Introduction
In 2004, women represented 51 percent of the 285
million people residing in the United States. In most age groups,
women account for approximately half of the population, with the
exception of people 65 years and older; among older Americans, women
represent almost 58 percent of the population. The growing diversity
of the U.S. population is reflected in the racial and ethnic distribution
of women across age groups. Black and Hispanic women account for
9 and 6 percent of the female population aged 65 and older, respectively,
but they represent 16 and 20 percent of females under 15 years of
age. Non-Hispanic Whites accounted for 82 percent of women aged
65 years and older, but only 59.3 percent of those under 15 years
of age.
In addition to race and ethnicity, income and
education are important factors that contribute to women’s health
and access to health care. In every family structure, women are
more likely than men to live in poverty. Poverty rates are highest
among women who are heads of their households: nearly one-quarter
of female heads of households are poor. Poverty rates are also higher
among women with no high school diploma (28.3 percent) than women
with a high school diploma (12.3 percent) or at least some college
education (8.4 percent). However, the number of women going to college
is increasing; more than 1.5 million women earned post-secondary
degrees in 2003, and women now represent more than half of recipients
of associate’s, bachelor’s, and master’s degrees.
America’s growing diversity underscores the importance
of examining and addressing racial and ethnic disparities in health
status and the use of health care services. In 2004, 62 percent
of non-Hispanic White females reported themselves to be in excellent
or very good health, compared to only 54.5 percent of Hispanic women
and 52 percent of non-Hispanic Black women. Minority women are disproportionately
affected by a number of diseases and health conditions, including
AIDS, diabetes, hypertension, and overweight and obesity. For instance,
in 2004, non-Hispanic Black and Hispanic women accounted for more
than three-fourths of women with AIDS. Just over one-third of non-Hispanic
White women have ever been tested for the Human Immunodeficiency
Virus (HIV), compared to 52.4 percent of non-Hispanic Black women
and 45.4 percent of Hispanic women.
Mental health is another important aspect of women’s
overall health. A range of mental health problems, including depression,
anxiety, phobias, and post-traumatic stress disorder, disproportionately
affect women. Moreover, pregnancy and the postpartum period are
times when women may be especially vulnerable to depression. Nearly
one-quarter of new mothers suffer mild depression, 9.7 percent show
moderate depression, and 6.5 percent show symptoms of severe depression.
Postpartum depression is most common among non-Hispanic Black and
American Indian/Alaska Native women.
Physical disabilities are prevalent among women
as well. Disability can be defined as impairment of the ability
to perform common activities like walking up stairs, sitting or
standing for 2 hours or more, grasping small objects, or carrying
items like groceries. Therefore, the terms “activity limitations”
and “disabilities” are used interchangeably throughout this book.
Overall, 15.4 percent of women and 12.8 percent of men report having
activity limitations. Diabetes is a chronic condition and a leading
cause of death and disability in the United States, and it is especially
prevalent among non-Hispanic Black women. Among women in this population,
diabetes occurs at a rate of 103.6 per 1,000 women, compared to
61.1 per 1,000 non-Hispanic White women. Hypertension, or high blood
pressure, is also more prevalent among non-Hispanic Black women
than women of other races. This disease occurs at a rate of 341.1
per 1,000 among non-Hispanic Black women, compared to 260 per 1,000
non-Hispanic White women and 197.5 per 1,000 Hispanic women.
Overweight and obesity are occurring at an increasing
rate among Americans of all ages and both sexes. Body Mass Index
(BMI) is a measure of the ratio of height to weight, and is often
used to determine whether a person’s weight is within a healthy
range. A BMI of 25 or greater is considered overweight, and a BMI
of 30 or greater is considered obese. In 2004, 51.7 percent of women
were overweight or obese. In 12 States, at least one-quarter of
women met the standard for obesity.
Some conditions, such as arthritis, disproportionately
affect non-Hispanic White women. In 2004, the rate of arthritis
among non-Hispanic White women was 279.4 per 1,000 women, compared
to 225.2 per 1,000 non-Hispanic Black women and 145.5 per 1,000
Hispanic women. Other conditions are more closely linked to family
income than to race and ethnicity. Rates of asthma, for example,
decline as income increases; among women with incomes under the
Federal poverty level, more than one-third have been hospitalized
for asthma in the past year, compared to 18.8 percent of women with
family incomes of 300 percent of the poverty level or more.
Many diseases and health conditions, such as those
mentioned above, can be avoided or minimized through good nutrition,
regular exercise, and preventive health care. In 2003, 18.6 percent
of women’s visits to physicians were for preventive care, including
prenatal care, screenings, and immunizations. Overall, 65.9 percent
of older women reported receiving a flu shot in 2004; however, this
percentage ranges from 45.3 percent among non-Hispanic Black women
to 68.4 percent of non-Hispanic White women. In addition to preventive
health care, preventive dental care is also important to prevent
dental caries and gum disease. In 1999-2002, 72.1 percent of women
with dental insurance saw a dentist in the past year, compared to
60.3 percent of women with health insurance but no dental coverage,
and 38.4 percent of women with no insurance at all.
There are many ways women (and men) can promote
health and help prevent disease and disability. Thirty minutes of
physical activity on most days of the week can reduce the risk of
chronic disease; women who report any exercise at all got an average
of 187 minutes of moderate exercise each week in 2004.
A healthy diet can also be a major contributor
to long-term health and prevention of chronic disease. However,
more than half of adult women’s diets include more than the recommended
amount of saturated fat and sodium and less than the recommended
amount of iron. Overall, 53 percent of women exceed the maximum
daily intake of saturated fat, 61.4 percent exceed the maximum amount
of sodium, and 82 percent do not meet the recommended amount of
iron. In addition, 41.3 percent do not have enough vitamin B12 in
their diets.
Contraceptive use is another important health
behavior; depending on the method, it can prevent unintended pregnancy
and the spread of sexually transmitted infections (STIs). In 2002,
35.8 percent of women with private insurance chose the contraceptive
pill, making it the most popular form of contraception in that group.
Female sterilization was the most common method of contraception
among women on Medicaid (used by 40.5 percent). Condoms, which can
prevent both pregnancy and the spread of STIs, were used by the
male partners of only 18 percent of women with public or private
insurance and 20.3 percent of uninsured women.
While some behaviors have a positive effect on
health, a number of others, such as smoking and alcohol and drug
use, can have a negative effect. In 2004, 22.3 percent of women
smoked. However, 43.9 percent of female smokers tried to quit. In
the same year, 44 percent of women reported any alcohol use in the
past month; however, relatively few women (14.9 percent) reported
binge drinking (5 or more drinks on the same occasion) and even
fewer (3.5 percent) reported heavy alcohol use (binge drinking on
5 or more days in the past month).
Use of cigarettes, alcohol, and illicit drugs
is particularly harmful during pregnancy. While use of illicit drugs
among pregnant women in general is reported by only 4.6 percent
of pregnant women, it is more common among pregnant adolescents,
of whom 16 percent reported drug use in the past month. The use
of tobacco during pregnancy is relatively rare as well, and has
declined steadily since 1989. In 2004, 10.2 percent of mothers reported
smoking during pregnancy. This rate was highest among American Indian/Alaska
Native women (18.2 percent) and non-Hispanic White women (13.8 percent).
Women’s Health USA 2006 can be an important
tool for emphasizing the importance of preventive care, counseling,
and education, and for illustrating disparities in the health status
of women from all age groups and racial and ethnic backgrounds.
Health problems can only be remedied if they are recognized. This
data book provides information on a range of indicators that can
help us track the health behaviors, risk factors, and health care
utilization practices of women throughout the United States.
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