Women Of Higher Socioeconomic Status Research Articles

External validation of SCORE2-Diabetes in the Netherlands across various Socioeconomic levels in native-Dutch and non-Dutch populations.

Adults with type 2 diabetes have an increased risk of cardiovascular events (CVE), the world's leading cause of mortality. The SCORE2-Diabetes model is a tool designed to estimate the 10-year risk of CVE specifically in individuals with type 2 diabetes. However, the performance of such models may vary across different demographic and socioeconomic groups, necessitating validation and assessment in diverse populations. This study aims to externally validate SCORE2-Diabetes and assess its performance across various socioeconomic and migration origins in the Netherlands. We selected adults with type 2 diabetes, aged 40-79 years and without previous CVE from the Extramural LUMC Academic Network (ELAN) primary care data cohort from 2007 to 2023. ELAN data were linked with Statistics Netherlands registry data to obtain information about the country of origin and socioeconomic status (SES). CVE was defined as myocardial infarction, stroke, or CV mortality. Non-CV mortality was considered a competing event. Analyses were stratified by sex, Dutch versus other non-Dutch countries of origin, and quintiles of SES. Of the 26,544 included adults with type 2 diabetes, 2,518 developed CVE. SCORE2-Diabetes showed strong predictive accuracy for CVE in the Dutch population (observed-to-expected ratio (OE)=1.000, 95% CI=0.990-1.008 for men, and OE=1.050, 95% CI=1.042-1.057 for women). For non-Dutch individuals, the model underestimated CVE risk (OE=1.121, 95% CI=1.108-1.131 for men, and OE=1.100, 95% CI=1.092-1.111 for women). The model also underestimated the CVE risk (OE>1) in low SES groups and overestimated the risk (OE<1) in high SES groups. Discrimination was moderate across subgroups with c-indices between 0.6 and 0.7. SCORE2-Diabetes accurately predicted the risk of CVE in the Dutch population. However, it underpredicted the risk of CVE in the low SES groups and non-Dutch origins, while overpredicting the risk in high SES men and women. Additional clinical judgment must be considered when using SCORE2-Diabetes for different SES and countries of origin.

Assessing the Role of Low Body Image as a Risk Factor for developing Addictive Behavior towards Exercise among Regular Exercising Women of Higher Socioeconomic Status

Assessing the Role of Low Body Image as a Risk Factor for developing Addictive Behavior towards Exercise among Regular Exercising Women of Higher Socioeconomic Status

Superwoman Schema and self-rated health in black women: Is socioeconomic status a moderator?

BackgroundThe Superwoman Schema (SWS) construct elucidates Black women's socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. Drawing from intersectionality and social psychological research on self-schemas, this study examined the extent to which SWS was associated with Black women's self-rated health. We also investigated whether socioeconomic status (SES) moderated the association between SWS, its five dimensions, and self-rated health. MethodsData were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women's Health Study, a cohort of African American self-identified women. SWS was assessed using Giscombé’s 35-item Superwoman Schema Scale. Socioeconomic status was measured by household income and educational attainment. Ordered logistic regression models were used and statistical interactions were run to test for moderation (N = 408). ResultsFirst, SWS dimension “obligation to help others” was associated with worse self-rated health (p < .05). Second, household income, but not education, moderated the association between SWS and self-rated health (p < .05): SWS overall was associated with worse self-rated health among higher income women but better self-rated health among lower income women. Third, income moderated the association between SWS dimension “obligation to present an image of strength” and self-rated health (p < .05): presenting strength was associated with better self-rated health for lower income women only. Fourth, moderation results revealed that SWS dimension “obligation to help others” was inversely associated with self-rated health particularly among higher income women. ConclusionsFindings speak to the complex interplay between SES and SWS dimensions as they relate to Black women's perceived health.

Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995-2020 period: A systematic review.

Smoking during pregnancy (SDP) is an important source of preventable morbidity and mortality for both mother and child. The aim of this study was to describe changes in the prevalence of SDP over the last 25 years in developed countries (Human Development Index >0.8 in 2020) and associated social inequalities. A systematic review was conducted based on a search in PubMed, Embase and PsycInfo databases and government sources. Published studies between January 1995 and March 2020, for which the primary outcome was to assess the national prevalence of SDP and the secondary outcome was to describe related socio-economic data were included in the analysis. The selected articles had to be written in English, Spanish, French or Italian. The articles were selected after successive reading of the titles, abstracts and full-length text. An independent double reading with intervention of a third reader in case of disagreement allowed including 35 articles from 14 countries in the analysis. The prevalence of SDP differed across the countries studied despite comparable levels of development. After 2015, the prevalence of SDP ranged between 4.2% in Sweden and 16.6% in France. It was associated with socio-economic factors. The prevalence of SDP slowly decreased over time, but this overall trend masked inequalities within populations. In Canada, France and the United States, the prevalence decreased more rapidly in women of higher socio-economic status, and inequalities in maternal smoking were more marked in these countries. In the other countries, inequalities tended to decrease but remained significant. During pregnancy, that is a period described as a window of opportunity, smoking and social vulnerability factors need to be detected to implement targeted prevention strategies aiming at reducing related social inequalities.

Breast cancer disparities: A literature review of the last five years.

e18686 Background: Breast cancer (BC) disparities are differences in cancer measures. Some of the disparities in BC among Black women and males include but are not limited to the disproportionate high mortality rates impacted by access to screening mammograms, the effect of breast density, access to genetic testing, genetic predisposition to triple-negative BC (TNBC), and other social constructs that prevent obtaining BC screening. We highlight disparities in BC among women of minority and lower socioeconomic status, discuss factors contributing to this racial disparity, and design innovative solutions to address these disparities. Methods: The PRISMA statements were followed for conducting this literature review. A comprehensive staged literature search was performed on PubMed, EMBASE, clinicaltrial.gov, Web of Science, and Cochrane Library, identifying relevant Medical Subject Headings (MeSH) keywords. Two investigators performed an independent literature search using the search terms. A third reviewer resolved conflicts. Articles with a publication date before 2017, those written in languages other than English, and those without data on BC Disparity were excluded. Results: Using the Mesh framework outlined, we accumulated 4125 studies. Studies were further screened for relevance to this project, leading to the inclusion of 35 studies. The literature shows that both non-modifiable and modifiable risk factors contribute to these racial disparities. The expression of cytokines and other chemical messengers in the tumor microenvironment is differential and prevalent in Black women. Furthermore, this tumor microenvironment is impacted by non-genetic risk factors, including obesity, consumption of alcohol and tobacco, and poverty. Another critical component of racial disparities in BC includes the social element of poorer medical care for women in the US. For example, lower breastfeeding rates in Black women are highly influenced by social factors, although it was found that breastfeeding is protective against TNBC. In addition, poor and near-poor women were less likely to receive sentinel lymph node biopsy and radiation after breast-conserving surgery than high socioeconomic-status women. Conclusions: In our study, we highlight how black women have higher mortality rates at any age of diagnosis than white women. It exemplifies the need to advocate for better healthcare for minority women. Precision cancer prevention is the key to addressing BC disparity based on geographic, socioeconomic, and racial factors. Rural healthcare centers in high-risk areas outside the catchment of existing National Cancer Institutes (NCI) can play a vital role in screening and managing BC survivors. We will need a multidisciplinary platform of investigators, including but not limited to internists using digital tools to improve breast cancer education and awareness of primary healthcare providers and community workers.

Psychological distress during pregnancy and adverse maternal and perinatal health outcomes: The role of socioeconomic status.

To study the contribution of socioeconomic status (SES) to the prevalence of psychological distress during pregnancy, and to investigate the association between psychological distress and maternal and perinatal health among different SES groups. This study was embedded in the Generation R study. Multiple self-reported questionnaires were used to measure psychological distress. Prevalence differences between SES groups were tested with the χ2 test. Linear and logistic regression analyses were used to examine the associations between psychological distress and maternal and perinatal health outcomes. Women of low SES experience symptoms of psychopathology distress 4.5 times as often and symptoms of stress 2.5 times as often as women with of high SES. Women of low SES experiencing symptoms of psychopathology are at greater risk of delivering preterm. We also found associations between psychological distress and adverse perinatal health outcomes among women of middle and high SES. The present study shows that the associations between SES, psychological distress, and maternal and perinatal health are complex, but do exist. To provide a better understanding of these associations, it is important to include mental health information in the standard national data collection on pregnant women, as this allows population-based studies.

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

BackgroundPerson-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES.MethodsData are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression.ResultsThe average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals.ConclusionsThe findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

Emergency remote instruction in 2020: Differential impacts on science, technology, engineering, and mathematics students’ confidence and belonging, by gender, race/ethnicity, and socioeconomic status

The COVID-19 pandemic forced higher education into emergency remote instruction in 2020. Impacts of this modality shift on undergraduates of different identities are important to document, for both current students who need support now and future students who may face other crises. A large survey in the United States asked students in science, technology, engineering, and mathematics (STEM) to report the impact of emergency remote instruction on their confidence to succeed and sense of belonging in STEM. Using those data, we find that the impact varies by gender, race/ethnicity, and socioeconomic status (SES). For instance, 63.3% of lower SES women identifying as underrepresented racial/ethnic minorities (URM) reported a decrease in their confidence to succeed, compared to 38.9% of non-URM, higher SES men who reported a decrease. On the other hand, 35.3% of URM, lower SES men reported that emergency remote instruction increased their sense of belonging, compared to 15.9% of non-URM, higher SES women. The large percentage reporting increased belonging was unexpected and adds to calls for more research into the experiences of URM men. Our results suggest researchers, instructors, and administrators working to mitigate shocks to higher education must consider multiple identities and take an intersectional view, because impacts of these crises are not neutral with respect to gender, race/ethnicity, and SES.

Prenatal acute thermophysiological stress and spontaneous preterm birth in Western Australia, 2000-2015: A space-time-stratified case-crossover analysis.

Epidemiologic evidence on acute heat and cold stress and preterm birth (PTB) is inconsistent and based on ambient temperature rather than a thermophysiological index. The aim of this study was to use a spatiotemporal thermophysiological index (Universal Thermal Climate Index, UTCI) to investigate prenatal acute heat and cold stress exposures and spontaneous PTB. We conducted a space-time-stratified case-crossover analysis of 15,576 singleton live births with spontaneous PTB between January 1, 2000 and December 31, 2015 in Western Australia. The association between UTCI and spontaneous PTB was examined with distributed lag nonlinear models and conditional quasi-Poisson regression. Relative to the median UTCI, there was negligible evidence for associations at the lower range of exposures (1st to 25th percentiles). We found positive associations in the 95th and 99th percentiles, which increased with increasing days of heat stress in the first week of delivery. The relative risk (RR) and 95% confidence interval (CI) for the immediate (delivery day) and cumulative short-term (up to six preceding days) exposures to heat stress (99th percentile, 31.2°C) relative to no thermal stress (median UTCI, 13.8°C) were 1.01 (95% CI: 1.01, 1.02) and 1.05 (95% CI: 1.04, 1.06), respectively. Elevated effect estimates for heat stress were observed for the transition season, the year 2005-2009, male infants, women who smoked, unmarried, ≤ 19 years old, non-Caucasians, and high socioeconomic status. Effect estimates for cold stress (1st percentile, 0.7°C) were highest in the transition season, during 2005-2009, and for married, non-Caucasian, and high socioeconomic status women. Acute heat stress was associated with an elevated risk of spontaneous PTB with sociodemographic vulnerability. Cold stress was associated with risk in a few vulnerable subgroups. Awareness and mitigation strategies such as hydration, reducing outdoor activities, affordable heating and cooling systems, and climate change governance may be beneficial. Further studies with the UTCI are required.

Occupational Factors and Socioeconomic Differences in Breast Cancer Risk and Stage at Diagnosis in Swiss Working Women.

Simple SummarySocioeconomic status and occupation affect the risk of breast cancer, the most common cancer in women, but whether the effect is the consequence of work exposure or of socioeconomic status is often difficult to understand. In a Swiss cohort study, these correlated factors were obtained at individual level. Controlling for socioeconomic status, women in high skill occupations and of high socioprofessional level were both at increased risk of breast cancer and at increased chance of an early diagnosis. This finding suggests that socioeconomic status and occupation both contribute to inequalities in breast cancer risk and early detection. Interdisciplinary studies with collection of biological, occupational and behavioural information are needed to further explain the causes of socioprofessional inequalities in risk and subtypes of breast cancer.Socioeconomic differences in breast cancer (BC) incidence are driven by differences in lifestyle, healthcare use and occupational exposure. Women of high socioeconomic status (SES) have a higher risk of BC, which is diagnosed at an earlier stage, than in low SES women. As the respective effects of occupation and SES remain unclear, we examined the relationships between occupation-related variables and BC incidence and stage when considering SES. Female residents of western Switzerland aged 18–65 years in the 1990 or 2000 census, with known occupation, were linked with records of five cancer registries to identify all primary invasive BC diagnosed between 1990 and 2014 in this region. Standardized incidence ratios (SIRs) were computed by occupation using general female population incidence rates, with correction for multiple comparisons. Associations between occupation factors and BC incidence and stage at diagnosis were analysed by negative binomial and multinomial logistic regression models, respectively. The cohort included 381,873 women-years and 8818 malignant BC, with a mean follow-up of 14.7 years. Compared with reference, three occupational groups predominantly associated with a high socioprofessional status had SIRs > 1: legal professionals (SIR = 1.68, 95%CI: 1.27–2.23), social science workers (SIR = 1.29; 95%CI: 1.12–1.49) and some office workers (SIR = 1.14; 95%CI: 1.09–1.20). Conversely, building caretakers and cleaners had a reduced incidence of BC (SIR = 0.69, 95%CI: 0.59–0.81). Gradients in BC risk with skill and socioprofessional levels persisted when accounting for SES. A higher incidence was generally associated with a higher probability of an early-stage BC. Occupation and SES may both contribute to differences in risk and stage at diagnosis of BC.

Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study

BackgroundWhile there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety. MethodsData were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used. ResultsObjective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety. LimitationsParticipants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status. ConclusionsThese findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.

Differences in Psychosocial Protective Factors by Race/Ethnicity and Socioeconomic Status and Their Relationship to Preterm Delivery.

Background: Non-Hispanic Black (“Black”) women in the United States deliver preterm at persistently higher rates than non-Hispanic White (“White”) women, and disparities in preterm delivery (PTD) also exist by socioeconomic factors. Research is needed to identify and understand factors that are protective against PTD for Black women and low socioeconomic status (SES) women.Methods: We examined seven potential protective factors at the individual, interpersonal, and neighborhood levels during pregnancy to determine if they (1) differed in prevalence by race/ethnicity and SES and (2) were associated with risk of PTD overall or within specific race/ethnicity and SES groups. We used prospectively collected data from n = 2474 women who were enrolled in the Pregnancy Outcomes and Community Health Study conducted in Michigan (1998–2004).Results: White women reported higher levels of self-esteem, mastery, perceived social support, instrumental social support, and reciprocity compared to Black women (all p < 0.01), while Black women reported higher levels of religiosity compared to white women (p < 0.01). High SES women reported higher levels of all protective factors compared to middle and low SES women (all p < 0.01). While protective factors were not independently associated with PTD, religiosity was associated with lower odds of PTD among low SES women (OR 0.6, 95% CI 0.4-0.9) and among Black women (OR 0.6, 95% CI 0.4–1.0), respectively.Conclusions: Our findings highlight the importance of assessing how protective factors may operate differently across race/ethnicity and SES to promote healthy pregnancy outcomes. Future studies should examine mechanisms that elucidate potential causal pathways between religiosity and PTD for Black women and low SES women.

El cuerpo cotidiano: itinerarios corporales de mujeres

This work aims to study women's body itineraries, through the interviews of women from high and low socioeconomic status (SES) who live in Santiago de Chile. The project inquiries bodies’ itineraries as a set of nutrition, exercise, and aesthetics care actions as everyday practices. This concept allowed reflecting on the body as a continuous becoming, a movement or action, and not a fixed entity. The project had a qualitative research design. Data was collected using reflexive interviews. Participants were asked to describe a typical day using magazine images. Every interview started with the question: “If your body could talk with images, how would it tell its day?”. Four women were interviewed, two of high SES and two of low SES. The data analysis was conducted the reflexive thematic analysis guidelines. The results compared high and low SES bodies itineraries organized by type of practice. Women of high SES describe their nutrition practices in terms of body awareness; how food affects their bodies. Low SES women instead talk about their nutrition from a self-control perspective. These women describe their food intake as something that must be at all times regulated. For them, nutrition becomes a constant failure because they usually lack self-control. Women of high SES describe the exercise as a pleasant activity, it is related to wellbeing. The interviewed women from this group reported exercising regularly. Women of Low SES described their lack of exercising in terms of laziness. Women of low SES report makeup as a daily aesthetic care practice. Women describe that they start applying makeup at their house, continue in the subway or bus on the way to work, and finish at the workplace. Makeup doesn’t have a delimited space or place. Women of high SES describe aesthetic care practices in terms of skincare. They emphasize that good-looking skin and body image reflect a healthy body. A significant difference between low and high SES women is that the first consider aesthetic care practices as superficial, while for the latter is an inner state that reflects exteriorly. In general terms, women of high SES refer to body itineraries in terms of awareness. Women regularly refer to how the practices of nutrition, exercise, and aesthetic care affect their bodies. Women of low SES instead describe their body itineraries as control practices that regularly fail. They don’t report body sensations. The analysis shows that the description of nutrition, exercise, and aesthetic care have moral (good/bad) and affective dimensions (how a body shall be affected in these practices). Being a caregiver emerged as a relevant issue when accounting for body itineraries. Two of the four women we interviewed were mothers, one from each SES. Caregiving was significant in nutrition and exercise practices. Women with children tend to eat when and what their children are eating. Eating tends to be a practice distributed in the routine. For example, a woman had a sandwich with her son before school and then a coffee after dropping him at school. Likewise, exercise is in function to the children’s routine. For example, a woman walks fast from the school to her house. Being a caregiver structures time and, as an effect, it is very significant in body itineraries. Finally, in the discussion the analysis was compared with other data. The different practices of women of high and low SES derive into different outcomes. Women of low SES are more obese and sedentary than women from high SES. The notion of body itineraries is an integrative concept to study nutrition, exercise, and aesthetic care. https://doi.org/10.16888/interd.2022.39.2.9

The necessary and sufficient conditions for retirement funding adequacy: A fuzzy set analysis

Although retirement funding adequacy literature has explored perceptions of retirement preparations and savings targets, there remains a lack of understanding of which conditions are necessary and sufficient for it to occur. This study identifies the necessary and sufficient conditions for retirement funding adequacy by examining the extent to which demographic, psychological and behavioural variables predict its occurrence. Within the context of South Africa, fuzzy set qualitative comparative analysis was used to test a complex model and qualify the processes that lead to retirement funding adequacy. The results show that educated women of higher socio-economic status are associated with retirement provisions. Thus, the inclusion and empowerment of women in financial planning activities results in positive retirement outcomes. Furthermore, retirement provisions precede retirement funding adequacy, and financial knowledge is a necessary condition for both retirement provisions and retirement funding adequacy. This research is relevant for financial planners and institutions encouraging individuals to plan and save for retirement in order to reduce the retirement funding adequacy gap experienced by retirees.

Validity of Self-Reported Anthropometric Measures in Estimating Obesity Prevalence in Brazil: Study with Data from the National Health Survey (PNS), 2013

Background Self-reported height and weight measurement is a simple and a non-invasive method of collecting data in population surveys. However, the inaccuracy of self-reported data may bias the population nutritional status evaluation. The aim of this study is to compare the obesity prevalence estimated with self-reported anthropometric data and with measured weight and height using data from the National Health Survey, Brazil, 2013. Methods A three-stage cluster sampling (census tracts, households, and individuals) with stratification of the primary sampling units and random selection in all stages was used to select Brazilian adults aged 18 years and over. Excluding pregnant women, measurements of weight and height were taken among all selected adults and were also self-reported during the interview on the same day. Logistic regression models were used to investigate the sociodemographic factors and lifestyles associated with the outcome "reported weight and height during the interview”. Obesity prevalence estimates calculated with self-reported and measured weight and height were compared in all variable categories. Results From the sample of 59,402 adults, 70.2% self-reported weight and height. Men were most likely to report their weight (OR = 1.14) and white people when compared to non-white (OR = 0.60). People from the upper socioeconomic class are 6.5 times more likely to report their weight and height during the interview. Healthy habits and medical consultation in the past year were significantly associated with the outcome. Among women, obesity prevalence estimated with self-reported measures (20.5%) was significantly lower than those with measured weight and height (24.4%), with larger differences among women of high socioeconomic status. No significant differences were found among men. Conclusions Given that the body mass index is used as a guide for identifying health risks, these findings indicate that direct measurement of height and weight should be performed whenever possible in Brazilian surveys to adequately support public health policies. Keywords: Health surveys; Nutritional status; Obesity; Self-reported anthropometric measures.

Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice.

Black women are more likely to undergo surgery for uterine fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking fibroid treatment. We aimed to identify factors that shape Black women's fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences, and compare experiences across age and socioeconomic status. We conducted semistructured interviews with 37 Black women undergoing surgery for fibroid management. We used a thematic analysis to code transcripts and identify themes. Participants were predominately single, college educated, and insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Knowledge and perceptions of fibroids were also influenced by community norms and differed by socioeconomic status; women of higher socioeconomic status had greater fibroid awareness than women of lower socioeconomic status. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. Although several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians. Fibroid management decisions were influenced not only by interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver intersectional gynecologic care that centers the voices of Black women seeking fibroid treatment.

Socioeconomic inequality in prevalence of cigarette and Water-pipe smoking among Iranian adults: A blinder- Oaxaca decomposition Analysis

Background: To assess the association between socioeconomic inequality and the prevalence of tobacco smoking among Iranian adults in 2010. Methods: Data from the fifth national STEPS survey (WHO STEPwise approach to NCD Surveillance) were analyzed. A Blinder-Oaxaca decomposition method was applied to assess the association between socioeconomic inequality and the prevalence of daily cigarette and water pipe (WP) smoking among Iranian men and women. Results: From 10,615 participants in the survey, 4,203 (39.5%) participants appeared to be in the first and fifth quintiles of socioeconomic status (SES). For men, the prevalence of daily cigarette smoking was higher among those with low SES (23.1%) than those with high SES (11.1%) (P&lt;0.001). The observed difference was mainly attributed to the educational level (8.6%). We found no significant difference in high compared to low SES women for cigarette smoking (P value= 0.881). Although there was no difference between high and low SES men for daily WP smoking, low SES women had a higher prevalence of WP smoking (4.4%) than high SES women (1.3%) (P value=0.027). Education level was the major factor (3.3%) to explain the corresponding difference. The difference in WP smoking in high and low SES men was not statistically significant (P value= 0.199). Conclusion: Cigarette smoking in men and WP smoking in women are associated with SES in Iran. Education was the main factor explaining the differences in the prevalence of cigarette and WP smoking in Iranian men and women. Results from this study must be considered as a pivotal basis for designing a tobacco control program at national and sub-national levels.

Intimate Partner Violence Against Pregnant Jordanian Women at the Time of COVID-19 Pandemic's Quarantine.

In Jordan, women experience considerable levels of different types of violence. The emerging data from different countries indicate that intimate partner violence (IPV) has intensified since the COVID-19 outbreak. The main purpose of the current study is to find out whether there is any difference in the incidence of IPV during and before the COVID-19 pandemic quarantine and whether any sociodemographical factors are related to the incidence of IPV against pregnant women during quarantine. A cross-sectional, correlational design was in this study. The snowball sampling technique was adopted to select the participants, which produced a nonrepresentative sample of 215 pregnant women. The participants completed the Arabic version of the World Health Organization's Domestic Violence Questionnaire Screening Tool (DVQST). We found that women were exposed to different types of IPV before and during the quarantine. The most prevalent form of IPV was control and humiliation (n 172, 80%) and the least prevalent was sexual violence ((n 33, 15.3%), (n 24, 11.2%), respectively). However, there were statistically significant lower DVQST scores during the COVID-19 quarantine than before the quarantine. All types of IPV are significantly correlated with each other and with relationship problems (marital conflict, verbal fighting, understanding each other). While the findings are not generalizable to the general population of pregnant women in Jordan because the sample consisted only of women of high socioeconomic status due to the use of a nonprobability sampling technique, national campaigns should be developed and implemented in order to reduce IPV and change community behaviors and attitudes toward violence against women. It is also recommended that policymakers develop plans to help pregnant women during quarantine by, for example, training care providers on how to access vulnerable women.

Socio-economic inequalities in overweight and obesity among women of reproductive age in Bangladesh: a decomposition approach

BackgroundOverweight and obesity of women is a growing concern all over the world. However, an understanding on the socio-economic inequalities in overweight and obesity of women received little attention, especially in the context of Bangladesh. Therefore, the objective of this study was to measure the inequality in overweight and obesity among women of reproductive age in Bangladesh as well as to explore the effect of various socio-economic factors on this inequality.MethodsThis study used data from the Bangladesh Demographic and Health Survey 2014 which is a nationally representative data. The concentration index of overweight and obesity was applied to measure the extent of socio-economic inequality. Finally, the concertation index was decomposed in order to understand the contribution of different socio-economic variables in inequality in overweight and obesity of women.ResultsThis study included a total of 16,624 women of reproductive age. The study found that the prevalence of overweight was about 29% and the rate of obesity was approximately 11%. The value of concentration index for overweight and obesity was 0.37 (p < 0.001). This study also observed that about 52% inequality was explained by household’s wealth status followed by watching television (25%), husband/partner’s educational status (around 7%), women’s educational status (about 5%), place of residence (approximately 4%).ConclusionsThis study found notable level of overweight and obesity among the women of Bangladesh. Various socio-economic factors like wealth status, education levels of women and partners, urban settings, women watching television predominantly contributed to the inequality in overweight and obesity among women of reproductive age. Therefore, the study suggests adopting necessary interventions targeting the women of higher socio-economic status to reduce the risk of life-threatening problems caused by overweight and obesity.

Social and Environmental Influences on Sexual Behaviors of College Black Women: Within Group Diversity Between HBCU vs. PWI Experiences.

Black women carry a disproportionate number of new HIV infections in the USA. Studies that have assessed HIV risk perception along with HIV prevention interventions for Black women have primarily focused on Black women of low socioeconomic status. Few studies have assessed HIV risk perceptions and sexual behavior among college-educated Black women of higher socioeconomic status despite their high risk of HIV. College-educated Black women are most likely to acquire HIV while in college, and there has been a marked absence of research assessing the environmental and cultural influences present throughout college-campuses, coupled with evaluating how these factors shape sexual behaviors. We conducted surveys with Black female students attending a historically Black college and Black female students attending a predominately White university, and compared baseline differences in sexual behaviors among both populations. Results showed that for participants attending the historically Black college certain sociocultural elements, such as music and media, had a significantly stronger influence on sexuality and sexual behaviors compared with students attending predominately White universities. The development of future HIV prevention interventions for Black women necessitates an understanding of the diverse microcultures that Black women come from. This research is high priority for college-educated Black women given this population's lack of inclusion in HIV prevention research.