Psychological Distress as a Barrier to Preventive Healthcare Among U.S. Women

To examine the role of psychological distress in accessing routine periodic health examinations among U.S. women of reproductive age, we examined data on 9,166 women aged 18–49 years from the 1998 National Health Interview Survey. In multivariate regression, women with psychological distress were more likely than non-distressed women to report delayed routine care, not having insurance, and lack of a usual source of care. Among women without a usual source of care, distressed women were more than six and one-half times more likely to delay care compared with non-distressed women. Women with psychological distress report delays in receiving routine care. Editors’ Strategic Implications: The findings suggest that, for distressed women in particular, continuity of care is vital in accessing routine care and obtaining timely and effective preventive services.     

HIV Testing Among U.S. Women During Prenatal Care: Findings from the 2002 National Survey of Family Growth

Objectives: To measure progress toward the US Public Health Service recommended goal that HIV screening be part of the routine battery of prenatal tests for all pregnant women, using data from a nationally-representative reproductive health survey. Methods: Data from the 2002 National Survey of Family Growth (NSFG) measure self-reported prenatal HIV testing for all women who had a completed pregnancy in the 12 months before interview. We estimated the percentage with a prenatal test for categories defined by major socio-economic groups, HIV risk, knowledge of HIV treatment, and access to health care. Results: Sixty-nine percent of 748 recently pregnant women reported receiving a prenatal HIV test. The percentage tested was significantly higher for women with incomes below 300% of the poverty level (76%) and women who reported some degree of HIV risk (82%), suggesting that prenatal care providers offer and encourage testing based on perceived risk, even though universal HIV screening is recommended. Testing was also higher among women with knowledge of interventions to prevent perinatal HIV transmission (74%), suggesting that more public information on these treatments might be helpful. Conclusions: A national estimate indicates that nearly one in 3 recently pregnant women reported they were not tested for HIV during prenatal care. Studies showing that prenatal testing for other infectious diseases can approach 100% suggest that a similar level of testing is attainable for perinatal HIV screening, particularly if it is incorporated into the routine package of prenatal tests and procedures offered to all pregnant women.     

Imported Compounded Diet Pill Use Among Brazilian Women Immigrants in the United States

In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18–50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.     

Prevalence of Overweight and Obesity Among US Immigrants: Results of the 2003 New Immigrant Survey

This study estimates the prevalence patterns of overweight and obesity of new immigrants in the US. The 2003 New Immigrant Survey (NIS) was used to generate representative estimates of the prevalence of overweight and obesity among new immigrants overall and by place of origin subgroup. More than 45% of new immigrants are either overweight or obese. Overall, the higher prevalences of both overweight and obesity were found in Latin/Caribbean immigrants, older age group, those with longer years of US residence, and current residents of the West region. Men have a higher overweight prevalence and women have a slightly higher obesity prevalence. The overweight prevalence was higher for immigrants living above the poverty level, but there was not much difference in the obesity prevalence by poverty level. There was notable heterogeneity in overweight and obesity prevalences within and across place of origin groups by age, poverty level, years of US residence, and current resident regions. The study suggests further investigation on the determinants of weight status by place of origin and the importance of tailored interventions for each group.     

Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth

Oral contraceptives are the most popular reversible method of contraception in the United States. Although most women using oral contraceptives are reliably protected against pregnancy, nearly half of the 3 million unintended pregnancies in the United States annually occur among the 90% of women who use contraception. Recent findings suggest that obesity may reduce the biologic effectiveness of oral contraceptives. The purpose of this study was to further investigate the potential obesity-oral contraceptive failure association using 2002 National Survey of Family Growth data. In this retrospective cohort of 1,491 women, body mass index (kg/m2) was derived from self-reported values, and oral contraceptive failure was defined as conceptions that occurred while women used oral contraceptives. Hazard ratios and 95% confidence intervals were obtained from Cox proportional hazards models. Obese women (body mass index > or = 30 vs. 18.5-24.9) had an increased risk of oral contraceptive failure (hazard ratio = 1.59, 95% confidence interval: 0.94, 2.68). Results were largely attenuated after adjustment for age, race/ethnicity, and parity. This population-based study found no association between obesity and oral contraceptive failure. While it is possible that misclassification or uncontrolled confounding obscured a true relation, it may be that there is no association. Large, prospective studies are needed to assess whether obesity plays a biologically relevant role in oral contraceptive effectiveness.     

Prevalence of Overweight Among Women of Childbearing Age in Nepal: Trends from 2001 to 2011 and Associations with Socio-demographic Factors

This study examined trends in overweight (body mass index, BMI ≥ 25.0 kg/m²) and underweight (BMI < 18.5 kg/m²) from 2001 to 2011 and associations between socio-demographic factors and overweight in 2011 among 15–49-year-old women in Nepal. Nationally representative cross-sectional data were used from three Demographic and Health Surveys conducted in Nepal in 2001 (n = 7,900), 2006 (n = 10,076) and 2011 (n = 5,873). Body weight and height were measured by trained personnel. Data on socio-demographic variables were obtained by interviewing the participants. The data were analysed using logistic regression models. The prevalence of underweight decreased from 26.6 to 18.1 % and the prevalence of overweight increased from 6.4 to 14.0 % between 2001 and 2011 (p < 0.001 for both, adjusted for age, parity and education). Both trends were more pronounced among the rural than the urban women. Although overweight was much more common in the urban (27.4 %) than in the rural areas (11.8 %) in 2011, the difference diminished substantially (odds ratio, OR, for being overweight in the urban vs. in the rural areas, 1.40, 95 % CI 1.15–1.70) when adjusted for other socio-demographic variables. The strongest independent predictors of being overweight were higher relative wealth and advanced age. Overweight has become almost as common phenomenon as underweight among women in childbearing age in Nepal. The urban–rural differences have slightly narrowed and overweight is still related to a higher socio-economic status in this population. Strategies to prevent further increases in the prevalence of overweight should urgently be developed and implemented at all levels of the society.     

健康教育提高育龄妇女避孕效率降低人工流产率的研究

对1800例已婚育龄妇女的避孕和人工流产情况进行流行病学调查,94.7％妇女正在避孕,58.4％妇女有过人工流产。对IUD、避孕药和阴茎套的续用率进行生命表分析,IUD15年累积续用率0.51。用Tietze法分析了原因和Cox模型检测与人工流产发生有关因素,提示妇女避孕知识缺乏与操作人不认真是最主要的,通过健康教育人工流产率明显下降。     

Accuracy of Body Mass Index Categories Based on Self-Reported Height and Weight Among Women in the United States

Objective The purpose of this study was to assess the accuracy of BMI categories based on self-reported height and weight in adult women. Methods BMI categories from self-reported responses were compared to categories measured during physical examination from women, age 18 or older, who participated in the National Health and Examination Survey, 1999–2004. We first examined strength of agreement using Cohen’s kappa, which, unlike sensitivity and specificity, allows for the comparison of polychotomous measures beyond chance agreement. Kappa regression identifies potential threats to accuracy. Likelihood of bias, as measured by under-reporting, was examined using logistic regression. Results Cohen’s kappa estimates were 0.443 for pregnant women (N = 724) and 0.705 for non-pregnant women (N = 5,910). Kappa varied by age and race, but was largely unrelated to socioeconomic status, health and health behaviors. Women who visited a physician in the last year or been diagnosed with osteoporosis were more accurate, while women most likely to under-report were older, white, non-Hispanic, and college-educated. Conclusions Our results suggest substantial agreement between self-reported and measured categories, except for women who are pregnant, above the age of 75 or without physician visits. Under-reporting may be more prevalent in well-educated, white populations than minority populations.     

“Coming to Town”: The Impact of Urbanicity, Cigarette Advertising, and Network Norms on the Smoking Attitudes of Black Women in Cape Town, South Africa

This study was conducted to examine the effect of urban living on smoking attitudes among black African women in South Africa. We examine how urbanicity affects attitudes toward smoking and how it moderates the relationship between both advertising exposure and network norms on black women's smoking attitudes. Respondents were 975 black women currently living in Cape Town townships, some of which were raised in rural villages or small towns. Respondents completed a cross-sectional survey, which included data on smoking attitudes, norms, and exposure to cigarette advertising. Multiple linear regression analysis was performed with smoking attitudes as the response variable, and urbanicity, cigarette advertising exposure, and network smoking norms as primary explanatory variables. Interactions were tested to determine whether urbanicity modified the effect of advertising exposure and network norms on smoking attitudes. Independent effects of urbanicity, exposure to cigarette advertising, and greater smoking prevalence within women's networks were associated with more favorable smoking attitudes. In addition, urbanicity moderated the relationship between network smoking norms and smoking attitudes, but not cigarette advertising exposure and smoking attitudes. Urbanicity, cigarette advertising, and networks play important roles in women's attitudes toward smoking, and potentially, smoking behavior. Overall, our results suggest that strong and creative anti-smoking efforts are needed to combat the potential for a smoking epidemic among an increasingly urbanized population of black women in South Africa and similar emerging markets. Additional research is warranted.     

Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

BackgroundThe relationship between diet quality and health care costs is unclear.ObjectiveThe aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs.DesignData from a longitudinal cohort study were analyzed.Participants/settingData for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health were analyzed.Main outcome measuresDiet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia’s universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS change ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤3 points], or “improved” [ARFS change ≥4 points]).Statistical analysesLinear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status.ResultsConsuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]).ConclusionsGreater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.     

山东省中小学生1985～2000年体质量指数及肥胖检出率趋势研究

目的分析山东省中小学生体重指数（BMI）及超重和肥胖发生率的长期趋势，为青少年生长发育研究提供依据。方法抽取1985，1995和2000年全国学生体质健康调研山东省资料，根据7～18岁中小学生的身高、体重，计算体质量指数（BMI）；按照《中国学生超重、肥胖BMI筛查标准》，分别计算男、女生各年龄组超重和肥胖检出率。结果男生BMI均值以及超重和肥胖检出率在多个年龄组显著高于女生。7～18岁男女生BMI均值呈逐渐升高趋势，但各年龄组间BMI差值并非均匀一致；总体来看，1995年BMI均值以及超重和肥胖检出率高于1985年，而2000年高于1995年。结论BMI均值、超重和肥胖检出率均随年代的增加而逐渐升高，并表现出一定的年龄和性别差异。山东省中小学生的超重和肥胖率正在以较快速度增长，并表现出明显的低龄化趋势。     

Estimates of contraceptive failure from the 2002 National Survey of Family Growth

BACKGROUND: In 2001, the US government's "Healthy People 2010" initiative set a goal of reducing contraceptive failure during the first year of use from 13% in 1995 to 7% by 2010. We provide updated estimates of contraceptive failure for the most commonly used reversible methods in the United States, as well as an assessment of changes in failure rates from 1995 to 2002. STUDY DESIGN: Estimates are obtained using the 2002 National Survey of Family Growth (NSFG), a nationally representative sample of US women containing information on their characteristics, pregnancies and contraceptive use. We also use the 2001 Abortion Patient Survey to correct for underreporting of abortion in the NSFG. We measure trends in contraceptive failure between 1995 and 2002, provide new estimates for several population subgroups, examine changes in subgroup differences since 1995 and identify socioeconomic characteristics associated with elevated risks of failure for three commonly used reversible contraceptive methods in the United States: the pill, male condom and withdrawal. RESULTS: In 2002, 12.4% of all episodes of contraceptive use ended with a failure within 12 months after initiation of use. Injectable and oral contraceptives remain the most effective reversible methods used by women in the United States, with probabilities of failure during the first 12 months of use of 7% and 9%, respectively. The probabilities of failure for withdrawal (18%) and the condom (17%) are similar. Reliance on fertility-awareness-based methods results in the highest probability of failure (25%). Population subgroups experience different probabilities of failure, but the characteristics of users that may predict elevated risks are not the same for all methods. CONCLUSION: There was no clear improvement in contraceptive effectiveness between 1995 and 2002. Failure rates remain high for users of the condom, withdrawal and fertility-awareness methods, but for all methods, the risk of failure is greatly affected by socioeconomic characteristics of the users.     

Reproductive Health and Sexual Violence Among Urban American Indian and Alaska Native Young Women: Select Findings from the National Survey of Family Growth (2002)

Existing data on American Indians and Alaska Natives (AI/ANs) has indicated high rates of unintended pregnancy, high-risk sexual behavior, and experiences of sexual violence. This study from the first analysis to examine AI/ANs and the urban AI/AN subgroup in the National Survey of Family Growth (NSFG) reports new findings of reproductive health and sexual violence among urban AI/AN young women. We examined 2002 NSFG data on urban AI/AN women ages 15–24 years for pregnancies/births, unintended pregnancy, sexual initiation and contraceptive use. We also examined non-voluntary first sexual intercourse among urban AI/AN women ages 18–44 years. Prevalence estimates and 95 % confidence intervals were calculated. Findings include prevalence rates of risk factors among urban AI/AN women ages 15–24 years including unprotected first sex (38 %), first sex with much older partners (36 %), three or more pregnancies (13 %) and births (5 %) and unintended pregnancies (26 %). Seventeen percent of urban AI/ANs ages 18–44 years reported experiencing non-voluntary first sex. Sixty-one percent of urban AI/AN women ages 15–24 years were not using any method of contraception. Current contraceptive methods among those using a method included: injections/implants (23 %), contraceptive pills (32 %) and condoms (25 %). Findings describe reproductive health risk factors among young urban AI/AN women and highlight the need for enhanced surveillance on these issues. Those working to improve AI/AN health need these data to guide programming and identify resources for implementing and evaluating strategies that address risk factors for this overlooked population.     

Co-Occurrence of Overweight/Obesity,Anemia and Micronutrient Deficiencies among Non-Pregnant Women of Reproductive Age in Ghana: Results from a Nationally Representative Survey

Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.     

Discontinuation and resumption of contraceptive use: results from the 2002 National Survey of Family Growth

BACKGROUND: Discontinuation of contraceptive use that is not immediately followed by resumption of use of another method while a woman is at risk is a common cause of unintended pregnancy. STUDY DESIGN: We provide new estimates of discontinuation for the pill, injectable, male condom, withdrawal and fertility-awareness-based methods, and identify socioeconomic characteristics associated with discontinuation for the pill, male condom and withdrawal. We provide new estimates of resumption of use by prior method used and identify socioeconomic characteristics associated with resumption of use. Estimates are obtained using the 2002 National Survey of Family Growth, supplemented by the 2001 Abortion Patient Survey to correct for underreporting of abortion. RESULTS: The fraction of method use segments discontinued for method-related reasons within 1 year was highest for the male condom (57%), withdrawal (54%) and fertility-awareness-based methods (53%), and lowest for the pill (33%), with the injectable in-between (44%). However, contraception was abandoned altogether in only 25% of cases. The probability of resuming use of a contraceptive was 72% in the initial month of exposure to the risk of an unintended pregnancy; this rose to 76% by the third month. CONCLUSION: The risk of discontinuation of use of reversible methods of contraception for method-related reasons, including a change of method, is very high, but fortunately the risk of abandoning use of contraception altogether is far lower, and most spells of exposure to risk of an unintended pregnancy following discontinuation are protected from the start by a switch to another method.     

Receipt of Recommended Prenatal Interventions and Birth Weight Among African-American Women: Analysis of Data from the 1988 National Maternal and Infant Health Survey

Objectives: While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. Method: This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. Results: The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. Conclusions: Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.     

Underreporting of Energy Intake Increases over Pregnancy: An Intensive Longitudinal Study of Women with Overweight and Obesity

(1) Background: Energy intake (EI) underreporting is a widespread problem of great relevance to public health, yet is poorly described among pregnant women. This study aimed to describe and predict error in self-reported EI across pregnancy among women with overweight or obesity. (2) Methods: Participants were from the Healthy Mom Zone study, an adaptive intervention to regulate gestational weight gain (GWG) tested in a feasibility RCT and followed women (n = 21) with body mass index (BMI) ≥25 from 8–12 weeks to ~36 weeks gestation. Mobile health technology was used to measure daily weight (Wi-Fi Smart Scale), physical activity (activity monitor), and self-reported EI (MyFitnessPal App). Estimated EI was back-calculated daily from measured weight and physical activity data. Associations between underreporting and gestational age, demographics, pre-pregnancy BMI, GWG, perceived stress, and eating behaviors were tested. (3) Results: On average, women were 30.7 years old and primiparous (62%); reporting error was −38% ± 26 (range: −134% (underreporting) to 97% (overreporting)), representing an ~1134 kcal daily underestimation of EI (1404 observations). Estimated (back-calculated), but not self-reported, EI increased across gestation (p < 0.0001). Higher pre-pregnancy BMI (p = 0.01) and weekly GWG (p = 0.0007) was associated with greater underreporting. Underreporting was lower when participants reported higher stress (p = 0.02) and emotional eating (p < 0.0001) compared with their own average. (4) Conclusions: These findings suggest systemic underreporting in pregnant women with elevated BMI using a popular mobile app to monitor diet. Advances in technology that allow estimation of EI from weight and physical activity data may provide more accurate dietary self-monitoring during pregnancy.     

Using Open-Ended Data to Enrich Survey Results on the Meanings of Self-Rated Health: A Study Among Women in Underprivileged Communities in Beirut,Lebanon

This study extends the debate on self-rated health by using different sources of data in the same study to explore the meanings of self-rated health among women who live in socio-economically disadvantaged communities in Beirut, Lebanon. Using data from the Urban Health Study, a cross-sectional household survey of 1,869 women between 15 and 59 years of age, multiple logistic regression models were developed to assess factors associated with self-rated health. Also, open-ended data was used to analyze women's explanations of their self-rated health ratings. Self-rated health was found to be a complex concept, associated not only with physical health but also with a combination of social, psychological, and behavioral factors. This open-ended analysis revealed new meanings of self-rated health that are often not included in self-rated health epidemiologic research, such as women's experiences with pain and fatigue, as well as exposure to financial stressors and the legacy of wars. We argue that triangulating survey and open-ended data provides a better understanding of the context-specific social and cultural meanings of self-rated health.     

中国居民的超重和肥胖流行现状

目的 分析我国超重和肥胖患病率水平及其在人群中的流行和分布规律。方法 利用中国居民营养与健康状况调查209849人的有效数据,计算全国的超重和肥胖患病率,用2000年人口进行标化。超重和肥胖的判断标准：7岁以下儿童根据1978年世界卫生组织推荐的Z评分标准,7～17岁人群采用2003年中国肥胖问题工作组推荐的标准,18岁及以上成年人采用卫生部《中国成人超重和肥胖症预防控制指南》推荐的标准。结果 我国居民超重率为17．6％、肥胖率为5．6％,二者之和为23．2％。大城市、中小城市、一类至四类农村的标化超重率分别为25．0％、21．6％、17．4％、15．1％、19．2％和12．8％,标化肥胖率分别为10．6％、7．2％、6．4％、4．3％、6．0％和2．7％。按照年龄段统计,0～6岁组的超重率为3．4％,肥胖率为2．0％;7～17岁组的超重率为4．5％,肥胖率为2．1％;18岁及以上组的超重率为22．8％,肥胖率为7．1％。超重率和肥胖率的性别差异在各年龄段和城乡之间有很大不同。结论 超重和肥胖人群已接近总人口的1／4,成为影响居民健康的重要疾患。随着城市化的进程,肥胖将成倍增加,防治工作迫在眉睫。