Central Pennsylvania Women Research Articles

Perceptions of firearms in a cohort of women exposed to intimate partner violence (IPV) in Central Pennsylvania

BackgroundAlmost one-half of U.S. women will experience intimate partner violence (IPV), defined as physical, sexual, or psychological harm by a current or former partner. IPV is associated with an increased risk of homicide, with firearms as the most commonly used weapon. We designed this study to better understand the correlation of interpersonal trauma exposures and demographic factors on firearm perceptions among a cohort of IPV-exposed women.MethodsTwo hundred sixty-seven women in central Pennsylvania with exposure to IPV were surveyed about perceptions of gun access, safety, and gun presence in the home. Trauma variables included IPV type, IPV recency, unwanted sexual exposure, and adverse childhood experiences (ACEs). Multivariable analyses examined three questions examining firearm perceptions controlling for trauma exposures and demographics.ResultsEase of firearm acquisition: Women who were older (mean 44.92 years +/− SD 12.05), compared to women who were younger (40.91 +/− SD 11.81 years) were more likely to describe it as easy or very easy to acquire a gun (aOR 1.05, 95%CI 1.004, 1.10).Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gun nearby (aOR 0.31, 95%CI 0.14, 0.67).Odds of guns in the home: Women who were divorced or separated (aOR 0.22, 95%CI 0.09, 0.54), women were widowed or single (aOR0.23, 95%CI 0.08, 0.67), and women who were partnered (aOR 0.45 95%CI 0.20, 0.97) had lower odds of having a gun in the home, compared to married women. There was no significant effect of the trauma variables on the odds of having a gun at home.ConclusionsWomen with more severe childhood trauma felt less safe around firearms, but trauma exposures did not predict the perception of gun prevalence in the local community or gun ownership. Instead, demographic factors of marriage predicted presence of a gun in the home.

Breast Cancer Surgery Decision-Making and African-American Women.

Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

Barriers to colorectal cancer screening among women in rural central Pennsylvania: Primary care physicians' perspective

Colorectal cancer (CRC) is the third leading cause of death among women in the USA. Rural populations have lower rates of CRC screening than their urban counterparts, and rural women have lower screening rates compared with rural men. The purpose of this qualitative study was to identify (1) beliefs of primary care physicians (PCPs) about CRC screening in rural communities, (2) factors that may cause gender disparities in CRC screening in rural areas, and (3) solutions to overcome those barriers. Semi-structured interviews were conducted with 17 PCPs practicing in rural central Pennsylvania. PCPs were asked about their CRC screening practices for women, availability of CRC screening services, reminder systems for CRC screening, and barriers to screening specific to their rural communities and to gender. Thematic analysis was used to identify major themes. All 17 PCPs endorsed the importance of CRC screening, but believed that there are barriers to CRC screening specific to women and to rural location. All PCPs identified colonoscopy as their screening method of choice, and generally reported that access to colonoscopy services in their rural areas was not a significant barrier. Barriers to CRC screening for women in rural communities were related to (1) PCPs' CRC screening practices, (2) gender-specific barriers to CRC screening, (3) patient-related barriers, (4) community-related barriers, and (5) physician practice-related barriers. Physicians overwhelmingly identified patient education as necessary for improving CRC screening in their rural communities, but believed that education would have to come from a source outside the rural primary care office due to lack of resources, personnel, and time. Overall, the PCPs in this study were motivated to identify ways to improve their ability to engage more eligible patients in CRC screening. These findings suggest several interventions to potentially improve CRC screening for women in rural areas, including encouraging use of other effective CRC screening modalities (eg fecal occult blood testing) when colonoscopy is not possible, systems-based reminders that leverage electronic resources and are not visit-dependent, and public health education campaigns aimed specifically at women in rural communities.

Prospective Association of Intimate Partner Violence with Receipt of Clinical Preventive Services in Women of Reproductive Age

BackgroundWomen who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services. MethodsWomen in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004–2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates. FindingsWomen exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25–4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41–4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist. ConclusionOverall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.

Overweight and Obesity in the Reproductive-Age Population of the Central Pennsylvania Women’s Health Study

Over 54% of currently non-pregnant women aged 18-45 in Central Pennsylvania are overweight or obese. To examine the overall health effects in women, the Central Pennsylvania Women’s Health Study (CePAWHS) had 2,002 women aged 18-45 complete a Random Digit Dial (RDD) general population telephone interview on their health status and health risk indicators for adverse pregnancy outcomes. This study of the CePAWHS population examined the correlates of overweight and obesity in a unique sample of reproductive-age women. The survey measured a large number of health-related variables including pregnancy history. This study also considered whether the definition of obesity affects the identification of correlates. Telephone interview participants were categorized as normal overweight or obese according to the BMI index and analyzed as BMI continuous. ANOVA and Chi-square tests were used to examine differences between BMI continuous and categorical variables. Odds ratios from logistic regression models and linear regression from ANCOVA were used to examine cross-sectional associations of the BMI continuous and categorical. Of the population, 27% were overweight and 25% obese using the BMI index and had a mean BMI of 26.99 ± 6.95. Other variables analyzed included environmental factors, pregnancy outcomes, and health habits and conditions. This research found that obesity in reproductive-age women is associated with a variety of environmental and health-related factors.

Prospective association between body mass index and receipt of preventive services: Results from the Central Pennsylvania Women's Health Study (CePAWHS)

ObjectiveWe examine whether overweight and obesity are associated with disparities in clinical preventive services receipt in a unique, prospective, population-based cohort of reproductive-age women. MethodWe used data from the Central Pennsylvania Women's Health Study (CePAWHS) longitudinal survey of women ages 18–45. The baseline random-digit-dial telephone survey was conducted in 2004–2005 and a second telephone interview two years later; 1342 participants comprised the analytic sample. Dependent variables were seven preventive services identified at follow-up. In addition to baseline body mass index (BMI) category, independent variables were selected based on the behavioral model of health services utilization. ResultsForty-six percent of the sample was classified as normal weight, 28% as overweight, and 26% as obese. In adjusted analyses, women who were overweight and obese, compared to women with normal weight, were more likely to receive preventive counseling for diet/nutrition, physical activity, and weight management (p<0.01). Overweight and obese women received more cholesterol and diabetes screening (p<0.05 and p<0.01, respectively). However, there were no differences by BMI category in receipt of Pap testing or reproductive counseling. ConclusionOverall, we found that women with overweight and obesity were more likely to receive preventive services, especially services relevant for overweight and obese populations.

Multilevel Analysis of the Determinants of Receipt of Clinical Preventive Services among Reproductive-Age Women

BackgroundWe investigated the impact of individual- and county-level contextual variables on women’s receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities. MethodsOutcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004–2005) were appended to prospective survey data from the Central Pennsylvania Women’s Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women’s preventive care. Multilevel analyses were performed. ResultsWe found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations. ConclusionsWomen’s receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women’s receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.

Improving Women’s Preconceptional Health: Long-Term Effects of the Strong Healthy Women Behavior Change Intervention in the Central Pennsylvania Women’s Health Study

Purpose To investigate the long-term (6- and 12-month) effects of the Strong Healthy Women intervention on health-related behaviors, weight and body mass index (BMI), and weight gain during pregnancy. Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women designed to modify key risk factors for adverse pregnancy outcomes; pretest–posttest findings from a randomized, controlled trial have been previously reported. The following questions are addressed: 1) were significant pretest–posttest changes in health-related behaviors (previously reported) maintained over the 12-month follow-up period; 2) did the intervention impact weight and BMI over the 12-month follow-up period; and 3) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period? Methods Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention ( n = 362) and from birth records for singleton births ( n = 45) during the 12-month follow-up period. Repeated measures regression was used to evaluate intervention effects. Main Findings At the 12-month follow-up, participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI. The intervention’s effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up. Among those who gave birth to singletons during the follow-up period, women who participated in the intervention had lower average pregnancy weight gain compared with controls. Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity, the adjusted means show a trend toward lower weight gain in the intervention group. Conclusion These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome, weight gain during pregnancy. Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy, it may be an effective obesity prevention strategy for women before, during, and after the transition to motherhood.

Transition to overweight or obesity among women of reproductive age.

Nearly two thirds of reproductive-aged women in the United States are currently overweight or obese, placing them at elevated risk for adverse health outcomes. This study identifies factors associated with transition in body mass index (BMI) category to overweight or obesity status over a 2-year period among women of reproductive age. Data were collected in the Central Pennsylvania Women's Health Study (CePAWHS), a longitudinal cohort study of reproductive-aged women. Participants were 689 women with normal or overweight BMI at baseline who were not pregnant at either baseline or 2-year follow-up. Separate multiple logistic regression analyses were estimated to model adverse change in weight category for women who were normal weight at baseline and to model transition to obesity among women who were overweight at baseline. Among women of normal weight at baseline, 18% became overweight or obese by follow-up; 25% of women overweight at baseline became obese. In multiple regression analyses, low physical activity at baseline was significantly associated with a 2-fold elevation in the odds of transitioning from normal BMI to overweight/obesity (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.06-4.20), as was having an interim live birth (OR 2.75, 95%CI 1.27-5.95). In contrast, demographics (lower education, younger age) were the only significant predictors of transition from overweight to obesity. Meeting physical activity guidelines should be encouraged among normal weight women of reproductive age as well as those who are overweight or obese, as low physical activity is a risk for transitioning from normal to overweight status. Younger overweight women are particularly at risk for transition to obesity.

The Moderating Influence of Asthma Diagnosis on Biobehavioral Health Characteristics of Women of Reproductive Age

Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women's Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18-45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.

Receipt of preventive counseling among reproductive-aged women in rural and urban communities

Preventive health interventions often occur less frequently among rural women compared to urban women. Preventive counseling is an important feature of comprehensive preventive healthcare provision, but geographic disparities in the receipt of preventive counseling services have not been fully described. In this study the framework of the behavioral model of healthcare utilization was employed to investigate the association between rurality and receiving preventive counseling. It was hypothesized that demographic differences in rural and urban communities, as well as differential healthcare resources, explain rural-urban healthcare disparities in preventive counseling. Data were collected by telephone survey during 2004-2005 for 2002 participants aged 18-45 years in the Central Pennsylvania Women's Health Study. Measures of preventive counseling were based on US Preventive Services Task Force recommendations as of 2004. Multivariable models assessed the independent contribution of rurality to the receipt of counseling for smoking, alcohol/drug use, birth control, nutrition, weight management, and physical activity. Rurality was assessed using Rural-Urban Community Area Codes. All models controlled for variables that predispose individuals to use health services (age, race/ethnicity, educational level), variables that enable or impede healthcare access (having a usual healthcare provider, using an obstetrician-gynecologist, poverty, and continuous health insurance coverage) and need-based variables (health behaviors and indicators). In bivariate analysis, the rural population was older, had lower educational attainment, and was more likely to be White, non-Hispanic. Urban women tended to report seeing an obstetrician-gynecologist more frequently, and engaged more frequently in binge drinking/drug use. Preventive counseling was low among both rural and urban women, and ranged from 12% of the population for alcohol/drug use counseling, to 37% for diet or nutrition counseling. The degree of rurality appeared to impact counseling, with women in small or isolated rural areas significantly less likely than urban women and women in large rural areas to receive counseling related to smoking, alcohol/drug use and birth control. Overall, rural women reported less counseling for alcohol/drug use, smoking, birth control, nutrition and physical activity. In multivariable analysis, rurality was independently associated with lack of preventive counseling for physical activity. However, adjusting for predisposing, enabling and need-based variables fully attenuated the effect of rurality in the remaining models. Younger age, higher educational attainment, and seeing any obstetrician-gynecologist were associated with receipt of counseling in several models. Most women do not receive recommended preventive counseling. While rural women are less likely than urban women to receive counseling, rurality generally was not independently associated with receipt of counseling once demographics, access to health care, and health behaviors and indicators were controlled. This suggests that both demographic differences between rural and urban communities as well as aspects of healthcare access govern rural-urban healthcare disparities in preventive counseling. These results speak to important targets for reducing urban-rural healthcare disparities in receiving preventive counseling, improving the health literacy of the rural population, educating rural healthcare providers about the need for preventive counseling, and the expansion of access to obstetrician-gynecologists in rural communities.

Preconception Predictors of Weight Gain During Pregnancy: Prospective Findings from the Central Pennsylvania Women's Health Study

We examined preconception (prepregnancy) predictors of pregnancy weight gain and weight gain that exceeds the 2009 Institute of Medicine (IOM) recommendations based on pre-pregnancy body mass index (BMI), in a prospective study. Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2 years later. The analytic sample includes 103 women who were not pregnant at baseline and gave birth to full-term singletons during the follow-up period. Preconception maternal weight category as well as health behaviors, psychosocial stress, parity, and age were examined as predictors of pregnancy weight gain and of weight gain in excess of the IOM recommendations using multiple linear and logistic regression analysis. Pregnancy weight gain averaged 33.01 pounds, with 51% of women gaining weight in excess of the 2009 IOM recommendations for their preconception weight category. Preconception overweight (BMI = 25-29.9) increased the odds of excessive pregnancy weight gain nearly threefold, whereas preconception physical activity levels meeting activity guidelines reduced the odds of excessive weight gain but was marginally statistically significant. Although future research examining the role of physical activity in relation to pregnancy weight gain is needed, preconception overweight and physical activity levels are prime targets for interventions to avoid excessive pregnancy weight gain.

Folic Acid Supplementation in Younger and Older Nonpregnant Women of Reproductive Age: Findings from the Central Pennsylvania Women's Health Study (CePAWHS)

This study explores variables associated with daily folic acid supplementation among nonpregnant women ages 18-24, in comparison with women ages 25-45. Health-related behaviors, reproductive status, health care access, and sociodemographic variables are included. Data are from a cross-sectional population-based survey of 2,002 women ages 18-45 in the Central Pennsylvania Women's Health Study. The analytic sample included 246 women ages 18-24 and 1,636 women ages 25-45 who were not pregnant at the time of survey. Seventeen percent of women ages 18-24 and 27% of women ages 24-45 used daily folic acid supplements. In multiple logistic regression analysis, folic acid use was significantly associated with only two variables among younger women: fruit consumption at least daily and regular physical activity levels meeting recommended guidelines. Among older women, folic acid use was associated with these same two health-related behaviors in addition to not smoking, seeing an obstetrician-gynecologist, receiving diet/nutrition counseling, being married or living with a partner, and no prior pregnancy. Folic acid use was not associated with pregnancy intention in either age group. Women ages 18-24 have significantly lower rates of folic acid supplementation compared with older women of reproductive age, but fewer variables are associated with folic acid use among younger women. Missed opportunities to educate younger women about the benefits of folic acid supplementation are identified.

Preconception Predictors of Birth Outcomes: Prospective Findings from the Central Pennsylvania Women’s Health Study

To examine maternal pre-pregnancy (preconception) predictors of birthweight and fetal growth for singleton live births occurring over a 2-year period in a prospective study. Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2-years later; self-report data and birth records were obtained for incident live births during the followup period. The analytic sample includes 116 singleton births. Baseline preconception maternal health status and health-related behaviors were examined as predictors of birthweight and fetal growth, controlling for prenatal and sociodemographic variables, using multiple regression analysis. Preconception BMI (overweight or obese) and vegetable consumption (at least one serving per day) had statistically significant independent and positive effects on birthweight and fetal growth. Maternal weight gain during pregnancy, a prenatal variable, was an additional independent predictor of birthweight and fetal growth. Sociodemographic variables were not significant predictors after controlling for preconception and prenatal maternal characteristics. Findings confirm that preconception maternal health status and health-related behaviors can affect birthweight and fetal growth independent of prenatal and socioeconomic variables. Implications for preconception care are discussed.

Predicting Pregnancy from Pregnancy Intentions: Prospective Findings from the Central Pennsylvania Women's Health Study (CePAWHS)

We examined whether adult women's intention for future pregnancy predicted actual pregnancies occurring in a 2-year follow-up study. Data are from the Central Pennsylvania Women's Health Study population-based longitudinal survey of women ages 18-45 (n = 1,420). The analytic sample consists of 889 nonpregnant women who had reproductive capacity. Intention for future pregnancy was ascertained at baseline, and women were re-interviewed 2 years later to document interval pregnancies. The impact of pregnancy intention on subsequent pregnancy was analyzed using multiple logistic regression adjusting for relevant covariates. At baseline, 46% of women were considering a future pregnancy. One hundred thirty-seven women became pregnant during the 2-year study; of these pregnancies, 83% were intended (occurring in women considering a future pregnancy at baseline) and 17% were unintended (occurring in women not considering a future pregnancy at baseline). Pregnancies occurred in 28% of women who at baseline were considering future pregnancy and 5% of women not considering pregnancy. In adjusted analysis, baseline pregnancy intention was predictive of with pregnancy occurrence in women ages 25-34 (adjusted odds ratio [OR], 4.19; 95% confidence interval [CI], 2.20-7.97) and ages 35-45 (adjusted OR, 26.89; 95% CI, 9.05-79.93), but not in women ages 18-24. In this prospective study, pregnancy intention was strongly associated with pregnancy incidence over a 2-year follow-up period among women ages 25 and older, suggesting that pregnancy intentions could be used to identify women at greater risk of pregnancy. Future investigation is needed to confirm these findings and to explore the reasons why pregnancy intentions were not predictive for women ages 18-24.

Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women’s Health Study Cohort

Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes. Analyses are based on data from a population-based cohort study of women ages 18-45 residing in Central Pennsylvania. A subsample of 847 non-pregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables. At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied. The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.

Improving Women's Preconceptional Health: Findings from a Randomized Trial of the Strong Healthy Women Intervention in the Central Pennsylvania Women's Health Study

Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest-posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women. Nonpregnant pre- and interconceptional women ages 18-35 were recruited in 15 low-income rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change. Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid. The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions.

Mental Health Status Among Rural Women of Reproductive Age: Findings From the Central Pennsylvania Women’s Health Study

We sought to examine variables associated with mental health among rural women of reproductive age, with particular attention given to rural area type and farm residence. We analyzed data from the Central Pennsylvania Women's Health Study, which included a random-digit-dialed survey of women aged 18 to 45 years. Hierarchical multiple linear and logistic regression models were estimated to predict 3 mental health outcomes: score on a mental health measure, depressive symptoms, and diagnosed depression or anxiety. Mental health outcomes were associated with different factors. Farm residence was associated with higher mental health score, and the most isolated rural residence was associated with less diagnosed depression or anxiety. Elevated psychosocial stress was consistently significant across all models. A key stress modifier, self-esteem, was also consistently significant across models. Other variables associated with 2 of the outcomes were intimate partner violence exposure and affectionate social support. Farm residence may be protective of general mental health for women of reproductive age, and residence in isolated rural areas may decrease access to mental health screening and treatment, resulting in fewer diagnoses of depression or anxiety.

Perceived risk of preterm and low-birthweight birth in the Central Pennsylvania Women's Health Study

Engaging women in preconception prevention may be challenging if at-risk women do not perceive increased risk. This study examined predictors of perceiving increased risk for preterm/low birthweight birth. Using the Central Pennsylvania Women's Health Study, a population-based sample of reproductive-age women, we analyzed whether sociodemographics, health and pregnancy history, health behaviors, attitudes, or health care utilization predicted risk perception of preterm/low-birthweight birth. Of the 645 women analyzed, 157 (24%) estimated their risk of preterm/low-birthweight birth to be very or somewhat likely. Higher perceived risk was associated with being underweight, previous preterm/low-birthweight birth, having a mother with previous preterm/low-birthweight birth, lower perceived severity of preterm/low birthweight, and smoking. Several factors known to predict preterm/low birthweight did influence risk perception in this study, whereas others did not. Further research on how these factors have an impact on participation in preconception care programs is warranted.

Participant Recruitment to a Randomized Trial of a Community-Based Behavioral Intervention for Pre- and Interconceptional Women: Findings From the Central Pennsylvania Women's Health Study

Community-based health studies rely on the ability of researchers to successfully recruit and retain participants from target populations, rather than from clinical settings. Many prior women's health studies have recruited in urban and suburban areas, but rural populations pose specific challenges. We describe the recruitment strategies employed in the Central Pennsylvania Women's Health Study to recruit 692 women in 15 low-income rural communities to a randomized trial of a behavioral intervention for pre- and interconceptional women. The organization of the project is described. Qualitative (e.g., focus groups of local project facilitators) and quantitative methods (e.g., surveys of participants) were used to assess the effectiveness of various recruitment techniques and the characteristics of the final enrolled sample. A triangular recruitment approach was used in 15 communities, which included partnering with local community organizations and use of both active and passive recruitment techniques. The most effective recruitment methods were (1) actively recruiting women in social service and childcare settings, (2) use of a toll-free project telephone number printed on all passive recruitment material, and (3) the combination of passive and active recruitment in educational settings. Together, these methods successfully achieved the recruitment goals: enrolling participants who were more likely to be rural, poor or near poor, non-white, and to have less access to health care than their counterparts residing in the target communities. Successful recruitment of typically hard-to-reach women, such as low-income rural women, is possible through implementation of a triangular recruitment approach in local communities.