The Arizona factbook on women's health

              1
TABLE OF CONTENTS
TABLE OF TABLES ................................................................................... 3
ACKNOWLEDGMENTS............................................................................ 4
INTRODUCTION ........................................................................................ 5
CANCER ..................................................................................................... 12
Breast ...................................................................................................... 12
Cervical................................................................................................... 12
Colorectal................................................................................................ 13
Lung........................................................................................................ 13
Ovarian ................................................................................................... 13
HEART DISEASE...................................................................................... 15
Cardiovascular Disease........................................................................ 15
Coronary Heart Disease .................................................................... 15
Coronary Artery Disease .................................................................. 16
Stroke ................................................................................................ 16
CHRONIC DISEASE................................................................................ 17
Arthritis ................................................................................................... 17
Chronic Bronchitis .................................................................................. 17
Chron’s Disease ...................................................................................... 18
Diabetes .................................................................................................. 18
Hypertension........................................................................................... 19
MUSCULOSKELETAL PAIN................................................................ 21
Back Pain ................................................................................................ 21
Carpal Tunnel Syndrome ........................................................................ 21
Osteoporosis ........................................................................................... 22
SEXUALLY TRANSMITTED DISEASE................................................ 23
HIV and AIDS ........................................................................................ 23
Chlamydia ............................................................................................... 25
Pelvic Inflammatory Disease .................................................................. 25
Gonorrhea ............................................................................................... 25
Herpes Simplex Virus ............................................................................. 25
Syphilis ................................................................................................... 26
2
TABLE OF CONTENTS
(continued)
REPRODUCTIVE ISSUES ....................................................................... 27
Menstruation........................................................................................... 27
Contraception.......................................................................................... 27
Adolescent Pregnancy ............................................................................ 29
Infertility................................................................................................. 30
Menopause.............................................................................................. 31
Hormone Replacement Therapy............................................................. 31
HEADACHES AND MIGRAINES........................................................... 32
NUTRITION, WEIGHT MANAGEMENT AND EXERCISE.............. 34
PSYCHOLOGICAL ISSUES .................................................................... 37
Depression .............................................................................................. 37
Stress ....................................................................................................... 38
Eating Disorders ..................................................................................... 39
DOMESTIC VIOLENCE.......................................................................... 41
Responding to the Problem..................................................................... 43
SUMMARY................................................................................................. 45
RESOURCES.............................................................................................. 46
3
TABLE OF TABLES
Introduction
Table 1A: Leading causes of infant death by age group, gender, ethnicity in Arizona, 1999 6
Table 1B: Leading causes of death among children 1-14 years old by gender, area and ethnic
group - Arizona, 1999
6
Table 1C: Leading causes of death among adolescents 15-19 years old by gender, area and
ethnic group - Arizona, 1999
7
Table 1D: Leading causes of death among young adults 20-44 years old by gender, area and
ethnic group – Arizona, 1999
7
Table 1E: Leading causes of death among middle -aged adults 45-64 years old by gender, area
and ethnic group – Arizona, 1999
8
Table 1F: Leading causes of death among elderly 65 years and older by gender, area and
ethnic group – Arizona, 1999
8
Table 2: Number of deaths by ethnic group, gender and county of residence – Arizona, 1999 9
Table 3A: Total age-adjusted mortality rates for leading causes of death by gender, Arizona,
1988-1998
10
Table 3B: Average age at death from all causes by gender and ethnicity, Arizona, 1988-1998 11
Cancer
Table 4: Mortality rate from selected chronic conditions per 100,000 persons in Arizona 14
Table 5: Number of deaths and death rate for major causes of death in Arizona in 1997 14
Chronic Disease
Table 6: Number of selected reported chronic conditions per 1,000 women by age 20
Table 7: Number of selected reported chronic conditions per 1,000 persons by geographic
region and place of residence
20
Sexually Transmitted Disease
Table 8: Arizona HIV infection surveillance report 24
Table 9: Female AIDS cases by exposure category and year of diagnosis – Arizona – 1981-
2000
24
Table 10: Female AIDS cases by race/ethnicity and year of diagnosis – Arizona – 1981-2000 25
Reproductive Issues
Table 11: Types of contraceptives used by men and women ages 15-44 in the U.S. – 1995 28
Table 12: Effectiveness rates of various contraceptive methods during first year of use 28
Table 13: Number of pregnancies by pregnancy outcome, ethnic group and year among
females 19 or younger, with rates – Arizona 1988-1998
29
Table 14: Pregnancies by pregnancy outcome and county of residence – Arizona – 1999 30
4
Acknowledgments
Acknowledgments
This volume, The Arizona Fact Book on Women’s Health, is one of several Fact Books published
by Arizona State University West’s Partnership for Community Development to inform public
policy and assist public and community-based organizations as they develop programs and
services to address issues relevant to residents of Arizona. The Fact Book’s intent is not to
advocate for particular programs or political agendas, but to present data and other information
that may be used as a basis for decision-making. While not an exhaustive treatment of women’s
health issues (in some instances statistics that would prove useful have not been compiled), this
book attempts to provide a current examination of the set of issues facing this population in
Arizona today.
I am appreciative of the contributions of Ms. Sue Tormala, who researched, compiled, and
developed this volume. Ms. Dana Campbell Saylor of the Governor’s Division for Women
provided invaluable suggestions for content as well as editing assistance. Dr. Mark Searle, Dean
of the College of Human Services, ASU West, supported this undertaking in numerous ways. In
addition, Ms. Lisa Kramer of the College of Human Services contributed to the development of
this book. Mr. Geoffrey Boyarsky provided design, production, and layout preparation. Several
other individuals provided valuable assistance in the development of the data contained herein.
In particular, I would like to acknowledge the following: Diane Dudley, Planned Parenthood of
Central Arizona; Marge Eberling, Arizona Integrated Medicine; Ann Marie Faxel, Phoenix
Memorial Health System; Lenette Golding, Phoenix Body Positive; Dr. Steven R. Harvey, The
Mental Health Association of Arizona; Randy Johnston, Remuda Ranch; Jane L. Lange, ADHS -
Office of Prevention and Health Promotion; Linda Larkey, Women’s Cancer Prevention,
Harrington Center; Jeanette Shea-Ramirez, Office of Women’s and Children’s Health; and
Jennifer Takaki, Student Research Assistant - Arizona State University.
In addition to the individuals who worked to develop and produce The Arizona Fact Book on
Women’s Health, it is important to recognize the support of its sponsors. The Arizona
Community Foundation, the Arizona Drug and Gang Prevention Resource Center, the
Governor’s Division for Women, Sun Health, and Dr. Thomas Keil, Dean of the College of Arts
and Sciences at ASU West, provided generous funding and support that made the development
of this volume possible and I am grateful for the value to the State of Arizona they saw in
producing a volume of this nature.
John Hultsman, Re.D.
Director, Partnership for
Community Development
College of Human Services
Arizona State University West
March, 2001
5
Introduction
There are approximately 275 million people living in the United States today; 140 million are
women. Of the 4.8 million living in Arizona, 2.4 million (or half) are women. The National
Center for Chronic Disease Prevention and Health Promotion reports that one out of ten
Americans say they are in fair to poor health. More females than males make that claim, twice
as many Blacks as Whites, 22% of the poor, 5% of the non-poor and more people living in the
south.
Among women, heart disease is the leading cause of death overall and cancer is the leading
cause of death among 25-44 year olds. In 1996, women made 471 million office visits to their
physicians, 41 million made hospital outpatient visits, 50 million made emergency room visits,
41 million surgical procedures were performed on women and 18 million women were
discharged from inpatient hospital visits.
National Health Expenditures in 1997 were $1,092 billion, or 13.5% of the gross domestic
products. $585.3 billion of these expenditures were in private funds and $507 billion came from
public funding.
Taking care of health is increasingly about education and prevention. Conventional medical care
focusing on crisis intervention, while often beneficial to the sick person, is not necessarily
effective in keeping us healthy. According to The Commonwealth Fund 1998 Survey of
Women’s Health, lower-income and less-educated women appear less likely than higher-income,
more educated women to receive regular preventive services, particularly in the area of breast
and cervical cancer screening. Smoking rates among women have remained at the 1993 levels,
with rates notably higher among lower-income women.
Collaborations between researchers, health professionals, policymakers and women themselves
are developing, fueled by recognition of the uniqueness of certain health issues to women, and
the differences in health and health care experiences between women and men.
The purpose of this book is to introduce the reader, in lay terms, to some of the most pressing
health issues affecting women in Arizona today. Statistical information is available throughout
the book to dramatize the narrative. The reader is encouraged to more thoroughly investigate
issues of interest to them from the resources identified at the end of the book.
There is much research on women’s health issues available from a wide variety of resources
today. No longer restricted to medical libraries, doctors and pamphlets, anyone can scour the
internet for hours on end, and not even begin to make a dent in reviewing the literature.
Statistics abound. A plethora of experts exists.
6
But not everyone has time to review all the literature available before evaluating and/or deciding
the direction of women’s health care in Arizona. This fact book, therefore, endeavors to
synthesize information from a broad examination of the literature. While by no means declaring
this to be a comprehensive review of the issues, it is a reflection of those issues affecting most
women in Arizona. Let us begin with some basics:
Table 1A.
LEADING CAUSES OF INFANT DEATH BY AGE GROUP, GENDER, ETHNICITY IN ARIZONA, 1999
(AZ Department of H ealth Services, Public Health Services, Bureau of Public Health Statistics)
Infant’s Age Gender Ethnicity
Total Neonatal
Post-neonatal
Male Female
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Total* 547 363 184 314 232 196 238 52 49 5 3
PERINATAL CONDITIONS 222 208 14 123 99 87 90 21 18 2 2
- Low birthweight/short gestation 65 64 1 32 33 22 31 6 3 0 2
- Respiratory distress syndrome 5 4 1 5 0 3 1 0 0 1 0
- Other respiratory conditions 39 33 6 24 15 14 16 6 3 0 0
- Intrauterine hypoxia or birth asphyxia 4 4 0 2 2 2 2 0 0 0 0
- Maternal complications 23 23 0 13 10 9 10 1 3 0 0
- Other perinatal conditions 23 22 1 14 9 9 11 3 0 0 0
CONGENITAL ANOMALIES 128 94 34 71 57 41 68 8 9 1 1
- Diseases of heart 17 7 10 9 8 6 9 0 2 0 0
- Respiratory system 23 21 2 15 8 8 12 1 1 0 1
- Brain, spinal cord or nervous system 8 4 4 4 4 1 6 0 1 0 0
- Other anomalies 22 20 2 10 12 9 9 3 1 0 0
SUDDEN INFANT DEATH SYNDROME 38 2 36 30 7 12 15 5 5 0 0
- Unintentional injury 26 5 21 16 10 10 11 1 3 1 0
- Pneumonia/Influenza 21 0 21 14 7 3 14 2 2 0 0
- Homicide 6 0 6 3 3 4 0 2 0 0 0
* Includes mortality from causes of death not shown in this table.
Table 1B.
LEADING CAUSES OF DEATH AMONG CHILDREN 1-14 YEARS OLD
BY GENDER, AREA AND ETHNIC GROUP - ARIZONA, 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Gender Area Ethnicity
Total Male Female Urban* Rural
Un-known
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Unintentional injury 99 65 34 68 39 1 32 35 6 26 0 0
- Motor vehicle-related 59 42 17 41 17 1 16 21 6 16 0 0
- Drowning 22 11 11 18 4 0 10 9 0 3 0 0
- Other injury 18 12 6 9 9 0 6 5 0 7 0 0
Malignant Neoplasms 28 13 15 22 5 1 11 11 3 3 0 0
Congenital Anomalies 17 8 9 13 4 0 6 7 2 2 0 0
Diseases of Heart 11 4 7 7 4 0 4 5 0 1 1 0
Homicide/Legal intervention 11 5 6 11 0 0 3 6 0 1 1 0
Pneumonia/Influenza 8 5 3 6 2 0 5 0 2 1 0 0
Suicide 7 6 1 3 4 0 3 2 0 1 0 0
Ill-defined conditions 6 4 2 4 0 2 3 1 1 1 0 0
Infections & Parasitic Diseases 5 3 2 4 1 0 3 1 0 1 0 0
- Septicemia 3 2 1 2 1 0 1 1 0 1 0 0
- Other Infections Diseases 2 1 1 2 0 0 2 0 0 0 0 0
Chronic Obstructive Pulmonary Disease 4 3 1 4 0 0 3 1 0 0 0 0
Cerebrovascular Disease 2 1 1 2 0 0 1 1 0 0 0 0
ALL CAUSES ** 246 143 103 179 57 10 97 84 16 43 2 3
* Maricopa, Pima, Pinal and Yuma Counties
** Includes mortality from causes of death not shown above
NOTE: leading causes are those with the greatest number of deaths statewide in 1999
7
Table 1C.
LEADING CAUSES OF DEATH AMONG ADOLESCENTS 15-19 YEARS OLD
BY GENDER, AREA AND ETHNIC GROUP - ARIZONA, 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Gender Area Ethnicity
Total Male Female Urban* Rural
Un-known
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Unintentional injury 122 90 32 82 36 4 51 39 6 23 2 0
- Motor vehicle-related 100 73 27 63 33 4 44 28 6 21 1 0
- Drowning 2 1 1 1 1 0 1 1 0 0 0 0
- Other injury 20 16 4 18 2 0 6 10 0 2 1 0
Homicide/Legal intervention 55 46 9 52 3 0 11 31 7 4 2 0
Suicide 36 31 5 23 11 2 17 13 0 5 0 0
Malignant Neoplasms 12 4 8 9 3 0 4 5 2 0 1 0
Diseases of Heart 7 7 0 7 0 0 3 3 1 0 0 0
Infectious & Parasitic Diseases 3 0 3 2 0 1 1 1 0 1 0 0
- HIV Infection 1 0 1 1 0 0 1 0 0 0 0 0
- Septicemia 1 0 1 1 0 0 0 1 0 0 0 0
- Other Infections Disease 1 0 1 0 0 1 0 0 0 1 0 0
Ill-Defined Conditions 2 2 0 1 1 0 0 1 0 1 0 0
Pneumonia/Influenza 1 1 0 1 0 0 0 0 0 1 0 0
Chronic Obstructive Pulmonary Disease 1 1 0 1 0 0 1 0 0 0 0 0
ALL CAUSES ** 277 211 66 199 63 15 108 104 16 39 6 2
* Maricopa, Pima, Pinal and Yuma Counties
** Includes mortality from causes of death not shown above
NOTE: leading causes are those with the greatest number of deaths statewide in 1999
Table 1D.
LEADING CAUSES OF DEATH AMONG YOUNG ADULTS 20-44 YEARS OLD
BY GENDER, AREA AND ETHNIC GROUP - ARIZONA, 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Gender Area Ethnicity
Total Male Female Urban* Rural
Un-known
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Unintentional injury 858 651 207 669 179 10 442 233 33 132 12 3
- Motor vehicle-related 439 315 124 324 109 6 181 140 12 91 11 2
- Other injury 419 336 83 345 70 4 261 93 21 41 1 1
Malignant Neoplasms 358 172 186 291 56 11 263 55 17 18 5 0
Suicide 350 281 69 273 67 10 232 70 14 28 4 0
Homicide/Legal intervention 293 228 65 257 31 5 85 140 29 35 2 0
Diseases of Heart 242 176 66 192 45 5 166 37 16 19 0 1
Infections & Parasitic Diseases 145 117 28 134 10 1 78 36 14 15 1 0
- HIV Infection 97 85 12 92 4 1 55 26 11 5 0 0
- Septicemia 23 13 10 18 5 0 12 5 0 6 0 0
- Other Infectious Disease 25 19 6 24 1 0 11 5 3 4 1 0
Alcoholism 97 64 33 62 34 1 50 8 2 36 0 0
Cerebrovascular Disease 47 23 24 43 2 2 24 15 2 5 1 0
Pneumonia/Influenza 53 37 16 46 7 0 27 9 1 15 1 0
Diabetes 46 28 18 41 4 1 27 9 0 10 0 0
Ill-Defined Conditions 45 33 12 33 9 3 22 12 3 8 0 0
Chronic Obstructive Pulmonary Disease 16 10 6 14 0 2 10 5 0 1 0 0
ALL CAUSES ** 2929 2048 881 2311 529 89 1650 698 149 379 27 13
* Maricopa, Pima, Pinal and Yuma Counties
** Includes mortality from causes of death not shown above
NOTE: leading causes are those with the greatest number of deaths statewide in 1999
8
Table 1E.
LEADING CAUSES OF DEATH AMONG MIDDLE-AGED ADULTS 45-64 YEARS OLD
BY GENDER, AREA AND ETHNIC GROUP - ARIZONA, 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Gender Area Ethnicity
Total Male Female Urban* Rural
Un-known
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Malignant Neoplasma 2078 1093 985 1662 414 2 1719 216 74 47 17 0
Diseases of Heart 1493 1075 418 1184 309 0 1188 157 66 64 8 3
Unintentional injury 469 353 116 349 118 2 296 83 11 66 3 6
- Motor Vehicle-Related 214 154 60 159 54 1 129 41 5 33 3 3
- Other injury 255 199 56 190 64 1 167 42 6 33 0 3
Chronic Obstructive Pulmonary Disease 269 149 120 212 55 2 237 12 10 6 2 2
Diabetes 257 153 104 207 50 0 131 65 12 44 3 0
Alcoholism 208 157 51 169 39 0 136 45 14 10 4 0
Cerebrovascular Disease 208 108 100 171 37 0 135 45 14 10 4 0
Suicide 219 162 57 158 61 0 189 14 2 8 3 1
Infectious & Parasitic Diseases 194 137 57 160 33 1 124 38 7 21 3 1
- HIV Infection 45 40 38 52 16 0 43 10 2 13 0 0
- Septicemia 68 40 28 52 15 0 43 10 2 13 0 0
- Other Infections Diseases 81 57 24 70 11 0 55 17 1 5 2 1
Pneumonia/Influenza 170 99 71 133 37 0 128 18 8 15 0 1
Nephritis, nephrotic syndrome and nephrosis 70 39 31 57 13 0 36 19 5 9 1 0
Homicide/Legal Intervention 68 43 25 49 19 0 37 14 5 10 0 2
Diseases of Arteries 62 44 18 46 16 0 42 16 4 0 0 0
ALL CAUSES ** 6696 4133 2563 5302 1387 7 5052 865 262 424 50 19
* Maricopa, Pima, Pinal and Yuma Counties
** Includes mortality from causes of death not shown above
NOTE: leading causes are those with the greatest number of deaths statewide in 1999
Table 1F.
LEADING CAUSES OF DEATH AMONG ELDERLY 65 YEARS AND OLDER
BY GENDER, AREA AND ETHNIC GROUP - ARIZONA, 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Gender Area Ethnicity
Total Male Female Urban* Rural
Un-known
Non-
Hispanic
White Hispanic Black
American
Indian Asian
Other/
Unknown
Diseases of Heart 8582 4307 4275 7104 1478 1 7636 599 153 139 29 6
Malignant Neoplasms 6373 3424 2949 5107 1267 0 5729 402 103 86 31 3
Cerebrovascular Disease 2047 852 1195 1691 356 0 1818 147 36 32 10 0
Chronic Obstructive Pulmonary Disease 2207 1084 1123 1800 407 0 2079 70 26 15 5 2
Pneumonia/Influenza 1471 731 740 1164 307 0 1301 96 21 40 8 2
Diabetes 742 355 387 580 162 0 507 139 25 67 4 0
Unintentional injury 603 293 310 477 126 0 519 40 6 31 4 1
- Falls 337 149 188 285 52 0 304 17 1 10 2 1
- Motor vehicle related 156 86 70 108 48 0 128 17 1 9 1 0
- Other injury 110 58 52 84 26 0 87 6 4 12 1 0
Alzheimer’s Disease 551 185 366 469 82 0 502 33 9 3 1 0
Atherosclerosis 424 186 238 327 97 0 383 22 8 7 1 0
Infectious & Parasitic Diseases 367 184 183 273 94 0 288 47 12 15 5 0
- HIV Infection 4 4 0 4 0 0 2 2 0 0 0 0
- Septecemia 232 112 120 159 73 0 177 32 9 12 2 0
- Other Infectious Disease 131 68 63 110 21 0 109 13 3 3 3 0
Diseases of Arteries 357 188 169 284 73 0 320 21 3 7 4 2
Nephrotis, nephrotic syndrome, nephrosis 334 175 159 234 100 0 267 33 14 17 2 0
Suicide 160 132 28 119 41 0 147 7 3 1 0 0
ALL CAUSES ** 28940 14141 14799 23447 5491 5 25554 2931 494 632 125 25
* Maricopa, Pima, Pinal and Yuma Counties
** Includes mortality from causes of death not shown above
NOTE: leading causes are those with the greatest number of deaths statewide in 1999
9
Table 2.
NUMBER OF DEATHS BY ETHNIC GROUP, GENDER AND COUNTY OF RESIDENCE – ARIZONA 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
TOTAL ETHNIC GROUP
Non-Hispanic White
Hispanic Black
American Indian
Asian Unknown
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
MALE
FEMALE
TOTAL
Total 20389 18006 38395 16528 15180 31708 2262 1638 3900 531 426 957 901 626 1527 107 116 223 60 20 80
APACHE 250 168 418 35 35 70 2 7 9 0 0 0 213 126 339 0 0 0 0 0 0
COCHISE 534 493 1027 423 376 799 95 99 194 9 12 21 2 1 3 4 5 9 1 0 1
COCONINO 292 250 542 157 161 318 37 26 63 5 2 7 93 61 154 0 0 0 0 0 0
GILA 333 291 624 276 238 514 30 24 54 0 0 0 27 28 55 0 1 1 0 0 0
GRAHAM 146 123 269 101 88 189 30 24 54 1 2 3 14 9 23 0 0 0 0 0 0
GREENLEE 35 32 67 24 17 41 11 15 26 0 0 0 0 0 0 0 0 0 0 0 0
LA PAZ 127 80 207 100 61 161 5 5 10 3 0 3 17 14 31 0 0 0 2 0 2
MARICOPA 10922 10119 21041 9230 8881 18111 1101 751 1852 353 302 655 135 102 237 83 73 156 20 10 39
MOHAVE 1057 750 1807 1004 713 1717 25 19 44 2 2 4 21 14 35 2 2 4 3 0 3
NAVAJO 343 268 611 165 140 305 23 15 38 5 2 7 149 111 260 1 0 1 0 0 0
PIMA 3640 3353 6993 2851 2764 5615 525 402 927 109 73 182 138 85 223 11 28 39 6 1 7
PINAL 830 622 1452 621 450 1071 131 101 232 21 17 38 55 53 108 1 1 2 1 0 1
SANTA
CRUZ
129 86 215 55 22 77 73 62 135 1 2 3 0 0 0 0 0 0 0 0 0
YAVAPAI 966 910 1876 931 883 1814 27 19 46 1 0 1 5 6 11 0 2 2 2 0 2
YUMA 567 355 922 412 275 687 127 64 191 11 8 19 13 4 17 3 4 7 1 0 1
UNKNOWN 218 106 324 143 76 219 20 5 25 10 4 14 19 12 31 2 0 2 24 9 33
10
Table 3A.
TOTAL AGE-ADJUSTED MORTALITY RATESi1 FOR LEADING CAUSES2 OF DEATH
BY GENDER, ARIZONA, 1988-1998
(AZ Department of Health Services, Public H ealth Services, Bureau of Public Health Statistics)
CAUSES / GENDER 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
DISEASES OF HEART
MALE 201.7 192.2 182.0 178.0 183.8 196.2 187.9 174.4 163.1 153.7 155.9
FEMALE 120.4 115.8 112.1 108.6 113.0 119.9 116.7 110.5 103.2 102.7 99.2
MALIGNANT NEOPLASMS
MALE 153.9 144.1 148.3 151.6 153.3 156.3 159.4 143.4 141.0 134.7 131.9
FEMALE 104.5 106.1 105.0 109.6 106.5 111.0 111.7 104.6 101.3 101.7 99.6
UNINTENTIONAL INJURIES, TOTAL
MALE 62.5 59.0 58.2 48.9 54.5 57.5 63.1 64.8 62.0 59.7 58.9
FEMALE 23.8 19.8 21.2 21.3 20.3 21.7 22.5 24.1 24.3 23.2 24.5
- - - MOTOR VEHICLE-RELATED
MALE 35.6 33.0 33.6 27.9 28.3 28.7 31.8 34.5 32.8 29.1 28.2
FEMALE 14.6 12.0 13.8 13.1 12.1 12.6 12.9 14.8 14.4 12.7 13.7
- - - OTHER THAN MOTOR VEHICLE
MALE 26.8 26.0 24.6 21.0 26.3 28.8 31.3 30.4 29.2 30.6 30.8
FEMALE 9.2 7.8 7.4 8.2 8.3 9.1 9.6 9.3 9.9 10.4 10.7
CEREBROVASCULAR DISEASE
MALE 26.1 26.9 26.1 27.2 27.1 28.0 30.5 26.5 28.4 26.4 26.1
FEMALE 26.8 26.7 28.4 27.5 27.3 31.6 30.6 30.1 29.3 31.3 29.5
C. O. P. D.
MALE 34.7 34.0 31.9 34.0 31.8 36.5 33.5 31.8 30.3 33.5 32.3
FEMALE 20.0 22.0 21.5 21.0 20.9 25.3 22.3 23.6 24.3 25.1 24.4
SUICIDE
MALE 29.4 28.5 29.9 27.6 26.4 30.6 32.9 30.8 26.8 27.8 27.3
FEMALE 6.6 6.4 6.0 6.0 5.8 6.7 7.3 8.4 5.9 6.1 6.8
INFECTIOUS & PARASITIC DISEASE
MALE 16.9 19.2 20.6 23.2 27.2 31.0 30.6 32.3 24.8 17.6 15.1
FEMALE 6.2 6.7 6.6 6.9 7.6 8.3 8.9 8.7 8.7 8.4 8.0
- - - HIV INFECTION
MALE 8.3 10.4 12.2 14.9 18.3 21.2 21.5 22.8 15.1 7.3 5.3
FEMALE 0.4 0.3 0.6 0.9 0.9 1.4 1.6 2.3 1.7 1.1 .7
PNEUMONIA & INFLUENZA
MALE 19.9 21.0 21.7 21.1 19.4 22.6 20.3 18.1 18.6 17.3 19.2
FEMALE 15.9 15.9 16.5 16.4 14.0 15.9 15.4 13.9 14.3 15.1 16.5
HOMICIDE
MALE 13.6 13.2 13.1 13.9 15.5 15.7 20.5 22.6 18.6 16.5 15.9
FEMALE 5.3 5.1 4.3 4.5 4.5 5.3 5.0 5.5 4.2 4.1 4.7
DIABETES
MALE 12.1 12.5 11.1 11.2 12.4 11.2 13.6 12.5 13.6 13.6 15.6
FEMALE 9.5 11.4 8.7 9.1 10.7 10.9 11.9 11.8 12.7 12.7 11.5
ALCOHOLISM
MALE 14.2 12.6 12.4 13.8 13.4 13.2 14.6 13.5 12.3 12.2 11.9
FEMALE 4.7 4.5 4.4 5.2 4.5 5.2 4.7 3.9 5.2 4.0 3.9
TOTAL, ALL CAUSES
MALE – AZ 684.2 659.2 655.5 649.0 675.6 707.6 716.2 676.7 642.7 618.2 616.7
FEMALE – AZ 420.0 416.0 407.8 414.1 415.1 443.7 448.1 433.2 427.4 424.6 424.8
MALE - US3 699.8 679.6 668.9 660.1 656.1 667.7 657.4 646.3 637.4 616.1 613.3
FEMALE - US 403.5 396.4 398.0 382.1 381.2 387.5 384.5 385.2 384.0 380.7 379.1
1 Adjusted to U.S. population of 1940 and presented per 100,000 population.
2 Leading causes are those 10 causes with the greatest number of deaths for males in 1998.
3 The U.S. data for 1998 are for 12 months ending June 1998.
11
Table 3B
AVERAGE AGE AT DEATH FROM ALL CAUSES BY GENDER AND ETHNICITY,
ARIZONA, 1988-1998
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
YEAR / GENDER ALL
ETHNIC
GROUPS1
NON-HISPANIC
WHITE HISPANIC2 BLACK
AMERICAN
INDIAN ASIAN3
1988, Total 67.8 69.9 58.1 57.6 47.0 NA
MALE 65.1 67.5 54.2 55.3 48.3 NA
FEMALE 71.2 73.0 63.7 60.9 55.1 NA
1989, Total 68.2 70.4 57.1 56.9 53.0 NA
MALE 65.3 67.7 54.1 55.7 49.4 NA
FEMALE 71.7 73.6 61.0 58.6 58.4 NA
1990, Total 68.4 70.6 58.5 58.1 51.4 NA
MALE 65.4 67.9 54.6 55.5 48.7 NA
FEMALE 72.2 73.9 64.1 61.6 56.1 NA
1991, Total 68.5 70.8 57.6 58.8 52.3 60.5
MALE 65.6 68.1 54.7 54.4 50.4 59.0
FEMALE 71.9 73.7 61.5 64.4 54.8 62.4
1992, Total 68.7 71.1 58.3 57.8 52.8 NA
MALE 65.8 68.5 54.8 54.7 49.0 NA
FEMALE 72.4 74.2 63.7 62.3 58.7 NA
1993, Total 68.6 71.1 57.9 56.2 51.9 NA
MALE 65.6 68.3 54.7 54.1 49.3 NA
FEMALE 72.2 74.3 62.7 59.2 55.8 NA
1994, Total 68.4 71.0 56.6 56.8 52.0 NA
MALE 65.2 68.2 52.5 54.5 48.7 NA
FEMALE 72.2 74.2 62.3 60.6 57.2 NA
1995, Total 68.5 71.0 57.4 57.4 52.2 NA
MALE 65.2 68.2 53.1 53.7 48.2 NA
FEMALE 72.4 74.2 63.6 62.9 57.8 NA
1996, Total 69.6 72.4 56.5 57.8 52.9 62.1
MALE 66.1 69.2 52.6 54.9 49.9 60.6
FEMALE 73.6 75.9 62.4 61.3 57.2 63.9
1997, Total 71.0 73.1 61.3 61.9 55.4 64.2
MALE 67.5 70.1 57.2 57.6 51.2 61.4
FEMALE 74.9 76.3 67.4 67.7 61.4 68.0
1998, Total 71.2 73.4 61.8 62.5 56.5 62.7
MALE 67.9 70.5 57.4 59.4 53.2 60.8
FEMALE 74.9 76.5 68.0 66.3 61.2 62.7
1 May include records with other/unknown ethnic groups
2 White of Hispanic origin
3 Due to statistically small numbers of deaths per year, data for Asians are shown only for 1991, 1996, 1997 and
1998. The smaller the number of events, the higher the variability, therefore all indicators for Asians should be
interpreted with caution.
12
Cancer
The 1998 cancer death rate in the United States of 114.2 per 100,000 people was the lowest in
eleven years (see Tables 4 & 5). Cancer mortality rates have improved for both males and
females in Arizona, accounting for approximately 23% of all deaths in 1997 (National Vital
Statistics Reports, Vol. 47, No. 19, June 30, 1999). In 1998, cancer was a 32.5% greater risk for
Arizona males than females). Arizona’s Blacks were two times more likely to die from cancers
in 1998 than Asians, who had the lowest risk among ethnic groups).
In 1998, lung cancer accounted for 30.5% of all cancer deaths among males, compared to 25.8%
among females. Breast cancer accounted for 16.2% of all female cancer deaths. Colorectal
cancer was the third leading cause of cancer mortality among both males (10.4%) and females
(9.8%).
Death rates for specific cancers varied considerably across ethnic groups. Lung cancer death
rates were 4.3 times higher among Blacks than American Indians in Arizona. The age-adjusted
mortality rate for breast cancer among Black females (21.6/100,000) was 3.3 times higher than
among Asian females.
Breast Cancer
Breast cancer affects an estimated one in eight women. Probably the most deeply feared cancer
among American women, its morbidity rate is second only to lung cancer. However, while
outcomes of this disease vary widely, a cure is often the result in cases detected early.
A woman’s chance of developing breast cancer varies greatly with her age, ethnic group,
menstrual history and family history of breast cancer. While the greatest risk factor is having a
mother or sister with breast cancer, studies indicate that less than 10% of all breast cancer is
thought to be inherited and no more than 5% comes from a genetic defect. Women who have
been exposed to high levels of estrogen over their lifetime seem to have a marked increase in
breast cancer. And, in the February 27, 1997 issue of the New England Journal of Medicine, the
National Institutes of Health published an epidemiological study stating that women with the
highest bone mass are at a much greater risk of postmenopausal breast cancer.
Cervical Cancer
Cancer of the cervix is one of the most common cancers affecting the reproductive organs.
Responsibility for approximately 95% of cervical cancer cases is attributed to one of several
strains of the human papillomavirus (HPV), a sexually transmitted infection. In most women,
the immune system response to HPV prevents the virus from doing harm. However, in a small
group of women, the virus will survive for years before converting cells on the surface of the
cervix into cancer cells. Often, women with cervical cancer (occurring most often in women
between the ages of 30 and 55) have no symptoms.
13
Colorectal Cancer
Cancer of the colon (large intestine) and the rectum is one of the most common forms of cancer
in the US and is the third leading cause of cancer deaths for women in the US. Although it is
unclear why, colorectal cancer affects men and women differently. While the rate of incidents
has remained somewhat steady in women, the number in men has increased. Some studies
suggest that improved dietary and exercise habits, as well as the relationship between certain
foods and the hormones produced during a woman’s childbearing years may explain the
reduction.
Approximately 20% of colorectal cancers can be traced to a predisposing gene. There is also
evidence that a sedentary lifestyle may increase the risk of developing colon cancer.
Lung Cancer
Lung cancer remains the most lethal cancer that strikes women. While cigarette smoking is still
believed to be the leading cause, a study conducted by The Commonwealth Fund indicates that
anti-smoking campaigns have had little impact among women, and smoking rates have remained
essentially unchanged. Even among women who do not smoke, lung cancer remains the third
highest cause of cancer-related death.
It is suspected that any type of lung cancer develops over the years due to a series of insults to
the lungs – from smoking, environmental carcinogens (i.e. radon or asbestos) and long-term lung
disease. The impact of these factors increases when weighed together. According to the
Harvard Guide to Women’s Health, there is preliminary evidence that women run about two
times the risk of developing lung cancer from smoking as men do, apparently doing more
damage to the DNA in women’s lung cells.
Until the causes of “nonsmoker” lung cancers are better understood, prevention will remain a
challenge. Work is being done to find chemical markers in the blood and urine that could
identify malignant cells earlier and offer hope. Early detection increases the rate of cure.
Ovarian Cancer
Ovarian cancer causes more deaths than any other gynecologic cancer and accounts for 6% of all
cancers in women. It is now estimated that more than 14,000 women die annually of the disease,
with postmenopausal women up to the age of 70 showing the highest incidence and mortality
rates. Difficult to detect, about 60% to 70% of the diagnoses are made after the disease is in an
advanced stage. Diagnosis is made based on a pelvic exam followed by an ultrasound and a
biopsy. The major risk factors include endocrine dysfunction, infertility, celibacy, high-fat diets,
higher socioeconomic status, and occupational exposure to talc and asbestos.
14
Table 4. Mortality rate from selected chronic conditions per 100,000 persons in Arizona
(Office of Epidemiology and Statistics – Arizona Department of Health Services)
Type of Chronic Condition 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
Coronary heart disease (all) 133.7 126.6 121.5 116.4 111.2 113.0 121.0 117.8 111.0 103.5 102.2 100.4
Coronary heart disease (Blacks) 164.0 114.4 105.2 135.4
Strokes (all) 27.4 26.6 26.9 27.4 27.5 27.2 30.1 31.5 28.5 29.0 29.2 28.0
Strokes (Blacks) 40.7 37.3 34.0 30.7
Cardiovascular disease 202.2 196.5 189.1 182.3 178.7 183.7 196.2 192.4 180.2 171.9 166.9 167.3
Cancers (all) 128.6 126.3 122.5 124.1 128.0 127.1 130.7 132.3 121.7 119.3 116.5 114.2
Lung Cancer 36.8 37.1 33.8 34.9 36.2 36.7 37.2 33.3 34.1 33.5 32.2 31.8
Breast Cancer (women) 21.5 20.6 20.2 21.2 20.5 20.0 21.6 21.4 17.2 17.2 19.3 18.2
Uterine Cancer 2.7 2.5 1.6 2.6 2.2 1.9 2.0 2.6 2.4 2.5 1.7 1.5
Colorectal Cancer 12.8 13.0 12.5 11.7 11.7 12.4 12.7 12.9 11.5 11.7 10.7 11.1
Chronic obstructive pulmonary disease 26.5 26.1 27.0 26.1 26.7 25.7 29.0 27.1 27.2 27.0 28.9 28.0
Table 5: Number of deaths and death rate for major causes of death in Arizona in 1997
(National Vital Statistics Reports, Vol. 47, No. 19, June 30, 1999)
Cause of Death Number Rate
HIV infection 162 3.6
Cancers (all) 8,448 185.5
Diabetes mellitus 947 20.8
Alzheimer’s disease 438 9.6
Heart diseases 10,174 223.4
Cerebrovascular disease 2,483 54.5
Pneumonia/influenza 1,274 28.0
Chronic obstructive pulmonary diseases 2,377 52.2
Chronic liver disease 606 13.3
Nephritis 328 7.2
Accidents 2,147 47.1
Motor vehicle accidents 954 20.9
Suicide 757 16.6
Homicide & Legal Intervention 431 9.5
15
Heart Disease
Heart disease is the nation’s leading killer of both men and women among all racial and ethnic
groups. Over 40% of deaths in America are caused by cardiovascular disease, which is also the
leading cause of death in people over the age of 35. The estimated cost of treating
cardiovascular disease and stroke in 1998 is $274.2 billion, including direct medical costs and
lost productivity. A nationwide prevention program could save $16.6 billion.
In Arizona, mortality rate from heart disease declined for the fifth consecutive year from
155/100,000 in 1993 to 125.8/100,000 in 1998. In 1992, the female rate was 99.2/100,000 and
the male rate was second lowest at 155.9/100,000 in the eleven year period (see Table 3A).
The survival rate for males experiencing heart disease was higher in 1998 than the survival rate
for females. Blacks in Arizona were 4.1 times more likely to die from heart disease than Asians
who were at the lowest risk of death among ethnic groups in Arizona.
Cardiovascular disease
Cardiovascular diseases kill more women than all forms of cancer, chronic lung disease,
pneumonia, diabetes, accidents and AIDS combined. More than one in five women have some
form of cardiovascular disease, and heart attack, stroke and other cardiovascular diseases have
killed more women than men every year since 1984. Stroke, alone, is the third leading cause of
death for American women, and the death rates are highest for African-American women.
Coronary heart disease is the leading cause of death for women in the United States over the
age of 50. 44% of all female deaths in America and most developed countries occur from
cardiovascular disease (CVD), particularly coronary heart disease and stroke. In fact, one of two
women will die of heart disease or stroke, compared with one in 26 who will die of breast cancer.
While men face a 5 to 6% morbidity rate from a heart attack, women’s risk is 11 to 12%.
Prior to menopause, women have less risk of heart disease than men do. However, the risk of
heart disease and stroke increases with age. Census projections have suggested that there are
now over 50 million American women over the age of 50. Research does indicate that
postmenopausal estrogen therapy may reduce that risk.
In addition, women whose husbands are recovering from heart attacks or open-heart surgery
appear to have a significantly increased risk of cardiovascular disease themselves. While
attention has always centered on the patient’s need to lower his or her risk factors to avoid
disease progression, the study indicates that is may be equally important to target the spouse of
the patient as well. Not surprisingly, the spouses often have the same risk factors as the patients,
including similarities in current and past smoking histories and exercise levels. However, studies
also indicate that twice as many women as men continue to smoke following a male patient’s
heart attack and fewer women exercise compared to men.
16
Coronary artery disease (CAD) is a form of heart disease caused by obstructions in the arteries
supplying blood to the heart. Although this is the number-one killer of both men and women in
this country, it tends to affect women 10-15 years later in life. Again, this is thought to be due to
the protective effect of estrogen in premenopausal women, which seems to stall the progress of
depositing fat and cholesterol in the blood.
While women have lower risk of CAD by virtue of their sex, the most significant risk factor for
women is age. Ethnicity also seems to play a role – the rate of CAD is highest in African
American men, then white men, African American women and white women. Rates of CAD in
Hispanics and Asians are lower for both sexes. Additional factors include: Hypertension,
diabetes, smoking, family history, obesity, a sedentary life style and cholesterol levels.
The symptoms of CAD range from none to angina to heart attack. In fact, while heart attack is
often the first symptom of CAD in a man, women are more likely to develop a chest pain as their
first symptom. The condition is most commonly evaluated today by: (a) exercise stress testing,
(b) thallium scanning, and (c) coronary angiography. Unfortunately, these methods are often
ineffective in evaluating women, creating false positive and false negative readings.
Consequently, clinicians are beginning to use noninvasive tests such as ultrasound in attempts to
improve accuracy in evaluation.
Stroke is the number one cause of serious, long-term disability among American women.
Although the incidence of stroke is 19% higher for men than for women, women are twice as
likely to die of them. This may be because women have a longer life expectance and tend to
have strokes at later ages. Certain conditions unique to or more common in women (i.e.
pregnancy and mitral valve prolapse) may predispose some women to strokes.
The risk of having a stroke increases with age; in fact, the chances double for each decade
beyond the age of 35. Certain inherited or acquired conditions can increase the likelihood of
strokes, including cancer, immobilization in bed, certain blood disorders, and the presence of
antibodies in the blood often found in women suffering from lupus.
The American Heart Association, in mounting a major public awareness campaign about women
and health disease, conducted 1,000 interviews among a national random sample of women 25
years and older.
17
Chronic Disease
Chronic illness is permanent and progressive and requires ongoing adaptation and management.
It is the most prevalent form of illness in the U.S. today (see Tables 6 & 7) and, according to
Women’s Health Care, a Comprehensive Handbook, poses one of the country’s most pressing
and challenging health care problems. Chronic disease is differentiated from an acute illness in a
number of ways. Chronic illness is long-term, progressive and requires ongoing care, whereas
acute illness is sudden and produces symptoms soon after exposure to the disease. Acute illness
responds to treatment and usually does not have long-term consequences. Chronic illness may
include a long period of latency where the disease process has begun but symptoms have not
appeared. Disability is sometimes associated with chronic illness.
Arthritis
Over 32 million Americans have arthritis, 85% of who are over the age of 45. Arthritis is two to
three times more common in women than in men and is the most prevalent chronic condition
reported in women overall. Under the age of 45, only 37 out of 1,000 women report arthritis,
while half (550) of every 1,000 women over 65 experience arthritis. About 25% of these women
experience limitations in activity because of their condition.
Arthritis is a general term for a number of different conditions involving swollen, painful or still
joints. There are more than 100 arthritic diseases, some causing more debilitation and pain than
others. Some of the forms more frequently experienced by women include:
?? Osteoarthritis: painful joints caused by a gradual loss of cartilage. Common in
individuals over 60, this breakdown in cartilage can result from physical injury,
mechanical stress or metabolic abnormality;
?? Lupus: a chronic auto-immune disease often characterized by rashes and fevers following
exposure to sunlight;
?? Psoriatic arthritis: more often observed in women patients suffering from psoriasis, this
condition, characterized by painful swollen joints, particularly in the fingers, toes, knees
and elbows; and
?? Chemically induced arthritis: a joint paid and stiffness resulting from use of some
medications used to treat acne, heart arrhythmia and hypertension
Chronic Bronchitis
Bronchitis is an inflammation of the lining of the bronchial tubes. When these tubes are
inflamed or infected, less air is able to flow to and from the lungs and heavy mucus is coughed
up.
18
Chronic bronchitis is an infectious condition. Defined by the presence of a mucus-producing
cough most days of the month, three months a year for two successive years, it develops over the
years, will not go away on its own and renders the infected person increasingly vulnerable to
infections.
While acute bronchitis is brief in duration or course and will respond to treatment, chronic
bronchitis persists over a long period of time, involves a permanent loss of function of affected
organs and may require an extended period of symptom management and treatment.
Cigarette smoking is the most common cause of chronic bronchitis. Air pollution and industrial
dusts and fumes are also causes. It affects an estimated 5.4% of the U.S. population. It is more
prevalent among females than males and, while it affects people of all ages, more incidences are
diagnosed in those over 45 years old. Women smokers of any age are ten times more likely to
die of these conditions than non-smokers.
Crohn’s Disease
Chron’s disease is a chronic, recurring inflammation of the intestine, usually affecting the lower
part of the small intestine. In some cases, both the small and large intestines are affected. It
occurs in about 150 of 100,000 people in the US. It is chronic condition that may recur at
various times over a lifetime and it remains most unpredictable.
While most pregnancies of women with Chron’s disease result in normal births, and the course
of the pregnancy and delivery is not usually impaired, it is important for women to discuss the
matter with their doctors before pregnancy. Children who do get the disease are sometimes more
severely affected than adults, with stunted growth and delayed sexual development in some
cases.
Several drugs are helpful in controlling the disease; however, there is no cure at this time. The
usual therapeutic goals are to correct nutritional deficiencies, control inflammation and relieve
abdominal pain, diarrhea and rectal bleeding.
Diabetes
Diabetes is a disease that affects the body’s ability to produce or respond to insulin, a hormone
that allows blood glucose to enter the body’s cells and be used for energy. Its complications
include blindness, kidney disease, amputations, coronary heart disease and stroke, making it the
seventh leading cause of death. The risk of diabetic coma is 50% higher among women than
men, yet, while approximately eight million women in the U.S. have diabetes, almost one-third
of them does not know it.
Diabetes falls into two main categories: Type 1 usually occurs during childhood and/or
adolescence, while Type 2 (the more common form) usually occurs after age 45. In addition,
pregnancy introduces the risk of gestational diabetes, developed in 2% to 5% of all pregnancies.
19
While gestational diabetes disappears when a pregnancy is over, women who have had it are at
increased risk for developing Type 2 diabetes later. Between 3-5% of pregnancies among
diabetic women result in death of the newborn within the first month, compared to a rate of 1.5%
for non-diabetic women.
In Arizona, the death rate from diabetes remained unchanged between 1996 and 1997, but
increased to 13.5/100,000 in 1998. Although diabetes is the 8th leading cause of death in the
U.S., Arizona has a 13% higher prevalence of diabetes than the U.S. It was the fourth leading
cause of death among American Indians and Hispanics, seventh among Blacks, and eighth
among white non-Hispanics and Asians (see Tables 1D, E, & F).
Ideally, diabetic women should be monitored frequently by a health care team knowledgeable in
diabetes care. Diabetics can reduce their risk if they are educated about their disease, if they
learn and practice the skills necessary to regulate their blood glucose levels and if they receive
regular checkups from their health care team.
Hypertension
Hypertension – consistently high blood pressure – is a common problem in the US and is a major
cause of stroke and heart disease. Approximately 20% of all adults have high blood pressure,
with the rate of incidence higher in men than in women. The blood pressure is the amount of
pressure exerted by the blood against the walls of the heart. African American women over 40
are twice as likely to have hypertension as white women of the same age.
Excess sodium in the diet and inadequate potassium and calcium have all been linked to
hypertension. Evidence exists that use of birth control pills may be associated with hypertension.
Psychological and social factors (particularly stress) also seem to be involved. Women who
drink 1 to 2 alcoholic beverages per day seem to be at lower risk than those who do not drink at
all, while heavy drinking women are at a much higher risk. Obesity also plays a role with
women weighing 20% more than their ideal weight developing hypertension four times more
frequently than non-obese women. Women with diabetes are also at risk for hypertension.
20
Table 6: Number of selected reported chronic conditions per 1,000 women by age
(National Center for Health Statistics: United States 1995)
Type of Chronic Condition
Under
45 years
45-64
years Total
65-74
years
75 years
and over
Arthritis 36.0 285.4 550.2 498.2 616.1
Intervertebral disc disorders 11.5 42.0 29.6 32.0 26.7
Disorders of bone or cartilage 2.6 17.0 33.9 34.4 33.2
Diabetes 9.7 65.4 128.4 134.3 121.1
Migraine headache 70.7 82.6 24.1 35.2 10.1
Heart disease 34.0 100.0 268.5 229.3 318.0
High blood pressure (hypertension) 30.3 212.9 442.1 423.8 465.3
Hardening of the arteries 0.3 6.1 38.6 26.6 53.7
Chronic bronchitis 58.9 88.7 71.8 72.4 70.9
Table 7: Number of selected reported chronic conditions per 1,000 persons
by geographic region and place of residence
(National Center for Health Statistics: United States 1995)
Type of Chronic Condition Northeast Midwest South West
All
MSA1
Central
City
Not
central
city
Not
MSA
Arthritis 124.7 122.7 130.3 117.6 119.0 119.4 118.8 147.5
Intervertebral disc disorders 21.7 20.9 25.5 20.7 22.7 20.7 23.8 22.4
Disorders of bone or cartilage 5.0 6.8 8.2 6.4 6.8 5.6 7.6 6.9
Diabetes 39.2 30.4 35.7 26.6 32.4 31.9 32.8 36.2
Migraine headache 35.3 47.1 46.3 51.3 45.3 43.2 46.5 45.9
Heart Disease 90.6 78.5 82.3 71.1 79.1 73./8 82.2 86.8
High blood pressure (hypertension) 111.2 111.6 127.8 98.2 112.6 118.2 109.3 121.4
Hardening of the arteries 8.3 7.6 5.5 7.8 6.5 6.5 6.5 9.2
Chronic bronchitis 52.6 60.2 57.5 49.6 54.9 52.5 56.3 58.1
1 Metropolitan Statistical Area
21
Musculoskeletal Pain
One out of every seven visits to primary care physicians is for musculoskeletal symptoms. The
musculoskeletal system includes the muscles and bones as well as the joints that connect one
bone to another, and the tendons that connect muscles to bones. Women are particularly likely to
develop disorders in distinct regions of the body, particularly the hands, wrists and the lower
back.
Back Pain
Back pain is ranked second only to headaches as the most frequent location of pain. The spine,
designed to absorb the impact of day-to-day living, has a series of curves in the neck, the upper
back and the lower back, which network with the ligaments, muscles and nerves. Low back
pain, often associated with reproductive functions and with obesity, is quite common in women,
as are osteoarthritis and osteoporosis. Studies reveal that back pain may be prevented or reduced
by adopting a short daily exercise program that increases flexibility of the back, while
strengthening the shoulder and abdominal muscles.
The causes of back pain include: muscle strains and spasms, osteoarthritis, sciatica, osteoporosis,
herniated disk and fibromyalgia. Infrequently, back pain can signal a more serious medical
problem. Back pain associated with any of the following requires a doctor’s attention:
?? Bladder or bowel control
?? Numbness in the groin or anal area
?? Weakness or numbness in one or both legs
?? Rapid weight loss
?? History of cancer
Back injuries are one of the most common causes of disability. It is estimated that the cost of
back pain in the United States exceeds $20 billion a year.
Carpal Tunnel Syndrome
At the base of the palm is a tight canal, or “tunnel”, which threads tendons and nerves from the
forearm to the hand and fingers. The nerve passing between the tunnel to reach the hand is
called the median nerve and the passage between the forearm and hand is called the “carpal
tunnel”.
Normally, this passage is very snug with just enough room for all the tendons and nerves.
Anything extra taking up room in the canal causes it to become tight and the nerve becomes
“pinched”, creating numbness and tingling. This is commonly referred to as Carpal Tunnel
Syndrome (CTS), a condition more common among women than men. Health conditions that
increase risk include thyroiditis, diabetes, some arthritis and pregnancy. The most common
cause of CTS is an inflammation of the tendons in the tunnel.
22
Occurring in about one out of every 1,000 people, carpal tunnel syndrome is particularly
common in women aged 50 to 70 years old. It is also common in people performing repetitive
hand motions, particularly those involving bending the wrist. These include typists, carpenters,
upholsterers, violinists, and waitresses, as well as people who knit, crochet, hook rugs or similar
activities, most of which are predominantly performed by women.
Symptoms often worsen at night and, over time, may progress from numbness and tingling in the
fingers to burning and aching there as well as painful numbness in the palm. In severe cases, the
affected fingers may become permanently numb and muscle atrophy may make the thumb
difficult to move.
Osteoporosis
Osteoporosis is a disease in which bones become fragile and more likely to break. Often called
the “silent disease” and characterized by low bone mass and deterioration of bone tissue,
osteoporosis is a major public health threat for more than 28 million Americans, 80% of whom
are women. One in two women will have an osteoporosis-related fracture in their lifetime; in
fact, women can lose up to 20% of their bone mass within five to seven years of menopause,
leading to osteoporosis.
In addition to sex and aging, risk factors include a family history, postmenopause, abnormal
absence of periods, anorexia nervosa or bulimia, a calcium-deficient diet, inactivity, excessive
use of alcohol and smoking. A woman’s risk of hip fracture from osteoporosis is equal to her
combined risk of breast, uterine and ovarian cancer.
The good news is that osteoporosis is largely a preventable disease. Research has enhanced
public knowledge about how to maintain a healthy skeleton, as well as the diagnosis and
treatment.
23
Sexually Transmitted Disease
A sexually transmitted disease is an infectious disease spread from person-to-person through
direct body contact or contact with infected body fluids; any disease acquired primarily through
sexual contact. Secondary contact can also be a source for some STD’s. Today, over 20 STD’s
are recognized. The major groups or organisms causing STD’s are bacteria, viruses, fungi and
metazoa.
Every year more than 12 million cases of sexually transmitted diseases are reported in the U.S.
These infections result in billions of dollars of preventable health care spending. The health
impact of STD’s is particularly severe for women. Because the infections often cause few or no
symptoms, they may go untreated, leaving women at risk for complications including ectopic
pregnancy, infertility, chronic pelvic pain and poor pregnancy outcomes.
HIV and AIDS
Although the first cases of AIDS in women were reported in the early 1980s, health care
providers have only relatively recently confirmed that HIV infection in women is a serious
problem that continues to worsen (see Tables 1C-F). Gynecological symptoms are more readily
recognized now than they were ten years ago and a female-specific diagnosis for AIDS (invasive
cervical cancer) has been recognized since 1993.
More powerful HIV therapies and successful prevention of opportunistic infections have
transformed AIDS care. People with AIDS are living longer and healthier lives. Research into
new therapies, coupled with the outreach and education programs of the past 15 years, have
reduced the number of new AIDS diagnoses, while slowing progression from HIV to AIDS and
decreasing the death rate.
While much of this is good news, the fact is that the picture for women is, unfortunately, not so
hopeful (see Tables 8-10). While the male morbidity rate among men infected with AIDS has
declined by 22%, women show only a 7% declining morbidity rate. AIDS is the leading cause of
death among 25 to 44 year old African American and Hispanic women and the third leading
cause of death between all women in this age group in the US. Women are one of the fasting
growing groups of new AIDS cases, yet while clinical research on potential treatments now
includes female participants, they represent only 12% of the total participants. Women are
currently 33% more likely to die from AIDS than men are because treatment usually begins
much later in women, if at all.
The reasons for this vary. In the early days of the epidemic, AIDS programs primarily targeted
gay men. Consequently, many women did not know as much about available services and
treatments. Additionally, doctors and clinics sometimes fail to recognize the early symptoms of
HIV in women. In spite of this, the treatment options do not vary much between men and
women, unless a woman is pregnant.
24
As women ask why HIV is affecting women differently than men, it is necessary to evaluate
societal response. Effective HIV/AIDS prevention and care services targeting women, especially
women of color, and those with less education and lower social status, must be developed and
integrated into existing structures.
From 1988 through 1998, Arizonans were less likely to die from HIV infection than their
national peers. The rate of deaths from HIV infection showed a sharp decline (76.2%) from
12.6/100,000 in 1995 to 8.4/100,000 in 1996, 4.2/100,000 in 1997 and 3.0/100,000 in 1998.
Mortality from HIV infection continues to remain (in Arizona) a more predominantly male
experience. In 1998, males accounted for 88.8% of deaths from HIV infection.
Table 8: Arizona HIV Infection Surveillance Report
(Arizona Department of Health Services – Disease Prevention Services)
(Cumulative Cases Through May 1, 2000 – Females)
HIV AIDS
Adult/Adolescent Exposure Category Number Percent1 Number Percent
Injecting drug user 175 (39%) [27%] 221 38%
Hemophiliac 0 (0%) [0%] 2 0%
Heterosexual contact with high risk individual 249 (56%) [38%] 215 37%
Transfusion with blood or blood products 20 (5%) [3%] 55 9%
Confirmed Occupational Exposure 1 0%
None of the above/unknown2 202 2,483 [31%] 94 16%
Table 9: Female AIDS Cases by Exposure Category and Year of Diagnosis – Arizona – 1981-2000
(Arizona Department of Health Services – Disease Prevention Services)
Exposure Category
1981
-
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Injecting drug user 6 13 10 13 13 22 24 12 23 24 17 18 13
Hemophiliac 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Heterosexual 5 6 8 16 15 23 24 26 29 28 25
Transfusion 6 10 7 0
Ped mom with HIV 0 0 0 0 0 0 0
None of the above 7 10 8 18 19 7 14
1 Percentages within parentheses ( ) exclude cases with missing or unknown data for that category.
Percentages within brackets [ ] are based on the total number of reported cases, including those with missing or
unknown data.
2 This category consists largely of persons who could not be located or interviewed.
25
Table 10: Female AIDS Cases by Race/Ethnicity and Year of Diagnosis – Arizona – 1981-2000
(Arizona Department of Health Services – Disease Prevention Services)
Race/Ethnicity
1981
-
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
White 14 18 19 17 27 27 27 38 39 43 36 27 28 16
Black 0 0 0 0 0 0 0 0 12 0 10 0 12 9 0
Hispanic 5 11 16 17 12 17
Asian/Pac. Isl.
Native American
Unknown
Chlamydia
This is the most common bacterial sexually transmitted disease in the U.S., causing an estimated
4 million infections annually, primarily among adolescents and young adults. Untreated
infections in women can progress to the upper reproductive tract, resulting in serious
complications. As many as 75% of women infected with chlamydia are symptom free. One in
ten adolescent females and 1 in 20 women of reproductive age are infected.
Pelvic Inflammatory Disease (PID)
PID refers to upper reproductive tract infection in women. These often develop when STD’s are
untreated or inadequately treated, affecting more than 750,000 women. Chronic pelvic pain and
harm to reproductive organs are results of PID; permanent damage to the fallopian tubes has
resulted from a single episode. Damage to the fallopian tubes is the only preventable cause of
infertility. One potentially fatal complication of PID is ectopic pregnancy, an abnormal
condition occurring when a fertilized egg implants in a location other than a woman’s uterus –
often in a fallopian tube. Among African American women, ectopic pregnancy is the leading
cause of pregnancy-related deaths.
Gonorrhea
Gonorrhea is a common bacterial STD that can be treated with antibiotics. While rates among
adults have declined, adolescent rates have risen or remain unchanged. The highest rates of
gonorrhea are observed in females ages 15-19. It is estimated that 50% of those infected have no
symptoms and, without early screening and treatment, 10 to 40% of them will develop PID.
Herpes Simplex Virus
The herpes simplex virus causes genital herpes. This disease may recur and has no cure. As
many as 30 million persons in the US may suffer from genital herpes. Most of those infected
never recognize symptoms, while others are symptomatic shortly after infection and never again.
26
Syphilis
A bacterial infection, syphilis is curable with antibiotics. Syphilis cases increased dramatically
from 1985 to 1990 among women of all ages. An analysis of 1993 data shows that the rates were
higher among female than male adolescents – sometimes twice as high. The syphilis rates for
African American women are seven times greater than the female population as a whole.
27
Reproductive Issues
Menstruation, pregnancy, childbirth, contraception, fertility and menopause present special
health care needs for women. The Centers for Disease Control and Prevention addresses a wide
range of reproductive health issues, with the overall goal of preventing illnesses and deaths.
Menstruation
The menstrual cycle involves the periodic release of a fertile egg or ovum from the ovary, the
preparation of the uterine lining for pregnancy and, if fertilization does not occur, the shedding
of the lining as a bloody vaginal discharge – menstruation. This cycle occurs in premenopausal
women and is controlled by finely tuned feedback between hormones of the pituitary gland,
hypothalamus and ovaries.
The average cycle is 28 days from the first day of one menstrual period to the first day of the
next with normal cycles lasting between 21 and 38 days. Menstrual flow lasts from three to
seven days. Most women lose only about three to four ounces of menstrual fluid each month.
Contraception
About 60% of U.S. women of reproductive age use some form of contraception. Birth control
pills were the choice for about 10 million women, while surgical sterilization was the option
most often selected by married couples and formerly married women (see Tables 11 & 12).
The birth control pill is the most reliable form of birth control, when used correctly without
missed days. Sterilization is the most common birth control method for women over 30 years of
age, and is used by 25% of women between the ages of 15 and 44. Research indicates that
sterilized women are less likely to use condoms during intercourse, making educational efforts
essential for this group unless they are sexually abstinent or have a mutually monogamous
relationship with a no-risk partner for acquiring the AIDS virus. Condoms, when used properly,
can prevent up to 85% of unwanted pregnancies by providing a direct physical barrier to sperm.
Some condoms are also lubricated with a spermicide that kills sperm, adding to their
effectiveness as contraceptives. The sponge is inserted deep into the vagina near the cervical
opening, and serves as both a physical and chemical barrier to sperm. It is most effective as a
contraceptive when used in combination with a spermicide and a condom. The diaphragm is a
popular form of birth control, which must be prescribed and fitted by a doctor. It is made of
strong, flexible latex rubber and is inserted into the vagina. It can be work up to 24 hours, which
allows for the spontaneity many couples desire.
28
Table 11: Types of Contraceptives used by Men and Women Ages 15-44 in the U.S. - 1995
(Strong/DeVault/Sayad, Human Sexuality, 3rd ed., 1999, Mayfield Publishing Company)
Total using contraception 64.2
Female sterilization 17.8
Oral contraceptive (the pill) 17.3
Male Condom 13.1
Male Sterilization 7.0
Withdrawal 2.0
Injectable (depo-provera) 1.9
Periodic abstinence 1.5
Diaphragm 1.2
Other methods 1.0
Implant (Norplant) 0.9
Intrauterine device (IUD) 0.5
Natural family planning 0.2
Not using contraception1 35.8
0 1 2 3 4 5 10 15 20 30 40 55 70
Table 12: Effectiveness Rates of Various Contraceptive Methods During First Year of Use
(Strong/DeVault/Sayad, Human Sexuality, 3rd ed., 1999, Mayfield Publishing Company)
Norplant 99.96
Vasectomy 99.85
Female sterilization 99.60
DMPA2 99+
Oral contraceptives 97
IUD 97
Condom (w/o spermicide) 88
Diaphragm (with spermicide) 82
Cervical Cap 82
Withdrawal 81
Fertility awareness w/abstinence 80
Vaginal spermicides (used alone) 79
0 10 20 30 40 50 60 70 80 90 100
1 Includes being surgically sterile, pregnant, seeking pregnancy, and not having intercourse
2 Failure rates for Depo Provera vary but are usually less than 1%
29
Adolescent Pregnancy
In the United States, there are about 1 million teenagers that become pregnant each year.
Approximately 70% of them do not receive adequate prenatal care.
Following a decline in the annual pregnancy rates among Arizona females aged 19 and younger
from 1994 to 1997, Arizona experienced an increase in both the number of teen pregnancies and
the teen pregnancy rate in 1998. The 1998 rate of 39.8/1,000 for females 19 and younger
exceeded by 4.7% the 1997 rate of 38/1,000. The rate for 15-17 year old teens increased 5.2%
from 44.6/1,000 in 1997 to 46.9/1000 in 1998. The pregnancy rate for older teens (18-19)
increased 2.1% from 128.4/1,000 in 1997 to 131.1/1,000 in 1998 (see Table 11 below).
Table 13. Number of Pregnancies1 by Pregnancy Outcome, Ethnic Group and Year
Among Females 19 or Younger, with Rates2 -- Arizona 1988-1998
(Office of Epidemiology and Statistics – Arizona Department of Health Services)
Ethnicity/Pregnancy Outcome 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
1998
Rates
WHITE3 , total 6,549 5,935 6,011 5,861 5,530 5,335 5,452 5,286 5,249 4,413 4,729 25.4
Births 4,181 4,104 4,116 4,061 4,060 4,024 4,023 4,042 4,033 3,129 3,165 17.0
Abortions 2,368 1,831 1,895 1,800 1,470 1,311 1,429 1,244 1,148 1,179 1,480 7.9
HISPANIC, total 3,514 3,874 4,507 4,860 5,116 5,237 5,633 5,902 6,190 5,442 5,793 70.0
Births 3,099 3,459 3,941 4,255 4,543 4,688 5,075 5,351 5,628 4,800 5,046 61.0
Abortions 424 415 566 605 573 549 558 551 562 642 747 9.0
BLACK, total 724 729 712 768 730 728 713 590 617 559 647 46.7
Births 552 593 562 620 570 581 576 491 498 445 493 35.6
Abortions 172 136 150 148 160 147 137 99 105 107 147 10.6
AMERICAN INDIAN, total 1,206 1,179 1,165 1,151 1,138 1,121 1,150 1,057 1,056 903 988 36.4
Births 1,144 1,137 1,101 1,102 1,080 1,060 1,095 991 996 838 925 34.1
Abortions 62 42 64 49 58 61 55 66 54 58 53 1.9
ALL ETHNIC GROUPS4, total 12,385 12,013 12,769 13,037 12,885 12,890 13,407 13,356 13,521 11,667 12,630 39.8
Births 9,043 9,375 9.767 10,108 10,307 10,438 10,858 10,973 11,247 9,314 9,793 30.0
Abortions 3,282 2,488 2,940 2,862 2,476 2,357 2,458 2,294 2,186 2,233 2,735 8.6
PREGNANCY RATE, total 49.3 46.6 50.5 50.2 48.4 48.6 49.3 47.4 45.4 38.0 39.8
Fertility rate5 36.0 36.4 38.6 38.9 38.7 39.4 39.9 38.9 37.8 30.4 30.9
Abortion rate 13.1 10.0 11.6 11.0 9.3 8.9 9.4 8.1 7.4 7.3 8.6
Teenage moms have a higher rate of anemia and pregnancy induced hypertension. Babies are
more likely to be born premature and/or suffer from low birth weight. The infants can be
predisposed to mental retardation, brain damage and injury at birth. Some of these problems are
due to the teenager’s physical immaturity, the fact that they are, themselves, still growing, and
poor nutrition. Because the pregnant teenager often denies the fact that she is pregnant, or
ignores it, proper care for the growing baby is delayed.
1 Fetal deaths are included in the total counts of pregnancies
2 All rates per 1,000 females 19 or younger
3 Not of Hispanic origin
4 Includes other and unspecified ethnicity
5 Number of births per 1,000 females 19 years or younger
30
Arizona Birth Statistics for December 1999
Approximately 6,933 babies were born to Arizona mothers in December, 1999, 398 more than in
November 1999. 38 out of every 100 were born to unmarried mothers, eleven were born to
teens, and seven were born with low birthweight. 44 out of every 100 deliveries were paid for by
public sources. Approximately 75% of mothers received prenatal care in the first trimester, and
89% had at least five or more prenatal visits. (See Table 12 for additional information.)
Table 14. Pregnancies by Pregnancy Outcome and County of Residence – Arizona – 1999
(AZ Department of Health Services, Public Health Services, Bureau of Public Health Statistics)
Total
Pregnancies Births
Fetal
Deaths Abortions
Arizona 91761 80505 600 10656
Apache 1122 1104 8 10
Cochise 1806 1668 16 122
Coconino 1986 1804 10 172
Gila 691 672 3 16
Graham 502 476 3 23
Greenlee 146 141 2 3
La Paz 141 135 2 4
Maricopa 58399 51503 394 6502
Mohave 1762 1745 12 5
Navajo 1804 1751 11 42
Pima 13595 11866 87 1642
Pinal 2532 2401 21 110
Santa Cruz 796 754 6 36
Yavapai 1745 1627 6 112
Yuma 2949 2841 19 89
Unknown 1785 17 1786
Infertility
Infertility is a disease or condition of the reproductive system. It may have one or several causes
and is diagnosed with a series of tests. Infertility includes difficulty conceiving, as well as the
inability to carry a pregnancy resulting in a live birth.
Infertility is a medical problem, affecting 15% of couples in the United States. While infertility
is on the rise, primarily because couples are delaying pregnancies to later ages, sop0histicated
tests and procedures are resulting in pregnancies that would not have been possible just a few
years ago. Thorough testing, drug therapy, surgery and assisted reproductive technologies, such
as in vitro fertilization are resulting in successful pregnancies.
There are two types of infertility: primary infertility, or the inability to conceive and carry a
baby to delivery, and secondary infertility, which is the inability to conceive after having had at
least one baby.
It is estimated that 8% of women between 20 and 29 are infertile; 15% between 30 and 34; 22%
from 35 to 39; and 29% from 40 to 44. A man’s fertility also declines as he ages, though not as
dramatically.
31
Researchers find that women’s reproductive health problems are responsibility for about 50% of
infertility cases, while man’s problems are responsible for 40%.
Menopause/Hormone Replacement Therapy
Menopause, also known as “the change of life” means the permanent cessation of the monthly
menstrual period. It consists of two phases: perimenopause, which generally occurs at 45 to 47
years of age and can last five to seven years; and menopause, where menstruation ceases
permanently for at least one year, usually occurring between 50 and 52.
One reason why menopause has recently become a leading women’s health issue has to do with
demographics. As women can now expect to live to an average age of 78, and since menopause
generally occurs around the age of 50 the typical woman now lives as much as a third of her life
after menopause begins.
Menopause is also taken more seriously now because of the serious impact it can have on a
woman’s health. New evidence that physical changes after menopause significantly increase a
woman’s risk of developing debilitating, life-threatening and costly diseases, particularly heart
disease and osteoporosis, have cast menopause in a new light. Additional side effects of
menopause may include hot flashes, vaginal dryness, nervousness, fatigue and depression.
Estrogen replacement therapy (ERT) has been a subject of great controversy in recent years, but
the tide is definitely turning in favor of long-term ERT for the prevention of both osteoporosis
and coronary artery disease. The benefits of hormone replacement therapy (HRT) are:
?? Less severe hot flashes
?? Relief of vaginal dryness and discomfort
?? Delay of the progression of osteoporosis
?? Reduced incidence of depression and fatigue
?? Decreased risk of heart disease, stroke, uterine cancer and possibly colorectal cancer
?? Reduced susceptibility to Alzheimer’s Disease
The negatives of ERT/HRT may include:
?? Possible occurrence of a menstrual cycle
?? Possible risk of cancer of the endometrium
?? Swollen breasts, nausea, high blood pressure and water retention
However, ERT is not an option for those women with a history of breast or uterine cancer,
estrogen-dependent ovarian cancer, a history of blood clots in the legs, pelvis or lungs,
gallstones, large uterine fibroids, active liver disease and some circulatory disorders.
32
Headaches & Migraines
For millions of Americans, headaches are a significant medical problem. Recurring headache
ranks seventh among complaints for people who seek medical advice. Headaches are part of a
continuum ranging from mild headaches that appear occasionally to severe headaches that occur
almost continually. Over time, a woman with a mild syndrome can develop a much more severe
condition or, with treatment, can revert to milder symptoms.
Headaches
An extremely common problem in women, particularly during reproductive years, headaches
occur more frequently, are more intense and disabling, as well as longer lasting in women than in
men. In 15% of women, headaches are severe enough to interfere with daily activities. Reasons
for this predominance in women appears to be related to the menstrual cycle. Studies indicate
that estrogen hormones are among the most potent chemicals known to cause headache. In fact,
several women develop headaches for the first time during menopausal years, when they are
experiencing fluctuations and irregularities in hormone levels. Headache is only a symptom,
caused by narrowing of the blood vessels.
Migraines
Migraine disease is a serious health and disability problem, affecting as many as 18 million
Americans. It is estimated that up to 38 million Americans have migraine genetic propensity. In
addition to being disabling, migraines can be life threatening. Migraine can induce strokes,
aneurysms, vision loss, dental problems, coma and even death. Twenty seven percent of all
strokes suffered by persons under the age of 45 are caused by migraine.
Contrary to popular myth, a migraine is not just a bad headache. While a headache is only a
symptom caused by narrowing of the blood vessels, migraine is a disease caused by expansion of
the blood vessels. During a migraine, inflammation of the tissue surrounding the brain
exacerbates the pain. Medicine often prescribed to treat a headache dilates the blood vessels,
thus making a migraine much worse.
Migraines are two to three times more common in women than in men. Unlike a headache, the
migraine disease has many symptoms, including numbness, prickling, tingling, nausea, vomiting,
intolerance to light or sound, depression and irritability. One migraine attack can last for several
hours, days or, in extreme cases, even weeks. Some neurologists believe that not all of these
episodes, which they call migraine equivalents, include a headache.
While the cause of migraine headaches is uncertain, many researchers favor the theory that they
are due to a vulnerability of the nervous system to sudden changes in the body or in the
environment. Several believe that migraine sufferers have inherited a more sensitive nervous
system response than others.
33
Approximately 20% of women experience “classic migraine”, a premonition or aura about an
hour before the migraine begins. Sometimes that aura is a small blind spot, flickering light or
colorful and expanding zigzag lines. An aura might begin with numbness in the fingers of one
hand, extending up the arm to the nose and mouth. Mood changes, hallucinations, experiences
of déjà vu, and thinking and language disorders precede some migraines. These auras can last
between 10 and 30 minutes.
Migraines are now recognized has having societal implications because of (a) their prevalence,
(b) lost workdays, and (c) reduced effectiveness at work, home and school. According to a
position paper published by the American Academy of Pain Medicine, 150 million work days per
year, equivalent to 1,200 million work hours, are lost each year due to head pain. The
corresponding annual cost to industry and the health care system due to migraine amounts to $5
to $17 billion.
34
Nutrition, Weight Management and Exercise
For thousands of years, people have recognized that the foods they eat affect their health and
well-being. Women are particularly prone to a number of diseases that may stem from, or be
exacerbated by, diet. While nutritional needs vary according to a person’s age, sex and
reproductive status, the body cannot produce some protein building blocks, vitamins, minerals
and fats on its own, so it must obtain these from diet.
Nutrition
There is no doubt that the foods we eat affect how our bodies work. Certain basic nutrients are
absolutely necessary for human health, while others have subtle effects on bodily processes.
Poor diet and lack of physical activity account for at least 300,000 deaths each year in the U.S.
and eight of the ten leading causes of death in the U.S. are related to diet and alcohol
consumption. Yet, state health agencies estimate the number of public health nutritionists
working in chronic disease programs is only 20% of the minimum number needed.
Nutritional needs vary according to a person’s age, sex and reproductive status. They also vary
from individual to individual within those groups depending on a person’s genetic makeup and
life situation. While women certainly recognize the relationship between nutrition and health,
they are barraged with confusing contradictory and often misleading information that is the result
of fads or promotions rather than translating scientific information into messages that women
may incorporate into their daily lives on a long-term basis.
Nutrition intervention has been shown to prevent and effectively treat heart disease in women.
Good nutrition can prevent and alleviate most of the common risk factors associated with heart
disease in women – high cholesterol, excess body weight and hypertension.
Between the ages of 10 and 15 (just before and during puberty), caloric requirements rise. In
fact, unless a girl reaches a critical weight (the ratio of body fat to muscle), she will not begin to
menstruate. Calcium absorption and retention increase prior to onset of the first period. This is
necessary if the skeleton is to develop properly. Yet teenage diets frequently appear to be low in
calcium. Irregular eating habits are characteristic of most adolescents and snacking is a normal
pattern which should be used in meal planning; typically, one fourth of teen calories come from
snacks. Often during these years, teenage girls subject themselves to low-calorie diets and fasts.
The result of these diets can be not only nutritional deficiencies, but also the emergence of eating
disorders, menstrual irregularities and possibly future fertility.
Adequate weight gain in pregnancy is usually a good sign that nutritional needs are being met.
For most women, eating only about 300 extra calories a day is enough to produce the desirable
weight gain. Pregnant teenagers require slightly more calories and protein than pregnant adults,
as well as calcium and phosphorous daily (400 mg more per day than a pregnant adult) because
their bones are still growing. Other women who may need extra nutrients or special diets during
pregnancy include those who have had three or more pregnancies within two years (including
35
induced abortions and miscarriages), those who smoke cigarettes or abuse alcohol and drugs,
those who have certain chronic diseases, and those who follow a vegetarian diet
Most women lose about 18 to 20 pounds within ten days of the birth. After that, the rate of loss
slows down. Breastfeeding women, to ensure adequate milk supply, need extra fluids, calories,
calcium and protein each day. Her caloric intake per day needs to increase by about 600 calories
over pre-pregnancy. Some women find that nursing babies are bothered by such foods as
broccoli, cauliflower, cabbage, Brussels sprouts, onion, garlic and chocolate – often developing
diarrhea and colic or other symptoms of indigestion after the mother eats these foots.
After menopause, as the estrogen levels in the body increases susceptibility to osteoporosis and
cardiovascular disorders, women are encouraged to increase their calcium and vitamin D while
restricting the intake of fats, cholesterol and salt.
Many elderly women experience appetite loss, either because of depression, tooth and gum
problems, medications and a diminished sense of taste. Nutritionists speculate that a sizable
proportion of depression, memory loss and debility in elderly women can be attributed to
nutritional deficiencies. At this time, it is wise that they include vitamin and mineral
supplements in their diet, as well as eat a diet rich in fiber such as fruits, vegetables, and grains to
diminish constipation.
The Arizona Nutrition Network is a network of public and private entities working together to
promote basic, consistent nutrition education messages to American consumers using a social
marketing strategy. The mission of AzNN is to shape food consumption in a positive way and to
promote health, reducing disease among all people living in Arizona. Targeting low income
single female heads of households with children, their goals are to promote basic, consistent
messages to assist Arizonans in choosing diets that meet nutrient requirements, promote health,
support active lives, and reduce chronic disease risks.
Weight Management and Exercise
A key to taking charge of health is to sustain a healthy weight. One fourth (24.8%) of Arizona
adults are overweight and only a few (3.1%) of these individuals report trying to increase
physical activity and change their diet to lose weight. More than 1 in 4 (26.4%) Arizona adults
have been told they have high blood cholesterol. Yet, studies show that excessive weight gain
and/or obesity may place women at higher risk for all five leading causes of death in which diet
plays a role: heart disease, certain cancers, stroke, diabetes and atherosclerosis.
Strategies to maintain a healthy weight and prevent further gain are vital to improve women’s
health and quality of life. Some strategies might include:
?? Become more physically active
?? Eat healthy
?? Set realistic weight goals
?? Listen to your body
?? Find support
36
A complete fitness program for women generally includes three basic types of exercise,
flexibility exercises, aerobic exercises and weight-bearing exercises. Women should also take
into account the amount of exercise they get as part of daily life.
Most exercise physiologists recommend aerobic exercises be performed for at least 20 minutes
three to five times a week. They should be preceded by five minutes of warm-up flexibility
exercises and followed by five to ten minutes of cool-down exercises. Adolescent and
premenopausal women should also incorporate some weight-bearing exercises into their regular
exercise routine about two times a week. These strength-training exercises should involve 8 to
12 lifts for each major muscle group.
37
Psychological Issues
One in four families and one in five individuals will require the services of a behavioral health
professional in their lifetime. More than 51 million American adults and children have a mental
or emotional illness in a single year. The full spectrum of mental disorders affects 22% of the
adult population in a given year. This section focuses on specific psychological diseases
prevalent among women.
Depression
According to the National Mental Health Association, one in four women can expect to develop
clinical depression during her lifetime regardless of age, race or income. This is not primarily
due to biological differences between men and women, as was once believed, but to a variety of
biological, social and psychological causes.
Depression is a brain disorder that affects thoughts, moods, feelings, behavior and physical
health. Expressions of depression can range from sadness and low self-esteem to disabling
apathy and suicidal behavior. It may develop in reaction to some outside event or have no
apparent cause. According to the Special Census of Maricopa County, Table 2 (10/27/95), there
are 317,547.75 women in Maricopa County who will suffer from depression during their
lifetime.
The American Psychological Association’s Task Force on Women and Depression found that
men suffer less depression, in part, because they employ different coping styles, i.e. action and
mastery strategies, while women tend to brood and dwell on their problems, often with other
women. For this reason, therapists often prescribe exercise as a partial antidote for depression in
women, giving women an increased sense of self-discipline, control and mastery. Other research
suggests that hormonal changes in women and genetics contribute to the incidence rate of
depression in women.
While many recognize that depression can cause sadness, withdrawal, irritability and anxiety, it
is also associated with fatigue, changes in eating and sleeping habits and several physical
symptoms, including chronic pain. Clinical depression is a serious illness that cannot be ignored.
It is, however, one of the most treatable of all medical illnesses. In spite of the fact that more
than 80% of sufferers can be successfully treated with medication, psychotherapy or a
combination, the National Institute of Mental Health estimates that by the year 2020, depression
will be the second leading cause of disability in the world.
It is noteworthy to consider the effect of depression on chronic illness, particularly cancer, heart
disease and stroke. Clinical depression occurs in about 10% of the general population, but it is
seen in about 25% of people with cancer. Since depression adds to a patient’s suffering and
interferes with the motivation to engage in the cancer treatment, early diagnosis and treatment
are important.
38
Research has also documented a high correlation between depression and increased risk of death
or disability in patients with heart disease. The prevalence of various forms of depression is
estimated from 40 to 65% in patients with a history of heart attack. In addition, 18-20% of
coronary patients without a history of heart attack may experience depression. Major depression
puts heart attack victims at greater risk and appears to add to the patients’ disability from heart
disease. In addition, they exhibit a 3-4 times greater risk of dying within six months than those
not suffering from depression.
The association between depression and stroke has long been recognized for its impact on
rehabilitation, family relationships and quality of life. Treatment of depression can abbreviate
the rehabilitation process and lead to more rapid recovery. It can also save health care costs.
Stress
Simply put, stress is any kind of force or pressure. It can be physical, such as the stress of
exercise or of a debilitating disease. It can also be emotional or situational, i.e. from a high-pressure
job. Stress is a physical, mental or emotional strain in response to a demand, pressure
or disturbance. When harnessed constructively, stress can fuel creativity, create excitement and
produce energy. When prolonged or triggered too often without adjusting to balance its effects,
it can threaten a person’s health and well being.
Many women are highly susceptible to “drowning in a sea of stress”. In addition to the
traditional sources of stress – such as young children and aging parents, women today also are
facing considerable stress in the workplace. Since the late 1960s, 300 hours of work have been
added to a working woman’s annual schedule. While both men and women often feel stressed
on the job, women’s stress is compounded by pay inequity (71% of men’s with comparable
training and responsibilities), lack of adequate health insurance and other benefits, and balancing
work and family responsibilities.
Stress can cause significant problems to overall physical health. Some of the main physical
consequences of stress include cardiovascular disease, aggravation of diabetic symptoms and
degradation of the immune system. All of this is having a financial impact. Stress management
programs, products and services totaled $9.4 billion in 1995 with an estimated 22% annual
growth. According to a 1998 survey published in the Detroit Free Press, 45% of Americans
regularly use some form of stress management.
Stress-related disorders are also impacting American industry, costing businesses over $150
billion annually. A 1998 study published in the Journal of Occupational Medicine indicates that
workers reporting depression and elevated stress levels generate higher healthcare costs than
those not affected by such conditions. Additionally, they reported that medical expenses were
46.3% higher for those workers.
39
Eating Disorders
Eating disorders are extreme expressions of a range of weight and food issues experienced by
both men and women. They include anorexia nervosa, bulimia nervosa and binge eating
disorder. All are serious emotional problems that can have life threatening consequences.
Research suggests that about one percent (1%) of female adolescents have anorexia. Another
four percent (4%) college-aged women have bulimia. About 50% of people who have been
anorexic develop bulimia and only five to ten percent (5-10%) of people with either eating
disorder are male.
Five to ten million women and one million men in the U.S. are struggling with eating disorders.
Recent studies reveal that over half of adult Americans, male and female, are overweight. About
one third (34%) of these are obese, many of whom have binge eating disorder. Without
treatment, up to 20% of people with serious eating disorders die. With treatment, that number
falls to 3%. With treatment, about 60% recover and maintain a healthy weight. In spite of
treatment, another 20% of people with eating disorders make only partial recoveries, and the
remaining 20% show no improvement, even with treatment.
Anorexia nervosa is characterized by self-starvation and excessive weight loss. Anorexics
weigh 85% or less than recommended for age and height. Menstrual periods stop in women and
male sex hormone levels fall. The anorexic is terrified of gaining weight, even though s/he is
markedly underweight. In addition, anorexia nervosa often includes depression, irritability,
withdrawal, compulsive rituals, and unusual eating habits.
Bulimia nervosa is also called the diet-binge-purge disorder. It is characterized by episodes of
binge eating, during which time the person feels out of control, and purges the contents by
vomiting, abusing laxatives, excessively exercising or fasting. This person diets between these
cycles and begins again.
Binge eating disorder is often called compulsive eating. This person binges frequently and
repeatedly. They may eat rapidly and secretly, or may snack and nibble all day long. They do
not regularly vomit, over-exercise or abuse laxatives. They have a history of diet failures and
tend to be depressed and obese.
If not arrested, starving, stuffing and purging can lead to irreversible physical damage and even
death. Eating disorders can affect every organ in the body and can cause irregular heartbeat,
kidney and/or liver damage, destruction of teeth and a weakened immune system, among other
things.
Eating disorders arise from a combination of long-standing, psychological, interpersonal and
social conditions. Feelings of inadequacy, depression, anxiety and loneliness, as well as troubled
family and personal relationships may contribute to the development of an eating disorder.
40
Some personality types (obsessive-compulsive and sensitive-avoidant, for example) are more
vulnerable to eating disorders. New research suggests that abnormal levels of brain chemicals
predispose some people to anxiety, perfectionism and obsessive-compulsive thoughts and
behaviors. Also, once a person begins starving, stuffing and purging, those behaviors can alter
the brain chemistry and prolong the disorder.
Eating disorders are treatable and people can recover from them. It is a difficult process that can
take several months or even years. Some do better than others. The best success comes from
working with physicians and counselors who help resolve medical and psychological issues that
contributed to, or resulted from, disordered eating.
41
Domestic Violence
Although improvements continue in the prevention and treatment of domestic violence, we
continue to witness disturbingly high rates of violence and abuse, inadequate accountability of
batterers, and serious subsequent health problems among victims.
Domestic violence occurs when any of a pattern of assaultive behaviors, including physical,
sexual, and psychological attacks, as well as economic coercion, are used by people against their
families and/or intimate partners. As defined in the Maricopa Association of Governments
Regional Domestic Violence Plan, domestic violence refers to violent behavior committed by
one partner against another. It can include physical, sexual, or psychological abuse with the
primary purpose of acquiring power and control over the other person.
Domestic violence is not peculiar to any social, economic or cultural backgrounds, as it occurs at
all levels of society, in all socio-economic levels, and among people of all ethnic backgrounds.
Domestic violence often occurs in a cycle, crossing generations. The cycle typically consists of
three phases:
?? tension-building, characterized by abusive language and verbal threats;
?? acute battering, wherein physical harm occurs; and
?? the honeymoon phase, in which the batterer is apologetic and promises to end the
assaultive behavior.
Too often, as a result of losing self esteem, the victim is unwilling or unable to leave the
assaultive situation, and the battering continues. In fact, according to the U.S. Department of
Justice, the most dangerous time for a woman who is being battered is when she leaves. In a
recent study in Michigan, for example, 75% of women killed by their partners were murdered
after the relationship was over. The U.S. Surgeon General reports that in over 90% of reported
domestic assaults, the man is the perpetrator. Thus, while both men and women can be victims,
the vast majority are women.
Statistics
In 1998, in the United States,
?? a woman is abused every eight seconds
?? one out of every four women is a victim of domestic violence at least once in her lifetime
(according to the FBI)
?? domestic violence is the single leading cause of injury to American women and affects
approximately four million victims every year
?? is the number one cause (35%) of emergency room visits by women
?? is the leading cause of death in the workplace for women, (according to the CDC) with
over 13,000 incidents reported last year (in addition, 74% of battered women reported
being harmed by their batterer while at work)
42
?? domestic violence costs businesses approximately $5 billion in lost productivity,
absenteeism, employee turnover and health care costs (yet only 28% of U.S. companies
have workplace violence policies, according to the U.S. Department of Justice)
?? 20% of all women are battered by their partners on a repeated basis; and two-thirds of
males who assault their wives once, repeat it within one year (according to the U.S.
Surgeon General)
?? fifty per cent of all homeless women and children are fleeing domestic violence (yet there
are three times as many animal shelters in this country as there are domestic violence
shelters)
In 1998, in Arizona:
?? crisis shelters responded to 20,436 family violence telephone calls, and 14,619 crisis calls
(i.e. sexual assault, suicide, etc.)
?? of the 26,717 women and children requesting shelter, 74% (or 19,775) were turned away
due to no availability of beds
?? of the women receiving shelter care, almost 50% were Caucasian, 25% were Hispanic,
12% were Native American, and 10% were African-American
In 1998, in Phoenix and the surrounding communities:
?? police departments received approximately 80,000 calls reporting domestic violence
?? thirty women, eight men, and one unborn child were killed in domestic violence
homicides in the Phoenix area, resulting in 66 children being without a parent
Battered Women, Economics and Health
In a report published by the Women’s Bureau of the U.S. Department of Labor in 1996, 96% of
female abuse victims who were employed had some type of problem in the workplace as a direct
result of their abuse and/or abuser. These problems included being late (over 60%), missing
work (over 50%), having difficulty performing job duties (over 70%), being reprimanded for
problems associated with the abuse (over 60%), and losing their job (over 30%).
Domestic violence is often exacerbated as women seek to gain economic independence, and
often increases when they attend school and training programs. Batterers often prevent women
from attending such programs, as well as sabotage their efforts at self-improvement.
Several studies have shown direct correlation between domestic violence and health problems.
This has been especially evident in the cases of welfare recipients who became homeless and/or
sheltered. A higher incidence (up to three times that in the general female population) of mental
health issues and post-traumatic stress disorder is recorded among battered women in this
population. According to the National Network to End Domestic Violence Fund, many victims of
domestic violence suffer from depression, mental health problems, post-traumatic stress disorder,
drug and alcohol abuse, and physical health problems.
43
For women who are not homeless or in shelters, there is still a clear relationship between their
victimization and health status. When loss of job and/or income occurs, as noted above, access to
affordable health care becomes limited, and too often the symptoms of poor health remain
unattended for financial reasons.
Responding to the Problem
The past decade has witnessed dramatic changes in the response to domestic violence throughout
the United States. Most of these changes have occurred in the criminal and civil justice systems,
program interventions, and prevention and education efforts. As a result, there is higher
accountability of perpetrators, increased safety and protection of battered women, more
availability of social services, hotlines and shelters, and a higher public awareness of the
problems and solutions. There is also a growing awareness that domestic violence is a complex
problem requiring comprehensive and coordinated community responses from a wide range of
stakeholders, including the legal and criminal justice systems, social service agencies, health care
providers, educational and religious institutions, the business/employer community, and policy-makers
at all levels of government.
The passage of the Violence Against Women Act in 1994 (the first legislation related to domestic
violence) presented several provisions pertaining to batterer accountability and victim protection.
Perhaps most notably, the issuance of grants (e.g. STOP Grants and Community Policing Grants)
were made available to states for the development and upgrading of victims services, training of
law enforcement personnel, and developing better communications and data collection.
Arizona’s STOP Grant in 1999 was $2.3 million.
In Arizona, the State Legislature has also been responsive to domestic violence issues, and
through efforts driven by the Governor’s Office for Domestic Violence, victim protection and
perpetrator accountability have increased. As a result of a major effort of the Maricopa
Association of Governments (MAG), a Regional Plan on Domestic Violence was developed in
1999, which provided a comprehensive framework for a coordinated community response to
domestic violence.
The MAG Plan contains 41 recommendations covering four major areas:
?? prevention and early intervention;
?? crisis intervention and transitional response;
?? systems coordination and evaluation; and
?? long-term response.
In developing the plan, the planning group (comprised of over 150 active participants) found that
the region already had many systems and protocols in place, and that the major needs centered
around an integration of systems, uniform enforcement of protocols, and consistent tracking and
sharing of domestic violence information. In addition, the group based their approach on similar
models used by Tucson/Pima County and Yavapai County so that the resulting plan would
provide consistency with other areas of the state.
44
Among the 41 recommendations contained in the MAG Regional Plan on Domestic Violence,
several were directly related to health care issues for women. Some examples of these are
briefly summarized as follows:
?? Standardize and implement annual training for all hospital personnel.
?? Implement universal screening and provide follow-up services to those who disclose in
hospitals, other health-focused environments, substance abuse and mental health intakes.
?? Integrate domestic violence in the curriculum of medical, nursing, physician assistant,
and nurse practitioner programs.
?? Create a policy change with Boards of Certification to require cross-training on domestic
violence and mental health/substance abuse.
?? Incorporate domestic violence early prevention and early treatment into mental health
and substance abuse treatment programs.
?? Establish/implement hospital protocols as mandated by the Health Resources and
Services Administration.
?? Establish/implement emergency service pre-hospital protocol (fire/emergency
departments).
?? Establish/implement medical/dental clinic and doctor office protocols.
Implications for Health Services for Women
The number of women who are victims of domestic violence far outnumber the number of
women who actually seek help from the justice system and health-related services. While there
have been positive trends in both the incidence of domestic violence and the program outcomes
related to both victim protection and batterer accountability, there remains an urgent need to
continue building on the coordinated community responses that appear successful.
The major implications for health care providers are two-fold:
?? they must remain attentive to the fact that many women may not be ready to address the
domestic violence in their lives; and
?? they must provide services and resources that follow-up on screening and reporting
policies.
Many women come into contact with health care providers because they require medical
attention, but not because they are seeking help for domestic violence. Thus, effective support
and education must be available in the health care setting. Likewise, screening and reporting
policies must ensure that follow-up services are integrated and coordinated. It is not enough to
simply provide victims with information on where to go next for help, and thus inter-agency and
community-based referrals must be held accountable.
45
Summary
The purpose of this book, as stated in the introduction, was to introduce the reader to some of the
most pressing health issues affecting women today. Health care is increasingly about education
and prevention. A review of the status of health among women in Arizona demonstrates that, in
1998:
? ?the mortality rate from coronary heart disease decreased overall, yet increased among Blacks
? ?the mortality rate from strokes decreased among all populations
? ?the mortality rate for cardiovascular disease increased
? ?the mortality rate from cancer decreased overall, while increasing in colorectal cancer
? ?the death rate from diabetes increased in 1998
? ?the number of new exposures to AIDS has decreased overall, yet increased among Blacks
? ?the rate of death from HIV infection showed a much slower decline among women than men
? ?Arizonans were less likely to die from HIV infection than their national peers
? ?the pregnancy rates of females under 20 increased for the first time since 1994
? ?the reported abortion rate for females under 20 increased overall
? ?74% of women and children requesting shelter from domestic violence were turned away
? ?thirty women and one unborn child were killed in domestic violence homicides
While these statistics and the narrative throughout this fact book indicate some improvements in
the status of women’s health in Arizona, they also dramatize the continuing challenges in other
areas. Inequities in the status of health care among ethnic groups is apparent. The increase in
the rate of teen pregnancy sounds an alarm to their increased risk of HIV and AIDS. The
absence of adequate shelter for victims of domestic abuse can only have a negative impact on
their homicide rate.
As decision makers ponder the direction of women’s health care in Arizona, there is a clearly
need for continued concentrated focus to insure that women’s unique health needs are
understood and addressed.
46
Resources
American Psychiatric Association
1400 K Street, N.W.
Washington, D.C. 20005
(888) 852-8330
American Psychological Association
Office of Public Affairs
750 First St., NE
Washington, D.C. 20002-4242
(202) 336-5700
Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852-2624
(301) 231-9350
Arizona Coalition Against Domestic Violence
100 W. Camelback, Suite 109
Phoenix, Arizona 85013
602-279-2900
800-782-6400
Arizona Department of Health Services
Bureau of Public Health Statistics
Office of Epidemiology & Statistics
www.hs.state.az.us
Arizona Nutrition Network
Arizona Department of Health Services
Offices of Nutrition Services
(602) 542-1886
Centers for Disease Control & Prevention
Office of Women’s Health
1600 Clifton Road, MS: D-51
Atlanta, GA 30033
Phone: (404) 639-7230
City of Phoenix Family Advocacy Center
2120 N. Central Avenue, Suite 250
Phoenix, Arizona 85004
602-534-2120
47
Governor’s Commission on
The Status of Women in Illinois
February 1998
Indiana Takes Action for Women’s Health 1999
M.A.G.N.U.M.
(Migraine Awareness Group: A National Understanding for Migraineurs)
113 S. St. Asapt St.
Alexandria, VA 22314
(703) 739-9384
Maricopa Association of Governments
302 N. First Avenue, Suite 300
Phoenix, Arizona 85003
602-254-6300
mag@mag.maricopa.gov
Mental Health Association of Arizona
6411 E. Thomas Rd.
Scottsdale, AZ 85251
Phone: (602) 994-4407
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
Building 31, Room 4C05
31 Center Drive, MSC 2350
Bethesda, MD 20892-2350
(301) 496-8188
National Institute of Mental Health
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663
(888) 8-ANXIETY
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
(800) 969-NMHA
48
National Osteoporosis Foundation
1232 22nd St., NW
Washington, D.C. 20037-1292
(202) 223-2226
Office of Epidemiology and Statistics
Bureau of Public Health Statistics
Arizona Department of Health Services
Phone: (602) 542-1216
Our Bodies, Ourselves for the New Century
The Boston Women’s Health Book Collective
A Touchstone Book
Published by Simon & Schuster
Copyright, 1984, 1992, 1998
RESOLVE National Office
1310 Broadway
Somerville, MA 02144-1731
The Commonwealth Fund
Health Concerns Across a Woman’s Lifespan
1998 Survey of Women’s Health
The Harvard Guide to Women’s Health
Karen J. Carlson, MD
Stephanie A. Eisenstat, MD
Pub: Harvard University Press
Copyright 1996
US Department of Health & Human Services
National Institutes of Health
Rockville, MD 20857
(800) 421-4211
Women’s Health Care – A Comprehensive Handbook
Edited by
Catherine Ingram Fogel and Nancy Fugate Woods
Sage Publications
Copyright 1995
49
For further information on domestic violence issues and resources in Arizona:
Community Information & Referral
602-263-8856
800-352-3792
National Domestic Violence Hotline
1-800-799-SAFE (7233)
National Sexual Abuse Hotline
1-800-656-HOPE (4673)
National Resource Center on Domestic Violence
1-800-537-2238
Shelter Hotline (CONTACS)-Maricopa County
602-263-8900
800-799-7739
50