African American Women In Washington Research Articles

Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study.

BackgroundInnovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods.ObjectiveThe primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation.MethodsThe proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3’s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5’s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers.ResultsThe National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021.ConclusionsFindings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health.International Registered Report Identifier (IRRID)PRR1-10.2196/29191

Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study.

BackgroundCommunity-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans.ObjectiveThis study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC.MethodsWe recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert.ResultsIn this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups).ConclusionsInvolving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.

Reproductive Health Knowledge among African American Women Enrolled in a Clinic-Based Randomized Controlled Trial to Reduce Psychosocial and Behavioral Risk: Project DC-HOPE

BackgroundWashington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care. MethodsProject DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ2 tests. Differences in postpartum mean total score by group were assessed via multiple linear regression. ResultsWomen in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001). ConclusionsAlthough intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.

Brief research report: sociodemographic factors associated with HIV status among African American women in Washington, DC

IntroductionAfrican American women living in Washington, DC have one of the highest Human immunodeficiency virus (HIV) incidence rates in the US. However, this population has been understudied, especially as it relates to factors associated with HIV status.MethodsThis cross-sectional study examined sociodemographic factors that were associated with having a negative or positive HIV status among a sample of 115 African American women between the ages of 24 and 44 years. We assessed such factors as age, education, sexual orientation, household income, sources of income, number of children, length of residency tenure in Washington, DC, and level of HIV-prevention knowledge.ResultsAmong the overall sample, 53 women self-identified as HIV-positive and 62 as HIV-negative. Compared to their HIV-negative counterparts, women who reported being HIV-positive were less educated, had lower household income, and had longer residency tenure in Washington, DC. There were no differences in HIV knowledge between HIV-positive and -negative study participants.ConclusionThese findings may provide important directions for targeting specific subpopulations of African Americans for HIV-prevention/intervention programs.

Intentions Modify Program Impact After a Nutrition Education Intervention

To examine whether expressed intentions modified program impact on diet. A nutrition education intervention was conducted with African American women in Washington, DC. Dietary recalls and surveys at post-intervention and follow-up were analyzed. At 20-week follow-up, frequent attenders reported .13 more fruit and vegetable servings per additional point post-intervention behavioral intentions score (p = .03) and .10 servings per point on follow-up intentions score (p = .07). Sustained intentions predicted dietary change, informing measurement and theory for nutrition interventions.

African American women's perspectives on ‘down low/DL’ men: implications for HIV prevention

African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as ‘down low’ or ‘DL’. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.

Abstract B56: An exploratory analysis of alcohol consumption and cancer-related dietary risk among low-income African American women in Washington, DC

Abstract To ameliorate cancer disparities, closer examination of dietary quality by alcohol consumption patterns may generate a better understanding of nutritional inadequacies and how they can be addressed among low-income populations. The present study was an exploratory analysis of alcohol intake and dietary quality among 156 low-income, African American women living in public housing in Washington, DC, in 2000. At baseline, the study collected up to three 24-hour dietary recalls on nonconsecutive days for each participant, as well as a questionnaire on demographic, socioeconomic, health, lifestyle, and psychosocial characteristics. Recall data were analyzed for energy, fat, alcohol (1 serving=13.7 grams), and fruit and vegetable (FV) intake, and a Healthy Eating Index (HEI) score was created. Alcoholic beverages were grouped into four categories: beer and ale, cordial and liqueur, distilled liquor, and wine. Days in which alcohol was consumed were grouped as light (&amp;gt;0 to &amp;lt;0.5 servings), moderate (≥0.5 to &amp;lt;1.0 servings), and heavy (≥1.0 servings) drinking days. Bivariate analysis was performed to examine participant characteristics by alcohol drinking status (drinkers vs. non-drinkers; Pearson 2 and Fisher's exact tests), to describe amounts and types of alcohol consumed per participant and per day, and to determine differences in four measures of dietary quality (total energy, % energy from fat, FV, and HEI) by drinking status (t-tests and Wilcoxon-Mann-Whitney tests) and, among drinkers only, amount of alcohol consumed (paired t-tests and Wilcoxon signed rank sum tests). Compared with non-drinkers (n=109), drinkers (n=47) were less obese (29.8% vs. 57.8%, p=0.007), more likely to currently smoke (80.8% vs. 52.3%, p=0.001), had more stressful life events (85.1% vs. 66.6% with ≥3 events, p=0.015), more likely to report same/worse health in the future (61.7% vs. 37.6%, p=0.006), and less likely to believe diet can prevent cancer (34.8% vs. 58.5%, p=0.007). On average, drinkers consumed 1.69 servings of alcohol, and most drinking days (65 out of 78) had heavy alcohol consumption (≥1.0 servings). Overall, dietary quality was poor, with mean (SE) HEIs of 56.97 (0.95) and 53.96 (1.20) among non-drinkers and drinkers, respectively (p=0.071). There were few differences in dietary quality by drinking status; mean daily total energy intake was higher among drinkers (2642.38 (152.16) kcal) than non-drinkers (2325.34 (92.77) kcal), though the difference was not statistically significant (p=0.0846). However, among drinkers only, total energy was higher and % energy from fat lower on drinking days compared to days without alcohol intake (2881.50 (197.26) kcal vs. 2385.38 (243.62) kcal, and 33.05% (1.44) vs. 37.48% (1.72), respectively). FV intake and HEI did not differ by drinking day. High rates of alcohol intake and overall poor dietary quality show the need for further work to look at dietary and alcohol patterns more closely to reduce cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B56.

Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy outcomes among African-Americans in Washington, DC.

This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington, DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes; (2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.

Patterns of alcohol consumption among pregnant African-American women in Washington, DC, USA.

The objective of this paper is to describe the patterns and associated behaviours related to alcohol consumption among a selected sample of pregnant women seeking prenatal care in inner city Washington DC. Women receiving prenatal care at one of nine sites completed an anonymous alcohol-screening questionnaire. Questions concerned the amount, type and pattern of alcohol consumption. Women were categorised as at no, low, moderate or high risk for alcohol consumption during pregnancy. For comparisons of risk levels of drinking, bivariate associations were examined using Fisher's exact test. Odds ratios (ORs) and 95% confidence intervals (CIs) were also computed. Although 31% of current/recent drinkers stated that they continued to drink during pregnancy, responses to quantity/frequency questions revealed that 42% continued to do so. Women who were at high compared with moderate risk acknowledged that others were worried about their consumption [OR=4.0, 95% CI 1.5, 10.6], that they drank upon rising [OR=6.7, 95% CI 1.8, 26.9], had a need to reduce drinking [OR=3.2, 95% CI 1.3, 8.1] and in the past 5 years had had fractures [OR=4.2, 95% CI 1.0, 17.8] or a road traffic injury [OR=3.4, 95% CI 1.0, 12.2]. Women in the high/moderate compared with low-risk group were more likely to have been injured in a fight or assault [OR=2.7, 95% CI 1.3, 5.6]. This study validated the usefulness of our questionnaire in identifying women who were at risk for alcohol consumption during pregnancy across a range of consumption levels. Using our screening tool, women were willing to disclose their drinking habits. This low-cost method identifies women appropriate for targeting of interventions.

Breast cancer treatment delay in African American women in Washington, DC.

Abstract Abstract #4164 Background: Delays in follow-up after a positive breast cancer screen are thought to contribute to racial/ethnic disparities in breast cancer outcomes. The goal of this study was to determine the relative impact of self-identified race and other relevant socio-demographic and logistic variables on time to diagnosis after an abnormal mammogram, and time to first treatment after a cancer diagnosis within the context of data collection for a large research study of the effectiveness of patient navigation.&amp;#x2028; Methods: Our sample includes 168 African-American and non-Hispanic white women with a documented invasive breast cancer diagnosis at an urban academic medical center during 2006 and 2007. The outcome variables were the number of days from abnormal mammogram to cancer diagnosis and from diagnosis to first treatment.&amp;#x2028; Results: The median number of days to breast cancer diagnosis following an abnormal mammogram was 20.5 days for African-Americans compared to 15 days for non-Hispanic white women. Median days to first treatment after diagnosis was 21 days for African-American women compared to 16 days for non-Hispanic white women. Neither difference was statistically significant. In addition, 76% of African-American women had private insurance versus 81% of non-Hispanic white women.&amp;#x2028; Conclusions: The identification of specific risk factors associated with a delay in diagnosis noted elsewhere in the literature and suggested in these preliminary findings could provide useful information regarding characteristics of women who are most likely to benefit from enhanced patient navigation efforts. Thus far, no statistically significant differences have been identified but the variety of factors that could contribute to the longer delay in disease management in African-American women compared to non-Hispanic white women, such as insurance status, provider location, household income, cultural issues, and other barriers to health care access, should be evaluated with a larger patient population. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4164.

Determinants of late prenatal care initiation by African American women in Washington, DC.

The objective of this study was to identify the determinants of late prenatal care (PNC) initiation among minority women in Washington, DC. DC-resident, African American women (n = 303) were recruited at 14 PNC facilities, representing the various types of PNC facilities located in DC: 4 hospital-based clinics, 5 community-based clinics, and 5 private practices. The women were interviewed at their first prenatal care visits to determine their perceptions of 63 barriers, motivators and facilitators influencing PNC initiation; substance use; and sociodemographic background. PNC initiation was classified as early (prior to the 20th week of gestation) or late (after the 20th week of gestation). The responses of women who initiated PNC early versus late were compared using bivariate and multivariate statistical procedures. Classification and Regression Trees analysis was used to identify groups at risk of late initiation. Variables contributing to late PNC initiation included maternal age not between 20 and 29 years, unemployment, no history of previous abortions, consideration of abortion, lack of money to pay for PNC, and no motivation to learn how to protect ones health. Three risk groups for late PNC initiation included 1) women consideringabortion and not employed outside their homes; 2) women not considering abortion who had no previous abortion experience; and 3) teenagers not considering abortion and with no previous abortions. The results of this study indicate that psychosocial barriers are more important than structural barriers. Of the psychosocial barriers, the major determinants of late PNC initiation were consideration of abortion and previous abortion experience.