Research Findings
Reflections on a Decade of Experience in Implementing a Center for Women's Health at an Academic Medical Center. Giardina EG, Cassetta JA, Weiss MW, Stein M, Press R, Frassetto G. J Women’s Health. 2006;15(3):319-29
On the 10th anniversary of the establishment of a Center for Women's Health (CWH) program, the opportunity to share the successes and limitations in developing a centralized approach to women's healthcare is provided. The development of the CWH at the Columbia University Medical Center, New York-Presbyterian Hospital was prompted by concerns that the health status for women is worse than for men in terms of disability, morbidity, and chronic illness. Moreover, women move through cycles of health and illness differently from men, and gender inequalities in research design and implementation and under-representation of women in clinical studies contributed to knowledge gaps concerning women's health, possibly leading to suboptimal care. The goal in developing a program was (1) to provide outstanding medical care to women based on prevention and treatment of unique aspects of women's health, (2) to develop professional training and programs promoting knowledge, understanding, and credible scientific efforts, and (3) to foster collaborative research and communication among researchers, practitioners, policymakers, and organizations. In this paper, the clinical and educational programmatic activities and lessons learned are described.
Association of Education and Race/ethnicity with Physical Activity in Insured Urban Women. Cassetta JA, Boden-Albala B, Sciacca RR, Giardina EG. J Women’s Health 2007;16(6):902-8.
Background: Physical inactivity is a growing problem facing American women. As little as 150 minutes of moderate physical activity (PA) weekly can reduce the risk of chronic diseases, such as heart disease and stroke. We developed a survey to determine levels and predictors of PA in a diverse population of urban women with access to healthcare. Methods: Total activity time (TAT) was calculated as the sum of all activity (walking, jogging or running, dancing, calisthenics, bicycling, aerobics, swimming) recorded over the preceding 2 weeks. Analysis of variance models were used to assess the effect of different variables on TAT. Results: The survey was completed by 242 women, mean age of 43.4 years. Ninety percent were insured; 66% were non-Hispanic white, 16% were Hispanic, and 10% were African American. Seventy-six percent of women were college graduates. Only 58% of participants recorded >or=150 minutes of PA/week. TAT was related to education, with a significant difference between high school and college graduates (290 +/- 80 vs. 502 +/- 40 min [SEM], p < 0.05). Conclusions: Education was strongly associated with TAT among these insured, diverse, and well-educated women. Only 58% exercised >or=150 minutes/week, underscoring the need to target exercise programs for all women and to close the gap between women of lower and higher educational attainment.
Metabolic Syndrome and Ischemic Stroke Risk: Northern Manhattan Study. Boden-Albala B, Sacco RL, Lee HS, Grahame-Clarke C, Rundek T, Elkind MV, Wright C, Giardina EG, DiTullio MR, Homma S, Paik MC. Stroke. 2008;39(1):30-5.
Background: More than 47 million individuals in the United States meet the criteria for the metabolic syndrome. The relation between the metabolic syndrome and stroke risk in multiethnic populations has not been well characterized. Methods: As part of the Northern Manhattan Study, 3298 stroke-free community residents were prospectively followed up for a mean of 6.4 years. The metabolic syndrome was defined according to guidelines established by the National Cholesterol Education Program Adult Treatment Panel III. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% CIs for ischemic stroke and vascular events (ischemic stroke, myocardial infarction, or vascular death). The etiologic fraction estimates the proportion of events attributable to the metabolic syndrome. Results: More than 44% of the cohort had the metabolic syndrome (48% of women vs 38% of men, P<0.0001), which was more prevalent among Hispanics (50%) than whites (39%) or blacks (37%). The metabolic syndrome was associated with increased risk of stroke (HR=1.5; 95% CI, 1.1 to 2.2) and vascular events (HR=1.6; 95% CI, 1.3 to 2.0) after adjustment for sociodemographic and risk factors. The effect of the metabolic syndrome on stroke risk was greater among women (HR=2.0; 95% CI, 1.3 to 3.1) than men (HR=1.1; 95% CI, 0.6 to 1.9) and among Hispanics (HR=2.0; 95% CI, 1.2 to 3.4) compared with blacks and whites. The etiologic fraction estimates suggest that elimination of the metabolic syndrome would result in a 19% reduction in overall stroke, a 30% reduction of stroke in women; and a 35% reduction of stroke among Hispanics. Conclusions: The metabolic syndrome is an important risk factor for ischemic stroke, with differential effects by sex and race/ethnicity.
Racial/Ethnic Disparities in Time to Follow-Up After an Abnormal Mammogram. Press R, Carrasquillo O, Sciacca RR, Giardina EG. J Womens Health. 2008;17(6):923-30.
Background: Although non-Hispanic white women have an increased risk of developing breast cancer, the disease-specific survival is lower for African American and Hispanic women. Little is known about disparities in follow-up after an abnormal mammogram. The goal of this study was to investigate potential disparities in follow-up after an abnormal mammogram. Methods: A retrospective cohort study of 6722 women with an abnormal mammogram and documented follow-up was performed at the Columbia University Medical Center, New York. The outcome was the number of days between the abnormal mammogram and follow-up imaging or biopsy. Cox proportional hazards models were used to assess the effect of race/ethnicity and other potential covariates. Results: The median number of days to diagnostic follow-up after an abnormal mammogram was greater for African American (20 days) and Hispanic (21 days) women compared with non-Hispanic white (14 days) women (p < 0.001). Racial/ethnic disparities remained significant in a multivariable model controlling for age, Breast Imaging Reporting and Data System (BIRADS) category, insurance status, provider practice location, and median household income. Conclusions: After an abnormal mammogram, African American and Hispanic women had longer times to diagnostic follow-up compared with non-Hispanic white women. Future efforts will focus on identifying barriers to follow-up so that effective interventions may be implemented.
Management of Obesity: a Challenge for Medical Training and Practice. Thande NK, Hurstak E, Sciacca R, Giardina EGV. Obesity. 2009; 17(1):107-13.
Background: Physicians often fail to encourage patients to make healthy choices. The task of lifestyle modification counseling may be even more daunting given the cultural and socioeconomic diversity of patient populations in the United States. The objective of this study is to evaluate the prevalence and predictors of attending and physician-in-training weight control counseling in an urban academic internal medicine clinic serving a unique low income multiethnic high risk population.Results: Seventy nine percent of subjects were either overweight or obese; sixty five percent of obese subjects were advised to lose weight. Attending physicians were more likely than physicians-in-training to counsel subjects on weight control (p < 0.01). Factors that were significantly (p< 0.05) associated with types of weight control counseling included obesity, cardiovascular disease risk factors, female gender, non-black race, college education, married status, and attending physician. Subjects advised to lose weight were more likely to report an attempt to lose weight (p < 0.01). Rates of weight control counseling among physicians are suboptimal, particularly among physicians-in-training.Conclusions: Physician training programs need to address barriers to the provision of weight control counseling and encourage the development of these skills.
Physical Activity Participation among Caribbean Hispanic Women Living in New York: Relation to Education, Income, and Age. Giardina EGV, Laudano M, Hurstak E, Saroff A, Fleck E, Sciacca R, Boden-Albala B, Cassetta J. J Women's Health, 2009, 18(2):187-193.
Background: Inadequate participation in physical activity is a serious public health issue in the United States with significant disparities among population groups. In particular, there is a scarcity of information about physical activity among Caribbean Hispanics, a group on the rise. Our goal was to accumulate data on physical activity among Caribbean Hispanic women living in New York and determine the relation between physical activity and age, marital status, education, income, primary language, and children in the household. Results: There were 318 self-identified Hispanic women who participated. Total activity time, mean 385 ± 26 minutes, and education (r=0.14, p<0.01) were significantly related. Women who had attended some college had greater total activity time than those with some high school education (p=0.046) or < 8th grade education (p=0.022). Walking as a form of transportation was the most frequent pursuit, 285 ± 21 minutes. Age (r = -0.34, p < 0.001) and education (r=0.25, p < 0.001) correlated with non-walking activity time (leisure-time). Non-walking activity times were greater in younger, i.e., 18-29 years (p<0.001), and college educated women (p<0.001). Physical activity recommendations were met by 11%; and 17% reported no physical activity.
Conclusions: Among Caribbean Hispanic women in New York, the current recommendations for physical activity are met by 11%. Our observation that education is a critical factor related to physical activity suggests that programs are needed to address the promotion of a physically active lifestyle are needed.
Metabolic Syndrome and the Burden of Cardiovascular Disease in Caribbean Hispanic Women Living in Northern Manhattan: a Red Flag for Education. Yala SM, Fleck EM, Sciacca R, Castro D, Joseph Z, Giardina EG. Metab Syndr Relat Disord. 2009 Jun 26.
Background: Metabolic syndrome has the highest prevalence among Mexican-American women. Little information is available for Caribbean Hispanics, the largest and fastest growing ethnic minority in the United States. We sought to evaluate the frequency of metabolic syndrome and its relationship with race/ethnicity, socioeconomic position, and education in women of largely Caribbean Hispanic origin. Results: There were 204 women enrolled; mean age was 58 +/- 11 years, Hispanic 44.1% (93% Caribbean), non-Hispanic white (NHW) 38.7%, and non-Hispanic black 9.8%. Education was some high school (<HS) 33.7%, HS graduate 11.2%, some college 12.9%, college graduate 10.1%, and postgraduate 32%. Health insurance was Medicaid 47.8% and commercial 52.2%. Area of residence was urban 77.1% and suburban 22.9%. The frequency of metabolic syndrome was 42.4%, and was increased in Hispanic women (63.3%) versus NHW (29.6%), women with <HS (72.6%) versus postgraduate education (32.1%), women with Medicaid (57.9% vs. 27.4%) and urban residence (47.5% vs. 27.2%). For all comparisons, p < 0.05. Education <HS was linked to increased risk of metabolic syndrome (odds ratio [OR] = 3.5 [1.2-10.0], p = 0.02). Hispanic women had the lowest level of education (p < 0.001) and the highest frequency of individual metabolic syndrome components (p < 0.01). Conclusion: Metabolic syndrome showed an alarming rate in less educated Caribbean Hispanic women and was independently associated with lower education level.
