(Alphabetical by First Author’s Last Name)
***Denotes Abstract Awardees
Allopregnanolone & Perceived Stress During Short-Term Smoking Cessation (35)
Alicia Allen, Mustafa al’Absi, Sharon Allen
Background: Smokers report that the most common cause for relapse is stress. Allopregnanolone (ALLO) is a neuroactive steroid metabolized primarily from progesterone and may protect against both stress and drug abuse behaviors.
Project Purpose: The purpose of this project is to examine the association between ALLO and perceived stress during short-term smoking cessation in a sample of premenopausal women.
Methods: Study participants complete in a controlled cross-over study in which they were randomized to complete two testing weeks in the follicular (F) menstrual phase followed by the luteal (L) phase or vice versa (L-F). The testing week consisted of two days of ad libitum smoking followed by four days of biochemically verified smoking abstinence. Blood samples were collected on the day before quit date and on the fourth day of smoking abstinence. Participants completed the Cohen Perceived Stress Scale (PSS) daily during the testing week. Descriptive statistics were computed to describe the study sample and ALLO levels. Linear growth curve models, adjusted for menstrual phase and testing order, were used to assess the effect of ALLO on PSS.
Results: Participants (n=62) were, on average, 30.3±6.7 years old and smoked 12.5±4.9 cigarettes/day. The majority of participants were White (55%) and had at least a high school education (77%). Higher absolute levels of ALLO on the day before quit date were associated with lower levels of PSS on the day before quit date (β= -2.25, p<0.01), as well as with a greater change in PSS during smoking cessation (β= 0.79, p<0.01). Further, a significant, positive association between change in ALLO and change in PSS during smoking cessation was observed (β= 0.17, p<0.01).
Discussion: Regardless of menstrual phase, higher absolute levels and less change in ALLO appear to be favorable during short-term smoking cessation. These seemingly different patterns of association may be associated with hormonal changes during smoking cessation. While these data are limited by selection bias and limited generalizability, the strengths include the study design and detailed measurement of outcomes. Additional research is needed to investigate the effect of this association on smoking cessation outcomes.
Parent Weight-Related Conversations: Helpful or Harmful? (18)
Jerica Berge, Rich MacLehose, Katie Loth, Marla Eisenberg, Dianne Neumark-Sztainer
Background: Little is known about parent weight-related talk (e.g. conversations about healthy eating, comments on child’s weight/size) and whether weight talk has the same negative effects on youth health behaviors and outcomes as weight teasing. The purpose of this study is to investigate associations between parent weight talk and adolescent weight and weight-related behaviors.
Methods: Data from EAT 2010 (Eating Among Teens) and F-EAT (Families and Eating and Activity in Teens) were used for the current analysis. Mothers and fathers (n = 3,424) and adolescents (n = 2,182) participated in the linked multi-level population-based studies. Parents and adolescents were socio-economically and racially/ethnically diverse. Linear regression was used to estimate the association between parent weight and weight-related conversations and adolescent BMI, dietary intake, physical activity, disordered eating behaviors and psychological outcomes adjusted for possible confounding variables. Additional regression models were fit to test for interactions by adolescent gender.
Results: Adolescents whose mothers and fathers talked with them about healthy eating and physical activity had higher fruit and vegetable intake and breakfast consumption and fewer sedentary behaviors. In contrast, adolescents whose mothers and fathers talked with them about weight/size or losing weight ate breakfast less often, did less physical activity, utilized more unhealthy weight control behaviors, dieted more, had higher levels of depression, lower body satisfaction, and lower self-esteem.
Conclusions: Findings suggest that parents’ weight-related talk can be helpful or harmful, depending on the focus of the conversation (health vs. weight control). Future intervention research may want to focus on teaching parents about the importance of conversations that focus on eating and physical activity as opposed to conversations focused on weight loss or size/shape change. Additionally, professionals who work with adolescents and their families may want to discuss with parents the importance of the type of conversation a parent engages in with their adolescent in order to avoid unintended consequences such as unhealthy weight control behaviors and weight gain.
Sex Differences in the Effectiveness of an Online Stress Management Intervention (9)
Therese Bermingham, Christiaan Greer, Patricia Frazier, Liza Meredith, Jacob Paulsen, Kelli Howard, AnnaMarie Vu, Andrea Belgrade, and Shinsig Kim
Background: Mental health problems are common among college students and the demand for counseling services often exceeds availability. Online interventions for students, one good solution to this problem, are surprisingly scarce. We have developed an online stress management program for students consisting of four online modules containing videos of an expert talking about research on stress and perceived control, videos containing information from other students, and online exercises. Students also complete stress logs in which they write about what they do and do not have control over in their lives. In a previous RCT with undergraduates at the University of MN (N = 233), those in the present control intervention reported significant decreases in stress, depression, and anxiety symptoms, with average within-group effect sizes from pre-test to 3 week follow-up of d = .43.
Purpose: Our goals were to (a) assess gender differences in stress and other mental health symptoms; (b) further evaluate the effectiveness of our online intervention; and (3) assess gender differences in the effectiveness of the intervention.
Methods: Participants were recruited through an Introductory Psychology course. Students who expressed interest in the study were randomly assigned in a 2:1 ratio to the intervention group (n = 200 females; n = 135 males) or the wait-list group (n = 116 females; n = 55 males) group, which received the intervention later in the semester. Participants completed the same outcome measures as in the prior study (Depression Anxiety Stress Scales [DASS] and Perceived Stress Scale [PSS]) as well as a measure of perceived present control which is the construct targeted in the intervention. Measures were completed prior to and following the online program which was completed over a 5-week period.
Results: At pre-test, women scored higher than men in perceived stress and on the anxiety and stress symptom scales of the DASS (but not depression) (all p’s <.01). They also scored lower on the measure of present control. To assess the effectiveness of the intervention, five ANCOVA’s were run with gender and treatment condition as independent variables and the three DASS scales, the PSS, and present control as the outcomes. Pretest scores on the outcome measures were included as covariates. There were significant treatment effects for stress symptoms, perceived stress, and present control (ps <.05) but not anxiety or depression. The between-group effect sizes ranged from d = .23 to d = .29. There was a significant gender by treatment interaction for present control indicating greater intervention effectiveness in increasing present control for women (d = .39) than men (d = .08).
Discussion: Online interventions are a cost-effective way to reduce stress, which is higher among female students. Lack of follow-up assessment is a weakness, especially since effect sizes were bigger at follow-up in previous research.
Angiotensin Converting Enzyme Inhibitors (ACEI) and Doxorubicin (DOX) Pharmacokinetics in Women undergoing Chemotherapy for Breast Cancer (26)
Anne Blaes, M.D., Ryan Shanley, M.S., Heather Beckwith, M.D., David Potter, M.D., David Yee, M.D., Kinjal Sanghavi, Pamala Jacobson, Pharm.D.
Background: DOX chemotherapy can cause cardiac complications in breast cancer survivors. ACE-I may protect against these complications.
Objective: We performed a pharmacokinetics study to determine whether DOX exposure is altered in breast cancer patients receiving DOX concurrently with ACEI.
Methods: Women with locally advanced breast cancer prescribed DOX and cyclophosphamide every 14 days were randomized to receive enalapril 10 mg daily or no enalapril during DOX chemotherapy. Blood samples for pharmacokinetics (DOX and doxorubicinol levels) were drawn at baseline, 0.5, 1.0, 2.0, 4.0, 24.0 and 48.0 hours after infusion with and without enalapril. Correlative laboratories were also obtained. Pharmacokinetic data was analyzed using non compartmental methods and DOX and doxorubicinol area under the curve (AUC) 0 to infinity, Cmax and half-life were estimated. Paired t-tests, two tailed, were used to determine whether DOX and its metabolite were altered with the use of enalapril (P<0.05).
Results: Nine women (median age 41 years) with no cardiac history received 60mg/m2 DOX every two weeks for four cycles. Mean (SD) AUC0- ∞ for DOX and doxorubicinol with enalapril exposure was 1235 (168.1) hr*ng/ml and 954.6 (219.6) hr*ng/ml, respectively. AUC0- ∞ for DOX and doxobubicinol without enalapril was 1238 (193.2) hr*ng/ml and 984.4 (219.9) hr*ng/ml, respectively. There appears to be no interaction between DOX (p=0.97) or doxorubicinol (p=0.78) and enalapril (Figure 1). Troponin and urine microalbumin did not change after DOX administration in either treatment arm. B—natriuretic peptide was elevated at 24 and 48 hours whether patients were on enalapril (p<0.01, 0.02, respectively) or off of enalapril (p<0.01, <0.01, respectively). No clinical cardiac events occurred. Enalapril was well tolerated (33% grade 1 dizziness).
Conclusion: ACEI, enalapril, does not appear to alter the pharmacokinetics of DOX chemotherapy. Ongoing efforts to determine the effectiveness of ACEI as a cardioprotective agent in women receiving DOX chemotherapy should be continued.
An Evaluation of the Association of Sitting Time and Physical Inactivity on Back Pain Among Service Sector Workers (32)
Anna Briggs, MPH, Patricia M. McGovern, PhD, Nico P. Pronk, PhD, Bruce H. Alexander, PhD, Jean M. Abraham, PhD, Andrew Ryan, MS, Beth Lundholm
As the workforce evolves into older, more sedentary, and more female dominated, risk profiles for prevalent health conditions, such as back pain also evolve. The development of effective intervention strategies has been hampered by limited information on occupational behaviors that are amenable to change (e.g., sitting).
The purpose of this study was 1) to identify work and workplace risk factors for back pain among service sector employees, and 2) to estimate the impact of sitting time on the prevalence of frequent back pain in a sample of service sector workers.
A retrospective, cross-sectional study design was utilized to establish a back pain risk profile and estimate the impact of sitting time on frequent back pain among employees from one Midwestern employer. Frequent back pain (yes) was classified by a response of “sometimes” or “always” to the question “How often do you experience back pain?” Median values for self-reported sitting time were used as cut-off values to create binary exposure variables. Prevalence odds ratios with 95% confidence intervals in a multivariable logit model were used to characterize associations between prevalent back pain and non-modifiable and modifiable factors.
Of 34,991 employees (70% response rate) included in the analysis, mean age was 47 years, 55% were female, and 94% White. Modifiable risk factors for back pain were: sitting >30h/wk (OR = 1.14) prolonged sitting at work (>1.0 h/day), not meeting physical activity guidelines (OR = 1.52), and current tobacco use (OR = 1.53). BMI had a positive dose response effect (OR range = 1.25-2.36).
These results add evidence that prolonged sitting contributes to disability from back pain. The definition has previously been defined as 4 or more consecutive hours and has been associated with obesity, cardiovascular diseases, all cause mortality, but not back pain. Results from this study are the first to show that frequent back pain may occur after only one hour of sitting for service sector workers. These results can inform intervention strategies for those most at risk. The large sample size in this study provided exceptional statistical power to explore this issue; however the absence of up to 30% of the study population and the reliance on self-reported outcomes may have influenced the results. The direction of these biases is not known.
The results of this study are timely and relevant to employers who are exploring innovative reductions in sedentary behavior among their employees, as the methods may be repeatable. We recommend that employers utilize theoretical programs that integrate occupational safety with health promotion programs to address modifiable behaviors (e.g., sitting, physical inactivity) and target to at-risk populations.
What Wise-Women Know: Localized Knowledge and Infectious Disease Control Strategies in a Post-Antibiotic Age (31)
Mageen C. Caines
Background/significance of topic: The reoccurring nightmare of modern medicine is our transition into a post-antibiotic age. Antibiotic-resistant bacteria haunt hospitals. “Plague” and “smallpox” scare us with visions of civilization-destroying pandemics, but the impact of those fear-inducing diseases pales next to the potential and actual disease burden imposed by relatively commonplace influenza, malaria, tuberculosis, and HIV. Burned out on “pandemic panic,” we hardly understand the danger we are in, as the tools we think will save us aren't working and pandemic is just one airplane ride away.
As the world loses our miracle pharmaceuticals, other ways to combat infectious disease must be explored. Drawing on knowledge that exists and is transmitted in the informal and invisible structures of “women’s knowledge,” public health is challenged to systematically examine the potential of these strategies for wider implementation. There is no excuse to not get our best medicines to as many people as we can – but as those medicines fail us, we need a back-up plan.
Methods to review literature: PubMed, JSTOR, use of expert texts, including, Microbial Threats to Health (Institute of Medicine), Infectious Disease Epidemiology (Nelson and Williams), and Handbook of Medicinal Herbs (Duke).
Results: In many parts of the world, botanical medicine is part of “women’s knowledge,” as an extension of home and garden, a function ancillary to war, and medical lay-knowledge passed through generations of “wise-women.” Many women in the US use botanical medicine (though they often don’t discuss it with medical doctors), and globally, many women are the distributors of household medicines, including botanicals. Interventions aimed at enhancing women’s ability to give medication to family members have been successful in the context of malaria in Africa, and empowering women is considered a primary infectious disease reduction strategy. Some of the botanical remedies that currently used are not reasonable substitutes for effective pharmaceutical interventions. Some botanical remedies can provide symptom relief and comfort, and some have potential for a long-term alternate solution but require further investigation. Promising botanical interventions have met resistance from large agencies such as the WHO.
Research, program and/or practice implications of findings: A combination of community-based research and biomedical research is ideal in this situation. Doctors should be able to discuss botanicals with patients and encourage patients to discuss them openly, reducing risks in their use and supporting pharmaceuticals as appropriate. Research should examine the effectiveness of commonly-used botanical interventions as an infection control strategy. Policy-makers should include women’s knowledge and botanical interventions in pandemic plans, as well as pharmaceuticals. Alternative and main-stream medicine should confer and work together instead of conflicting. Finally, women should be asked what they know about practical (applied) infection control and encouraged to discuss this knowledge as participants in policy-generating conversations.
A Parenting Education and Support Group for Incarcerated Mothers: Changes in Parenting Confidence, Support, and Amount of Contact with Children (1)***
Erin C. Casey, B.S., Natisha Alicea, Rebecca J. Shlafer, PhD
The number of women incarcerated in the United States is growing at an alarming rate, more than doubling between 1991 and 2007 (Maruschak, 2010), and majority of these women (61%), or 65,600 total, are mothers (Glaze & Maruschak, 2008; Maruschak, 2010). This number is likely an underestimation of the number of incarcerated mothers, as parenting status of inmates is inconsistently recorded. Many of these incarcerated mothers served as the primary caregiver of their children prior to their incarceration and will return to parenting once released. Thus the maintenance and promotion of mother-child relationships is an important step toward mitigating negative outcomes for these families.
To meet this need, many prisons across the nation have implemented parenting programs for incarcerated mothers. Pollock (2003) reports that 38 states offered some form of parenting class. Despite the widespread existence of these programs, very few have been evaluated. The current study aims to evaluate Isis Rising, a prison-based parenting program.
Isis Rising consists of 2 components: doula support for pregnant women and a New Moms Group for mothers of young children, the latter of which is the focus of the current study. The group meets for 2 hours weekly for 12 weeks. Group leaders teach a curriculum designed to provide emotional support and increase women’s parenting knowledge.
The current study examines changes in a variety of parenting related issues among 37 incarcerated women during their participation in the New Mom’s Group. Upon entry into the group, mothers completed an Initial Survey querying basic demographic information, frequency of contact with children, confidence and knowledge as a parent, quality of relationship with children, stress, and level of support received from other mothers and staff at the facility. At the end of the 12-week program, women completed identical follow-up measures.
At follow-up, participants reported significantly higher confidence as a parent, t(38)=2.27,p=.03 as well as receiving more support from other incarcerated mothers, t(38)=3.46,p<.001, and prison staff, t(38)=2.75,p=.009. Mothers reported both marginally more in person visits with children and letters written at post-test, t(36)=1.94,p=.06 and t(36)=1.85,p=.07 respectively.
The increased confidence and support participants gain from the New Moms Group can be invaluable as women in prison are among the most vulnerable women in society (Maeve, 2003). Further, the increased contact with children through visitation and letter writing may help maintain the mother-child relationship throughout the mother’s incarceration and assure a smooth transition upon her release and return to caregiving.
The current study is limited by the use of maternal report. Future studies should aim to include report by prison staff as well as observational and behavioral measures of participant outcomes. Despite this limitation, the study adds to the paucity of research on participants’ outcomes in prison-based parenting programs.
The Association of State-Level Commitment to Protecting Female Rights with Gender Gap in Early Life Investment and Infant Mortality in India (5)
Sanjukta Chaudhuri, Ph.D.
BACKGROUND/SIGNIFICANCE OF TOPIC: There is abundant research demonstrating various forms of discrimination against the girl child in India. Such discrimination is rooted in a cultural preference for sons and aversion towards daughters. Discrimination against girl children takes the form of selective lower allotment of essential early-life childhood investment (food, nutrients, vaccination, and illness treatment). This results in disproportionately high infant mortality among girls, also known as excess female infant mortality.
PURPOSE OF PROJECT: This project argues that in India, such gender gap in early life investment and infant mortality can be traced to state-level lack of commitment towards enabling girl children to realize their basic human rights to life, health, and survival. In this backdrop, a recent study* has proposed a new metric of female status (Full Rights Realization Rate - FRRR), defined as the proportion of females in early life who fully achieve a basket of basic rights. The purpose of this current project was to develop the FRRRs for four early life stages for females in India – infancy/childhood, early adolescence, late adolescence, and early adulthood.
METHODS: National Family Health Surveys (NFHS 1992-93; 1998-99; 2005-06) of India were used in a pseudo-cohort analysis of two birth cohorts (first cohort born between 1982 and 1984; second cohort born between 1988 and 1990) to trace the FRRRs over the four stages of early life. State-level FRRRs were calculated for fourteen states of India. Multivariate linear regression models and multivariate logistic regression models were then used to study the association of state-level FRRRs with (a) gender gaps in several categories of early life investment – breastfeeding; four types of vaccination including BCG, polio, measles, and DPT; two types of illness treatment including diarrhea and fever; and (b) gender gap in infant mortality for infants between ages 0 and 5 years of age.
RESULTS: For most life stages, large proportions, if not majority of females achieve only a partial basket of rights and can even be deprived of all of their most basic human rights. Higher state-level FRRRs have negative and significant associations with gender gaps in early life investment and infant mortality. Higher state-level commitment to enabling female rights realization thus reduces discrimination against the girl child.
IMPLICATIONS: Disturbingly low full rights realization rates of even the most essential rights that are normally regarded as universal and unalienable underscore the low status of girl children in India and hence the need for higher level of commitment to enabling the girl children to realize their basic human rights.
*Chaudhuri, Sanjukta. 2013. “A Life Course Model of Rights Realization, Female Empowerment, and Gender Inequality in India” (In press: World Development).
Sexual Attitudes and Behaviors in Women of Somali Descent (42)
Jennifer Connor, PhD, Beatrice “Bean” E. Robinson, PhD, Amira Ahmed, BA, Shanda Hunt, MPH, Megan Finsaas, BA
We will present results from a qualitative pilot study of women of Somali descent in the MSP metropolitan area, home to the largest Somali population in the U.S. This study is amongst the first to examine sexuality- and HIV-related knowledge, attitudes, and behaviors of Somali women living in the US.
Background: Pilot project funded by: UCare Minnesota Fund Council (Minnesota Medical Foundation); Program in Health Disparities Research and IDEA Multicultural Research Award (both at the University of Minnesota), and St. Cloud State University.
Purpose: To document sexual behaviors and attitudes towards sexual education, condom use, female genital cutting, and sexual activities for a small group of Somali women who agreed to be interviewed about these sensitive topics.
Method: This research was approved by two University Institutional Review Boards (UMN Twin Cities and St. Cloud State University). An interviewer of Somali descent conducted the semi-structured interviews with 30 Somali women, aged 18-40 years. Women were recruited through word of mouth, and were compensated with a $30 giftcard. The interview was developed in English and translated into Somali. Participants were given the option of doing the interview in English or Somali; 8 selected English, and 22 were interviewed in Somali. Interviews were audio-recorded and translated as necessary into English, back-translated by a bilingual Somali college student volunteer, and transcribed by a professional transcription service. Quantitative codes were developed that documented the occurrence of behaviors, or indicated whether women had positive or negative attitude towards topics. Limitations included small sample size and missing data due to unclear answers.
Results: Most women had been tested for HIV (86%), usually as an immigration requirement. Over half had used condoms, primarily as a means of birth control rather than disease prevention. Most (93%) had experienced female genital cutting, although most were opposed to it in principle, and 86% would not choose the practice for their daughters. A substantial minority of women experienced pain with sexual intercourse (40%); and those who had undergone the most severe forms of female genital cutting were most likely to experience sexual pain (Χ² = 5.0; p = .03). Thematic analysis revealed that most women explained (1) cultural and religious prohibitions towards many sexual behaviors, (2) the culture of privacy around sexuality, (3) that Islam beliefs protected from them from disease, and (4) their belief that the Quar’an encourages men to attend to their wives sexual satisfaction.
Practice Implications: Physicians working with Somali women should discuss condom use with women, and may need to educate patients about the importance of disease prevention. Physicians should ask about sexual pain, especially with women who experienced the more severe forms of female genital cutting (i.e., Type II or III).
Somali Voices: Lack of Cultural Sensitivity Inhibits Ability to Embrace Western Medicine and Enable Safer Births (2)
Nancy Deyo, MA
According to UNICEF, one in 12 women in Somalia currently die in childbirth. The study objective was to understand cultural traditions that influence Somali women’s childbirth experiences and determine best practices required to embrace Western medicine and enable safer births. Snowball sampling was utilized to recruit participants in Minneapolis, Minnesota, where over 50% of the U.S. Somali population lives, according to the U.S. Census Bureau. Focus groups were conducted with 25 Somali women who gave birth in Somalia, refugee camps and the U.S. and experienced both traditional and Western childbirth practices. Focus groups with 15 Somali men, including three religious leaders provided perspective on Somali men’s influence over childbirth traditions. Twenty key distinctions between Somali cultural traditions and Western medicine were identified. Notably, Somali women’s uniform fear of cesarean sections encompassed not only physical risks but also personal risks of losing their husbands; providers’ poor understanding of female circumcision led to obstetric fistula; and lack of traditional postpartum support left U.S. Somali women feeling isolated and depressed. In-depth interviews with seven health care professionals identified twelve best practices for culturally sensitive care including making midwives available to Somali patients and learning life stories as a heuristic tool. Health providers, government agencies and nonprofit organizations in Africa and the U.S. have a collective obligation to implement community-led interventions to embrace culturally sensitive childbirth traditions as a potential means to help ensure safer births.
Tunneling Nanotubes: A Communication Highway For Chemo Resistance In Ovarian Cancer (27)
E.L. Dickson, V. Thayanithy, R. Isaksson Vogel, P. Argenta, M.A. Geller, S. Subramanian, E. Lou
Background: The biologic mechanisms of chemotherapy resistance in ovarian cancer remain unclear. Intercellular communication may play an undetermined but critical role in this process. Tunneling nanotubes (TnTs) -- long, thin actin-based cytoplasmic extensions that mediate intercellular transfer of cellular cargo – represent a novel candidate to explain evolution of resistance in treatment-refractory malignant ovarian cells. Potential cargos of interest include ERCC1 - a nucleotide excision repair protein that has been associated with resistance to cisplatin in ovarian cancer cell lines – and microRNAs (miRNAs) 29b and 199a, which are upregulated in cisplatin-resistant ovarian cancer cells. The purpose of this study was to investigate transfer of ERCC1 and miRNA cargo between susceptible and chemoresistant cells.
Methods: We cultured platinum-sensitive (A2780) and resistant (C200 and SKOV3) ovarian cancer cells, as well as normal ovarian epithelial cells(IOSE). SKOV3 cells were transfected with either GFP-labeled ERCC1 or GFP-labeled miRNA 29b and 199a and examined for intercellular transfer via TnTs connecting distant SKOV3 or co-cultured IOSE stromal cells. In separate experiments, SKOV3 cells treated with doxorubicin were co-cultured with A2780 cells to assess the ability of TnTs to act as a conduit for transmission of therapeutic drugs.
Results: A hyperglycemic, low-serum, acidic medium stimulated TnT formation between A2780 and both platinum-resistant cell lines (C200 and SKOV3), as well as between SKOV3 and stromal IOSE. ERCC1-GFP, and also miRNA 29b and miRNA 199a, were transported via TnTs from SKOV3 cells to each other and to stromal IOSE cells. TnTs mediated transfer of doxorubicin from SKOV3 to A2780 cells, inducing cell death in recipient drug-naïve cells.
Conclusions: TnT formation is stimulated in conditions of cellular stress and creates direct cytoplasmic connections between connected cells in vitro. Our data suggests that these conduits facilitate cellular exchange between platinum-sensitive and resistant ovarian cancer cells, as well as between ovarian cancer cell lines and normal ovarian epithelial stromal cells. Using currently available therapeutic agents to target TnTs and disrupt this communication provides a novel approach to overcoming the clinically significant problem of platinum resistance in ovarian cancer.
Work-Family Balance-Related Stress and Mothers’ Healthful Eating and Physical Activity (19)
Friend S, Draxten ML, Fulkerson JA, Horning ML, Schow R
Background: An increasing number of mothers are juggling both work and parenting responsibilities and many do so as single parents. The stress and time required to balance work and family life may be inversely associated with mother’s healthful eating and physical activity.
Purpose: To describe mothers’ reports of stress due to work-family balance and associations with demographic characteristics, dietary intake and physical activity behaviors.
Methods: Working mothers (n=109) participating in HOME Plus, a community-based, randomized trial to promote healthful eating behaviors and home food environments with 8-12 year old children and their families, completed baseline surveys that included demographic characteristics, dietary intake, and physical activity behaviors. Chi-square analyses assessed differences in low versus high work-family balance-related stress and the following demographic variables: work status (part time, full time), household income (less than $20,000-$35,000, $35,000-$99,000, $100,000+), education level (college degree, no college degree), and relationship status (partner, no partner). In addition, ANOVA analyses assessed differences in level of physical activity and intake of fruits, vegetables, fast food, and sugar-sweetened beverages within the past week.
Results: More than 40% of working mothers agreed with each of the following: a) because of my job, I miss out on home or family activities I want to participate in, b) because of my job, my family time is less enjoyable or more pressured, and c) working leaves me with too little time or energy to be the kind of parent I want to be. Mothers working full-time (p < 0.001) and those without a partner (p = 0.02) were more likely to report feeling high levels of stress related to work-family balance. Levels of work-family stress did not differ by household income or education level. Compared to mothers who reported low levels of work-family balance-related stress, mothers who reported high levels of stress ate fewer servings of vegetables per day (2.0 servings versus 2.6, p = 0.03). However, daily servings of fruit, frequency of drinking sugar-sweetened beverages, frequency of eating at fast food restaurants, and physical activity level did not differ between mothers with high or low levels of stress related to work-family balance.
Discussion: Regardless of income level and education, many working mothers feel that stress related to work-family balance is impacting their life and for many, it may be associated with poorer food choices, particularly vegetable intake. Efforts that demonstrate how to increase children’s assistance in healthful meal planning and preparation may be particularly helpful for mothers experiencing stress due to balancing work and family. In addition, providing healthful eating strategies that can be easily incorporated into everyday life may help working mothers improve their overall health and decrease their risk for nutrition-related health problems.
Lifestyle Intervention for Chronic Disease (20)
Dwenda Gjerdingen, MD; Christine Danner, PhD
Background. The United States is seeing an epidemic of metabolic syndrome related chronic diseases – e.g., obesity, diabetes, hypertension, hyperlipidemia, and cardiovascular disease – that adversely affects the lives of millions of citizens. Although the etiology of these diseases is multifactorial, lifestyle often plays an important role by promoting obesity and insulin resistance, which then lead to metabolic syndrome, diabetes, and other related diseases. Chronic disease treatment models that systematically and consistently address lifestyle choices have the potential to control or even reverse the progression of these diseases. Unfortunately, most medical practices do not offer such lifestyle interventions for patients with chronic disease.
Purpose. The purposes of this study are to: 1. Test the feasibility of developing a sustainable lifestyle group intervention for patients with one or more metabolic syndrome-related chronic diseases (metabolic syndrome, diabetes, obesity, hypertension, or dyslipidemia), using previously validated behavioral techniques. 2. Begin to evaluate the impact of our lifestyle intervention on lifestyle and health outcomes.
Methods. This pilot feasibility study seeks to enroll approximately 20 English literate adult Bethesda Clinic patients with a metabolic syndrome related chronic disease (metabolic syndrome, diabetes, obesity, hypertension, or dyslipidemia) in a group lifestyle intervention. The lifestyle intervention will consist of twelve 90-minute group meetings over 6 months, led by a therapist and family physician. The meetings will include lifestyle education, group discussion and feedback, and individual goal-setting on topics related to nutrition, exercise, smoking cessation, etc. Group leaders will use behaviorally oriented techniques that have proven successful in previous research, such as motivational interviewing, goal setting, primary care physician collaboration, and positive affect induction. Intervention outcomes will be assessed through weight, blood pressure, and survey measures, including a lifestyle risk assessment tool (measures physical activity, diet, smoking, second hand smoke, alcohol consumption, and general health), and SF-12 (measures general health, mental health, bodily pain, energy/fatigue, physical and social function, role-physical and role-emotional).
Discussion. We anticipate that this study will demonstrate that it is feasible to develop a sustainable, intensive practice-based lifestyle intervention for primary care patients with chronic disease. We also anticipate that this intervention will improve patients’ activity levels and nutrition, and produce improvement trends in weight, blood pressure, function, and chronic pain. Finally, we believe that this intervention will serve as a model that can be used by other primary care practices. This study is particularly important to women, who tend to report greater prevalence of chronic disease, and who have greater barriers to lifestyle change, compared to men.
Ovarian Hormones and Leukocyte Infiltration in Injured Skeletal Muscle (7)
Angela G Greising, Tara L Mader, Emily A Kvasnicka, and Dawn A Lowe
Recovery of skeletal muscle from injury is a critical component of overall physical function. Post-menopausal women and estrogen-deficient mice exhibit dampened recovery from muscle injury. Little is known about the effects of estrogen on skeletal muscle inflammatory response following injury; however, estrogen has been shown to be anti-inflammatory in other tissues (i.e., vascular system, brain, neural tissues and cardiac muscle). It has been speculated that there is a cellular effect of estrogen on skeletal muscle repair, but the mechanisms through which this occurs are not well understood. We hypothesized that estrogen modulates the inflammatory response time course through recruitment of inflammatory cells, and decreases the duration of the inflammatory response. To test this hypothesis, mice were rendered estrogen deficient, through ovariectomy, or maintained normal levels of circulating estrogens. Muscle injury was induced by the performance of eccentric contractions. Mice were allowed to recover for 3 or 7 days following injury, at which time muscles were dissected and prepared for immunohistochemical analyses of leukocytes. The results indicate that the infiltration of leukocytes into skeletal muscle cells is not significantly affected by the presence or absence of estrogen but an effect of time since injury was observed. The amount of interstitial leukocytes present was affected by estrogen and this effect was dependent on the number of days since injury. This result indicates that lack of estrogen led to a delayed immune response in injured muscle.
Depressive Symptoms, Adiponectin, and Cardiometabolic Risk in Middle-Aged Women (10)
Harlos R; Hill R; Wang Q; Clark CJ; Bromberger JT; Mancuso P; Kravitz HM; Everson-Rose SA
Introduction: Cardiovascular disease and depression are common comorbidities yet the mechanisms linking these conditions are unclear. This study examined the cross-sectional association of depressive symptoms with cardiometabolic risk and whether adiponectin, an anti-inflammatory cytokine, contributes to this association in a cohort of middle-aged women.
Methods: Data from two sites of the Study of Women’s Health Across the Nation were used to assess depressive symptoms, measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and cardiometabolic risk, measured with the Framingham Risk Score (FRS), an indicator of 10-year CVD risk, and prevalent Metabolic Syndrome (MetSyn), defined by ATP-III criteria. Adiponectin was analyzed from stored serum samples. Linear and logistic regression models, with similar successive covariate adjustments, were used to analyze these relationships.
Results: Mean CES-D score was 10.6±9.2; 25% had scores ≥16. Mean FRS was 8.7 (range, 0-24); 20% met criteria for MetSyn. Raw mean adiponectin level was 9.9±4.9 μg/mL. Women with CES-D scores ≥16 had a 1-point higher FRS (b=.98; 95% CI, 0.18-1.79) and 64% greater odds of prevalent MetSyn [95% CI, 1.03-2.60] than women with low CES-D scores, adjusted for age, race and site. These associations were reduced following risk factor adjustment (FRS: b=.57; 95% CI, -0.23-1.36; MetSyn: OR=1.56; 95% CI, 0.95-2.54); adding adiponectin further reduced the point estimates by 30% for FRS (b=.40; 95% CI, -0.39-1.19) and by 13% for MetSyn [OR=1.36; 95% CI, 0.81-2.28]. Adiponectin was significantly inversely related to FRS, MetSyn, and depressive symptoms.
Translation: Clinicians should consider preventive treatments to mitigate potential inflammatory effects of depressive symptoms and subsequent CVD risk in women at mid-life. Research is needed to determine if increasing adiponectin levels has therapeutic potential.
Conclusions: Depressive symptoms were associated with greater cardiometabolic risk and adiponectin consistently attenuated these associations. Additional research is needed with a longitudinal component to further clarify these patterns.
Are Pregnancy Feelings and Attitudes Associated with Postpartum Depressive Symptoms? (11)
Wendy L. Hellerstedt,MPH, PhD, Jeremy Grey, MPH, Phd, Judy Punyko, MPH, PhD, Cheryl Barber MPH
Background/Purpose: Postpartum depression (PPD) has long-lasting negative effects on women’s health and well-being and on infant health and development. PPD rates may range from 9-16% and are disproportionately higher in socially vulnerable women. Because negative feelings about pregnancy are also common in socially vulnerable populations, we assessed whether pregnancy attitudes and feelings were associated with postpartum depressive symptoms, independent of sociodemographic factors.
Methods: We examined data from 7,339 adult respondents of Minnesota’s 2004-2008 Pregnancy Risk Assessment Monitoring System survey. Respondents were randomly selected from their infants’ Minnesota birth certificate at 2-4 months’ postpartum. Postpartum depressive symptoms were assessed with the Patient Health Questionnaire-2 screener that asked how often respondents felt “down, depressed, or hopeless” and “had little interest or pleasure in doing things” since their infant’s birth. We examined postpartum depressive symptoms conventionally (i.e., present if respondent answered “always” or “often” to either question) and by severity (i.e., “no”, “occasional”, “intermediate”, “severe” symptoms). We assessed maternal pregnancy feelings/attitudes about this pregnancy with questions about pregnancy attempts in the three months prior to this pregnancy (coded “trying”, “not trying”, “neither trying to prevent or become pregnant”); happiness about this pregnancy (coded “happy”, “unhappy”, “ambivalent”); and maternal and perceived partner satisfaction with the timing of this pregnancy (coded “intended”, “mistimed/unwanted”). Maternal and perceived partner intention responses were combined into one variable to examine intention concordance (coded “both intended”, “partner intended”, “mother intended”, “neither intended”). We assessed the associations of pregnancy attitudes and feelings with reported presence and severity of postpartum depressive symptoms in adjusted multivariable and polytomous logistic regression models that included covariates for sociodemographics; pregnancy health, health care, and substance use; and stressors prior to pregnancy.
Results: In crude analyses, each pregnancy intention and attitude variable was associated with a two-fold increase in risk for the presence of postpartum depressive symptoms, In adjusted analyses only partner intended/maternal not intended versus both intended was associated with increased risk (adjusted odds ratio (AOR), 1.45; 95% confidence interval (CI), 1.0, 2.0). Discordance in parental pregnancy intention was also associated with postpartum depressive symptom severity. Compared to parents who both intended this pregnancy, mothers who reported this pregnancy was unintended by them and intended by their partners were more likely to have intermediate postpartum depressive symptoms than no depressive symptoms (AOR, 1.68; 95% CI, 1.0,2.8).
Discussion: The findings may have been biased because of different time frames for reporting intention (i.e., at the time of conception) and depressive symptoms (2-4 months’ postpartum) and because partner intention reflected maternal perception. Nonetheless, the perception that a partner wanted a pregnancy that was not intended by the mother was a risk factor for the presence and severity of postpartum depressive symptoms, independent of measures of social vulnerability.
Correlates of Early Postpartum Contraceptive Use (43)
Wendy L. Hellerstedt, MPH, PhD, Jeremy Grey, MPH, PhD, Judy Punyko, MPH, PhD , Cheryl Barber, MPH
Background/Purpose: The postpartum period presents a time of risk for unwanted conception because contraceptive use may be inconsistent or delayed. Short pregnancy intervals are associated with social vulnerability and with maternal and offspring health risks. We identified correlates of contraceptive use in women at 2-4 months postpartum who are at risk for rapid repeat pregnancy.
Methods: We examined data from 7,392 adult respondents of Minnesota's 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Respondents were randomly selected from their infants’ Minnesota birth certificate at 2-4 months’ postpartum. Postpartum contraceptive use was operationalized as a dichotomous variable in response to a question about whether the respondent (or partner) was doing anything to keep from becoming pregnant at the time of the survey. Because breastfeeding may be associated with contraceptive use (or interpreted as contraception by respondents), we stratified analyses by breastfeeding duration (more than one week and one week or less). The variables in multivariable logistic regression analyses included pre-conception contraception; sociodemographics; pregnancy health, health care, and substance use; pre-conception stressors; infant size for gestation; and postpartum depressive symptoms.
Results: Eighty-seven percent of the respondents indicated they were doing something to prevent pregnancy postpartum; 21% reported they were doing something to prevent pregnancy when they became pregnant; and 75% reported breastfeeding for at least one week. Associations between postpartum contraceptive use and its correlates were similar in combined and in breastfeeding-stratified models: pre-pregnancy contraceptive use, prenatal contraceptive counseling, and having had a postpartum well-woman visit were positively associated while having other/no source of income versus wages and having experienced intimate partner violence prior to pregnancy were negatively associated. For women who did not breastfeed, the number of stressors experienced in the 12 months before their infants’ birth was positively associated with not using postpartum contraception (p = .01 for trend). For those who breastfed, parity of 2+ compared to none prior to this pregnancy was negatively associated (adjusted odds ratio 0.76; 95% confidence interval, 0.6,0.9)
Discussion: Eighty-seven percent of PRAMS respondents reported postpartum contraceptive use, but the survey data were insufficient to determine how women defined contraceptive use, when they began use, type(s) of contraceptives they used, and how efficiently and consistently they used them. Despite limitations, our data showed that pre-pregnancy contraceptive use and prenatal contraceptive counseling were positively associated with postpartum contraceptive use. Because postpartum contraceptive use was negatively associated with having had a postpartum maternal health care visit, these data suggest the need for directive prenatal contraceptive counseling with socially vulnerable women to reduce their risk for rapid repeat pregnancy. We found that correlates of postpartum contraceptive use did not vary substantively by breastfeeding duration of one week or more vs. none or less than one week.
The Effect of Combinatorial Oral Contraceptives on Nicotine Withdrawal and Craving (36)
Katie Hinderaker, Nicole Tosun, M.S., Alicia Allen, M.P.H., Ph.D., Sharon Allen, M.D., Ph.D.
Research has shown that ovarian hormones may affect a woman’s ability to quit smoking. The purpose of this study was to determine craving and withdrawal symptomatology by menstrual phase during acute smoking abstinence in women on a combination birth control pill (BCP; Tri-Sprintec) with steady hormonal levels compared to women not on birth control pills (no-BCP) with fluctuating cyclic hormonal levels. We hypothesized that the BCP women would experience different levels of craving and withdrawal symptomatology than the no-BCP women and that the BCP women would experience less variation by menstrual phase in craving and withdrawal symptomatology than the no-BCP women.
Women (n=42) aged 18-40 who smoked >5 cigarettes/day and experienced regular menstrual cycles were enrolled in a larger controlled cross-over study. Participants quit smoking for two four-day periods: once during Follicular (F) phase/1st week of Tri-Sprintec and once during Luteal (L) phase/3rd week of Tri-Sprintec. Participants completed daily questionnaires: the Minnesota Nicotine Withdrawal Scale (MNWS), the Questionnaire of Smoking Urges-Brief (QSU), and the Center for Epidemiologic Studies Depression Scale (CES-D). After 4 days of abstinence, participants returned to ad libitum smoking for approximately 6 weeks, then completed identical procedures in the alternate menstrual phase. Phase variation was calculated by subtracting Follicular scores from Luteal scores (L-F). Analyses included descriptive statistics, as well as logistic regression and growth curve models using SAS 9.2.
Participants were 27.1+6.3 years old and smoked an average of 10.4 cigarettes/day. The BCP group was significantly younger than the no-BCP group (23.4+4.7 vs. 29.0+6.2, p=0.005, respectively); therefore subsequent analyses controlled for age. Groups were matched on depressive symptoms, menstrual phase, race, and time to first morning cigarette. There were several significant differences in phase variation between the two groups. On Day 1 of abstinence, BCP women reported greater withdrawal symptomatology in F phase while no-BCP women reported greater symptomatology during L phase (-2.00+6.54 vs. 1.77+5.76, p=0.03). On Day 3, BCP women reported more depressive symptoms in F phase while no-BCP women reported more depressive symptoms in L phase (-1.45+5.22 vs. 3.56+9.90, p=0.05). On Day 4, BCP women scored higher on QSU Factor 2 (Relief of Negative Affect) during L phase whereas no-BCP women scored higher in F phase (2.67+4.72 vs. -1.61+5.76, p=0.05). No other significant differences were found.
These results suggest that there may be phase variations in withdrawal symptomatology, depressive symptoms, and relief of negative affect experienced by BCP and no-BCP women during acute smoking abstinence. Limitations of this study include a small sample size and the significant age difference between the groups. The results of this study and related studies could be used to help direct women toward optimal conditions for smoking cessation.
The Real Deal with Those Sexy High Heels (34)
Angela Honstad MD, David Wright MD, Amir Rizkala, MD, Sarah Anderson MD, Julie Switzer MD
Background/significance: Women are continuously exposed to fashion ads portraying high heeled footwear as a symbol of sophistication, attraction, and beauty. The high heeled shoe alters the weight bearing surface of the foot and the mechanics of the gait. Reports of low back pain, anterior knee pain, and painful foot deformities have frequently been attributed to high heeled footwear yet with the glamorous portrayal of high heels, patients continue to wear them. The purpose of our synthesis of literature poster is to educate women on the negative effects of high heel footwear. We hope that this empowers them to make informed decisions when purchasing and wearing their favorite footwear.
Methods to review literature: A PubMed literature search was performed using the keywords “effects” and “high heels”. This search returned 36 articles. Review of these articles allowed us to eliminate 7 articles which either did not relate to our topic or were commentaries. The remaining 29 articles from PubMed were included for use in our review. A search of the literature through the American Academy of Orthopaedic Surgeons (AAOS) was also performed using the same keywords. This search identified 1 article which was included in our review.
Results: Multiple biomechanical studies have been performed to compare gait, force applied across the surfaces of the foot, and the muscle/nerve activity with and without high heeled footwear. These studies have shown a decrease in the length of the gastrocnemius muscle leading to a reduction in the active ankle range of motion. (Csapo et al, 2010) They also show an alteration in the center of gravity leading to alterations in lumbar lordosis and increasing the activity of the paraspinal musculature. (Mika et al, 2012 and Iqbal et al, 2012) The effects of high heeled shoes on anterior knee pain in young women was also evaluated. Females have a higher incidence of anterior knee pain than males. Many contributing factors have been identified, including the use of high heeled shoes. (Kerrigan et al 2005; Fulkerson et al 2000) High heeled footwear was shown to cause increased internal knee abduction resulting in increased medial joint loading. (Barkema et al 2012) This increased stress on the joint as well as increased knee flexion while ambulating in high heels may put these women at increased risk of osteoarthritis of the knee. (Simonsen et al 2012) Multiple deformities and painful conditions of the foot including bunions, Morton's Neuroma, Haglund's deformity, achilles contractures, hammertoe deformity, venous disease, and metatrsalgia have been associated with the use of high heeled footwear in females. There is a direct correlation between increasing discomfort and increasing heel height. (Hong et al 2005)
Research/program/and or practice implications of findings: These results support the hypothesis that high heeled shoes can not only cause discomfort but can have permanent negative effects on the musculoskeletal and vascular systems. These effects extend beyond the feet to include low back pain, knee pain and degenerative joint disease, ankle/foot deformities and degeneration. Patients need education regarding the negative effects that high heeled footwear can have; we need to recommend against the use of high heeled footwear, especially in patients that already have signs of joint degeneration. Patients that persist in their desire to wear high heeled shoes should be guided to look for shoes with a wider toe box and lower heel.
Meeting the mental health needs of rural women (12)
Jane C. Hovland, Claudia V. Weber
The integration of mental health care in patients’ medical homes fosters improved communication among professionals and ultimately improves patient outcomes. Integration of care demands more than co-location services – it relies on shared information and decision making, with the patient at the center. In spite of improvements in health record keeping, most individuals seeking mental health care experience silos of care and many health care providers have raised concerns about losing patients in the secrecy associated with traditional mental health care delivery systems.
Ten years ago, the authors and their colleagues created a telemental health service to model integration of mental health care in rural primary care clinics. The aims of the service were to 1.) increase communication among patient, physician, and mental health providers, 2.) reduce the wait for mental health services from 3 months to fewer than 7 days, and 3.) reduce travel time for mental health services for rural residents.
From one site and 3 visits in the first year, the project has now expanded to 14 rural primary care sites crossing the state and multiple health care systems. As of the date of submission, almost 4,000 patient visits have occurred, with approximately 60% of services being delivered to women of all ages.
General mechanisms of referral and integration of care will be presented, centered on the goals of delivering quality care in patients’ medical or health care homes and actively collaborating with patients’ providers to improve patient outcomes and compliance.
Demographic and grouped data about women using the service will be presented, including co-occurring mental and physical disorders, use of psychotropic and non-psychotropic medications, and self-rating scales associated with depression.
Lastly, patient satisfaction and referring provider satisfaction data will be presented. These metrics have been consistently high since the project’s inception.
Cortisol, Menstrual Phase and Response to Nicotine among Female Smokers (37)
Eileen Huttlin, Nicole Tosun, MS, Alicia Allen, MPH, PhD, Sharon Allen, MD, PhD, & Mustafa al'Absi, PhD
Previous research indicates that stress may increase cigarette craving and smoking pleasure, and some reports suggest that cortisol may modulate a smoker’s response to nicotine. The present study analyzes the relationship between salivary cortisol levels with subjective responses to nicotine among female smokers during ad libitum smoking. We hypothesize that higher cortisol levels will be associated with increased positive and decreased negative subjective responses to nicotine in both phases of the menstrual cycle.
Females aged 18-40 who smoked at least 5 cigarettes per day, reported regular menstrual cycles and were not taking oral contraceptives or psychotropic medications were recruited. Participants completed two identical weeks of testing, one during the follicular phase (F) and one during the luteal phase (L) of the menstrual cycle. On day 2 of each testing week, participants both self-collected salivary cortisol samples at specific times throughout the day and completed a nicotine response lab session. This lab session involved administration of nicotine nasal spray and completion of surveys, specifically the Subjective State Scale (SSS) and Visual Analog Scale (VAS), to assess subjective response. Ad libitum smoking was allowed during this day. Descriptive statistics and correlation coefficients were computed using SAS 9.2.
Participants (n=99) were 29.1± 6.9 years old and smoked an average of 12.3± 5.5 cigarettes per day. During the F phase, higher morning salivary cortisol levels were significantly associated with decreased negative affect and decreased withdrawal scores in response to the nicotine nasal spray (r= -0.212, p=0.034 and r= -0.295, p=0.003, respectively). This was not seen in the L phase (p > 0.05).
Results from this analysis indicate that cortisol may modulate some of the subjective response to nicotine in women smokers during the F phase but not the L phase. Therefore, cortisol may play a role in the phase effects on smoking cessation attempts previously reported. A large sample size and a within-subjects design strengthened this analysis. A limitation, however, is the self-collection of the salivary cortisol samples by participants. Additional research is warranted to further characterize the relationship between cortisol and response to nicotine.
A History of Major Depressive Disorder in Current Postmenopausal Smokers and the Association with Body Composition and other Maladaptive Behaviors (38)
Lindsay Jarvis, Alicia Allen, Ph.D., M.P.H., Sharon Allen, M.D., Ph.D.
A multidirectional relationship exists between obesity and depression. This association between depression and obesity is stronger in women. Due to this link, it is important to examine the factors that could lead to obesity in smokers who are depressed or who have depressive vulnerabilities. There is current evidence to suggest that tobacco use may moderate the relationship between major depressive disorder (MDD) and obesity. Since this relationship between depression, smoking behavior and obesity has not been thoroughly examined, we aim to explore these associations in a sample of postmenopausal smokers, as they are at high risk for both depressive symptoms and obesity.
Postmenopausal women at least 40 years of age, in stable physical/mental health and who reported a desire to quit smoking (>7 on a Likert scale), were recruited to participate in a smoking cessation research study. At screening, participants completed the Structured Clinical Interview for DSM-IV (SCID) interview with study staff and were classified as no lifetime history of MDD or history of MDD. Those with current MDD were excluded and referred for treatment. Percent lean body mass and body fat were measured using a dual-energy x-ray absorptiometry (DXA). Fitness test measures included a grip test, step test and chair raise. Exercise and relaxation minutes per day over the last 7 days were based on self-report. Descriptive statistics and ANOVA/ANCOVAs were computed using SAS 9.2.
Participants (n=125) were an average of 56.8±5.7 years old, 95.1% white, and 20.5% had an income ≤ $20,000. Participants reported smoking an average of 19.1±7.7 cigarettes per day and had an average FTND score of 5.1±1.8. Two trends were noted. First, participants with a history of MDD (n=61) reported exercising fewer minutes per day than participants with no history of MDD (n=64; 9.45±18.43 v.17.73±27.65, p=0.090). Second, participants with a history of MDD had a lower waist-hip ratio than participants with no history of MDD (0.80±0.06 v.0.83±0.08, p=0.083). No significant differences were found in smoking behaviors nor the fitness, body composition or food craving measures.
Overall there were no significant differences found in any obesity-related measures between those who did have a history of MDD and those who did not. While these results were limited by self-report and limited to postmenopausal smokers, our observations are consistent with previous research that suggests the association between obesity and MDD is moderated by smoking. Smokers may substitute smoking for other maladaptive behaviors that could lead to obesity. These results indicate that more research is needed to explain how smoking might moderate the relationship between MDD and obesity.
The Roles of Partner Communication and Relationship Status in Adolescent Contraceptive Use (44)***
A.Z. Johnson, MSW; R. Sieving, RN, PhD; S. Pettingell, PhD
BACKGROUND: With high rates of pregnancy and sexually transmitted infections among adolescents, factors that influence youths’ contraceptive use require close examination. Although previous research identifies partner sexual communication as increasing the likelihood of contraceptive use among adolescents, the nuances in the associations between these variables have received less attention. This study examined how different types of partner communication relate to contraceptive use among adolescent girls, and whether this association varied by partner relationship status.
METHODS: Baseline self-report data from 253 sexually active 13-17 year old girls enrolled in Prime Time, a randomized youth development intervention study, were used to examine associations between partner communication specific to contraceptive use (4-item scale; a=0.69), partner relationship status (casual vs. main partner), and contraceptive use (condom use consistency, hormonal contraceptive consistency). Partner relationship status was also analyzed as a moderator. Following initial bivariate analyses, GEE regression models assessed main effects and interactions on contraceptive use outcomes.
RESULTS: The majority of girls in this sample (72%) classified their most recent sexual partner as a “main” partner, indicating that they were only going out with each other. In a multivariate model, earlier partner communication (RR=1.3, p<.001) and ‘main’ partner status (RR=0.65, p<0.01) were both associated with hormonal contraceptive consistency. In an interaction model, the impact of partner communication on hormonal contraceptive consistency was greater in main partnerships than in casual partnerships. In contrast, neither partner communication nor partner relationship status was significantly associated with condom use consistency in a multivariate model.
LIMITATIONS/STRENGTHS: These findings may not be generalizable to girls at high risk for negative sexual health outcomes who do not access clinic services. However, for this particular population, a closer look at the nuances of different types of communication adds to the current body of literature around factors associated with consistent contraceptive use.
CONCLUSIONS: Our findings suggest that earlier communication, particularly communication specific to contraceptive use, has a stronger association with hormonal contraceptive consistency than with condom use consistency. The association between partner communication and hormonal use is particularly robust with adolescent girls’ main partners. Findings indicate that clinicians should consider asking questions that help them understand the nature of adolescent girls’ relationships with their sexual partners when encouraging contraceptive use. When discussing partner communication, early communication specific to contraceptive use should be stressed.
Healthcare Disparities among US Women with Severe Psychological Distress (13)
Pamela Jo Johnson, MPH, PhD; Pat McGovern, PhD, MPH; Dwenda Gjerdingen, MD, MS
Background: Previous research suggests that people with serious mental illness have higher prevalence of physical illness, are more likely to have suboptimally treated chronic conditions, and die, on average, 25 years earlier than the general population.
Purpose: To examine disparities in healthcare coverage, healthcare access, and unmet healthcare needs for women with severe psychological distress (SPD). Methods: Data were from a nationally representative sample of women, ages 18 to 64 (n = 14,421 unweighted), taken from the 2012 National Health Interview Survey (NHIS). Severe Psychological Distress was defined using the K6 with a score of 13+. Healthcare measures included insurance coverage, reasons for delayed care, and types of foregone care due to cost. Descriptive analyses included cross-tabulations with design-based f-tests. Logistic regression was used to examine healthcare coverage and access disparities adjusted for age, race/ethnicity, education, marital status, employment, poverty, insurance, usual source of care, health status, functional limitation, current drinker, and region. Analyses were conducted with StataSE and accounted for unequal probability of selection and complex sample design of NHIS.
Results: Overall, 4% of women ages 18-64 had SPD, which equates to nearly 4 million US women. However, 21% had never been told by a provider that they had depression, bipolar, or another mental health disorder. Women with and without SPD were significantly different on most sociodemographic and health status variables. COVERAGE: Women with SPD are less likely to report private coverage (32% vs. 67%, P<0.001), more likely to report public coverage (41% vs. 14%, P<0.001) and be uninsured (29% vs. 18%, P<0.001) than women without. In multivariate analysis, women with SPD have 1.5 times higher odds of being uninsured compared with non-SPD women (95% CI 1.1-2.0). DELAYED CARE: Women with SPD are significantly more likely to delay care due to cost (OR=1.9, 95% CI 1.5-2.9), and have nearly two-fold higher odds of delayed care for all reasons examined compared with non-SPD women. FOREGONE CARE: For all seven types of care examined, women with SPD are significantly more likely to have foregone care due to cost than non-SPD women. Notably, women with SPD have significantly higher odds of needing but not getting mental health care (OR=8.2, 95% CI 6.1-11.0), specialist care (OR=3.3, 95% CI 2.5-4.4), and follow-up care (OR=3.2, 95% CI 2.4-4.2).
Discussion: Our findings reveal that US women with SPD have considerable healthcare disparities compared with non-SPD women using a nationally representative sample from the most currently available NHIS data. It is unclear if delays are associated with healthcare systems or mental illness itself. Foregone mental health care suggests gaps in mental health parity laws. There are likely system-level, provider, and patient-related factors that contribute to disparities, many of which the Affordable Care Act may not adequately address.
Born Too Soon: Trends in Childbirth Before 39 Weeks Gestation Without Medical Indication, 1995-2009 (22)
Katy B. Kozhimannil, PhD, MPA; Michelle Macheras, MA; Scott A. Lorch, MD, MSCE
Context: Childbirth is the most common and costly reason for hospitalization in the U.S. There is increasing clinical and policy attention to labor induction and cesarean delivery occurring without medical indication between 37 and 39 weeks of completed gestation (“early term” deliveries).
Objectives: To measure prevalence, change over time, and individual characteristics associated with early term non-indicated delivery.
Design, Setting, and Participants: Retrospective, longitudinal analysis using linked hospital discharge and birth certificate data for the 7,296,363 full term, uncomplicated births that occurred between 1995-2009 in 3 states (Missouri, California, and Pennsylvania).
Main Outcome Measures: The primary outcome is early term non-indicated delivery, either medical induction of labor or cesarean delivery, and calculated among all uncomplicated deliveries between 37-44 weeks gestation. Gestational age is from birth certificates, and medical procedures and indications are and measured using hospital discharge records. Secondary outcomes include prolonged length of stay, and neonatal respiratory distress or ventilation.
Results: Across all uncomplicated births, the rate of early term non-indicated delivery was 3.18%, increasing from 2.12% in 1995 to 3.74% in 2009. After controlling for clinical, socio-demographic, and hospital factors, the risk of having a non-indicated delivery before 39 weeks was 78% higher in 2009 compared with 1995 (hazard ratio (HR)=1.78 95%CI [1.73-1.82]). Factors associated with greater odds of early term non-indicated delivery included advanced maternal age, white race, higher education levels, private health insurance, and delivering at smaller volume or non-teaching hospitals.
There were racial/ethnic differences in the risk of early term non-indicated birth by mode of delivery, with non-white women having substantially lower rates of non-indicated induction, compared with white women; however, black women had higher rates of non-indicated cesarean delivery (HR=1.26 [1.23-1.29]) compared with white women.
Impacts of early term non-indicated delivery on secondary outcomes depended on mode of delivery, with labor induction being associated with greater odds of prolonged length of stay for both mothers (adjusted odds ratio (AOR)=1.68 [1.66-1.71]) and infants (AOR=1.54 [1.52-1.56]) and cesarean with double the odds of infant respiratory distress or ventilation (AOR=2.11 [2.07-2.16]).
Conclusions: Early term non-indicated delivery has increased over the past 15 years. In 2009, nearly 4% of all full term infants without complications were born too soon in the U.S., with no medical indication.
How Estradiol Impacts Musculoskeletal Strength In Females: Phosphorylation of Myosin Regulatory Light Chain (8)***
Shaojuan Lai, MD, PhD, Brittany C. Collins, MS, Dawn A. Lowe, PhD
Background: In aged women, muscle dysfunction is dually affected by aging and aging induced ovarian hormone senescence. Estradiol is the key ovarian hormone because it regulates the structure and function of myosin, the primary contractile protein in muscle affecting strength. However, the molecular mechanisms by which estradiol affects muscle function in females are not clear. Since phosphorylation of myosin regulatory light chain (pRLC) affects myosin cross bridge structure and function during skeletal muscle contraction and estradiol affected pRLC in cardiac muscle, we hypothesized that estradiol affects skeletal muscle strength in females through regulating pRLC.
Objectives: To elucidate estradiol's role on pRLC and the related signaling pathway as a mechanism of estradiol on musculoskeletal strength in females.
Methods: Young female mice were sham operated or ovariectomized or ovariectomized but immediately received estradiol treatment. These mice together with aged ovarian senescent mice were applied to evaluate estradiol's role on pRLC and related signaling pathway. An in vitro muscle incubation system was used to test the modulation of pRLC on muscle force. C2C12 cells were applied to assess the response of skeletal muscle cells to estradiol.
Results and Discussion: C2C12 cells showed a dose-dependent increases in pRLC under estradiol treatment, suggesting skeletal muscle cells are responsive to estradiol in the manner of pRLC. In muscles of ovariectomized mice, pRLC was reduced 52-74% relative to ovary intact-counterpart (P<0.026), which was accompanied by reduced muscle force. Both reduced muscle force and pRLC were rescued by estradiol treatment. In aged ovarian senescent female mice, levels of pRLC were also reduced compared to young counterparts. When pRLC was inhibited by a myosin light chain kinase (MLCK) inhibitor, muscle force potentiation was decreased, which was rescued by estradiol treatment. These data suggest pRLC via estradiol is not through traditional MLCK. Interestingly, in both ovariectamized mice and aged ovarian senescent mice, expression of neuronal nitric oxide synthase (nNOS) in skeletal muscle was reduced, which was reversed by estradiol treatment. Inhibition of nNOS activity resulted in decreased pRLC, indicating nNOS is a pRLC regulatory protein mediated by estradiol. Furthermore, expression of estrogen receptor beta (ERβ) was diminished in aged muscles while ERα increased and G protein-coupled estrogen receptor 1 (GPER) remained unchanged compared to young mice. In addition, regulation of pRLC and nNOS by estradiol was mediated by ERß but not ERα or GPER. By applying cutting edge physiological, cellular and molecular technologies at the cell, tissue and whole body levels, the above results indicate that in females estradiol regulates skeletal muscle pRLC, thus muscle strength, through ERß mediated non-MLCK signaling pathway involving nNOS. Thus, our results provide some insights on how estradiol benefits musculoskeletal performance in aged females and help develop selective ERß modulators to prevent/improve muscle dysfunction.
Computational Modeling of Pelvic Floor Stress Distribution and Its Implications in Urinary Incontinence (23)
Chi-Lun Lin, Guangjian Wang Ph.D., Arthur Erdman Ph.D., Gerald Timm Ph.D.
Background: Urinary incontinence is a major women’s health problem. In the United States it affects over 10 million women each year with an estimated annual treatment cost of billions of dollars. Mechanical stress to pelvic continent mechanisms is a major risk factor for urinary incontinence. Thus, even in healthy young female athletes excessive rigorous jumping can cause urine leakage. We have hypothesized that such a stressful event could temporarily or eventually permanently compress and injure critical continence-related pelvic nerves and muscular structures resulting in urine leakage.
Purpose: To identify stress distribution and stress levels in a human pelvic computer model in response to jumping using the finite element method, and to investigate the effect of pressure compression on nerve physiology in isolated nerves.
Methods: For computer simulation studies a geometric model of female pelvis is constructed with MRI scans from a volunteer. The tissue mechanical properties are taken from the literature. With both the geometric model and the tissue properties the stress distribution in response to a jumping in pelvic structures is simulated using ABAQUS/Explicit. For neurophysiological experiments nerve compound action potentials (CAP) are recorded in freshly isolated swine phrenic nerves. Standard electrophysiological methods are used for amplification and recording of the nerve signals. A custom modified nerve recording chamber is used to study the effect of various pressure compressions on nerve compound action potential.
Results: A jumping load as a subject jumps from 1-foot height to the ground exerted a force (created a velocity field) on and caused a distinct distribution of stress/pressure in pelvic floor muscles. As shown in the inserted figure (left) there appears to be certain “hot spots” in pelvic floor muscles that may experience high stress levels. These include areas that intersect with lateral pelvic walls, areas adjacent to pelvic hiatus and to a lesser degree the muscle of puborectalis. In physiological measurements, four nerve samples have been tested thus far. After baseline recordings the nerves were compressed at 100 mmHg for 10 minutes and allowed to recover for additional 10 minutes. A total block of CAP by compression was seen in one sample. In other two samples compression reduced CAP conduction velocity by approximately 74% and increased CAP duration by approximately 110%. In the fourth sample compression did not cause significant changes. Changes in CAP returned to baseline levels after ten minutes recovery. This is shown in the inserted figure (right).
Discussion: The power of computer simulation lies in its ability to reveal and potentially predict the physio-anatomical responses of various pelvic structures to a prescribed load condition that can’t be achieved by other methods. Its results must be fully validated. This has not been done. Distinct stress distribution in pelvic floor muscles and significant block of nerve compound action potential by compression is observed. The next step is to determine if lies underneath these “hot spots” there associated with a distribution of continence-related nerves. The levels of stress that can be detrimental to continence mechanisms remain to be determined. If irreversible nerve injury can result in permanent incontinence strategies to prevent such an injury may prove to be useful in the treatment of urinary incontinence.
The Effect of Apolipoprotein E (Apoe) Genotype on Synchronous Neural Interactions (SNI) in Healthy Brains (17)
Margaret Y. Mahan, Arthur C. Leuthold, PhD, John J. Stanwyck, Angeliki Georgopoulos, MD, Apostolos P. Georgopoulos, MD, PhD
In this study, we analyzed the effect of apolipoprotein E (apoE) genotype on SNI distributions in cognitively healthy women of various ages to determine the relations between apoE genotype and neural communication. ApoE is involved in lipid metabolism in the brain but its effects on brain function are not understood. Three apoE isoforms (E4, E3, and E2) are the result of cysteine-arginine interchanges at two sites: there are zero interchanges in E4, one interchange in E3, and two interchanges in E2. The resulting six apoE genotypes yield five groups with respect to the number of cysteine residues per mole (0-4 CysR/mole). The use of the number of CysR/mole to characterize the apoE molecule converts the categorical apoE genotype scale, consisting of 6 distinct genotypes above, to a 5-point continuous scale, allowing the use of statistical analyses suitable for continuous variables. Using such analyses, here we show for the first time that apoE affects in a graded and orderly manner neural communication, as assessed by analyzing the relation between the number of CysR/mole and synchronous neural interactions (SNI) measured by magnetoencephalography (MEG) in 130 cognitively healthy women. By investigating the statistical properties along the range of CysR/mole SNI distributions, the 4-CysR/mole (E2/2) SNI distribution was found to have unique properties. The special status of the 4-CysR/mole distribution was reinforced by the results of a hierarchical tree analysis where the 4-CysR/mole (E2/2) SNI distribution occupied a separate division by itself and the remaining CysR/mole SNI distributions were placed at increasing distances from the 4-CysR/mole distribution, according to their number of CysR/mole, with the 0-CysR/mole (E4/4) being farthest away. These results support the idea that the number of CysR/mole is an important quantitative factor underlying the effect of apoE on SNI. In addition, these findings suggest that the 4-CysR/mole (E2/2) SNI distribution could serve as a reference distribution. When the SNI distributions of individual women were expressed as distances from this reference distribution, there was a substantial overlap among women of various CysR/mole. This orderly variation of SNI with the number of CysR/mole is in keeping with recent advances and ideas regarding the molecular mechanisms underlying the differential effects of apoE in the brain which emphasize (a) the healthier stability conferred on the apoE molecule by the increasing number of cysteine-arginine interchanges, with 4-CysR/mole (E2/2) being the best case, as opposed to (b) the instability and increased chance of toxic fragmentation of the apoE molecule with lower number of CysR/mole, with 0-CysR/mole (E4/4) as the worst case. Overall, we show for the first time that the apoE genotype affected the SNI distribution in a systematic and graded fashion, according to the number of CysR/mole in the apoE molecule.
Posttraumatic Stress Disorder Symptoms and Food Addiction in Women, by Timing and Type of Trauma Exposure (14)
Susan Mason, Alan Flint, Karestan Koenen, Andrea Roberts, Jessica Agnew-Blais, and Janet Rich-Edwards
Background: Post-traumatic stress disorder (PTSD) is a potentially important risk factor for obesity and obesity-related diseases, but the mechanisms linking PTSD to weight gain remain unclear. Emerging animal and clinical evidence suggests that chronic stress may provoke consumption of high-calorie foods, triggering dopaminergic reward systems that counteract feelings of distress. Over the long term, this eating pattern is associated with addiction-like behaviors and brain adaptations in rats, thus some stress-related overeating may constitute ‘food addiction.’ Purpose: We examined the association of lifetime PTSD symptoms and age at PTSD onset with a measure of current food addiction in 2009 in the Nurses’ Health Study II (NHSII).
Methods: The NHSII ascertained timing of trauma exposure and PTSD symptoms in 2008 and current food addiction in 2009. Food addiction was defined as >3 clinically significant symptoms on a modified version of the Yale Food Addiction Scale. Confounder-adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression.
Results: Of 49,408 women in the study sample, approximately 80% reported some type of trauma exposure, with 66% of the trauma-exposed reporting at least 1 lifetime PTSD symptom. Eight percent of the cohort met the criteria for food addiction. There was a dose-response relationship between number of lifetime PTSD symptoms and food addiction. Women with the greatest number of PTSD symptoms (6-7 symptoms) had more than twice the prevalence of food addiction as women with no PTSD symptoms (PR=2.66; 95% CI: 2.37, 2.98). PTSD symptoms were more strongly related to food addiction when symptoms began at an earlier age; for example, among women with symptom onset at age <10 years, the PR for food addiction associated with 6-7 PTSD symptoms was 3.67 (95% CI: 3.10, 4.33). In addition, PTSD symptoms in response to childhood physical abuse were more strongly related to food addiction than PTSD symptoms in response to other traumas.
Strengths and limitations: The strengths of this study include a large sample size and rich covariate data, as well as novel eating behavior data. The primary limitations were lack of data on timing of food addiction onset, and use of a screening questionnaire rather than a diagnostic interview for identification of PTSD symptoms.
Conclusions/ applications: PTSD symptoms are associated with an increase in food addiction prevalence in this cohort of women. If this finding is replicated, it may have implications for the treatment of PTSD and for obesity prevention strategies among women with histories of trauma.
Contraceptive Use Among Emerging Adult College Women (45)
Leslie Morrison PhD RN, Renee Sieving PhD RN PNP, Sandy Pettingell PhD, Linda Bearinger PhD RN, Barbara McMorris PhD, Wendy Hellerstedt PhD MPH
Background/significance: Emerging adulthood is a unique developmental period from 18 to 25 years of age. Because most emerging adults are sexually active, unintended pregnancy disproportionately affects this population and, therefore, contraceptive use is an important health consideration. While proximal determinants of contraceptive use are well understood, less is known about distal determinants of contraceptive consistency among emerging adult women attending college.
Purpose of project: Using emerging adult developmental theory and a positive youth development (PYD) framework, we explored risk and protective factors associated with consistent contraceptive use among emerging adult female college students, and whether the effects of risk factors were ameliorated in the presence of protective factors.
Methods: We conducted a secondary analysis of cross-sectional data from Wave III of the National Longitudinal Study of Adolescent Health (Add Health). Our sample included 842 18-25 year old women attending 4-year colleges. Consistent contraceptive use was defined as use of contraception “all of the time” with intercourse in the past 12 months. Risk indicators included heavy episodic drinking (consumption of five or more drinks ≥ two times/month), marijuana use (past month frequency), and depressive symptoms (responses to 10 items from the CES-D). Protective factors examined included self-esteem (four items from the Rosenberg Self-Esteem Scale), confidence (“How confident are you of yourself?”), independence (“How independent are you?”), and life satisfaction (“How satisfied are you with your life as a whole these days?”). We used multivariate logistic regression models to evaluate relationships between protective factors and consistent contraceptive use and between risk indicators and consistent contraceptive use. We also examined whether protective factors moderated the effects of risk indicators on consistent contraceptive use.
Results: Self-esteem, confidence, independence, and life satisfaction were all positively and independently (p < 0.05) related to consistent contraceptive use. Life satisfaction had the strongest relationship with consistent contraceptive use; in a multivariate model including all protective factors, life satisfaction was positively related to consistent contraceptive use (OR = 1.25, p = 0.05). Marijuana use and depressive symptoms were independently and negatively (p < 0.05) related to consistent contraceptive use. In a multivariate model of covariates and risk indicators, both marijuana use (OR = 0.98, p = 0.05) and depressive symptoms (OR = 0.91, p < 0.001) were negatively related to consistent contraceptive use. Protective factors did not moderate the relationships between risk indicators and consistent contraceptive use.
Discussion: This cross-sectional study, an initial investigation of associations between protective factors, risk indicators and consistent contraceptive use, supports further longitudinal investigation of these relationships. Together with findings from previous studies regarding protective factors, our findings support the use of strengths-based interventions to promote consistent contraceptive use among female college students during their emerging adulthood.
Rural Health Care Initiative, Sierra Leone (6)
Carol Nelson MD
Program: Rural Health Care Initiative (RHCI) is a program of the Sierra Leone Community of Minnesota. The mission of RHCI is to improve the health of the people of Tikonko Chiefdom in rural Sierra Leone, with a primary focus on maternal and child health. Located in West Africa, Sierra Leone continues to recover from a decade of civil war that devastated its health care system. It ranks at the bottom of all the development indicators for maternal and child health. RHCI is part of a non-profit organization and is gaining NGO status in Sierra Leone. Two teams of volunteers from Minnesota, including staff from Boynton Health Service, have traveled to the Tikonko Chiefdom to establish relationships, gather information and lay the ground work to partner with the villages to improve health. Information about the current status of health in Sierra Leone will be presented. RHCI has plans to improve maternal and child health include partnering with the local community health center and implementing training for the traditional birth attendants. RHCI plans to establish a maternal waiting home and improve transportation for ill patients needing a higher level of care to the Bo Hospital or MSF (Doctors Without Borders) Hospital located in that region of Sierra Leone.
Prenatal Hot Yoga and Health: Knowledge, Attitudes, and Beliefs and Ambient Air Measurements (24)
Viann N. Nguyen, MPH, Patricia Frazier, PhD, Steven L. Feng, Shilpa Babbar, MD, Nicole Calloway Rankins, MD, MPH, James D. Blando, PhD
There is an emerging form of yoga called hot yoga, where one practices in a room heated to 105°F. Clinical studies have found that expectant mothers who practice room-temperature prenatal yoga have better birthing outcomes than those who follow a more traditional prenatal exercise routine. However, there are currently no clinical studies that examine prenatal hot yoga effects. To assess the spread of prenatal hot yoga, we distributed knowledge, attitudes, and beliefs surveys to hot and non-hot yoga studios and Parent-Teacher Associations in Southeastern Virginia. Additionally, a thermal environment meter was used to measure ambient air conditions during three 90-minute hot yoga classes.
In total, 74 respondents were included in the data analysis, with 53 hot yoga practitioners and 21 non-hot yoga practitioners. Survey respondents tended to be White, college-educated females in the upper-30s age range. Groups were similar except hot yoga practitioners were statistically significantly (P<.05) more likely to currently be pregnant; desire to be pregnant if not currently pregnant; and have someone, not necessarily an obstetrician/gynecologist (OB/GYN), discuss prenatal exercise safety with them. Non-hot yoga practitioners trusted their OB/GYN as a source of prenatal hot yoga safety knowledge (rating: 9.3/10) more than themselves (rating: 7.1/10). On the other hand, hot yoga practitioners trusted themselves (rating: 8.7/10) more than their OB/GYN (rating: 7.7/10). Hot yoga practitioners also ranked OB/GYNs below a friend or acquaintance who had practiced yoga while pregnant (rating: 7.9/10) as a trusted source of health information. Of the 39 females who had practiced prenatal hot yoga, 87.5% would do so again.
Ambient air testing results determined that relative humidity ranged from 23-50% in hot-yoga classes. The measured WBGT temperature, an integrated measure of environmental heat, ranged from 86-104°F. NIOSH Recommended Exposure Level (REL) for acclimated persons is 86°F WGBT. Overall, the dry bulb, representing actual air temperature, ranged from 102.3-131.7°F.
This has implications for OB/GYNs and education campaigns. OB/GYNs may need to be aware that those who engage in prenatal exercise other than traditional yoga are less likely to be receptive to receiving safety information. Likewise, because hot yoga practitioners are more likely to trust other individuals who have experience with hot yoga than their OB/GYN in regard to prenatal hot yoga advice, OB/GYNs should redefine their approach when discussing prenatal exercise with this patient population. Individuals practicing hot yoga should be aware that the ambient air temperature would most likely change during practice and may be higher than the temperature advertised.
Though this study provides new, quantitative information on the burden of exercising in a heated room, these findings are subject to several limitations. The survey has a small sample size and probable response bias, and ambient air measurements were only conducted at one site.
The Crone: Archetype: Women Reclaim the Authentic Self by Resonating with Crone Images (15)
Joanne Sienko Ott, CFA, MA
The purpose of this research is to describe the lived experience of women who resonate or activate crone archetypal images. The literature describes the crone archetype as a pre-existent form in the collective unconscious that embodies instinctive ways of channeling wisdom, inner knowing, and intuition, guiding us through the transition of life, and going inward to bring forth the light for transformation. When women resonate or activate the crone archetypal image they tap into the psyche, to reclaim primordial images and receive the power within them that honor older women. Seven in-depth interviews were completed with older women who described their experiences of resonating with crone archetypal images. In order to reflect the psycho-spiritual nature of this research, the method utilized was organic inquiry. To ensure this research reflected the women’s perspective about their experiences and in their voice, critical feminist ethnographic principles were employed. The results of the interviews demonstrated that when women resonated with their images, they embodied the dynamic forms of the crone archetype explained in the literature. However, most significant was the finding that women affirmed their authentic self and trusted their inner feminine way of knowing. The implications of this research suggest that when women resonate or activate crone archetypal images that honor older women, they find a positive sense of self and purpose that can ultimately benefit society and integrate them into culture as they transition through aging.
Severity of Incontinence Symptoms in Smokers and Role of Tobacco Exposure and Respiratory Symptoms (25)
Ellen Overson BA, Alicia Allen, PhD MPH, Louise Hertsgaard, MA, Sharon Allen, MD PhD, Jean Wyman, PhD RN, Dorothy Hatsukami, PhD
Background: Urinary incontinence affects 25-45% of women and 11-34% of men around the world. Smoking increases the risk of both stress and urge urinary incontinence and though the mechanisms remain unclear, one hypothesis is that smokers cough more frequently, causing the involuntary leakage of urine.
Purpose: The goal of this study was to examine the relationship between urinary incontinence and two conditions - respiratory symptoms and tobacco exposure - in a sample of smokers. It is hypothesized that increased respiratory symptoms and tobacco exposure would be associated with increased urinary incontinence.
Methods: Men and women, ages 18-70, who smoked 10-40 cigarettes daily for the past year, were recruited to participate in a smoking cessation study. At screening, participants reported smoking behavior history, urinary symptoms via two validated International Consultation on Incontinence Questionnaires (ICIQ), respiratory symptoms, medical history and demographics. Height and weight were obtained along with urine sample (for analysis of cotinine, a metabolite of nicotine and measure of tobacco exposure). Descriptive statistics and ANOVA/ANCOVAs, adjusting for sex, BMI, age, diuretics, and current health problems, were conducted using SAS 9.2.
Results: Participants (n=202) were, on average, 47.3±11.7 years old, 58% female, and smoked an average of 19.3±7.3 cigarettes per day. Compared to men and women with reported symptoms of stress incontinence (SI), those who reported no SI symptoms had significantly lower urinary cotinine values (5018.4±2433.6 ng/mL vs. 3753.8±2143.3 ng/mL, respectively, p=0.004) and there was a trend indicating they may have a lower self-rated cough (4.5±2.4 vs. 3.6±2.4, respectively, p=0.060). A trend was noted where those with no symptoms of urge incontinence had fewer pack-years (28.5±15.6 vs. 31.0±19.3 p=0.060). There was a sex by ICIQ score interaction, where men with no urinary symptoms had higher cotinine values compared to men with mild and moderate symptoms (4576.13±2201.9 vs. 3900.7±2451.5 vs. 3776.6±2614.4, respectively); the same was not observed in women (3138.7±1731.6 vs. 4777.3±2222.6 vs. 3437.7±2494.6; p=0.032).
Strengths/weaknesses: The strength of this study is that it adds to the literature as there are few studies defining relationship between respiratory symptoms and urinary incontinence in both men and women who smoke. Weaknesses include the lack of data on the obstetrical history, which can affect urinary incontinence, and the small sample size.
Implications: There is an association between increased self-reported cough and urinary incontinence symptoms. Further, increased tobacco exposure, as defined by urinary cotinine, appears to be associated with stress incontinence symptoms while a more chronic tobacco exposure, as defined by pack-years, is associated with urge incontinence symptoms. The sex difference with ICIQ score suggests that higher cotinine levels may affect men and women differently. More research is needed with a larger cohort to further explore the relationships between tobacco exposure, urinary symptoms, and respiratory symptoms.
Health and Safety of Women Worker’s in Informal Sector in India (33)
Sigamani Panneer Ph.D and Gurumurthy Ramachandran Ph.D., CIH
Background and significance of the topic: In emerging economies, women in the workforce are more vulnerable to occupational hazards. India has experienced an enormous expansion in industrial production over the past two decades. Empirical research and reports published by governmental and research institutions shows that most of workforce in India is engaged in the so-called “informal sector” of the economy that does not come under the purview of existing occupational laws. The objectives of the paper are to review the occupational hazards of women workers in beedi rolling work, construction work, fish processing, and tobacco cultivation.
Methods to review literature: We reviewed the peer reviewed literature and secondary governmental data published between 1990 and 2013, relating to occupational hazards of women workers in the informal sector. The review began with using key phrases such as: informal economy, occupational health in agriculture, female work participation, and health concerns of female workforce in informal sector.
Results: The key findings summarized below are derived from the four case studies. 1) 91% of the total workforce and ~95% of the female workforce in India is employed in the informal economy. 2) The Factories Act of 1948 is applicable only to the 9% of the workforce in the organized sector. Even the Unorganized Sector Social Security Act of 2008 does not adequately cover women workers. 3) There is scant investigation of injury and accidents and inadequate compensation. 4) It is evident that women’s work remains unpaid or underpaid, unrecognized, uncounted as part of household income. 5) Some of the undernourishment of women and infants, and poor maternal and child health has been attributed to the lack of adequate welfare benefits (e.g., maternity leave) for female workers. 6) There is higher prevalence and incidence of occupational diseases particularly pulmonary & skin diseases, back pain, heat stroke, dehydration, cervical pain, psychological stress among female workers.
Policy implications: 1) Significant labor law reforms including new laws and amendments to existing ones to adequately cover the informal sector and the female workforce. The laws should provide for routine worksite inspections and risk assessments. 2) Provision of primary healthcare at the workplace as well as access to infrastructure including potable water, toilet, and first aid. 3) Provision of respiratory and dermal protective devices and adequate injury protection. 4) Development of a culture of health and safety consciousness in stakeholders including owners, employers, labor unions, workers and enforcement agencies. 5) Interdisciplinary approach to understanding the socioeconomic determinants and risk factors relating to women’s health and well-being in the informal employment sectors in India. 6) The occupational health service delivery system needs to undergo substantial changes to provide comprehensive integrated healthcare to protect women’s health and safety.
Biotin Status Response in Pregnant, Nonpregnant and Lactating Women Consuming a Dietary Biotin Intake Exceeding Current Recommendations (21)
Cydne A. Perry, PhD, Allyson West, PhD, Jian Yan, PhD, Xinyin Jiang, PhD, and Marie A. Caudill, PhD, RD
Background: Although it is recognized that biotin status is compromised during human pregnancy, no human dietary studies have been conducted to assess dose-response relationships, maternal-fetal compartmentation, or dietary biotin requirements. Consequently, the Food and Nutrition Board of the Institute of Medicine are not able to establish a recommended dietary allowance (RDA) for biotin. Instead an adequate intake (AI) level of 30μg biotin/d for adults is estimated without upward adjustments for pregnant women. An upward adjustment to 35µg/d is estimated for lactating women after accounting for milk biotin content and infant milk consumption. However, no studies have examined the relationships between maternal biotin intake, biotin status and milk biotin content during human lactation. Our objective is to perform a dose-response controlled feeding study in pregnant and lactating women to scientifically inform dietary biotin recommendations.
Design: A 12-wk controlled feeding was extended to enable a dose response assessment of biotin in healthy control (non-pregnant/non-lactating) women of reproductive age (n=21), pregnant (n=26, 27wk gestation) and lactating (n=28, 5wk postpartum) women. Quantitation of the biotin content of the diet consumed by study participants was performed by liquid chromatography-mass spectrometry (LC-MS). Twenty-four hour urine collections were used to measure maternal biotin status including those linked to biotin deficiency (i.e. 3-hydroxyisovaleric acid (3-HIA) and 3hydroxyisovaleryl-carnitine (3HIA-Car) via LC-MS. Breast milk samples were also collected and biotin concentrations were determined via LC-MS.
Results: The 7-day mixed diet consumed by all study participants over the 12-wk study period yielded an average biotin intake of ~60g/d. This dose is two times the biotin AI for nonpregnant and pregnant women (30g/d) and greater than the AI for lactating women (35g/d). In response to the study dose, urinary biotin excretion did not differ (P=0.27) by reproductive group. Pregnant women excreted more urinary 3-HIA compared to both control (p=0.001) and lactating (p<0.001) women. Control women excreted more 3HIA-Car compared to pregnant (P=0.015) and lactating women (P=0.023). Breast milk biotin concentrations decreased from baseline to study end (P=0.02)
Conclusions: The elevated urinary excretion of 3-HIA in pregnant women consuming the study dose indicates that intake levels greater than 60µg biotin (2x the current AI of 30 µg /d) are needed during the third trimester of pregnancy. The higher urinary excretion of 3HIA-Car in control women suggests an intake level greater than the study dose may be needed. The decrease in breast milk biotin concentrations throughout the study may indicate that an intake level greater than 60µg biotin (higher than the current AI of 35µg/d) is needed to sustain a higher biotin level in breast milk.
Girls: How We Feel and What We Do: Relationships Between Mental Health, Skills Sets and Violence (16)
Calae D. Philippe, MBBS, MPH, Renee Sieving PhD, RN,FSAHM, Iris Borowsky MD, PhD, Sandra Pettingell, PhD
Background/Significance: Over the last decade, adolescent girls have become increasingly involved in violence. Perpetration of both physical and relational violence has been linked to other risk behaviors and poor health outcomes. Thus, understanding protective influences that reduce adolescent girls’ risk of violence perpetration, including individual-level protective factors, is an important area of study.
Purpose of the Project: To examine relationships between protective factors (self-esteem, positive mental health, stress management skills, fight avoidance skills) and violence perpetration among adolescent girls at high risk for violence involvement.
Methods: Study participants (n=253) were 13-17 year old adolescent girls enrolled in Prime Time, a clinic-based randomized controlled trial with girls that self-identified as being involved in high levels of violence perpetration. This study examined the following self-report measures from the Prime Time baseline survey: physical violence perpetration in the past 6 months (5-item scale, α=0.79), relational violence perpetration in the past 30 days (6-item scale,α=0.77), positive mental health (6-item scale, α=0.89), self-esteem (4-item scale, α=0.89), stress management skills (8-item scale, α=0.86), and fight avoidance skills (5-item scale, α=0.70). Linear regression models were used to predict each form of violence perpetration controlling for age, race/ethnicity, history of violence victimization, and clustering of participants within clinics.
Results: Bivariate analyses showed that positive mental health, stress management skills, and fight avoidance skills were all inversely and significantly related to perpetration of both relational and physical violence. In contrast, self-esteem was not significantly related to either violence outcome. Girls who reported higher levels of relational aggression victimization and physical violence victimization were significantly more likely to perpetrate relational aggression and physical violence, respectively. Multivariate analysis revealed that stress management skills and fight avoidance skills were both significantly protective against perpetration of relational violence and physical violence. In multivariate models that accounted for these skill sets and history of violence victimization, positive mental health did not have independent effects on either relational or physical violence.
Strengths /Weaknesses: Findings suggest that both stress management skills and fight avoidance skills may protect adolescent girls involved in health risk behaviors – including those who have been victims of violence – from perpetrating physical and relational violence. This is one of the first studies to examine the association of stress management skills, fight avoidance skills, and violence perpetration in clinic-attending adolescent girls. Findings are not generalizable to other populations of adolescent girls. Because this is a cross-sectional study, we are unable to provide insight into causality.
Practice Implication: To help reduce girls’ risk of perpetrating physical and relational violence, healthcare providers serving adolescent girls involved in health risk behaviors should identify those who have been victims of violence and assess and foster girls’ development of stress management and fight avoidance skills.
Identifying Genes that Cause Ovarian Cancer (28)
Lee Pribyl and Timothy Starr, PhD
Ovarian cancer is the fifth leading cause of cancer deaths in women resulting in about 15,000 deaths per year. Identifying the genetic factors involved in ovarian cancer is a crucial step in developing more effective cancer treatments. We have developed a forward genetic screen, which involves the induction of random mutations, aimed at identifying the mutations that cause ovarian cancer. We are using the Sleeping Beauty (SB) transposon system in transgenic mice to generate random mutations. The mice are engineered to harbor three specific transgenes: a transposase, a transposon and a fallopian-tube specific Cre recombinase. Transposition is directed to the fallopian-tubes using a Cre recombinase-Estrogen receptor fusion protein. This fusion protein is activated in mice by injections of 4-Hydroxytamoxifen (4-OHT). Within two weeks of 4-OHT injection we can detect activation of the SB system. We have established a cohort of 30 4-OHT treated mice along with 30 control mice that are being aged and monitored for tumor formation. Once mice become morbid they will be euthanized and tissue samples will be collected. DNA from ovarian tumors will be analyzed for common transposon insertion sites (CIS). This CIS list will identify the genes that are most often disrupted or activated by the transposon, suggesting that this transposition caused a mutation that has contributed to ovarian cancer. Further analysis of the identified genes will allow us to determine their role in ovarian tumor formation which will help in the advancement of patient specific cancer therapies.
Follicular-Luteal Differences in Cocaine Self-administration in Monkeys and the Effect of a Nondrug Alternative Reward (46)
Carly J. Rasmussen
Previous research demonstrated that non-drug reinforcers, such as saccharin (SACC), are an effective treatment for drug abuse in females and males over a range of fixed-ratio (FR) schedules of phencyclidine (PCP) (Carroll and Cosgrove 2003). This study investigated the effects of non-drug reinforcer, SACC, on cocaine abuse. The goal of the present study was to examine the effect of impulsive choice for cocaine (.4 mg/ml) when concurrently available with SACC (vs. water) in normally cycling females during the follicular and luteal phases of the menstrual cycle. Rhesus macaques have a menstrual cycle analogous to humans.
In component 1, cocaine and water were available from two drinking spouts for 3 hour sessions once a day under fixed-ratio (FR) 4 schedules. In component 2, cocaine and concurrent SACC was available for 3 hour sessions under FR 4 schedules. Components 1 and 2 were repeated over several follicular and luteal phases. Females consumed more cocaine during their follicular phase than luteal phase. A nondrug alternative, saccharin, reduced cocaine self-administration. Female macaques consumed more saccharin during the luteal than the follicular phase.
Distorted Sex Ratio: An Indication of Sex Discrimination (30)
Lisa Roberts, Dr.PH, Susanne Montgomery, Ph.D
Background: Infanticide is a known issue in Indian history resulting in a low female to male sex ratio. Rather than being an issue of the past it continues to evolve. Indeed, despite governmental interventions, India’s low sex ratio shows a worsening trend, most likely due to sex determination followed by abortion of female babies, particularly when there are already one or more girls in the family in the context of son preference. These factors and the skewed sex ratio (< .93- .97) at birth may be indications that systematic gender discrimination continues. The purpose of the project was to evaluate the sex ratio at birth at a rural Indian hospital.
Method: Aggregate hospital data from a 100-bed rural hospital in central India were reviewed for delivery trends (2001 to 2009). Detailed chart reviews were done for deliveries in 2010 and 2011 (N = 1110). Available demographic variables were abstracted and the importance of critical emerging trend variables validated through qualitative follow-up interviews.
Results: Trend analyses of hospital delivery data found sex ratios had improved from 2001 to 2006, but then declined again. A two-years intensive chart abstraction found, the sex ratio at birth averaged 0.75. Among babies born by Cesarean section the sex ratio at birth was 0.68. Social norms and expectations that have a bearing on fertility patterns include early marriage and childbearing within one year; strong son preference which jeopardizes the well-being of women who do not produce sons; and young women who do not have decision making power in family planning, nor where to deliver or who will attend the birth.
Conclusion: Results exposed a continuing distorted sex ratio and contextual follow-up revealed deep-rooted sex discrimination, supporting the interpretation of our data that female feticide and infanticide are a currently continuing practice in rural India. Strengths: two concurrent years of detailed birth records were analyzed and aggregate data on sex ratio at birth were analyzed for a ten-year trend. Weaknesses: data collection and analysis were limited to extraction of available medical records with some missing data, approximation of mothers’ ages, and retrospective analysis. The results are informative for transcultural researchers and healthcare professionals interested in understanding gender discrimination.
The Impact of Body Mass Index on the Associations Between Pubertal Timing and Self-harm, Depression, and Self-esteem in Adolescent Girls (41)
Emily Ruedinger MD, Rebecca Shlafer PhD, Melanie Wall PhD, Fion Hsueh MS, Dianne Neumark-Sztainer, PhD, MPH, RD
Background: Early pubertal development has emerged as a risk factor for self-harm, depression, and low self-esteem. Compared to their on-time peers, girls who experience early puberty are also more likely to have elevated BMI. Current literature suggests that body mass index (BMI) and emotional health also influence each other, in a bidirectional manner. Despite evidence that pubertal timing, emotional health, and BMI are all inter-related, few studies that have examined the associations between pubertal timing and emotional health have accounted for BMI.
Purpose: To identify how, if at all, BMI impacts the relationship between pubertal timing and self-harm, depression, and self-esteem in a diverse group of female adolescents.
Methods: Data were drawn from EAT 2010 (Eating and Activity in Teens), a population-based survey of diverse adolescents. A subset of female participants (n=1165) were categorized into four pubertal groups based on self-reported age of menarche: very early (11%, age ≤ 10 yrs), early (25%, age 11 yrs), on-time (52%, age 12-13 yrs), and late (12%, age ≥14 yrs). The sample population demonstrated the expected inverse relationship between BMI and pubertal timing. Regression analysis was performed adjusting for race, age at time of survey, and socioeconomic status (SES) to determine the associations between pubertal timing and self-harm, depression, and self-esteem. These analyses then were repeated including BMI as a covariate.
Results: Initial analyses adjusting for race, age at time of survey, and SES, revealed that, compared to their on-time peers, girls who experienced very early puberty had higher odds of self-harm behavior (OR = 1.56, 95% CI: 1.01-2.42), significantly higher depressive symptom scores (β = 1.03, SE = 0.50), and significantly lower self esteem scores (β = -0.93, SE = 0.36). When analyses were repeated including BMI as an additional covariate, the odds of engaging in self-harm behavior and the difference in depression scores were no longer statistically significant. However, self-esteem scores remained significantly lower for girls who experienced very early puberty compared to their on-time peers. (β = -0.83, SE = 0.36).
Discussion: Initial, unadjusted outcomes supported previous research, but the associations between early pubertal timing and self-harm behavior and depression were no longer significant when adjusting for BMI. This indicates that BMI plays an important role in the relationship between pubertal timing and emotional health, and highlights the need to adjust for BMI in future studies. Clinically, providers can consider weight, pubertal timing, and mental health as inter-related and may use any of these topics as entry-points into discussion with patients and families about all of these issues. This study was limited by the cross-sectional nature of the data but is notable for use of BMI as a novel, significant covariate and diversity of the sample population.
Isis Rising Pregnancy and Parenting Support Group In Prison: The Women Served (3)
Leah Schillmoeller, Erin Casey, & Rebecca Shlafer
Over the past two decades, the United States has seen a staggering increase in the number of incarcerated women, rising from 43,845 in 1991 to 111,387 in 2011 (Cohen, 1991; Carson & Sabol, 2012). The number of mothers incarcerated in the United States has more than doubled during that same time (Maruschak et al., 2010). Further, approximately 6-10% of women are pregnant when entering prison (Glaze & Maruschak, 2008). Incarcerated women are at risk for numerous physical and mental health issues (Fazel & Baillargeon, 2011). Additionally, children with incarcerated mothers often face challenges such as social stigma and disruptions in their close relationships. Isis Rising is a unique prison-based program serving incarcerated women and their children by offering doula support to pregnant women and parental support to mothers of young children. The program aims to empower women in their birth experience and support them in their roles as mothers during their incarceration. This poster will describe the demographic characteristics, parenting experiences, and life histories of women participating in Isis Rising.
Data from 47 participants were collected via self-report at the start of the 12-week program. The average age of participants was 27.7 years (range = 19–40). Most (n = 19) women described themselves as White or Caucasian. Eleven women described themselves as Native American, eight indicated they were Black or African American, five described themselves as mixed race, two women described themselves as Latina, and one woman described herself as Hmong. Women involved in the program completed between 4 and 16 years of education. On average, women completed 11.4 years of school, with a majority of women (n = 30) completing at least 12 years of schooling. Participants’ sentences ranged from 3 to 62 (M=18.3 months).
Thirty-eight percent of participants were pregnant while participating in Isis Rising. Women had between 0 (this woman was currently pregnant) and 9 children. On average, women participating in Isis Rising had 2.8 children. Nearly half of the women (49%), experienced abuse as a child, and nearly two-thirds (64%), experienced domestic violence in adulthood. Nearly one third (30%) of mothers were in foster care as children themselves, and a sizable portion (36%) were raised by someone other than a biological parent.
The current study is unique as there are few data on similar prison-based parenting programs, despite their widespread existence (Loper & Novero, 2010). Future research should utilize both self-report measures, as well as substantiated cases of abuse and foster placement. These data provide a picture of a group of women participating in a prison-based parenting program, demonstrate their unique and complex needs, and provide a foundation for future research on similar programs.
Handcuffed During Labor: Shackling and Concurrent Policies for Pregnant Inmates in Minnesota and Across the Nation (47)
Aly Scrignoli, Alison Siu, Erin C. Casey, B.S., & Rebecca Shlafer, PhD
The number of incarcerated women in the United States has more than doubled in recent years from 68,469 in 1995 to 112,797 in 2010 (Bureau of Justice Statistics). It is estimated that between 6%-10% of incarcerated women are pregnant at the time they enter prison (Glaze & Maruschak, 2008). Women who give birth while in custody are often subject to shackling during labor, in addition to other policies that can make the birth a highly stressful experience. This poster describes state shackling policies affecting inmates who give birth in custody. We will examine policies specific to Minnesota’s only women’s prison – Minnesota Correction Facility (MCF) – Shakopee, and compare Minnesota’s policies with policies across the United States.
Prison policies for pregnant inmates are important to consider as maternal stress during pregnancy has important implications for pregnancy and birth outcomes, including preterm birth and low-birth weight infants (Collins et al., 2004; Giscombe & Lobel, 2005). When a pregnant woman is shackled to the bed, it can restrict doctors’ ability to properly treat the woman, especially in the case of an emergency. Such a delay during labor could cause the infant to have permanent brain damage due to lack of oxygen flow to the brain (ACLU, 2012). Additionally, when the mother is restrained, she often cannot move freely enough to manage labor pain or to allow her legs to be put in stirrups. Being restrained can also reduce the blood flow to the newborn and cause acute stress injuries such as cuts and bruises to the mother. Being shackled may also exacerbate the problems with balance many pregnant women experience, as the woman is unable to quickly move a limb to prevent a fall. Because shackling limits mobility, restraining women can also lead to ineffective breast-feeding as well as prevent proper healing after the baby is born (ACLU, 2012).
Shackling policies vary widely from state to state. The American Congress of Obstetricians and Gynecologists (ACOG) opposes the shackling of pregnant women due to health risks to mother and child (ACLU, 2012). In 2008, The Bureau of Prisons has banned the shackling of pregnant inmates in federal prisons in all cases except those with extreme risk for escape or violence (ACLU, 2012). Eighteen states have laws restricting shackling pregnant prisoners, ten of which restrict shackling the entire time the woman is in the hospital. In Minnesota, there is no law prohibiting shackling pregnant women, but MCF-Shakopee maintains a no shackling policy unless the woman is deemed a danger. Directly after the child is born, however, the woman is restrained. This poster will document variation in shackling policies by state and consider the implications of shackling for maternal and child health.
Factors Associated with Change in Activities of Daily Living Dependence in Older Long-stay Nursing Home Residents (4)
Kristine M.C. Talley, PhD, RN, GNP-BC, Kay Savik, MS, Hong Zhao, MS and Jean F. Wyman, PhD, RN, GNP-BC
Background: Understanding change in Activities of Daily Living (ADL) dependence in long-stay nursing home residents may help identify when to intervene to delay its progression.
Objective: To describe change in ADL dependence among long-stay nursing home residents and identify associated factors.
Methods: Longitudinal analysis of nursing home Minimum Data Set data linked to the 2004 National Nursing Home Survey using a sample of 7,735 residents, age ≥65 years without terminal illness living in 1097 nursing homes for at least 6 months. Linear mixed models estimated change in ADL dependence over 18 months.
Results: Most residents were non-Hispanic white (88.9%) females (75.4%) with a mean age of 84.8±8.0 years and mean length-of-stay of 3.3 years living in urban (52.24%) for-profit (59.2%) nursing homes. Only 60% of the sample remained at 18 months. On average, ADL dependence increased 1.5 points (12.4%) over 18 months. Age, gender, and length-of-stay did not predict ADL change. Baseline cognitive impairment levels were associated with increasing rates of ADL change. Residents with no baseline cognitive impairment had no change in ADL dependence, those with the mean level (2.4) of impairment increased 1.8 points (11.1%), and those with the highest level of impairment (6.0) increased 3.2 points (15.8%).
Conclusions: Older women comprise 75% of long-stay nursing home residents, who experience increasing ADL dependence throughout their residency. The greatest ADL change occurred with higher levels of cognitive impairment. Interventions to maintain ADL function should be developed for residents with cognitive impairment and be provided throughout a resident’s entire stay.
Impact of Exercise on Changing Food Cravings in Postmenopausal Women during Smoking Cessation (39)
Alison Teo, M.Eng., Alicia Allen, M.P.H., Ph.D., Sharon Allen, M.D., Ph.D.
Women smokers cite weight gain following smoking cessation as a primary barrier to successful quit attempts. A major factor contributing to post-cessation weight gain is increased food intake, which has been generally associated with cravings for sweet or rich foods. Exercise is hypothesized as a useful smoking cessation intervention to limit weight gain as it increases overall caloric output, with vigorous exercise showing significant benefit in clinical trials. While exercise has been shown to affect appetite, research exploring this relationship within the context of smoking cessation is lacking. Therefore, this study seeks to investigate the impact of an exercise program (versus relaxation) on food cravings during smoking cessation in postmenopausal female smokers.
Postmenopausal women who smoked ≥10 cigarettes/day and were in stable physical/mental health were enrolled in this prospective, randomized study. Participants were assigned to a smoking cessation intervention group, which was then randomized to use exercise or relaxation as an adjunct to a smoking cessation intervention. The intervention also included open labeled varenicline (Chantix) and group behavioral counseling. Participants completed the Questionnaire on Cravings for Sweet or Rich Foods (QCSRF) weekly for four weeks (one week prior to quit date, on quit date and for two weeks after quit date) and once three months after quit date to assess cravings for sweet, rich, and salty foods. Analysis of the results included descriptive statistics and logistic regression models adjusting for smoking history, smoking status, and medication compliance.
Participants (n=103) were mostly non-Hispanic white (98%), with an average age of 56.6+5.4 and baseline BMI of 28.0+5.7. Preliminary results of this study show a decrease in food cravings from baseline at all time points (p-value<0.05). Those randomized to exercise had a greater reduction in intensity of cravings for sweet foods compared to those randomized to relaxation (-1.24+1.83 versus -0.25+1.58, respectively, p-value=0.013). No other significant differences were found.
The results of this study indicate that food cravings decrease following cessation of smoking, suggesting that other factors may play a larger role in influencing post-cessation weight gain. Strengths of the study include the randomized study design, employment of an established exercise program appropriate for older women, and use of an Interactive Voice Response (IVR) system to encourage intervention adherence. Limitations of the study include the relatively homogenous subject group (specifically with regard to race and ethnicity), use of self-reported measures of exercise and relaxation, and lack of food records. Further studies should explore the role of food intake, caloric intake, and caloric output (including basal metabolic rate) and their associations with food cravings and weight gain following smoking cessation.
Funding: University of Minnesota Foundation Student Research Grant, NIH/NIDA R01-DA024872, NIH/NIDA/OWHR P50-DA033942, NIH/NCRR M01RR00400, NIH/NCRR 1UL1RR033183, NIH/NCATS 8UL1TR00011
Prospective Association Between Mitochondrial Copy Number and Stage of Breast Cancer (29)
Bharat Thyagarajan, Renwei Wang, Heather Nelson, Helene Barcelo, Woon-Puay Koh, Jian-Min Yuan
Background: Mitochondrial DNA (mtDNA) copy number in peripheral blood is prospectively associated breast cancer risk when blood was collected within 3 years of diagnosis. Results from a previous retrospective study suggests that breast cancer stage can influence mtDNA copy number in peripheral blood
Objectives: We evaluated the prospective association between mtDNA copy number in peripheral blood and breast cancer at different stages.
Methods: We utilized data from a previously reported nested case-control study of 88 breast cancer cases with pre-diagnostic blood samples and 252 individually matched controls among participants of the Singapore Chinese Health Study in whom blood was collected within 3 years of breast cancer diagnosis to evaluate the association between mtDNA copy number and breast cancer stage.
Results: Conditional logistic regression analyses showed that a positive association between mtDNA copy number and breast cancer risk only among women with advanced breast cancer (stages III and IV); OR (95% CIs) for 2nd and 3rd tertile of mtDNA copy numbers were 2.41 (0.71-8.13) and 4.28 (1.23-14.83) respectively compared with the 1st tertile (Ptrend = 0.02). There was no association between mtDNA copy number and breast cancer risk among women with localized breast cancer (stages I and II) (Ptrend = 0.50).
Conclusion: This study supports a prospective association between increased mtDNA copy number and breast cancer risk that is dependent on the stage of breast cancer. Future studies are warranted to confirm these findings and evaluate the utility of mtDNA copy number as a biomarker for early detection of breast cancer.
Smoking-related Symptomology During Short-term Smoking Abstinence by Menstrual Phase and Depressive Symptoms (40)
Nicole Tosun, M.S., Scott Lunos, M.S., Alicia Allen, Ph.D., M.P.H., Mustafa al’Absi, Ph.D., Dorothy Hatsukami, Ph.D., Sharon Allen, M.D., Ph.D.
BACKGROUND: Research has shown that a woman’s ability to quit smoking may vary by menstrual phase. Depressive symptoms and withdrawal symptomatology may also play a role in risk for relapse. The aim of this controlled cross-over study was to determine the effect of menstrual phase (Follicular [F] versus Luteal [L]) and depressive symptoms on smoking-related symptomology (SRS) during acute smoking abstinence. Specifically, we asked the following questions: (1) Is there a difference in SRS by menstrual phase, (2) Is there an association between level of depressive symptoms and SRS, and (3) Is there a menstrual phase by depressive symptoms interaction?
METHOD: Women, ages 18-40, who smoked at least 5 cigarettes per day, had self-report regular menstrual cycles, and were in stable mental/physical health were recruited for the study. Women on exogenous hormones or psychotropic medications were excluded. Eligible participants were randomized to testing order (e.g. F phase followed by L phase or vice versa). Each testing week consisted of six consecutive days (2 days of ad lib smoking followed by 4 days of smoking abstinence) where participants attended daily clinic visits and completed self-report questionnaires on SRS. Analysis was performed using random-intercept models with fixed effects for order, phase, depressive symptoms, and testing week with and without a phase by depressive symptoms interaction.
RESULTS: Participants (N=147) were, on average, 29.7±6.6 years of age and smoked approximately 12.7±5.8 cigarettes per day. Most were white (56%) with at least a high school diploma or equivalent (93%). SRS varied by menstrual phase such that women reported higher perceived stress and greater withdrawal in the L phase compared to the F phase during smoking abstinence (23.2±0.6vs.20.9±0.6,p<.05; 9.1±0.4vs.8.0± 0.4,p<.05; respectively). Significant associations between level of depressive symptoms and SRS were noted for withdrawal, anticipated relief from negative affect, premenstrual symptoms (PMS), perceived stress, and positive/negative affect, (p<0.05). All associations were positive except for positive affect. A menstrual phase by depressive symptoms interaction was found for PMS of pain and negative affect, (p<0.05) indicating a stronger association between depressive symptoms and SRS during the F phase. No other significant differences were found.
CONCLUSION: These data suggest that menstrual phase and depressive symptoms may influence SRS during acute smoking abstinence. Specifically, higher stress and withdrawal during the L phase was observed and there was a positive association between level of depressive symptoms and SRS. Finally, the interaction reveals that specific SRS in acute smoking abstinence may be more strongly associated with depressive symptoms during the F phase compared to the L phase. A large sample size and a cross-over design strengthen this analysis while the generalizability is limited since it was not a cessation trial. Future research should explore how these observations may extend to smoking cessation efforts.
Low Income Women’s Expectations, Needs, and Desires for Social Support in the Postpartum Period: A Feasibility Study (48)
Nicolle M. Uban, PhD, CNM; Cynthia Peden-McAlpine, PhD, ACNS, BC
The postpartum period represents a significant transition in women’s lives. This critical period of adjustment is characterized by physical, emotional and psychological stressors that impact women’s experiences, adaptation and health and wellness. Common stressors in the puerperal period include: the transition to motherhood and associated role change and role stress; physical stressors including hormonal fluctuations, altered sleep, and pain; psychological stressors including interpersonal relationship challenges, self esteem and self confidence, and postpartum depression (PPD).
Social support has been identified as a factor contributing to women’s experiences in the postpartum period (Beck, 2001; Dennis, 2003). Lack of social support is also a predictor of functional status during this period (McVeigh, 1997). There is a body of literature examining the association between social support interventions provided by health professionals, and negative affect in the new mother (Armstrong, Fraser, Dadds et al., 1999; O’Hara, Stuart, Gorman, & Wenzel, 2000). Critical gaps in maternal support needs have been identified in the literature, indicating that high risk populations of women might benefit from targeted social support services/interventions (Armstrong, Fraser, Dadds et al., 1999; Dennis, 2003; Shaw, Levitt, Wong et al., 2006).
The purpose of this feasibility study was to examine and describe low-income postpartum women’s perceptions, expectations, and desires for social support; and, the feasibility and acceptability of a postpartum doula as a vehicle for postpartum social support. This study utilized focus groups, a social support survey, and a socio-demographic survey. The sample included 30 participants. A pilot test with one participant was conducted to trial the focus group questions and user-friendliness of the surveys. Then, three focus groups were conducted: Group 1 (nine participants); Group 2 (fifteen participants); and Group 3 (five participants). Recruitment was conducted by a community doula program in the Midwest with an established priority to serve low-income women.
Four categories of support emerged during content analysis, identifying types of postpartum support that were most important and areas where participants experienced gaps in support: (1) Functional; (2) Physical; (3) Educational/Informational; and, (4) Emotional support/Presence. The social support survey findings confirmed this information, and identified deficits in the availability of individuals within participants support networks. Each participant had experience with birth doulas and expressed interest in postpartum doula support. The findings from both surveys reiterate the importance of a broader social support network for new mothers.
This study adds to existing research by laying a foundation for designing an effective intervention targeted to meet postpartum women’s support needs. The data offers those providing support to mothers information to expand current practices, to include postpartum doula support interventions. Additional research is indicated in order to determine the effectiveness of targeted, individualized, in-home social support interventions for postpartum women.