Man-Made Medicine and Women’s Health: The Biopolitics of Sex/Gender and Race/Ethnicity

Author(s):  
Nancy Krieger ◽  
Elizabeth Fee
2016 ◽  
Vol 25 (1) ◽  
pp. 4-10 ◽  
Author(s):  
Jennifer L. Plank-Bazinet ◽  
Susan G. Kornstein ◽  
Janine Austin Clayton ◽  
Worta McCaskill-Stevens ◽  
Lauren Wood ◽  
...  

Author(s):  
Marcia L Stefanick ◽  
Abby C King ◽  
Sally Mackey ◽  
Lesley F Tinker ◽  
Mark A Hlatky ◽  
...  

Abstract Background National guidelines promote physical activity to prevent cardiovascular disease (CVD), yet no randomized controlled trial has tested whether physical activity reduces CVD. Methods The Women’s Health Initiative (WHI) Strong and Healthy (WHISH) pragmatic trial used a randomized consent design to assign women for whom cardiovascular outcomes were available through WHI data collection (N = 18 985) or linkage to the Centers for Medicare and Medicaid Services (N30 346), to a physical activity intervention or “usual activity” comparison, stratified by ages 68–99 years (in tertiles), U.S. geographic region, and outcomes data source. Women assigned to the intervention could “opt out” after receiving initial physical activity materials. Intervention materials applied evidence-based behavioral science principles to promote current national recommendations for older Americans. The intervention was adapted to participant input regarding preferences, resources, barriers, and motivational drivers and was targeted for 3 categories of women at lower, middle, or higher levels of self-reported physical functioning and physical activity. Physical activity was assessed in both arms through annual questionnaires. The primary outcome is major cardiovascular events, specifically myocardial infarction, stroke, or CVD death; primary safety outcomes are hip fracture and non-CVD death. The trial is monitored annually by an independent Data Safety and Monitoring Board. Final analyses will be based on intention to treat in all randomized participants, regardless of intervention engagement. Results The 49 331 randomized participants had a mean baseline age of 79.7 years; 84.3% were White, 9.2% Black, 3.3% Hispanic, 1.9% Asian/Pacific Islander, 0.3% Native American, and 1% were of unknown race/ethnicity. The mean baseline RAND-36 physical function score was 71.6 (± 25.2 SD). There were no differences between Intervention (N = 24 657) and Control (N = 24 674) at baseline for age, race/ethnicity, current smoking (2.5%), use of blood pressure or lipid-lowering medications, body mass index, physical function, physical activity, or prior CVD (10.1%). Conclusion The WHISH trial is rigorously testing whether a physical activity intervention reduces major CV events in a large, diverse cohort of older women. Clinical Trials Registration Number: NCT02425345


2018 ◽  
Vol 22 (06) ◽  
pp. 1019-1028 ◽  
Author(s):  
Juhua Luo ◽  
Cynthia A Thomson ◽  
Michael Hendryx ◽  
Lesley F Tinker ◽  
JoAnn E Manson ◽  
...  

AbstractObjectiveTo assess the extent of error present in self-reported weight data in the Women’s Health Initiative, variables that may be associated with error, and to develop methods to reduce any identified error.DesignProspective cohort study.SettingForty clinical centres in the USA.ParticipantsWomen (n 75 336) participating in the Women’s Health Initiative Observational Study (WHI-OS) and women (n 6236) participating in the WHI Long Life Study (LLS) with self-reported and measured weight collected about 20 years later (2013–2014).ResultsThe correlation between self-reported and measured weights was 0·97. On average, women under-reported their weight by about 2 lb (0·91 kg). The discrepancies varied by age, race/ethnicity, education and BMI. Compared with normal-weight women, underweight women over-reported their weight by 3·86 lb (1·75 kg) and obese women under-reported their weight by 4·18 lb (1·90 kg) on average. The higher the degree of excess weight, the greater the under-reporting of weight. Adjusting self-reported weight for an individual’s age, race/ethnicity and education yielded an identical average weight to that measured.ConclusionsCorrelations between self-reported and measured weights in the WHI are high. Discrepancies varied by different sociodemographic characteristics, especially an individual’s BMI. Correction of self-reported weight for individual characteristics could improve the accuracy of assessment of obesity status in postmenopausal women.


Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2107
Author(s):  
Sparkle Springfield ◽  
FeiFei Qin ◽  
Haley Hedlin ◽  
Charles B. Eaton ◽  
Milagros C. Rosal ◽  
...  

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds. Methods: A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women’s Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity. Results: High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15–1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7–9) (1.36 (1.28–1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1–7 days per week) (1.28 (1.20–1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03). Conclusion: Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 791-791
Author(s):  
Carrie Karvonen-Gutierrez ◽  
Michelle Hood ◽  
Joshua Ehrlich ◽  
Richard Neitzel ◽  
Kelly Ylitalo

Abstract This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adjusted logistic regression model, vision, hearing, and PN impairments were associated with statistically significantly higher odds of recurrent falls in the past year (odds ratio (OR) = 1.58, 1.76, 2.11, respectively; all p<0.01), after adjustment for age, race/ethnicity, economic strain, and depressive symptoms. The presence of all three sensory impairments was associated with nearly 6-fold increased odds of recurrent falls (OR=5.65, 95% CI 3.25, 9.82) compared to women with no impairments. Sensory impairments often onset during mid-life and early late adulthood. This work demonstrates that these impairments are associated with falls and that women with impairments across multiple sensory domains are at greatest risk.


Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Julius O Asubonteng ◽  
Jessica White ◽  
Rebecca Thurston ◽  
Suresh Mulukutla ◽  
Stephen Wisniewski ◽  
...  

Objective: The metabolic syndrome (MetS) and subclinical CVD measures are associated with a higher risk of future cardiovascular disease (CVD) events. Furthermore, individuals with MetS have a greater burden of subclinical CVD, such as the presence of carotid plaque (CP) and larger adventitial diameter (AD). Midlife women proceeding through the menopausal transition are vulnerable to developing MetS and are also at greater risk of CVD, a risk that varies by race/ethnicity. We hypothesized that there are racial/ethnic differences in the association between MetS and measures of subclinical atherosclerosis. Methods: Participants from 6 sites of the Study of Women’s Health Across the Nation (SWAN) were analyzed if they were free of clinical CVD and had measures of CP and AD at the 12th annual visit. Women were identified as having MetS if they met the criteria defined by the International Diabetes Federation (IDF). Multivariable logistic and linear regression models were used to investigate the relationship of MetS with CP and AD overall and separately within each race/ethnicity group. Study site, age, height, LDL-C, smoking status, menopausal status, hormone use, and education level were included as covariates. Further analysis adjusted for inflammatory and metabolic biomarkers. Results: The 1454 women were, on average, 59.6 years old 43.5% had evidence of MetS, and 85.8% were postmenopausal. The race/ethnicity breakdown was 51.1% White, 30.3% Black, 12.7% Chinese, and 5.8% Hispanic. Overall, MetS was associated with the presence of CP and higher AD after adjusting for covariates (OR (95%): 1.65 (1.31, 2.08); β (SE): 0.344(0.035) mm, p< .0001, respectively). In race-specific models, MetS was significantly associated with AD in White, Black, Hispanic, and Chinese participants, adjusting for covariates (β (SE): 0.305 (0.043) p<.0001; 0.401(0.077) p<.0001; 0.466 (0.147) p= 0.0023; 0.291 (0.098) p = 0.0035; respectively). MetS was significantly associated with CP in White participants only (OR (95%): 1.89 (1.39, 2.57)). When high-sensitivity C-reactive protein and insulin resistance were included in the model, MetS remained significantly associated with AD in Black (0.327(0.86), p = 0.0002) and White (0.212(0.051) p<.0001) participants, and MetS remained significantly associated with CP in Whites participants (1.55 (1.08, 2.23)). Conclusion: MetS is associated with subclinical atherosclerosis, and the association varies by race/ethnicity in midlife women. This variation may help explain differences in incidence rates of CVD events between racial/ethnic groups.


Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Miriam E Van Dyke ◽  
Tiffany Lemon ◽  
Karen A Matthews ◽  
Emma Barinas-Mitchell ◽  
Tené T Lewis

Introduction: Millions of Americans encounter the legal system each year, although persons of low socioeconomic status and racial/ethnic minorities are disproportionately impacted. The health implications of having legal or police problems have been well-documented, especially among incarcerated populations. Missing from the literature, however, is an insight into the health of those closest to the individuals facing legal and/or police problems—their family. Hypothesis: Using data from the Study of Women’s Health Across the Nation (SWAN), we examined the hypothesis that stress related to family member(s) with legal/police problems (FLPP) is associated with higher body mass index (BMI, kg/m 2 ) across 12 years and examined whether this association varied by education or race. Methods: Participants were 1,550 white, 935 Black, 281 Japanese, and 250 Chinese middle-aged women. Data from baseline through year 13 were analyzed using generalized estimating equations with a year fixed effect. Models were adjusted for site, year, age, race/ethnicity, education, menopausal status, smoking, alcohol use, physical activity, caloric intake, and depressive symptoms. Results: Of the 3,016 women included at baseline, 16.1% of women reported any FLPP, although lower educated women reported more FLPP (20.4%) than higher educated (12.3%) women, and slightly more FLPP than middle educated women (18.9%). Similarly, Black women reported more FLPP (23.8%) than white (14.3%), Japanese (8.5%), and Chinese (7.6%) women. EducationxFLPP interaction was observed such that among lower, but not middle or higher educated women, FLPP that were reported to be very upsetting were on average associated with higher BMI in age, year, race/ethnicity, menopausal status, and site-adjusted models (beta=0.35, p=0.03), although this association became marginal in fully-adjusted models (beta=0.31, p=0.09). Although race/ethnicityxFLPP interaction was not observed, in race-stratified models, very upsetting FLPP were on average marginally associated with increased levels of BMI among Black women only, in both minimally (beta=0.21, p=0.06) and fully-adjusted (beta=0.21, p=0.08) models. Conclusions: Our findings based on 12 years of data suggest that lower educated women and Black women who report having a family member with legal or police problems and who find this very upsetting on average have higher BMI. SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this abstract is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.


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