The Office of Research on Women’s Health National Institutes of Health Fourth Edition Office of Research on Women’s Health Office of the Director National Institutes of Health TABLE OF CONTENTS TOWARD MORE INDIVIDUALIZED MEDICINE: INTRODUCING THE WOMEN OF COLOR HEALTH DATA BOOK, FOURTH EDITION .......................................................vii HIGHLIGHTS .........................................................................................................................ix LIST OF TABLES AND FIGURES ..........................................................................................xi FACTORS AFFECTING THE HEALTH OF WOMEN OF COLOR .......................................... 1 Ethnic and Racial Heritage ................................................................................................ 3 American Indians and Alaska Natives ............................................................................... 7 Native Hawaiians and Other Pacific Islanders..................................................................12 Health Care Systems .....................................................................................................15 Native Hawaiians ...........................................................................................................16 Other Pacific Islanders....................................................................................................17 Hispanics or Latinos ........................................................................................................19 Blacks or African Americans ............................................................................................24 Asian Americans ..............................................................................................................32 Major Subpopulations ....................................................................................................34 Factors Affecting Health .................................................................................................37 References .......................................................................................................................44 HEALTH ASSESSMENT .......................................................................................................63 Life Expectancy ...............................................................................................................65 Self-Reported Health Ratings ..........................................................................................66 Major Causes of Death ....................................................................................................68 Ranking of Causes of Death ...........................................................................................69 Death Rates by Cause of Death .....................................................................................70 Age-Adjusted Death Rates .............................................................................................71 Other Causes of Death ....................................................................................................73 Drug- and Alcohol-Induced Deaths .................................................................................73 Deaths From Motor Vehicle Accidents .............................................................................73 Deaths From Suicide .....................................................................................................74 iii ■ Women of Color Health Data Book Deaths From Firearm-Related Events ..............................................................................74 Deaths From Homicide ..................................................................................................74 Deaths From HIV Infections ............................................................................................75 Behavior and Lifestyles ....................................................................................................75 Body Weight: Women ....................................................................................................75 Body Weight: Adolescent Females.................................................................................. 78 Exercise ........................................................................................................................80 Tobacco Use Among Women .........................................................................................82 Tobacco Use Among Adolescent Females ......................................................................84 Alcohol Consumption Among Women .............................................................................85 Alcohol Consumption Among Adolescent Females ..........................................................87 Alcohol-Related Deaths ..................................................................................................89 Use of Illicit Substances by Women ................................................................................90 Use of Illicit Substances by Adolescent Females ..............................................................92 Drug-Related Morbidity and Mortality ...............................................................................94 Sexual Behavior: Adolescent Females .............................................................................96 Physical and Sexual Assault/Abuse ................................................................................97 Preventive Health Care Services ......................................................................................98 Preventive Health Measures ...........................................................................................98 Outpatient Health Care Visits ........................................................................................101 Prenatal Care ..............................................................................................................103 Substance Use During Pregnancy ................................................................................104 Birth Outcomes: Weight ...............................................................................................107 Birth Outcomes: Infant and Maternal Mortality ................................................................109 Health Insurance Coverage and Services ......................................................................111 The Uninsured .............................................................................................................111 Health Insurance Coverage: Women .............................................................................114 Obtaining Health Care Services ....................................................................................117 Morbidity and Mortality ..................................................................................................121 Hypertension ...............................................................................................................121 Cardiovascular Disease ................................................................................................122 Cancers ......................................................................................................................123 Cerebrovascular Diseases ............................................................................................131 Diabetes Mellitus .........................................................................................................132 Sexually Transmitted Infections Among Women .............................................................134 Sexually Transmitted Infections Among Adolescent Females ...........................................138 iv Women of Color Health Data Book ■ HIV Infection and AIDS .................................................................................................140 Mental Health Among Women ......................................................................................146 Mental Health Among Adolescent Females ....................................................................149 Osteoporosis and Arthritis ............................................................................................150 References .....................................................................................................................153 v TOWARD MORE INDIVIDUALIZED MEDICINE: INTRODUCING THE WOMEN OF COLOR HEALTH DATA BOOK, FOURTH EDITION Janine A. Clayton, M.D.,* Claudette E. Brooks, M.D.,** and Susan G. Kornstein, M.D.*** Consider the following case study. Daniela G., a 52- year- old moderately overweight Latina, arrives as a new patient at a family practice in her community. It is her first visit to the doctor since her youn gest child was born 18 years earlier, thanks to newly acquired insurance coverage from the Affordable Care Act. Her complaints include difficulty seeing on the right side, mild headaches, and problems with concentration and writing. What would be your first impression of this patient? Her vision and motor problems could be due to a fall, or they could be early signs of diabetes or hypertension- related stroke, both common in middle- age women with elevated body mass index. But as a woman of color, what features make Daniela unique with regard to health? How do race, ethnicity, and cultural influences affect the health of women of color like her in ways that might escape the attention