Amal J. Khoury

Predictors of Breastfeeding Intention Among Low-Income Women

Objective: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. Methods: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. Results: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. Conclusions: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in ones ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women.

Screening Mammography: A Cross-Sectional Study to Compare Characteristics of Women Aged 40 and Older From the Deep South Who Are Current, Overdue, and Never Screeners

PURPOSE We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. METHODS Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were associated with mammography screening status. RESULTS Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly associated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recommendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. CONCLUSION Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.

Breast Cancer Fatalism: The Role of Women's Perceptions of the Health Care System

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents’ knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.

Thinking about women’s health: the case for gender sensitivity

This paper argues for a health care approach that focuses less on gender equity in access to resources and more on gender sensitivity--that is attention both to gender differences in research practice and policy. Women have a lower mortality rate than men but experience more disease and disability throughout their lifetimes. Women also experience more depression and anxiety disorders whereas men have higher rates of substance abuse and antisocial personality disorders. The reasons for these differences are not understood but a gender sensitivity framework in health research would expand knowledge about how both biological sex factors and social gender roles influence health for each sex. In addition since women utilize health care more frequently than men health services require an approach based on their gender-specific needs. Health policies that affect access to health care services also often have an important gender component. Hence gender sensitivity in research practice and health policy can bring out better health for women and men.

Knowledge, attitudes, and practices of underserved women in the rural South toward breast cancer prevention and detection.

The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers conducted 6 focus groups to assess barriers of minority women in Mississippi toward breast cancer prevention and clinical trials. These women had little knowledge of treatment options and negative perceptions of screening and clinical trial participation. This research equips others to identify new health education strategies. Conclusions also provide insight into prevention for other minority populations, such as Latina, Asian, and American Indian women.

Evaluation of a Comprehensive Loving Support Program Among State Women, Infants, and Children (WIC) Program Breast-Feeding Coordinators

Background Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC) Breastfeeding Promotion Project Team developed a comprehensive program that included patient and family education, staff training, public awareness activities, health professional outreach, and partnerships with the community. The program also implemented a breastfeeding-friendly clinic environment project and a videotape project. This study was conducted to evaluate the impact of Mississippis LSMBW activities among WIC breastfeeding coordinators in the United States. Method The cross-sectional study was performed with the use of a mailed, self-administered questionnaire. Results Representatives of 50 state WIC agencies returned the survey. Of these 50 agencies, 36 (72%) had effectively used education materials created by the state of Mississippi. Breastfeeding coordinators reported that among the campaign activities, staff training, community outreach, and peer counseling were most beneficial. They also identified the videotape project developed by Mississippi as useful in addressing barriers to breastfeeding and in training support groups, staff, and health care professionals. Conclusion This study showed that Mississippis outreach activities and motivational videotape had a positive impact on coordinators’ promotion of breastfeeding.

The association between chronic disease and physical disability among female Medicaid beneficiaries 18-64 years of age.

BACKGROUND Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and people with physical disability experience some added risks of secondary conditions including chronic disease. Yet, little is known about the prevalence of chronic disease among women living with a physical disability who use Medicaid, a particularly disadvantaged population. OBJECTIVE This study described the prevalence of chronic disease among adult (18-64 years), female, Florida Medicaid beneficiaries living with a physical disability between 2001 and 2005. METHODS Using Medicaid eligibility and claims files, we extracted ICD-9 codes for physically-disabling conditions and Current Procedure Terminology codes for mobility-assistive devices to define three levels of physical disability. RESULTS Participants appeared to be at high risk for both physical disability and chronic diseases. Close to half of the women had been diagnosed with one or more physically-disabling conditions, and 5.3% used mobility devices. One-third of the women had hypertension and sizeable proportions had other chronic diseases. Women with physical disability were more likely to have co-morbid chronic diseases than their able-bodied counterparts. DISCUSSION Our findings support the need for improved chronic disease prevention among female Medicaid beneficiaries, particularly those with physical disability. Strategies to improve prevention, screening and treatment in this population may mitigate the trends toward higher physical disability rates in the low-income, working-age population and may prevent high Medicare and Medicaid costs in the long-run.

Women's health centers and managed care

0 ne of the most important changes under way in the U.S. health care system is the growth of managed care. Increasing attention is being paid to the implications of the growing number of persons enrolled in managed care plans of various types for consumer satisfaction, quality, and costs of care.l Less attention has been paid to the effects of managed care on the organizational characteristics, service mix, and viability of specific types of health care providers, especially those providing unique health care options or serving clients with special needs. Although many specialized health care organizations and those serving as providers of last resort (such as community health centers and public health department programs) are concerned about the transition to managed care, few studies have investigated the impact of managed care on these providers. This article considers the impact of the growth of managed care on various kinds of women’s health centers. Women’s health centers are organizational entities, in both the public and private sectors, providing clinical services designed for and marketed to women in both hospital-sponsored and nonhospital settings. Although the concept of women’s health centers dates to the Women’s Health Movement of the 1960s and 197Os, centers have been growing in number during the 1980s and 199Os, particularly within the hospital sector, and are increasingly diverse in organizational characteristics and services provided.’ The 1994 National Survey of Women’s Health Centers describes five types of women’s health centers in operation nationwide in 1993-1994: primary care centers (12% of all centers), reproductive health centers (71%), birth or childbearing centers (4%), breast care centers (6%), and various “other” types (6%) of primarily hospitalowned or -operated centers that provide education and referral services, inpatient pavilions, or specialty outpatient services (eg, breast and bone imaging).3 There were an estimated 3,600 women’s health centers in the United States in 1993 serving an estimated 14.5 million women (about 14% of the female population ages 15 and over). Approximately 7.8 million women relied

The implications of affiliations between Catholic and non-Catholic health care organizations for availability of reproductive health services

Four case studies of successfully negotiated affiliations between Catholic and non-Catholic organizations reveal the strategies employed to address a range of reproductive health services.

Universal iron supplementation: a simple and effective strategy to reduce anaemia among low-income, postpartum women.

OBJECTIVE To reduce prevalence of anaemia in low-income postpartum women. DESIGN A randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one of three treatment groups: (i) selective anaemia screening of high-risk women as recommended currently (control); (ii) universal anaemia screening and treatment of anaemic women (group I); and (iii) universal Fe supplementation of 65 mg/d for two months to all low-income women (group II). All study participants within each clinic received the same treatment. Women were followed up at 6 months after delivery. Hb was measured at baseline and at follow-up. The primary outcome variable was the proportion of women with anaemia after treatment. SETTING Eleven health clinics in Mississippi. SUBJECTS Low-income, postpartum women. RESULTS Baseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for continuous variables and the χ2 test for categorical variables. Fifty-two per cent of postpartum women were anaemic (Hb < 12·0 g/dl) and the rate decreased to 33 % at 6 months after the intervention. Group II women, who received universal Fe supplementation, improved their Hb status significantly (P < 0·001) at 6 months postpartum compared with the other groups. Prevalence of anaemia was also significantly lower among group II women (22·5 %) compared with controls (34 %) and group I women (43 %; P < 0·001). CONCLUSIONS A universal Fe supplementation strategy was effective in reducing the prevalence of anaemia among low-income postpartum women.