Placing the burden on the individual: overweight and obesity in African American and mainstream women's magazines

One third of all U.S. adult women, and more than 75% of African American women, are overweight or obese. This study examined overweight and obesity editorial content (N=406) in three mainstream and three African American women's magazines between 1984 and 2004. Content analysis was used to determine which strategies were suggested regarding diet, overweight, and obesity, which components of social cognitive theory were offered (behavior, person, or environment), and whether or not there were differences in the genres. The results suggest that although a wide range of strategies were being offered, the vast majority were behavioral changes with an individual solution focus. Although African American and mainstream magazines suggested many of the same strategies, nearly half more frequently appeared in one or the other genre. Mainstream magazines were twice as likely to offer the limiting or eliminating of fast food or junk food, eating more protein, eating lower-fat foods, and eating smaller portions. African American magazines were much more likely to cover fad diets and to suggest readers rely on God or faith in their diet plans. The average number of strategies offered per article was significantly higher in mainstream than in African American magazines.

Innocence and experience: sexuality among young people in modern France, c. 1750-1950

Prying into the sex lives of young people in the past has always proved a challenging exercise. Historians have often ended up relying on the testimony from adult observers or on the quantitative evidence provided by illegitimacy rates. This article adopts a more direct route by drawing on first-hand accounts of early sexual experiences written by French people in diaries, childhood reminiscences and autobiographies. As a preliminary, it analyses the way various authorities depicted young people as sexual (or non-sexual) beings, and the state of sex education in France before the mid-twentieth century. It then considers the way people depicted their first stirrings of sexuality during childhood and adolescence. Finally, it examines evidence from the "ego documents" on sexual relations in the run-up to marriage.

Place, health and home: gender and migration in the constitution of healthy space

This paper contributes to recent literature that considers the role of everyday activity in constructing 'healthy space', specifically exploring the tension between agency and structural processes in explanation. The focus is a comparison of two groups of migrant women in British Columbia, Canada: South Asian Sikhs from Punjab, India, and Afghan-Muslim refugees. It explores the routine practices whereby they work to create 'healthy space' as they orchestrate their families' health. Through food preparation and consumption practices, traditional healing and religious observance, the women delineate the physical, social and symbolic dimensions of healthy space. The women's narratives demonstrate the productive capacity of everyday routines in forging healthy space within the particularities of migrant settlement.

An overview and update on the metabolic syndrome: implications for identifying cardiometabolic risk among African-American women

Identifying patients with cardiovascular risks was once the simple process of recognizing the traditional risk factors. However, since the National Cholesterol Educational Program Adult Treatment Panel III guidelines were released in 2001, and again revised in 2004, identification of cardiovascular risk has become more complicated. This article provides both an overview and an update on the metabolic syndrome as a cluster of risk factors for both type 2 diabetes and cardiovascular disease (CVD). Specific issues are discussed as they relate to African-American women and their prevalence of the metabolic syndrome and cardiometabolic risk. Nurses are optimally prepared to identify the early signs of cardiometabolic risk by testing for and assessing the metabolic syndrome. Likewise, nursing is in a position to provide teaching and counsel regarding the needed lifestyle alterations for patients with metabolic syndrome in order to reduce the risk of type 2 diabetes, cardiovascular disease, and/or stroke.

Alcohol and other drug disorders, comorbidty and violence in rural African American women

African-American women report less alcohol and drug (AOD) use than Caucasian women. However, African-Americans disproportionately experience negative health and social consequences of AOD use. This is especially true for rural women, many of whom live in poverty and have debilitating co-morbid psychiatric disorders that go undiagnosed and treated. It is imperative that health professionals be knowledgeable about AOD use, co-morbid disorders, and how to screen for them. This manuscript is focused on examining rural African American women (n = 142) with and without AOD disorders on the following variables: drugs of abuse, Axis I psychiatric disorder, and adult and childhood victimization.

Self-Care Process as Experienced by Middle-Aged Thai Women

My purpose in this study was to explore the process of self-care actions in promoting health among middle-aged Thai women. Data were obtained from in-depth recorded interviews with 15 middle-aged Thai women living in Bangkok. Findings showed that the process of self-care actions for achieving health among middle-aged Thai women moved through a series of five stages: (1) perceiving health status, (2) developing awareness of the importance of one's own health, (3) finding motivation for self-care, (4) taking control for self-care, and (5) evaluating the consequences of self-care activities. I conclude that the process of self-care actions originated from women's internal demands and the formulation of self-care action is intertwined with women's values, beliefs, and way of life. Specific guidance about self-care and encouragement from nurses are meaningful for women to effectively perform self-care actions resulting in the promotion of long-term wellness in the later years of life.

Literature review: Afghanistan women's health crisis, health service delivery, and ethical issues for international aid

The literature indicates that the health of women in Afghanistan is poor. In 1997 maternal mortality in Afghanistan was one of the worst in the world. Difficulties in establishing health services revolve around fundamentalist Islamic ideas and ongoing violence within Afghanistan. The literature holds advice on key behaviours for health professionals who may chose to work in Afghanistan. The literature also identifies the local level action that is occurring as the issue of women's health is recognised. Humanitarian assistance has been provided, with international aid agencies having to weigh the ethical responsibilities they hold and one agency tragically facing the violent loss of its own staff. Easy answers are not in the literature, merely an opportunity to understand, consider, and take action about what is facing women in Afghanistan and those who try to help.

Older women's attitudes, behavior, and communication about sex and HIV: a community-based study

OBJECTIVES

To examine the effects of race and marriage on the sexual attitudes, behavior, and patient-physician communication about sexuality and HIV/AIDS among older women.

METHODS

This was a cross-sectional survey of 55 community-residing women aged 58-93.

RESULTS

57% of respondents had engaged in sexual activity since the 60th birthday. Nearly 60% of single women who had been sexually active in the previous 10 years reported that they had not used a condom; 21% of women with a current sexual partner agreed that condom use is not necessary "if you can no longer get pregnant." African American women were significantly more likely to report making changes in their sexual behavior due to HIV (53% vs. 19% white, p = 0.02). Married and African American women were more likely to discuss sex with a physician (80% vs. 47%; p = 0.03 and 75% vs. 46%, p = 0.05, respectively). African Americans were more likely to have had a physician initiate such a discussion (69% vs. 38%, p = 0.04).

CONCLUSIONS

Older women in this sample were sexually active, engaged in potentially risky sexual behavior, and believed that physicians should address issues of sexuality. Older African American women were significantly more likely than white women to report HIV-related changes in their behavior and to discuss sex with a physician. This community-based study corroborates clinical research and suggests both a gap and a disparity in older women's dialogue with physicians. It also indicates the need for more broadly generalizable data on issues pertinent to older women's sexual health.

Intimate partner violence against women in eastern Uganda: implications for HIV prevention

Background

We were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT).

Methods

The study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study.

Results

During November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1–0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1–0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2–16.2) and the husband having another partner (OR 2.4, 95% CI 1.02–5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5–5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence.

Conclusion

Intimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.

Cookin' Up Health: developing a nutrition intervention for a rural Appalachian population

Cookin' Up Health is a culturally targeted and individualized tailored nutrition intervention using a computer-based interactive format. Using a cooking show theme, the program demonstrates step-by-step meal preparation emphasizing healthy selection and portion control. Focus groups were conducted with women in two rural counties in West Virginia to guide the development of the intervention. Women felt more susceptible to heart disease because the changing role of women creates more stress and less time; weight loss was a greater motivator for dietary change than was preventing heart disease; social support is a barrier and facilitator for dietary change; cultural heritage and the way women were raised were major barriers to making health changes as adults; convenience and the cost of eating healthier were major factors when trying to make changes in diet; and women did not feel confident in their ability to maintain dietary changes.

Predictors of quality of life among women with coronary heart disease

BACKGROUND

Health-related quality of life (HRQOL) is an increasingly relevant outcome as the population ages and associated morbidities increase. The purpose of this study was to evaluate predictors of HRQOL among ethnically diverse women hospitalized for coronary heart disease (CHD) and determine the impact of a brief, educational intervention on HRQOL 6 months post-hospitalization.

METHODS

Women (n = 160; mean age 63 years, 53% minority) admitted for CHD at three academic hospitals who completed a 6 month secondary prevention trial were studied. The SF-36 was administered at admission and 6 months. Multiple linear regressions were used to identify significant independent predictors of 6 month HRQOL.

RESULTS

Significant improvements in HRQOL were noted from admission to 6 months post-hospitalization. Subjects reporting better HRQOL at 6 months included those who were employed, married, physically active, enrolled in cardiac rehabilitation, and not depressed. Women who received an educational intervention had significantly less bodily pain at 6 months compared with usual care in a model adjusted for baseline HRQOL and physical activity goal adherence (p = 0.04).

CONCLUSIONS

Baseline HRQOL (8 SF-36 subscales), physical activity (3 SF-36 subscales) and marital status (1 SF-36 subscale) were the major determinants of HRQOL at 6 months post-hospitalization. Future interventions and preventive efforts should be targeted to women with CHD who have impaired HRQOL and may be at increased risk of poor clinical outcomes.

Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China

BACKGROUND

'Sitting month' is a Chinese tradition for women's postpartum custom. The present study aims to explore the postpartum dietary and health practices of puerperal women and identify their influential factors in three selected regions of Hubei, China.

METHODS

A cross-sectional retrospective study was conducted in the selected urban, suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of 2100 women who had given birth to full-term singleton infants in the past two years were selected as the participants. Data regarding postpartum practices and potentially related factors were collected through questionnaire by trained investigators.

RESULTS

During the puerperium, 18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still popular among the participants. About half of the women didn't get out of the bed two days after giving birth. The average time they stayed in bed during this period was 18.0 h. One third of them didn't have any outdoor activities in that time periods. The educational background of both women and their spouses, location of their residence, family income, postnatal visit, nutrition and health care educational courses were found to be the influencing factors of women's postpartum practices.

CONCLUSION

Traditional postpartum dietary and health behaviours were still popular among women in Hubei. Identifying the factors associated with traditional postpartum practices is critical to develop better targeting health education programs. Updated Information regarding postpartum dietary and health practices should be disseminated to women.

Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China

BACKGROUND

'Sitting month' is a Chinese tradition for women's postpartum custom. The present study aims to explore the postpartum dietary and health practices of puerperal women and identify their influential factors in three selected regions of Hubei, China.

METHODS

A cross-sectional retrospective study was conducted in the selected urban, suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of 2100 women who had given birth to full-term singleton infants in the past two years were selected as the participants. Data regarding postpartum practices and potentially related factors were collected through questionnaire by trained investigators.

RESULTS

During the puerperium, 18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still popular among the participants. About half of the women didn't get out of the bed two days after giving birth. The average time they stayed in bed during this period was 18.0 h. One third of them didn't have any outdoor activities in that time periods. The educational background of both women and their spouses, location of their residence, family income, postnatal visit, nutrition and health care educational courses were found to be the influencing factors of women's postpartum practices.

CONCLUSION

Traditional postpartum dietary and health behaviours were still popular among women in Hubei. Identifying the factors associated with traditional postpartum practices is critical to develop better targeting health education programs. Updated Information regarding postpartum dietary and health practices should be disseminated to women.

REVIEW: Customs, Culture, and Tradition—What Role Do They Play in a Woman’s Sexuality?

INTRODUCTION

Sexual health is an assumed right for every individual, but we know little regarding customs, culture, or tradition and the role they play on the sexual experiences for a woman. A woman's sexuality must be considered in the context of the environment in which she and her partner live. Culture, social customs of the community, and religion often determine the acceptance and achievement of sexual health for both men and women.

AIM

This is a review of the available literature on the impact of culture on a woman's sexual satisfaction, with emphasis placed on information from cultures practicing female genital circumcision (FGC).

RESULTS

FGC provides a spectrum of surgical excisions and outcomes. The spectrum of FGC surgical excisions can alter well-being, obstetrical outcomes, and sexual responses. The psychologic aspects of a painful procedure in a young child may also impact her future sexual responsiveness.

CONCLUSION

There is a paucity of information on which to base conclusions and the effect of culture on a woman's sexual satisfaction. Preliminary data suggest the need for further research using markers specific to the culture and her satisfaction.

An Exploration of Female Genital Mutilation

Female genital mutilation (FGM) is a form of violence against women that has recently been labeled a public health issue. This article will define and describe the procedure as well as discuss its physical and psychological implications. An exploration of the cultural significance of the practice will shed light on its continued existence in underdeveloped and developed nations. In addition, an examination of suggested guidelines for creating and implementing effective interventions will ensue.

Manufacturing heterosexuality: hormone replacement therapy and menopause in urban Oaxaca

For several decades, hormone replacement therapies have been prescribed to women, not only to prevent disease but to improve the sexual functioning of menopausal women. The medical promotion of continued sexual activity in a woman's post-reproductive years is exported to locations outside of North America and Europe, which provides an opportunity to critically examine the cultural roots that have informed expert biomedical representations. This ethnographic study examined menopause and social class in Oaxaca de Juarez, Mexico using interviews, questionnaires, and textual analysis. The research found that biomedicine in conjunction with the pharmaceutical industry promoted culturally constructed gender hierarchies under the guise of optimal menopausal health. However, women's actual experience of gender and sexuality in mid-life diverged significantly from these expert representations. Themes that emerged in interviews and questionnaires included the importance of motherhood in old age, diminished sexual desire as not problematic, and greater sexual freedom at a post-reproductive age. Ultimately, biomedical discourse was not the sole arbiter of appropriate menopausal womanhood and femininity.

International Sexual Harassment

This paper on international sexual harassment begins with a presentation of the definitions, models, and consequences of sexual harassment. Following this discussion, a description is given of a nine-country research program that examined reactions to academic sexual harassment. A brief review of incidence studies and international laws related to sexual harassment are also included.

Racial/Ethnic and Socioeconomic Differences in Multiple Risk Factors for Heart Disease and Stroke in Women: Behavioral Risk Factor Surveillance System, 2003

OBJECTIVE

To examine racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke among women.

METHODS

Data from 153,466 adult women in the 2003 Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of U.S. adults, were used to assess the prevalence of multiple (i.e., >or=2 of diabetes, current smoking, high blood pressure, high cholesterol, obesity, or physical inactivity) risk factors for heart disease and stroke. Descriptive and multivariable analyses assessed differences in multiple risk factors among racial/ethnic and socioeconomic groups.

RESULTS

More than one third (36.5%) of all women had multiple risk factors. The age-standardized prevalence of multiple risk factors was lowest in whites and Asians. After adjustment for age, income, education, and health coverage, the odds for multiple risk factors was greater in black (OR = 1.53, 95% CI = 1.42-1.64) and Native American women (1.36, 95% CI = 1.11-1.67) and lower for Hispanic women (OR = 0.83, 95% CI = 0.76-0.91) compared with white women. Prevalence estimates and odds of multiple risk factors increased with age; decreased with education, income, and employment; and were lower in those with no health coverage. Smoking was more common in younger women, whereas older women were more likely to have medical conditions (high blood pressure, high cholesterol, or diabetes) and be physically inactive.

CONCLUSIONS

Over one third of U.S. women have two or more risk factors for heart disease and stroke. Prevention programs that target risk reduction are especially critical to decrease the burden of heart disease and stroke in these higher-risk U.S. women.

Spirituality, coping, and HIV risk and prevention in a sample of severely mentally ill Puerto Rican women

Hispanics have been disproportionately impacted by HIV/AIDS. Although HIV risk is significantly elevated among severely mentally ill persons (SMI), the risk of infection appears to be even greater among those SMI who are Hispanic, reflecting the increased risk of HIV among Hispanics. We report on findings from the first 41 participants in a qualitative study examining the context of HIV risk and risk reduction strategies among severely mentally ill Puerto Rican women residents in northeastern Ohio. Individuals participated in a baseline interview, two follow-up interviews, and up to 100 hours of shadowing. Interviews and shadowing activities were recorded and analyzed using a grounded theory. The majority of individuals reported using identification with a religious faith. A large proportion of the participants reported that their religious or spiritual beliefs were critical to their coping, had influenced them to reduce risk, and/or provided them with needed social support. Several participants also reported having experienced rejection from their faith communities. The emphasis on spirituality among Puerto Rican SMI is consistent with previous research demonstrating the importance of spirituality in the Hispanic culture and reliance on spiritual beliefs as a mean of coping among SMI. Our results support the incorporation of spiritual beliefs into secular HIV prevention efforts.

An examination of sociocultural factors associated with health and health care seeking among Latina immigrants

The purpose of this study was to examine the sociocultural factors associated with health maintenance and health care seeking among Latina immigrants. Data were collected from eight focus groups with 54 Latina immigrants between the ages of 19 and 62 (M=29.3+/-9.34). The PEN-3 model provided the framework for the study. Most of the participants came from Mexico; 46% had not completed high school; 85.2% had been in the United States for less than 7 years, and 73.6% reported not having health insurance coverage. Participants identified both positive and negative perceptions, enablers, and nurturers associated with health maintenance and health care seeking. Participants acknowledged the importance of physical, mental, and spiritual health and what they should do to be healthy. Despite such knowledge, they tended to engage in unhealthy behaviors due to a variety of nonstructural barriers such as lack of time, "tradition," and procrastination. They tended to use alternative/complementary medicine first, and then seek medical help if these practices are not effective. Many women believe that they do not have control over their own health attributing this lack of control to the "system." Participants also mentioned structural barriers to seeking health care such as lack of transportation, lack of proper documentation, lack of health insurance, language barriers, long waiting time at the clinics, and lack of knowledge on where to go for affordable care. Our study suggests that there are important structural and nonstructural barriers that hinder health maintenance and care seeking. The findings also lend support to the PEN-3 model, and suggest that positive perceptions, enablers, and nurturers associated with health maintenance and health care seeking, if properly reinforced, can counterbalance negative perceptions, enablers and nurturers in this population.

The promises and limitations of female-initiated methods of HIV/STI protection

New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on "female-controlled" preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-à-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations-for better and for worse-shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men.

Factors related to physical activity in Hispanic women

Hispanic women are more likely to be sedentary than the general population. Increasing physical activity in this at-risk group is an important challenge in the prevention and management of coronary heart disease. This article reviews research conducted with Hispanic women in whom physical activity was the primary focus of study or the primary outcome of interest. Computer and manual searches were performed to identify articles published from 1990 to 2005. Factors that influence physical activity in Hispanic women include self-efficacy, having a concern for own and family health, social support and norms for physical activity, serving as a role model to others, and perceived neighborhood resources. Despite significant efforts to understand and promote physical activity among Hispanic women, much work remains to be done in this area. Future research should include attention to cultural, social, and contextual resources in understanding and promoting physical activity.

Values and beliefs about obesity and weight reduction among African American and Caucasian women

Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs. Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds. Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)>or= 30 from the general internal medicine clinics of a large tertiary care facility. Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period. AA women cited culture specific barriers to weight loss more so than did C women. AA women and C women also differed on how health care professionals could help them with weight loss. These findings have implications for nursing's role in the design of culturally relevant weight-loss programs.

Factors Associated with Effective Contraceptive Use Among a Sample of Latina Women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.