Arlene Michaels Miller

Acculturation, resilience, and depression in midlife women from the former Soviet Union.

BackgroundA growing body of literature has demonstrated that demographic factors and acculturative stress contribute to depression in recent immigrants from many countries. Few studies examine potentially protective personality factors, such as resilience, for dealing with the challenges related to the early postmigration transition period. ObjectivesThe purpose of this analysis is to examine relationships among demographic characteristics, acculturation, psychological resilience, and symptoms of depression in midlife women from the former Soviet Union who recently immigrated to the United States. MethodData for this analysis are from a larger cross-sectional study that explored the impact of immigration during midlife on women’s health. The volunteer sample included 200 women from the former Soviet Union, 45–65 years old, who had lived in the U.S. fewer than 6 years. This analysis involves measures of acculturation, demands of immigration, resilience, and depressed mood. ResultsFindings include very high scores on the depression scale compared to U.S. norms. Older women, and those reporting greater demands of immigration, had higher scores on the depression scale. However, lower depression scores were found for women reporting greater English usage and resilience. DiscussionThe results corroborate previous studies that suggest high levels of depression in immigrant women, but additional validation is suggested to differentiate symptoms of depressed mood from clinical depression in this culture. Findings also suggest that interventions that encourage use of English language and enhance resilience may help decrease symptoms of depression in midlife women who are recent immigrants from the former Soviet Union.

Sociodemographic Characteristics, Biological Factors, and Symptom Reporting in Midlife Women

ObjectiveThe purpose of this study is to examine the influence of Sociodemographic characteristics, reproductive hormones, and body composition on symptoms reported by generally well midlife women. DesignThe design was a 24-cell, randomly selected quota sample, stratified by four occupations that varied in professional status, two races, and three age groups. One hundred fifty-three women, aged 35 to 69, who worked 20 or more hours a week, who were not on hormone replacement therapy, who were not pregnant, and who did not have a hysterectomy prior to the age of 53 participated in the study. Data were collected at 10 employment sites. Symptoms were assessed by a 22-item symptom index. Serum hormone levels of estradiol and follicle stimulating hormone (FSH) were drawn for each woman, and body composition was assessed by body mass index (BMI). ResultsChi-square tests showed that significantly more White women than Black women experienced nervous tension, loss of urine, and vaginal dryness. Analyses of variance showed that women experiencing hot flashes had significantly higher FSH levels, lower estradiol levels, and higher BMI than women not experiencing this symptom. Estradiol (odds ratio 0.988) and BMI (odds ratio 1.094) were significant predictors of experiencing hot flashes when entered into a stepwise logistic regression with age and FSH level as covariates. ConclusionsFindings suggest that symptoms experienced by midlife women are consistent across races, and that interventions targeting weight reduction may improve hot flashes experienced by midlife women.

Acculturation and Depressive Symptoms in Korean Immigrant Women

Depression is one of the most prevalent health problems for immigrants in the United States (U.S.) and it has been associated with the process of acculturation. A cross-sectional study was conducted to identify subgroups of Korean immigrant women based on their Korean as well as American acculturation levels using cluster analysis and to determine whether these subgroups differ on depressive symptoms in 200 Korean immigrant women aged 20–64. Cluster analysis identified four as the most appropriate number of subgroups: they were designated as Korean cluster (45%), Marginalized cluster (26%), American cluster (22%), and Bicultural cluster (7%). Korean cluster had high scores on Korean acculturation and low American acculturation, Marginalized had low for both, American had high scores on American acculturation, low for Korean acculturation, and Bicultural had high scores for both. Women in the Marginalized subgroup reported significantly higher depression scores than women in the American and Korean clusters. It is important to identify immigrants who do not relate to either their heritage culture or the new host culture and address their mental health risk issues.

Menopausal status, moderate-intensity walking, and symptoms in midlife women.

The purpose of this randomized clinical trial study was to determine the effectiveness of a 24-week, home-based, moderate-intensity, walking intervention in improving symptoms (vasomotor, uro-genital/sexual, sleep, psychological, cognitive, physical) experienced by midlife women. One hundred and seventy-three Caucasian and African American women aged 45 to 65 who were not on hormone therapy, had no major signs or symptoms of cardiovascular disease, and were sedentary in their leisure activity were randomly assigned to the moderate-intensity walking group or the nonexercise control group. The exercise prescription was walking at a frequency of 4 times a week for a duration of 20 to 30 minutes. The symptom impact inventory included the frequency, intensity, and bothersomeness of 33 symptoms collected at baseline and 24 weeks. Adherence was measured with a heart rate monitor and exercise log. Average adherence to frequency of walking was 71.6% of the expected walks. After 24 weeks, there were no differences between the walking and control group on change in symptoms. However, multiple regression revealed that frequency of adherence to walking along with change in physical symptoms and menopausal status were significant predictors of change in sleep symptoms. While walking did not improve most symptoms experienced by midlife women, frequency of walking may improve sleep.

Health Promotion Attitudes and Strategies in Older Adults

The purpose of this study was to describe older adults’ attitudes and beliefs regarding wellness, self-care, and participation in health promotion activities. Six focus groups were conducted with 45 men and women aged 62 to 91. The White Crane Model of Healthy Lives for Older Adults was developed based on the focus group themes. Being healthy incorporates multiple components, including functional independence, self-care and management of illness, positive outlook, and personal growth and social contribution. Being healthy is determined by self-evaluation in the context of chronic illness or disability and the social and/or physical environment. Strategies for maintaining health and motivation for healthy behavior are identified. Socialization and social support are central to participation in programs, and interpersonal engagement is particularly important. Flexibility in choice and structure of programs contribute to seniors’sense of control over their health. Programs should be challenging and tailored to older adults’ needs and expectations.

Midlife Women's Adherence to Home-Based Walking During Maintenance

BackgroundDespite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3–6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. ObjectiveThe purpose of this study was (a) to describe midlife womens maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. MethodsThere were Black and White women participants (N = 90) aged 40–65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. ResultsRetention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DiscussionThese results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in womens walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Measuring Adherence to a Women’s Walking Program

The purpose of this study is to demonstrate the use of a self-report exercise log and a heart-rate monitor in the measurement of adherence to the dimensions of an exercise prescription and to propose an alternative way to define adherence to a 24-week home-based women’s walking program, which reflects the dynamic process of behavior change. Adherence was measured with exercise logs, Polar Vantage XL Heart-Rate Monitors, and pre-to postintervention change in VO2 max. Of the dimensions of the exercise prescription, frequency of walks documented by both the heart-rate monitor and the exercise log had a higher correlation than duration and intensity of walking, with change in VO2 max suggesting that frequency was potentially the most predictive adherence measure. Examination of the total number of walks and the number and sequence of weeks without walks over the 24-week intervention revealed dynamic patterns of adherence suggesting variation in the degree of behavioral change.

Outcomes of a Home-Based Walking Program for African-American Women

Purpose. As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks. Design. Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers. Setting. The centers were in predominately African-American communities. Participants. Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center. Intervention. Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks. Methods. Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition. Results. Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments. Conclusion. Findings suggest the potential impact of workshop group support on adherence in African-American women.

Psychosocial risk factors for work‐related musculoskeletal disorders of the lower‐back among long‐haul international female flight attendants

AIM This paper is a report of a study to examine the relationships between work-related psychosocial factors and lower-back work-related musculoskeletal disorders among long-haul international female flight attendants. BACKGROUND Recent attention has focused on the influence of work-related psychosocial factors on work-related musculoskeletal disorders. To date, however, little is known about the influence of psychosocial factors at work on lower back work-related musculoskeletal disorders in female flight attendants. METHOD A cross-sectional, mailed survey was conducted in 2004 with flight attendants in one major airline who were randomly selected from a union membership list. The work-related psychosocial factors included psychological job demand, decision latitude, social support, job insecurity, and external environmental concerns. Physical load was defined by overall strenuousness across 41 job tasks and measured by a 4-point scale of strenuousness. Lower-back work-related musculoskeletal disorders were defined as lower-back symptoms that occurred at least once a month or lasted at least 1 week in the past year and caused at least moderate pain. FINDINGS The flight attendants with lower back work-related musculoskeletal disorders, compared with those without lower-back work-related musculoskeletal disorders, had higher perceived psychological job demands, job insecurity, and physical load. After controlling for physical load and personal factors, high job insecurity significantly increased the risk for lower-back work-related musculoskeletal disorders. CONCLUSION Occupational health nurses in the airline industry should be cognizant of the importance of assessing the influence of both job tasks and work-related psychosocial factors on lower-back work-related musculoskeletal disorders.

Identifying individual and contextual barriers to seeking mental health services among Korean American immigrant women

The purpose of this qualitative study was to explore perceptions about barriers to Korean American immigrant womens seeking mental health services. Four focus groups were conducted with 27 Korean American participants, including two groups of providers and two groups of community women. Discussions were recorded and transcribed to identify and code themes. Barriers included language problems, cultural differences, lack of time, financial limitations, lack of transportation, lack of knowledge, lack of funding for community agencies, lack of partnership with churches, and perceived stigma. Recommendations include ethnically and linguistically matched mental health services, community outreach services, training for providers, and community education.