Why African-American women are at greater risk for pregnancy-related death

PURPOSE: Our study aim was to identify factors that may contribute to the racial disparity in pregnancy-related mortality. METHODS: We examined differences in severity of disease, comorbidities, and receipt of care among 608 (304 African-American and 304 white) consecutive patients of non-Hispanic ethnicity with one of three pregnancy-related morbidities (pregnancy-related hypertension, puerperal infection, and hemorrhage) from hospitals selected at random from a statewide region. RESULTS: African-American women had more severe hypertension, lower hemoglobin concentrations preceding hemorrhage, more antepartum hospital admissions, and a higher rate of obesity. The rate of surgical intervention for hemorrhage was lower among African-Americans, although the severity of hemorrhage did not differ between the two racial groups. More African-American women received eclampsia prophylaxis. After stratifying by severity of hypertension, we found that more African-Americans received antihypertensive therapy. The rate of enrollment for prenatal care was lower in the African-American group. Among women receiving prenatal care, African-American women enrolled significantly later in their pregnancies. CONCLUSIONS: We have identified racial differences in severity of disease, comorbidities, and care status among women with pregnancy-related complications that would place African-Americans at disadvantage to survive pregnancy. These differences are potentially modifiable.     

AIDS and women at risk

Because acquired immune deficiency syndrome (AIDS) has often been perceived as a disease of gay men, little attention has been given to the increasing number of women exposed to AIDS. An overview of the disease reveals that its victims confront both physical and psychosocial problems of great complexity and that social workers have much to contribute to meet the needs of men and women who are affected.     

Coping and HIV infection in African-American women

HIV is impacting African-American women at alarming rates. Many of these women are poor and socially disadvantaged, resulting in a combination of stressors that impacts the quality of their lives. This study investigated whether coping style (i.e., problem-focused, emotion-focused) varies as a function of HIV status or stage of HIV-related illness. Secondly, we examined whether the use of a particular style is associated with three areas of functioning among HIV-infected women: general psychological distress, depressive symptomatology, and physical symptomatology. Ninety-nine HIV-infected women and 143 noninfected women completed measures assessing coping styles and functioning. No significant differences emerged in coping styles between the HIV-infected and noninfected women or for the groups when symptomatic women were examined separate from asymptomatic women. Greater emotion-focused coping was associated with less general psychological distress and depression specifically. Problem-focused coping interacted with illness stage to predict all areas of functioning. By identifying effective coping strategies among African-American women with HIV, mental health professionals can design empirical interventions that can help improve quality of life for these women.     

AIDS prevention for women at risk: Experience from a national demonstration research program

This paper discusses data from a national research program working with large numbers of women at risk for HIV. Important similarities between injection drug using (IDU) women and the non-injecting partners of IDU men have been shown. High levels of non-injection drug use are common to both groups, as is crack use and the trading of sex for crack. Despite considerable knowledge about AIDS, risky sex and drug injection behaviors are the rule. A number of important principles for outreach and intervention with women have also emerged, including the need for simultaneously aggressive and sensitive out-reach strategies and for interventions that take into account the full context of these women's lives.Principal Investigators and Members of the Consortium who contributed to the data contained in this article: Marcia Andersen, Ph.D.; Robert Baxter, M. Ed.; Sandra Baxter; George Beschner, M. S. W.; Patrick Biernacki, Ph.D.; Stanley Broadnax, M.D.; Vivian Brown, Ph.D.; Larry DeNeal, Ph.D.; Sherry Deren, Ph.D.; Antonio Estrada, Ph.D.; David Fleming, M. D.; Samuel Friedman, Ph.D.; Sena Gates; Peggy Glider, Ph.D.; Ted Hammett, Ph.D.; Dana Hunt, Ph.D.; Lynne Kotranski, Ph.D.; Clyde McCoy, Ph.D.; Josette Mondanaro, M.D.; Harvey Musikoff, Ph.D.; Richard Needle, Ph.D.; Fen Rhodes, Ph.D.; Rafaela Robles, Ed.D.; Roy Ross; Bruce Rounsaville, M.D.; Jean Schensul, Ph.D.; Vernon Shorty; Harvey Siegal, Ph.D.; Merrill Singer, Ph.D.; Frederick Snyder, Ph.D.; Barbara Sowder, Ph.D.; Richard Stephens, Ph.D.; Sally Stevens, Ph.D.; Kenneth Vogtsberger, M.D.; Judith Walton; Deena Watson, M. S.; Wayne Wiebel, Ph.D.; Mark Williams, Ph.D.; Robert Wood, M.D.     

Low awareness of cardiovascular disease risk among low-income African-American women

Focus groups were conducted with low-income African-American women in six different community settings in Northern California to assess their awareness of and concern for cardiovascular disease (CVD). These women had low awareness of the prevalence of CVD, attributed CVD to stress and low socioeconomic status, saw the media as an important source of health-related knowledge, and saw a need for more community awareness on CVD among African-American people.     

Comparative analysis of breast cancer risk factors among African-American women and White women

The authors assessed risk factor profiles among 1,505 African-American and 1,809 White women in the 1993-2001 Carolina Breast Cancer Study. Multiple logistic regression models for case-control data were used to estimate odds ratios for several factors. Racial differences were observed in the prevalence of many breast cancer risk factors among both younger (aged 20-49 years) and older (aged 50-74 years) women. For older women, the magnitude and direction of associations were generally similar for African-American and White women, but important racial differences were observed among younger women. In particular, multiparity was associated with increased risk of breast cancer among younger African-American women (for three or four pregnancies: adjusted odds ratio (OR) = 1.5, 95% confidence interval (CI): 0.9, 2.6; for five or more pregnancies: OR = 1.4, 95% CI: 0.6, 3.1) but not among younger White women (for three or four pregnancies: OR = 0.7, 95% CI: 0.4, 1.2; for five or more pregnancies: OR = 0.8, 95% CI: 0.2, 3.0). The relations with age at first full-term pregnancy and nulliparity also varied by race. Case-only analyses before and after further adjustment for tumor stage and hormone receptor status revealed little effect on results. Hence, racial variations in both prevalences of and risks associated with particular factors may contribute to the higher incidence of breast cancer among younger African-American women.     

Hair relaxer use and risk of uterine leiomyomata in African-American women

Hair relaxers are used by millions of black women, possibly exposing them to various chemicals through scalp lesions and burns. In the Black Women's Health Study, the authors assessed hair relaxer use in relation to uterine leiomyomata incidence. In 1997, participants reported on hair relaxer use (age at first use, frequency, duration, number of burns, and type of formulation). From 1997 to 2009, 23,580 premenopausal women were followed for incident uterine leiomyomata. Multivariable Cox regression was used to estimate incidence rate ratios and 95% confidence intervals. During 199,991 person-years, 7,146 cases of uterine leiomyomata were reported as confirmed by ultrasound (n = 4,630) or surgery (n = 2,516). The incidence rate ratio comparing ever with never use of relaxers was 1.17 (95% confidence interval (CI): 1.06, 1.30). Positive trends were observed for frequency of use (P(trend) < 0.001), duration of use (P(trend) = 0.015), and number of burns (P(trend) < 0.001). Among long-term users (≥10 years), the incidence rate ratios for frequency of use categories 3-4, 5-6, and ≥7 versus 1-2 times/year were 1.04 (95% CI: 0.92, 1.19), 1.12 (95% CI: 0.99, 1.27), and 1.15 (95% CI: 1.01, 1.31), respectively (P(trend) = 0.002). Risk was unrelated to age at first use or type of formulation. These findings raise the hypothesis that hair relaxer use increases uterine leiomyomata risk.     

Coping Skills Among African-American Breast Cancer Survivors

Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.     

Identifying risk factors for disparities in breast cancer mortality among African-American and Hispanic women

BackgroundThis study evaluated the risk factors associated with racial disparities in female breast cancer mortality for African-American and Hispanic women at the census tract level in Texas from 1995 to 2005.MethodsData on female breast cancer cases were obtained from the Texas Cancer Registry. Socioeconomic and demographic data were collected from Census 2000. Network distance and driving times to mammography facilities were estimated using Geographic Information System techniques. Demographic, poverty and spatial accessibility factors were constructed using principal component analysis. Logistic regression models were developed to predict the census tracts with significant racial disparities in breast cancer mortality based on racial disparities in late-stage diagnosis and structured factors from the principal component analysis.ResultsLate-stage diagnosis, poverty factors, and demographic factors were found to be significant predictors of a census tract showing significant racial disparities in breast cancer mortality. Census tracts with higher poverty status were more likely to display significant racial disparities in breast cancer mortality for both African Americans (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.95–3.04) and Hispanics (OR, 5.30; 95% CI, 4.26–6.59). Spatial accessibility was not a consistent predictor of racial disparities in breast cancer mortality for African-American and Hispanic women.ConclusionPhysical access to mammography facilities does not necessarily reflect a greater utilization of mammogram screening, possibly owing to financial constraints. Therefore, a metric measuring access to health care facilities is needed to capture all aspects of access to preventive care. Despite easier physical access to mammography facilities in metropolitan areas, great resources and efforts should also be devoted to these areas where racial disparities in breast cancer mortality are often found.     

Osteoporosis and African-American women

African-American women are missing from the list of risk factors for osteoporosis although over 300,000 currently have osteoporosis. Possible bone structure differences such as greater peak bone mass, a slower rate of bone loss after menopause, and better quality of bone microarchitecture in African-American women have not been supported by research. Approaches such as calcium intake, hormone replacement therapy, and medications which prevent and treat osteoporosis need to be undertaken.     

Patterns of blood donations among individuals at risk for AIDS, 1984.

Of 978 respondents to an anonymous questionnaire targeted to reach homosexuals in Boston during October 1984, 88 (9 per cent) reported recent blood donation. When compared to non-recent donors, high-risk respondents who were recent blood donors were younger, less open about their sexual preference, and more likely to obtain their information about AIDS (acquired immunodeficiency syndrome) from television and newspapers. These results suggest that particular subgroups of the population at risk for AIDS would benefit from expanded educational programs.     

女女性接触者/群体及艾滋病相关危险行为

女女性接触者(women who have sex with women,WSW)直译为“与女性有性行为的女性”,与之对应的是男男性接触者(men who have sex with men,MSM)。这两个概念是人们对HIV/AIDS的认识发展到一定程度后产生的,所指皆为一个由多样亚人群所组成的人群,与MSM群体“包括了一部分男同性恋者,但不能代替男同性恋者”一样,WSW群体以     

Use of electric bedding devices and risk of breast cancer in African-American women

In this case-control study, the authors aimed to examine whether use of an electric bedding device increased breast cancer risk in African-American women. Cases were 304 African-American patients diagnosed with breast cancer during 1995-1998 who were aged 20-64 years and lived in one of three Tennessee counties. Controls were 305 African-American women without breast cancer who were selected through random digit dialing and frequency-matched to cases by age and county. Information on the use of an electric blanket or heated water bed and other risk factors was collected through telephone interviews. Breast cancer risk associated with use of an electric bedding device increased with the number of years of use, the number of seasons of use, and the length of time of use during sleep. When women who used an electric bedding device for more than 6 months per year (and therefore were more likely to have used a heated water bed, which generates lower magnetic fields) were excluded, the corresponding dose-response relations were more striking. Similar trends in dose response were shown in both premenopausal and postmenopausal women and for both estrogen receptor-positive and estrogen receptor-negative tumors. The use of electric bedding devices may increase breast cancer risk in African-American women aged 20-64 years. Such an association might not vary substantially by menopausal status or estrogen receptor status.     

Assessment of global coronary heart disease risk in overweight and obese African-American women

OBJECTIVE: To examine, with the use of national guidelines, coronary heart disease (CHD) risk with increasing BMI for primary prevention in urban African-American women. RESEARCH METHODS AND PROCEDURES: Participants were recruited for CHD risk factor screening from 20 churches as part of a larger study of nutrition and fitness (Project Joy). All participants had a demographic, smoking and medical history assessment, and the following measurements were taken: weight, height, waist circumference, blood pressure, lipid levels, and glucose. Three methods of defining risk, the Framingham Point Scoring System, a count of risk factors, and the presence of the multiple metabolic syndrome, based on the National Cholesterol Education Program Adult Treatment Panel III Report and BMI classes established by the Clinical Guidelines, were used. RESULTS: A total of 396 women were eligible. Participants were 40 to 80 years of age and had marked excess prevalence of overweight and obesity (84%); 55% were obese. There was a linear increase in risk factors as BMI increased. Lipids did not differ significantly among BMI classifications. Seventeen percent of women had multiple metabolic syndrome. Eight percent and 16% of women in the normal and overweight BMI classes, respectively, had two or more modifiable risk factors. There was no difference in number of modifiable risk factors among the obese classes. The Framingham Point Scoring System assigned a <10% risk of a hard CHD event in 10 years to 97% of the women. DISCUSSION: National risk assessment guidelines for primary prevention of CHD may not be adequate for overweight and obese urban African-American women and require further study.     

Event-related potentials in women at risk for alcoholism

Event-related potentials (ERPs) elicited during information processing tasks are useful for assessing brain function. Abstinent male alcoholics exhibit deficits in ERPs. The present study found that female alcoholics with early onset alcoholism (18.3 ± 1.3 years) showed significant deficits in P300 amplitude relative to both high-risk and low-risk controls. Two interpretations of these findings are possible. P300 amplitude reduction among the alcoholic women might be a neuropathological consequence of excessive drinking. Alternatively, lower amplitude of the P300 wave may be a marker for alcoholism risk segregating within high-risk families and associated with development of alcoholism. The later interpretation is favored based on the unlikely possibility that the nonalcoholic high-risk women would later convert to alcoholic status due to their age (mean age of 35.6 ± 1.6 years).