Women's Health Commons^™

Association Of Birth Weight And Preterm Birth With Subsequent Risk For Hypertension In Women From The Women’S Health Initiative, Christian P. Daniele

Masters Theses

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

"The Land That Feminism Forgot": Birthzillas, Madwives, And The Politics Of Chilbirth, Amber Vayo

Doctoral Dissertations

“The Land that Feminism Forgot” is an in-depth exploration of the politics of childbirth that draws together qualitative and quantitative evidence to theorize the connections between treatment in childbirth and maternal mortality. Situating the qualitative research in the larger national context, the second chapter offers a State Reproductive Autonomy Index that provides an overview of the reproductive policy landscape at the national level. The dissertation then explores the role of institutionalized childbirth, medical mistrust, and obstetric violence in the U.S.’s longstanding maternal mortality crisis and offers policy suggestions in key public health areas. Through 120 qualitative interviews with people who …

The Impact Of A Lifestyle Intervention On Risk Factors Of Cardiovascular Disease And Type Ii Diabetes Among At-Risk Hispanic Women, Kathryn A. Wagner

Doctoral Dissertations

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes …

Elucidating Mechanisms Influencing Maternal Postpartum Health: The Protective Benefits Of Breastfeeding And Associations With Allostatic Load, Experiences Of Stress, And Resiliency, Bi-Sek J. Hsiao

Doctoral Dissertations

Research has established breastfeeding as protective of maternal health, but little is known about the ways breastfeeding interacts with chronic stress pathways and interfaces with stressors such as discrimination and neighborhood deprivation, which are salient in the experiences of many marginalized communities. This research addresses these knowledge gaps through secondary analyses of prospective cohort data generated by the Community Child Health Research Network through Community Based Participatory Research processes. Analytical samples were derived from 2510 postpartum women from five regions in the U.S. who self-identified as Black, Hispanic, or White. Study 1 investigated and found an inverse association between breastfeeding …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

Birthweight And Risk Of Autoimmune And Thyroid Conditions Within The Women’S Health Initiative, Brian C. Monahan

Masters Theses

Autoimmune and thyroid conditions account for a substantial proportion of the morbidity and mortality experienced in the United States, affecting >40 million Americans combined. Co-occurrence of both an autoimmune and thyroid condition is also likely, particularly among women. Epidemiologic studies on both sets of conditions have examined many risk factors, including demographic, lifestyle, genetic, and environmental risk factors. However, one area which has been neglected is the effect of early life exposures on the development of autoimmune and thyroid conditions. To investigate the potential association between an individual’s birth weight (by category;in uteroand early childhood, extending the hypothesis to include …

Impact Of Parity On Gait Biomechanics, Bekah P. Stein

Masters Theses

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women.

Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women.

Methods: 28 healthy female participants (14 parous, 14 …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Estimating Age-Specific Contraceptive Use For Spacing Of Childbirth For All Countries In Sub-Saharan Africa From 1985 To 2030 Using A Bayesian Hierarchical Time Series Model, Gregory Guranich

Masters Theses

Contraceptive usage for spacing of childbirth is an important indicator for understanding family planning practices as well as fertility transitions. Fertility transition are especially important in sub-Saharan Africa where fertility remains high in many countries. However, estimates and short-term projections are generally not available for countries in this region. We developed a Bayesian hierarchical time series model to estimate and project usage of contraceptives for spacing by 5-year age groups for all countries in sub-Saharan Africa for the years 1985-2030. Estimating country-age-year specific usage is challenging due to limited data availability. We use Bayesian hierarchical models to share information across …

Antipsychotic Drug Use And Postmenopausal Breast Cancer Risk In The Women’S Health Initiative (Whi): A Prospective Cohort Study, Anna George

Masters Theses

Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …

Gender, Class, Caste And Health Status Of Abandoned Elderly Women In Bangalore, South India, Olya Clark

Doctoral Dissertations

The research study centers on issues of health, quality of life, and access to health care among abandoned elderly women in Bangalore, India, specifically focusing on interrelationship of class, caste, structural factors and health. Despite increasing feminization of India’s older population, elderly women’s abandonment and its health consequences has received little attention in existing research literature. The study seeks to explain the causes of elderly female abandonment and concomitant social and health consequences, by examining how their life experiences are shaped, sustained and changed by their class, caste, and gender positions. Elderly abandonment is not unique to India but exists …

Maternal Postpartum Depression And Father Involvement Across The Transition To Parenthood, Katie Newkirk

Doctoral Dissertations

Maternal postpartum depression is a common complication of childbirth that affects the whole family. Fathers’ greater involvement in childcare can buffer children from the negative effects of mothers’ depression, and aid in mothers’ recovery, so it is important to understand under what conditions fathers become more or less involved when mothers are depressed. Prior research has supported both a compensation hypothesis, whereby fathers compensate for the effects of mothers’ depression on mothers’ parenting by being more involved in parenting, and a spillover hypothesis, whereby mothers’ negative emotionality causes fathers to pull back from family life and be less involved in …

Hormonal Contraceptive Use Among Active Duty Army Servicewomen. Trends And Implications For Risk Of Musculoskeletal Injury., Melanie K. Hosker

Doctoral Dissertations

Almost 40% of servicewomen use hormonal contraception every year, and 60% will use a contraceptive method in their military career. Rates of contraceptive use and musculoskeletal injury are higher among servicewomen as compared to civilians. Gender differences in rates of musculoskeletal injury have led investigators to question the role of sex hormones, including contraception. Recent studies suggest that hormonal contraceptives may decreased risk of anterior cruciate ligament (ACL) injury, potentially decreasing early onset osteoarthritis (OA). We utilized the Total Army Injury and Health Outcome Database, which prospectively captured demographics, clinical and pharmacy records on over 5.6 million Army soldiers since …

Foki Vitamin D Receptor Gene Polymorphisms And Metabolic Health In Pregnant Saudi Women, Maysa Alzaim

Doctoral Dissertations

Lifestyles have been dynamically changing in the past few years in Saudi Arabia, and the prevalence of non-communicable diseases (NCDs), such as obesity, diabetes, hypertension, high cholesterol, and other cardiovascular diseases (CVD), is notably increasing. In fact, NCDs are affecting a growing number of people in SA, especially women of childbearing age. Vitamin D deficiency has also become pandemic and a major public health concern among the Saudi population despite the abundance of sunlight. The most vulnerable groups are pregnant women and their newborns. Previous studies have correlated low vitamin D status with a higher risk of adverse short- and …

Association Of Follicle-Stimulating Hormone And Depression And Depressive Symptoms In Older Postmenopausal Women, Dana Fritz

Masters Theses

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed …

Micronutrients, Inflammation And Depression Among Women Of Reproductive Age From The National Health And Nutrition Examination Survey 2005-2008, Joycelyn M. Faraj

Doctoral Dissertations

Depression is the leading cause of disease burden among women. Recent evidence indicates that inflammation is associated with depression, and factors that contribute to inflammation can be addressed through nutritional and lifestyle interventions. Vitamins B₆ and D have been linked with depression and have established roles in inflammation, yet their associations with depression in the presence of low-grade inflammation remain unknown. The purpose of this research was to investigate how high sensitivity C-reactive protein (hs-CRP), a biomarker of inflammation, contributes to different dimensions of depression and to determine to what degree inflammation affects the association between vitamins B_{6 …}

A Comparison Of Techniques For Handling Missing Data In Longitudinal Studies, Alexander R. Bogdan

Masters Theses

Missing data are a common problem in virtually all epidemiological research, especially when conducting longitudinal studies. In these settings, clinicians may collect biological samples to analyze changes in biomarkers, which often do not conform to parametric distributions and may be censored due to limits of detection. Using complete data from the BioCycle Study (2005-2007), which followed 259 premenopausal women over two menstrual cycles, we compared four techniques for handling missing biomarker data with non-Normal distributions. We imposed increasing degrees of missing data on two non-Normally distributed biomarkers under conditions of missing completely at random, missing at random, and missing not …

Macronutrients And The Risk Of Premenstrual Syndrome, Serena C. Houghton

Doctoral Dissertations

Premenstrual syndrome (PMS) affects 8-20% of reproductive-aged women, impacting work, family, and social interactions. Limitations in available PMS treatments, including side effects and limited medication efficacy, indicate the need for improved prevention. Modifiable risk factors for prevention of PMS include dietary factors. Several micronutrients have been identified as risk factors, but there has been little evaluation of macronutrients. Thus, the research aim was to examine prospectively whether macronutrient consumption was associated with PMS development among a subset of women enrolled in the Nurses’ Health Study II cohort. Chapter 1 evaluates the association of fat intake and PMS risk. Among 3,638 …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Identifying Menstrual Symptom Patterns In Young Women Using Factor And Cluster Analysis, Felicia A. Quintana-Zinn

Masters Theses

Approximately 80% of reproductive age women experience physical or emotional symptoms prior to onset of menses. Of these women, approximately 20% experience symptoms severe enough to interfere with social functioning and life activities and meet criteria for premenstrual syndrome (PMS). More than 100 different symptoms are associated with PMS, the most common of which include breast tenderness, headache, anger, and depression. Symptom groupings tend to be stable within an individual but can vary distinctly between women. Potential differences in the etiology of symptoms suggest that PMS should not be considered a single condition in research or clinical studies, but rather …

The Effects Of Ovarian Hormones And Exercise On Gene Markers Of Cardiac Dysfunction, Anisha S. Patel

Masters Theses

Heart disease is the leading cause of death in women in the United States. Premenopausal women appear to have better cardiac function and lower risk of heart disease compared to male postmenopausal female counterparts. Ovarian hormone loss influences blood pressure homeostasis and causes systemic inflammation, which may result in chronic stress on the heart. Two key physiological changes in cardiac dysfunction are reemergence of the fetal gene pattern and myocardial remodeling. Physical activity has been linked to improved cardiac function. The purpose of this study was to investigate the effects of ovariectomy on early markers of cardiac dysfunction and fibrosis …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Stress And Depression During Pregnancy Among Hispanic Women: Risk For Adverse Birth Outcomes And The Role Of Physical Activity, Kathleen Szegda

Doctoral Dissertations

Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) …

Associations Between Vitamin D Status, Adiposity, And Inflammatory Biomarkers In Young Women (18 – 30 Years), Adolphina Addo-Lartey

Doctoral Dissertations

We conducted a cross-sectional analysis among 270 (18- to 30-year old) female participants in the UMass Amherst Vitamin D Status Study (n = 270) to assess the extent to which dietary intakes of calcium and vitamin D are associated with obesity markers. We also evaluated the association between serum 25-OHD concentrations and both adiposity and inflammatory biomarkers. Study participants were mostly Caucasians (84.5%) with normal BMI, although about half of women had high adiposity (total body fat ‘TBF’≥ 32%). Women reporting adequate intakes of calcium (≥ 1000 mg/day) but low intakes of vitamin D (< 600 IU/day) were more than twice as likely to have a high percentage of TBF compared to women with adequate intakes of both calcium and vitamin D. In addition, women with lower calcium intake from supplements were twice as likely to have a waist circumference ≥ 80 cm (OR = 2.04; 95% CI: 1.04 – 3.99) compared to women in the highest tertile of calcium intake. The magnitude of this association is important since among young women 18-30 years old, a waist circumference greater than 80 cm indicates central obesity and suggests increased visceral adiposity, which contributes to hyperlipidemia and other obesity-related chronic conditions. Among all women, total vitamin D, food vitamin D, and supplemental vitamin D intake were not associated with serum 25-OHD concentration (P > 0.05). However, among supplement …

Understanding Health Issues Among Adolescent Females In A Northeast Province Of Afghanistan, Amina Davlatshoeva

Doctoral Dissertations

The purpose of this study is to develop a deeper understanding of the health issues facing adolescent females (ages 18-21) in rural, northeastern Afghanistan. Incorporating participant observations, in-depth interviews, and narrative inquiries, this study seeks to illustrate adolescent females’ perspectives on health issues. To achieve this goal, ten adolescent females were interviewed in rural, northeastern Afghanistan during 2010. The participants were between 18- and 21-years old. The one-on-one interviews were conducted in a multiple-response format and were structured around three research questions:

• How does a young female’s understanding of health issues shape her identity in northeastern Afghanistan?
• In what ways …

Coffee And Tea Consumption And The Risk Of Lung Cancer In A Population Of Postmenopausal Women, Abigail Santos

Masters Theses

Lung cancer has been the leading cause of cancer death in women for
the past three decades. Although smoking is the most important risk
factor for lung cancer, not all lung cancer deaths in American women
are attributed to smoking and the role of dietary exposures remain
unclear.In particular, the effect of coffee consumption and tea
consumption on lung cancer risk remains inconclusive. Therefore we
assessed these associations prospectively in 83,777 women between the
ages of 50-79 who did not have a previous history of cancer. Daily
coffee and tea consumption (cups/d) were assessed via a baseline
questionnaire while the …