Prepregnancy Obesity Trends Among Low-Income Women, United States, 1999–2008

There is limited data on prepregnancy obesity trends specifically among low-income women, a population at high risk for obstetric complications. Using the Pregnancy Nutrition Surveillance System, we assessed prepregnancy obesity [body mass index (BMI) ≥ 30 kg/m(2)] trends among women who participated in the Supplemental Nutrition Program for Women, Infants, and Children in 1999, 2004, and 2008. Prepregnancy BMI was calculated using measured height and self-reported prepregnancy weight. We report unadjusted contributor (state, territory or Indian tribal organization) specific trends, and both unadjusted and adjusted overall trends, to account for changes in maternal age and race-ethnic distributions, using 1999 as the referent. Of the 27 contributors in 1999, 2 had a prepregnancy obesity prevalence <20%, and 1 had a prevalence ≥ 30%. Of the 35 contributors in 2008, none had a prepregnancy obesity prevalence <20%, and 14 had a prevalence ≥ 30%. From 1999 to 2008, the overall prevalence of prepregnancy obesity increased among all racial-ethnic groups, except among American Indian/Alaskan Natives, where it remained high, but stable. Overall prepregnancy obesity increased most rapidly among Hispanics, and remained stable from 2004 to 2008 among non-Hispanic blacks. In 2008, prevalence was highest among American Indian/Alaskan Natives (36.1%) and lowest among Asians/Pacific Islanders (10.8%). The adjusted prepregnancy obesity prevalence increased from 24.8% in 1999 to 28.3% in 2008, a relative increase of 14.1%. Prepregnancy obesity among low-income women increased from 1999 to 2008 and varied by race-ethnicity. These data can be used by obesity prevention programs to better target high-risk women.     

Can We Capture the Intersections? Older Black Women,Education, and Health

BackgroundRace/ethnicity, gender, and socioeconomic status are the three most prominent factors to predict health outcomes. Despite the fact that persistent health inequalities are found between groups, we know little about how the interrelatedness of these social positions influences the health of older adults.PurposeIn this study, we apply a feminist intersectional approach to the study of health inequalities, treating social variables as multiplicative rather than additive to capture the mutually constitutive dimensions of race/ethnicity, gender, and education.MethodsThis paper makes use of data from the National Social Life, Health and Aging Project, a nationally representative sample of 3,005 community-dwelling U.S. adults aged 57 to 85 years old, to explore intersections of race, gender, and education. We use a combination of stratified analysis with an interaction term to test multiplicative effects.ResultsFirst, our findings confirm that Black women with less than a high school education have the poorest self-rated health. Second, at the bivariate level, we find highly educated White men are not the converse of lower educated Black women. Third, at the multivariate level, we find being Black and female has an effect on health beyond those already accounted for by race and gender.ConclusionThis research demonstrates the explanatory power of an intersectionality approach to deepen understanding of the overlapping, simultaneous production of health inequalities by race, class, and gender.     

Women, the media, and heart disease. For better or for worse?

OBJECTIVE: To analyze the nature and presentation of print media messages regarding cholesterol and heart disease in women. The hypothesis is that print media messages about cholesterol and heart disease may encourage and perpetuate the use of cholesterol-lowering drugs in women. METHODS: A hand-search of the "seven sisters" of American women's magazines and of two Canadian women's magazines. All print material related to cholesterol and heart disease in women was photocopied and the content analyzed qualitatively. The print media content was divided into two categories: magazine articles and drug industry-sponsored advertisements. Themes were identified and were analyzed for the messages they contained about heart disease, cholesterol, and the use of cholesterol-lowering drugs in women. RESULTS: From the magazine articles, three main messages were identified. First, heart disease is the number one killer of women. Second, women must demand recognition of their hig risk of heart disease and demand equal access to prevention and treatment services for heart disease. Third, lifestyles changes are not enough. Cholesterol-lowering drugs should be considered. Drug advertisements also emphasize that postmenopausal women are at high risk of heart disease and that lifestyle changes are inadequate or insufficient to lower this risk. In both cases, high blood cholesterol is considered not as a risk factor for heart disease but as the disease itself. CONCLUSIONS: Magazine articles and drug advertisements act synergistically and may encourage and promote the use of cholesterol-lowering drugs in women. Postmenopausal women not on hormone therapy are particularly targeted.     

Non-normal Screening Mammography Results,Lumpectomies, and Breast Cancer Reported by California Women, 2001–2009

BackgroundAlthough screening mammography may contribute to decreases in breast cancer mortality in a population, it may also increase the risk of false positives, anxiety, and unnecessary and costly medical procedures in individuals. We report trends in self-reported non-normal screening mammography results, lumpectomies, and breast cancer in a representative sample of California women.MethodsData were obtained from the 2001, 2005, and 2009 cross-sectional California Health Interview Surveys (CHIS) and weighted to the California population. CHIS employed a multistage sampling design to administer telephone surveys in 6 languages. Our study sample was restricted to women 40 years and older who reported a screening mammogram in the past 2 years. Sample sizes were 13,974 in 2001, 12,069 in 2005, and 15,552 in 2009. Women reporting non-normal results were asked whether they had an operation to remove the lump and, if so, whether the lump was confirmed as malignant.FindingsBetween 2001 and 2009, the percent of California women who reported having been diagnosed with breast cancer was relatively stable. For each of the three age groups studied, the percentage of non-normal mammography results increased and the percentages of lumpectomies decreased and, for every woman reporting a diagnosis of breast cancer, three women reported a lumpectomy that turned out not to be cancer. This ratio was greater for younger women and less for older women.ConclusionsDespite relatively constant rates of breast cancer diagnosis from 2001 to 2009, the percentage of non-normal mammography results increased and lumpectomies declined.     

Rethinking Preconception Care: A Critical,Women’s Health Perspective

Objectives Preconception care aims to provide care to reproductive aged individuals in order to improve pregnancy and birth outcomes. Given that preconception care is a public health priority, it is important to evaluate the evolution of this health paradigm and the promotion of preconception messages that are obtained by the public. We identified online preconception health messages, which were critically assessed through a women’s health perspective. Methods We searched for “preconception care” on three major search engines. Websites were included if they were U.S.-based, provided content in English, and mentioned preconception care. Blogs and journal articles were excluded. The final sample included 52 websites. Using a content analysis approach, we assessed the presence of gender bias and identified other emergent themes. Results The majority of websites focused on preconception care for women only (67%). The recommendations centered on: (1) health behaviors for women (e.g., folic acid, drinking, smoking); (2) visiting healthcare providers; and (3) evaluating medical risks. Moreover, most content implied that women desired, or should desire, pregnancy. Overall, the messages used biomedical language and rarely mentioned other important health topics, such as social support and violence. Conclusions The primary messages presented on preconception care websites emphasized biomedical aspects of women’s health. The current context of preconception care medicalizes this pre-pregnancy period by defining it as a biomedical condition requiring lifestyle changes and interventions. Additionally, the biases presented in these messages assumed women want and are capable of pregnancies and excluded an integral factor for heteronormative reproduction—men.

     

Fatigue,Worry, and Fear—Life Events in the Narratives of Women With Fibromyalgia

In this article we explored narrated life stories of 20 women with a long history of fibromyalgia to reach a deeper understanding of how people interpret the causes and consequences of different life events and illness experiences. Based on narrative analysis, we identified three model narratives that illustrate the different life courses of women with fibromyalgia. In addition, we described a counternarrative that questions fibromyalgia as a chronic disease. In this narrative study, we give insights to the invisible symptoms and unheard experiences that are associated with fibromyalgia and to the ongoing discussion on the etiology and maintenance of fibromyalgia.     

Sexually Transmitted Diseases Among Pregnant Women: 5 States,United States, 2009–2011

Introduction Screening for specific sexually transmitted diseases (STDs) during pregnancy has been a longstanding public health recommendation. Prior studies have described associations between these infections and socioeconomic factors such as race/ethnicity and education. Objectives We evaluated the prevalence of STDs and the correlation socioeconomic factors have with the presence of these infections among pregnant women in the United States. Methods We conducted an analysis using self-reported data from 12,948 recently pregnant women from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 5 states during 2009–2011. Responses to questions about curable STDs (chlamydia, gonorrhea, syphilis, trichomoniasis) diagnosed during pregnancy were utilized to calculate weighted STD prevalence estimates and 95% confidence intervals (CI). A logistic regression was also conducted to identify maternal socioeconomic characteristics significantly associated with STDs; results are displayed as adjusted prevalence ratios (aPR). The PRAMS protocol was approved at PRAMS participating sites and by CDC’s Institutional Review Board. Results Overall, 3.3% (CI 2.9–3.7) reported?≥?1 curable STD during her most recent pregnancy. The adjusted STD prevalence was higher among women with younger age (aPR, 2.4; CI 1.8–3.4), non-Hispanic black race/ethnicity (aPR, 3.3; CI 2.4–4.1), unmarried status (aPR, 2.1; CI 1.4–3.0), no college education (aPR, 1.4; CI 1.0–1.9), annual income <?$25,000 (aPR, 2.0; CI 1.3–3.2), and no pre-pregnancy health insurance (aPR, 1.4; CI 1.1–1.8). Conclusions for Practice This is the largest study of prevalence of self-reported curable STDs among U.S. pregnant women. Differences in STD prevalence highlight the association between certain socioeconomic factors and the presence of STDs.     

Breast Cancer Prevention Knowledge, Attitudes, and Behaviors Among College Women and Mother–Daughter Communication

Although breast cancer prevention targets mostly women ages 40 and older, little is known about breast cancer prevention for young women and mother’s advice. The purpose of this study was to examine breast cancer prevention knowledge, attitudes, and behaviors among college women and mother–daughter communication. Hispanic and non-Hispanic students at a southwestern university completed a breast cancer prevention survey with items for mother’s advice, breast self-awareness and risk reduction knowledge, self-efficacy, susceptibility, family history, provider breast self-exam (BSE) recommendation, peer norms, BSE practice, and demographics. An openended item was also used to elicit types of mother’s advice. Logistic regression was used to assess predictors for receiving mother’s advice for breast cancer prevention and BSE practice. Self-reported data using a survey were obtained from 546 college women with a mean age of 23.3 (SD = 7.75). Nearly 36 % received mothers’ advice and 55 % conducted BSE. Predictors for receiving mother’s advice were age, self-efficacy, and family history of breast cancer. Predictors for BSE practice were mother’s advice, age, self-efficacy, and provider BSE recommendation. Family history of breast cancer and knowledge were not significant predictors for BSE practice. Findings support the need for clinicians, community health educators, and mothers to provide breast cancer prevention education targeting college women.     

Women’s Autonomy and Unintended Pregnancy Among Currently Pregnant Women in Bangladesh

This paper examines the net effect of women's autonomy on their pregnancy intention status among currently pregnant Bangladeshi women. This study is based on data from the Bangladesh Demographic Health Survey, 2007 (BDHS). A subset of interviews from currently pregnant women (718) were extracted from 10,146 married women of reproductive age. The BDHS 2007 used a pre-tested, structured questionnaire to collect sociodemographic, women's empowerment, and pregnancy information. Associations between unintended pregnancy and explanatory variables were assessed using bivariate analysis. Logistic regression was used to assess the net effect of women's autonomy on current pregnancy intention status after controlling for other variables. Results indicate that women's autonomy is a significant predictor of unintended pregnancy after adjusting for other factors. A unit increase in the autonomy scale decreases the odds of unintended pregnancy by 16%. Besides autonomy, our results also indicate that current age, number of children ever born, age at marriage, religion, media access, and contraceptive use exert strong influences over unintended pregnancy. Women who have ever used contraceptives are 82% more likely to classify their current pregnancies as unintended compared with women who are non-users of contraceptives. Improvement in women's autonomy and effective and efficient use of contraceptives may reduce unintended pregnancies as well as improve reproductive health outcomes.     

Respiratory Illness Hospitalizations Among Pregnant Women During Influenza Season, 1998–2008

To examine health care burden, pregnancy outcomes and impact of high risk medical conditions among pregnancy hospitalizations during influenza season. Length of stay, hospitalization charges, and delivery complications were compared between hospitalizations with and without respiratory illness and compared by presence of high risk medical conditions. Length of stay and hospital charges were significantly increased among respiratory illness hospitalizations versus non-respiratory hospitalizations. Among respiratory illness hospitalization, the odds of intrauterine fetal demise were increased (adjusted odds ratio (aOR) 2.50, 95 % confidence interval (CI) 1.97–3.18). Among live births, there were higher odds of preterm delivery (aOR 3.82, 95 % CI 3.53–4.14), cesarean delivery (aOR 3.47, 95 % CI 3.22–3.74), and fetal distress (aOR 2.33, 95 % CI 2.15–2.52). The presence of high risk medical conditions did not impact pregnancy outcomes. Among pregnant women hospitalized during influenza season, those with respiratory illness were more likely than those without respiratory illness to have poor perinatal outcomes, regardless of the presence of high risk conditions. Efforts to minimize influenza morbidity, including universal vaccination and early antiviral therapy should be promoted among all pregnant women.     

Association between Bone Turnover,Micronutrient Intake,and Blood Lead Levels in Pre-and Postmenopausal Women,NHANES 1999–2002

Background

Blood lead levels (BLLs) have been shown to increase during periods of high bone turnover such as pregnancy and menopause.

Objectives

We examined the associations between bone turnover and micronutrient intake with BLLs in women 20–85 years of age (n = 2,671) participating in the National Health and Nutrition Examination Survey, 1999–2002.

Methods

Serum bone-specific alkaline phosphatase (BAP) and urinary cross-linked N-telopeptides (NTx) were measured as markers of bone formation and resorption, respectively. Lead was quantified in whole blood. The association between tertiles of BAP and NTx, and BLLs was examined using linear regression with natural log_-transformed BLLs as the dependent variable and interpreted as the percent difference in geometric mean BLLs.

Results

In adjusted analyses, mean BLLs among postmenopausal women in the upper tertiles of NTx and BAP were 34% [95% confidence interval (CI), 23%–45%] and 30% (95% CI, 17%–43%) higher than BLLs among women in the lowest tertiles of NTx and BAP, respectively. These associations were weaker, but remained statistically significant, among premenopausal women (NTx: 10%; 95% CI, 0.60%–19%; BAP: 14%; 95% CI, 6%–22%). Within tertiles of NTx and BAP, calcium intake above the Dietary Reference Intake (DRI), compared with below the DRI, was associated with lower mean BLLs among postmenopausal women but not premenopausal women, although most of the associations were not statistically significant. We observed similar associations for vitamin D supplement use.

Conclusions

Bone resorption and bone formation were associated with a significant increase in BLLs among pre-and postmenopausal women.     

Self-Reported Impulsivity,Rather than Sociosexuality,Predicts Women’s Preferences for Masculine Features in Male Faces

Previous research has suggested that an individual’s sociosexual orientation (i.e., their willingness to engage in sexual behavior outside of long-term relationships) may influence the qualities they find attractive in a potential mate. Results, however, have not been consistent and, moreover, studies have tended to draw from specific social groups. Here, we tested the relationship between sociosexuality and female’s preferences for masculinity in male faces, using a diverse population. We furthermore investigated impulsivity alongside sociosexuality, as this trait has been suggested as a “root” cause of variation in sexual behavior (Cross, 2010) and thus may better explain variation in mate choice. Results showed a significant association between increases in both sociosexuality and two subcomponents of impulsivity and greater preferences for masculine male features. Regression analysis suggested that a subcomponent of impulsivity, namely lack of planning, was the primary determinant of preferences. We discuss the implications these results have for our understanding of female attraction to masculine features.     

HIV-Related High Risk Sexual Behaviors and Practices Among Women in Bogotá, Colombia

ABSTRACT

Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.