Florida Women Research Articles

Abstract C002: The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California

Abstract Introduction: Disparities in healthcare reflect varying access to quality care, and the reception of quality care increases survival. Multiple factors can contribute to disparities in health care. Although the Affordable Care Act (ACA) offered the health disparities reduction by promoting access to equitable and more efficient health care, however there is still a wide gap in healthcare access, quality, and outcomes. One important factor is the lack of Medicaid expansion (ME) in all states of the US. In this study, the effect of ME is compared in California and Florida, the states with and without ME respectively, by looking into hysterectomy procedures (HP) done in these two states. Methods: We used 2009 and 2011 Florida and California State Inpatient Database (SID) of the Healthcare Cost and Utilization Project (HCUP). Our included population (n=3,043,460) were female portion of the database. The outcome variable was hysterectomy identified by ICD-9 codes. Patient-level factors including race/ethnicity, age, insurance type, income level, and other comorbidities were analyzed as explanatory variables. Logistic regression analyses were used to identify independent predictors of hysterectomy. Statistical analysis was conducted using SAS Version 9.4. Results: Among the Florida subjects, highest rate of HP is observed in Caucasian women (57.26%) followed by black women (21.85%). Also, the likelihood of HP is increased in women who are age 36-45 (39.83%) followed by age 46-55 (34.95%), and belong to the 1st and 2nd income levels (49.51%). Among the California subjects, highest rate of HP is in Caucasian women (52.35%) followed by Hispanics (29.09%), and women age 46-55 (39.69%) followed by age 36-45 (36.31%), and belong to 2nd and 3rd income levels (51.13%). Logistic regression analysis demonstrates that the odds of hysterectomy had a higher increase in Florida women in 2011 vs. 2009 (OR=1.238, 95% CI: 1.214-1.262), comparing to California (OR=1.124, 95% CI:1.107-1.141) respectively. Also, odds of HP had a higher increase among Florida women during 2011 Vs 2009 in comparison to that of California women. The increased odds were seen among the 2 lowest income levels, and insurance types. Conclusions: We found that likelihood of HP were seen more in Florida than California during years of 2009 and 2011. Also, we observed the reduction of likelihood of HP among California women during 2011 post-ACA when comparing to 2009, due to ME. However, the likelihood of HP was higher in Florida during 2011where the lack ME was a factor. Findings from this study highlights the importance of protective and preventable healthcare access for everyone regardless of races/ethnicities and other socio-economic factors, thus, brings better management of chronic diseases and improves women’s health at large. The provisions of important structures of ACA, such as Medicaid expansion, and health insurance exchange, in all states may reduce the health disparity among Medicaid holders, and self-pay patients. Citation Format: Zahra Bahrani-Mostafavi, Susan Rucker. The effect of ACA and Medicaid expansion on hysterectomy procedures among women in Florida and California [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C002.

Abstract P3-14-14: A mediation analysis of racial disparity in breast cancer survival

Abstract Introduction: Non-Hispanic Black (African American, AA) women have the worst breast cancer outcomes of any racial/ethnic group. In comparison to non-Hispanic white (white) women, disparities in breast cancer survival for AA women have persisted over the past several decades, although there has been some recent improvement both at the national level and for AA women in Florida. However, we recently reported that AA women in Florida still have twice the rate of breast cancer death compared to their white counterparts. Therefore, more targeted approaches are needed to eliminate survival disparities for AA women diagnosed with breast cancer. The purpose of this study was to conduct a multiple mediation analysis to identify the most important factors causing the disparity in breast cancer survival for AA women. Identifying the most important mediators will provide opportunities for targeted policies, programs, and interventions to ultimately eliminate the prognostic effect of race/ethnicity for Florida women diagnosed with breast cancer. Methods: The study population is comprised of women in Florida diagnosed with breast cancer between 2004 and 2015 who were reported to the Florida Cancer Data System. The following putative mediators were analyzed in this study: residence in high poverty neighborhoods, having Medicaid or no insurance, advanced disease stage at diagnosis, high tumor grade, negative hormone receptor status, and receipt of surgery, based on our causal diagram. The outcome of interest was 5-year breast cancer-specific death. Sociodemographic and clinical characteristics were compared between African American and white women. The Cox model was used to obtain hazard ratios (HR) with 95% confidence intervals (CI) for the direct effect of AA race/ethnicity and indirect effects via mediators. Age was treated as a confounder in the model and mediators were treated as independent. The relative effect for African American ethnicity and each mediator, which is the percentage of the total effect of AA race/ethnicity explained (directly and indirectly) on breast cancer survival, are also provided. Results: African American women were more likely to be younger at diagnosis, living in high poverty neighborhoods, to be insured via Medicaid or uninsured, to have more advanced disease (stage, grade) with hormone receptor negative tumors, and less likely to receive surgery as treatment. From our mediation model, after accounting for all potential mediators, the direct effect associated with African American ethnicity was a 17% (HR = 1.17: 95% CI, 1.11-1.23) increased rate of breast cancer death, which represented 3.9% of the total racial/ethnic effect. The indirect and relative effects of mediators are provided in Table 1. Conclusions: This analysis identified receipt of surgery, advanced disease stage, hormone receptor negative disease, insurance status, and high tumor grade as the most important mediators of the racial/ethnic disparity in breast cancer survival for African American women in Florida. These results have ramifications for increasing access to screening services, providing options for health insurance, and ensuring prompt receipt of curative surgery to eliminate the prognostic effect of race/ethnicity for African American women diagnosed with breast cancer in the Florida. Study limitations are that these results are hypothesis generating based on the current status of methodology to examine multiple mediators in survival models. Table 1.Direct and Indirect Effects for the Association of African American Race/Ethnicity with 5-year Breast Cancer-Specific SurvivalDirect & indirect effectsCox Proportional Hazard ModelHR95%. CIrel effAA race/ethnicity (Direct Effect)1.171.11, 1.233.9%Surgery3.182.93, 3.4728.3%Advanced stage3.092.84, 3.3627.5%Hormone receptor negative1.581.51, 1.6511.1%Medicaid-Uninsured1.481.40, 1.579.6%High grade1.471.42, 1.539.4%High poverty1.341.23, 1.477.2%Hormone treatment1.111.09, 1.142.5%Immunotherapy1.081.02, 1.151.9%Radiation1.041.03, 1.051.0%Chemotherapy0.910.89, 0.92Total Effect60.1050.8, 71.1100.0%Abbreviations: AA, African American; HR, hazard ratio; CI, confidence interval. Citation Format: Robert B. Hines, Xiang Zhu, Eunkyung Lee, Carolyn Rapp, Albert Volk, Asal M. Johnson. A mediation analysis of racial disparity in breast cancer survival [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-14.

Loneliness Progression Among Older Adults During the Early Phase of the COVID-19 Pandemic in the United States and Canada.

ObjectivesOlder adults are at high risk for complications from coronavirus disease 2019 (COVID-19). Health guidelines recommend limiting physical contact during the pandemic, drastically reducing opportunities for in-person social exchange. Older adults are also susceptible to negative consequences from loneliness, and the COVID-19 pandemic has likely exacerbated this age-related vulnerability.MethodsIn 107 community-dwelling older individuals (65–90 years, 70.5% female) from Florida, the United States, and Ontario, Canada, we examined change in loneliness over the course of the pandemic after implementation of COVID-19-related physical distancing guidelines (March–September 2020; T1–T5; biweekly concurrent self-report) using multilevel modeling. We also explored gender differences in loneliness during the early phase of the COVID-19 pandemic at both data collection sites.ResultsConsistent across the 2 sites, levels of loneliness remained stable over time for the full sample (T1–T5). However, our exploratory moderation analysis suggested gender differences in the trajectory of loneliness between the United States and Canada, in that older men in Florida and older women in Ontario reported an increase in loneliness over time.DiscussionLeveraging a longitudinal, binational data set collected during the early phase of the COVID-19 pandemic, this study advances understanding of stability and change in loneliness among a North American sample of individuals aged 65 and older faced with the unique challenges of social isolation. These results can inform public health policy in anticipation of future pandemics and highlight the need for targeted intervention to address acute loneliness among older populations.

That Swimsuit Reveals You: Body Image and Bathing Suits of Florida Women

Swimsuits are the most revealing garment that American women wear publicly. Yet wearing them affects how women feel about their bodies and attractiveness. Quantitative and qualitative data were collected from convenience samples of Florida women and analyzed in terms of five strata: Competitors (competitive swimmers, beauty-pageant contestants, swimsuit models); College students (Afro-Caribbean, Asian, Black/Afro-American, Hispanic, White); and Adult women (North Florida Black and White; South-Beach Hispanic, and pregnant, as well as older women (doing water aerobics). Anthropometric data (BMI, waist circumference, waist-hip ratios, and bust-waist ratios) were collected and related to Figure Rating Scales and body descriptors, preferred and actual body shapes and sizes, and swimwear types and usage by situations (one-piece, two-piece, bikini, and thong worn in the presence of family and friends or on the beach and in private). Results, matching the literature show participants: (1) overestimate their body size and shape discrepancy from cultural ideals; (2) are affected by the media-depicting “thin ideal. Details of swimwear usage show that for Black and some Hispanic women, constructions of attractiveness are changed to laud larger size to mediate body dissatisfaction and enhance swimsuit use. For Asian women, conservative values rather than body size affect swimsuit usage. But even competitors who enjoy the benefits of swimsuits, as well as women of all ages (body-dissatisfaction continues throughout the lifespan) and ethnic/racial groups, still express body dissatisfaction.

Abstract 13510: Impact of Adverse Pregnancy Outcomes on Indication for Lipid Therapy in Women

Introduction: Lifetime risk for cardiovascular disease (CVD) is higher in women who experience adverse pregnancy outcomes (APOs) including pre-eclampsia, preterm birth, gestational hypertension, and gestational diabetes. APOs are risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD) in contemporary cholesterol guidelines. Hypothesis: History of APOs impacts consideration for lipid therapy in a significant proportion of women with borderline to intermediate CVD risk . Methods: A single center retrospective chart review of new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019 was performed. New female patients were routinely screened for pregnancy history with an obstetrics questionnaire, and cardiovascular history and lipid profiles were collected where available. Patients were stratified by age and calculated 10-yr risk of a cardiovascular event using the ACC/AHA Pooled Cohort Equation. APO history within age and risk categories in addition to pregnancy history documentation in electronic health records were then assessed. Results: Of the 182 new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019, average age was 49 years old and 71.3% were Caucasian. 25% of the study population had history of APO, and of patients with history of APO, only 55% had documented lipid profiles, 46% had pregnancy history documented in the obstetrics section of the electronic health record, and 17% had pregnancy history documented in their past medical history section. For patients aged 40-75 y/o with borderline-intermediate 10-yr CV event risk, risk-enhancing factors influenced consideration of potential statin therapy, with 20% of patients in the intermediate risk group having history of APO. Conclusions: Pregnancy history impacts potential statin therapy in a significant percentage of women aged 40-75 y/o with borderline-intermediate 10-yr ASCVD risk. However, APOs are often under-recognized and poorly documented as non-traditional CVD risk factors in women. Efforts to improve recognition of APOs in clinical practice should be promoted to improve CVD risk reduction efforts, particularly in young women.

Abstract 3343: The Florida women’s cancer study: Breast cancer presentation among African American and Afro Caribbean women in south Florida, a 10-year cohort

Abstract Introduction: The Black population in the US constitutes about 4 million immigrants. Of this, 50% is from the Caribbean region. Jamaica is the largest contributing country, followed by Haiti and Trinidad and Tobago. Florida has the second largest Caribbean population in the USA. Breast cancer is the main cause of cancer death among females responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Little is known about the molecular subtypes of breast cancer and the demographics of Black Caribbean Immigrants. Objectives: Study the demographics of BC patients in the African diaspora, determine similarities and differences in cause, subtype and outcome of women with breast cancers in African American (AA) and Afro-Caribbean (AC) immigrants. Methods: Approved by the Ethics Committee of the University of Miami IRB. Patients treated for breast cancer between 2006 to 2016 were included. Abstracted data included sociodemographic factors, genetic testing results, and treatment histories. Results: A retrospective US-based cohort of 1369 women (self-identified as black), diagnosed with BC - the Florida Women’s Cancer Study (FLWCS), at Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital in Florida. This cohort contains data from 624 (46%) African-American (AA) women and 507 (37%) AC women diagnosed with breast cancer between 2006-2016. Ninety per cent (n=1232) of the cohort is of non-Hispanic ethnicity.FLWCS country distribution includes is composed of Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States (Antigua, St. Kitts and Nevis, Anguilla, Dominica, St. Lucia and Grenada) at 2.5%. ACwomen living in Miami were diagnosed at a younger age (53.7 years versus 54.9 years), than AA women.Twenty-eight percent of the AA women were premenopausal compared with 32% of the AC women. The AA women had a higher BMI, 32.1 vs 29.8 (p=0.0001), a lower proportion of HER2 positive breast cancer of 17.6% versus 23% (p=0.027), and more children 3.1 versus 2.8 (p=0.023), than the AC women. The rate of HER2 overexpression in the Caucasian population is12% while HER2 positivity was seen in 26.2% Jamaican women, 25.8% in Haitian women and 26.5% in Cuban women (p=0.043) respectively. Less than 5% of the cohort underwent genetic testing with less than 1% having a pathogenic germline mutation. Conclusion: African American (AA) and AC women have many similarities there are significant differences in terms of ancestral diversity, inherited genetic mutations, environmental exposures and access to medical care. Thus, it is imperative to gain an understanding of the causes of cancer in AC women in their own countries in order to better serve those immigrant populations once they reach the US. Citation Format: Priscila Barreto Coelho, Matthew Schlumbrecht, Danielle Cerbon, Carlos Parra, Judith Hurley, Sophia George. The Florida women’s cancer study: Breast cancer presentation among African American and Afro Caribbean women in south Florida, a 10-year cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3343.

Prevalence of epithelial abnormalities and high-risk human papilloma virus in cervicovaginal Pap smears of population subgroups as a guide toward evidence-based best practice.

The 2012 American Society for Colposcopy and Cervical Pathology Consensus Guidelines provide information for managing abnormal cervical cancer screening tests and cancer precursors. According to these guidelines for Pap smear diagnosis of Atypical squamous cells of undetermined significance, reflex high risk (HR) human papilloma virus (HPV) genotyping is required among women 21 years of age or older. Whereas, in women of 30 to 65 years of age, HR-HPV can be ordered by the clinicians as part of co-testing with any diagnosis and every 5 years with a negative Cervico-Vaginal Pap test (CVPT). A retrospective review of the CoPath database of the Pathology Department at the University of Florida, College of Medicine Jacksonville, FL, was performed to identify North Florida (NF) women who underwent CVPT and HR-HPV testing between 2006 and 2014. The women were stratified by race and age, respectively. The study included 19,933 CVPTs. Significant differences in the outcomes' distributions were found among age and race groups, respectively. Highest prevalence of HPV positivity was found in African American women, and in 14- to 20-year-old women, respectively. Twenty- to 30-year-old women had the highest percentage (59%) of epithelial abnormality. The most common HR-HPV genotypic distribution was other HR-HPV. This study underscores the importance of using both HR-HPV and CVPT for screening for cervical cancer, and confirms the need for special focus on managing high-risk populations subgroups, such as African American women, and women of ages 14 to 20 years especially in high-risk populations.

A Forgotten Front: Florida During the Civil War Era ed. by Seth A. Weitz and Jonathan C. Sheppard

Reviewed by: A Forgotten Front: Florida During the Civil War Era ed. by Seth A. Weitz and Jonathan C. Sheppard Wesley Moody A Forgotten Front: Florida During the Civil War Era. Edited by Seth A. Weitz and Jonathan C. Sheppard. (Tuscaloosa: University of Alabama Press, 2018. Pp. xii, 258. $39.95, ISBN 978-0-8173-1982-3.) A Forgotten Front: Florida During the Civil War Era is a collection of ten essays about different aspects of Florida and the Civil War. Of the eleven states that seceded, it seems that the least has been written about Florida. Thus, any work on Florida's Civil War history is welcome. The subjects covered in A Forgotten Front seem almost random. It appears that the editors chose the writers first, as opposed to choosing the subject and seeking out the expert. That is not necessarily negative. In this case, it has led to an interesting selection of essays, but this collection should not be the first book anyone interested in Florida's role in the American Civil War should read. The book is not a general overview, as the title leads readers to believe. As with any collection of essays, the quality of contributions varies. R. Boyd Murphree offers an excellent chapter on Governor John Milton and the many problems he faced as the chief executive of a militarily weak and vulnerable state. Seth A. Weitz, one of the coeditors, uses the Compromise of 1850 to explain politics in antebellum Florida. He convincingly argues that it was the compromise that drove Florida's moderates into the camp of the radical Democrats, thus leading to secession. Other chapters, while well written and researched, do not add much to the book. Jonathan C. Sheppard provides a chapter on the Union capture of Amelia Island. This historical event was minor, even by Florida standards. A historian is always loath to say an event is so insignificant as to not warrant further study. However, the editors' choice of such an inconsequential episode for one of the book's few chapters on military history completely downplays the importance of military action in Florida during the Civil War. There were military events in Florida that played a role in the Civil War as a whole. The military actions surrounding Fort Pickens in Pensacola led directly to the outbreak of hostilities at Fort Sumter, just to name one encounter hugely more important than the capture of Amelia Island. Tracy J. Revels's chapter on Florida women could easily have been about any southern state. That the experience of women in Florida during the war was all but the same as in other states is not a criticism, but it is a common observation among historians and makes for an unenlightening chapter. So, too, with Robert A. Taylor's chapter "Florida Hispanics in the Civil War," which seems to be based on little more than going through the old muster rolls looking for Hispanic-sounding names. [End Page 452] The lone chapter dealing with race and Florida court cases is one of the weakest in the book. The entire chapter leads up to the postbellum Florida Supreme Court case Walker v. Gatlin (1867) and brings up the very interesting legal and financial question of whether future Florida governor David S. Walker owed James H. Gatlin money for a slave Walker had purchased prior to the outlawing of slavery. The problem is that the author, Chris Day, uses the case to discuss African Americans' pursuit of freedom and "activism in the courtroom" (p. 155). While it might have had that effect, the case was about money. The Democratic Party of Florida was extremely active in the postwar period in trying to control the freedpeople and make the social system as much as possible as it had been before the war. Day may have picked one of the few things not motivated by race during this period to write about. There are strong chapters. David Nelson, in the concluding chapter, examines how the Civil War and many of the war-related controversies are remembered in Florida. Like with most other southern states, Florida's memory of the Civil War was dominated by what...

Using a Health Literacy Analytic Framework to Explore Zika Virus and Reproductive Health.

Background:The emergence of Zika virus as sexually transmissible and associated with birth defects may affect reproductive planning and contraception use for people in Florida.Objective:This exploratory study employed a health literacy analytic framework to explore knowledge, attitudes, beliefs, and behaviors related to reproductive health in the context of Zika among reproductive-age women and men in Florida.Methods:Reproductive-age people in Florida (N = 40) were interviewed between September and December 2016 about their knowledge, attitudes, beliefs, and behaviors regarding Zika and reproductive health. Thematic analysis using a health literacy framework was employed.Key Results:Participants reported they would use reputable online sources to access Zika information. Whereas participants generally understood Zika outcomes, transmission, and symptoms, they reported hearing more prevention messages on mosquito transmission compared to sexual transmission. Overall, participants reported Zika was not concerning given their appraisal of personal circumstances. Participants were confident they could prevent Zika via sexual transmission despite not following the recommended guidelines. Participants discussed how their understanding of Zika changed their behaviors related to mosquito control but not through sexual transmission.Conclusions:This study illustrated a disconnect between reproductive-age people's understanding of Zika-related prevention information and their reproductive decision-making behavior. Strategies to promote appraisal of risk for sexual transmission of Zika, infection, and unintended pregnancy are needed. [HLRP: Health Literacy Research and Practice. 2018;2(2):e78–e87.]Plain Language Summary:Men and women of reproductive age in Florida may be at risk for Zika virus and related negative health outcomes. This study assessed how Florida men and women find, understand, and evaluate Zika-related health information, and how that applies to their prevention behaviors. This study used health literacy as an analytic framework for an emerging health issue.

Measuring the Storm: Methods of Quantifying Hurricane Exposure with Pregnancy Outcomes

AbstractIncreasing coastal populations and storm intensity may lead to more adverse health effects from tropical storms and hurricanes. Exposure during pregnancy can influence birth outcomes through mechanisms related to healthcare, infrastructure disruption, stress, nutrition, and injury. However, accurate estimation of health effects may be limited by nonspecific exposure definitions that create potential misclassification. The two predominant hurricane exposure assignments are (1) the county of a FEMA presidential disaster declaration; and (2) the specified area within a storm track. The authors propose a third method: meteorological severity of wind speed. Based on the Saffir-Simpson categories, wind speed was examined through binary and quartile comparisons. All three methods of exposure classification were compared by examining the associations with county-level preterm birth and low-birth-weight rates among Florida women who were pregnant during the 2004 hurricane season. The county-level environme...

Trends in Contraceptive Use among Florida Women: Implications for Policies and Programs

Our study objective was to assess changes in effective contraceptive use among women at risk of unintended pregnancy in Florida in 2008 and 2009 compared with 2002 and 2004. Contraceptive use questions were available from Florida's Behavioral Risk Factor Surveillance System (BRFSS) for both periods (n=4,606). Log binomial regression was used with appropriate methods to account for complex sampling in the BRFSS. We examined the change in four effective contraceptive use groups: sterilization, long-acting reversible contraceptive (LARC), short-acting reversible contraceptive (SARC), and barrier methods. Prevalence ratios comparing the two time periods were adjusted by demographic characteristics, employment, insurance status, children at home, poverty level, health behaviors, and health status. No evidence of change was found in sterilization (Adjusted Prevalence Ratio APR=0.96; 95% CI: 0.84-1.10) or SARC (APR=1.01; 95% CI: 0.87-1.18). The overall use of LARC increased and use of barrier methods decreased significantly over the two periods (APR=1.68; 95% CI: 1.09-2.60 and APR=0.77; 95% CI: 0.61-0.98, respectively). Only two population groups experienced significant changes in prevalence in the four use groups over this period. Non-Hispanic White women increased their use of LARC (APR=2.89; 95% CI: 1.58-5.29) and women who have never been married decreased their use of barrier methods (APR=0.51; 95% CI: 0.33-0.77). Contraceptive use in Florida continues to be low overall with some shift towards more effective long-term methods. New efforts are needed to promote and increase family planning practices, which include the use of effective contraceptives.

The Black and White of infant back sleeping and infant bed sharing in Florida, 2004-2005.

Not using the infant back sleep position is an established risk factor for sudden unexpected infant death (SUID). Infant bed sharing may also increase SUID risk, particularly under certain circumstances. Both of these infant sleeping behaviors are disproportionately higher among Black mothers. We explored the relationship between not using the infant back sleeping and infant bed sharing, developed separate risk factor profiles for these behaviors, and identified maternal characteristics contributing to racial differences in their practice. Merged 2004-2005 birth certificate and Pregnancy Risk Assessment Monitoring System data for 2,791 non-Hispanic Black and White Florida women were evaluated using univariable and multivariable analyses to develop risk factor profiles for infrequent back sleeping and frequent bed sharing. Cross-product interaction terms were introduced to identify factors contributing to racial differences. Infrequent back sleeping and frequent bed sharing were reported by two-thirds of Black women and one-third of White women. There was no association between the infant sleeping behaviors when adjusted for race (adjusted odds ratio [aOR], 1.04; 95% CI, 0.83-1.31). The infant sleeping behaviors shared no common independent maternal characteristics. Father acknowledgement on the birth certificate was a strong contributor to racial differences in infrequent back sleeping while breastfeeding, trimester of entry to prenatal care, and maternal depression revealed notable racial differences for bed sharing. Behavior-specific and race-specific public health messages may be an important public health strategy for reducing risky infant sleeping behaviors and decreasing SUIDs.

Exploring Dental Care Misconceptions and Barriers in Pregnancy

Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low-birthweight infants. Little is known about childbearing women's experiences in obtaining dental care. The objective of this study was to explore Florida women's experience of barriers in obtaining dental care before and during their pregnancies. Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face-to-face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women's experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were assessed about the participants' perspectives on obtaining oral health care before and during pregnancy. Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Misconceptions about the appropriateness of oral health care during pregnancy may affect women's access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted.

Grander in Her Daughters: Florida's Women during the Civil War (review)

Grander in Her Daughters: Florida's Women during the Civil War (review)

Grander in Her Daughters: Florida's Women during the Civil War

Grander in Her Daughters: Florida's Women during the Civil War

Grander in Her Daughters: Florida's Women during the Civil War

In 1861 the Philadelphia Inquirer dubbed Florida “‘the smallest tadpole in the dirty pool of secession’” (p. 1), and certainly the state has been neglected in Civil War scholarship. If Florida is sorely absent from general Civil War studies, then women of the state remain almost nonexistent. The only Florida woman who has received attention is Susan Bradford Eppes of Tallahassee, who seems to epitomize the ideals of the southern belle. As Tracy J. Revels points out, however, nothing could be further from the truth. The majority of Florida's women were blacks, poor whites, or yeoman-class crackers. According to Revels, all Florida women were laborers; even the small number of plantation women were “harried matrons” (p. 3). Thus Florida offers a somewhat different picture of the home front—or does it? Despite valiant efforts to present the perspectives of women across race and class, Revels is forced to rely on elite sources. Thus the early chapters retell a story that is familiar to all scholars of the Southern home front. White women offered open expressions of enthusiasm, while privately they spoke of their doubts and fears. Revels argues that Floridian women were losing heart as early as 1862 by which time state funds for needy families were already proving inadequate.

Grander in Her Daughters: Florida's Women During the Civil War

Grander in Her Daughters: Florida's Women During the Civil War

Grander in her daughters: Florida's women during the Civil War

Though the women of Florida suffered Civil War traumas and privations commensurate with women throughout the Confederacy, few of their experiences have become part of the historical record. With Grander in Her Daughters: Florida's Women during the Civil War Tracy J. Revels rescues from neglect these women and the challenges they faced. Drawing largely on primary source discoveries, Revels recounts the experiences of wives and widows, Unionists and secessionists, black female slaves and their plantation mistresses, business owners and refugees. Revels finds that no matter their political allegiance, these women lived dual lives, divided in their loyalties between what they often perceived as the competing interests of their nation and their families. Isolated and largely unsettled, Florida remained a frontier into the middle of the nineteenth century. At the outbreak of hostilities in 1861 many Floridians embraced the Southern cause, and the state contributed more than its just share of manpower to the Confederacy. Revels shows that Florida's women, however, were not of one mind in their reaction to the conflict. Using diaries, letters, contemporary published sources, and an extensive series of United Daughters of the Confederacy scrapbooks, she presents the panorama of war through the eyes of such women. Revels confirms that Florida's white women largely shared in the sisterhood of the Confederacy, supporting the cause by making uniforms, serving as nurses, and raising funds. They took on greater managerial responsibilities on farms and plantations, and they endured hardships and deprivations while awaiting the soldiers' return. Not all of Florida's women were Confederates, however, and Revels brings to light the diversity of the female experience. She demonstrates that slave women grew increasingly resistant to their condition as the war dragged on. Unionist women aided the Federals, free black women found new opportunities for employment, and poor women focused much more on providing for their families than on any cause of a political nature.

Mortality in Florida professional firefighters, 1972 to 1999

Exposure to occupational hazards among firefighters may lead to increased mortality from cancer, lung, or heart disease. Age- and gender-adjusted mortality rates of 34,796 male and 2,017 female Florida professional firefighters between 1972 and 1999 were compared with the Florida general population. One thousand four hundred eleven male and 38 female firefighter deaths with known causes were identified. In male firefighters, mortality due to all causes and most non-malignant diseases was significantly less than expected. There was no excess overall mortality from cancer, but excesses existed for male breast cancer [standardized mortality ratio (SMR = 7.41; 95% confidence interval (CI): 1.99-18.96) and thyroid cancer (SMR = 4.82; 95% CI: 1.30-12.34)]. Mortality from bladder cancer was increased and approached statistical significance (SMR = 1.79; 95% CI: 0.98-3.00). Firefighters certified between 1972 and 1976 had excess mortality from bladder cancer (SMR = 1.95; 95% CI: 1.04-3.33). Female firefighters had similar morality patterns to Florida women except for atherosclerotic heart disease (SMR = 3.85; 95% CI: 1.66-7.58). Excess mortality risk from bladder cancer may be related to occupational exposure during firefighting. The thyroid cancer and breast cancer risk in males, as well as the excess risk of cardiovascular disease mortality noted in females warrant further investigation.

Making Waves: Female Activists in Twentieth-Century Florida

From Ruth Bryan Owen, Florida's first congresswoman, and Mary McLeod Bethune, founder of Bethune-Cookman College, to Betty Mae Tiger Jumper, the first chairwoman of the Seminole Tribe, and Marjory Stoneman Douglas, champion of the Everglades, Making Waves examines the lives and works of women activists who made a significant impact on Florida in the last century. This collection enriches our understanding of the history of modern Florida and the role women played in it. To a degree greater than any other southern state in the 20th century, Florida experienced dramatic economic, political, social, and environmental challenges, and Florida's women were in the forefront of the great social and political responses to those challenges. These 13 essays describe the contributions made by women in urban renewal, civil liberties, civil rights, child welfare, labor unions, education, environmental protection, rural extension work, and women's liberation. By illuminating the involvement of the state's women in many of these fundamental issues, Making Waves provides a long-overdue chapter in Florida history. It will also contribute to the advancement of the study of women's history by examining women's activism in a variety of contexts and illustrating how this activism was often circumscribed by class and racial bias.