Mental health status among rural women of reproductive age: findings from the Central Pennsylvania Women's Health Study

Objectives. We sought to examine variables associated with mental health among rural women of reproductive age, with particular attention given to rural area type and farm residence.Methods. We analyzed data from the Central Pennsylvania Women’s Health Study, which included a random-digit-dialed survey of women aged 18 to 45 years. Hierarchical multiple linear and logistic regression models were estimated to predict 3 mental health outcomes: score on a mental health measure, depressive symptoms, and diagnosed depression or anxiety.Results. Mental health outcomes were associated with different factors. Farm residence was associated with higher mental health score, and the most isolated rural residence was associated with less diagnosed depression or anxiety. Elevated psychosocial stress was consistently significant across all models. A key stress modifier, self-esteem, was also consistently significant across models. Other variables associated with 2 of the outcomes were intimate partner violence exposure and affectionate social support.Conclusions. Farm residence may be protective of general mental health for women of reproductive age, and residence in isolated rural areas may decrease access to mental health screening and treatment, resulting in fewer diagnoses of depression or anxiety.Research on the mental health of rural women in the United States is sparse.1 Although some aspects of rural life—such as a slower pace and smaller, more tight-knit communities—are thought to be conducive to mental health, other aspects of rural life are stressful, especially for women. For example, women in rural areas may have fewer opportunities to participate in paid employment, may have restricted social contacts, or may have less access to social services and health care compared with women in more urbanized areas. In this study, we examined the variables associated with the mental health status of rural women of reproductive age, for whom mental morbidity could be important both for their own health and for the well-being of their children and families.Although rural areas vary with respect to population size, sociodemographic composition, cultural context, and socioeconomic factors, several generalizations can be made. First, because rural residents are disproportionately poor,2 rural women are likely to experience numerous stressors related to mental health problems. These stressors include economic deprivation, lack of job benefits such as health insurance, and social isolation in the smallest rural communities. Other aspects of small rural communities that might affect women’s mental health include the reinforcement of traditional gender roles, which can result in limiting women’s participation in employment or higher education and in creating barriers to women’s access to shelters or other social services for victims of intimate partner violence.3Some literature suggests that farm residents are at higher risk for health and mental health problems compared with nonfarm residents. Although some of these studies focus on the risk of suicide and farm-related injuries among men, it is noteworthy that many women who reside on farms are involved in farm work to some degree, and all women who reside on farms are involved in caregiving of family members engaged in farm work. The mental health risks to women of living on a farm and direct involvement in farming might include stressors such as the economic uncertainty of farming, low levels of job demand and control, lack of external recognition for their work, fatigue, emotional and social isolation, and the trauma associated with injuries and functional impairments.3^–5Although some studies have suggested that rural residence generally is not associated with higher levels of mental health problems compared with urban residence, with the exception of suicide among males,2^,6^,7 depression prevalence has been found to be slightly higher among residents of rural areas compared with residents of urban areas.8 Studies also showed that women consistently report higher levels of mental distress compared with men, regardless of place of residence. Also, to the extent that rural women, compared with urban women, have higher rates of some chronic conditions, such as obesity, and more limitations of activity caused by chronic conditions,2 they might be expected to experience greater levels of comorbid depression. A better understanding of the determinants of rural women’s mental health problems is needed to identify appropriate targets for interventions.Furthermore, because rural areas are often medically underserved, access to screening and treatment services for mental health problems is lower in rural areas, reducing the likelihood of diagnosis and receipt of needed care.9^–12 In particular, rural areas compared with urban areas have less availability of specialty mental health services, including mental health providers such as psychiatrists, child psychiatrists, and psychologists as well as inpatient psychiatric services.13Little research has focused on women’s mental health in various types of rural communities, comparing isolated areas with more populous rural areas. In this study, we examined 3 mental health outcomes among rural women of reproductive age living in these types of communities, with a focus on aspects of psychosocial stress and potential stress modifiers. Psychosocial stressors included acute or chronic demands or challenges as appraised by women, such as living in poverty or being exposed to domestic violence or discrimination on the basis of race/ethnicity or gender, which may affect their mental health and functioning. Stress modifiers included factors that have been found in previous research to buffer or exacerbate the individual’s response to stress, including religiousness or spirituality,14 self-esteem,15 and social support.16 We examined the following 3 research questions: (1) What are the correlates of mental health status among rural women of reproductive age? (2) Do modifiers of psychosocial stress, including religiousness, self-esteem, and social support, alter the effects of other predictors on mental health outcomes? (3) Does the type of rural residential setting or residence on a farm affect women’s mental health status after we controlled for other variables?On the basis of findings from previous mental health research, we hypothesized that rural women’s mental health status would be adversely affected by psychosocial stressors. We also expected that stress modifiers would reduce the effect of these stressors on mental health outcomes. In view of rural women’s potentially reduced access to social, economic, and health care resources, as well as the limited literature linking farm residence to mental health problems among rural men, we hypothesized that residing in more isolated rural settings and on farms would be associated with less optimal mental health outcomes among women in our sample.     

Intake of Lutein and Zeaxanthin Differ with Age, Sex, and Ethnicity

Lutein and zeaxanthin are carotenoids that are selectively taken up into the macula of the eye, where they may protect against development of age-related macular degeneration. Accurate assessment of their intakes is important in the understanding of their individual roles in eye health. Current dietary databases lack the appropriate information to ascertain valid dietary intakes of these individual nutrients. The purpose of this research is to determine intakes of lutein and zeaxanthin separately in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The top major food sources for lutein and zeaxanthin intake in NHANES 2003-2004 were analyzed for lutein and zeaxanthin by high-performance liquid chromatography from June to August 2006. Results were applied to dietary data from 8,525 participants in NHANES 2003-2004. Lutein and zeaxanthin food contents were separated into lutein and zeaxanthin in the nutrient database. Mean intakes from two nonconsecutive 24-hour recalls were grouped into food groups based on nutrient composition; these were matched to the new database, and lutein and zeaxanthin intakes were calculated separately. Among all age groups, both sexes, and all ethnicities, intakes of lutein were greater than of zeaxanthin. Relative intake of zeaxanthin to lutein decreased with age, with zeaxanthin to lutein ratios lower in females. Zeaxanthin to lutein ratios in Mexican Americans was considerably greater than other ethnicities (other Hispanics, non-Hispanic white, non-Hispanic black, other races). Lower zeaxanthin to lutein ratios were measured in groups at risk for age-related macular degeneration (eg, older participants, females). Our findings suggest that the relative intake of lutein and zeaxanthin may be important to age-related macular degeneration risk. Future studies are needed to assess the individual associations of lutein and zeaxanthin in eye health.     

Promoting Physical Activity Among Youth Through Community-Based Prevention Marketing

BACKGROUND: Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9–13 years of age) called VERB™ Summer Scorecard. Based on the national VERB™ media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS: The VERB™ Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS: The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS: Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.     

School Vending Machine Purchasing Behavior: Results From the 2005 YouthStyles Survey

BACKGROUND: Competitive foods are often available in school vending machines. Providing youth with access to school vending machines, and thus competitive foods, is of concern, considering the continued high prevalence of childhood obesity: competitive foods tend to be energy dense and nutrient poor and can contribute to increased energy intake in children and adolescents. METHODS: To evaluate the relationship between school vending machine purchasing behavior and school vending machine access and individual-level dietary characteristics, we used population-level YouthStyles 2005 survey data to compare nutrition-related policy and behavioral characteristics by the number of weekly vending machine purchases made by public school children and adolescents (N = 869). Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed using age- and race/ethnicity-adjusted logistic regression models that were weighted on age and sex of child, annual household income, head of household age, and race/ethnicity of the adult in study. Data were collected in 2005 and analyzed in 2008. RESULTS: Compared to participants who did not purchase from a vending machine, participants who purchased ≥3 days/week were more likely to (1) have unrestricted access to a school vending machine (OR = 1.71; 95% CI = 1.13–2.59); (2) consume regular soda and chocolate candy ≥1 time/day (OR = 3.21; 95% CI = 1.87–5.51 and OR = 2.71; 95% CI = 1.34–5.46, respectively); and (3) purchase pizza or fried foods from a school cafeteria ≥1 day/week (OR = 5.05; 95% CI = 3.10–8.22). CONCLUSIONS: Future studies are needed to establish the contribution that the school-nutrition environment makes on overall youth dietary intake behavior, paying special attention to health disparities between whites and nonwhites.     

Effectiveness of a Lifestyle Intervention Program Among Persons at High Risk for Cardiovascular Disease and Diabetes in a Rural Community

Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community. Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (N = 101). Participants set targets to reduce fat intake and increase physical activity (≥150 mins/week) in order to achieve a 7% weight loss goal. Findings: Eighty-three percent (n = 84) of participants completed the 16-session core program and 65 (64%) participated in 1 or more after-core sessions. Of those completing the core program, the mean participation was 14.4 ± 1.6 and 3.9 ± 1.6 sessions during the core and after core, respectively. Sixty-five percent of participants met the 150-min-per-week physical activity goal during the core program. Sixty-two percent achieved the 7% weight loss goal and 78% achieved at least a 5% weight loss during the core program. The average weight loss per participant was 7.5 kg (range, 0 to 19.7 kg), which was 7.5% of initial body weight. At the last recorded weight in the after core, 52% of participants had met the 7% weight loss goal and 66% had achieved at least a 5% weight loss. Conclusion: Our findings suggest that it is feasible to implement a group-based DPP in a rural community and achieve weight loss and physical goals that are comparable to those achieved in the DPP.     

Providing appropriate services to individuals in the community: a preliminary case-mix for model allocating personal care services

Personal care services are often provided to clients in community settings through highly discretionary processes. Such processes provide little guidance for caseworkers concerning how public resources should be allocated. The results of such processes almost guarantee that individuals with very similar needs will receive very different levels of care resources. Such disparities in treatment open the door to inequity and ineffectiveness. One way to address this problem is through case-mix classification systems that allocate hours of care according to client needs. This paper outlines the preliminary steps taken by one state in its movement toward such a system.