Journal of Women's Health

Meditation is a common type of complementary and alternative medicine (CAM), and the evidence for its usefulness for health promotion is growing. Women have higher rates of overall CAM use than men do, but little is known about gender differences in meditation practices, reasons for use, or perceived benefits.

Data from the 2012 National Health Interview Survey (NHIS) were used. The NHIS design is a multistage probability sample representative of US adults aged ≥18 (n = 34,342). Design-based F-test and logistic regression were used; all analyses were weighted and were performed in 2017–2018.

Overall, 10.3% of women and 5.2% of men reported using some type of meditation in the past year (p < 0.001). Among meditators, a higher percentage of women used meditation with yoga, tai chi, or qi gong, but men were more likely to use specific types of stand-alone practices (e.g., mindfulness) than women (p < 0.001 for each type). The most common reason reported for using meditation was to reduce stress (35%). Although women and men reported similar reasons for meditating, there were gender differences in the prevalence of some reasons. Both men and women perceived meditation to be helpful (90% and 94%, respectively).

There are gender differences in prevalence, purpose, and perceived benefits of using meditation. US adults aged ≥18 use meditation and find it helpful. Although currently less prevalent among men, providers can consider meditation as a tool for health promotion in both men and women.

Transgender individuals are more likely to experience social and economic barriers to health and health care, and have worse mental health outcomes than cisgender individuals. Our study explores variations in mental health among minority genders after controlling for sociodemographic factors.

Multistate data were obtained from the 2014 to 2016 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Data were included from respondents who were asked whether they identified as transgender, and if so, as male-to-female (MTF), female-to-male (FTM), or gender nonconforming. Frequent mental distress (≥14 days in the last month of “not good” mental health) was the primary outcome of interest. Analysis was performed using design-adjusted Chi-square tests and multivariable logistic regression models of frequent mental distress with gender identity as the independent variable of interest.

Of 518,986 respondents, 0.51% identified as transgender. Higher rates of frequent mental distress were found between FTM (24.7% [18.5–32.3]) and gender nonconforming populations (25.4% [18.7–33.5]), compared with the MTF population (14.2% [10.9–18.3]). After controlling for sociodemographic factors, non-transgender female (adjusted odds ratio [aOR] 1.39 [confidence interval, CI 1.32–1.46]), FTM (aOR 1.93 [CI 1.26–2.95]), and gender nonconforming (aOR 2.05 [CI 1.20–3.50]) identities were associated with increased odds of frequent mental distress compared with non-transgender males.

Our findings suggest differences in the mental health of transgender and non-transgender individuals, and between gender minorities within transgender population. The differences persist after controlling for sociodemographic factors. Our results suggest that considering the spectrum of minority genders within the transgender population may be important in understanding health outcomes.

The black-white disparity in hypertension (HTN) among U.S. women persists after accounting for known risk factors. Pregnancy complications may reveal increased risks for later HTN. We examined the contribution of HTN risk factors measured at both midlife and pregnancy to black-white disparities in midlife HTN.

Data came from a Michigan-based longitudinal study beginning in pregnancy. At 7–15 years postpregnancy (n = 615, mean age = 37), women were assessed for cardiovascular health, including blood pressure, and categorized as hypertensive (n = 126), prehypertensive (n = 149), and normotensive (n = 340). Midlife risk factors for HTN were assessed in four domains: socioeconomic status (SES), psychosocial, behavioral, and physiological. We used generalized logit models to assess the degree to which each domain attenuated the black (vs. white) odds ratio (OR) for HTN at midlife. We then added indicators of pregnancy health, that is, preterm delivery, prepregnancy body mass index (BMI), C-reactive protein (CRP) levels, depressive symptoms, smoking, hypertensive disorders, and lipid levels.

Black women had 3.3 (95% CI: 2.0–5.5) times the odds of HTN compared to white women after adjusting for age. Following adjustment for midlife SES, and psychosocial, behavioral, and physiological factors, the OR was 2.1 (95% CI: 1.2–4.0). Adjustment for prepregnancy BMI, CRP, and depressive symptoms during pregnancy reduced the OR to 1.9 (95% CI: 1.0–3.7).

Known risk factors measured at midlife explained some, but not all, of the race disparity in midlife HTN. Indicators of pregnancy health also contributed to the race disparity in HTN at midlife.

Acute vaso-occlusive pain episodes in sickle cell disease (SCD) are associated with increased rates of hospitalization and early mortality. Despite the observation that women have higher rates of acute vaso-occlusive pain episodes than men, sex-specific risk factors for acute vaso-occlusive pain have not been identified. We tested the hypothesis that acute vaso-occlusive pain is temporally associated with the onset of menstruation in women with SCD.

Initially, using a cross-sectional study design, we administered questionnaires, including validated measures of SCD pain frequency and severity within the last 30 days, as well as menstrual symptoms in a discovery group (n = 103). We then confirmed our findings by administering the same questionnaires online in a replication group (n = 118). A validated questionnaire was used to define dysmenorrhea.

In the initial discovery group, 28% (29 of 103) reported acute vaso-occlusive pain episodes temporally associated with menstruation, and 72% (74 of 103) did not. Of the 29 reporting acute vaso-occlusive pain associated with menstruation, 90% (26) and 10% (3) did and did not meet criteria for dysmenorrhea, respectively. In the replication group, 36% (43 of 118) reported acute vaso-occlusive pain temporally associated with menstruation. Of the 43 reporting acute vaso-occlusive pain associated with menstruation, 60% (26) and 40% (17) did and did not meet criteria for dysmenorrhea, respectively.

In both the discovery and replication groups, we demonstrate that acute vaso-occlusive pain is temporally associated with the onset of menstruation that women with SCD can distinguish from dysmenorrhea.

Dienogest provided significantly greater reduction in endometriosis-associated pelvic pain (EAPP) than placebo in a 24-week, randomized, double-blind study of Chinese women with endometriosis. The current open-label extension study investigated the efficacy and safety of dienogest for 28 additional weeks in this population.

Women with endometriosis were eligible to enroll at completion of the 24-week, placebo-controlled study (n = 220). All women, regardless of prior study treatment, received dienogest 2 mg once daily for up to 28 weeks. Absolute change in EAPP from baseline on a 1–100 mm visual analog scale (VAS), bleeding pattern, adverse events (AEs), laboratory parameters, and bone mineral density (BMD) were evaluated.

The open-label study was completed by 203 (92.3%) women. At the end of open-label study, mean (SD) change from baseline in EAPP score on VAS was −43.1 mm (26.54 mm) and −39.8 mm (31.15 mm) in the prior-dienogest and prior-placebo groups, respectively. Other assessments confirmed that dienogest maintained or enhanced efficacy after 28 weeks of additional treatment. Dienogest initiation was associated with longer, but fewer, spotting/bleeding episodes. Bleeding frequency and intensity decreased progressively during continued treatment. Treatment-emergent AEs, generally mild or moderate, led to withdrawal in 2 (0.9%) patients during the open-label study. Dienogest had no effect on BMD.

Dienogest 2 mg once daily is effective and safe in the long-term management of EAPP in Chinese women with endometriosis, with progressive decreases in EAPP and bleeding irregularities during continued treatment. Efficacy and safety results of this study were consistent with previous studies in Caucasian patients.

Poor dietary quality, measured by the Healthy Eating Index 2010 (HEI-2010), is associated with risk of gestational diabetes mellitus (GDM) and type 2 diabetes. The aim was to investigate the association between dietary quality and glycemic control in women with GDM.

The study included 1220 women with GDM. Dietary quality was calculated by HEI-2010 score from a Food Frequency Questionnaire administered shortly after GDM diagnosis; higher scores indicate higher dietary quality. Subsequent glycemic control was defined as ≥80% of all capillary glucose measurements meeting recommended clinical targets below 95 mg/dL for fasting, and below 140 mg/dL 1-hour glucose after meals.

As compared with Quartile 1 of HEI-2010 score, Quartiles 2, 3, and 4 showed increased adjusted odds of overall optimal glycemic control (odds ratio [95% confidence interval] 1.90 [1.34–2.70], 1.77 [1.25–2.52], and 1.55 [1.09–2.20], respectively). Increased odds of glycemic control were observed in Quartiles 2, 3, and 4 as compared with Quartile 1 of HEI-2010 score for 1-hour postbreakfast and 1-hour postdinner. Mean capillary glucose was lower in Quartiles 2, 3, and 4 of HEI-2010 score when compared with Quartile 1 for 1-hour postdinner (p = 0.03).

Clinicians should be aware that even a small improvement in diet quality may be beneficial for the achievement of improved glycemic control in women with GDM. Trial registration: Clinical Trials.gov number, NCT01344278.

Research has documented multilevel risk factors associated with experiencing incapacitated sexual assault among undergraduate women. Less is known about multilevel risk factors associated with nonincapacitated sexual assault. This study examines and compares the different settings, coercion methods, and relationships in which incapacitated and nonincapacitated sexual assaults occur among undergraduate women.

Our sample included 253 undergraduate women who reported experiencing sexual assault during college on a population-based survey of randomly selected students at two colleges in New York City in 2016 (N = 1671, response rate = 67%). We examined event-level data on their most significant sexual assault incident since entering college. Using multivariable statistical analysis, we identified situational contexts associated with incapacitated and nonincapacitated assault incidents adjusting for binge drinking, illicit drug use, and other confounding sociodemographic and psychosocial variables.

Almost half (47%) of women who experienced sexual assault reported being incapacitated due to alcohol or drugs during the most significant incident. Being at a party before the event and “acquaintance” perpetrators were associated with incapacitated sexual assault after adjusting for binge drinking and other confounders. Meeting a perpetrator through an Internet dating app or indicating the perpetrator was an intimate partner were each associated with nonincapacitated assault incidents. Perpetrator use of physical force and verbal coercion were also associated with nonincapacitated assault incident.

The different situational contexts associated with incapacitated and nonincapacitated sexual assaults have important implications for the design of prevention strategies that will effectively target the diverse risk environments in which campus sexual assault occurs.

Research shows that individuals can improve mental health by increasing experiences of positive emotions. However, the role of positive emotions in perinatal mental health has not been investigated. This study explored the extent to which positive emotions during infant feeding are associated with maternal depression and anxiety during the first year postpartum.

One hundred and sixty-four women drawn from a longitudinal cohort of mother–infant dyads were followed from the third trimester through 12 months postpartum. We measured positive emotions during infant feeding at 2 months using the mean subscale score of the modified Differential Emotions Scale. Depression and anxiety symptoms were assessed with the Beck Depression Inventory-II and State Trait Anxiety Inventory-State subscale at months 2, 6, and 12. Generalized linear mixed models were used to estimate crude and multivariable associations.

Among women with no clinical depression during pregnancy, higher positive emotions during infant feeding at 2 months were associated with significantly fewer depression symptoms at 2, 6, and 12 months and with lower odds of clinically significant depression symptoms at 2 and 6 months. In contrast to depression outcomes, women with clinical anxiety during pregnancy who experienced higher positive emotions had significantly fewer anxiety symptoms at 2, 6, and 12 months and lower odds of clinically significant anxiety at 2 and 6 months.

Positive emotions during infant feeding are associated with depression and anxiety outcomes during the first year postpartum and may be a modifiable protective factor for maternal mental health.

Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. The treatment response and overall survival (OS) improved after incorporating rituximab with chemotherapies. Yet, available evidence as to whether women and men may benefit similarly from rituximab have not been adequately addressed, particularly in the real-world setting. The objective of this study was to examine sex differences in the clinical outcomes of rituximab in DLBCL patients using the Taiwan Cancer Registry Database and National Health Insurance Research Database.

All DLBCL patients aged 20 years and older during 2009–2013 were identified (n = 4490; women = 2048). Cox proportional hazard models were used to compare the results.

The baseline characteristics were similar between women and men with DLBCL, except that women had lower Charlson comorbidity index (CCI), and that fewer women underwent R-CHOP. In the survival analysis, women had better OS and longer time to treatment failure. The multivariate analysis of OS showed that the female sex remained to be an independent favorable prognostic factor regardless of Ann Arbor stages, age, treatments, CCI, and practice settings. In the subgroup analysis, the female advantage was only significant in the patients receiving rituximab-CHOP chemotherapy instead of in those receiving other rituximab-containing or non-rituximab therapies. This advantage diminished when rituximab dose was higher.

From our population-based study, women demonstrated more survival benefits from the use of rituximab-containing induction chemotherapies for DLBCL.

There have been limited data on sex-specific risk factors for coronary artery disease (CAD) in patients with stable chest pain. This study was performed to investigate whether risk factors for CAD differ by sex in stable symptomatic patients.

Data were obtained from a nation-wide registry, enrolling 1025 patients (age, 62.0 ± 11.0 years, 587 women) with chest pain who underwent elective invasive coronary angiography under the suspicion of CAD.

A total of 373 patients (36.4%) had obstructive CAD (≥50% stenosis) (men vs. women: 33.8% vs. 38.3%, p = 0.135). In men, univariate analyses showed that age, renal function, total cholesterol, low-density lipoprotein cholesterol, triglyceride, C-reactive protein (CRP), left ventricular (LV) systolic function, and septal annular velocity of LV (e′) were significantly associated with the presence of obstructive CAD. Among these factors, a high CRP level (≥0.50 mg/dL) was an independent predictor of CAD in multivariable analysis (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.26–6.82; p = 0.012). In women, univariate analyses showed that age, waist circumference, heart rate, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, LV systolic function, LV mass index, e′ velocity, E/e′, and left atrial size were significantly associated with the presence of obstructive CAD. Among these factors, lower e′ velocity (<6.35 cm/s) was an independent predictor of CAD in multivariable analysis (OR, 2.38; 95% CI, 1.21–4.70; p = 0.012).

Among patients with stable chest pain, inflammation and LV diastolic dysfunction are independently associated with obstructive CAD in men and women, respectively.

In the U.S. military, chlamydia and gonorrhea are common sexually transmitted infections, especially among female service members. The aim of this study was to determine whether the number of gonorrhea diagnoses sustained an increased hazard of chlamydia among military women.

This population-based study involved an analysis of all female gonorrhea cases in the U.S. Army reported in the Defense Medical Surveillance System between 2006 and 2012. The effect of the number of gonorrhea diagnoses on the hazard of chlamydia was analyzed using the Prentice-Williams-Peterson gap-time model.

Among 3,618 women with gonorrhea diagnosis, 702 (19.4%) had a subsequent chlamydia diagnosis yielding a rate of 6.06 (95% CI = 5.63–6.53) cases per 100 person-years. Compared to women with one gonorrhea diagnosis, the hazard ratio of chlamydia for women with two gonorrhea diagnoses was 5.09 (95% CI = 4.42–5.86) and for women with three gonorrhea diagnoses was 6.53 (95% CI = 3.93–10.83). The median time to chlamydia diagnosis decreased from 2.39 to 0.67 years for women with two to three gonorrhea diagnoses.

The hazard of chlamydia increased significantly with the number of gonorrhea diagnoses and the median time to chlamydia diagnosis decreased with an increasing number of gonorrhea diagnoses among U.S. Army women.

Gender difference in the workplace continues to be a subject of great discussion. Cross-sectional studies demonstrate that women are often underrepresented in key leadership roles. We sought to examine the proportion of women in cardiology leadership positions and to compare the findings with the differences prevalent in the overall cardiology faculty. Furthermore, we aspired to compare the proportion of women in leadership positions to the proportion in which they entered the cardiology field.

This is a cross-sectional online study of Cardiology fellowship programs identified by American Medical Association's Fellowship and Residency Electronic Interactive Database (AMA FREIDA), conducted from March to April 2017. Data of all (n = 512) cardiology fellowship program directors as well as 69% (n = 140) cardiology division chiefs were collected.

A lower percentage of women held the role of division chief (5% vs. 95%) and program director (14% vs. 86%). However, when compared to the proportion of women in the 1992 fellowship cohort, women were significantly overrepresented in the role of program directors, with no significant difference in representation at the level of division chief. When compared to the overall cardiology faculty, program directors had significantly more publications and were more likely to have an academic rank of full professor (40% vs. 28%) or associate professor (37% vs. 23%). Male program directors had a significantly higher number of research publications, H-index, and academic rank than their female counterparts; however, such difference was not seen at the level of division chief.

Gender difference is present in both program director and division chief roles. However, when compared to the historical cohort, significant overrepresentation of women was seen in the program director position, while proportionate representation was seen in the division chief role.

The Surveillance, Epidemiology, and End Result (SEER) database shows a variable increase in endometrial cancer incidence over time. The objective of this review was to examine published endometrial cancer rates and potential etiologies.

Endometrial cancer incidence was obtained from the SEER Program database from 1975 through 2014, and a test for trend in incidence was calculated. Changes in risk factors thought to be associated with endometrial cancer, including age, obesity, diabetes, diet and exercise, reproductive factors, and medications (hormone therapy [HT] including Food and Drug Administration [FDA]-approved and non-FDA–approved [compounded] estrogens and progestogens, tamoxifen, and hormonal contraceptives) were found through PubMed searches. Temporal trends of risk factors were compared with endometrial cancer trends from SEER.

Although endometrial cancer rates were constant from 1992 to 2002 (women 50–74 years of age), they increased 2.5% annually with a 10% increase from 2006 to 2012 (trend test 0.82). Use of approved prescription estrogen–progestogen combination products decreased after the publication of the Women's Health Initiative (WHI) data, whereas other risk factors either remained constant or decreased during the same time; however, compounded bioidentical HT (CBHT) use increased coincident with the endometrial cancer increase.

Endometrial cancer rate increases after the first publication of WHI data in 2002 may be associated with the decreased use of approved estrogen–progestogen therapy, the increase in CBHT use, and the prevalence of obesity and diabetes; potential relationships require further evaluation.

In 2012, updated cervical cancer screening recommendations were released with consensus on Papanicolaou (Pap) testing every 3 years for women age 21–65 years or Pap–human papillomavirus (HPV) cotesting at 5-year intervals for women age 30–65 years. Primary study aims: Assess current use of Pap-HPV cotesting and describe local population trends over time in Pap and Pap-HPV cotesting. Secondary aim: Assess sociodemographic factors correlating with screening.

We assessed Rochester Epidemiology Project data for Pap and Pap-HPV cotesting among women age 16 years and older living in Olmsted County, Minnesota, yearly from 2005 (study population n = 47,203) through 2016 (study population n = 49,510). We calculated 3-year (Pap) and 5-year (Pap-HPV) moving prevalence rates of screening as proportion of eligible population. Multivariable logistic regression was used to assess factors potentially associated with screening.

In 2016, 64.6% of 27,418 eligible 30- to 65-year-old women were up to date with cervical cancer screening; 60.8% had received Pap-HPV cotest screening. Significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21- to 29-year-old women. Coincident with decreasing Pap screening rates, Pap-HPV cotesting significantly increased among women age 30–65 years, from 10.0% in 2007 to 60.8% in 2016.

This suggests increasing adoption of 2012 screening recommendations in the 30- to 65-year-old population. However, decline in Pap screening among 21- to 29-year-old women is concerning. Disparities by race, ethnicity, smoking status, and comorbidity level were observed. Results suggest need for multilevel patient and clinician interventions to increase cervical cancer screening adherence.

The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States.

We identified pregnancies among women aged 10–54 years during 2001–2013 from five U.S. health plans participating in the Cancer Research Network (CRN) and the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). We extracted information from the health plans' administrative claims and electronic health record databases, tumor registries, and infants' birth certificate files to estimate the frequency and incidence of PAC, defined as cancer diagnosed during pregnancy and up to 1 year postpartum.

We identified 846 PAC events among 775,709 pregnancies from 2001 to 2013. The overall incidence estimate was 109.1 (95% confidence interval [CI] = 101.8–116.7) per 100,000 pregnancies. There was an increase in the incidence between 2002 and 2012 (the period during which complete data were available), from 75.0 (95% CI = 54.9–100.0) per 100,000 pregnancies in 2002 to 138.5 (95% CI = 109.1–173.3) per 100,000 pregnancies in 2012. The most common invasive cancers diagnosed were breast (n = 208, 24.6%), thyroid (n = 168, 19.9%), melanoma (n = 93, 11.0%), hematologic (n = 87, 10.3%), and cervix/uterus (n = 74, 8.7%).

Our study provides contemporary incidence estimates of PAC from a population-based cohort of U.S. women. These estimates provide the data needed to help develop clinical and public health policies aimed at diagnosing PAC at an early stage and initiating appropriate therapeutic interventions in a timely manner.

The present study aimed to compare the surgical and oncological outcomes between young and older women with colorectal cancer (CRC).

This retrospective study included 1815 women with CRC between 2010 and 2014. Participants were divided into a young group (under the age of 65 years) and an old group (65 years and older). The surgical and oncological outcomes were compared between the two groups using univariate and multivariate analyses.

Around 45.1% (N = 819) patients were the older group. The old group had a higher comorbidity rate and a lower proportion of receiving postoperative chemotherapy. The old group also had a significantly higher blood loss (190 ± 611 mL vs. 145 ± 200 mL, p = 0.027) and a higher rate of intraoperative transfusion (5.4% vs. 3.0%, p = 0.011). They were found to develop more complications after surgery (11.7% vs. 7.8%, p = 0.015). The overall survival (OS) of the old group was lower than that of the young group (5-year OS rates: 72.8% vs. 83.8%, p < 0.001; adjusted hazard ratio: 1.86, 95% confidence interval: 1.49–2.33). However, the cancer-specific survival (CSS) was not significantly different between the old and young groups (5-year CSS rates: 84.7% vs. 84.9%, p = 0.076).

Older women with CRC had poorer OS than young women with CRC, but had similar CSS. Therefore, the management of comorbidities along with cancer treatment may be important in older women with CRC.

The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA healthcare services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women Veterans with cancer.

We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (e.g., stages I-IV) between January 1, 2010, and December 31, 2010, in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage.

We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women Veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (p < 0.01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (p = 0.03).

Understanding cancer incidence among women Veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to U.S civilian women, the geographic dispersion and small incidence relative to male cancers raise challenges for high quality, well-coordinated cancer care within the VA.

Although social exposures have complex and dynamic relationships and interactions, the existing literature on the impact of rural–urban residence on stage at breast cancer diagnosis does not examine heterogeneity of effect. We examined the joint effect of social support, social relationship strain, and rural–urban residence on stage at breast cancer diagnosis.

Using data from the Women's Health Initiative (WHI) (n = 161,808), we describe the distribution of social, behavioral, and clinical factors by rural–urban residence among postmenopausal women with incident breast cancer (n = 7,120). We used rural–urban commuting area (RUCA) codes to categorize baseline residential addresses as urban, large rural city/town, or small rural town, and the surveillance, epidemiology, and end results staging system to categorize breast cancer stage at diagnosis (dichotomized as early or late). We then used univariable and multivariable logistic regression to estimate odds ratios (ORs) and associated 95% confidence intervals (95% CI) for the relationship between rural–urban residence and stage at breast cancer diagnosis. We included separate interaction terms between rural–urban residence and social strain and social support to test for statistical interaction.

Of the social, behavioral, and clinical factors we examined, only younger age at WHI enrollment screening was significantly associated with late stage at breast cancer diagnosis (p = 0.003). Contrary to our hypothesis, rural–urban residence was not significantly associated with stage at breast cancer diagnosis among postmenopausal women ([adjusted OR, 95% CI] for urban compared with small town: 1.08 [0.76–1.53]; large town compared with small town: 1.16 [0.74–1.84]; and urban compared with large town: 0.93 [0.68–1.26]).The associations did not vary by social support or social strain (p for interaction between RUCA and social strain and social support, respectively: 0.99 and 0.17).

Future studies should examine other potential effect modifiers to identify novel factors predictive or protective for late stage at breast cancer diagnosis associated with rural–urban residence.

While the incidence of epithelial ovarian cancer (EOC) is lower among African American (AA) women compared with European American (EA) women, AA women have markedly worse outcomes. In this study, we describe individual, social, and societal factors in health-related quality of life (HRQL) in AA women diagnosed with EOC in the African American Cancer Epidemiology Study (AACES) that we hypothesize may influence a patient's capacity to psychosocially adjust to a diagnosis of cancer.

There were 215 invasive EOC cases included in the analysis. HRQL was measured using the SF-8 component scores for physical (PCS) and mental (MCS) health. We used least squares regression to test the effects of individual dispositional factors (optimism and trait anxiety); social level (perceived social support); and societal-level factors (SES defined as low family income and low educational attainment, and perceived discrimination) on HRQL, while adjusting for patient age, tumor stage, body mass index, and comorbidity. Mediation analysis was applied to test whether social support and physical activity buffer impacts of EOC on HRQL.

Optimism, trait anxiety, social support, poverty, and past perceived discrimination were significantly associated with HRQL following diagnosis of EOC. Specifically, higher family income, lower phobic anxiety, and higher social support were associated with better wellbeing on the MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, whereas higher optimism was associated with higher MCS. Physical activity (MET-min/week) and social support displayed significant overall mediation for effects of SES on MCS and PCS, but not for trait anxiety.

Both pre- and postdiagnosis characteristics of AA women with EOC are important predictors of HRQL after cancer diagnosis. Individual, social, and societal-level factors each contribute to HRQL status with EOC and should be assessed.