Lorena Garcia

Acculturation and Reported Intimate Partner Violence Among Latinas in Los Angeles

This study sought to understand the relationship between acculturation and reporting intimate partner violence (IPV) among Latinas. A cross-sectional interviewer-administered survey was conducted at public health care clinics throughout Los Angeles County. Logistic regression was used to estimate the effect of acculturation on reporting IPV. An increasing trend of reporting IPV was observed among Latinas who were more acculturated (chi-square = 41.02, p = .0006). Highly acculturated Latinas were more likely to report IPV compared with least acculturated Latinas (prevalence odds ration = 2.18, 95% confidence level = 0.98, 4.89) and moderately acculturated Latinas were more likely to report IPV compared with least acculturated Latinas (prevalence odds ration = 1.29, 95% confidence level = 0.69, 2.43). Culturally competent IPV prevention programs may be the key to significantly reducing the number of women exposed to this serious public health problem.

Homicides and Intimate Partner Violence: A Literature Review

The purpose of this article is to examine the literature on intimate partner homicides (IPH). The review begins by describing the factors, magnitude, and consequences associated with IPH, focusing on studies from the United States. Second, the article discusses the public health implications of preventing IPH and the limitations associated with the IPH literature. Last, the article concludes with recommendations of IPH in terms of practice, policy, and research.

Obesity, Physical Activity, and Their Interaction in Incident Atrial Fibrillation in Postmenopausal Women

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF. Methods and Results The Womens Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI‐ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Coxs hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8% were African American, and 3.6% were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5‐kg/m2 increase; 95% confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95% CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033). Conclusions Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.

Association between diabetes, diabetes treatment and risk of developing endometrial cancer.

Background:A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women’s Health Initiative (WHI).Methods:A total of 88 107 postmenopausal women aged 50–79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer.Results:Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13–1.85 for diabetes, HR=1.57, 95% CI: 1.19–2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08–1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk.Conclusions:Our results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains.

High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative

BACKGROUND The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load. OBJECTIVE We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression. DESIGN This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Womens Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954). RESULTS We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth compared with first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth compared with first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression. CONCLUSIONS The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women.

Severe obesity, heart disease, and death among white, african american, and hispanic postmenopausal women

To compare mortality, nonfatal coronary heart disease (CHD), and congestive heart failure (CHF) risk across BMI categories in white, African American, and Hispanic women, with a focus on severe obesity (BMI ≥ 40), and examine heterogeneity in weight‐related CHD risk.

Multiple Healthful Dietary Patterns and Type 2 Diabetes in the Women's Health Initiative

The relationship between various diet quality indices and risk of type 2 diabetes (T2D) remains unsettled. We compared associations of 4 diet quality indices--the Alternate Mediterranean Diet Index, Healthy Eating Index 2010, Alternate Healthy Eating Index 2010, and the Dietary Approaches to Stop Hypertension (DASH) Index--with reported T2D in the Womens Health Initiative, overall, by race/ethnicity, and with/without adjustment for overweight/obesity at enrollment (a potential mediator). This cohort (n = 101,504) included postmenopausal women without T2D who completed a baseline food frequency questionnaire from which the 4 diet quality index scores were derived. Higher scores on the indices indicated a better diet. Cox regression was used to estimate multivariate hazard ratios for T2D. Pearson coefficients for correlation among the indices ranged from 0.55 to 0.74. Follow-up took place from 1993 to 2013. During a median 15 years of follow-up, 10,815 incident cases of T2D occurred. For each diet quality index, a 1-standard-deviation higher score was associated with 10%-14% lower T2D risk (P < 0.001). Adjusting for overweight/obesity at enrollment attenuated but did not eliminate associations to 5%-10% lower risk per 1-standard-deviation higher score (P < 0.001). For all 4 dietary indices examined, higher scores were inversely associated with T2D overall and across racial/ethnic groups. Multiple forms of a healthful diet were inversely associated with T2D in these postmenopausal women.

Relationship between adiposity and admixture in African-American and Hispanic-American women

Objective:The objective of this study was to investigate whether differences in admixture in African-American (AFA) and Hispanic-American (HA) adult women are associated with adiposity and adipose distribution.Design:The proportion of European, sub-Saharan African and Amerindian admixture was estimated for AFA and HA women in the Womens Heath Initiative using 92 ancestry informative markers. Analyses assessed the relationship between admixture and adiposity indices.Subjects:The subjects included 11 712 AFA and 5088 HA self-identified post-menopausal women.Results:There was a significant positive association between body mass index (BMI) and African admixture when BMI was considered as a continuous variable, and age, education, physical activity, parity, family income and smoking were included covariates (P<10−4). A dichotomous model (upper and lower BMI quartiles) showed that African admixture was associated with a high odds ratio (OR=3.27 (for 100% admixture compared with 0% admixture), 95% confidence interval 2.08–5.15). For HA, there was no association between BMI and admixture. In contrast, when waist-to-hip ratio (WHR) was used as a measure of adipose distribution, there was no significant association between WHR and admixture in AFA but there was a strong association in HA (P<10−4; OR Amerindian admixture=5.93, confidence interval=3.52–9.97).Conclusion:These studies show that: (1) African admixture is associated with BMI in AFA women; (2) Amerindian admixture is associated with WHR but not BMI in HA women; and (3) it may be important to consider different measurements of adiposity and adipose distribution in different ethnic population groups.

Alcohol consumption and body weight change in postmenopausal women: results from the Women's Health Initiative

Objective:To determine whether alcohol consumption is associated with incident overweight or obesity in normal-weight, postmenopausal women.Design:Prospective cohort study considering baseline alcohol consumption and subsequent weight change over 7 years.Subjects:15 920 normal-weight (body mass index (BMI): 18.5 to <25 kg m−2), postmenopausal women enrolled in the Women′s Health Initiative Clinical Trial.Measurements:Body weight change, and incident overweight and obesity (BMI, 25.0 to <30 and ⩾30 kg m−2) over 7 years.Results:One-third of the 13 822 women included in the analytical cohort reported no alcohol consumption. BMI differed little between abstainers (22.8±1.58 kg m−2) and alcohol consumers in the upper quintile (22.7±1.53 kg m−2). Among normal-weight women, the risk of becoming overweight or obese over a 7-year follow-up period was 35% or 88% lower, respectively, for women in the upper quintile of alcohol intake relative to abstainers (hazard ratio (HR), 0.65; 95% confidence interval (CI), 0.58–0.73; or HR, 0.12; 95% CI, 0.05–0.25, respectively). Risk for overweight and obesity was not significantly modified by age. Wine consumption showed the greatest protective association for risk of overweight (HR, 0.75; 95% CI, 0.68–0.84), followed by liquor (HR, 0.85; 95% CI, 0.78–0.93) and beer (HR, 0.90; 95% CI, 0.82–1.00).Conclusion:Postmenopausal women of normal weight who report moderate alcohol intake have a reduced risk of becoming overweight or obese over time. Perhaps, weight control measures in this population should target behaviors other than reduction in alcohol for those of normal BMI consuming moderate amounts.

Unintended Pregnancy and Intimate Partner Violence Before and During Pregnancy Among Latina Women in Los Angeles, California

The purpose of this paper was to examine the relationship between unintended pregnancy and intimate partner violence (IPV) before and during pregnancy among Latinas. A cross-sectional interview measuring pregnancy intent, IPV, and acculturation, using the Acculturation Rating Scale for Mexican Americans (ARSMA-II), was conducted among Latina women in their 2nd or 3rd trimester of pregnancy at clinics in Los Angeles (n = 313). Overall, 44% of women reported an unintended pregnancy. The prevalence of physical (any) and emotional (only) abuse 12 months before pregnancy was 11% and 22%, respectively. Although both types of IPV decreased during pregnancy (10% and 19%, respectively), most reports of physical IPV during pregnancy (53%) were among women who did not report physical abuse before pregnancy. After adjusting for other factors, physical IPV before pregnancy was not associated with unintended pregnancy (adjusted OR = 0.92; 95% CI = 0.40, 2.16). The prevalence of unintended pregnancy was highest (76%) among highly acculturated Latinas. However, when an unintended pregnancy occurred among less acculturated Latinas, who comprised the majority of the sample (n = 270), it was associated with greater risk of physical IPV during pregnancy (unadjusted OR = 2.57; 95% CI = 1.06, 6.23); although the confidence interval included one after adjusting for other factors (adjusted OR = 2.79; 95% CI = 0.98, 7.92). An unintended pregnancy may have a unique impact on relationships in the context of Latino culture, where family and pregnancy are highly valued. Pregnancy often creates an opportunity for providers to discuss issues related to abuse and family planning with women who do not regularly access care. The results from this study may be used to increase the cultural sensitivity with which violence and reproductive health are addressed among the diverse population of Latinas when they connect with prenatal services.