Welfare reform and women's health: review of the literature and implications for state policy

In August 1996, the Personal Responsibility Work Opportunity Reconciliation Act (P.L. 104-193) was signed into law, ending a 60-year federal entitlement guaranteeing families some basic level of assistance during periods of economic hardship. Several components of this new legislation have the potential to impact upon the health and well-being of women and children. We summarize studies examining the relationship between welfare participation and physical and mental well-being of women and what is known about the effects of poverty on health; the patterns of employment among welfare participants and the health consequences of low-wage work on women; domestic violence among welfare recipients; the potential health consequences of the provisions of the new Temporary Assistance to Needy Families (TANF) program for women's and adolescent health; and the consequences of the new TANF provisions for the health and well-being of immigrant women. We discuss the implications for policy makers in monitoring and minimizing the negative impact of welfare reforms on women's health and well-being.     

Psychosocial aspects of selected issues in women's reproductive health: Current status and future directions.

Emphasizing research published in the past decade, this article presents a summary and evaluation of psychosocial investigations of women's reproductive health, with a focus on selected aspects of menstruation, pregnancy and birth, infertility, and menopause. In some areas, studies have focused on negative physical and psychological concomitants of these health issues. However, research reveals substantial individual variability, with most women adapting well to reproductive health changes. Although methodological and conceptual shortcomings have limited firm conclusions, research has advanced our understanding of the multivariate biological, psychological, and social influences on women's reproductive health and associated outcomes. Understanding and promoting women's reproductive health across the lifespan requires biopsychosocial approaches to research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of interpersonal violence in adulthood on women's job satisfaction and productivity: The mediating roles of mental and physical health.

Objective: With growing awareness of the prevalence of interpersonal violence victimization among women, research has begun to examine the impact of these experiences on employment. To date, much of this work in the United States has centered on low-income women moving from public assistance to paid employment and research gaps in our understanding of a broader range of working women's experiences still exist. The present study explored the impact of multiple types of victimization (sexual violence, physical intimate partner violence, psychological abuse, and stalking) on a range of work outcomes (job satisfaction, job benefits, job interference). Method: A random-digit-dial telephone survey of 1,079 women living in New Hampshire was conducted. Measures included questions about victimization in adulthood and current perceptions of employment. Results: A multivariate analysis of variance and regression analyses showed clear links between victimization experiences and negative work outcomes. Mental and physical health symptoms represent important mediators explaining these links. Conclusion: Results support the need for workplace policies and supports that provide safety nets for survivors and encourages the development of community norms that assist survivors in accessing such supports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provision of mental health services in women's health centers

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.     

Overview: Forging research priorities for women's mental health.

After a decade of reports underscoring the inadequacy of existing scientific knowledge for understanding gender differences in mental disorder and its treatment, the National Institute of Mental Health has developed a women's mental health research agenda with five priority areas for research: diagnosis and treatment of mental disorder, mental health issues for older women, violence against women, multiple roles, and poverty. This overview highlights some of the major findings in each of these five areas and introduces the more in-depth treatment given in this Psychology in the Public Forum section to the areas of violence, poverty, and multiple roles. It also underscores the importance of identifying sources of gender bias in all mental health research. Women's mental health issues have become officially recognized as part of the NIMH research agenda. Only time and continued monitoring will determine how these official policy priorities will become translated into actual funding and research initiatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women, psychology, and public policy: Selected issues.

Asserts that the dramatic changes in women's work and family roles in recent decades have profound implications for employment and family policy. It is argued that the market forces used by economists to adjust salary levels do not counteract the forces that devalue women's contributions to the economy. Depressed wages and a benefit structure based on earnings increases the likelihood of poverty of women. Many employment issues, such as the assumption that workers and family members are physically and mentally able-bodied, disabled women's employment status, and the relationships among women's physical and mental health status and work and family roles, require psychological research. The slowness of public policies to reflect women's changing roles is discussed, and tools for meeting the challenges of change, including science and technology and educational equity, are presented. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and well-being of black women: toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

Women's occupational health: a critical review and discussion of current issues

Action to improve women's occupational health has been slowed by a notion that women's jobs are safe and that any health problems identified among women workers can be attributed to unfitness for the job or unnecessary complaining. With increasing numbers of women in the labor force, the effects of work on women's health have recently started to interest health care providers, health and safety representatives and researchers. We begin our summary of their discoveries with a discussion of women's place in the workplace and its implications for occupational health, followed by a brief review of some gender-insensitive data-gathering techniques. We have then chosen to concentrate on the following four areas: methods and data collection; directing attention to women's occupational health problems; musculoskeletal disease; mental and emotional stress. We conclude by pointing out some neglected occupational groups and health issues.     

Conclusions: the future of research on black women's health

The preponderance of studies on Black women's health cited in the eight articles of this special issue were published in medical and public health journals, rather than in health psychology journals. Health psychology stands conspicuously apart from other health disciplines in this neglect and exclusion of Blacks and Black women. On the other hand, although there are many studies of Black women's health published in medical and public health journals, these studies have neglected a variety of important cultural and social-contextual variables, and often are methodologically inadequate. Hence, we conclude that studies on Black women's health that examine neglected variables and employ rigorous methods are needed in health psychology, behavioral medicine, and the other health disciplines as well. Specific variables and hypotheses that might be addressed in such future research are highlighted.     

Mental health effects of women's multiple roles.

At a time when some combination of work and family is the life-style preference of most Americans, but the two domains remain largely described as espousing conflicting values, it is important that the mental health effects of multiple roles be explored for possible directions for future research. This article reviews the problems and benefits associated with women juggling multiple roles, then points to the need for research that considers the physiological pathways involved in responses to stressful environmental and psychological conditions. Models that frame such efforts should be sensitive not only to the experience of the individual but also to the extent to which women's lives are embedded in a context full of feedback loops. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the services provided by the women's health nurses in a Sydney Area Health Service

OBJECTIVES: To describe the client characteristics and nature of services provided by women's health nurses and to examine whether the goals set for the service are being met. DESIGN: A retrospective study of women's health nurse (WHN) records from 1987 to 1991. SETTING AND SUBJECTS: All women attending the women's health nurse in the Southern Sydney Area Health Service, 1987 to 1991. Older women and women of non English-speaking background are specific targets for this service. OUTCOME MEASURES: Pap test and breast self-examination practices were examined in relation to age and ethnic background. Use of general practitioner services was examined for all women attending the women's health nurse in 1991. RESULTS: Forty-five per cent of clients were aged over 50, and 29 per cent were from a non English-speaking background. Older women were more likely to return for subsequent visits to the women's health nurse. The practice of breast self-examination increased significantly between visits among all women. Forty-one per cent of women had not had a Pap test for at least three years, 93 per cent of these women were screened at their first visit. Eighty-seven per cent of women on their first visit and 86 per cent of women revisiting the women's health nurse had seen their general practitioner within the previous year. CONCLUSION: Women's health nurses are meeting the goals set for their service in relation to health promotion and the screening of women. Their services are perceived by their clients as complementary to those provided by their general practitioners.     

Women's health: Review and research agenda as we approach the 21st century.

This article reviews past research and projects future research directions regarding women's health. Sex differences in mortality and morbidity, along with evidence that the quality and quantity of these differences are changing, are examined. Over the past decade, concurrent with dramatic changes in lifestyle and social roles for women, mortality rates have shifted, resulting in a decreasing advantage for women. Explaining the consequences of these dynamic changes requires understanding the health effects of such variables as perceived control, the experience of life roles, perceived and actual social support, and redefinition of gender roles. The future portends additional changes that will significantly affect women's health. In establishing an explicit psychological research agenda on women's health, (a) general recommendations for research are provided and (b) important issues that have not yet received a great deal of research attention (e.g., women and acquired immune deficiency syndrome [AIDS], psychopharmacology, reproductive technologies) are highlighted. This article expands the current discourse in health psychology and raises a number of issues for serious consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's changing work roles: Impact on health, family, and public policy.

Women's work roles have changed enormously. This article describes the long-term and short-term changes in women's paid employment. It also introduces a set of Public Forum articles that discuss the consequences of these changes for women's health and for their families and delineate the government's responses to women's changing work roles. The impetus for this Public Forum section came from a workshop conducted under the auspices of the John D. and Catherine T. MacArthur Foundation Network on the Determinants and Consequences of Health-Promoting and Health-Damaging Behaviors. Therefore, the article also discusses the mission of the Network and why multidisciplinary, collaborative research on the effects of women's employment is vital. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of mental and physical health service utilization among Vietnam veterans.

This study investigated predictors of mental and physical health care service utilization among 1,632 male (n = 1,200) and female (n = 432) Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Using Anderson's theory as a model (Anderson & Bartkus, 1973), the authors examined both direct and mediated relationships among predisposing factors (i.e., age, marital status, and combat exposure), enabling factors (e.g., household income and insurance), and need factors (e.g., medical and psychological symptomatology) and physical and mental health care utilization outcomes. Need factors were the most consistent and strongest mediators of predisposing variables for both physical and mental health care service utilization, although there were differences between male and female veterans. For men, combat exposure indirectly predicted mental health care utilization through the need variables (with the effects of posttraumatic stress disorder being greatest). For women, physical health problems mediated the relationship between combat exposure and physical health outpatient care utilization. These findings have implications for screening and outreach efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using participatory research to help promote the physical and mental health of female social workers in child welfare

Forty female workers from child welfare agencies were interviewed in focus groups regarding the positive and negative aspects of their work, their perceptions of its effects on their physical and mental health, and what they did in response to either cope or to protect their health. The results showed that despite certain positive aspects of their work, these women overwhelmingly felt that their work had adversely affected both their physical and mental health, and that they used a variety of strategies (both problem focused and emotion focused) to cope. Implications are discussed in terms of the need for intervention at the micro-, mezzo-, and macrolevels, as well as in terms of the appropriateness of participatory research methods for future studies with this population.     

The “CEO” of women's work lives: How Big Five Conscientiousness, Extraversion, and Openness predict 50 years of work experiences in a changing sociocultural context.

Few long-term longitudinal studies have examined how dimensions of personality are related to work lives, especially in women. We propose a life-course framework for studying work over time, from preparatory activities (in the 20s) to descending work involvement (after age 60), using 50 years of life data from the women in the Mills Longitudinal Study. We hypothesized differential work effects for Extraversion (work as pursuit of rewards), Openness (work as self-actualization), and Conscientiousness (work as duty) and measured these 3 traits as predictor variables when the women were still in college. In a prospective longitudinal design, we then studied how these traits predicted the women's subsequent work lives from young adulthood to age 70 and how these effects depended on the changing sociocultural context. Specifically, the young adulthood of the Mills women in the mid-1960s was rigidly gender typed and family oriented; neither work nor education variables at that time were predicted from earlier personality traits. However, as women's roles changed, later work variables became related to all 3 traits, as expected from current Big Five theory and research. For example, early personality traits predicted the timing of involvement in work, the kinds of jobs chosen, and the status and satisfaction achieved, as well as continued work participation and financial security in late adulthood. Early traits were also linked to specific cultural influences, such as the traditional feminine role, the women's movement, and graduate education for careers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Explaining women's employment patterns: 'orientations to work' revisited

Explanations of the persisting differences in the structure of men's and women's employment have long been debated in the social sciences. Sociological explanations have tended to stress the continuing significance of structural constraints on women's employment opportunities, which persist despite the removal of formal barriers. Neo-classical economists, in contrast, have emphasized the significance of individual choice, an argument which has been recently endorsed by Hakim who suggests that patterns of occupational segregation reflect the outcome of the choices made by different 'types' of women. In this paper, a previous debate relating to the explanatory utility of men's 'orientations to work' is used to argue that employment structures are the outcome of both choice and constraint, and that this is the case for women, as well as men. The argument is illustrated with evidence from cross-nationally comparative biographical interviews carried out in five countries.     

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.     

The menopause: women's psychology and health care

Menopause has often been described as a time of loss and decay in the lay and medical literature. The present research aims at defining women's perception of themselves and their health care needs in this period of life. Through a community-based sample of women, participative assessments were performed and their conclusions contrasted with the opinions of male and female gynecologists. Though both groups coincided concerning the relevance of loneliness, partnership, beauty and the "empty nest" syndrome, several items showed a marked difference between both groups. Gynecologists tended to perceive women as much more striving for an active sex-life, depressed, lacking projects for the future and worried about their health care than they actually were. Women, instead, stressed the relevance of menopause as a life crisis laden with opportunities for self-accomplishment and positive changes in life-style towards greater autonomy.     

Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans.

Though the broader literature suggests that women may be more vulnerable to the effects of trauma exposure, most available studies on combat trauma have relied on samples in which women's combat exposure is limited and analyses that do not directly address gender differences in associations between combat exposure and postdeployment mental health. Female service members' increased exposure to combat in Afghanistan and Iraq provides a unique opportunity to evaluate gender differences in different dimensions of combat-related stress and associated consequence for postdeployment mental health. The current study addressed these research questions in a representative sample of female and male U.S. veterans who had returned from deployment to Afghanistan or Iraq within the previous year. As expected, women reported slightly less exposure than men to most combat-related stressors, but higher exposure to other stressors (i.e., prior life stress, deployment sexual harassment). No gender differences were observed in reports of perceived threat in the war zone. Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with postdeployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom service members may be as resilient to combat-related stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)