Women's Health Research Progress, Pitfalls, and Promise (2010) / Chapter Skim
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2 Research on Determinants of Women's Health
2 Research on Determinants of Women's Health
Pages 35-94
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From page 35... ...
, but in general, biologic and physiologic, or "downstream," determinants of health are identified as modifiable through complex pathways by proximal determinants (such as drugs, surgical interventions, and health behaviors) and "upstream" determinants (such as social and economic policies)
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From page 36... ...
aSocial conditions include economic inequality, urbanization, mobility, cultural values, and attitudes and policies related to discrimination and intolerance on the basis of race, sex, and other differences. Although race is an individual characteristic, its influence on health is strongly influenced by the social context of race.
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From page 37... ...
. This section discusses research on behavioral factors that are major contributors to morbidity and mortality among women: smoking, eating habits and physical activity, sexual risk behavior, and alcohol use.
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Diabetes High dietary trans fatty acids Respiratory Low intake of fruits and vegetables Other NCDs Alcohol use Low PUFA (in place of SFA) Injury FIGURE 2-2 Deaths in women attributable to total effects of individual risk factors, by disease.
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From page 39... ...
As is true for the US population as a whole, tobacco use is the leading cause of preventable death in women. Smoking substantially increases women's risk of a number of cardiovascular outcomes, including coronary heart disease and stroke (Bermudez et al., 2002; Kawachi et al., 1993; Stampfer et al., 2000)
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. Weight gain is associated with smoking cessation (Caan et al., 1996; Flegal et al., 1995)
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. Eating Habits and Physical Activity The prevalence of obesity, defined as a body-mass index (BMI)
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Whereas prior evidence came largely from studies of men, several large US cohort stud ies of women -- such as the Nurses' Health Study, the Women's Health Initiative (see Box 2-1 for a brief description) , the Women's Health Study, and the Black Women's Health Study -- have resulted in a vast literature on the roles of eating habits and physical activity in women's health (Hu et al., 2001; Martinez et al., 1997)
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and Mexican-American women (about 42%) are more likely to be obese than non-Hispanic white women (about 32%)
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Prevalence estimates are age-adjusted to the 2000 US Figure 2-3.eps standard population. Age-adjusted percentage of adults 20 years old or older who were obese during 2003–2006 varied by race or ethnicity in women and ranged from 53.3% bitmap of non-Hispanic black women to 41.8% of Mexican American women and 31.6% of non-Hispanic white women.
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From page 45... ...
. White women and those with more education and income, who generally have more resources and flexibility, are more likely to engage in leisure activities, whereas other groups of women are more likely to be classified as physically active when occupational activity, household activity, and walking for transportation are considered as physical activities (Brownson et al., 2000; Eyler et al., 2002; Sternfeld et al., 1999; Young and Cochrane, 2004)
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From page 46... ...
.11 Relative costs of healthy and unhealthy foods and cultural differences in food choices and methods of food preparation may also play some role in differences in diet quality in populations of women. Research involving Latina women has found that acculturation into mainstream culture in the United States is associated with a degradation of diet 9 Consumption of fruits and vegetables is associated with lower risk of numerous chronic diseases, including some cancers and cardiovascular disease.
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From page 47... ...
. For example, the Nurses Health Study showed the health benefits of brisk walking, including an association between walking briskly for 3 or more hours per week and a reduced risk of coronary heart disease (Manson et al., 1999)
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. Accumulation of fat in either may reduce the image and esteem of a girl or woman in her own mind as well as among her peers: this situation may oc cur in girls and women more than boys and men (Crocker, 1999; Wing et al., 12 For example, overweight and obesity are clearly associated with an increased risk of many can cers, including cancers of the breast in postmenopausal women, colon cancer, endometrial cancer, adenocarcinoma of the esophagus, and renal cancer.
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From page 49... ...
. Research on Interventions Evidence of the effectiveness of interventions to increase physical activity and improve eating habits in women and girls comes largely from studies that have targeted these behaviors, often in concert, as a means of reducing or man aging weight or reducing the risk of diabetes, cardiovascular disease, and other health outcomes (Bayne-Smith et al., 2004; Pate et al., 2005)
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From page 50... ...
A review of 32 studies of nutrition-counseling and physical-activity interventions to reduce the risk of cardiovascular disease in women found that, overall, interventions administered in health-care settings tended to produce modest but statistically significant effects on physical activity or exercise, dietary fat, weight loss, blood pressure, and serum cholesterol (Wilcox et al., 2001)
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. Sexual Risk Behaviors Sexual risk behaviors increase the chances of adverse outcomes associated with sexual contact, including sexually transmitted infections (STIs)
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Research on Sexual Risk Behavior and Protective Factors Rates of STIs and unintended pregnancy in those who are sexually active are highest in adolescence and young adults in their early 20s (Finer and Henshaw, 2006)
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Most have been implemented in schools, and most have used a comprehensive approach that addresses avoidance of pregnancy and STIs through abstinence and through the use of condoms and other forms of contraception. Although some interventions are ineffective, studies have indicated strongly that well-designed comprehensive interventions generally reduce sexual risk behaviors and do not increase sexual activity (Kirby, 2007)
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. At their most effective, the curriculum-based interventions appear to reduce adolescent sexual risk-taking (Kirby et al., 2007)
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. On the basis of risk-factor research, such organizations as the National Campaign to Prevent Teen and Unplanned Pregnancy have produced evidence-based materials outlining how programs to reduce sexual risk behaviors can better reach high-risk populations, such as black and Hispanic individuals and communities (The National Campaign to Prevent Teen Pregnancy, 2010)
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From page 56... ...
and behavioral determinants that affect women's health, social and community factors affect health as well, and they modify responses to other determinants. This section discusses some of those factors -- exposure to violence, stress and social connections, social disadvantage, and environmental factors.
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. Women who experience violence have higher rates of later arthritis, asthma, heart disease, gynecological problems, and risk factors for HIV or sexually transmitted diseases and have lower self-rated health than those who do not experience violence (Campbell et al., 2002; HHS, 2008b)
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. In the clinical arena, effective HIV-prevention programs that include attention to how intimate-partner violence and dating violence affect HIV risk are
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. In the last 20 years, more has been learned about the effects of repeated exposure to stress and specifically to the chronic stress associated with social disadvantage (McEwen and Gianaros, 2010; Seeman et al., 2009)
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. A substantial literature shows that socially isolated people are at increased risk for death from multiple causes (Berkman and Syme, 1979; Friedmann et al., 2006)
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The probability of engaging in high-risk behaviors decreased monotonically as social connections increased (Berkman and Glass, 2000)
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Although there is substantial documentation of the association between greater social connection and health, no successful interventions have been developed to improve health by strengthening social ties. Social Disadvantage There are multiple reasons why groups are relegated to more disadvantaged positions in society, and those positions have health consequences.
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From page 63... ...
. Cultural factors may affect men and women differently; for example, US-born Mexican Americans have much higher rates of substance abuse than Mexican-born Mexican Americans and the differences are greater in women than in men (Lara et al., 2005; Vega et al., 1998)
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. Those findings are consistent with research that showed a stronger association of SES with cardiovascular disease in women than in men (Diez Roux et al., 2007)
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Cultural Factors Transmitted from generation to generation, culture is defined in many ways, but is generally considered a distinguishing set of characteristics of a population
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Cultural norms may determine whether women engage in employment outside the home, the circumstances under which caregiving is undertaken, how women respond to domestic violence, and the nature and type of social support given and received. Cultural norms also affect health decisions from prevention to treatments and may influence choices regarding sexual risk behaviors, contracep tion, and the acceptability of the HPV vaccine.
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From page 67... ...
Given the increasing ethnic diversity in the US population, understanding cultural factors and their relation ship to specific health outcomes remains an ongoing challenge. Health Care Prior IOM reports have summarized the adverse health consequences of poor health care, and these are not reiterated here (IOM, 2001b, 2002b,c, 2003, 2004b, 2009b)
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From page 68... ...
. Medicaid covers many services that are important to women, paying for two-fifths of births in the United States, nearly two-thirds of all publicly funded family-planning services, a wide array of preventive screening services without copayments, and long-term care (Kaiser Family Foundation, 2007)
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. For example, a larger share of women than of men have a usual source of care, which is linked to timely receipt of preventive services (DeVoe et al., 2003)
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Data are presented for women-specific condi tions, including two dimensions of treatment for breast cancer21 and receipt of first-trimester prenatal care. In addition, a subset of sex-specific data is presented for a few indicators that are relevant to both sexes.
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. CONCLUSIONS • There is substantial evidence of the role of individual behavior (for example, smoking, eating habits and physical activity, sexual risk behaviors, and al cohol use)
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American Journal of Psychiatry 165(3)
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2004. Improve ments in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: The path program.
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2005. Socioeconomic status in health research: One size does not fit all.
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American Journal of Preentie Medicine 23(4)
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American Journal of Clinical Nutrition 87(5)
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1997. Neighborhood environments and coronary heart disease: A multilevel analysis.
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2007. Mari tal status, marital strain, and risk of coronary heart disease or total mortality: The Framingham Offspring Study.
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2000. Social and contextual etiology of coronary heart disease in women.
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2001. Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity.
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2008b. Adverse health conditions and health risk behaviors associated with intimate partner violence -- United States, 2005.
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2010. Alcohol intake and risk of coronary heart disease in younger, middle-aged, and older adults.
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1993. Socioeconomic factors and cardiovascular disease: A review of the literature.
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1998. Environmental risk factors and female breast cancer.
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1999. A prospective study of walking as compared with vigor ous exercise in the prevention of coronary heart disease in women.
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2009. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease.
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American Journal of Public Health 92(11)
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American Journal of Public Health 95(9)
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American Journal of Epidemiology 120(8)
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2004. Dating violence and associated sexual risk and pregnancy among adolescent girls in the United States.
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1986. Body fat distribution and hyperinsulinemia as risk factors for diabetes and cardiovascular disease.
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2002. A path model of chronic stress, the metabolic syndrome, and coronary heart disease.
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2008. The joint effects of physical activity and body mass index on coronary heart disease risk in women.
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1996. Breast cancer and environmental risk factors: Epidemiological and experimental findings.
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