Skip to main content

Advertisement

SpringerLink
Log in

Osteoporosis Medications Used by Older African–American Women: Effects of Socioeconomic Status and Psychosocial Factors

  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

This study examined the effects of socioeconomic status, knowledge and Health Belief Model variables on ever use of hormone therapy and other osteoporosis medications among older African–American women. One-hundred and two African–American women, 60 years old or older, randomly selected from Registers of Voters and a list of participants in educational activities of a university hospital, were interviewed in their homes. Data collected concerned knowledge of osteoporosis, Health Belief Model variables, and cues to action such as history of hysterectomy, personal and family history of cancer, bone mineral density testing, and discussion with a physician about osteoporosis. Socioeconomic status indicators included years of education and household income. The average respondent age was 71.1 years; 47% were current or previous users (ever users) of hormone therapy, and 11% were ever users of other osteoporosis medications. Knowledge of osteoporosis, (odds ratio = 1.4), Hormone therapy benefits, (odds ratio = 1.63), a hysterectomy (odds ratio = 4.35), and a family history of cancer (odds ratio = 4.0) increased the odds of ever using hormone therapy. Perceptions of susceptibility (odds ratio = 3.5) and discussion with a physician about osteoporosis (odds ratio = 6.4) increased odds of ever using other osteoporosis medications. Socioeconomic status mediated the effects of knowledge of osteoporosis on ever using hormone therapy. Efforts to promote bone health to older African–American women should focus primary efforts to increasing perceptions of susceptibility to fracture and persuading physicians to initiate discussions about fracture prevention with African–American patients before a fracture occurs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. JA Barrett JA Baron MR Karagas ML Beach (1999) ArticleTitleFracture risk in the US Medicare population J Clin Epidemiol 52 243–249 Occurrence Handle10.1016/S0895-4356(98)00167-X Occurrence Handle1:STN:280:DyaK1M3isV2nug%3D%3D Occurrence Handle10210242

    Article  CAS  PubMed  Google Scholar 

  2. SE Kellie JA Brody (1990) ArticleTitleSex-specific and race-specific hip fracture rates Am J Public Health 80 326–328 Occurrence Handle1:STN:280:By%2BC28vot1Q%3D Occurrence Handle2305917

    CAS  PubMed  Google Scholar 

  3. L Adams-Campbell L Rosenberg RA Washburn RS Rao KS Kim S Palmer (2000) ArticleTitleDescriptive epidemiology of physical activity in African–American women Prev Med 30 43–50 Occurrence Handle10.1006/pmed.1999.0604 Occurrence Handle1:STN:280:DC%2BD3c7htFersw%3D%3D Occurrence Handle10642459

    Article  CAS  PubMed  Google Scholar 

  4. KA Jackson Savaiano DA (2001) ArticleTitleLactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans J Amer Coll Nutr 20 198S–207S Occurrence Handle1:CAS:528:DC%2BD3MXktValtLo%3D

    CAS  Google Scholar 

  5. JA Kotzan BC Martin WE Wade (1999) ArticleTitlePersistence with estrogen therapy in a postmenopausal Medicaid population Pharmacotherapy 19 363–369 Occurrence Handle10.1592/phco.19.4.363.30935 Occurrence Handle1:STN:280:DyaK1M3js1Gltw%3D%3D Occurrence Handle10221376

    Article  CAS  PubMed  Google Scholar 

  6. KM Brett JH. Madans (1997) ArticleTitleUse of postmenopausal hormone replacement therapy: Estimates from a nationally representative cohort study Am J Epidemiol 145 536–545 Occurrence Handle1:STN:280:ByiB3Mjjt1c%3D Occurrence Handle9063344

    CAS  PubMed  Google Scholar 

  7. I Rosenstock VJ Strecher MH. Becker (1988) ArticleTitleSocial learning theory and the health belief model Health Educ Quart 15 175–185 Occurrence Handle1:STN:280:BieB2czkvVM%3D

    CAS  Google Scholar 

  8. SE Geller R Derman (2001) ArticleTitleKnowledge, beliefs and risk factor for osteoporosis among African–American and Hispanic women J Natl Med Assoc 93 13–21 Occurrence Handle1:STN:280:DC%2BD3s7jvVarsA%3D%3D Occurrence Handle12653376

    CAS  PubMed  Google Scholar 

  9. C Unson N Dunbar L Curry L Kenyon K. Prestwood (2001) ArticleTitleThe effects of knowledge, attitudes, and significant others on decisions to enroll in a clinical trial on osteoporosis: Implications for recruitment of older African–American women J Natl Med Assoc 93 392–401 Occurrence Handle1:STN:280:DC%2BD3MnjsFKhsA%3D%3D Occurrence Handle11688920

    CAS  PubMed  Google Scholar 

  10. C Unson E Siccion J Gaztambide S Gaztambide P Mahoney-Trella K. Prestwood (2003) ArticleTitleNon-adherence and treatment preferences among older women: A qualitative study J Womens Health 12 1037–1045 Occurrence Handle10.1089/154099903322643965 Occurrence Handle1:STN:280:DC%2BD2c%2Fht12isA%3D%3D

    Article  CAS  Google Scholar 

  11. C Hsieh K Novielli J Diamond D Cheruva (2001) ArticleTitleHealth beliefs and attitudes toward the prevention of osteoporosis in older women Menopause 8 372–376 Occurrence Handle10.1097/00042192-200109000-00013 Occurrence Handle1:STN:280:DC%2BD3Mvos1Sjtw%3D%3D Occurrence Handle11528365

    Article  CAS  PubMed  Google Scholar 

  12. JA Grisso JL Kelsey BL Strom et al. (1994) ArticleTitleRisk factors for hip fracture in black women. The Northeast Hip Fracture Study Group N Engl J Med 330 1555–1559 Occurrence Handle1:STN:280:ByuB3s3isF0%3D Occurrence Handle8177244

    CAS  PubMed  Google Scholar 

  13. JM Neuner EP McCarthy RB Davis RS Phillips (2003) ArticleTitlePhysician counseling on hormone replacement therapy and bone loss: Do socioeconomic and racial characteristics of women influence counseling? J Womens Health 12 495–504 Occurrence Handle10.1089/154099903766651621

    Article  Google Scholar 

  14. AF Brown EJ Perez-Stable EE Whitaker et al. (1999) ArticleTitleEthnic differences in hormone replacement prescribing patterns J Gen Intern Med 14 663–669 Occurrence Handle10.1046/j.1525-1497.1999.10118.x Occurrence Handle1:STN:280:DC%2BD3c%2FktVCltg%3D%3D Occurrence Handle10571714

    Article  CAS  PubMed  Google Scholar 

  15. National Osteoporosis Foundation. Boning up on Osteoporosis: A guide to prevention and treatment. 1998

  16. J Hays JK Ockene R Brunner et al. (2003) ArticleTitleEffects of estrogen plus progestin on health-related quality of life N Engl J Med 348 1839–1854 Occurrence Handle10.1056/NEJMoa030311 Occurrence Handle1:CAS:528:DC%2BD3sXjsVCht7k%3D Occurrence Handle12642637

    Article  CAS  PubMed  Google Scholar 

  17. L. Speroff (1998) ArticleTitleThe heart and estrogen/progestin replacement study (HERS) Maturitas 31 9–14 Occurrence Handle10.1016/S0378-5122(98)00104-2 Occurrence Handle1:STN:280:DyaK1M7ptFaquw%3D%3D Occurrence Handle10091199

    Article  CAS  PubMed  Google Scholar 

  18. KJ Miller JC Conney NL Rasgon LA Fairbanks GW. Small (2002) ArticleTitleMood symptoms and cognitive performance in women estrogen users and nonusers and men J Am Geriatr Soc 50 1826–1830 Occurrence Handle10.1046/j.1532-5415.2002.50511.x Occurrence Handle12410901

    Article  PubMed  Google Scholar 

  19. MP Brincat (2000) ArticleTitleHormone replacement therapy and the skin Maturitas 35 107–117 Occurrence Handle10.1016/S0378-5122(00)00097-9 Occurrence Handle1:CAS:528:DC%2BD3cXltlygurY%3D Occurrence Handle10924836

    Article  CAS  PubMed  Google Scholar 

  20. A. Graziottin (2000) ArticleTitleLibido: The biologic scenario Maturitas 34 IssueIDSupp 1 9–16 Occurrence Handle10.1016/S0378-5122(99)00072-9

    Article  Google Scholar 

  21. InstitutionalAuthorNameWriting Group of the Women’s Health Initiative Investigators (2002) ArticleTitleRisks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative Randomized Controlled Trial JAMA 288 321–333

    Google Scholar 

  22. InstitutionalAuthorNameThe Women’s Health Initiative Steering Committee. (2004) ArticleTitleEffects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative Randomized Controlled Trial JAMA 291 1701–1712

    Google Scholar 

  23. EM Rogers (1995) Diffusion of Innovations EditionNumber4 The Free Press New York

    Google Scholar 

  24. B Ettinger A Pressman P Silver (1999) ArticleTitleEffect of age on reasons for initiation and discontinuation of hormone replacement therapy Menopause 6 282–289 Occurrence Handle1:STN:280:DC%2BD3c%2FotVeisw%3D%3D Occurrence Handle10614674

    CAS  PubMed  Google Scholar 

  25. T Vihtamaki R Savilahti R. Tuimala (1999) ArticleTitleWhy do postmenopausal women discontinue hormone replacement therapy Maturitas 33 99–105 Occurrence Handle10.1016/S0378-5122(99)00047-X Occurrence Handle1:STN:280:DC%2BD3c%2FmsVOnsQ%3D%3D Occurrence Handle10597873

    Article  CAS  PubMed  Google Scholar 

  26. D Friedman-Koss CJ Crespo MF Belanntoni RE Andersen (2002) ArticleTitleThe relationship of race/ethnicity and social class to hormone replacement therapy: Results from the Third National Health and Nutrition Examination Survey Maturitas 9 264–272

    Google Scholar 

  27. C Finley EW Gregg LJ Solomon E Gay (2001) ArticleTitleDisparities in hormone replacement therapy use by socioeconomic status in a primary care population J Community Health 26 39–49 Occurrence Handle10.1023/A:1026537114638 Occurrence Handle1:STN:280:DC%2BD3MzgslWhsw%3D%3D Occurrence Handle11297189

    Article  CAS  PubMed  Google Scholar 

  28. L Rosenberg JR Palmer S Rao I. Adams-Campbell (1998) ArticleTitleCorrelates of postmenopausal female hormone use among black women in the United States Obstet Gynecol 91 454–458 Occurrence Handle10.1016/S0029-7844(97)00699-6 Occurrence Handle1:STN:280:DyaK1c7ltVynsw%3D%3D Occurrence Handle9491877

    Article  CAS  PubMed  Google Scholar 

  29. HH Weng CM McBride HB Bosworth SC Grambow IC Siegler LA. Bastian (2001) ArticleTitleRacial differences in physician recommendation of hormone replacement therapy Prev Med 33 668–673 Occurrence Handle10.1006/pmed.2001.0943 Occurrence Handle1:STN:280:DC%2BD3MnntFOktA%3D%3D Occurrence Handle11716665

    Article  CAS  PubMed  Google Scholar 

  30. S. Kumanyika (2001) Minority populations L Burke IS Ockene (Eds) Compliance in Healthcare and Research Futura Publishing Company, Inc. Armonk, NY 195–218

    Google Scholar 

  31. DO Clark (1995) ArticleTitleRacial and educational differences in physical activity among older adults Gerontol 35 472–480 Occurrence Handle1:STN:280:BymD3cvkvFM%3D

    CAS  Google Scholar 

  32. CA Pratt L Ha SR Leviene CB Pratt (2003) ArticleTitleStroke knowledge and barriers to stroke prevention among African–Americans: Implications for health communication J Health Commun 8 369–281 Occurrence Handle10.1080/10810730305725 Occurrence Handle12907401

    Article  PubMed  Google Scholar 

  33. T Satterfield SM Johnson P Slovic N Neil JR Schein (2000) ArticleTitlePerceived risks and reported behaviors associated with osteoporosis and its treatment Women Health 31 21–40 Occurrence Handle10.1300/J013v31n04_02 Occurrence Handle1:STN:280:DC%2BD3M3hvVOguw%3D%3D

    Article  CAS  Google Scholar 

  34. SJ Blalock RF DeVellis KB Giorgino et al. (1996) ArticleTitleOsteoporosis prevention in premenopausal women: Using a stage model approach to examine the predictors of behavior J Health Psychol 15 84–93 Occurrence Handle10.1037//0278-6133.15.2.84 Occurrence Handle1:STN:280:BymB28fpsVE%3D

    Article  CAS  Google Scholar 

  35. S Gabriel TS Kneeland LJ Melton SuffixIII MM Moncur B Ettinger ANA Tosteson (1999) ArticleTitleHealth-related quality of life in economic evaluations of osteoporosis Med Decision Making 19 141–148 Occurrence Handle1:STN:280:DyaK1M3ks1WjtQ%3D%3D

    CAS  Google Scholar 

  36. W Fisher M Sand W Lewis Boroditsky R (2002) ArticleTitleCanadian menopause study-I: Understanding women’s intentions to utilize hormone replacement therapy Maturitas 37 1–14 Occurrence Handle10.1016/S0378-5122(00)00163-8

    Article  Google Scholar 

  37. S Robert JS. House (1996) ArticleTitleSES differentials in health by age and alternative indicators of SES J Aging Health 8 359–388 Occurrence Handle1:STN:280:BymE3Mfhslc%3D Occurrence Handle10165980

    CAS  PubMed  Google Scholar 

  38. O Knesebeck G Luschen WC Cocerkham J Siegrist (2003) ArticleTitleSocioeconomic status and health among the aged in the United States and Germany: A comparative cross-sectional study Soc Sci Med 57 1643–1652 Occurrence Handle10.1016/S0277-9536(03)00020-0 Occurrence Handle12948573

    Article  PubMed  Google Scholar 

  39. J Ware KK Snow M Kosinski B Gandek (1993) SF-36 Health Survey Manual and Interpretation Guide Health Institute, New England Medical Center Hospitals Boston, MA

    Google Scholar 

  40. S Bellantonio R Fortinsky K. Prestwood (2001) ArticleTitleHow well are community-living women treated for osteoporosis after hip fracture? J Am Geriatr Soc 49 1197–204 Occurrence Handle10.1046/j.1532-5415.2001.49237.x Occurrence Handle1:STN:280:DC%2BD3MrhtF2ktw%3D%3D Occurrence Handle11559379

    Article  CAS  PubMed  Google Scholar 

  41. L Quine DR Rutter L Arnold (2000) Comparing the Theory of Planned Behavior and the Health Belief Model: The example of safety helmet use among schoolboy cyclists P Norman C Abraham M Conner (Eds) Understanding and Changing Health Behaviour: From Health Beliefs to Self-regulation Harwood Academic Publishers Amsterdam 73–100

    Google Scholar 

  42. JA Harrison PD Mullen LW Green (1992) ArticleTitleA meta-analysis of studies of the Health Belief Model with adults Health Education Research 7 107–116 Occurrence Handle1:STN:280:ByyK3cvnsFM%3D Occurrence Handle10148735

    CAS  PubMed  Google Scholar 

  43. KF Mauck MT Cuddihy RT Trousdale GR Pond VS Pankratz LJI Melton (2002) ArticleTitleThe decision to accept treatment for osteoporosis following hip fracture: Exploring the woman’s perspective using a Stage-of-Change Model Osteoporosis Int 13 560–564 Occurrence Handle10.1007/s001980200073 Occurrence Handle1:STN:280:DC%2BD38zmslSmsw%3D%3D

    Article  CAS  Google Scholar 

  44. RD Chapurlat DC Bauer M Nevitt K Stone SR Cummings (2003) ArticleTitleIncidence and risk factors for a second hip fracture in elderly women: The study of osteoporotic fractures Osteoporosis Int 14 130–136 Occurrence Handle1:STN:280:DC%2BD3s3htlKhtQ%3D%3D

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Communication Department, Western Connecticut State University, 181 White Street, CT, Danbury, 06810, USA

    Christine G. Unson PhD

  2. Associate Professor, Center on Aging, School of Medicine, University of Connecticut Health Center, USA

    Richard Fortinsky PhD & Karen Prestwood MD

  3. Department of Behavioral Science and Community Health, School of Dental Medicine, Western Connecticut State University, USA

    Susan Reisine PhD

Authors
  1. Christine G. Unson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Fortinsky PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen Prestwood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Reisine PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine G. Unson PhD.

Additional information

NIH Grant No. 5P60-AG1363111 supported this paper. Dr. Unson was connected with the Center on Aging, University of Connecticut Health Center when this study was conducted.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Unson, C.G., Fortinsky, R., Prestwood, K. et al. Osteoporosis Medications Used by Older African–American Women: Effects of Socioeconomic Status and Psychosocial Factors. J Community Health 30, 281–297 (2005). https://doi.org/10.1007/s10900-005-3706-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-005-3706-3

Key words

Search

Navigation