Women's health (Hillsdale, N.J.)最新文献

Serious questions have been raised about the common practice of relying on self-report measures to assess the relation between subjective role experiences on the one hand and both mental and physical health symptoms on the other. Such self-report measures may reflect a common underlying dimension of negative affectivity (NA), thereby leading to spurious results. In this article, we present findings from analyses in which we estimate, using a hierarchical linear model, the relation between subjective experiences in job and marital roles and self-reports of symptoms of psychological distress after controlling for NA in a sample of 300 full-time employed men and women in married couples. Results demonstrate (a) that NA can account for a great deal of the variation in self-reported psychological distress, as much as half in the case of the men in the sample; (b) that estimates of the relations between a self-reported predictor of social-role quality (e.g., marital-role quality, job-role quality) may be biased by failure to include NA as a predictor of self-reported psychological distress; (c) that the degree of bias in these estimates is dependent on the nature of the predictor, and (d) that the role of NA as a confounder does not appear to be dependent on gender.

This study examined attitudes of African American women toward medical care and health insurance. Data were analyzed from the National Medical Expenditure Survey, a large household survey conducted by the Agency for Health Care Policy and Research and focusing on insurance and health care utilization. The responses of African American women tended neither to downplay the importance of receiving health care as essential to health maintenance and recovery from illness, nor to minimize health insurance as a worthwhile investment. When African American women did give responses discounting the importance of health care, the attitude difference failed to account for race-related differences in utilization. There was no evidence in the data to indicate that attitudes lead African American women to neglect seeking medical care or acquiring health insurance, and solutions to the problem of medical care underutilization must be sought elsewhere.

Non-insulin-dependent diabetes mellitus is a serious metabolic disorder that affects an estimated 16 million Americans. Among African American women, diabetes has reached epidemic proportions, with 1 in 4 black women 55 years and older having diabetes. It is only within the last decade that diabetes research has begun to examine racial differences in the etiology, treatment, and long-term complications of diabetes. This review bring together the research that focuses on African American women within the context of diabetes research in the general population. Particular emphasis is placed on diabetes risk factors, complications of diabetes, and pharmacologic and nonpharmacologic treatment approaches. Diabetes prevention and public health issues related to diabetes and the African American women are discussed. The literature reviewed points to the importance of screening and early detection of diabetes among high-risk African American women, as well as the need for improved quality of care and patient educational services and programs in diabetes appropriate to the needs of African American women.

In this article we briefly review data on the poor state of Black women's health and then analyze the nature of research on their health in health psychology and behavioral medicine. We demonstrate that health psychology and behavioral medicine not only exclude Black women as participants in empirical studies, but also fail to thoroughly investigate the problems that are most prevalent among and accountable for the poor health of Black women. We conclude that this special issue devoted to Black women's health is crucial and long overdue.

Cancer mortality rates are greater for African Americans than for whites. Reasons for this are due in part to the disproportionate number of the poor who are African American. Of particular concern are breast, cervical, and colorectal cancer, as screening exams, when used regularly, can reduce mortality. As part of an National Cancer Institute-funded study to improve breast and cervical cancer screening among low-income, predominately African American women, a survey was done to collect data on knowledge, attitudes, and practices related to breast, cervical, and colorectal cancer. A total of 300 women, African American and white residents of low-income housing communities, completed the survey. More African American women than white women had a mammogram within guidelines (52% vs. 40%), a clinical breast exam within the last year (60% vs. 56%), a Pap smear within the last 3 years (80% vs. 59%), and a Fecal Occult Blood Test within the last year (21% vs. 17%). Slightly more white women had a flexible sigmoidoscopy (FS) exam within the last 5 years (31% vs. 24%). When adjusted for age differences in the two populations, the differences in receiving regular screening exams were not statistically significant. Variables related to receiving these tests for all women included receiving regular check-ups (breast cancer); beliefs (breast and colorectal cancer screening), and knowledge (cervical cancer). Among African American women, barriers to screening were important for breast screening and regular checkups were related to Pap smear screening (odds ratio [OR] = 13.9, p < .01). High perceived risk of colorectal cancer was related to recent FS only for white women (OR = 47.9, p = .012). Women in this homogenous income group had similar rates of screening and had similar barriers to receiving recommended screening tests; thus, interventions should address beliefs and knowledge of risk targeted to all low-income women.

After reviewing the literature on health effects of intimate violence, we report secondary analyses of responses of 439 black women who participated in the Commonwealth Fund's national survey on women's health. Lower income women were more likely to experience partner violence but not childhood abuse; and income group was related to self-esteem, depressive symptoms, and perceived health status. Childhood physical and sexual abuse and partner violence were intercorrelated; both abuse history and partner violence were related to greater risk for depressive symptoms, lower life satisfaction, and lower perceived health care quality. Partner violence was also related to lower self-esteem and perceived health status. Sexually abused women had more difficulties in interpersonal relationships, including lower perceived health care quality even with self-esteem and depressive symptoms controlled. Implications for prevention, training, and future research as well as methodological issues in research on violence against black women are discussed.

This article reviews data concerning the prevalence, causes, and consequences of obesity among African American women. It shows that approximately 50% of adult African American women are considered obese by prevailing standards. Moreover, this prevalence appears to be increasing. Obesity has an important influence on the development of a variety of morbidities among African American women. The effect of obesity on longevity among African American women is less clear. The reasons for the very high prevalence of obesity among African American women are unknown. Data supporting various putative genetic, physiological, and psychosocial influences are discussed.

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.

African American women are less likely than white women to receive and perform adequate breast screening, and represent a group that has not been thoroughly researched in the area of breast cancer risk. In general, perceptions of risk and worry about cancer are both related to obtaining mammography and possibly other screening activities. We examine African American women's worry and beliefs about breast cancer, and their intentions to perform breast and genetic screening behaviors, using the self-regulatory model. Participants were recruited via media announcements; they completed questionnaires addressing several aspects of the self-regulatory model. Forty-one percent of participants were underestimators, 23% were overestimators, and 37% were extreme overestimators of their own personal risk for breast cancer. Several variables were significant predictors of willingness to undergo mammography and genetic screening, including ethnic identity, attitudes toward the physician, emotional distress, and risk overestimation. These data highlight the importance of psychological variables in understanding screening in African American women and hold promise for intervention design.

The preponderance of studies on Black women's health cited in the eight articles of this special issue were published in medical and public health journals, rather than in health psychology journals. Health psychology stands conspicuously apart from other health disciplines in this neglect and exclusion of Blacks and Black women. On the other hand, although there are many studies of Black women's health published in medical and public health journals, these studies have neglected a variety of important cultural and social-contextual variables, and often are methodologically inadequate. Hence, we conclude that studies on Black women's health that examine neglected variables and employ rigorous methods are needed in health psychology, behavioral medicine, and the other health disciplines as well. Specific variables and hypotheses that might be addressed in such future research are highlighted.