Environment For Women Research Articles

Policy Development for Human Papillomavirus Vaccine Introduction in Low-Resource Settings

The objectives of this analysis are: (1) to describe the policy environment related to human papillomavirus (HPV) vaccine introduction; (2) to identify the policy processes and key stakeholders in HPV vaccine introduction; (3) to summarize specific characteristics about HPV vaccines and their introduction that may be barriers to introduction; and (4) to recommend advocacy strategies to achieve a positive environment for cervical cancer prevention. This descriptive qualitative study of HPV vaccine policy development used an iterative, inductive, theme-based approach to data analysis. The study was conducted in four developing countries—India, Peru, Uganda, and Vietnam. Study participants were comprised of a total of 237 national policymakers, legislators, officials, and senior managers from ministries of health, finance, and planning; leaders of medical and health professional associations; cancer institutes; heads of nongovernmental organizations; and women's health advocates. While differences existed among low-income countries in specific cervical cancer, women's health, adolescent health, or immunization policy environments, we found the policymaking process itself, specific concerns related to HPV vaccines, and the information needs of policymakers for HPV vaccine introduction to be strikingly similar. Data on burden of cervi- cal cancer, HPV vaccine safety and efficacy, and cost-effectiveness and vaccine affordability were top issues reported by policymakers. Advocacy strategies need to address these issues in order for HPV vaccine policy formulation and approval to be successful.

Oral contraceptives and postmenopausal hormones and risk of contralateral breast cancer among BRCA1 and BRCA2 mutation carriers and noncarriers: the WECARE Study

The potential effects of oral contraceptive (OC) and postmenopausal hormone (PMH) use are not well understood among BRCA1 or BRCA2 (BRCA1/2) deleterious mutation carriers with a history of breast cancer. We investigated the association between OC and PMH use and risk of contralateral breast cancer (CBC) in the WECARE (Women's Environment, Cancer, and Radiation Epidemiology) Study. The WECARE Study is a population-based case-control study of 705 women with asynchronous CBC and 1,398 women with unilateral breast cancer, including 181 BRCA1/2 mutation carriers. Risk-factor information was assessed by telephone interview. Mutation status was measured using denaturing high-performance liquid chromatography followed by direct sequencing in all participants. Outcomes, treatment, and tumor characteristics were abstracted from medical records. Ever use of OCs was not associated with risk among noncarriers (RR = 0.87; 95% CI = 0.66-1.15) or BRCA2 carriers (RR = 0.82; 95% CI = 0.21-3.13). BRCA1 carriers who used OCs had a nonsignificant greater risk than nonusers (RR = 2.38; 95% CI = 0.72-7.83). Total duration of OC use and at least 5 years of use before age 30 were associated with a nonsignificant increased risk among mutation carriers but not among noncarriers. Few women had ever used PMH and we found no significant associations between lifetime use and CBC risk among carriers and noncarriers. In conclusion, the association between OC/PMH use and risk of CBC does not differ significantly between carriers and noncarriers; however, because carriers have a higher baseline risk of second primaries, even a potential small increase in risk as a result of OC use may be clinically relevant.

Reproductive development and parental investment during pregnancy: Moderating influence of mother's early environment

The association between a woman's age at menarche and the birth weight of her children is highly variable across human populations. Life history theory proposes that a woman's early environment may moderate this association and thus account for some of the variation between populations. According to one life history theory model, for individuals who develop in a childhood environment of high local mortality rates (experienced subjectively as psychosocial stress), it can be adaptive to mature earlier, have more offspring during their reproductive lifetime, and reduce investment in each offspring. In an environment of low psychosocial stress, however, it may be adaptive to mature later, have fewer offspring, and invest more in each. In this study, birth weight and proportionate birth weight (neonate's birth weight as a percentage of its mother's prepregnancy weight) were used as measures of parental investment during pregnancy. In a sample of 580 first-time mothers, we tested the hypothesis that the psychosocial stress experienced as a child would moderate the association between age at menarche and investment during pregnancy. We found that earlier menarche in those women who experienced stressful life events before 15 years of age was associated with a lower birth weight and proportionate birth weight. Conversely, in those who reported no childhood stressors, earlier menarche was associated with increased birth weight and proportionate birth weight. Our data suggest that the moderating influence of the childhood psychosocial environment on the association between age at menarche and parental investment throughout gestation operates in a dose-dependent manner.

Disclosing HIV serostatus to family members: Effects on psychological and physiological health in minority women living with HIV.

Directly disclosing a positive HIV serostatus to family members can have psychological and physiological health benefits. Perceptions that one is in a supportive family environment may enhance these benefits. We examined a mediated moderation model in which we expected interactions between serostatus disclosure to family members and HIV-specific family support to be associated with women's perceived stress, which in turn would explain depressive symptoms and 24-h urinary cortisol in women living with HIV (WLWH). Low-income ethnic minority WLWH (n = 82) reported the percentage of family members they had directly disclosed their serostatus to, perceptions of HIV-related support from family members, perceived stress, and depressive symptoms. Cortisol was measured via 24-h urinary collection. Disclosure to spouses and children coupled with high levels of family support was associated with higher levels of depressive symptoms in women. For disclosure to spouses, this relationship was explained by higher perceived stress. Direct disclosure to mothers in tandem with high support was associated with lower cortisol, and this relationship was explained through higher levels of perceived stress. The effects of serostatus disclosure on perceived stress and health in WLWH may depend, in part, on women's family environment and to whom they disclose to within that environment.

Alcohol Intake and Cigarette Smoking and Risk of a Contralateral Breast Cancer: The Women's Environmental Cancer and Radiation Epidemiology Study

Women with primary breast cancer are at increased risk of developing second primary breast cancer. Few studies have evaluated risk factors for the development of asynchronous contralateral breast cancer in women with breast cancer. In the Women's Environmental Cancer and Radiation Epidemiology Study (1985-2001), the roles of alcohol and smoking were examined in 708 women with asynchronous contralateral breast cancer (cases) compared with 1,399 women with unilateral breast cancer (controls). Cases and controls aged less than 55 years at first breast cancer diagnosis were identified from 5 population-based cancer registries in the United States and Denmark. Controls were matched to cases on birth year, diagnosis year, registry region, and race and countermatched on radiation treatment. Risk factor information was collected by telephone interview. Rate ratios and 95% confidence intervals were estimated by using conditional logistic regression. Ever regular drinking was associated with an increased risk of asynchronous contralateral breast cancer (rate ratio = 1.3, 95% confidence interval: 1.0, 1.6), and the risk increased with increasing duration (P = 0.03). Smoking was not related to asynchronous contralateral breast cancer. In this, the largest study of asynchronous contralateral breast cancer to date, alcohol is a risk factor for the disease, as it is for a first primary breast cancer.

The relationship between prenatal care, personal alcohol abuse and alcohol abuse in the home environment

Aims: Nearly one-fourth of African-American women receive no prenatal care during the first trimester of pregnancy. The aim of the current study is to identify factors that underlie inadequate prenatal care among African-American women. Maternal alcohol abuse has been examined as one risk factor for inadequate prenatal care, but findings have been inconsistent, perhaps because (a) alcohol use during pregnancy is substantially under-reported and (b) studies have not considered the wider social network in which maternal alcohol use takes place. The current study attempts to clarify relationships between personal alcohol use, alcohol use in the home environment, and prenatal care in a sample of post-partum women.Methods: Participants were 107 low-income, primarily African-American women. All participants completed a computer-based screening which assessed personal and environmental alcohol use, prenatal care and mental health.Findings: Environmental alcohol use was related to delayed prenatal care while personal alcohol use was not. More specifically, after controlling for demographic variables, the presence of more than three person-episodes of binge drinking in a woman's home environment increased the odds of seriously compromized prenatal care by a factor of seven.Conclusions: Findings suggest the need to further assess environmental alcohol use and to examine the reliability of personal alcohol use measures.

Environmental adversity and reproductive aging

OBJECTIVE: Evidence shows that women from socio-economically disadvantaged backgrounds enter menopause 1-2 years earlier than their more affluent counterparts. To date, no study has examined whether the socioeconomic conditions of a woman's environment may accelerate the reproductive aging process underlying her entry into menopause. Here, we assessed community socioeconomic status (SES) and neighborhood quality in relation to ovarian aging (indexed by antral follicle count [AFC]) in a sample of reproductive-age women with regular menses.

Variants in the ATM Gene Associated with a Reduced Risk of Contralateral Breast Cancer

Between 5% and 10% of women who survive a first primary breast cancer will subsequently develop a second primary cancer in the contralateral breast. The Women's Environment, Cancer, and Radiation Epidemiology Study was designed to identify genetic and environmental determinants of contralateral breast cancer (CBC). In this study, 708 women with asynchronous CBC served as cases and 1,397 women with unilateral breast cancer served as controls. ATM, a serine-threonine kinase, controls the cellular response to DNA double-strand breaks, and has been implicated in breast cancer risk. Complete mutation screening of the ATM gene in all 2,105 study participants identified 240 distinct sequence variants; only 15 were observed in >1% of subjects. Among the rare variants, deleterious alleles resulting in loss of ATM function were associated with a nonsignificant increase in risk of CBC. In contrast, carriers of common variants had a statistically significant reduction in risk of CBC. Four of these 15 variants were individually associated with a significantly decreased risk of second primary breast cancer [c.1899-55T>G, rate ratio (RR), 0.5; 95% confidence interval (CI), 0.3-0.8; c.3161C>G, RR, 0.5; 95% CI, 0.3-0.9; c.5558A>T, RR, 0.2; 95% CI, 0.1-0.6; c.6348-54T>C RR, 0.2; 95% CI, 0.1-0.8]. These data suggest that some alleles of ATM may exert an antineoplastic effect, perhaps by altering the activity of ATM as an initiator of DNA damage responses or a regulator of p53.

Dose to the Contralateral Breast From Radiotherapy and Risk of Second Primary Breast Cancer in the WECARE Study

To quantify the risk of second primary breast cancer in the contralateral breast (CB) after radiotherapy (RT) for first breast cancer. The study population included participants in the Women's Environmental, Cancer, and Radiation Epidemiology study: 708 cases (women with asynchronous bilateral breast cancer) and 1399 controls (women with unilateral breast cancer) counter-matched on radiation treatment. Participants were <55 years of age at first breast cancer. Absorbed doses to quadrants of the CB were estimated. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using multivariable-adjusted conditional logistic regression models. Across all patients, the mean radiation dose to the specific quadrant of the CB tumor was 1.1 Gy. Women <40 years of age who received >1.0 Gy of absorbed dose to the specific quadrant of the CB had a 2.5-fold greater risk for CB cancer than unexposed women (RR = 2.5, 95% CI 1.4-4.5). No excess risk was observed in women >40 years of age. Women <40 years of age with follow-up periods >5 years had a RR of 3.0 (95% CI 1.1-8.1), and the dose response was significant (excess RR per Gy of 1.0, 95% CI 0.1-3.0). Women <40 years of age who received a radiation dose >1.0 Gy to the CB had an elevated, long-term risk of developing a second primary CB cancer. The risk is inversely related to age at exposure and is dose dependent.

Women’s Lifelong Exposure to Neighborhood Poverty and Low Birth Weight: A Population-Based Study

To determine whether women's lifelong residential environment is associated with infant low birth weight. We performed race-specific stratified and multivariate binomial regression analyses on an Illinois vital record dataset of non-Latino White and African-American infants (1989-1991) and their mothers (1956-1975) with appended United States census income information. Non-Latino White women (N = 267) with a lifelong residence in low-income neighborhoods had a low birth weight (<2,500 g) incidence of 10.1% vs. 5.1% for White women (N = 10,647) with a lifelong residence in high-income neighborhoods; RR = 2.0 (1.4-2.9). African-American women (N = 18,297) with a lifelong residence in low-income neighborhoods had a low birth weight incidence of 17% vs. 11.7% for African-American women (N = 546) with a lifelong residence in high-income areas; RR = 1.5 (1.2-1.8). The adjusted population attributable risk (PAR) percent of LBW for lifelong residence in low-income neighborhoods was 1.6% for non-Latino White and 23.6% for African-American women. Non-Latino White and African-American women's lifelong residence in low-income neighborhoods is a risk factor for LBW; however, African-Americans experience a greater public health burden from this phenomenon.

The Pill: Time for a New Look

Based on the popularity of the birth control pill (“The Pill”), its economic importance, and its role as a daily component of the modern woman's environment and lifestyle, we decided to study pill usage habits and the cognitive and behavioral causes of noncompliance. Our findings led us to suggest design solutions to promote consistency of use and improve attitudes toward the pill. We conducted a field study of birth control pill dispensers, performed a task analysis of pill taking, and distributed a detailed questionnaire among 380 Israeli women. Our suggestions for improving compliance include incorporating memory aids, creating better packaging design, and reducing the medical stigma of the pill by positioning it as a designed, daily lifestyle item.

Oral Contraceptives, Postmenopausal Hormones, and Risk of Asynchronous Bilateral Breast Cancer: The WECARE Study Group

To investigate whether oral contraceptive (OC) use and postmenopausal hormones (PMH) are associated with an increased risk of developing asynchronous bilateral breast cancer among women diagnosed with breast cancer younger than 55 years. The WECARE (Women's Environment, Cancer, and Radiation Epidemiology) study is a population-based, multicenter, case-control study of 708 women with asynchronous bilateral breast cancer and 1,395 women with unilateral breast cancer. Risk factor information collected during a telephone interview focused on exposures before and after the first breast cancer diagnosis. Treatment and tumor characteristics were abstracted from medical records. Multivariable conditional logistic regression was used to estimate rate ratios (RR) and 95% CIs. OC use before the first breast cancer diagnosis was not associated with risk of asynchronous bilateral breast cancer (RR = 0.88; 95% CI, 0.67 to 1.16). OC use after breast cancer diagnosis was also not significantly associated with risk (RR = 1.56; 95% CI, 0.71 to 3.45). Risk did not increase with longer duration of use or among women who had begun using OCs at a younger age. No evidence of an increased risk of asynchronous bilateral breast cancer was observed with PMH use before (RR = 1.21; 95% CI, 0.90 to 1.61) or after breast cancer diagnosis (RR = 1.10; 95% CI, 0.67 to 1.77). Neither duration nor type of PMH were associated with risk. Age at and time since first breast cancer diagnosis did not substantially affect these results. This study provides no strong evidence that OC or PMH use increases the risk of a second cancer in the contralateral breast.

Is External Noise a Risk to Fetal Hearing Development? A Review

Some researchers have suggested that excessive noise in a pregnant woman's environment can adversely affect the developing fetal ear, and studies have reported that each year up to three per 1000 newborns have some degree of hearing loss. Should noise be considered a causative factor in some cases of congenital hearing loss? Whereas some experimental animal studies have shown that loud noise external to the pregnant mother's abdomen has detrimental effects on the developing fetal ear, resulting in measurable hearing loss in the newborn animal, other studies have not supported the hypothesis. Two retrospective studies reported hearing loss in some children (ranging in age from 4 to 14 years) born to mothers who worked in noisy environments while pregnant, but the findings are controversial. Intrauterine ambient noise levels vary from 50 to 80 dB, mostly from normal internal maternal sounds. Most transmitted external sounds are attenuated by maternal tissues before they reach the fetus; however, lower-frequency sounds are attenuated less than are higher frequencies. Whether or not resultant sound levels can cause permanent damage to the developing fetal ear is still not firmly established. This is a brief review of the pertinent literature.

Risk for contralateral breast cancer among carriers of the CHEK2*1100delC mutation in the WECARE Study

The protein encoded by the CHEK2 gene is involved in cellular repair of DNA damage. The truncating mutation, CHEK2*1100delC, seems to increase the risk for breast cancer. We investigated whether the CHEK2*1100delC mutation carrier status increases the risk for asynchronous contralateral breast cancer (CBC) and whether it interacts with radiation therapy (RT) or chemotherapy in regard to CBC risk. The germline mutation frequency was assessed in 708 women with CBC and 1395 women with unilateral breast cancer (UBC) in the Women's Environment, Cancer and Radiation Epidemiology (WECARE) Study whose first primary breast cancer was diagnosed before age 55 years and during 1985–1999. Seven women with CBC (1.0%) and 10 women with UBC (0.7%) were CHEK2*1100delC variant carriers (rate ratio (RR)=1.8, 95% confidence interval (CI)=0.6–5.4 for CBC vs UBC). Carriers who received RT for their first breast cancer, compared with non-carriers not treated with RT, had an RR of developing CBC of 2.6 (95% CI=0.8–8.7). We found no significant associations between the CHEK2*1100delC mutation and CBC overall or among those treated with RT. However, the sampling variability was such that modest increases in risk could not be excluded. Nonetheless, because this is a rare mutation, it is unlikely to explain a major fraction of CBC in the population.

Variation of Breast Cancer Risk Among BRCA1/2 Carriers

The risk of breast cancer in BRCA1 and BRCA2 mutation carriers has been examined in many studies, but relatively little attention has been paid to the degree to which the risk may vary among carriers. To determine the extent to which risks for BRCA1 and BRCA2 carriers vary with respect to observable and unobservable characteristics. Probands were identified from a population-based, case-control study (Women's Environmental Cancer and Radiation Epidemiology [WECARE]) of asynchronous contralateral breast cancer conducted during the period of January 2000 to July 2004. Participants previously diagnosed with contralateral breast cancer or unilateral breast cancer were genotyped for mutations in BRCA1 and BRCA2. All participants had their initial breast cancer diagnosed during the period of January 1985 to December 2000, before the age of 55 years. Incidence of breast cancer in first-degree female relatives of the probands was examined and compared on the basis of proband characteristics and on the basis of variation between families. Among the 1394 participants with unilateral breast cancer, 73 (5.2%) were identified as carriers of deleterious mutations (42 with BRCA1 and 31 with BRCA2). Among the 704 participants with contralateral breast cancer, 108 (15.3%) were identified as carriers of deleterious mutations (67 with BRCA1 and 41 with BRCA2). Among relatives of carriers, risk was significantly associated with younger age at diagnosis in the proband (P = .04), and there was a trend toward higher risk for relatives of contralateral breast cancer vs unilateral breast cancer participants (odds ratio, 1.4 [95% confidence interval, 0.8-2.4]; P = .28). In addition, there were significant differences in risk between carrier families after adjusting for these observed characteristics. There exists broad variation in breast cancer risk among carriers of BRCA1 and BRCA2 mutations.

Effect of Systemic Adjuvant Treatment on Risk for Contralateral Breast Cancer in the Women's Environment, Cancer and Radiation Epidemiology Study

Results from randomized trials indicate that treatment with tamoxifen or chemotherapy for primary breast cancer reduces the risk for contralateral breast cancer. However, less is known about how long the risk is reduced and the impact of factors such as age and menopausal status. The study included 634 women with contralateral breast cancer (case patients) and 1158 women with unilateral breast cancer (control subjects) from the Women's Environment, Cancer and Radiation Epidemiology Study. The women were younger than age 55 when they were first diagnosed with breast cancer during 1985-1999. Rate ratios (RRs) and 95% confidence intervals (CIs) for contralateral breast cancer after treatment with chemotherapy or tamoxifen were assessed by multivariable adjusted conditional logistic regression analyses. Chemotherapy was associated with a lower risk for contralateral breast cancer (RR = 0.57, 95% CI = 0.42 to 0.75) than no chemotherapy. A statistically significant association between chemotherapy and reduced risk for contralateral breast cancer persisted up to 10 years after the first breast cancer diagnosis and was stronger among women who became postmenopausal within 1 year of the first breast cancer diagnosis (RR = 0.28, 95% CI = 0.11 to 0.76). Tamoxifen use was also associated with reduced risk for contralateral breast cancer (RR = 0.66, 95% CI = 0.50 to 0.88) compared with no use, and the association was statistically significant for 5 years after the first diagnosis. The associations between chemotherapy and tamoxifen treatment and reduced risk for contralateral breast cancer appear to continue for 10 and 5 years, respectively, after the initial breast cancer is diagnosed. Ovarian suppression may have a role in the association between chemotherapy and reduced risk for contralateral breast cancer.

Deforestation and its Impacts on Indigenous Women: A Case from the Chittagong Hill Tracts in Bangladesh

In 1994, Bangladesh ratifi ed the Convention on Biological Diversity, agreed at the 1992 Earth Summit in Rio de Janeiro. The country has also adopted various policies, approaches and programs to protect forests in the country. Despite this, deforestation continues apace in this country. The Chittagong Hill Tracts (CHT), an area of 5093 square miles (about 10 percent of Bangladesh), is a hilly-forested area with 12 indigenous groups, where extensive deforestation has already occurred. This is the main cause of hardship for forest dwellers, especially the indigenous peoples. As the Women Environment and Development (WED) debate has recognized, women are the main victims of any environmental crisis. This study analyzes the impacts of deforestation on the indigenous women in the CHT. It has been found from this study that there is an interwoven relationship between the indigenous women and the forest and they are severely affected by deforestation.

The survey of women's labor environment in Jeonnam and policy implication

The survey of women's labor environment in Jeonnam and policy implication

Reasons for Unprotected Intercourse in Adult Women

Despite the increased availability of contraception, unprotected intercourse and unintended pregnancy are common among adult women. We sought to identify reasons why adult women at risk of unintended pregnancy have unprotected intercourse. A comprehensive search of electronic databases of MEDLINE, CINAHL, and PSYCHOINFO, from 1995 to 2005, was conducted. Reference lists from relevant published papers and reviews related to contraceptive practices and pregnancy intendedness were also hand searched. The Bronfenbrenner ecological framework was used as a guide in the discussion of the findings. There were 16 studies that met inclusion criteria, and these provided numerous reasons why adult women had unprotected intercourse. Reasons were found at the individual, interpersonal, and societal levels. Individual reasons included concerns with contraceptive side effects, a low perceived risk for pregnancy, lack of knowledge, and attitudes and beliefs. Interpersonal reasons included partners, families, or friends who discouraged the use of contraception. Societal reasons included access problems, inconvenience, and cost. There are multiple reasons why women have unprotected intercourse. These reasons were located in overlapping domains of influence. Factors in a woman's environment at the interpersonal and societal level may significantly influence her contraceptive use behavior.

Mixed messages: a qualitative study of the meanings and context of high school students' tobacco use in Turkey

Although smoking by adults in Turkey is a widely practiced, socially accepted habit, social influences on tobacco uptake by Turkish youth have been studied little. This paper reports findings from interviews (42 10th graders plus 10 other students and 24 adults) and three focus groups in a study with high school students in Dursunbey, Turkey. Interviewees reported that youth smoking is not culturally acceptable, but that contradictory messages and pressures abound. A context in which smoking is embedded in men's and women's social environments influences many youth to become smokers. Smoking is expected of men by the time they enter military service or are economically independent. Smoking by women, especially professionals, is increasingly common. Although virtually all adults disapprove of youth's smoking as age-inappropriate behavior, ubiquitous counter-examples of adult smoking in homes, schools, coffee houses and media dilute tobacco controls. Few youth or adults expressed concern about the relationship of tobacco to health. Sanctions in family and school environments are little enforced. Students' smoking-related attitudes and behaviors appear modeled more after behavior of their teachers than their less-educated parents, and smoking is common by teachers at school. Reduction of smoking by Turkish youth calls for comprehensive, sustained programs to de-normalize tobacco use in family, school and other settings, with special attention to smoking uptake by young women.