Women's health (Hillsdale, N.J.)最新文献

There have been numerous studies demonstrating the enormous cancer burden for African American women and the impact of structural barriers in the dissemination of cancer control interventions. Few of these studies have dealt with the influence of cultural factors in the success or failure of intervention research. The purpose of this review is to provide a critical appraisal of qualitative studies that inform on social-cultural factors in cancer screening programs for African American women, and to evaluate the extent to which general methodologic criteria have been used in these studies. The article discusses the theoretical underpinnings of social science qualitative methodologies, including ethnography, hermeneutics, ethnomethodology, and symbolic interactionism. Published qualitative studies from 1980 to 1996 on cancer screening among African American women are critically reviewed. Among the themes identified were bruises as contributory to breast cancer development; the low priority women placed on personal preventive screening behaviors in the context of other family health priorities; and the importance of female friends, relatives, and social networks in the flow of cancer information. The importance of qualitative approaches to cancer prevention and control programs and policies is threefold: (a) collection of greater depth of information, (b) identification of processes and relations among behaviors, and (c) framing of variables and hypotheses for quantitative research. Greater emphasis on methodologic rigor will be necessary, however, if qualitative studies of cancer screening are to effectively inform the development of research, programs, and policies.

Personality assessed with the Minnesota Multiphasic Personality Inventory (MMPI) in college was used to predict exercise behavior measured at midlife in 3,630 men and 796 women enrolled in the University of North Carolina Alumni Heart Study. Logistic regression models were fitted for each of the MMPI clinical scales to test the predictive effect of personality, gender, and their interaction on adult exercise behavior. Lower depression, social introversion, and psychopathic deviance scores were associated with increased probability of exercising in midlife for both men and women. Furthermore, better psychological health (indexed by lower hypochondriases and psychasthenia) in college was generally predictive of increased exercise for men, whereas higher scores on these same factors predicted midlife exercise for women. There were two other patterns of gender interactions: (a) for men, lower scores on hysteria and schizophrenia scales were associated with increased probability of exercising at midlife, whereas these factors were unrelated to exercise for women and (b) for women, lower ego strength and higher college scores on paranoia and mania were associated with exercise behavior at midlife. These data suggest that early adulthood personality predictors of exercise behavior at midlife are both gender-neutral and gender-specific; that is, where no gender differences exist, healthier personality traits predict exercise at midlife, and when gender differences do occur, healthier college patterns of personality predict exercise behavior for men and sedentary behavior for women.

In this study we examined the relations among psychosocial factors associated with pregnant women's attitudes toward genetic carrier testing for cystic fibrosis (CF). A sample of 511 pregnant women attending various health clinics for general prenatal care were educated about CF. Women's health beliefs, coping styles, and attitudes toward CF carrier screening were assessed. Results from structural equation modeling analyses indicated that women who perceived themselves as more likely to be carriers of the CF gene and who perceived greater benefits of screening were positively inclined toward genetic screening. Perceived barriers to screening were negatively associated with women's attitudes toward CF genetic testing. In addition, the findings suggest that some types of avoidant coping styles may indirectly influence one's decision to undergo genetic screening through perceptions of risk, benefits, and barriers. Given the advent of genetic screening options for many diseases, in this study we address some issue in women's attitudes toward prenatal screening that are relevant to a variety of genetic screening programs.

Heart disease is the leading cause of death among women in the United States. The prognosis for heart disease is worse for women than for men. Also, although women are less likely than men to initially present with a myocardial infarction (MI), they are more likely to die following an MI. A number of factors have been identified that partially account for the gender difference in post-MI morbidity and mortality. However, limited data are available on the sex differences in clinical, psychosocial, and demographic factors that may combine to explain the poorer prognosis for women following an acute MI. The Cardiac Arrhythmia Suppression Trials collected detailed demographic, clinical, and psychosocial data on 2,043 men and 448 women following acute MIs. Analyses indicate that women had a worse clinical, socioeconomic, and psychosocial profile than did men. In addition, significant differences in psychosocial profiles persisted after controlling for demographic and clinical data, suggesting that women presenting with MIs have a cluster of complex factors that put them at high risk for morbidity and mortality following an MI. Future longitudinal studies that include adequate numbers of women as well as reliable assessments of both clinical and psychological variables are needed to better understand the factors that influence the poor prognosis for women with coronary heart disease.

This article reviews the empirical literature on women and HIV prevention and evaluates the predictive utility of prevailing models of health behavior change. The review focuses on three constructs that are central to the health belief model, protection motivation theory, and the theories of reasoned action and planned behavior: perceived vulnerability to HIV risk, outcome expectancies related to HIV preventive behaviors, and self-efficacy to reduce risk. The critical review pays particular attention to methodological and conceptual problems that may arise in applications of these models to the specific circumstances of HIV and AIDS and the specific experiences of women. Last, the ways in which these models should be adapted and expanded to adequately explain extra-individual influences on women's preventive behavior are discussed.

This study examined cardiovascular reactivity differences among hostile men and women. Sixty-four individuals (33 women 31 men; M = 19.9 years of age) were selected from a sample of 105 volunteers based on their Cook-Medley Hostility Scale scores (Cook & Medley, 1954; less than or equal to 24). Analyses revealed no significant sex differences in Cook-Medley Hostility scores. At baseline, men had higher mean systolic blood pressure (SBP) level. However, during the Stroop Color-Word Conflict Task (Stroop, 1935), high-hostile men and women exhibited similar cardiovascular responses. Further analyses revealed that cardiovascular responses to the Stroop task were differentially associated with among men and women as a function of anger suppression. For women, anger suppression was positively associated with diastolic blood pressure (DBP) responses and negatively associated with SBP responses. In contrast, anger suppression was negatively associated with DBP changes and not associated with SBP responses for men. The results suggest that personality factors, such as high hostility and anger suppression, may influence the degree to which men and women differ in their cardiovascular responses to interpersonal stressors.

Despite wide variation in the reporting of hot flashes and night sweats among menopausal women, what differentiates symptomatic from asymptomatic women is not well understood. In this article, we use longitudinal data from a large cohort of initially premenopausal women to address premenopausal factors predictive of length of the perimenopause, frequency of hot flash/night sweat (HF/NS) reporting, bothersomeness of HF/NS, and treatment seeking during menopause. The sample for analysis consists of 454 women from the Massachusetts Women's Health Study who were premenopausal at baseline and postmenopausal by the sixth and last study follow-up. Each of the four study outcomes was modeled as a function of premenopausal characteristics using logistic regression. Results confirm a wide range of symptom reporting, with 23% of women not reporting HF/NS at any of the six interviews. Variables related to greater frequency of HF/NS reporting included a longer perimenopause, more psychological and physical symptoms prior to menopause, lower education, and more negative attitudes toward menopause prior to menopause. Symptom bothersomeness was related to greater frequency of HF/NS reporting, smoking, and being divorced. Variables that predicted medical doctor consultation were greater frequency and bothersomeness of symptoms, higher education, and greater health care utilization. We conclude that general symptom reporting, attitudes toward menopause, and lifestyle factors can explain some of the individual variation in symptom reporting.

Rape victims have many emergency medical needs, yet there has been very little research examining whether victims are receiving desired assistance. In this study, 147 rape victim advocates were interviewed about their most recent case in which a victim has sought treatment in an emergency room (ER). The results of this study indicated that there is some inconsistency in which services victims receive and that many women did not obtain the resources they wanted. Some forms of assistance were not provided to victims due to lack of resources in their communities (e.g., follow-up medical care). Other services were not offered due to problems in the implementation of available services (e.g., the morning-after pill [ethinyl estradiol-norgestrel] to prevent pregnancy). This research also examined how characteristics of the hospitals, the assaults themselves, and the victims impacted whether women would receive desired help. These findings indicated that women who were treated in hospitals affiliated with the Catholic church; those who were raped by their friends, dating partners, or husbands; those who experienced multiple forms of forced penetration (vaginal rape and anal rape, oral rape, or rape by an object); women of Color; and victims who did not present a sympathetic demeanor in the ER were less likely to receive several forms of assistance, such as treatment of physical injuries, arranging follow-up medical care, information and treatment for sexually transmitted diseases, information on the risk of pregnancy, the morning-after pill, and information on the physical and psychological health effects of sexual assault. Victims who were taken to hospitals that had coordinated response teams (e.g., Sexual Assault Response Teams) to work with survivors were more likely to receive some forms of treatment (e.g., information on the physical and psychological health effects of sexual assault). Implications for future research and policy initiatives in women's health are discussed.

In this study, we examine the patterns of use of hormone replacement therapy (HRT) among women age 51 to 60 years and describe the characteristics of women who currently use HRT, previously used HRT, and have never used HRT. A brief postal survey of 800 women in this age range was used to determine HRT status. Telephone interviews were then conducted with 258 women (111 currently using HRT, 47 who previously used HRT, and 100 who had never used HRT) to determine characteristics of women who currently or previously used HRT or never used HRT, type of HRT used, duration of use, and reasons for use and nonuse. Nearly 40% of women were currently using HRT, 14% had previously used HRT, and 47% had never used HRT. Women currently using HRT were more likely than those not using HRT to have had a hysterectomy, attribute a greater number of symptoms to the climacteric, be in paid employment, and report a greater number of visits to the doctor over the past 12 months. HRT use among Australian women in their 50s is high and rising. Hysterectomy status, the attribution of symptoms to menopause, paid employment, and health care use were the most important correlates of HRT use. Few women specified long-term prevention of osteoporosis or heart disease as a reason for taking HRT.

The Transtheoretical Model has been used extensively to investigate smoking behavior. However, gender and ethnic differences in key constructs of the Transtheoretical Model have not been fully evaluated. This gap in the literature is addressed in this brief report. We examined gender and ethnic differences in stages of change (readiness to quit smoking), perceived pros (benefits) and cons (costs) of smoking, and self-efficacy (confidence) in ability to quit among smokers seeking cessation treatment. Participants were 330 smokers ages 18 to 75, who responded to advertisements for a free minimal-contact smoking cessation program. Thirty percent of women were confident they could quit smoking compared to 53% of men. Women reported more pros of smoking and more cons of smoking than men. White smokers reported more pros of smoking than African smokers. These findings highlight the need to bolster quitting confidence among women and to identify alternatives to the pros of smoking relevant to women smokers.