Carmen Radecki Breitkopf

Coping with the Experience of Rape

The coping strategies that a victim of a rape engages in can have a strong impact on the development and persistence of psychological symptoms. Research provides evidence that victims who rely heavily on avoidance strategies, such as suppression, are less likely to recover successfully than those who rely less heavily on these strategies. The present study utilized structural path analysis to identify predictors of avoidance coping following rape and examined factors in the assault itself (e.g., force, alcohol use), sequelae of the assault (e.g., self-blame, loss of self-worth), and social support as potential direct and indirect predictors of avoidance coping. From a sample of 1,253 university women, the responses of 216 women who endorsed an experience of rape were examined. Results suggested that sequelae of the assault such as feelings of self-blame and negative reactions received from others are potentially important predictors of avoidance coping. Implications of the results for future rape recovery research are discussed.

Effects of hormonal contraception on bone mineral density after 24 months of use

OBJECTIVE: To measure the effect of 24 months of depot medroxyprogesterone acetate use on bone mineral density compared with oral contraception (pills) and nonhormonal contraception. METHODS: Women aged 18–33 years self-selected oral contraception, depot medroxyprogesterone acetate, or nonhormonal contraception (controls). Those selecting pills were randomized to formulations containing either 35 &mgr;g ethinyl estradiol and norethindrone or 30 &mgr;g ethinyl estradiol and desogestrel. Controls were frequency matched on age and race/ethnicity to hormonal contraception users. Dual-energy X-ray absorptiometry of the lumbar spine (L1–L4) was performed at baseline, 12 months, and 24 months. Percent change in bone mineral density was analyzed by using analysis of covariance, adjusting for age, race/ethnicity, weight-bearing exercise, calcium intake, smoking status, and body mass index. RESULTS: Of the 191 women making up the final sample, 86 used pills, 47 used depot medroxyprogesterone acetate, and 58 used nonhormonal contraception. Women using depot medroxyprogesterone acetate for 24 months experienced, on average, a 5.7% loss in bone mineral density, with a 3.2% loss occurring between months 12 and 24. On average, users of desogestrel pills experienced a 2.6% loss in bone mineral density after 24 months. Bonferroni-adjusted pairwise comparisons demonstrated that bone mineral density changes from baseline to 24 months among depot medroxyprogesterone acetate users differed significantly from changes experienced by either of the pill groups or the control group. Changes in bone mineral density among users of either pill did not significantly differ from each other or from controls. CONCLUSION: Loss of bone mineral density associated with depot medroxyprogesterone acetate use appears to be linear during the first 2 years of use. Shifts in bone mineral density among pill users were not significant when compared with controls. LEVEL OF EVIDENCE: II-1

Poor Knowledge Regarding the Pap Test Among Low‐Income Women Undergoing Routine Screening

CONTEXT Many women undergoing cervical cancer screening lack appropriate understanding of the Pap test. It is important to evaluate knowledge and informational needs about Pap testing among groups who may have difficulty accessing care or a relatively low likelihood of obtaining follow-up for an abnormal result, such as minority and low-income women. METHODS A sample of 338 women undergoing cervical screening at two clinics in Texas completed a questionnaire measuring their knowledge of Pap testing and asking what specific information they would like to know about the test. Group comparisons and qualitative analyses were conducted. RESULTS Women correctly answered an average of 8.7 out of 20 questions; the range was 0-17. Mean scores were higher among white women (10.2) than among blacks (8.4) and Hispanics (7.4), among women with more than a high school education than among their less educated counterparts (10.0 vs. 7.9) and among women with an annual household income of at least

Factors Associated With Completion of the Human Papillomavirus Vaccine Series

10,000 than among those with a lower income (9.3 vs. 8.4). Knowledge scores did not differ according to Pap history. Open-ended questioning identified a need for information on the purpose of the test, exam procedures, abnormal test results and prognosis. CONCLUSIONS Minority women and those of low socioeconomic status had poor understanding of Pap testing. Identifying misunderstandings in this vulnerable population and improving patient education on the most basic aspects of Pap testing may increase adherence to follow-up when abnormalities are detected.

Effects of depot medroxyprogesterone acetate and 20-microgram oral contraceptives on bone mineral density.

and administration of the first dose of the vaccine between January 1, 2007, and July 1, 2007. Charts were reviewed until November 26, 2008, for a minimum 17 months of follow-up. Completion was defined as receipt of 3 HPV vaccinations. Charts were reviewed for age, race/ethnicity, type of insurance (private vs Medicaid/Child Health Insurance Program [CHIP]), and distance from home to the clinic. Sexual history variables included sexual activity status prior to initiation of the series and history within 3 years of vaccine initiation of a gynecological exam and/or Papanicolaou (Pap) test, HPV DNA test, or sexually transmitted infection. The reason for each visit was classified as nonsick visit (well child, well woman, contraception), sick visit, or vaccine only. If the patient did not complete the series, the chart was reviewed to determine if the patient had any clinic visits after she was due for her next shot. Statistical analyses were performed using SPSS, version 12.0, with an α level of <.05 determining statistical significance. Missing data did not exceed 2% for any of the predictor variables with the exception of sexual activity status for which 27% were missing. Only Caucasian, African American, or Hispanic patients were included in analyses assessing race/ ethnicity, as these 3 groups comprised >98% of the sample. Bivariate relationships between patient characteristics and vaccine series completion were conducted. Variables that were significant were entered into a logistic regression analysis using backward stepwise elimination.

Association of race, body fat and season with vitamin D status among young women: a cross-sectional study

OBJECTIVE: Hormonal contraceptives may adversely affect bone mineral density. However, racial differences and the reversibility of these changes are poorly understood. This study measured bone mineral density changes during hormonal contraceptive use and after discontinuation in a triethnic population. METHODS: Bone mineral density was measured every 6 months for up to 3 years in 703 white, African-American, and Hispanic women using oral contraceptives (OCPs), depot medroxyprogesterone acetate (DMPA), or nonhormonal contraceptives, and in 68 DMPA discontinuers for up to 2 additional years. Mixed-model regression analyses were used to estimate the percentage change in bone mineral density for each contraceptive method. RESULTS: Over 3 years, DMPA and OCP users lost more bone mineral density than did nonhormonal contraceptive users (−3.7% and −0.5% compared with +1.9% at lumbar spine, and −5.2% and −1.3% compared with +0.6% at femoral neck, respectively). No differences were observed by race in bone mineral density changes that resulted from DMPA or OCP use. However, DMPA users aged 16–24 years lost more bone mineral density at the spine (4.2% compared with 3.2%, P=.006) and femoral neck (6.0% compared with 4.2%, P=.001) than those aged 25–33 years. After DMPA discontinuation, women who selected nonhormonal contraceptives gained bone mineral density (+4.9% at spine, +3.2% at femoral neck), whereas those who selected OCP recovered spinal (+2.3%) but not femoral neck bone mineral density (−0.7%). CONCLUSION: Use of very–low-dose OCPs may result in a small amount of bone loss. Use of DMPA results in greater bone loss, but this is largely reversible at the spine. Use of very–low-dose OCPs after DMPA discontinuation may slow bone recovery. LEVEL OF EVIDENCE: II

Racial differences in body fat distribution among reproductive-aged women

Objective  The purpose of this study was to provide an estimate of vitamin D status in young women residing in south‐east Texas and to determine factors that predict 25‐hydroxyvitamin D (25‐OHD) concentration.

Anxiety symptoms during pregnancy and postpartum.

We examined the influence of race/ethnicity on body fat distribution for a given body mass index (BMI) among reproductive-aged women. Body weight, height, and body fat distribution were measured with a digital scale, wall-mounted stadiometer, and dual-energy x-ray absorptiometry, respectively, on 708 healthy black, white, and Hispanic women 16 to 33 years of age. Multiple linear regression was used to model the relationship between race/ethnicity and different body fat distribution variables after adjusting for BMI, age at menarche, and demographic and lifestyle variables. For a given BMI, white women had the highest total fat mass (FM(total)), trunk fat mass (FM(trunk)), and leg fat mass (FM(leg)), whereas Hispanic women had the highest percentage of FM(trunk) (%FM(trunk)) and trunk-to-limb fat mass ratio (FMR(trunk-to-limb)). Conversely, black women had the lowest FM(total), FM(trunk), percentage body fat mass (%FM), %FM(trunk), and FMR(trunk-to-limb), and the highest percentage of FM(leg). The %FM was similar in whites and Hispanics and lower in blacks. The race x BMI interactions were significant for almost all of the body fat distribution variables. Increasing in differences with increasing BMI were apparent between blacks and whites in FM(trunk), %FM(trunk), FMR(trunk-to-limb), %FM(leg), and %FM, and between blacks and Hispanics in FM(trunk), %FM(trunk), FMR(trunk-to-limb), and FM(leg). In summary, the distribution of body fat for a given BMI differs by race among reproductive-aged women. These findings raise questions regarding universally applied BMI-based guidelines for obesity and have implications for patient education regarding individual risk factors for cardiovascular disease and metabolic complications.

Correlates of weight loss behaviors among low-income African-American, Caucasian, and Latina women.

This cross-sectional study compared the distribution of anxiety symptoms among pregnant, non-pregnant, and postpartum women of lower socioeconomic status. Participants were 807 women who were pregnant (24–36 weeks), postpartum (2–8 weeks), or not pregnant. Anxiety and depressive symptoms were assessed by the state-trait anxiety index and the Beck depression inventory, respectively. English and Spanish versions of the instrument were available. Group differences in anxiety were evaluated using analysis of variance. Multivariate regression was performed to evaluate differences in anxiety while controlling for marital status, education, race/ethnicity, employment, cohabitation, income, parity, history of depression/anxiety, and depressive symptoms. Anxiety scores were lower among postpartum women relative to pregnant and non-pregnant women (both P < 0.001), who did not differ (P = 0.99). After controlling for depressive symptoms and patient characteristics, anxiety remained lowest among postpartum women. Additionally, history of depression/anxiety and depressive symptoms were significant predictors of anxiety in the multivariate analysis. Comparatively low anxiety and depressive symptoms were observed among women who were 2–8 weeks postpartum. Anxiety symptoms that occur postpartum may not appear until later in the postpartum period.

Awareness of Breast Density and Its Impact on Breast Cancer Detection and Risk

OBJECTIVE: To examine the prevalence and correlates of weight reduction behaviors among low-income women. METHODS: A total of 1,709 Caucasian, African-American, and Latina women aged 12–58 years attending a federally funded family planning clinic reported their weight loss behaviors during the past 30 days, including using diet pills, exercising, purging (vomiting, laxatives, diuretics), and dieting. Approximately 60% (n = 999) had a body mass index of 25 or greater. RESULTS: Overall, 35.3% (n = 603) of women dieted, 43.7% (n = 746) exercised, 15.1% (n = 258) used diet pills, and 4.3% (n = 69) purged. Only 14.8% (n = 253) of the sample reported both dieting and exercising. The odds of exercising for weight loss decreased as parity increased. Those who smoked currently or in the past were more likely than nonsmokers to report purging (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.2, 5.4). African Americans were least likely to diet or exercise compared with Caucasians and Latinas. Exposure to family members using diet pills (OR 4.6; 95% CI 3.2, 6.5), dieting (OR 2.1; 95% CI 1.6, 2.8), or purging (OR 5.6; 95% CI 2.7, 11.9) was associated with increased odds of performing these behaviors oneself. CONCLUSION: This research demonstrates that low-income women frequently use maladaptive strategies, such as diet pills and purging, to lose weight. Obesity and family exposure to these behaviors places women at increased risk of unhealthy behaviors. Interventions designed to reduce obesity must include precautions regarding the dangers of these practices. LEVEL OF EVIDENCE: III