF categories (low, moderate, and high). After adjustment for age, smoking, and baseline health status, the relative risk (RR) of all-cause mortality was determined for each group. Further multivariate analyses were performed to examine the contribution of each predictor (e.g., age, BMI, CRF, smoking status, and baseline health status) on all-cause mortality while controlling for all other predictors. RESULTS: During follow-up (113,145 woman-years), 195 deaths from all causes occurred. Compared with normal weight (RR = 1.0), overweight (RR = 0.92) and obesity (RR = 1.58) did not significantly increase all-cause mortality risk. Compared with low CRF (RR = 1.0), moderate (RR = 0.48) and high (RR = 0.57) CRF were associated significantly with lower mortality risk (p = 0.002). In multivariate analyses, moderate (RR = 0.49) and high (RR = 0.57) CRF were strongly associated with decreased mortality relative to low CRF (p = 0.003). Compared with normal weight (RR = 1.0), overweight (RR = 0.84) and obesity (RR = 1.21) were not significantly associated with all-cause mortality. DISCUSSION: Low CRF in women was an important predictor of all-cause mortality. BMI, as a predictor of all-cause mortality risk in women, may be misleading unless CRF is also considered.     

Diet composition and risk of overweight and obesity in women living in the southwestern United States

OBJECTIVE: It is unknown whether dietary patterns or macronutrient composition contribute to the observed differences in rates of overweight and obesity among Hispanic and non-Hispanic white women in the United States. We assessed the association of dietary patterns and macronutrient composition with overweight and obesity in Hispanic and non-Hispanic white women. DESIGN: Cross-sectional analysis of dietary data from a case-control study of breast cancer. PARTICIPANTS: Population-based control participants (871 Hispanic and 1,599 non-Hispanic white women) from the southwestern United States who completed the diet and other components of the interview and whose anthropometric measurements were available. MAIN OUTCOME MEASURES: Body mass index (BMI; calculated as kg/m(2)), weight status (overweight, BMI 25 to 29.9; obese, BMI>30). STATISTICAL ANALYSES PERFORMED: Dietary patterns were defined using factor analysis. Associations of dietary patterns and macronutrient composition with overweight and obesity as compared with normal weight were assessed with logistic regression. RESULTS: Hispanic women reported consuming more energy, a greater proportion of energy from fat and vegetable protein, less alcohol, and less energy from animal protein compared with non-Hispanic white women. Western and dieter patterns were associated with higher prevalence of overweight and obesity; the Prudent dietary pattern was associated with a 29% lower prevalence of overweight and a halving of the prevalence of obesity similarly in Hispanic and non-Hispanic white women. Higher proportions of energy from protein (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.28 to 2.56) and animal protein (OR 2.10 95% CI 1.47 to 2.98) were associated with a greater risk of overweight; greater proportions of energy from fat (OR 2.28, 95% CI 1.27 to 4.08), protein (3.55 95% CI 2.38 to 5.29), or animal protein (3.44 95% CI 2.31 to 5.14) were associated with higher risk of obesity among non-Hispanic white women only. CONCLUSIONS: A Western dietary pattern was associated with greater risk and a Prudent diet with reduced risk of overweight and obesity. To reduce risk of overweight and obesity, Hispanic women should maintain healthful aspects of a native Hispanic diet, and non-Hispanic white women should replace animal protein with vegetable protein.     

The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women

BACKGROUNDS: Overtly obesity is relatively rare among the Japanese despite the high prevalence of metabolic disorders, which suggests the need to develop simple and effective methods for assessing metabolic risks among the non-obese individuals as part of public health education. METHODS: We compared body mass index (BMI), waist circumference, and waist-to-height ratio (W/Ht) as indices for evaluation of clustering of coronary risk factors (hypertension, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, and low HDL cholesterol) in 4,668 men and 1,853 women with BMI < 25 kg/m(2). RESULTS: The sum of coronary risk factors correlated positively with all anthropometric indices, with the closest correlation found for W/Ht. Multiple regression analysis showed that height was a negative independent predictor of the sum of coronary risk factors, while age and waist circumference were positive independent predictors. Among the various proposed anthropometric indices for the evaluation of metabolic risk, the sensitivities for identification of clustering of >/=2 and >/=3 coronary risk factors were highest for a waist-to-height ratio >/=0.5 in both genders. CONCLUSIONS: Waist-to-height ratio is more sensitive than BMI or waist circumference alone to evaluate clustering of coronary risk factors among non-obese men and women.     

Sexual orientation and women's smoking

An extensive review of the literature on sexual orientation and health, lesbian health, and women and smoking revealed no studies that focus on smoking among lesbians or bisexual women. However, several health surveys conducted in the past 15 to 20 years report rates of current smoking. Findings from these studies as a whole suggest that lesbians are more likely than heterosexual women to smoke. Research on women and smoking is reviewed to identify potential risk factors for lesbians' smoking. Implications for future research and for prevention and intervention are discussed.     

Physical activity, cardiorespiratory fitness and body mass index as predictors of substantial weight gain and obesity: the Canadian physical activity longitudinal study

BACKGROUND: Obesity is a growing health issue in Canada and the identification of the determinants of obesity is important for the development of prevention strategies. The purpose of this investigation was to determine the relationships between physical activity, cardiorespiratory fitness, body mass index (BMI), and the development of future obesity. METHODS: The sample included 459 adults (18+ y; 223 men, 236 women) from the Canadian Physical Activity Longitudinal Study (PALS; 2002-04). Data on physical activity, smoking, alcohol consumption, BMI, and cardiorespiratory fitness (VO2max) were collected in 1981 and 1988. The mean BMI, physical activity, and VO2max were calculated across the 1981 and 1988 measures. Self-reported height and weight were collected in the 2002-04 survey, and participants were classified as overweight (BMI 25 to 29.9 kg/m2) or obese (BMI 230 kg/m2). Logistic regression was used to predict overweight, obesity or substantial weight gain (10 kg or more) in 2002-04, controlling for age, sex, smoking and alcohol use. RESULTS: Higher VO2max in 1981-88 was associated with lower odds of obesity in 2002-04 (OR = 0.87; 95% Cl: 0.76-0.99, p < 0.05), and higher BMI in 1981-88 was associated with higher odds of obesity in 2002-04 (1.84; 1.52-2.20, p < 0.0001). In women, higher VO2max (0.82; 0.72-0.93) resulted in lower odds of a 10 kg weight gain. CONCLUSIONS: The results indicate that cardiorespiratory fitness and previous BMI are important predictors of future weight gain and obesity, and should be incorporated in strategies to identify individuals at increased risk of obesity.     

Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference?

CONTEXT: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers. METHODS: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual. RESULTS: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year. CONCLUSIONS: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.