15.Minority Women's Health Concerns
v What Health Problems Affect a Lot of Hispanic Americans/ Latina Women?Obesity and Overweight Being overweight means that you have too much body weight made up of muscle, bone, fat, and water. Obesity is a common problem that occurs when you have too much body fat. With too much body fat, you have a higher chance of having heart disease, diabetes, high blood pressure, stroke, breathing problems, arthritis, and some cancers. If you carry fat around your waist, you are more likely to have heart disease, diabetes, or cancer. Obesity in Mexican American women, the largest Hispanic/Latino subgroup, is 1.5 times more common (reaching 52%) than in the general, female population. And 57.1% of Hispanic American/Latino women are sedentary (have no leisure-time physical activity). Doing regular physical activity (30 minutes most days of the week is best) and eating better can help prevent obesity. Obesity is measured with a Body Mass Index (BMI). BMI shows the relationship
of weight to height. Women with a BMI of 25 to 29.9 are considered overweight,
while women with a BMI of 30 or more are considered obese. All adults (aged 18 years
or older) who have a BMI of 25 or more are considered at risk for premature death
and disability from being overweight or obese. These health risks increase as the BMI
rises. Your health care provider can help you figure out your body mass or go to
www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm. Not only are health care providers concerned about
how much fat a person has, but also where the fat is located on the body. Women with
a "pear" shape tend to store fat in their hips and buttocks. Women with an "apple"
shape store fat around their waists. For most women, carrying extra weight around their
waists or middle (with a waist larger than 35 inches) raises health risks (like heart
disease, diabetes, or cancer) more than carrying extra weight around their hips or thighs.
Heart Disease Heart disease is the leading cause of death in African American, Latino,
American Indian/Alaska native and white populations. More than 61 million
Americans have some type of heart disease, including high blood pressure,
coronary heart disease, stroke, congestive heart failure, and other related
conditions. More than 950,000 Americans die each year of heart disease, or one
person every 33 seconds. In 1999, more women in the United States died of heart disease and stroke
compared to all forms of cancer. Of these women, 11% were African American, 3%
were of Hispanic origin (who may be of any race), 88% were white, 1% were Asian
American/Pacific Islander women, and less then 1% were American Indian/Alaska
native women. Several risk factors contribute to the likelihood of women getting
heart disease: smoking, high blood pressure (hypertension), high blood
cholesterol, obesity, physical inactivity, and a family history of the disease.
Age-adjusted death rates from heart disease among females in minority
populations vary greatly, from a low of 113.8 per 100,000 persons (Asian
American or Pacific Islanders) to a high of 284.1 (African Americans). Although the term heart disease can refer to any heart ailment, it is usually
associated with coronary heart disease. Blocked arteries in the heart severely
restrict the amount of blood that can flow to the heart. In turn, this
insufficient blood flow deprives the heart muscle of much-needed oxygen and
nutrients. When the blood supply is interrupted, the muscle cells of the heart
suffer irreversible injury and die. This condition is known as a heart attack. • African American women have the highest mortality rate from heart
disease (284.1 per • American Indian/Alaska Native women have significantly lower death
rates from heart disease • Hispanic women have lower death rates from heart disease (137.1 per
100,000) than do white • Asian American/Pacific Islander women have the lowest mortality rate
from heart disease of all In 1999, almost one-third of deaths of African American women (29.4%), over
one-quarter of deaths of Hispanic or Latina women (26.9%) and Asian
American/Pacific Islander women (25.7%), and one-fifth of deaths of American
Indian/Alaska Native women (21.1%) were attributed to heart disease. (Thirty-one
percent of white women died from heart disease in 1999, the largest percentage
of any group of women.) Stroke Each year in the United States, approximately 700,000 people experience a new stroke or repeat strokes, and about 4.7 million people are stroke survivors. In 2000, 61.7% of those who died from stroke were females. Stroke and other cerebrovascular diseases were the third leading cause of death for minority women in the United States (excluding American Indian/Alaska Native women). With cerebrovascular diseases, an obstruction, rupture, or other disorder in the blood vessels leading to the brain restricts the supply of oxygen to the brain. Insufficient oxygen to the brain usually results in a stroke. Cerebrovascular diseases can result in weakness, paralysis of some parts of the body, difficulties with speech, loss of consciousness, or death. Major risk factors for stroke are similar to those for heart disease, including smoking, high blood pressure, and high blood cholesterol. • African American women have the highest death rate from stroke of all
women, at 78.1 deaths • Asian American/Pacific Islander women have a mortality rate from stroke
of 48.6 per 100,000 • American Indian/Alaska Native women have the second lowest mortality
rate from stroke, at • Hispanic women have the lowest death rate from stroke (36.4 deaths per 100,000 persons). Cancers All cancers combined is the leading cause of death for Asian American/Pacific Islander women, and the second leading cause of death among other American women of color. Cancers occur when specific cells in the body malfunction and begin to divide uncontrollably; the resulting mass of cells forms a tumor. If the tumor continues to grow unchecked, it begins to invade the normally functioning cells of vital organs and can then become life threatening. For all cancers combined in 1999, death rates for African American women were highest of all women (200 deaths per 100,000). white women were a close second (169 per 100,000), followed by American Indian/Alaska Native women (109 per 100,000); Asian American/Pacific Islander (104 per 100,000); and Latino women, who had the fewest deaths from all cancers combined (101 per 100,000). 1) Lung cancer. The incidence of lung cancer, the leading cancer
killer of women, is on the rise. • African American women have the highest mortality rate from lung
cancer (40.2 per 100,000) • American Indian/Alaska Native women have a mortality rate from lung
cancer of 25.6 per • Asian American/Pacific Islander women and Hispanic women have the
lowest death rates from 2) Breast cancer. The second leading cause of cancer death among all
American women is • African American women have the highest mortality rate from breast
cancer of all population • Hispanic women have the second highest mortality rate from breast cancer
of minority • American Indian/Alaskan Native women have high mortality rates from
breast cancer (14.7 per • And between 1990 and 1997, Asian American/Pacific Islander women have
consistently 3.) Cervical Cancer. Cancer of the cervix, a very common kind of
cancer in women, is a The most common symptom of cervical cancer is abnormal bleeding. Many ethnic groups share the things that can make you more likely to get cervical cancer, such as having more than one sexual partner, starting sexual intercourse at a young age, and other dangerous sexual behavior. You can help find cervical cancer early, when it is most treatable, by getting regular Pap tests and pelvic exams. Pap tests should begin about three years after a woman begins having sexual intercourse, but no later than at 21 years old. Women should then have Pap tests at least once every three years. You should talk with your health care provider about how often you should have a Pap test and pelvic exam. Maternal and Infant Health 1) Maternal mortality. Maternal mortality rates are based on the
number of maternal deaths due • In 2000, African American women of all ages had a maternal mortality
rate of 20.1 per • Hispanic women of all ages had a maternal mortality rate of 9.0 per
100,000 live births in 2) Infant mortality rates. Infant mortality, defined as the death of
a child before age one, is pregnancy and result in poor birth outcomes, such as infant mortality, low birth weight, and negative consequences for child health and development. These risk factors–including pregnancy-associated hypertension, diabetes, tobacco and alcohol use during pregnancy, and anemia–often differ widely by maternal age and by race/ethnicity. • African American women have the highest infant mortality rate (14.1
per 1,000 births), while • Native/Part Hawaiian women have the second highest infant mortality
rate (9.6), followed by • Hispanic women have an overall infant mortality rate of 5.8. Within
this group of women, • Asian American/Pacific Islander women have an infant mortality rate of
5.6, the lowest of all
3) Low-birth-weight live births. Low-birth-weight infants are born
weighing less than 2,500 • In 2000, African American women had the highest incidence of
low-birth-weight babies of any • Of Hispanic/Latina women, 6.4% of all babies born to these mothers
were-low birth-weight • Of Asian American/Pacific Islander women, 7.3% of all babies are of
low-birth-weight. • In 2000, 6.8% of infants born to American Indian/Alaska Native women
were HIV/AIDS Currently, an estimated 800,000 to 900,000 people are living with HIV, Human Immunodeficiency Virus, in the United States, and approximately 40,000 new infections will occur every year. In addition, 774,467 cases of AIDS, Acquired Immunodeficiency Syndrome (the advanced stages of HIV) have been reported in the United States, including 134,441 cases among women. Approximately a half million people have died from AIDS in this country since the epidemic has been reported. Long considered a man’s disease, HIV/AIDS is a rapidly growing public health problem among women, particularly minority women. Since 1985, the proportion of AIDS cases among adolescent and adult women has more than tripled, from 7% in 1985 to 25% in 1999. One-fourth of all American women are African American and Hispanic/Latina, but more than three-fourths of all AIDS cases in the United States occur in African American and Hispanic/Latina women. In 2000, 80% of new AIDS cases in women occurred among African American and Hispanic/Latina females. Among women, two major forms of HIV transmission include intravenous (IV) drug use and heterosexual contact. In 2000, 38% of women with AIDS were infected through heterosexual exposure to HIV, and 25% said they had contracted it through IV drug use. Many women report that they did not know they were at risk for HIV/AIDS when they contracted the disease. • African American women accounted for 58% of all AIDS cases among women
reported • Hispanic/Latina women are at least 3 times more likely to die from
HIV/AIDS than are white • American Indian/Alaska Native women had 426 cases of AIDS between 1985 and present. • HIV/AIDS rates in Asian American/Pacific Islander women are less than 20
deaths per
Other Sexually Transmited Diseases In the United States, more than 65 million people are currently living with an incurable sexually transmitted disease (STD). An additional 15 million people become infected with one or more STDs each year. Many people underestimate the prevalence of STDs and know little about the facts, the warning signs, and their risk of contracting one or more STDs. In addition, the health impact of STDs is severe for women, particularly for minority women. Because the infections often cause few or no symptoms and may go untreated, women are at risk for complications from STDs, including ectopic (tubal) pregnancy, infertility, chronic pelvic pain, and poor pregnancy outcomes. These diseases include chlamydia, pelvic inflammatory disease, gonorrhea, human immunodeficiency virus (HIV), herpes simplex virus, human papillomavirus (HPV), and syphilis. Latex condoms, when used consistently and correctly, are effective in decreasing one’s chances of contracting many, but not all, of these diseases. Teenagers are the age group that has the highest risk of contracting STDs. Each year an estimated 3 million teenagers contract one or more STDs. They are more likely to engage in high-risk behaviors that increase their chances of contracting STDs, such as multiple partners, unprotected sex, and for young women, choosing sexual partners older than themselves. In addition, teenage girls have a higher chance of contracting some STDs (such as chlamydia, gonorrhea, and HIV) than do teenage males because of the biological makeup of female bodies. 1) Chlamydia. Chlamydia is the most commonly reported bacterial STD
in the United States. It 2) Pelvic inflammatory disease (PID). PID refers to an upper
reproductive tract infection in abnormal condition that occurs when a fertilized egg implants itself in a location other than inside a woman’s uterus, often in a fallopian tube. If left untreated PID infections can progress to involve the upper reproductive tracts and may result in serious complications. Minority women reported one-third of all PID cases. Among African American women, the incidence of ectopic pregnancy is 1.5 times higher than that of all other women of color. 3) Gonorrhea and Syphilis. Gonorrhea and syphilis are common
bacterial infections that can be Many women who contract gonorrhea do not show symptoms, and sometimes symptoms are so mild that they are mistaken for a bladder or vaginal infection. Gonorrhea infections that occur in the throat usually do not have symptoms and often go undetected. Adolescent females between the ages of 15 and 19 have the highest rates of gonorrhea. Gonorrhea: • In 1999, 75% of reported gonorrhea cases occurred among African
American women, 19% of • One percent of American Indian/Alaska Native women and Asian
American/Pacific Islander • Seven percent of Hispanic women in this age group contracted
gonorrhea. The rate of Syphilis: • Syphilis rates were the lowest among white non-Hispanic women (less
than one per 100,000) • Between 1991 and 1994, the rates of syphilis declined in Hispanic
women by two-thirds and • The overall rate of syphilis among minority women in 1999 was highest
among African • Almost one per 100,000 Hispanic/Latina women contracted syphilis in 1999. 4) Genital Herpes. Genital herpes is caused by the herpes simplex
virus (HSV), a highly In the United States, 1 out of 5 (or 45 million people) ages 12 and over have genital herpes (HSV type 2). Of these people, almost 46% are of African American descent, compared to 18% of white Americans. African American women are three times more likely than white women to be infected with genital herpes (HSV type 2). Most of the people infected with HSV never recognize the symptoms of genital herpes, so they do not know they are infected. Among women, HSV is frequently more severe in individuals with weakened immune systems, including those infected with HIV. Though there are treatments for genital herpes, it has no cure. 5) Human papillomavirus (HPV). HPV refers to a group of more than 100
different viruses,
Diabetes Mellitus Diabetes mellitus ranks among the top 10 causes of death among all women. More than one-half of all Americans with diabetes are women. From 1990 to 1998, diabetes rates increased 70% for women between the ages of 30 and 39. It is much more prevalent among minority females than among their white counterparts. In 2000, this disease was the fourth most common cause of death for African American, American Indian/Alaskan Native, and Hispanic females. (Among white women, diabetes was the seventh leading cause of death in 2000, responsible for 2.8% of deaths from all causes.) Although a cure for diabetes does not yet exist, this disease is treatable. Type I Diabetes.. Type I diabetes, in which the body stops producing insulin, requires insulin injections. Type I diabetes was previously called juvenile-onset diabetes or insulin-dependent diabetes. In Type 1 diabetes, the body destroys the cells that produce insulin. Autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes. Type 1 diabetes may account for 5-10% of all diagnosed cases of diabetes. Type II Diabetes. In Type II diabetes, formerly known as adult-onset diabetes or non-insulin-dependent diabetes, the body produces insulin, but in insufficient quantities. Type II diabetes may account for 90-95% of all diagnosed cases. Risk factors include older age, obesity, physical inactivity, and race/ethnicity. Minority women are 2-3 times more likely than non-Hispanic, white women to have Type II diabetes. Gestational Diabetes. Gestational diabetes is a type of diabetes which develops during pregnancy. The body becomes intolerant towards sugar. During pregnancy, treatment is needed to normalize the mother’s blood to avoid complications with the infant. Gestational diabetes is common among obese women and those with a family history of diabetes. • In American Indian/Alaska Native women, diabetes was the fourth leading
cause of death in • Among all Hispanic women, diabetes was the fourth most common cause of
death in 2000, • Among African American women, diabetes was the fourth leading cause of
death in 2000, • For Asian American/Pacific Islander women, diabetes was the fifth most
common cause of Tuberculosis Tuberculosis is the single leading cause of worldwide deaths among women of reproductive age. Long considered a disease of the old, tuberculosis (TB) accounts for 750,000 deaths worldwide among women ages 15-44. Bacteria called Mycobacterium tuberculosis cause TB. TB can attack the body in a number of places, but it usually attacks the lungs. Only individuals who are sick with TB of the lungs are infectious. Like the common cold, tuberculosis spreads through the air when a patient with untreated TB disease coughs, sneezes, or spits. Common symptoms of TB disease include a cough that persists for weeks or months, chest pain, fever (particularly at night), weight loss, and loss of appetite. In 2002,15,078 cases of TB were reported to the Centers for Disease Control and Prevention in the United States. • United States-born African Americans have the highest rates of TB in this
country. Of people • Foreign-born Americans have much higher TB rates. Black, non-Hispanic
foreign-born • Among females with TB, 81% of reported cases occurred in minority
populations. Of these Psychiatric Disorders Psychiatric diseases and conditions can be the result of a behavioral, psychological, or biological (physical) dysfunction. About 22-23% of the United States adult population–or 44 million people–have psychiatric disorders that would be diagnosable if they had visited a mental health provider. Only about 1 in 4 actually receive the care they need. In the United States, mental disorders collectively account for more than 15% of the overall burden of disease (measured in lost years of healthy life) from all causes and slightly more than the burden associated with all forms of cancer. Nearly 12.4 million women (12.0%) in this country are affected by a depressive disorder each year. Depressive disorders include major depression, dysthymic disorder (a less severe but more chronic form of depression), and bipolar disorder (manic-depressive illness). Depressive disorders can increase the risk of suicide. Although men are 4 times more likely than women to die by suicide, women report attempting suicide about 2 to 3 times as often as do men. Major depression, for example, afflicts an estimated 5% of Americans. However, nearly twice as many women suffer from major depression than do men (6.5% verses 3.3%). Among minority women, depression may be worsened by factors such as low education and income levels, lack of employment, acculturation difficulties for immigrants, marital and family problems, racism, and single parenthood. Several psychiatric disorders, including anxiety disorders and mood disorders, disproportionately strike females. Approximately twice as many females as males suffer from these disorders. However, men and women are equally affected by social phobias (overwhelming anxiety in everyday social situations) and obsessive-compulsive disorder. In addition, more than 90% of those afflicted with eating disorders are women, and 86% report the onset of these disorder by the time they are 20. Eating disorders–anorexia nervosa, bulimia nervosa, and binge eating disorder–are often perceived to be an affliction of white girls and young women in middle and upper socio-economic classes. However, women and girls (and increasingly, men) of all ethnic groups are susceptible. A recent study has shown that African American women were more likely to binge eat more often, and they reported fasting, laxative abuse, or diuretic abuse more often than did their white counterparts. Eating disorders among ethnically and culturally diverse girls may be underreported due to the lack of population-based studies that include representatives from these groups. The mistaken perception that non-white females are at decreased risk for eating disorders may also contribute to the lack of detection. 1) Depression. • Hispanic/Latino women have the highest lifetime prevalence of
depression (24%) among all • African American women are less likely to have this disorder (16%)
than white women (22%). • Among American Indian/Alaska Native female adolescents, one study
found 14% were 2) Suicide. • In 2000, American Indian/Alaska Native women of all ages (except women 65
years and • In 2000, Asian American/Pacific Islander women of all ages had the
second highest mortality • That same year, African American women of all ages had a mortality
rate from suicide of 1.8. • Only American Indian/Alaska Native women in this age group had a
lower mortality rate, which • Hispanic women had a mortality rate from suicide of 1.8 (as did
African American women) in v Violence Against Women Violent crimes against women are a major public health problem in our country. These acts include homicide, rapes, sexual assaults, robberies, and both aggravated and simple assaults. In a 1996 survey, at least half of all women reported having been physically assaulted at some point in their lifetime. Each year, about 1 million women are stalked in this country, and about 4 million women are physically abused by their spouses or live-in partners. Persons who are known to the victims commit 6 out of 10 of all rapes and sexual assaults against women. In 1998, an estimated 900,000 women reported acts of non-lethal violence by intimate partners: current or former spouses, boyfriends, or girlfriends (whether heterosexual or same-sex partners). The consequences of non-lethal physical or sexual violence, whether actual or threatened, and of psychological/emotional abuse, can include post-traumatic stress disorder, clinical depression, substance abuse, dissociative disorders, and suicide attempts; and physical consequences may include fractured and broken bones, scarring, bruising, lacerations, organ damage, and miscarriages. In 2001, intimate partner violence made up 20% of all nonfatal cases of violent crime experienced by women. Women living in households with an annual household income of less than $10,000 experience intimate partner violence at significantly higher rates than women in households with annual incomes of $10,000 or more. Violence is not linked specifically to racial or ethnic factors. However, it is linked to socioeconomic status. • Fifty-two percent of African American women are subject to physical
assault at some point in • Among American Indians/Alaska Native women of all ages, 61% stated they
had been victims • Among all women, Hispanic women are the least likely group to be
victims of rape. Hispanic • Asian American/Pacific Islander women are the least likely group to be
victims of physical
v Getting Health Care Although this isn’t a problem with the health of women, it can lead to health problems because many women can’t get the right health services, medicines, and supplies when they need them. Some reasons include: • They can’t pay for it and don’t have health insurance. • They have no way to get to a doctor. • They have physical limitations that make it hard to get to a doctor. • They don’t understand the language. There are more uninsured Hispanic American/Latino women than any other race/ethnic group (30%), even though many of them are employed or live with someone who is employed. Only 26% have private health insurance, 27% receive Medicaid coverage, and 7% receive Medicare. This lack of insurance is due in part to the fact that Hispanics are more likely than non-Hispanics to be employed in industries and jobs that do not provide health benefits. Also, within the various industries, Hispanics are less likely than non-Hispanics to be offered health coverage by their employers. Problems with language, transportation, child care, immigration status, or cultural differences act as further barriers to health care services. Lack of access to health care is a major barrier to early detection and treatment of breast cancer and cervical cancer, and one that many Hispanic American/Latino women face. Uninsured Hispanic women with breast cancer are more than twice as likely than other women to be diagnosed with breast cancer in the advanced stages of the disease. The disease is more difficult to treat successfully when it is diagnosed in its advanced stages, and survival rates are lower. More often than any other group, Hispanic Americans/Latinos have no regular source of health care. In addition, the low incomes of many Hispanic Americans/Latinos as compared to other groups make it hard to obtain individual health insurance outside of employer- or government-sponsored plans. Even when they are eligible for Medicaid or state-sponsored child health insurance programs, many Hispanic American families fear that enrolling family members in such plans could be used against them when they apply for citizenship. What types of care coverage exist? How do I find out about them? Finding health insurance often requires good research and finding answers to lots of questions. There are a number of different kinds of health care coverage: Private Insurance • Employer sponsored–fully or partly paid by an employer, includes
health maintenance • Individual insurance– private health insurance that a person buys
through an insurance Public Insurance • Medicare– federal government health insurance program for people 65
and older, or who are • Medicaid – federal and state health insurance program run by states
for low-income or disabled For more information on health insurance, contact these organizations: • Agency for Healthcare Research and Quality Phone: (800) 358-9295 Internet Address: http://www.ahrq.gov • Bureau of Primary Care Phone: (800) 400-2742 Internet Address: http://www.bphc.hrsa.gov/ • Centers for Medicare & Medicaid Services (CMS) Phone: 877-267-2323 Internet Address: http://www.cms.hhs.gov • Insurance Association of America Phone: 202-824-1600 Internet Address: http://www.hiaa.org/index_flash.cfm For More Information You can find out more about health problems in Hispanic American/Latino women by contacting the National Women’s Health Information Center at 800-994-WOMAN (9662), visiting the NWHIC Minority Women’s section (http://www.4woman.gov/minority/index.cfm), and contacting the following organizations: Office of Minority Health Phone: (301) 443-5224 (301) 589-0951 (Publications) TDD line: 800) 444-6472 Internet address: http://www.omhrc.gov Office of Minority and Women’s Health Phone: (301) 594-4490 Internet address: http://bphc.hrsa.gov/OMWH/home.HTM
Source: Office of Women’s Health
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