Older Minority Women Research Articles

Low economic status is associated with suboptimal intakes of nutritious foods by adults in the National Health and Nutrition Examination Survey 1999-2002

Chronic diseases are the leading cause of death among older Americans. Many of the chronic health conditions that result in the loss of independence, disability, and reduced quality of life in older adults are preventable through healthful lifestyle including proper nutrition. Household income is a major economic factor that impacts food choices and nutritional status of individuals. The study examines the socioeconomic characteristics of adults, 60 years and older, and assesses the correlations between household income and food choices and nutritional status of adults. Adults (n = 2675) in the National Health and Nutrition Examination Survey, 1999 to 2002, were grouped into 1 of the 3 household income categories: low income ( 350% of poverty). Their sociodemographic characteristics and unadjusted mean nutrient and MyPyramid food group intakes were estimated. Multiple regression models were used to control for age and sex variability in mean estimations. Pairwise (t tests) mean comparisons were made among the income groups, at a priori α = .05 level of significance. Survey design effects were used in the analyses. There were 24.9%, 43.0%, and 32.1% adults in low-, medium-, and high-income groups, respectively. Only 77% of low-income adults were fully food-secure. Compared with medium- and high-income groups, the low-income group had a higher proportion of women (66.9%), Hispanics (20.1%) or non-Hispanic blacks (11.4%), adults having less than high-school-level education (34.2%), and adults who were widowed (40.6%) or divorced (12.1%). After controlling for age and sex, low-income adults consumed 526 kJ less than medium-income adults and 1050 kJ less than high-income adults. Lower proportion of low-income adults ate at or above the Adequate Intake or Estimated Average Intake levels for many micronutrients. They ate less fruit, vegetables, milk, meat, poultry, and fish than high-income adults. Older minority women living in low-income households are in urgent need for food assistance and nutrition intervention programs.

Gender-specific care of the patient with diabetes: Review and recommendations

Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have focused almost exclusively on men. The purpose of this review was to survey the literature about the sex-specific features of DM and to make recommendations for the gender-specific care of patients. An initial literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender, women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search terms were included. The strength of each recommendation was assessed. : Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for CAD. Disease management programs for patients with diabetes have been shown to save money and improve outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes available. Gender-specific care of the patient with diabetes should be informed by evidence-based recommendations.

Comparing Participants' Rating and Compendium Coding to Estimate Physical Activity Intensities

This study assessed agreement between participants' rating (PMET) and compendium coding (CMET) of estimating physical activity intensity in a population of older minority women. As part of the Women on the Move study, 224 women completed a 7-day activity diary and wore an accelerometer for 7 days. All activities recorded were coded using PMET and CMET methodologies. MET-mins were computed for total activity in 10 activity dimensions (MET = metabolic equivalent, where 1 MET is the amount of energy expended at rest). Results revealed that correlations between the two methods were high (ranging from .81 to .98) but the means were significantly different (p < .05) for total activity and for 7 of the 10 activity dimensions. In general, MET-mins based on PMET were higher than those based on CMET, and agreement between methods was low (ranging from .26 to .31). Revising the MET values assigned to PMET improved agreement with CMET. Accelerometer MET-mins were significantly associated with total activity for both methods; however, their correlations were low. Agreement with accelerometer MET-mins was low and was similar for revised PMET and CMET. The revised participants' rating provides an alternative method to rank individuals because it provides similar results to the compendium coding; however, neither method accurately estimates accelerometer MET-mins.

Breast cancer screening barriers and mammography completion in older minority women

OBJECTIVES The study tested a behavioral and structural barriers model of breast cancer screening, while seeking to determine age effects of behavioral barriers, in order to identify the factors that inhibit screening among older, minority women. 405 older African-American women eligible for a federally funded cancer screening program were enrolled in the study. Participants were administered an intake questionnaire and followed for 3 months to determine mammography use. Three months after enrollment in the program, 79% had not received breast cancer screening. The oldest cohort had significantly lower rates of mammography (just 16% of screened women were > or = 60, p<0.05). Behavioral barriers (knowledge/information deficits, cancer risk perception, cancer fears) inhibited mammography in the oldest group; their breast cancer information deficits included less knowledge of breast cancer risk, treatment, and survivability (all p<0.001). Older women, with greater breast cancer risk than younger cohorts, should be targeted as a high need population for cancer screening. Even when financial and insurance barriers are removed mammography rates are 1/3 those of women <50. Since failure to be screened is related to knowledge and information barriers, health care providers have the potential to educate their older patients and subsequently increase the likelihood they will have regular cancer screening.

Considering HIV Risk and Intimate Partner Violence Among Older Women of Color: A Descriptive Analysis

ABSTRACT This study describes the types of intimate partner violence (IPV) and sexual HIV-risk factors reported by a sample of 139 African American and Latina women ages 50 and older receiving care in outpatient clinics of an urban medical center. Additionally, we obtained estimates of the associations between experiencing IPV in a primary heterosexual relationship and the following HIV-risk behaviors among our sample of older minority women: (a) having multiple sexual partners, (b) STD history, (c) partner-related risk (i.e., having a partner who has multiple sexual partners, is HIV-infected, injecting drugs, and/or has an STD), and (d) self-perception of risk for HIV infection. Results indicate that many of these women are engaged in sexual risk behaviors, and such behaviors are associated with increased likelihood of IPV for this cohort. Implications for health care professionals are discussed.

Type A behavior and daily living activity among older minority women.

The association between type A behavior pattern (TABP) and physical activity is unclear, with studies reporting both positive and negative results and some reporting no association. Because previous studies have looked primarily at the relationship between TABP and exercise, the purpose of this study was to assess the association between TABP and (1) total activity, (2) activity at work, (3) exercise, (4) household chores, (5) leisure activity, and (6) inactivity. Two hundred twenty-seven women (111 African American, 116 Hispanic) from a larger study (Women on the Move) were used in the analysis for this study. The mean age was 49.3 years (SD 7 years), mean weight 77 kg (SD 17.6 kg), and mean body mass index (BMI) 30 (SD 6.5). As part of the Women on the Move Study, participants completed a 7-day diary and a 10-item Activity Temperament Scale. Multiple regression analysis was conducted to test the relationship between TABP and daily activity. Significant findings were observed for total activity and leisure activity with the Activity Temperament Scale summary score. Both had positive associations, indicating that those who had a higher score on the Activity Temperament Scale also had higher total activity kilocalories (kcal) and leisure activity kilocalories. Significant positive findings were also observed for total activity, leisure activity, and exercise with individual items on the Activity Temperament Scale. Household chores, work, and inactivity had significant negative associations with one or more of the individual items on the Activity Temperament Scale. Although previous studies have reported on TABP and physical activity (primarily exercise), these findings provide new information specific to daily living activity by dimension in an older minority population. Results suggest a positive association between TABP and daily living activity with a general pattern of higher scores associated with higher activity and lower scores associated with higher inactivity. However, even though some significant findings were observed, the overall models did not reveal meaningful associations.

An opiate receptor antagonist, antaxone, influences dopamine system functions in morphine dependent rats

Introduction: Mammography is under-used among older minority women. Identifying differences in their attitudes and beliefs by stage of mammography adoption will guide interventions for these under-studied and under-served women.Methods: A total of 253 older urban women were interviewed, assessing breast cancer knowledge, perceived mammography benefits and barriers, stage of mammography adoption, personal experience with breast cancer, physical and cognitive functioning, smoking status, source and frequency of regular medical care, and demographics. Analyses compared scale scores and individual items by stage of mammography adoption. Multivariate analysis used linear and logistic regression with stepwise model selection.Results: Sample mean age was 72.5 years; 88% were African American. About half (52%) had had a mammogram within the past 2 years (i.e., action stage of mammography adoption). Of the rest, 16% were thinking about having a mammogram in the next 6 months (contemplators) and 32% were not thinking about having a mammogram within 6 months (precontemplators). Knowledge and benefit scores were lowest for precontemplators. Overall barrier scores were highest for precontemplators (P < .001), but contemplators were most likely to worry about finding a lump (P < .05). Lower perceived barriers, provider recommendation, regular medical care somewhere other than a private physician's office, and age <75 years were independently associated with more favorable mammography stage (R2 = .47).Conclusion: Mammography interventions for older urban women should combine provider recommendations with barrier-reducing interventions. Knowledge is associated with mammography contemplation, but barriers may affect whether contemplation leads to action. Precontemplators may need explanation of the rationale for screening; contemplators may need intervention to assuage fears.

Keeping mammography referral appointments: motivation, health beliefs, and access barriers experienced by older minority women

Older women of color tend to have much lower rates of regular mammography screening for breast cancer than younger Caucasian women; yet, they have higher rates of mortality. This study was designed to increase mammography rates among inner-city women aged 50 years or older. Another goal was to investigate differences in mammography utilization related to race/ethnicity and language after barriers associated with cost and the difficulty of making an appointment are removed. A peer delivered intervention, which consisted of interview, mammography referral, and the scheduling of a next-day appointment, was conducted among a convenience sample of 151 culturally and racially diverse older women through a primary care referral project operating within an urban emergency department (ED). A brief motivational interview and mammography referral at the time of an ED visit, including scheduling of a next-day no cost appointment, was followed by a cross-sectional telephone survey of utilization and motivating and hindering factors. Follow-up was achieved with 96 women (66%). Fifty-eight women (60%) had a post-intervention mammogram; of those, 69% were first time users. More than 90% planned a repeat mammogram the following year. Of the 27 who did not receive a mammogram, 21 (77%) requested a “second try” appointment. These findings demonstrate that an interactive intervention among older women of color has the potential to dramatically increase mammography rates.

The older woman: Ethnicity and health

Abstract: This article on minority women populations and health care seeks to address the economic impact of health care for such populations, discuss the scope of the problem surrounding women's health, address the health status of minority older women, identify ethnocultural strategies and nursing implications for the health care of older women from varying ethnic backgrounds, and provide resources to assist health care providers. (Geriatr Nurs 2000;21:183-7)

Ethnic Differences in Patterns of Care of Stage 1A1 and Stage 1A2 Cervical Cancer: A SEER Database Study

Objective. The aim of this study was to evaluate patterns of care for women with Stage 1A1 and 1A2 cervical cancer utilizing the SEER database.Methods. Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age.Results. Three remarkable differences among subgroups were identified. (1) Among women ≥35 years of age, whites were more likely to have Stage 1A1 cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1.05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients ≥35 years of age were more likely to undergo hysterectomy than younger patients both for 1A1 and 1A2 stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel–Haenszel test of independence χ2 = 102.9943, P value < 0.001. (3) Black and Hispanic women ≥35 years of age with 1A2 disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A2 were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A1 patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07.Conclusions. Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A1) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A1 and 1A2 disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A2 cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility-sparing, less definitive procedures than whites.

Differences in the Quality of Housing Units Occupied by Elderly Men versus Elderly Women

Unmet housing needs can be more costly and more hazardous to health and well-being in the case of elderly than in the case of nonelderly, because the elderly in general spend more time in their homes. The purpose of this paper, based on the data from the 1991 wave of the American Housing Survey, is to examine the adequacy/ quality of housing units headed by those aged 65 years or older and to examine factors that would predict poor-quality housing headed by older persons. The findings indicate that housing units occupied by older minority women, especially those living with relatives or with nonrelatives were the most likely to be deficient, whereas those occupied by white older women living alone were the least likely to be deficient. Policy and social service implications of the findings are also discussed.

Mammography Screening for Older Minority Women

This project facilitated access to mammography screening for older ethnic minority women through health education and coordination of service networks for aging and health care services. Health education sessions were held in senior centers, followed by a mammography screening in a mammography van or at a health care facility. Of the participants in the education sessions, 38% received a mammogram. More women who did not obtain a mammogram believed that cancer treatments were worse than the disease. Also, more African American and White women than Hispanic women did not recognize age as a risk factor for cancer Of the Hispanic women, 30% believed that early diagnosis did not make a difference in one's outcome, compared with 20% of White women and 8% of African American women.

Knowledge, perceptions, and mammography stage of adoption among older urban women

Introduction: Mammography is under-used among older minority women. Identifying differences in their attitudes and beliefs by stage of mammography adoption will guide interventions for these under-studied and under-served women. Methods: A total of 253 older urban women were interviewed, assessing breast cancer knowledge, perceived mammography benefits and barriers, stage of mammography adoption, personal experience with breast cancer, physical and cognitive functioning, smoking status, source and frequency of regular medical care, and demographics. Analyses compared scale scores and individual items by stage of mammography adoption. Multivariate analysis used linear and logistic regression with stepwise model selection. Results: Sample mean age was 72.5 years; 88% were African American. About half (52%) had had a mammogram within the past 2 years (i.e., action stage of mammography adoption). Of the rest, 16% were thinking about having a mammogram in the next 6 months (contemplators) and 32% were not thinking about having a mammogram within 6 months (precontemplators). Knowledge and benefit scores were lowest for precontemplators. Overall barrier scores were highest for precontemplators ( P < .001), but contemplators were most likely to worry about finding a lump ( P < .05). Lower perceived barriers, provider recommendation, regular medical care somewhere other than a private physician's office, and age <75 years were independently associated with more favorable mammography stage ( R 2 = .47). Conclusion: Mammography interventions for older urban women should combine provider recommendations with barrier-reducing interventions. Knowledge is associated with mammography contemplation, but barriers may affect whether contemplation leads to action. Precontemplators may need explanation of the rationale for screening; contemplators may need intervention to assuage fears.

Children, adolescents, and older minority women are more likely to be homicide victims than other segments of the population in the United States

Children, adolescents, and older minority women are more likely to be homicide victims than other segments of the population in the United States

Poverty and Health: Older Minority Women and the Rise of the Female-Headed Household

This analysis uses the 1984 Survey on Aging (SOA) supplement to the National Health Interview Survey (NHIS) to compare the relative impacts of poverty and health on the propensity of unmarried older black, Hispanic, and non-Hispanic white women to live with family. The results reveal that for blacks and Hispanics, economics are more significant than health in determining whether a woman lives with her children. Our findings also show that black unmarried elderly females are more likely than similar non-Hispanic white women to head their households. The literature and our findings suggest that black and Hispanic older women have fewer options in living arrangements than non-Hispanic older women in the event of diminished health.