Health Of American Women Research Articles

Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm

ObjectiveThe researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors. MethodsThis article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey. ResultsParticipants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses. ConclusionsThis article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.

Between Black mothers and daughters: a critical intergenerational duoethnography on the silence of health disparities and hope of loud healing

IntroductionBlack American women's health outcomes have been altered by a number of factors. Those factors include social determinants of health, lack of culturally competent healthcare providers, and generations of medical racism leading to prolonged pain, delayed care, and sometimes, untimely deaths.MethodsThis original research article centers Southern Black women's lived experiences through family storytelling. We explored generations of health narratives in regard to age, region, and at times, their own acts of silence. Building from theorizing on loud healing, two Black daughters turned the mic on for their mothers by engaging in a critical intergenerational double duoethnography to discuss decades of healing over a 3 months long conversation (in person, over the phone, and on video chat).ResultsThe analysis of the interviews/dialogue between Black mothers and daughters identified several themes connected to loud healing: (1) some healths lessons are quietly taught from intergenerational trauma; (2) the silencing of Black matriarchs occurs in generations not just spirals; (3) loud healing is a faith-filled call to action; (4) mothers and daughters help turn the mic on for each other; (5) Loud healing is affirming and produces visibility; (6) the body teaches culturally competent health lessons; (7) Trusting loud healing to leave the mic on and door open.DiscussionOur collective and individual lived experiences reveal the very real impacts of culture, identity, and power on Black women's health and storytelling. By interrogating the past with our stories, this group of Black mothers and daughters represents three generations of medical erasures, amplification of voice, and the need for loud healing for loud, tangible change.

Effects of exercise training on health capabilities and life satisfaction among overweight and obese African American women.

More importance has been placed on exercise training due to increase in the overweight and obese population. However, few studies have researched the effects of exercise training on the health capabilities and life satisfaction levels of overweight and obese African American women. This study sought to determine the effect of a 12-week exercise training on health capabilities and life satisfaction levels of overweight and obese African American women. Participants, who passed an initial screening and pre-assessment, were measured current health capabilities and life satisfaction levels both prior to, and following, the 12-week exercise training. The results from this study indicated an improvement in health capabilities, although with no significant differences following exercise training, while a significantly higher life satisfaction levels was observed among the overweight and obese African American women. The findings suggest that exercise training can be beneficial to enhance overweight and obese African American women's health capabilities and life satisfaction levels. Exercise professionals should provide the appropriate exercise trainings so that overweight and obese African American women can optimize life satisfaction levels.

'I was broken in so many different ways': The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being.

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.

Phenotyping stress exposures related to perinatal health disparities.

Black American women living in low-resource environments are exposed to multiple stressors and are at high risk for perinatal complications. Stress exposure likely impacts pregnancy and birth complications via alterations in health systems that are engaged in regulating the stress response. Stressors may vary in terms of magnitude and pattern of effect on such health systems. In the present study, we test associations between three types of stress exposure: perceived stress, negative life events, and discrimination stress on neuroendocrine and cardiac response to a controlled laboratory stressor during the first trimester of pregnancy. In all, 100 pregnant Black women with Medicaid insurance completed a laboratory assessment during which salivary cortisol and heart rate variability (HRV) were used to measure stress response to the Trier Social Stress Test (TSST). Results revealed that only discrimination stress was significantly associated with cortisol and HRV in response to the TSST. High levels of discrimination stress were associated with lower levels of cortisol reactivity and higher levels of HRV across the visit. These results highlight the differential impact of domains of stress exposure on stress regulation during pregnancy and provide further evidence of the impact of discrimination stress on Black American women's health.

Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women's Heart & Health Study.

Health disparities research has demonstrated a negative relationship between racial discrimination and African American women's maternal health outcomes. Yet, the relationship between racial discrimination and preterm labor, a key measure of maternal health, remains understudied. This study sought to examine the associations between preterm labor and direct and vicarious racial discrimination among African American women at three life stages: childhood, adolescence, and adulthood. Logistic regression methods were used to analyze cross-sectional data from the African American Women's Heart & Health Study (AAWHHS; N = 173). The AAWHHS includes detailed maternal health information on a community sample of African American women residing in the San Francisco Bay Area. Findings indicated each unit increase in adolescent direct racial discrimination was associated with a 48% increase in the odds of preterm labor (OR: 1.480, 95% CI 1.002-2.187, p < 0.05) and each unit increase in childhood vicarious racial discrimination was associated with a 45% increase in the odds of preterm labor (OR: 1.453, 95% CI 1.010-2.092, p < 0.05) after adjusting for number of pregnancies and socioeconomic variables. This study provides evidence of an association between life-stage racial discrimination and preterm labor risk among African American women, underscoring a need to consider how both directly and vicariously experienced racial discrimination at different developmental periods impact racial disparities in birth outcomes.

How socioeconomic status influences self-care for Black/African American women: A differential item analysis

It is well documented that Black/African American (Black) women's health is impacted by socioeconomic status (SES). Self-care can improve health but this is also contingent upon SES; though it is unclear which activities are impacted. This cross-sectional study performed differential item functioning with 47 self-care activities rated by 223 Black women. Participants were compared across activities by SES group-a composite score encompassing personal income, highest degree obtained, employment status, and number of dependents. Findings suggest SES impacts half of self-care activities with most being practiced significantly more by Black women with the highest SES as opposed to the lowest. The activities that were most influenced by SES included striving for balance, scheduling regular activities with their children, and finding ways to laugh. Such differences speak to the impact of SES on the overall health of Black women. Research on Black women's health would benefit from targeting the impact of SES on self-care in order to better increase the health of Black women.

Stress and cancer-related lifestyle factors among African American heterosexual couples.

Intimate partners can have a profound influence on individuals’ health behaviors. In this exploratory research, we investigated the concordance of cancer-related lifestyle factors including smoking, body mass index, physical activity, fruit and vegetable intake, red meat intake, and alcohol use within African American heterosexual couples. We also examined whether females’ stress is associated with their own (actor effect) and males’ cancer-related lifestyle factors (partner effect), and vice versa. We analyzed a total of 216 heterosexual couples (i.e., N = 432 individuals) recruited from black churches. Intraclass correlation coefficients (ICCs) were calculated and multilevel modeling in which individuals are nested within couples was conducted. Results showed that there was high concordance of body mass index (ICC = 1.68, p < .001), fruit and vegetable intake (ICC = 1.62, p < .001), red meat intake (ICC = 1.50, p = .001), and alcohol use (ICC = 1.74, p < .001) between spouses. A multilevel analysis showed that there were actor and partner effects of stress on females’ BMI; females’ stress was positively associated with their own BMI (actor effect; β = .42, p = .006) and males’ stress was positively associated with females’ BMI (partner effect; β = .39, p = .026). Also, females’ stress was positively associated with their own red meat intake (actor effect; β = .20, p = .019). In conclusion, high concordance of cancer-related lifestyle factors (BMI, fruit and vegetable intake, red meat intake and alcohol use) exists between African American spouses. Given the identified actor and partner effects of stress on females’ BMI, a couple-based lifestyle or weight management intervention that targets both male and female spouses’ stress and coping will be promising, particularly to enhance African American women’s health behaviors. Future studies need to investigate mechanisms underlying concordance and discordance of cancer-related lifestyle factors in African American couples. Also, factors that explain African American male spouses’ health behaviors need to be uncovered.

Effects of a Sexual Health Interview among Arab American Women: An Experimental Disclosure Study.

Although sexuality is an important aspect of peoples' health and well-being, many people-professionals and patients alike-find sexuality uncomfortable to discuss. In Arab culture, certain sexual thoughts and behaviors are taboo, particularly for women, and it is not known whether an interview in which Arab American women disclose their sexuality to a health professional would be well-received and beneficial or upsetting and harmful. This experimental study tested whether engaging in a disclosure-oriented sexual health interview affects Arab American women's sexual and psychological health. A sample of 134 Arab American women, ages 18-35 years (M = 20.6), completed self-report measures of sexual health and attitudes and psychological symptoms, and then were randomized to an interview or control (waitlist) condition. The 60-min disclosure interview inquired about sexual attitudes, experiences, and conflicts. Five weeks later, all participants completed follow-up measures. Post-interview reports suggest that participants responded favorably to the interview and generally benefited from participation. Analyses of covariance (controlling for baseline levels of the outcome measure) indicated that the interview led to significantly greater sexual satisfaction and less discomfort with sexual self-disclosure at 5-week follow-up, compared to controls; the two conditions did not differ on follow-up sexual self-schema, sexual self-esteem, or psychological symptoms. Moderation analyses revealed that participation in the interview differentially improved the sexual self-schema of women with no past sexual experience, compared to women with sexual experience. These experimental findings suggest the value, rather than the risk, of clinicians encouraging Arab American women to openly disclose and discuss their sexual experiences and attitudes in a confidential, empathic setting.

African American Sexual Assault Survivors and Mental Health Help-Seeking: A Mixed Methods Study.

Little research has focused on African American women's sexual assault victimization and mental health seeking. A mixed methods study was conducted to explore African American women's sexual assault in relationship to mental health seeking and experiences with mental health providers in a large community sample. Quantitative survey and qualitative interview data indicated unique correlates of immediate and longer term seeking of help from various mental health sources. Barriers and facilitators of African American women's mental health seeking were identified and qualitative themes were uncovered relevant to this group of survivors. Implications for research and clinical practice with this population are provided.

Environmental Exposures, the Epigenome, and African American Women's Health.

Stress is a common feature of modern life, but both the extent of exposure to stressors and the downstream effects of these stress exposures can vary considerably among individuals, communities, and populations. When individuals are exposed to repeated or chronic stress, wear and tear on the body can accumulate and manifest in many ways. The term "allostatic load" represents the physiological consequences of repeated or chronic exposure to environmental stressors and is linked to fluctuating and/or heightened neural or neuroendocrine responses. African American women are one population subgroup that has been identified as potentially having both an elevated allostatic load and an enhanced resilience to external factors. One mechanism by which environmental stressors may impact human health is via epigenetic remodeling of the genome. This review will focus on what is known about how different types of environmental stressors may affect the epigenome and explore links between epigenetic reprogramming and altered allostatic load and resilience as it pertains to African American women's health.

Gendered Racial Microaggressions Scale for Asian American Women: Development and initial validation.

Asian American women's (AAW's) mental health issues have received growing public attention; recent statistics suggest alarmingly high suicide rates among AAW. Yet, little research has examined the nuanced oppression that AAW face and the daily effects of compounded racism and sexism contributing to their mental health issues. Applying the intersectionality and microaggressions framework, we developed the Gendered Racial Microaggressions Scale for Asian American Women (GRMSAAW) using data collected from 564 AAW. Items were developed via literature review, focus group, and expert review. Exploratory (N = 304) and confirmatory (N = 260) factor analyses suggested a 4-factor structure and produced 22-item scales of frequency and stress appraisal with the following subscales: (a) Ascription of Submissiveness, (b) Assumption of Universal Appearance, (c) Asian Fetishism, and (d) Media Invalidation. Internal consistency estimates were .80 and above for frequency and stress appraisal scales, and the scales accounted for 52% and 60% of variance, respectively. Examination of a bifactor model containing one general factor and four group factors suggested that GRMSAAW could be represented unidimensionally (total scale score) for the purpose of applied measurement. Initial construct validity was established as GRMSAAW scores were associated with sexism, racial microaggressions, depressive symptoms, and internalized racism in ways consistent with theory. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Reducing disparities and achieving equity in African American women's health.

The colloquial phrase "Black Don't Crack" refers to perceptions of African American women retaining youthful features over time and seemingly defying the aging process. This conjecture appears to only be skin deep, as across almost every health indicator, African American women fare worse than women in other racial/ethnic groups. African American women experience excess morbidity in obesity, diabetes, and adverse birth outcomes, and are more likely than women of other ethnic groups to die from breast and cervical cancer, cardiovascular disease, and HIV/AIDS. This article provides an overview of social, biological, psychological, and cultural factors that contribute to African American women's health. Attention is directed to cultural factors that are both protective and risky for African American women's health. There is a need to garner a better understanding of the complex nature of health disparities experienced by African American women in order to move the field forward in making progress toward achieving health equity for this population. This article addresses this need and offers recommendations for translating science in this area into meaningful population level impact. (PsycINFO Database Record

Exploring Spirituality Among African American Women: Implications for Promoting Breast Health Behaviors.

The purpose of this qualitative study was to gain understanding of the definition, meaning, and function of spirituality to African American women. Four categories emerged that add insight for nurses to develop innovative spiritual-based strategies to promote African American women's positive health behaviors. Implications for promoting breast health behaviors are described.

The Impact of Racism on the Sexual and Reproductive Health of African American Women.

African American women are disproportionately affected by multiple sexual and reproductive health conditions compared with women of other races/ethnicities. Research suggests that social determinants of health, including poverty, unemployment, and limited education, contribute to health disparities. However, racism is a probable underlying determinant of these social conditions. This article uses a socioecological model to describe racism and its impact on African American women's sexual and reproductive health. Although similar models have been used for specific infectious and chronic diseases, they have not described how the historical underpinnings of racism affect current sexual and reproductive health outcomes among African American women. We propose a socioecological model that demonstrates how social determinants grounded in racism affect individual behaviors and interpersonal relationships, which may contribute to sexual and reproductive health outcomes. This model provides a perspective to understand how these unique contextual experiences are intertwined with the daily lived experiences of African American women and how they are potentially linked to poor sexual and reproductive health outcomes. The model also presents an opportunity to increase dialog and research among public health practitioners and encourages them to consider the role of these contextual experiences and supportive data when developing prevention interventions. Considerations address the provision of opportunities to promote health equity by reducing the effects of racism and improving African American women's sexual and reproductive health.

Racial and Gender Discrimination in the Stress Process: Implications for African American Women's Health and Well-Being

In recent decades, sociologists have increasingly adopted an intersectionality framework to explore and explain the complex and interconnected nature of inequalities in the areas of race, class, and gender. Using an inclusion-centered approach and a sample of 204 low-socioeconomic-status (SES) African American women, the authors theorize and explore the role of racial and gender discrimination in the stress process. Analyses examine relationships between social stressors (racial and gender discrimination) and individual stressors occurring in each of six distinct social contexts. Furthermore, the authors evaluate the effects of racial and gender discrimination as compared to individual stressors on three indicators of mental health and well-being. Findings suggest that racial and gender discrimination increases risk for poor health and low well-being, working both directly and indirectly through increased vulnerability to individual stressors. This research demonstrates the value of a more comprehensive study of stressors that influence the health of low-SES African American women and other multiply disadvantaged groups.

Health Beliefs of African American Women on Breast Self-Exam

PurposeInvestigate the relationship between African American women's health beliefs in regard to breast cancer screening behaviors. Data sourcesA sample of 131 African American women, age 20–65, from a family practice clinic and 3 rural churches in Southeast. ConclusionsOne-hundred and nine of the participants reported practicing breast self-exam (BSE) within the past 12 months. However, 21 women had never practiced BSE. Fear of not doing it correctly was a main barrier. Implication for practiceSteps should be taken to increase confidence and resolve barriers of African American women through the development of culturally sensitive educational training on BSE and cancer prevention.

Physical, Behavioral, and Mental Health Issues in Asian American Women: Results from the National Latino Asian American Study

Asian American women's health has been understudied while the Asian American population is increasing. The purpose of this study was to examine the physical, behavioral, and mental health of Asian American women. Using a nationally representative sample (n=1097) from the National Latino Asian American Study (NLAAS), the first comprehensive epidemiologic survey in the United States, we examined the annual rates of behavioral, physical, and mental healthcare service use, including general medical, specialty mental health, and any medical services, in three major subgroups of Asian American women. Health problems varied with three major subgroups of Asian American women. In physical health, Chinese American women reported the highest rates of headache, other pain, hypertension, heart diseases, heart attacks, chronic lung diseases, and asthma. Vietnamese American women reported the highest rates of ulcer, stroke, and diabetes. Filipino American women had the highest rates of cancers and epilepsy. In behavioral health, Filipino women ranked highest on all types of drug use and cigarette smoking, compared with their counterparts. In mental health, Filipino American women reported significantly better mental health self-rating compared with their Chinese and Vietnamese American counterparts. Asian American women from each ethnic group sought health services at distinct rates. However, the help-seeking patterns of health services are similar. Asian American women encountered various physical, behavioral, and mental health problems, yet they had low rates of seeking healthcare services. Hence, it is critical to further examine factors associated with the underestimation of physical and mental health problems and underuse of health services by Asian American women.

Pleasing the Masses: Messages for Daily Life Management in African American Women's Popular Media Sources

Using African American women's insights on their own health experiences, we explored how their daily life management was linked to the "strong Black woman" (SBW) script, and the health implications of that script. Using the search term "strong Black woman," we identified 20 articles from African American women's magazines and 10 blog sites linked to the SBW script and analyzed their content. We created thematic categories (role management, coping, and self-care) and extracted issues relevant to African American women's health. Adherence to the SBW script was linked to women's daily life management and health experiences. Themes such as self-sacrificial role management ("please the masses"), emotional suppression ("game face"), and postponement of self-care ("last on the list") incited internal distress and evinced negative health consequences. Scientists, activists, and health care professionals would be aided in forming initiatives aimed at reducing health disparities among African American women by heeding the insights on their health experiences that they express in popular media sources.

Still Piecing It Together: Women's Primary Care

The 20-year anniversary of Women’s Health Issues is an opportune time to consider whether the past two decades have seen substantial progress in improving primary care for American women. At least as early as 1992, when Clancy and Massion (1992) described women’s health care as ‘‘a patchwork quilt with gaps,’’ health services researchers and health care providers have been aware of the unique challenges to providing coordinated, comprehensive, high-quality primary care services to women. One of the major issues is how to integrate and coordinate routine reproductive health services with other components of women’s primary care in a seamless delivery system. This is not a trivial question, because reproductive caredincluding, for example, contraceptive services, pregnancy-related care, infertility services, gynecological care, and gender-specific cancer screeningdis needed by all women at some point in their lives. Despite the fact that women are the majority of health care consumers, this issue has not beenwidely recognized by those promoting ideal conceptions of ‘‘primary care’’ or the newer concept of a ‘‘patient-centered medical home.’’ Have we made any progress at all? Historical patterns of care delivery based on the specialty areas of physicians, as well as on the ways in which health services are funded or reimbursed, have resulted in fragmented primary care for women. Most women have directly experienced fragmentation. Any womanwho has visited her family physician for a regular checkup and then had tomake a separate visit (with another copay) for a routine Pap smear understands that her convenience and needs are not foremost in the design of basic health services. Anywomanwhose obstetrician-gynecologist has told her that she has to go elsewhere for a cholesterol test knows that a reproductive health specialist does not provide comprehensive care. Any womanwho reports symptoms of postpartum depression or consequences of intimate partner violence to her