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...on Women
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www.ProjectCork.org
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Summer 2006
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Intimate partner violence, substance use, and HIV among low-income women - Taking a closer look.
Burke JG; Thieman LK; Gielen AC; O'Campo P; McDonnell KA. Violence Against Women 11(9): 1140-1161, 2005. (28 refs.)
This article focuses on the intersection of intimate partner violence (IPV), substance use, and HIV status among a sample of low-income urban women (n = 611). Differences emerged by drug type, categorization of IPV, and HIV status. Rates of IPV did not differ between HIV-negative and HIV-positive women, but differing rates of substance use were found to be highly significant. The relationship between IPV and drug use appeared to be stronger for HIV-negative women. Descriptive data capturing temporal relationships between substance abuse and IPV support continued examination of types of IPV separately. These findings indicate the need to create comprehensive intervention strategies to address all three issues. Copyright 2005, Sage Publications Inc.
A group randomised trial of two methods for disseminating a smoking cessation programme to public antenatal clinics: Effects on patient outcomes.
Campbell E; Walsh RA; Sanson-Fisher R; Burrows S; Stojanovski E. Tobacco Control 15(2): 97-102, 2006. (37 refs.)
Objective: To assess the differential effectiveness of two methods of disseminating a smoking cessation programme to public hospital antenatal clinics. Design: Group randomised trial. Setting: 22 antenatal clinics in New South Wales, Australia. Intervention: Clinics were allocated to a simple dissemination (SD) condition (11 clinics) which received a mail-out of programme resources or to an intensive dissemination (ID) condition (11 clinics) which included the mail-out plus feedback, training, and ongoing support with midwife facilitator. Main outcome measures: Independent cross sectional surveys of women on a second or subsequent visit undertaken pre-dissemination and 18 months after dissemination. Outcomes were: (1) levels of smoking status assessment by clinic staff; (2) proportion of women identifying as having been smokers at their first visit who reported receiving cessation advice; (3) proportion of these women who had quit (self report and expired air carbon monoxide (CO)); and (4) smoking prevalence among all women (self report and CO). Subjects: 5849 women pre-dissemination (2374 SD, 3475 ID) and weighted sample of 5145 women post-dissemination (2302 SD, 2843 ID). Results: There were no significant differences between the groups on change on any outcome. Change in either group was minimal. In the post-dissemination survey, the cessation proportions were 6.4% (SD) and 10.5% (ID). Conclusions: Relatively modest strategies for encouraging incorporation of smoking cessation activities into antenatal care were not effective in the long term. Alternative strategies should be implemented and evaluated. The findings reinforce the importance of a whole population approach to tobacco control. Copyright 2006, BMJ Publishing Group.
Alcohol intake and ovarian cancer risk: A pooled analysis of 10 cohort studies.
Genkinger JM; Hunter DJ; Spiegelman D; Anderson KE; Buring JE; Freudenheim JL et al. British Journal of Cancer 94(5): 757-762, 2006. (42 refs.)
Alcohol has been hypothesized to promote ovarian carcinogenesis by its potential to increase circulating levels of estrogen and other hormones; through its oxidation byproduct, acetaldehyde, which may act as a cocarcinogen; and by depletion of folate and other nutrients. Case-control and cohort studies have reported conflicting results relating alcohol intake to ovarian cancer risk. We conducted a pooled analysis of the primary data from ten prospective cohort studies. The analysis included 529 638 women among whom 2001 incident epithelial ovarian cases were documented. After study-specific relative risks ( RR) and 95% confidence intervals ( CI) were calculated by Cox proportional hazards models, and then were pooled using a random effects model; no associations were observed for intakes of total alcohol ( pooled multivariate RR 1.12, 95% CI 0.86-1.44 comparing >= 30 to 0 g day(-1) of alcohol) or alcohol from wine, beer or spirits and ovarian cancer risk. The association with alcohol consumption was not modified by oral contraceptive use, hormone replacement therapy, parity, menopausal status, folate intake, body mass index, or smoking. Associations for endometrioid, mucinous, and serous ovarian cancer were similar to the overall findings. This pooled analysis does not support an association between moderate alcohol intake and ovarian cancer risk. Copyright 2006, Nature Publishing Group.
Borderline personality and substance use in women.
Feske U; Tarter RE; Kirisci L; Pilkonis PA. American Journal on Addictions 15(2): 131-137, 2006. (66 refs.)
The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD ( including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD. Copyright 2006, American Academy of Psychiatrists in Alcoholism and Addictions.
Definition and outcome of a curriculum to prevent disordered eating and body-shaping drug use.
Elliot DL; Moe EL; Goldberg L; DeFrancesco CA; Durham MB; Hix-Small H. Journal of School Health 76(2): 67-73, 2006. (37 refs.)
Almost one half of male and female students participate in high school-sponsored athletics, and high school also is a time when classroom health promotion curricula are less effective. The Athletes Training and Learning to Avoid Steroids is a sport team-centered drug-use prevention program for male high school athletes, which has been shown to reduce alcohol and illicit drug use. Just as anabolic steroid use is associated with male athletes, female sport participants may be at a greater risk for disordered eating and body-shaping drug use. Extending sport team-centered programs to young women athletes required defining and ranking factors related to developing those harmful behaviors. Survey results from a cross-sectional cohort of female middle and high school student athletes were used to identify and prioritize potential curriculum components, including mood and self-esteem, norms of behavior, perceptions of healthy body weight, effects of media depictions of women, and societal pressures to be thin. The derived sport team-centered program was prospectively assessed among a second group of female student athletes from 18 high schools, randomized to receive the intervention or the usual care control condition. The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) intervention is a scripted, coach-facilitated, peer-led 8-session program, which was incorporated into a teams usual training activities. The ATHENA program significantly altered the targeted risk factors and reduced ongoing and new use of diet pills and body-shaping substances (amphetamines, anabolic steroids, and sport supplements). These findings illustrate the utility of a structured process to define curriculum content, and the program's positive results also confirm the sport team's potential as a vehicle to effectively deter health-harming behaviors. Copyright 2006, American School Health Association.
Dyadic alcohol use and relationship quality as predictors of condom non-use among adolescent females.
Woodrome SE; Zimet GD; Orr DP; Fortenberry JD. Journal of Adolescent Health 38(3): 305-306, 2006. (7 refs.)
We examined alcohol use concordance (respondent and partner alcohol use) and relationship quality as predictors of condom non-use among adolescent women. Both variables were significant independent predictors of condom non-use. These results suggest that both the individual's and her partner's behaviors should be taken into consideration in research and clinical practice. Copyright 2006, Society for Adolescent Medicine.
'Hardcore drinking' portrayals of alcohol con-sumption in young women's and men's magazines.
Lyons AC; Dalton SI; Hoy A. Journal of Health Psychology 11(2): 223-232, 2006. (37 refs.)
Young adults and young women in particular are drinking more alcohol than ever before, with implications for risky behaviours and long-term health. This study explored the ways in which alcohol and drinking were represented in six monthly UK magazines (three targeted at young men, three at young women) across a three-month period (18 magazines). We identified three main discourses across the texts, namely the drug alcohol, masculinity and machismo; and drinking as normality. These discourses constructed women's and men's drinks and drinking behaviours in sharp contrast. Drinking was aligned with traditional masculine images, although new kinds of drinks were aligned with traditional feminine images-and derided in men's magazines. Findings highlight how gender, constructed in relation to the other, is an important aspect of representations of drinking patterns in young adults. Copyright 2006, Sage Publications Ltd.
Building a residential treatment program for dually diagnosed women with their children.
Worley LLM; Conners NA; Crone CC; Williams VL; Bokony PA. Archives of Women's Mental Health 8(2): 105-111, 2005. (36 refs.)
The epidemic of drug and alcohol abuse in our nation impacts millions of women, mothers, and children. Addicted mothers with complex problems and numerous co-morbidities present unique treatment challenges. This intergenerational cycle of abuse and addiction is difficult to stop. Arkansas CARES (Center for Addictions Research Education and Services, referred to in this article as CARES) initially was created to treat addicted pregnant and postpartum women and their infants. CARES evolved into a residential treatment program for dually diagnosed mothers with their children. This paper is a synopsis of a presentation delivered at the North American Society for Psychosocial Obstetrics and Gynecology. It shares a glimpse inside the treatment program and lessons learned along the way in an effort to assist others who are interested in building treatment programs for addicted women with their children. Copyright 2005, Springer.
Midwives' attitudes to counselling women about their smoking behaviour during pregnancy and postpartum.
Thyrian JR; Hannover W; Roske K; Scherbarth S; Hapke U; John U. Midwifery 22(1): 32-39, 2006. (19 refs.)
Objective: to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum. Design: survey using postal questionnaires. Setting: the entire federal state of Mecklenburg-West-Pomerania in Germany. Participants: 189 midwives constituting 77% of all midwives working in that State. Findings: midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice. Key conclusions: smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking. Implications for practice: midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions. Copyright 2006, Churchill Livingstone.
Place and space: The where and why of drug-use location among rural African American women.
Brown EJ; Smith FB. Journal of Family Nursing 12(2): 185-200, 2006. (15 refs.)
Increasing drug use among rural African American women and its effect on children warrants investigation. This article describes drug-use locations of rural African American women who use cocaine and construct their lives to conceal it from children. During 4 years, a 30-respondent ethnography was conducted. Data from in-depth interviews and field notes were analyzed for recurrent themes and patterns of drug-use location using NVivo. Most respondents with children used most often outside their households. One third (n = 10) used within their households when children were away or in designated spaces off limits to children. More respondents (n = 11) without children at home used in non-designated spaces; in contrast, few respondents (n = 2) with children at home used in non-designated spaces within the household. Most respondents thought they were successful at concealing their cocaine use. Implications for choice of space and place of drug use for themselves and their children are discussed. Copyright 2006, Sage Publications.
Gender and age disparities for smoking-cessation treatment.
Steinberg MB; Akincigil A; Delnevo CD; Crystal S; Carson JL. American Journal of Preventive Medicine 30(5): 405-412, 2006. (49 refs.)
Background: Physicians play a critical role in tobacco-dependence treatment, especially prescribing cessation medications. However, it is unclear whether efforts are meeting recommended standards. This study evaluates the frequency and predictors of tobacco-use identification, counseling for tobacco dependence, and the prescription of cessation medications in a nationally representative sample of physician-patient encounters. Methods: More than 58,000 physician-patient ambulatory encounters from the National Ambulatory Medical Care Survey 2001 and 2002 were analyzed in 2004-2005, including patient demographics, diagnoses, tobacco counseling, and prescriptions. Results: Tobacco-use status was identified in 69% of patient encounters, with 16% of those encounters indicating current use. Tobacco counseling Occurred in 22.5% of visits by tobacco users, and 2.4% of tobacco users were prescribed cessation medications. These rates are similar to previous analyses in 1991. Patient characteristics associated with being more likely to receive Counseling include being a new patient (adjusted Odds ratio [OR]=1.34, 95% confidence interval [CI]=1.00-1.77) and having a tobacco-caused diagnosis (OR=2.71, CI=1.95-3.78). Characteristics associated with a lower likelihood of receiving medication include female gender (OR=0.45, CI=0.22-0.90) and age 65 and above (OR=0.14, CI=0.03-0.63), while a tobacco-caused diagnosis (OR=3.91., CI=1.64-9.29) and patient prompting (OR=15.31, CI=3.36-69.8) were associated with higher likelihood of receiving medications. Conclusions: Despite increasing national attention, the identification of tobacco status, counseling rates, and the use of cessation medications by physicians are low and unchanged from 1991. Women and elderly tobacco users were much less likely to receive prescriptions for cessation medications, while patients requesting treatment and those with tobacco-caused diagnoses were more likely. Further educational and public health campaigns are needed to encourage the use of these effective medications, especially in women and the elderly. Copyright 2006, Elsevier Science, Inc.
Why do young women smoke? I. Direct and interactive effects of environment, psychological characteristics and nicotinic cholinergic receptor genes.
Greenbaum L; Kanyas K; Karni O; Merbl Y; Olender T; Horowitz A et al. Molecular Psychiatry 11(3): 312-322, 2006. (69 refs.)
Despite the health hazards, cigarette smoking is disproportionately frequent among young women. A significant contribution of genetic factors to smoking phenotypes is well established. Efforts to identify susceptibility genes do not generally take into account possible interaction with environment, life experience and psychological characteristics. We recruited 501 female Israeli students aged 20 - 30 years, obtained comprehensive background data and details of cigarette smoking and administered a battery of psychological instruments. Smoking initiators (n = 242) were divided into subgroups with high (n = 127) and low (n = 115) levels of nicotine dependence based on their scores on the Fagerstrom Tolerance Questionnaire and genotyped with noninitiators (n = 142) for single nucleotide polymorphisms (SNPs) in 11 nicotinic cholinergic receptor genes. We found nominally significant (P < 0.05) allelic and genotypic association with smoking initiation of SNP rs2072660 and multilocus haplotypes (P < 0.007 - 0.05) in CHRNB2 and nominal (P < 0.05) allelic or genotypic association of SNPs in CHRNA7 (rs1909884), CHRNA9 (rs4861065) and CHRNB3 (rs9298629) with nicotine dependence. Employing logistic regression and controlling for known risk factors, the bestfitting model for smoking initiation encompassed a 5 SNP haplotype in CHRNB2, neuroticism and novelty seeking (P = 5.9 similar to 10 similar to 14, Nagelkerke r(2) = 0.30). For severity of nicotine dependence, two SNPs in CHRNA7 (rs1909884 and rs883473), one SNP in CHRNA5 (rs680244) and the interaction of a SNP in CHRNA7 (rs2337980) with neuroticism, were included in the model (P= 2.24 similar to 10 similar to 7, Nagelkerke r(2) = 0.40). These findings indicate that background factors, psychological characteristics and genetic variation in nicotinic cholinergic receptors contribute independently or interactively to smoking initiation and to severity of nicotine dependence in young women. Copyright 2006, Nature Publishing Group.
Problem drinking in women evaluated for infertility.
Chang G; McNamara TK; Haimovici F; Hornstein MD. American Journal on Addictions 15(2): 174-179, 2006. (41 refs.)
Clinicians may wish to use the T-ACE, a screening instrument for prenatal risk drinking, for their infertile patients. Twenty-eight T-ACE negative and 23 T-ACE positive women presenting to an academic infertility clinic completed two interviews about their drinking. The 23 T-ACE positive participants were also randomized to receive a brief intervention. The T-ACE distinguished between heavier and lighter patterns of alcohol use in this sample. Moreover, it appeared that although the average quantity of alcohol consumed per drinking day was unchanged, the overall mean percentage of days drinking declined significantly from the time of enrollment to follow-up in all groups. Copyright 2006, American Academy of Psychiatrists in Alcoholism and Addictions.
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