Preconception Health Promotion Among Maryland Women

Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009–2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57–1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51–0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26–0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05–2.89) or diabetes (aOR 2.79, 95 % CI 1.20–6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92–3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16–2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.     

四川省孕期妇女孕前保健知识及需求调查

目的了解四川省孕期妇女对孕前保健服务的认知状况及其需求情况,为制定孕前保健服务策略提供科学依据。方法根据四川省经济状况和地理分布,2011—07／12随机抽取四JiJ省8个市（成都、内江、资阳、乐山、南充、眉山、自贡、遂宁）及其相应各1个区县,对在当地妇幼保健机构进行产前检查的孕期妇女及家庭成员进行孕前保健认知情况及需求情况的调查。结果孕期妇女孕前检查率为61．8％,实际孕前体检项目以常规项目为主,血常规检查应答率为70．66％,其次为B超、尿常规、乙肝甲肝等,性激素6项利用最少,应答率为6．97％;了解孕前保健知识最主要的途径是亲朋好友,应答率为75．18％,途径需求调查排首位的是医务人员,应答率为57．45％;对认知水平影响因素分析显示,文化程度、家庭人均月收入、就医便利程度、是否计划怀孕和服务了解途径（报刊书籍、亲朋好友、网络）对孕前保健知识认知水平的影响有统计学意义（P〈0．05）。结论四川省孕前体检率较低,主要为常规项目检查;文化程度、家庭人均月收入、就医便利程度、是否计划怀孕及相关知识获取途径是影响育龄妇女孕前保健认知水平的重要因素。     

Obesity and Immigration Among Latina Women

Several studies have shown a positive association between acculturation and obesity in Hispanics. We sought to examine the association in a sample of urban Hispanic women. Using data collected in the Chicago Breast Health Project, we used logistic regression to examine the association of obesity (BMI ≥ 30 kg/m²) with language acculturation and years in the US in a sample of 388 Hispanic women. Women self-reported the number of years they had lived in the US (mean 17.6) as well as their preferred language across several domains, which was used to calculate a language acculturation score. Nearly all the women (98%) were born outside the US with the majority (65%) born in Mexico and the majority of women (69%) had low language acculturation, i.e., answered “only Spanish” in every domain. Over half of the women were obese (56%). In multivariable analysis, odds of obesity was twice as high among women living in the US for greater than 20 years compared to those in the US for 10 years or less (OR/year = 2.07, 95% CI 1.25–3.42). In contrast, low language acculturation was not associated with odds of obesity (OR = 1.14, 95% CI 0.70–1.86). While greater years in the US increased odds of obesity among Hispanic women, no association of obesity with language acculturation was found. These results suggest that mechanisms other than language contribute to the immigration effect.     

Preconception Stress,Birth Weight,and Birth Weight Disparities Among US Women

Objectives. We examined the impact of preconception acute and chronic stressors on offspring birth weight and racial/ethnic birth weight disparities.Methods. We included birth weights for singleton live first (n = 3512) and second (n = 1901) births to White, Mexican-origin Latina, other-origin Latina, and Black women reported at wave IV of the National Longitudinal Study of Adolescent Health (2007–2008; ages 24–32 years). We generated factor scores for preconception acute and chronic stressors from wave I (1994–1995; ages 11–19 years) or wave III (2001–2002; ages 18–26 years) for the same cohort of women.Results. Linear regression models indicated that chronic stressors, but not acute stressors, were inversely associated with birth weight for both first and second births (b = −192; 95% confidence interval = −270, −113; and b = −180; 95% confidence interval = −315, −45, respectively), and partially explained the disparities in birth weight between the minority racial/ethnic groups and Whites.Conclusions. Preconception chronic stressors contribute to restricted birth weight and to racial/ethnic birth weight disparities.Birth weight, a marker of infant health, predicts infant survival and subsequent health status. Low birth weight, defined as weight less than 2500 grams, is associated with increased risk of developing both short-term and long-term health problems.1 The prevalence of restricted birth weight has been increasing since the 1980s in the United States,2 and marked differences in birth weight persist by race/ethnicity.3,4 Limitations of prenatal care and other pregnancy interventions to address the increase over time and disparities in prevalence of adverse birth outcomes1,5 have led to a focus on preconception health, defined broadly as health before a pregnancy (although often used in public health practice to denote health during the reproductive years) and including interconception health, or health between pregnancies.6,7 Drawing on a life course framework,8–10 the concept of preconception health suggests that infants are affected not only by maternal exposures in the 9-month prenatal period, but also by maternal development before the pregnancy.One preconception exposure of interest is stress. Pearlin’s stress process model posits that social characteristics including those surrounding race/ethnicity in the United States lead to stress exposures that affect health,11–13 and has been used to understand elevated risk of adverse health outcomes among minority groups.14,15 It is worth noting that elevated stress is not inherent to persons of minority race/ethnicity, because race/ethnicity is a social construct and not a biological one. Rather, stress results from historical and societal constraints leading to differential life chances across groups.16In studies of its health consequences, stress was defined most frequently as exposure to an inventory of life events within a specified period of time.17 These acute stressors, such as a death in the family or exposure to a crime, are relatively brief in duration but may have continued ramifications.17,18 Consistent with a life course perspective, more recent studies examined chronic stressors as a risk factor for health outcomes.18,19 These stressful life conditions, including individual and neighborhood socioeconomic disadvantage, recur or accumulate throughout a respondent’s life. However, measurement of chronic stressors is less standardized across studies than that of acute stressors; validated scales of acute events19 but not chronic conditions have been developed.Physiologic mechanisms have been hypothesized to link maternal stress to maternal and infant health.20–22 For example, cumulative stress exposure may result in accelerated aging, or “weathering,” wearing down the body’s adaptive systems.21,22 Weathering in particular was proposed as a source of racial/ethnic disparities in perinatal health, such that the higher stress experienced by African American women causes their reproductive functioning to deteriorate more rapidly than that of White women.22 Other possible pathways through which stress can lead to birth outcome disparities include infection,23 nutrition,19 and pregnancy complications.24The majority of studies assessing the effects on birth outcomes of stress and related factors have relied on prenatal measurement with mixed results.19,25,26 A smaller number of studies have examined effects of acute stressors or specific chronic stressors in the reproductive period.27–30 Although several of these analyses suggested associations, this work included limitations such as small sample sizes,27 European cohorts not generalizable to the United States,29 or retrospectively reported preconception measures.30 Furthermore, none included both acute and chronic stressors or compared racial/ethnic differences for groups besides non-Hispanic Black and non-Hispanic White.To address these gaps in the literature, the objective of this study was to examine the impact of maternal preconception acute stressors (or stressful life events) and preconception chronic stressors (or stressful life conditions) on offspring birth weight and racial/ethnic birth weight disparities. Our hypotheses were as follows: (1) acute and chronic stressors will be inversely associated with birth weight, (2) the distributions of birth weight and stress will vary by maternal race/ethnicity, and (3) stress will partially explain racial/ethnic differences in birth weight where such differences exist. Our conceptual model is shown in Figure 1.Open in a separate windowFIGURE 1—Conceptual model depicting hypothesized relationships among maternal race/ethnicity, preconception stress, and offspring birth weight: National Longitudinal Study of Adolescent Health, United States, 1994–2008.     

Work Organization and Health Among Immigrant Women: Latina Manual Workers in North Carolina

Objectives. We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life.Methods. We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009–2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life.Results. Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor’s power and safety climate) was associated with fewer depressive symptoms and better MCS.Conclusions. Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.Immigrant and low-income workers constitute a vulnerable population that is at significant risk for occupational injury and illness. These workers often have the most demanding jobs in the most dangerous industry sectors (e.g., agriculture, construction).1-5 When they work in less hazardous sectors, such as manufacturing, they generally work in industries such as poultry and meat processing, which have substantial hazards and few protections.6-7 These manufacturing hazards include exposure to toxicants (e.g., cleaners, solvents), exposure to biological materials (e.g., feces, dander), repetitive motion injuries, slips and falls, and lacerations and amputation from sharp tools and machinery.Although addressing conventional risk factors (e.g., chemical and mechanical exposures) remains important for improving the health of immigrant and low-income workers, greater attention is being given to how work organization affects their health and safety.5,8 The National Institute for Occupational Safety and Health (NIOSH)9 defines “work organization” as the processes and organizational practices that influence job design. Work organization domains include the timing of when work is performed, such as shifts and hours worked, seasonality, and flexibility; the physical and psychological demands of work; the control or decision latitude workers have, including variation in effort and choice in performing work; and style of supervision and support, including supervisor support and control and work safety climate.10,11Work organization has most often been considered in its effects on job satisfaction and health of white-collar workers. Although work organization is believed to be particularly influential in the health and safety of vulnerable workers, little research has examined work organization and health outcomes for vulnerable populations such as immigrant workers.5,8,12 Even less research has focused on work organization among immigrant women. For example, recent analyses of work organization and health among US immigrant workers in agriculture13-15 and construction16-18 have shown that, among agricultural workers, job demands are associated with poorer physical health13; high worker control is associated with better mental health14; and poor safety climate is associated with greater musculoskeletal discomfort.15 Among construction workers, poor work safety climate is associated with poor work safety behavior.16 However, participants in these studies have been almost exclusively male.Recent analyses of work organization and health among immigrant poultry processing workers have included a substantial number of women.19-22 These analyses showed that management practices, such as poor safety commitment, and job design, such as authority, variety, psychological workload, frequent awkward posture, and repetitive movement, are associated with risk of recent musculoskeletal problems, respiratory problems, and self-reported injury or illness.19-21 In a similar way, organizational hazards, including low job control and high psychological demand, are associated with increased risk for epicondylitis, rotator cuff syndrome, and back pain.22 However, these analyses have not focused on women or on gender differences. A qualitative analysis of female immigrant household domestic workers in Spain reported that such work organization factors as job control affect health.23,24The job demand–control–support model10,11 provides a framework for examining the association of work organization and health among women immigrant manual workers. This model posits that jobs with greater physical and psychological demand or stressors will result in poorer health. However, jobs with greater control or decision latitude can result in better health and can offset the effects of demand leading to poor health. Finally, support of peers and supervisors, including perceived safety climate25 (how workers perceive supervisors’ valuing safety over production) reduces occupational injury and buffers the effects of job demands.The place of work organization in the health of immigrant women is particularly important. These women have major family, child care, and domestic responsibilities that they need to integrate into their work responsibilities.12,26 Immigrant women are also extremely vulnerable to workplace physical and sexual harassment, as they often do not speak English, do not know their rights, and may lack proper work documents.27-29This analysis had 2 goals. The first was to delineate work organization attributes of full-time employed immigrant Latinas with manual occupations. The work organization attributes included indicators of job demands, decision latitude, and support. The second goal was to determine the associations of work organization attributes with health characteristics of these women, including physical health, mental health, and health-related quality of life. We tested 3 hypotheses: (1) greater job demands will be associated with poorer physical health, mental health, and health-related quality of life; (2) greater decision latitude will be associated with better physical health, mental health, and health-related quality of life; and (3) greater job support (higher perceived supervisor control, better job safety climate) will be associated with better physical health, mental health, and health-related quality of life.     

Job-Related Stress and Chronic Health Conditions Among Filipino Immigrants

Objectives We investigate how duration in the US impacts the relationship between job-related stress and health conditions among Filipino immigrants. Methods Using data from the Filipino American Community Epidemiologic Study, a cross-sectional sample of 1,381 immigrant Filipinos was obtained. Negative binomial regression was used to examine the interaction between years residing in the US and job concerns on number of self-reported health conditions. Results Job concern is positively associated with health conditions for all immigrants no matter what length of time they have spent in the US. This association is strongest for recent immigrants and the strength of the association weakened with increasing time spent in the US. Conclusions Findings suggest that job-related stressors are associated with adverse health outcomes among Filipino immigrants and that this relationship is strongest for newer immigrants. New immigrants should be recognized as a vulnerable group with regard to the impact of work on their well-being.     

Exploring Knowledge and Attitudes Related to Pregnancy and Preconception Health in Women with Chronic Medical Conditions

Women with chronic medical conditions are at increased risk for pregnancy-related complications, yet little research has addressed how women with diabetes, hypertension, and obesity perceive their pregnancy-associated risks or make reproductive health decisions. Focus groups were conducted with 72 non-pregnant women stratified by chronic condition (diabetes, hypertension, obesity) and by previous live birth. Participants discussed their intention for future pregnancy, preconception health optimization, perceived risk of adverse pregnancy outcomes, and contraceptive beliefs. Four major themes were identified, with some variation across medical conditions and parity: (1) Knowledge about pregnancy risks related to chronic medical conditions was limited; (2) Pregnancy intentions were affected by diabetes and hypertension, (3) Knowledge about optimizing preconception health was limited; and (4) Lack of control over ability to avoid unintended pregnancy, including limited knowledge about how medical conditions might affect contraceptive choices. Women with diabetes and hypertension, but not obesity, were generally aware of increased risk for pregnancy complications, and often expressed less intention for future pregnancy as a result. However, diabetic and hypertensive women had little knowledge about the specific complications they were at risk for, even among those who had previously experienced pregnancy complications. Neither chronic condition nor perceived risk ensured intent to engage in preconception health promotion. We observed knowledge deficits about pregnancy-related risks in women with diabetes, hypertension, and obesity, as well as lack of intent to engage in preconception health promotion and pregnancy planning. These findings have important implications for the development of preconception care for women with chronic medical conditions.     

Preconception Health: Awareness, Planning, and Communication Among a Sample of US Men and Women

It is important to educate both men and women about preconception health (PCH), but limited research exists in this area. This paper examines men’s and women’s awareness of exposure to PCH information and of specific PCH behaviors, PCH planning, and PCH discussions with their partners. Data from Porter Novelli’s 2007 Healthstyles survey were used. Women and men of reproductive age were included in the analysis (n = 2,736) to understand their awareness, planning, and conversations around PCH. Only 27.9% of women and men reported consistently using an effective birth control method. The majority of men (52%) and women (43%) were unaware of any exposure to PCH messages; few received information from their health care provider. Women were more aware than men of specific pre-pregnancy health behaviors. Women in the sample reported having more PCH conversations with their partners than did men. PCH education should focus on both women and men. Communication about PCH is lacking, both between couples and among men and women and their health care providers. PCH education might benefit from brand development so that consumers know what to ask for and providers know what to deliver.     

Social Norms,Acculturation, and Physical Activity Among Latina Women

Physical activity promotes health and is important for preventing chronic conditions, such as obesity and cardiovascular disease. Little is known about factors associated with different types of PA among Latina women, particularly Dominicans, who now constitute the fifth largest group of Latinos in the United States. The purpose of this study was to examine whether occupational physical activity, acculturation, familism, and norms held by family and friends are associated with three types of PA: vigorous and moderate leisure-time physical activity (LTPA), and resistance training. Interviews were conducted with 418 Dominican women. We assessed self-reported PA using standardized measures. Data were collected between July 2010 and July 2012 in New York City. Most women reported no vigorous LTPA or resistance training (74.5 and 73.1?%, respectively); about half (52.1?%) reported no moderate LTPA. After adjusting for sociodemographic factors, occupational physical activities were associated with greater LTPA. Acculturation was not associated with any outcome. Positive family norms about exercise were associated with increased LTPA and resistance training. Family norms may play a critical role in PA and should be included in programs to increase PA among Latina women.     

Perceptions of stress and resilience among Latina women enrolled in prenatal care in Metro Atlanta through an ecosocial lens

Stress across the life course is highly prevalent, particularly among immigrant and racial/ethnic minority women who face adversities associated with structural and interpersonal racism. Understanding how women perceive and describe stress and resilience can provide cultural context to inform interventions to improve health among pregnant women facing adversity. The goal of this project was to examine how external stressors and coping strategies prior to and during pregnancy are reflected in Latina women's narratives about their lives through an Ecosocial framework. This mixed methods research study explores pregnant Latina women's psychosocial well-being before and during pregnancy based on Ecosocial theory. We conducted 111 surveys with Latina women receiving prenatal care in Atlanta, Georgia in 2017–2018. We conducted 24 in-depth interviews, chosen purposively from survey respondents, collecting narratives of stress and resilience over the course of pregnancy. We purposively sampled equal numbers of women who did and did not report an ongoing stressor in the survey. The survey and interview guide were focused on domains of stress, psychosocial being, coping and resilience. The majority of survey participants spoke Spanish (86%) and were born in Mexico (42%) or Guatemala (27%). Less than half (37%) reported ongoing stress, most commonly from a loved one's illness or work-related problem. The majority of women felt they should control emotional responses to external stressors during pregnancy to protect their baby's health. Women described motherhood and previous challenges as sources of maturity and improved coping. Familial financial and emotional support were perceived as critical to women's successful coping.     

Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women

To compare preconception health indicators (PCHIs) among non-pregnant women aged 18–44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997–2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting <high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10–1.29), fair/poor health (AOR 1.14, 95 % CI 1.06–1.22), no health insurance (AOR 1.12, 95 % CI 1.05–1.19), no annual checkup (AOR 1.12, 95 % CI 1.04–1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08–1.33), smoking (AOR 1.08, 95 % CI 1.03–1.14), <5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02–1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01–1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, <5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. Interventions sensitive to Appalachian culture to improve preconception health may be warranted for this population.     

Health and Health Care Disparities Among Homeless Women

While disparities in health and health care between vulnerable (e.g., minorities, low-income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the neediest within these generally needy populations, and to plan interventions to reduce their health and health care disparities. With data from 1,331 women residing in Los Angeles County California, in one of the largest, most comprehensive studies of the health of homeless women to date, this study examined the health and health care disparities among homeless African American, Latina, and white women. This study further explored if race/ethnicity and other factors that predispose homeless women to poor health, or enable them to obtain better health care, were associated with their unmet need for medical care. The study found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups.     

Health Inequality Among Estonian Women

In Eastern Europe, in post-Communist countries, transformations during the past 10 years have considerably affected the life of women. Our aims were to (a) examine health status and socioeconomic inequalities among Estonian women, and (b) study the relationships between women's social roles and health. A group of 659 women, aged 18-45, completed the Health Questionnaire for Adults (HQA) and the General Health Questionnaire (GHQ). Income had the largest effect on self-related health and psychoemotional health ratings. The second important indicator was education. Women's additional social roles (marital status, parental role) were not detrimental to their health in our study.     

Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity

IntroductionPrior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity.MethodsWe analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18–44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status.ResultsIn every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57–2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19–1.41) and Black race alone (PR, 1.47; 95% CI, 1.36–1.58).ConclusionsWomen at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.     

Preconception Health of Reproductive Aged Women of the Mississippi River Delta

Optimal preconception health (PCH) may improve maternal and infant outcomes, priority issues in Mississippi (MS). Our study objective was to compare the PCH of women in the MS Delta to other regions. We analyzed Behavioral Risk Factor Surveillance System data from 2005, 2007, and 2009, and limited analyses to 171,612 non-pregnant black and white women 18–44 years of age. Region was defined as 14 MS Delta counties (MS Delta), remainder of MS (MS non-Delta), Delta states (LA, AR, TN), and non-Delta US states. We calculated adjusted prevalence ratios (aPR) to assess associations between region and 16 indicators of optimal PCH, controlling for demographic characteristics. Healthy PCH factors such as consuming ≥5 fruits and vegetables daily and normal body mass index (18.5 kg/m² to <25 kg/m²), respectively, were more prevalent in the MS non-Delta (aPR = 1.3; 95 % CI: 1.0,1.7 and aPR = 1.2; 95 % CI: 1.0,1.4), non-MS Delta (aPR = 1.5; 95 % CI: 1.2,2.0 and aPR = 1.3; 95 % CI: 1.1,1.5) and non-Delta states (aPR = 1.7; 95 % CI: 1.3,2.2 and aPR = 1.4; 95 % CI: 1.2,1.6) compared to the MS Delta. Physical activity levels were higher among non-Delta US states compared to the MS Delta (aPR = 1.3; 95 % CI: 1.1,1.4). Household income and race confounded the associations between region and PCH. Reproductive aged women in the MS Delta had poorer PCH, particularly for physical activity and nutrition, than women in other regions. MS Delta service providers and public health practitioners should consider implementing or enhancing lifestyle, nutrition, and physical activity interventions, with a special focus on reducing income-based and racial disparities.