Racial/ethnic variations in women's health: the social embeddedness of health

Exploring the Interplay of Social Safety Nets, Race, Ethnicity, and Nativity on Psychological Distress Among Low-Income Mothers

Low-income mothers face numerous challenges that increase their vulnerability to psychological distress. Their perceived or actual difficulty in accessing vital support networks, whether public or private, can significantly amplify this distress. Socially assigned identities, such as nativity, ethnicity, and race, intersect with socioeconomic factors, influencing mental health outcomes. Using data from the Future of Families and Child Wellbeing Study, our research investigated the impact of public and private safety nets on maternal psychological health. We found that, even after accounting for socioeconomic factors, non-Hispanic, US-born White mothers experienced higher levels of psychological distress compared to minoritized mothers. The role of safety nets varied by race and ethnicity, with private safety nets providing unique protection to Black and Hispanic mothers, while support was associated with increased distress only among White mothers. These findings highlight the need to consider sociocultural history when assessing safety net impacts on mental health.

Community emergency medical services approaches to fall prevention: a systematic review

BACKGROUND

Falls are a leading cause of morbidity and mortality among older adults in the USA. Current approaches to fall prevention often rely on referral by primary care providers or enrolment during inpatient admissions. Community emergency medical services (CEMS) present a unique opportunity to rapidly identify older adults at risk for falls and provide fall prevention interventions in the home. In this systematic review, we seek to assess the efficacy and qualitative factors determining success of these programs.

METHODS

Studies reporting the outcomes of fall prevention interventions delivered by EMS were identified by searching the electronic databases PubMed, Embase, Web of Science Core Collection, CINAHL and the Cochrane Central Register of Controlled Trials through 11 July 2023.

RESULTS

35 studies including randomised and non-randomised experimental trials, systematic reviews and qualitative research primarily from Western Europe, the USA, Australia and Canada were included in our analysis. Current fall prevention efforts focus heavily on postfall referral of at-risk community members. CEMS fall prevention interventions reduced all-cause and fall-related emergency department encounters, subsequent falls and EMS calls for lift assist. These interventions also improved patient health-related quality of life, independence with activities of daily living, and secondary health outcomes.

CONCLUSIONS

CEMS programmes provide an opportunity for direct, proactive fall prevention on the individual level. Addressing barriers to implementation in the context of current emergency medical systems in the USA is the next step toward widespread implementation of these novel fall prevention interventions.

Mind, body, and spirit: a constructivist grounded theory study of wellness among middle-class Black women

Previous studies show that Black women in the United States experience disproportionately poorer health outcomes compared to women of other racial/ethnic groups. Recently the focus is on improving the health of Black women in the United States. However, there is little empirical evidence on what Black women need to improve their health to be well. The goal of this constructivist grounded theory was to increase the understanding of wellness among middle-class Black women (N = 30) in a large Midwestern city in the United States through an intersectional lens. The findings show that the connection and balance between mind, body, and spirit was the core experience of wellness among middle-class Black women. Mind, body, and spirit was described in three ways-(a) mentally managing, (b) physically caring for my body, and (c) connecting spiritually-with the women also noting the barriers and facilitators they endured to be well. Each of these categories highlight the tension middle-class Black women experience with trying to be well. Implications for future practice and research with middle-class Black women are discussed.

The Role of Infant Health Problems in Constraining Interneighborhood Mobility: Implications for Citywide Employment Networks

Infant health problems are a persistent concern across the United States, disproportionally affecting socioeconomically vulnerable communities. We investigate how inequalities in infant health contribute to differences in interneighborhood commuting mobility and shape neighborhoods' embeddedness in the citywide structure of employment networks in Chicago over a 14-year period. We use the Census Bureau's Longitudinal Employer-Household Dynamics' Origin-Destination Employment Statistics to analyze commuting networks between 2002 and 2015. Results from longitudinal network analyses indicate two main patterns. First, after the Great Recession, a community's infant health problems began to significantly predict isolation from the citywide employment network. Second, pairwise dissimilarity in infant health problems predicts a lower likelihood of mobility ties between communities throughout the entire study period. The findings suggest that infant health problems present a fundamental barrier for communities in equally accessing the full range of jobs and opportunities across the city-compounding existing inequalities.

Associations between household income and disordered eating differ across sex and racial identity in a population-based sample of adults

BACKGROUND

Most research on socioeconomic status (SES) and eating disorders (EDs) has focused on young White women. Consequently, little is known regarding how SES may relate to EDs/disordered eating in older adults, men, or people with different racial identities. We examined whether associations between SES and EDs/disordered eating differed across age, sex, and racial identity in a large, population-based sample spanning early-to-later adulthood.

METHODS

Analyses included 2797 women and 2781 men ages 18-65 (Mage  = 37.41, SD = 7.38) from the population-based Michigan State University Twin Registry. We first examined associations between SES and dimensional ED symptoms, binge eating (BE), and self-reported ED diagnoses across age and sex in the full sample. We then examined the impact of racial identity on associations by conducting within- and between-group analyses among Black and White participants.

RESULTS

In the full sample, lower SES was associated with significantly greater odds of BE and lifetime EDs in men, but not women, across adulthood. The association between lower SES and greater BE risk was stronger for Black men than for White men, though significant in both groups. Conversely, Black women showed a positive association between SES and dimensional ED symptoms that significantly differed from effects for Black men and White women.

CONCLUSIONS

Associations between socioeconomic disadvantage and EDs/disordered eating may be particularly robust for men in adulthood, especially men with a marginalized racial identity. Oppositely, Black women may encounter social pressures and minority stress in higher SES environments that could contribute to somewhat heightened ED risk.

PUBLIC SIGNIFICANCE

Little is known regarding how associations between socioeconomic status (SES) and eating disorders (EDs) may differ across age/sex or racial identity. We found lower SES was associated with greater odds of a lifetime ED or binge eating in men only, with a particularly strong association between lower SES and binge eating for Black men. Results highlight the importance of examining how SES-ED associations may differ across other aspects of identity.

The influence of racial-ethnic discrimination on women's health care outcomes: A mixed methods systematic review

BACKGROUND

In the U.S, a wide body of evidence has documented significant racial-ethnic disparities in women's health, and growing attention has focused on discrimination in health care as an underlying cause. Yet, there are knowledge gaps on how experiences of racial-ethnic health care discrimination across the life course influence the health of women of color. Our objective was to summarize existing literature on the impact of racial-ethnic health care discrimination on health care outcomes for women of color to examine multiple health care areas encountered across the life course.

METHODS

We systematically searched three databases and conducted study screening, data extraction, and quality assessment. We included quantitative and qualitative peer-reviewed literature on racial-ethnic health care discrimination towards women of color, focusing on studies that measured patient-perceived discrimination or differential treatment resulting from implicit provider bias. Results were summarized through narrative synthesis.

RESULTS

In total, 84 articles were included spanning different health care domains, such as perinatal and cancer care. Qualitative studies demonstrated the existence of racial-ethnic discrimination across care domains. Most quantitative studies reported a mix of positive and null associations between discrimination and adverse health care outcomes, with variation by the type of health care outcome. For instance, over three-quarters of the studies exploring associations between discrimination/bias and health care-related behaviors or beliefs found significant associations, whereas around two-thirds of the studies on clinical interventions found no significant associations.

CONCLUSIONS

This review shows substantial evidence on the existence of racial-ethnic discrimination in health care and its impact on women of color in the U.S. However, the evidence on how this phenomenon influences health care outcomes varies in strength by the type of outcome investigated. High-quality, targeted research using validated measures that is grounded in theoretical frameworks on racism is needed. This systematic review was registered [PROSPERO ID: CRD42018105448].

An Intersectional Approach to Understanding Barriers to Healthcare for Women

Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.

Does overruling Roe discriminate against women (of colour)?

On 24 July 2022, the landmark decision Roe v. Wade (1973), that secured a right to abortion for decades, was overruled by the US Supreme Court. The Court decision in Dobbs v. Jackson Women's Health Organisation severely restricts access to legal abortion care in the USA, since it will give the states the power to ban abortion. It has been claimed that overruling Roe will have disproportionate impacts on women of color and that restricting access to abortion contributes to or amounts to structural racism. In this paper, we consider whether restricting abortion access as a consequence of overruling Roe could be understood as discrimination against women of color (and women in general). We argue that banning abortion is indirectly discriminatory against women of color and directly (but neither indirectly, nor structurally) discriminatory against women in general.

Women's Health: Population Patterns and Social Determinants

Women's health, and what we know about it, are influenced by social factors. From the exclusion of women's bodies in medical research, to the silence and stigma of menstruation and menopause, to the racism reflected in maternal mortality, the relevance of social factors is paramount. After a brief history of research on women's health, we review selected patterns, trends, and inequalities in US women's health. These patterns reveal US women's poor and declining longevity relative to those in other high-income countries, gaps in knowledge about painful and debilitating conditions that affect millions of women, and deep inequalities that underscore the need to redress political and structural features of US society that enhance health for some and diminish it for others. We close by describing the challenges and opportunities for future research, and the promise of a social determinants of health approach for advancing a multilevel, intersectional, and biosocial understanding of women's health.

Take the Day Off: Examining the Sick Role for Chronic Back Pain by Race and Gender

Research has largely overlooked the public’s willingness to validate entrance to the sick role for individuals experiencing chronic pain. To fill this gap, we conducted a survey experiment to assess how race, gender, and their intersection impact (1) the legitimation of missing work due to pain and (2) recommendations for help seeking, examining the role of both respondents and vignette characters. We find that respondent characteristics are associated with perceived acceptability of missing work due to pain, and both respondent and vignette characteristics are associated with help-seeking endorsements. White females are least likely to view pain as an acceptable excuse to miss work but are most likely to endorse help-seeking measures, while black women are recommended the most treatments for pain. We theorize how results provide evidence to counter assumptions of objectivity and linearity of the sick role and how gender and race influence the social response to pain.

Comparing different operationalizations of allostatic load measured in mid-life and their patterning by race and cumulative life course socioeconomic status

Since its conceptualization, there has been a lack of consensus on the best way to operationalize allostatic load (AL). As a marker of the cumulative, physiological wear and tear on the body resulting from chronic exposure to stressors, it follows that AL should be higher among people who have faced more stressful life experiences. Thus, the purpose of this study was to construct AL scores using different operationalizations and, as a measure of construct validity, compare whether each construction produced expected disparities in AL by race and a composite socioeconomic status (SES) variable which accounts for measures over the life course; we also explored differences by sex. We conducted the study in a sample of 45-52-year-old offspring from the Child Health and Development Studies, a longitudinal birth cohort established in the early 1960s. AL scores were constructed in 6 different ways and included 10 biomarkers from inflammatory, neuroendocrine, cardiovascular, and metabolic systems. Our main approach to constructing AL was to sum across high-risk biomarker quartiles, correct for medication use, and use sex-specific high-risk quartiles for specific biomarkers. Alternative constructions did not use sex-specific quartiles and/or weighted biomarkers within subsystems and/or did not correct for medication use. We estimated differences in AL scores by race, SES, sex and their pairwise interactions. All constructions of AL, including the main approach, produced expected disparities by race (higher scores for Black vs. non-Black participants) and life course SES (higher scores for low vs. high SES participants). However, disparities by sex only emerged when the AL score was constructed via approaches that did not use sex-specific high-risk quartiles; for these alternative constructions, overall, female participants had higher AL scores than male participants and Black female participants had the highest AL scores in the sample. For most constructions, the pairwise interaction between sex and SES, showed a stronger disparity in AL scores between low and high-SES female compared with low- and high-SES male participants; this suggests that, in terms of lowering AL, high life course SES may be more important for female than male participants. In conclusion, our results suggest that the basic AL concept is consistently expressed in different operationalizations, making it an especially useful and robust tool for understanding disparities by race and SES.

The Political Realignment of Health: How Partisan Power Shaped Infant Health in the United States, 1915-2017

The US two-party system was transformed in the 1960s when the Democratic Party abandoned its Jim Crow protectionism to incorporate the policy agenda fostered by the civil rights movement, and the Republican Party redirected its platform toward socioeconomic and racial conservatism. The authors argue that the policy agendas promoted by the two parties through presidents and state legislatures codify a racially patterned access to resources and power detrimental to the health of all. To test the hypothesis that fluctuations in overall and race-specific infant mortality rates (IMRs) shift between the parties in power before and after the political realignment (PR), the authors apply panel data analysis methods to state-level data from the National Center for Health Statistics for the period 1915 through 2017. Net of trend, overall, and race-specific IMRs were not statistically different between presidential parties before the PR. This pattern, however, changed after the PR, with Republican administrations consistently underperforming Democratic ones. Net of trend, non-Southern state legislatures controlled by Republicans underperform Democratic ones in overall and racial IMRs in both periods.

Long-Term Mortality in Women With Pregnancy Loss and Modification by Race/Ethnicity

Pregnancy loss is a common reproductive complication, but its association with long-term mortality and whether this varies by maternal race/ethnicity is not well understood. Data from a racially diverse cohort of pregnant women enrolled in the Collaborative Perinatal Project (CPP) from 1959 to 1966 were used for this study. CPP records were linked to the National Death Index and the Social Security Death Master File to identify deaths and underlying cause (until 2016). Pregnancy loss comprised self-reported losses, including abortions, stillbirths, and ectopic pregnancies. Among 48,188 women (46.0% White, 45.8% Black, 8.2% other race/ethnicity), 25.6% reported at least 1 pregnancy loss and 39% died. Pregnancy loss was associated with a higher absolute risk of all-cause mortality (risk difference, 4.0 per 100 women, 95% confidence interval: 1.4, 6.5) and cardiovascular mortality (risk difference, 2.2 per 100 women, 95% confidence interval: 0.8, 3.5). Stratified by race/ethnicity, a higher risk of mortality persisted in White, but not Black, women. Women with recurrent losses are at increased risk of death, both overall and across all race/ethnicity groups. Pregnancy loss is associated with death; however, it does not confer an excess risk above the observed baseline risk in Black women. These findings support the need to assess reproductive history as part of routine screening in women.

The MI-PHOTOS Project: Understanding the Health and Wellbeing of Rural Historically Marginalized Mothers Through Photovoice

Despite the persistent health inequities faced by rural women in the United States, few researchers have partnered with women in rural communities to co-create sustainable change. To fill this gap, Mothers Improving Pregnancy and Postpartum Health Outcomes Through stOry Sharing (MI-PHOTOS) employed a community-based participatory research (CBPR) approach by partnering with mothers, community leaders, and community-based organizations in Robeson County, North Carolina, a rural, racially diverse county. The project's aims were (a) to promote maternal health by listening to mothers' stories of having and raising children in their community and (b) to develop a shared understanding of these mothers' strengths and challenges. MI-PHOTOS utilized photovoice, an exploratory and qualitative CBPR methodology. Grounded theory guided data analysis. During photovoice discussions, conversation focused on maternal experiences and evoked strengths, facilitators, and barriers impacting maternal health. Themes focused on (a) MI-PHOTOS serving as a social support group for the community and family stressors that mothers faced and (b) the necessity of professional support programs. Three overarching findings emerged during this process: (a) MI-PHOTOS as an informal support group, (b) mental health stigmatization, and (c) the need to bridge home visiting programs with peer and confidential therapeutic services. Future work should incorporate mothers' and communities' strengths into program development by drawing on existing home visiting programs, identifying opportunities for peer-support, and creating referral networks for individual, confidential therapeutic services. Through continued community partnership, we can generate fuller understandings of mothers' experiences of having and raising children and ultimately promote health equity among rural mothers.

Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action

Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

Race/ethnicity, gender and the SES gradient in BMI: The diminishing returns of SES for racial/ethnic minorities

Using the 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES), this study uses the case of obesity to examine whether and to what extent racial and ethnic minorities experience fewer benefits from higher SES relative to their white counterparts. Study results provide support for the diminishing returns in health hypothesis and add an intersectional dimension to this perspective by uncovering stark gendered racial/ethnic disparities in BMI. Specifically, research findings demonstrate that higher income and education is associated with lower BMI among white but not black or Mexican American adults. The most substantial decrease in BMI associated with increase in individual-level SES was observed among white women. Taken together, empirical evidence from this study underscores difficulty in overcoming adverse health effects of lower ascribed status (i.e. gender or race/ethnicity) even with attainment of higher achieved social status (i.e. educational attainment or income) and offers promising avenues for future research on identifying complex hierarchies that shape population health outcomes.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

‘Mind Your Business and Leave My Rolls Alone’: A Case Study of Fat Black Women Runners’ Decolonial Resistance

The Black female body has been vilified, surveilled, and viewed as ‘obese’ and irresponsible for centuries in Western societies. For just as long, some Black women have resisted their mischaracterizations. Instead they have embraced a ‘fat’ identity. But little research has demonstrated how Black fat women participate in sport. The purpose of this study is to show how Black fat women who run use social media to unapologetically celebrate Blackness and fatness. This research uses a case-study approach to illuminate a broader phenomenon of decolonial resistance through running. In addition to analysis of websites, blogs, and news articles devoted to Black women’s running, we discuss the (social) media content of two specific runners: Mirna Valerio and Latoya Shauntay Snell. We performed a critical discourse analysis on 14 media offerings from the two runners, including websites, Twitter pages, and blogs collected over a five-month period from September 2020–January 2021. The analysis examined how they represent themselves and their communities and how they comment on issues of anti-fat bias, neoliberal capitalism, ableist sexism, and white supremacy, some of the pillars of colonialism. Whereas running is often positioned as a weight-loss-focused and white-dominated colonial project, through their very presence and use of strategic communication to amplify their experiences and build community, these runners show how being a Black fat female athlete is an act of decolonial resistance. This study offers a unique sporting example of how fat women challenge obesity discourses and cultural invisibility and how Black athletes communicate anti-racist, decolonial principles.

Food Security Characteristics Vary for Undergraduate and Graduate Students at a Midwest University

The study objective was to determine prevalence of food insecurity and its associations with socioecological model (SEM) characteristics for undergraduate and graduate students. An online questionnaire was distributed to a convenience sample of students aged 18-34 at a Midwestern university. Of the 938 responses, 675 were complete for analysis. Outcome measures included demographics, food security level, housing, food access barriers, coping strategies, and food assistance program usage. Results found that predictors associated with undergraduate food insecurity included non-White race, receipt of financial aid, lower self-reported health status, living off-campus, employment, and food cost (p < 0.001). Graduate student food insecurity was associated with Asian self-identification, employment, food cost, no time to prepare foods, and lack of foods for dietary needs (p < 0.001). Students with food insecurity were more likely to buy cheap food (p < 0.001). Almost 50% of food-insecure undergraduates asked friends or family to help buy food. Food-insecure students were more likely to want information on meal preparation and budgeting. More graduate students were likely to know of and use food pantries. Overall, food insecurity was higher among undergraduate than graduate students. Universities should consider institutional and policy changes tailored to the separate populations to mitigate the prevalence of campus food insecurity.

Neighborhood archetypes and breast cancer survival in California

PURPOSE

Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival.

METHODS

Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included.  The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity.

RESULTS

California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity.

CONCLUSIONS

By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.

Integrating Surveillance Data to Estimate Race/Ethnicity-specific Hysterectomy Inequalities Among Reproductive-aged Women: Who's at Risk?

BACKGROUND

Inequalities by race and ethnicity in hysterectomy for noncancerous conditions suggest that some subgroups may be shouldering an unfair burden of procedure-associated negative health impacts. We aimed to estimate race- and ethnicity-specific rates in contemporary hysterectomy incidence that address three challenges in the literature: exclusion of outpatient procedures, no hysterectomy prevalence adjustment, and paucity of non-White and non-Black estimates.

METHODS

We used surveillance data capturing all inpatient and outpatient hysterectomy procedures performed in North Carolina from 2011 to 2014 (N = 30,429). Integrating data from the Behavior Risk Factor Surveillance System and US Census population estimates, we calculated prevalence-corrected hysterectomy incidence rates and differences by race and ethnicity.

RESULTS

Prevalence-corrected estimates show that non-Hispanic (nH) Blacks (62, 95% confidence interval [CI] = 61, 63) and nH American Indians (85, 95% CI = 79, 93) per 10,000 person-years (PY) had higher rates, compared with nH Whites (45 [95% CI = 45, 46] per 10,000 PY), while Hispanic (20, 95% CI = 20, 21) and nH Asian/Pacific Islander rates (8, 95% CI = 8.0, 8.2) per 10,000 PY were lower than nH Whites.

CONCLUSION

Through strategic surveillance data use and application of bias correction methods, we demonstrate wide differences in hysterectomy incidence by race and ethnicity. See video abstract at, http://links.lww.com/EDE/B657.

Does maternal race or ethnicity modify the association between maternal psychiatric disorders and preterm birth?

PURPOSE

Preterm birth risk has been linked to maternal racial and ethnic background, particularly African American heritage; however, the association of maternal race and ethnicity with psychiatric disorders and preterm birth has received relatively limited attention.

METHODS

The Consortium on Safe Labor (2002-2008) is a nationwide U.S. cohort study with 223,394 singleton pregnancies. Clinical data were obtained from electronic medical records, including maternal diagnoses of psychiatric disorders. Relative risk (RR) and 95% confidence intervals (CI) were estimated for the association between maternal psychiatric disorders and preterm birth (<37 completed weeks) using log-binomial regression with generalized estimating equations. The interaction effect of maternal psychiatric disorders with race and ethnicity was also evaluated.

RESULTS

Non-Hispanic White (RR, 1.42; 95% CI, 1.35-1.49), Hispanic (RR, 1.44; 95% CI, 1.29-1.60), and non-Hispanic Black (RR, 1.21, 95% CI, 1.13-1.29) women with any psychiatric disorder were at increased risk for delivering preterm infants, compared with women without any psychiatric disorder. However, non-Hispanic Black women with any psychiatric disorder, depression, bipolar disorder, and schizophrenia had a significantly lower increase in preterm birth risk than non-Hispanic White women.

CONCLUSIONS

Despite the significant association between maternal psychiatric disorders and preterm birth risk, psychiatric disorders did not appear to contribute to racial and ethnic disparities in preterm birth.

Beliefs Associated with Intention to Use PrEP Among Cisgender U.S. Women at Elevated HIV Risk

Women comprise 19% of those newly diagnosed with HIV in the U.S. There is a wide gap between recommended use of pre-exposure prophylaxis (PrEP) and actual uptake among women who are eligible for PrEP. In order to identify women's beliefs and intentions about starting PrEP, a survey, informed by the reasoned action approach, was administered to 160 cisgender PrEP-eligible women, age 18-55, in Philadelphia and New York City. The mean age was 40.2 years (SD = 11.78), 44% had completed high school, 75% were unemployed, and 85% experienced financial instability in the past 3 months. Multivariate linear regression analyses identified sets of behavioral and normative beliefs associated with intention to start PrEP in the next 3 months. Behavioral beliefs reflected views about PrEP benefits such as preventing HIV, and normative beliefs reflected perceptions of support or lack thereof from others including partners, friends, mother, and children. These findings can be used to inform interventions to foster greater PrEP uptake among women.

Gendered tri-racial stratification and health disparities

Despite extensive evidence confirming racial and gender health disparities, little research considers how race theory might aid in understanding these patterns. Using the Collaborative Psychiatric Epidemiology Surveys (CPES), this study fills this void by integrating two research areas-sociology of race and medical sociology-to assess the utility of Bonilla-Silva's tri-racial stratification perspective in predicting health patterns. More specifically, I address the following questions: is the tri-racial stratification thesis aligned with the health profiles of racial groups in the U.S.? Does the applicability of this perspective differ for women and men? Last, do the health patterns suggested by tri-racial stratification persist after adjusting for social factors (socioeconomic status and social support) often invoked to explain health disparities? Results indicate that the racial patterning of life-threatening conditions lend partial support for tri-racial stratification for women and men. Self-rated health findings yield counterintuitive patterns. Furthermore, social factors do not explain the majority of ethnic differences in health. Research and theoretical implications of these findings are discussed.

Income inequality and racial disparities in pregnancy-related mortality in the US

In this ecological study, we examined the associations between state-level income inequality and pregnancy-related mortality among non-Hispanic (NH) black and NH white populations across the US. We estimated total population and race-specific 5-year pregnancy-related mortality ratios in each state based on national death and live birth records from 2011 to 2015. We obtained data on Gini coefficients for income inequality and population-level characteristics from the US Census American Community Survey. Poisson regression with robust standard errors estimated pregnancy-related mortality rate ratios (RR) and 95% confidence intervals (CI) associated with a one unit increase in income inequality overall and separately within black and white populations. Adjusted linear regression models estimated the associations between income inequality and magnitude of the absolute and relative racial inequity in pregnancy-related mortality within states. Across all states, increasing contemporaneous income inequality was associated with a 15% and 5-year lagged inequality with 14% increase in pregnancy-related mortality among black women (aRR = 1.15, 95% CI = 1.05; 1.25 and aRR = 1.14, 95% CI = 1.04; 1.24, respectively) after controlling for states' racial compositions and socio-economic conditions. In addition, both lagged and contemporaneous income inequality were associated with larger absolute and relative racial inequities in pregnancy-related mortality. These findings highlight the role of contextual factors in contributing to pregnancy-related mortality among black women and the persistent racial inequity in maternal death in the US.

Gender discrimination in the United States: Experiences of women

Objective

To examine reported experiences of gender discrimination and harassment among US women.

Data Source and Study Design

Data come from a nationally representative, probability‐based telephone survey of 1596 women, conducted January‐April 2017.

Methods

We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity.

Principal Findings

Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas’ odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks’ odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non‐LGBTQ women.

Conclusions

Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.

Defining and Theorizing About Culture: The Evolution of the Cultural Determinants of Help-Seeking, Revised

BACKGROUND

The recent interest in defining and theorizing about social determinants of health has illuminated the importance of culture as a central phenomenon of interest. However, cultural processes appear in multiple places in social determinants of health models, and their specifics are not delineated or operationalized.

OBJECTIVES

This theory development article describes the complexity of defining cultural variables and uses medical anthropology to show how cultural domains, constructs, and variables can be defined.

METHODS

Using cultural anthropology theory, empirical work, and a literature synthesis as a starting point, the evolution of the cultural determinants of help-seeking theory is explored and the revision of the theory is highlighted.

RESULTS

The expanded theory include structural concepts as control variables, reframes illness as "suffering," and adds concepts of course, cure, manageability, meaning in life, functioning, social negativity, and perceived need.

DISCUSSION

Strategies for and benefits of isolating and operationalizing cultural variables for middle-range theory development and testing are discussed.

Dry Bean Preferences and Attitudes among Midwest Hispanic and Non-Hispanic White Women

Bean (Phaseolus vulgaris L.) intakes in the United States (US) lag behind dietary recommendations despite their positive nutrition profile, health benefits for reducing chronic disease risk, and inclusion in nutrition assistance programs. Low-income groups, including Hispanics, have an increased risk of cardiovascular disease, type 2 diabetes, obesity, and some cancers. Hispanic dietary quality and bean consumption may decline with increasing acculturation. Intakes at recommended levels could improve health in all vulnerable low-income populations. The study objectives were to describe dry and canned bean preferences, consumption frequency, and attitudes among low-income Hispanic and non-Hispanic white women, and to assess if these characteristics differed by ethnicity and acculturation level among the Latinas. A convenience sample of 158 women, aged 18–65 years, completed a written survey in English or Spanish at two healthcare clinics, one Special Supplemental Nutrition Program for Women, Infants and Children office, and five County Extension nutrition education and outreach programs in Iowa. Less acculturated Latinas consumed beans more often, preferred dry to canned, bought in bulk, valued color and shape in dry bean selection, and held less positive attitudes toward canned beans in contrast to bicultural/more acculturated and non-Hispanic white women. Ethnicity and acculturation level have a role in varying purchase patterns and attitudes regarding dry and canned beans. Culturally-held differences should be considered in nutrition programs and leveraged to increase consumption and improve health.

Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans

OBJECTIVE

To identify patterns of risk and resilience by the intersections of race/ethnicity and sexual orientation in mental health symptom severity, sexism, and social support among U.S. women veterans.

METHODS

A national sample of women veterans (n = 648, 38% sexual minority, 15% racial/ethnic minority) was recruited online in 2013 using social networking websites and listservs. Using cross-sectional survey data, we evaluated main and interactive associations between race/ethnicity and sexual orientation on depression, anxiety, posttraumatic stress, unhealthy alcohol use, sexism, and social support. Models were adjusted for other demographic characteristics.

RESULTS

Across depression, anxiety, and sexism, White heterosexual women reported the least distress and racial/ethnic minority heterosexual women the most distress (race/ethnicity x sexual orientation interactions p < .05). Among White women, sexual minority women reported greater levels of depression, anxiety, and sexism than heterosexual women. The effects were the opposite among racial/ethnic minority women, where heterosexual women reported similar or worse depression, anxiety, and sexism than sexual minority women. There were no race/ethnicity or sexual orientation interaction effects on posttraumatic stress symptoms or unhealthy alcohol use and marginally significant effects on social support.

CONCLUSIONS

Among women veterans, race/ethnicity and sexual orientation were associated with mental health and sexism, alone and in combination. Findings suggest that those who were both racial/ethnic and sexual minorities may develop resilience from their lived experience. On the other hand, women veterans with a minority race/ethnicity or a minority sexual orientation appeared more vulnerable to adverse outcomes and may need targeted care.

Adverse life experiences and risk of unintended pregnancy in adolescence and early adulthood: Implications for toxic stress and reproductive health

Objective

We examined the effects of adverse life experiences (ALEs) on rates of unintended first pregnancy, including differential effects by race/ethnicity and socioeconomic status, among women in a national longitudinal cohort study.

Methods

We drew upon 15-years of data from 8810 adolescent and young adult females in the National Longitudinal Study of Adolescent to Adult Health. Using 40 different ALEs reported across childhood and adolescence, we created an additive ALE index, whereby higher scores indicated greater ALE exposure. We employed Cox proportional hazard models, including models stratified by racial/ethnic and socioeconomic groups, to estimate the effects of ALEs on time to first unintended pregnancy, controlling for time-varying sociodemographic, health and reproductive covariates.

Results

Among all women, a 1-standard deviation increase in ALE scores was associated with an increased rate of unintended first pregnancy (adjusted Hazard Ratio 1.11, 95% Confidence Interval=1.04-1.17). In stratified models, associations between ALE scores and risk of unintended pregnancy varied across racial/ethnic, socioeconomic, and age groups and according to various elevated ALE thresholds. For example, the 1-standard deviation increase in ALE score indicator increased the unintended pregnancy risk for African-American (aHR=1.12, CI=1.01-1.25), Asian (aHR 1.69, CI=1.26-2.26), and White women (aHR=1.12, CI=1.03-1.22), women in the lowest ($0-$19,999; aHR=1.21, CI = 1.03-1.23) and highest (>$75,000; aHR=1.36, CI=1.12-1.66) income categories, and women aged 20-24 (aHR=1.13, CI=1.04-1.24) and >24 years (aHR 1.25, CI=1.06-1.47), but not among the other sociodemographic groups.

Conclusion

ALEs increased the risk of unintended first pregnancy overall, and different levels of exposure impacting the risk of pregnancy differently for different sub-groups of women. Our ongoing research is further investigating the role of stress-associated adversity in shaping reproductive health outcomes and disparities in the United States.

Testing the influence of cultural determinants on help-seeking theory

Despite increased risks for mental health problems, East Asian immigrant women have the lowest overall service-utilization rates of any cultural group in the United States. Although the influence of cultural processes as the cause of low service use is widely speculated, no empirical study has tested cultural determinants (including culturally specific idioms of distress, culture-based illness interpretations, or concerns about social consequences), social contextual factors, perceived need (PN), and help-seeking (HS) behaviors. In the present study, we examined how cultural determinants, such as symptom experience, beliefs and interpretations, and perceptions about the social environment, affect PN and HS type for Japanese women living in the United States. Increasing physical symptom severity increased the predicted probability of endorsing PN. For those participants with PN, 48.6% of them used medical HS (χ2 = 11.27, p = .00), and 12.5% of them used the psychological HS (χ2 = 7.43, p = .01). Multivariate logistic regression revealed that, when PN is considered with the other cultural variables while controlling for structural variables, PN increases the odds of medical HS (OR = 2.78, 95% CI [1.0-5.8], p < .01). The odds of medical HS are also increased with higher social support (OR = 1.07, 95% CI [1.0-1.1], p < .01). Finally, the presence of interpersonal stigma beliefs decreased the odds of medical HS (OR = 2.4, 95% CI [1.1-5.3], p < .03). Clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trends in cervical cancer incidence and mortality in Oklahoma and the United States, 1999-2013

BACKGROUND

The twin prevention strategies of HPV vaccination and cervical cancer screening reduce new cases and averts deaths, yet women still develop or die from cervical cancer. To assess and better understand the burden of cervical cancer in Oklahoma, we analyzed incidence and mortality trends in Oklahoma from 1999 to 2013.

METHODS

We obtained age-adjusted cervical cancer incidence and mortality rates and calculated standardized rate ratios (RR) for women in Oklahoma compared to the US. To evaluate temporal changes in annual age-adjusted incidence and mortality, we calculated the annual percent change (APC) using the Joinpoint Regression Program.

RESULTS

We observed higher age-adjusted incidence (RR: 1.2; 95% CI: 1.1, 1.3) and mortality (RR: 1.2; 95% CI: 1.1, 1.2) rates among women in Oklahoma compared to the US. The overall incidence and mortality rates in Oklahoma were 9.7 and 2.9 per 100,000 women, respectively. In Oklahoma, the highest age-adjusted incidence rates were in American Indian/Alaska Native (AI/AN) (14.8 per 100,000 females) and Asian or Pacific Islander (API) (11.7 per 100,000 females) women and the highest mortality rates were in AI/AN (4.5 per 100,000 females) and African American (AA) (3.9 per 100,000 females) women. Incidence rates decreased for AA women (APC: -4.0; 95% CI: -7.7, -0.2), but were stable for all other races and ethnicities in Oklahoma (APC: -0.8; 95% CI: -2.2, 0.7). A stable trend for mortality was observed in Oklahoma (APC: 0.1; 95% CI: -2.2, 2.5) each year.

CONCLUSION

Women in Oklahoma had a higher cervical cancer incidence and mortality rate than the US. A disproportionately higher incidence of cervical cancer among AI/AN and API women and deaths among AI/AN and AA women were observed signaling continuing racial disparities.

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

OBJECTIVE

This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).

DESIGN

This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) - the co-occurrence of physical and psychiatric health problems - are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.

RESULTS

Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to 'Psychiatric Only' health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.

CONCLUSION

These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.

Perspectives of Fear as a Barrier to Self-Management in Non-Hispanic Black Men With Type 2 Diabetes

BACKGROUND

Self-managing type 2 diabetes (T2D) is critical but often challenging for non-Hispanic Black (NHB) men. Fears may contribute to poor self-management; however, the evidence is sparse. The purpose of this study is to examine the relationship between fear and diabetes self-management in NHB men from the southern United States.

METHODS

Nineteen NHB men with T2D were recruited from barbershops and churches. Interviews were conducted using a semistructured interview guide. Transcripts were analyzed using a phenomenological approach and focused on identifying common themes describing the perceptions of fear as a barrier to self-managing T2D in the study participants.

RESULTS

More than 68% of the sample was >55 years of age, where 42% reported an annual income of ≥$100,000, 74% were married, and 26% had a college degree. Fifty-three percent expressed fear with diabetes management, while 47% reported no fears with diabetes management. Direct fears associated with self-management included the use of needles and syringes for self-monitoring and medication adherence, respectively. Indirect fears were associated with the development of adverse complications resulting in poor mental and physical quality of life. No fears were reported secondary to diabetes knowledge, perceived control, and social support.

CONCLUSIONS

In this sample of NHB men, fear was perceived by many as a direct barrier to self-management and an indirect barrier to optimal quality of life. These findings suggest the need to address the fears of NHB men when guiding treatment and developing research interventions to improve self-management skills.

Factors Influencing on Mental Health Help-seeking Behavior Among Korean Women: A Path Analysis

PURPOSE

The purpose of the study was to identify factors influencing mental health help-seeking behavior among women in the community.

METHODS

A cross-sectional design was used. Participants were 402 women in South Korea. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and a path analysis by IBM SPSS 21.0 and AMOS 21.0.

RESULTS

There was a significant, but weak positive correlation between perceived need and help-seeking intentions for formal mental health help (r=0.09, p<0.05). In the path analysis, significant the factors influencing help-seeking intentions were perceived need, attitude, and belief toward mental illness, and the attitude of them had the greatest effect. These factors accounted for 12.2% of the total variance, and the model fit was acceptable.

CONCLUSION

The findings of the study reveal that positive mental illness interpretation and consequence can predict mental health help-seeking behavior of women as well as the perceived need for mental health help.

Perceptions about Iranian-Kurds' ethnic-inequality in health

BACKGROUND

Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people's perception on inequality of health in Iranian-Kurds and its determinants.

METHODS

The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel.

RESULTS

Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization.

CONCLUSIONS

Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People's awareness, resources management and allocation are factors requiring more consideration when choosing policy options.

Semantic Examination of a Japanese Center for Epidemiologic Studies Depression: A Cautionary Analysis Using Mixed Methods

Background Cross-cultural research relies on the linguistic, conceptual, and semantic equivalence of instruments. Widely used translations of the Center for Epidemiologic Studies Depression (CESD) for cross-cultural samples should be analyzed to reaffirm conceptual and semantic equivalence. Purpose This methodological study aimed to discover and resolve problematic translations of a Japanese version of the CESD. Design Sequential explanatory mixed method design using spiraling integration. Methods Sample includes 34 first-generation Japanese women living in the US and 72 community-based women in Japan. Ethnographic analysis of the semantic meanings of items was followed by t tests to compare original and retranslated item means, as well as Cronbach's reliability and corrected item-total correlations analyses. Results Six problematic items were retranslated: bothered, failure, hope, restless sleep, happiness, and "getting going." Reliabilities for the CESD that included the new CESD item translations were the same; however, most item-scale correlations were higher for the revised translations across the two groups. Conclusions We conclude that both failure and "getting going" may be culturally bound items. Implications for cross-cultural and ethnographic nursing research include planning mini-ethnographic analysis when using translations to discover and reconcile cultural differences in connotations, motivations, and goals.

Stressful Life Events Around the Time of Unplanned Pregnancy and Women's Health: Exploratory Findings from a National Sample

Objective Little is known about how women's social context of unintended pregnancy, particularly adverse social circumstances, relates to their general health and wellbeing. We explored associations between stressful life events around the time of unintended pregnancy and physical and mental health. Methods Data are drawn from a national probability study of 1078 U.S. women aged 18-55. Our internet-based survey measured 14 different stressful life events occurring at the time of unintended pregnancy (operationalized as an additive index score), chronic disease and mental health conditions, and current health and wellbeing symptoms (standardized perceived health, depression, stress, and discrimination scales). Multivariable regression modeled relationships between stressful life events and health conditions/symptoms while controlling for sociodemographic and reproductive covariates. Results Among ever-pregnant women (N = 695), stressful life events were associated with all adverse health outcomes/symptoms in unadjusted analyses. In multivariable models, higher stressful life event scores were positively associated with chronic disease (aOR 1.21, CI 1.03-1.41) and mental health (aOR 1.42, CI 1.23-1.64) conditions, higher depression (B 0.37, CI 0.19-0.55), stress (B 0.32, CI 0.22-0.42), and discrimination (B 0.74, CI 0.45-1.04) scores, and negatively associated with ≥ very good perceived health (aOR 0.84, CI 0.73-0.97). Stressful life event effects were strongest for emotional and partner-related sub-scores. Conclusion Women with adverse social circumstances surrounding their unintended pregnancy experienced poorer health. Findings suggest that reproductive health should be considered in the broader context of women's health and wellbeing and have implications for integrated models of care that address women's family planning needs, mental and physical health, and social environments.

Survival Disparities Associated with Congenital Diaphragmatic Hernia

BACKGROUND

We assessed sociodemographic and clinical factors that are associated with survival among infants with congenital diaphragmatic hernia (CDH).

METHODS

Using data from the Metropolitan Atlanta Congenital Defects Program, we ascertained 150 infants born with CDH between 1979 and 2003 and followed via linkage with state vital records and the National Death Index. Kaplan-Meier survival probabilities and adjusted hazard ratios (HRs) were calculated for socioeconomic and clinical characteristics.

RESULTS

Survival increased from 40 to 62% over the study period. White infants born before 1988 were 2.9 times less likely to survive than those born after 1988. Black infants' survival did not show significant improvement after 1988. White infants' survival was not significantly affected by poverty, whereas black infants born in higher levels of poverty were 2.7 times less likely to survive than black infants born in lower levels of neighborhood poverty. White infants with multiple major birth defects were 2.6 times less likely to survive than those with CDH alone. The presence of multiple defects was not significantly associated with survival among black infants.

CONCLUSIONS

Survival among infants and children with CDH has improved over time among whites, but not among blacks. Poverty is associated with lower survival among blacks, but not among whites. The presence of multiple defects is associated with lower survival among whites, but not among blacks. The differential effects of poverty and race should be taken into account when studying disparities in health outcomes. Birth Defects Research 109:816-823, 2017. © 2017 Wiley Periodicals, Inc.

Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States

BACKGROUND

Although black women experienced greater cervical cancer incidence and mortality rate reduction in recent years, they continue to have higher incidence rates than whites. Great variations also exist among geographic regions of the US, with the South having both the highest incidence and mortality rates compared to other regions. The present study explores the question of whether living in the South is associated with greater racial disparity in cervical cancer incidence and mortality by examining race- and region-specific rates and the trend between 2000 and 2012.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) 18 Program data was used. Cervical cancer incidence and mortality rates, annual percent changes, and disparity ratios were calculated using SEER*Stat software and Joinpoint regression for four groups: US14-Non-Hispanic White (NHW), US14-Non-Hispanic Black (NHB), South-NHW, and South-NHB, where South included 4 registries from Georgia and Louisiana and US14 were 14 US registries except the four South registries.

RESULTS

The average age-adjusted cervical cancer incidence rate was the highest among South-NHBs (11.1) and mortality rate was the highest among US14-NHBs (5.4). In 2012, the degree of racial disparities between South-NHBs and South-NHWs was greater in terms of mortality rates (NHB:NHW = 1.80:1.35) than incidence rates (NHB:NHW = 1.45:1.15). While mortality disparity ratios decreased from 2000-2012 for US14-NHB (APC: -1.9(-2.3,-1.4), mortality disparity ratios for South-NHWs (although lower than NHBs) increased compared to US14-NHW. Incidence rates for NHBs continued to increase with increasing age, whereas rates for NHWs decreased after age 40. Mortality rates for NHBs dramatically increased at age 65 compared to a relatively stable trend for NHWs. The increasing racial disparity with increasing age in terms of cervical cancer incidence rates became more pronounced when corrected for hysterectomy prevalence.

CONCLUSIONS

Black race and South region were associated with higher cervical cancer incidence and mortality. Cervical cancer rates uncorrected for hysterectomy may underestimate regional and racial disparities. Increasing incidence rates for older NHBs compared to NHWs warrant further research to determine whether screening should continue for NHBs over age 65.

Resilience in low-income African American women living and aging with HIV

Women are living with HIV into middle and older age and are likely to face multiple comorbidities and stressors as they age. This study focused on understanding how women who experience multiple forms of oppression and ongoing adversity are still able to adapt and stand strong. Using a theoretical framework of resilience and a feminist research ideology, interviews of eight middle-aged and older African American women living with HIV were analyzed. Despite experiences of HIV-related discrimination, trauma, and violence, these women demonstrated a remarkable ability to adapt and maintain support. Implications for research and practice are discussed.

Explaining Race Differences in Health among Older Adults

Research demonstrates that race disparities in health often persist after controlling for individual socioeconomic status (SES). Yet little is known about the contribution of community socioeconomic context to race disparities in health among older adults. The authors hypothesized that Black older adults’ disadvantaged health status is partly explained by individual SES but further explained by their greater likelihood of living in more socioeconomically disadvantaged communities. The results of multilevel analyses demonstrate that living in such communities helps explain Black older adults’higher number of chronic conditions and worse self-rated health compared to non-Black older adults. Moreover, Black older adults may even have slightly better self-rated health than non-Black older adults once individual SES and community socioeconomic context are controlled. Understanding race and socioeconomic inequalities in health over the life course will require attention to the complex relationships between race, individual SES, and the socioeconomic and racial community contexts in which people interact and live their lives.

Changing conceptions of health and life course concepts

Health as a social concept is very important in medical sociology. More complicated conceptions of health as a multi-dimensional concept have emphasized not only physical health status, but aspects of overall well-being. This article continues in the tradition of a multi-dimensional concept of health, but adds in the complexity of variation over the life course. As people age, chronic health problems become more common. Mobility and sensory limitations also increase. How does this impact how people view their health? How do more complicated understandings of the life course and variation by social factors link to an expanded model of health. This literature review article covers material on concepts of health and life course concepts. The concluding portions of the article focus on the need to improve measurement, to incorporate diversity related to social factors such as gender and race, and to incorporate a broader understanding of health problems into conceptions of health across the life course.