California Women Research Articles

Perinatal Outcomes in the Setting of Active Phase Arrest of Labor

Diagnosis of active phase arrest has been defined as no cervical change for a minimum of 2 hours in the setting of an adequate uterine contraction pattern. However, cesarean deliveries performed for active phase arrest often fail to meet these criteria. Previous studies have demonstrated that a majority of women diagnosed with active phase arrest will achieve a vaginal delivery if given at least 4-hours before a diagnosis of active phase arrest is made. These studies also showed low rates of maternal and neonatal complications among all women with active phase arrest, and similar rates for cesarean and vaginal deliveries. To confirm these findings, this retrospective cohort study evaluated perinatal outcomes in Californian women with a live, term, cephalic, singleton birth who were diagnosed with active phase arrest of labor for at least 2-hours and delivered between 1991 and 2001 (n = 1014). Two comparisons were made. In the first, rates of adverse perinatal outcomes among women with active phase arrest were compared by mode of delivery: vaginal or cesarean. In the second, outcomes of women who delivered vaginally were compared in those with or without active phase arrest. Of the 1014 women identified with active phase arrest, 33% (335) went on to deliver vaginally, and 68% (679) underwent cesarean deliveries. Among these women, multivariable logistic regression analysis showed that cesarean delivery was associated with an increased risk of chorioamnionitis (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 2.21–5.15), endomyometritis (aOR 48.41, 95% CI 6.61–354), postpartum hemorrhage (aOR 5.18, 95% CI 3.42– 7.85), and severe postpartum hemorrhage (aOR 14.97, 95% CI 1.77–126). There was no significant association between cesarean delivery and adverse neonatal outcomes in women with active phase arrest. Women with active phase arrest who delivered vaginally had significantly increased odds of chorioamnionitis (aOR 1.78, 95% CI 1.22–2.36) and shoulder dystocia (aOR 2.37, 95% CI 1.33– 4.25). There were no differences in rates of other adverse neonatal outcomes and active phase arrest, including sepsis, neonatal intensive care unit admission, clavicular fracture, Erb’s palsy, and acidemia. These findings suggest to the investigators that an attempt to achieve vaginal delivery in women diagnosed with active phase arrest should be made because it poses no additional risk to the neonate and may reduce the maternal risks associated with cesarean delivery.

Adherence to Recent Screening Mammography among Latinas: Findings from the California Women's Health Survey

Latinas are less likely than other racial/ethnic groups to engage in mammography rescreening, but little research has examined why Latinas overdue for screening have not had a mammogram recently. This study investigates the factors that affect adherence to screening mammography guidelines among previously screened Latinas. Data are from a population-based, random-digit-dial annual probability survey of California women. Participants included 1298 Latinas aged > or =40 who ever had a mammogram. Multivariate logistic regression was used to examine what factors differentiate adherence to recent screening (having a mammogram < or =2 years ago) from being overdue for screening (having a last mammogram >2 years ago). Perceived barriers to screening were also examined among women overdue for a mammogram. Relationships between self-reported perceived barriers to screening and the identified differentiating factors were assessed using chi-square tests. Adherence to recent mammography was reported by 83.9% of previously screened Latinas. When controlling for significant covariates, factors associated with adherence to recent screening included being aged 50-64, having a college education, preferring to interview in Spanish, having health insurance, and reporting a usual source of care (p < 0.05). Lack of affordability was the most frequently cited perceived barrier to screening among Latinas overdue for screening. Age, education, health insurance, and usual source of care were significantly associated with specific perceived barriers to screening mammography. Results underscore the impact that affordability of, knowledge about, and convenience in obtaining mammograms have on adherence to recent screening. Strategies to improve mammography adherence among Latinas may need to consider that solely improving access to insurance or a regular source of healthcare, although important, may not be sufficient to improve rates of Latinas' screening mammography adherence.

Examining factors linked to overweight and obesity in women of different sexual orientations

Objectives Our goal was to examine possible mechanisms for the relationship of sexual minority status and obesity. The mechanisms we considered were energy intake, measured as consumption of fruits and vegetable, past diet attempts and energy expenditure measured as physical activity and number of days when poor physical or mental health interfered with usual activities. We hypothesized that women with a female partner have greater energy imbalance by expending less energy and have higher energy intake than women with a male partner thereby causing overweight and obesity. Methods The study was a secondary data analysis of the California Women's Health Survey (CWHS), an annual probability survey that produces a representative sample of the female California population. After pooling data from the years 2001–2005, we obtained a representative sample of 14,197 Californian women. Multiple regression analyses were used to test for mediation. Results We found higher prevalence of overweight and obesity in sexual minority women. There was no support for mediation in that gender of sexual partner was not significantly related to measures of energy intake and expenditure. Conclusions The findings from the present study further implicate sexual minority status in the risk for overweight and obesity, yet do not identify the chosen measures of energy intake and expenditure as mediators for this relationship.

Differences in breast cancer subtype distribution exist among ethnic subgroups of Asian women in California.

Abstract Abstract #2088 Background: Distinct breast cancer subtypes have been identified by gene expression analysis. Little is known about the distribution of these subtypes among Asian women. We previously reported an increased frequency of HER2-positive breast cancers among certain ethnic subgroups of Asian women in California. To follow up on that finding in detail, we undertook the current analysis to explore factors associated with differences in breast cancer subtype distribution among Asian women in California.&amp;#x2028; Methods: We defined immunohistochemical surrogates for each breast cancer subtype among Chinese, Japanese, Filipina, Korean, Vietnamese and South Asian patients in the population-based California Cancer Registry diagnosed in the period 1999-2005. Subtypes were defined using combinations of immunohistochemical markers: luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-) and HER2+/ER- (ER-, PR-, HER2+). Polytomous logistic regression was used to evaluate associations between breast cancer subtype and age, race, AJCC stage, tumor grade, tumor histology, socioeconomic status, nativity and hospital ownership (private vs. public). Models were used to compare differences in these characteristics simultaneously across the four breast cancer subtypes.&amp;#x2028; Results: Of 12,245 Asian women diagnosed with invasive breast cancer, 7,217 (59%) women had data for all three immunohistochemical markers. The majority of breast cancers among Japanese women were of the luminal A subtype (67%), with a low frequency of basal-like (10%) and HER2+ (22%) cancers. Korean, Filipina and Vietnamese women had a high frequency of HER2+ cancers (35%, 31% and 31%, respectively) compared to Non-Hispanic White women diagnosed during this period (n=12,996, 21%). In regression analyses among Asian women, the four subtypes varied significantly in their associations with age group (p=0.01), detailed Asian ethnicity (p&amp;lt;0.0001), stage (p&amp;lt;0.0001), grade (p&amp;lt;0.0001), histology (p&amp;lt;0.0001), year of diagnosis (continuous; p=0.03) and hospital ownership (p&amp;lt;0.0001). However, there was no significant variation among the subtypes in their relationships with socioeconomic status (p=0.94) or nativity (p=0.29).&amp;#x2028; Conclusions: Differences in the distribution of breast cancer subtypes exist among Asian women according to ethnicity, as well as other demographic and disease characteristics. These differences were not associated with place of birth or socioeconomic status. Breast cancers among Japanese women had the most favorable subtype distribution, while Korean women had the least favorable distribution. Further study may identify genetic and environmental risk factors responsible for these differences, with implications for prevention and treatment. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2088.

Validation of OncoVue®, a new individualized breast cancer risk estimator in the Marin County, California adolescent risk study.

Abstract Abstract #502 Background: Improved models for estimating individual breast cancer risk are urgently needed for guiding clinical decisions. The OncoVue model was developed by analysis of a large case-control study genotyped for 117 common, functional single nucleotide polymorphisms (SNPs) in candidate genes likely to influence breast carcinogenesis. Multivariate logistic regression analyses were used to develop a model employing 22 SNPs in 19 genes together with the Gail Model risk factors. In the original studies of the model building set and two independent validation sets, OncoVue exhibited improved individualized risk estimation, compared to the Gail Model alone, by correctly placing more cases and fewer controls at elevated risk. Here, we sought to examine the performance of OncoVue in women from the Marin County, California breast cancer adolescent risk factor study.&amp;#x2028; Materials and Methods: Buccal cell DNA was isolated from 177 controls and 169 age-matched women diagnosed with breast cancer between 1997 and 1999. All samples were anonymously coded to remove case-control status and provided to InterGenetics along with all other relevant personal history information. DNAs were genotyped for the 22 SNP variants in OncoVue and combined with personal factors to calculate the risk scores for the individual participants. OncoVue scores were then returned to the Marin County study investigators who conducted the analyses using case-control status.&amp;#x2028; Results: Positive likelihood ratios (PLR) were calculated as the proportion of patients with breast cancer with an elevated risk estimate (12%) divided by the proportion of disease-free individuals with an elevated risk estimate. For OncoVue the PLR was 2.2, whereas for the Gail Model the PLR was 0.9, demonstrating a 2.4-fold statistically significant (p=0.036) improvement. In additional comparisons using normalized control scores, OncoVue exhibited a 51% improvement compared to the Gail Model in assigning elevated risk to cases.&amp;#x2028; Conclusion: In this blinded validation study OncoVue exhibited significantly improved performance, compared to the Gail model alone, in estimating individual risk among Marin County, California women. The improved performance of OncoVue was similar to that observed in two previous independent validation sets, thus, supporting the clinical utility of OncoVue for more accurate individualized breast cancer risk estimation. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 502.

Second trimester prenatal ultrasound for the detection of pregnancies at increased risk of Trisomy 18 based on serum screening

To describe ultrasound findings in fetuses with Trisomy 18. Prospective population-based cohort study of second trimester ultrasound among Californian women who were at increased risk of chromosome abnormality based on serum screening between November 1999 and April 2001. Structural anomalies plus the following soft markers were assessed: nuchal fold thickening, choroid plexus cyst (CPC), echogenic intracardiac focus, echogenic bowel, renal pyelectasis, clenched hands; clinodactyly; short femur, short humerus and a single umbilical artery (SUA). Overall, 8763 women underwent ultrasound evaluation, including 56 whose fetuses had Trisomy 18. Ultrasound anomalies were seen in 89% of Trisomy 18 fetuses, as compared with 14% of normal fetuses. If the genetic sonogram was normal (no structural anomaly and no soft marker), the risk was reduced by approximately 90%. The ultrasound soft markers were typically seen in conjunction with structural anomalies in affected fetuses and in the absence of a structural anomaly, most isolated ultrasound soft markers were not associated with Trisomy 18. The only exception was an isolated CPC, seen as the only finding in 11% of fetuses with Trisomy 18. If the genetic sonogram is used as a sequential test following serum biochemistry, a normal ultrasound study reduces the likelihood of Trisomy 18 substantially even if a woman has abnormal serum biochemistry. The presence of an isolated CPC raises the risk, but not high enough to prompt invasive testing.

Pregnancy-associated colon and rectal cancer: perinatal and cancer outcomes

Objective. Assess the impact of colorectal cancer on maternal and neonatal outcomes.Methods. Cases were identified using several computer-generated linkage analyses. Maternal and newborn hospital discharges in California were linked to birth and if applicable infant death certificate records. This database was then linked to the California Cancer Registry, to create a cohort of women with pregnancy-associated colon and rectal cancer. This cohort was compared to pregnant women in California without colorectal cancer. Our secondary comparison was to non-pregnant, Californian women with colorectal cancer who could be aged-matched.Results. Women with pregnancy-associated colorectal cancer were more likely to undergo cesarean section (OR: 1.9) and to develop puerperal infections (OR: 2.8). In addition, higher rates of preterm delivery were found both secondary to scheduled deliveries and preterm labor (OR for preterm labor, 2.8). Neonatal outcomes were fairly similar between the two groups. Pregnancy was not found to have a significant effect on survival (HR: 0.73).Conclusions. We found that women with pregnancy-associated colorectal cancer had excellent maternal and neonatal outcomes. This is likely secondary to the fact that most women are diagnosed after delivery. In addition, survival is similar between pregnancy-associated and non-pregnancy associated cases.

Breast Health Issues of Undocumented Women in California and Texas

Breast Health Issues of Undocumented Women in California and Texas

Lifetime Interpersonal Violence and Self-Reported Chlamydia trachomatis Diagnosis among California Women

To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. This was a cross-sectional analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as women's cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics. Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI 3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a woman's cumulative experience of violence and her risk of past CT diagnosis. There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their current intimate relationships. Sexual risk reduction counseling may also be important for women who have a history of risky sexual behaviors and who are likely to be reinfected.

Cohort Profile: The biopsychosocial religion and health study (BRHS)

How did the study come about? In The Secrets of Long Life in the National Geographic Buettner explored longevity among three communities in Sardinia Italy, Okinawa Japan, and Loma Linda California. Loma Linda is largely a community of 7th-day Adventists. In 1969 initial research found that among individuals surviving past age 35 Adventist women in California lived 3.7 years longer than their counterparts and Adventist men 6.2 years longer. In a later, larger California sample the differences were even stronger—4.4 years for women and 7.3 years for men. Exercise, vegetarian diet, not smoking, eating nuts and social support have been found to predict longevity in Adventists. Yet even when these and several psychological variables are controlled church attendance still predicts greater longevity. Interest has been increasing regarding the association of both mental and physical health with religion or spirituality. There have been a number of literature reviews that have concluded that the associations of religion and health are largely positive. In fact, Hall concluded religious attendance was more cost-effective in increasing longevity than statin-type medications. While some have questioned the quality of these research conclusions and others have pointed out that the benefits or costs of religion may vary depending on the indicator of religious involvement, there is general agreement regarding the need for more and better research on the subject. Nonetheless, Hummer and his colleagues concluded there was consistent evidence that religious attendance was associated with lower mortality risk in cross-sectional and prospective studies. They also concluded there was a need for more diverse measures of religious involvement, comparison among specific subpopulations, and a better understanding of the pathways by which religion might influence health (p. 1226). It was with this goal in mind that this Biopsychosocial Religion and Health Study was developed.

Why do low-income women not use food stamps? Findings from the California Women’s Health Survey

To determine factors associated with Food Stamp Program (FSP) participation in a potentially eligible California population. The California Women's Health Survey is an on-going annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Statistical procedures included chi2 and logistic regression. California, USA, from 2002 to 2004. A total of 527 FSP female participants and 1405 potentially eligible non-participant females, aged 18 years and older. The following characteristics remained independently and positively related to FSP participation: single mother with children; unemployed; on welfare; on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children); and US-born. Women under 25 years and those over 54 years were less likely to participate than women aged 25-54 years. Hispanic/Latino ethnicity was also negatively related to participation. Over 42 % of potentially eligible non-participants cited 'don't need them' as the reason for not applying for FSP, but 34.9 % either do not think they are eligible or do not know how to apply. Potentially eligible non-participants who cite 'don't need them' as a reason for not applying are less likely to be food insecure, to have inadequate income and to use alternative emergency aid, compared to women citing all other reasons. The highest level of need is among those who cite worry about citizenship or stigma as reasons for not applying. Strategies to increase participation in FSP should incorporate messages that change the public's perception of the programme, in addition to simplifying the application process, raising awareness of eligibility criteria and improving customer service.

Tea and Suffrage

This article explores the special relationship between tea and woman suffrage in the early twentieth century. It examines the use of tea by varied suffragists in the California woman suffrage campaign of 1911, showing how and why suffragists used tea as a tool for gaining the vote and why tea held a privileged position as a suffrage food. It explores the meanings and uses of tea in the United States at the turn of the century and argues that the feminine, domestic, and refined associations of tea made it particularly useful for suffragists. It shows how tea was extensively used by suffragists, who served it and sold it in aid of the cause, in order to make a claim for their domesticity and refinement, even as they made relatively radical political claims and fought a popular image of mannish, extremist suffragettes.

Impact of ASC‐H terminology on the detection of HSILs in medically underserved California women

In this study we evaluated CDP: EWC, a large public health screening program for low-income women to determine whether the ASC-H term, introduced in the 2001 revision to the Bethesda System, has facilitated the detection of the most serious precancerous cervical lesions such as CIN-II-III/CIS, including accuracy of detection and minimizing diagnostic delays. Pap test and biopsy data from the period 2003-2006 were compared with those from 1995-1999, and included analysis of a subset of rarely and never-screened for each study period. More ASC-H Pap tests were followed by CIN-II+ biopsies (20%) than ASCUS Pap tests (5%). Thirteen percent of ASC-H showed CIN-III/CIS on follow-up biopsy. Following the introduction of ASC-H, negative and LSIL Pap tests followed by CIN-III/CIS biopsies decreased from 5.6% to 0.37% and 9.2% to 4.4%, respectively. Fewer CIN-III/CIS cases were preceded by Pap tests with negative and ASCUS results in 2003-2005 as compared with 1995-1999. The number of days from screening to diagnosis for women aged 25-39 years with ASC-H Pap test results (58 days) was less than for ASCUS results (78 days) for the current study period. In this high-risk multi-ethnic population, ASC-H more effectively communicates equivocal findings likely to represent HSIL leading to more rapid follow-up. The incidence of CIN-II or CIN-III/CIS following ASC-H Pap tests is lower than generally appreciated for this population, including for rarely or never-screened high-risk women. Fewer CIN-III/CIS lesions were detected following negative and ASCUS Pap results. Compliance with follow-up is less than ideal for this population.

Cervical cancer incidence, mortality, and survival among Asian subgroups in California, 1990-2004

Aggregated cancer statistics for Asians mask important differences in cancer burden among Asian subgroups. The purpose of this study was to describe the relative patterns of cervical cancer incidence, mortality, and survival among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese women in California, using data from the California Cancer Registry. All cervical cancer cases diagnosed among the 6 subgroups and non-Hispanic whites (NHW) from 1990 to 2004 were identified and used to calculate incidence and mortality rates and trends. The Kaplan-Meier method was used to calculate 5- and 10-year survival probabilities by subgroup, and Cox proportional hazards methodology was used to calculate survival differences adjusted for race and ethnicity, age, stage at diagnosis, socioeconomic status, and treatment factors. Vietnamese and Korean women experienced greater cervical cancer incidence and mortality than NHW women, whereas rates among Chinese, Japanese, and South Asians were comparable or lower. Five-year unadjusted survival probabilities were greatest for South Asians (86%) and Koreans (86%), followed by Vietnamese (82%), Chinese (79%), and Filipinos (79%), as compared with NHW (78%) and Japanese (72%). The adjusted risk of cervical cancer death was significantly lower for South Asians, Koreans, Vietnamese, and Filipinos than for NHW women, but not for Chinese and Japanese. Cervical cancer incidence rates vary substantially across the major Asian subgroups. Despite higher incidence and mortality rates compared with NHW women, Vietnamese, Koreans, and Filipinos have better survival outcomes. Further studies are needed to examine the factors behind these survival differences.

Air Pollution and Preeclampsia Among Pregnant Women in California, 1996–2004

Air Pollution and Preeclampsia Among Pregnant Women in California, 1996–2004

Cervical cancer control research in Vietnamese American communities.

Census data show that the U.S. Vietnamese population now exceeds 1,250,000. Cervical cancer among Vietnamese American women has been identified as an important health disparity. Available data indicate the cervical cancer disparity may be due to low Papanicolaou (Pap) testing rates rather than variations in human papillomavirus infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina White women in California during 2000 to 2002 were 14.0 and 7.3 per 100,000, respectively. Only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear compared with 84% of non-Latina White women. Higher levels of cervical cancer screening participation among Vietnamese women are strongly associated with current/previous marriage, having a usual source of care/doctor, and previous physician recommendation. Vietnamese language media campaigns and lay health worker intervention programs have been effective in increasing Pap smear use in Vietnamese American communities. Cervical cancer control programs for Vietnamese women should address knowledge deficits, enable women who are without a usual source of care to find a primary care doctor, and improve patient-provider communication by encouraging health-care providers to recommend Pap testing as well as by empowering women to ask for testing.

What happens to youth removed from parental care?: Health and economic outcomes for women with a history of out-of-home placement

Although the link between out-of-home placement and mental health problems in youth has been well-documented, few studies have examined the long-term functioning of adults with a history of out-of-home placement. In the present study, data from the California Women' s Health Survey were used to examine the odds of recent mental and physical health problems, low educational attainment, and economic adversity for women, ages 18 and older, with ( n = 368) or without ( n = 9240) a history of out-of-home placement. Results revealed that history of out-of-home placement was associated with mental health problems, poor subjective health, smoking, obesity, low educational attainment, living in poverty, and use of public assistance in adulthood. Routine screening for mental health problems, as well as early intervention and prevention efforts, should be targeted to youth in or transitioning to out-of-home placement in an effort to prevent long-term mental health problems. Educational interventions that facilitate collaboration between foster care agencies and the schools should be tested to learn whether they are associated with greater employment opportunities and better economic functioning in adulthood.

Who is Using Emergency Contraception?: Awareness and Use of Emergency Contraception Among California Women and Teens

Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.

The economic burden of breast cancer in California

This paper estimates the healthcare costs and the value of lost productivity from premature deaths for California women with breast cancer in 2001, with an updated estimate for 2008. Multiple secondary data sources were used to estimate the healthcare cost of breast cancer. Mortality costs were estimated as the product of the number of deaths and the expected value of a woman's future earnings. The total economic cost of breast cancer in California was $1.43 billion in 2001, or $1.91 billion in 2008 dollars. Breast cancer is costly both in terms of healthcare dollars and the value of lost lives. Regular screening and access to treatment for all women will allow the disease to be diagnosed earlier, the prognosis improved, and the economic burden reduced.

Women's childhood and adult adverse experiences, mental health, and binge drinking: the California Women's Health Survey.

BackgroundThis study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.Materials and methodsData were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.ResultsThe prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood.ConclusionIdentifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.