Racial differences in obesity risk knowledge among low-income reproductive-age women

Public Awareness of Obesity and Risk of Pelvic Floor Disorders: A Cohort Study

IMPORTANCE

Obesity is a risk factor for pelvic floor disorders (PFDs), but limited information exists about the public awareness of this association.

OBJECTIVE

Our primary objective was to assess awareness of the association between obesity and PFDs, comparing 2 cohorts of women with body mass index (BMI) <30 versus BMI ≥30.

STUDY DESIGN

We conducted a cross-sectional, survey-based cohort study. The survey included questions about demographics, height and weight self-assessment, and the risk of PFDs with obesity. Our primary outcome was the rate of women correctly identifying that obesity increases the risk of PFDs.

RESULTS

Of 377 eligible participants 272 (72.1%) completed the survey, with 266 analyzed. Of these, 159 (59.8%) had a BMI <30 and 107 (40.2%) had a BMI ≥30. Comparing the cohorts, the lower BMI cohort was older (mean age of 54.4 ± 18.3 vs 48.4 ± 17.5 years, P = 0.008) and had higher rates of graduate/professional school (35.2% vs 19.6%, P = 0.04). Both groups had similarly high rates of PFDs. There was no difference in identifying obesity as a risk factor for PFDs, although the lower BMI group was less likely to identify the implications of weight loss on urinary incontinence (UI) (27.7% vs 45.8%, P = 0.002). Controlling for potential confounders, obesity remained positively associated with knowledge about the implications of weight loss on UI (odds ratio, 2.5; 95% confidence interval, 1.5-4.4).

CONCLUSIONS

Few women identified the increased risk of PFDs with obesity. Obese women may have increased awareness of the implications of weight loss on UI.

Obesity Risk Knowledge, Weight Misperception, and Diet and Health-Related Attitudes among Women Intending to Become Pregnant

OBJECTIVE

Our aim was to evaluate obesity risk knowledge, weight misperception, and diet and health-related attitudes among women intending to become pregnant compared to those not intending to become pregnant.

DESIGN

We conducted a cross-sectional survey of health behaviors, including obesity risk knowledge, weight misperception, and diet and health-related attitudes among women (aged 16 to 40 years) attending reproductive health clinics in southeast Texas. Data were collected through self-administered questionnaires and chart review. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and obesity risk knowledge, weight misperception, and health-related attitudes after adjusting for age, race, income, and gravidity.

RESULTS

Overall, 1,726 women completed the survey, of which 1,420 responded to a question on pregnancy intention. Of these, 126 stated they were intending to become pregnant. Obesity risk knowledge (adjusted odds ratio=1.14; 95% confidence interval [CI] 0.74 to 1.77) and weight misperception (adjusted odds ratio=1.17; 95% CI 0.75 to 1.83) did not differ between women intending and not intending to become pregnant. In addition, diet and health-related attitudes did not differ between these two groups (P>0.05 for all). Among women intending to become pregnant, 51% had low obesity risk knowledge and 31% misperceived their body weight. Further, 76% of these women felt confused about what constitutes a healthy diet, although 47% believed that their current diet was healthy and saw no reason to change their current eating patterns. While weight misperception did not differ significantly between the two groups, overweight women intending to become pregnant were more likely to misperceive their weight than obese women intending to become pregnant (71% vs 10%; P<0.001).

CONCLUSIONS

There is a need for improved preconception counseling, especially for women intending to become pregnant, regarding the risks associated with being overweight or obese, misperception of body weight, and negative diet and health-related attitudes.

Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices

Background

Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not.

Methods

To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies.

Results

A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported.

Conclusion

Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.