D. Selected Health Behaviors and Behavioral Risks

Many human behaviors negatively affect women’s health, such as smoking, overeating and poor nutrition, binge and chronic drinking, and lack of exercise. The Behavioral Risk Factor Surveillance System (BRFSS) monitors many risky behaviors and their impact on chronic disease prevention. Indiana has been a pioneer among the states participating in BRFSS since 1984, in cooperation with the Centers for Disease Control (CDC). This is a rich source of data about adult health behaviors and preventive practices. However, the data are self-reported, so there is a danger of under-reporting behaviors that are socially unacceptable or unhealthy, such as smoking or binge drinking, and over-reporting behaviors that are socially desirable, such as the amount of exercise done. Responses are also affected by participants’ ability to recall past behaviors accurately. Furthermore, the survey excludes households without telephones, which may result in a biased sample that under-represents part of the population about which information is most needed, such as the medically underserved population.

The first table in this section shows Indiana’s rankings for seven important women’s health factors: overweight, smoking, participation in physical activity, fair or poor health status, Pap smear, mammogram, and diabetes.

Recently, the Surgeon General released a report indicating that smoking constitutes a serious, and growing, health risk for American women. According to that report, “smoking is the leading known cause of preventable death and disease among women.” Although the number of American men who smoked used to be higher than the number of women who smoked, since World War II women have begun to equal men in number of smokers. Today, lung cancer surpasses breast cancer as the leading cause of cancer deaths among women. Adolescent girls represent a major segment of the growing female smoking population. Negative effects of tobacco use include cardiovascular disease, cancers, chronic lung disease, general morbidity, sexual dysfunction, and complications of pregnancy, such as low birth weight and intrauterine growth retardation. The negative effects of smoking and second-hand smoke were evident as long ago as the nineteenth century, when Alice B. Stockham noted, “Few realize the ill effects of [tobacco], especially upon the pregnant woman, the fetus and the infant” (Stockham 1901, page 327). Smoking is also said to contribute to the development of wrinkles, a point that some hope to use to combat smoking among young and middle-aged women (Greenberger 2001, page 222). However, women generally find it tougher to quit smoking than men do. The sponsoring of beauty pageants, sports events, and music events by tobacco companies represents a mixed message for women, especially young women, looking to avoid or cease smoking.

In Indiana, 26.9% of people age 18 and over are current smokers according to 2000 BRFSS data. Approximately 26.9% of adult men smoke, and approximately 25.5% of adult women smoke. Over the last decade, Indiana has consistently exceeded the national average for smoking by women (21.2% in 2000). As the BRFSS rankings show, Indiana ranks fourth in the prevalence of smoking among women compared to the other states and the District of Columbia. Smoking prevalence in the United States is higher among women with 9-11 years of education (32.9%) than among women with 16 or more years of education (11.2%). Smoking prevalence also varies nationally by ethnic and racial group.

Smoking during pregnancy is difficult to track, although it appears to be decreasing. However, according to the Surgeon General, it could still be as high as 22%. However, a higher percentage of women stop smoking during pregnancy than at other times in their life. Unfortunately, only one-third of women who refrain from smoking during pregnancy are still abstaining a year after their baby is born. In Indiana in 1999, 20.9% of births were to mothers who smoked.

Obesity is another serious American epidemic. “The American public has experienced a dramatic increase in obesity since the National Health and Nutrition Examination Survey (NHANES II) conducted between 1976-1980” (Rose 2001). Since 1991, obesity (body mass index of 30 or higher) among adults has increased by nearly 60%. In the United States in 1999, 19.5% of people were classified as obese, compared to 19.9% in Indiana in the same year. In Indiana, the increase in obesity since 1991 has been only slightly less dramatic than the national increase. The increase in Indiana happened sooner (by 1995) and has leveled off since then. Over half of Indiana residents age 18 and over are either overweight or obese based on body mass index (BMI). A higher percentage of blacks are obese compared to whites in Indiana.

Women are differentially impacted by obesity when it comes to cardiovascular risk (Avis and Crawford 2001, p. 231), with risk increasing as women age and gain weight. Some of these weight changes may be associated with biological changes during and after menopause, although research results are inconclusive at the moment.

Acute (binge) and chronic drinking are serious health risks. Binge drinking is defined as the consumption of five or more alcoholic drinks on a single occasion at least once in the past month. In the United States in 1998, 20% of teenage girls reported some alcohol consumption during the past month and 7% reported binge drinking. Nationally, pregnant women aged 15-44 report lower use of alcohol and less binge drinking than non-pregnant women of the same age. In Indiana in 1999, 10.6% of women age 18 or older self-reported acute (binge) drinking and 1.0% of women self-reported chronic drinking. Acute (binge) drinking was an activity among 35.6% of women aged 18-24 in the same year, compared to 19.0% of the overall population. Chronic drinking was a problem for 3.4% of women in the same age group in the same year, compared to 6.1% of the overall population. Women engage in binge and chronic drinking less than men across almost all age groups. The exception is for women age 65 and over, who self-reported chronic drinking in about equal percentage as men.

A sedentary lifestyle is one where adults report little or no leisure-time physical activity or irregular activity. According to the Surgeon General’s report on physical activity and health, “people of all ages can improve the quality of their lives through a lifelong practice of moderate physical activity. . . . people who are already physically active will benefit even more by increasing the intensity or duration of their activity” (U.S. Department of Health and Human Services 1999). Sixty percent of all Americans are not regularly active, and one-fourth of all Americans engage in no regular physical activity of any kind. Only 15% of American adults report engaging regularly in stimulating physical activity during leisure time, and approximately 22% of adults regularly engage in sustained physical activity during leisure time. Physical inactivity is more prevalent among women than among men, among blacks and Hispanics than among whites, among older than among younger adults, and among less affluent and less educated than among more affluent and more educated Americans.

Women in Indiana are slightly more likely than men to be sedentary more than two days out of a month (1999 BRFSS data). For 2000, women were limited in their activities for 3.4 of the past 30 days compared to 3.6 for men and 3.4 overall in Indiana (unpublished 2000 BRFSS data). In 1998, 27% of Indiana residents reported no leisure time physical activity, but no separate statistics are available for women.