The Black Women's Health Study (BWHS)

Black Women's Health Study Publications

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Black Women's Health Study
Slone Epidemiology Center at Boston University
1010 Commonwealth Avenue
Boston, MA 02215
1-800-786-0814
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Last Updated: April, 2009

Articles are listed chronologically from the least to the most recent.
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Rosenberg L, Adams-Campbell L, Palmer JR. The Black Women’s Health Study: A follow-up study for causes and preventions of illness. J Am Med Wom Assoc 1995;50:56-8.

Most previous epidemiologic studies have been of white populations. The Black Women’s Health Study, a follow-up study, is the largest study of U.S. black women yet conducted. This paper discusses the study methods. The major aims include identifying risk factors for breast cancer and other cancers. The study will also assess risk factors for a wide range of other serious illnesses that affect black women, such as high blood pressure, diabetes, uterine fibroids and lupus.
Rosenberg L, Rao RS, Adams-Campbell L, Palmer JR. Risk factors for myocardial infarction among African-American women. (Abstract) Am J Epidemiol 1997;145:S45.

Risk factors for myocardial infarction (heart attack) in black women have received little study. Cigarette smoking, high blood pressure, diabetes, high cholesterol levels, family history of heart attack, and overweight were associated with a higher risk of heart attack.
McAlindon T, Felson D, Palmer J, Zhang Y, Rosenberg L. Associations of cigarette smoking and alcohol with systemic lupus erythematosus (SLE) among participants in the Black Women’s Health Study. (Abstract) Arthritis Rheum 1997;40(Suppl):S162.

In preliminary analyses, cigarette smoking was more common and alcohol consumption less common among women who reported having lupus than among women who did not have this condition.
Rosenberg L, Palmer JR, Adams-Campbell LL. Postmenopausal female hormone use and venous thromboembolic disease in black women. (Letter) Am J Obstet Gynecol 1997;177:1275.

Recent studies suggest that the risk of clots in the legs or lung may be higher among women who are using postmenopausal female hormones than among nonusers. Data from the BWHS support this possibility. These findings have been confirmed by data from randomized studies.
Rosenberg L, Palmer JR, Rao RS, Adams-Campbell LL. Correlates of postmenopausal female hormone use among black women in the United States. Obstet Gynecol 1998;91:454-8.

The use of menopausal female hormone supplements was highest among women who had had both ovaries removed. Rates were also higher among women who lived in the West, were thin, or had higher levels of education. These findings suggest that factors associated with female hormone use in black and white women are similar. See discussions of the benefits and risks of female hormone supplements in the January 2002 Newsletter and the January 2003 Newsletter.
Kumanyika S, Mauger D, Mitchell D, Smiciklas-Wright H, Palmer JR. Comparison of food diaries vs. 24-hour recalls for food frequency data calibration in black women. (Abstract) Eur J Clin Nutr 1998;52(2S):S84.

In a diet validation study, food diaries and 24-hour recalls gave similar values for intake of fat, saturated fat, fiber and beta-carotene when adjusted for energy intake.
Lancaster K, Smiciklas-Wright H, Kumanyika S, Mitchell D, Mauger D, Palmer J. Comparison of characteristics of responders vs. non-responders for 3-day food records in African-American women. (Abstract) FASEB J 1998;12(4) Part I:A525.

Women who provided food records did not differ materially in terms of body mass index, age, education, or region of residence from those who did not provide records.
McAlindon T, Felson D, Palmer J, Rosenberg L. Associations of body mass index (BMI), smoking, and alcohol with SLE in the Black Women’s Health Study. (Abstract) Lupus 1998;7(S1):70.

In preliminary analyses, lupus was positively related to cigarette smoking, and inversely to alcohol use. The relationship to body mass index was unclear.
Kim KS, Adams-Campbell L, Palmer JR, Rosenberg L. Physical activity and high blood pressure: Black Women’s Health Study. (Abstract) Ethn Dis 1998;8:272.

Strenuous physical activity in the past year was associated with reduced risk of high blood pressure.
Palmer JR, Rosenberg L, Adams-Campbell LL, Rao RS. Correlates of hysterectomy in African-American women. (Abstract) Am J Epidemiol 1998;147:S58.

These preliminary analyses suggest that nonmedical factors, namely the region of the U.S. in which a woman lives and her level of education, may play a role in the high rate of early hysterectomy among African-American women.
Rosenberg L, Palmer JR, Adams-Campbell LL, Rao RS. Obesity and hypertension among college-educated black women in the United States. J Hum Hypertens 1999;13:237-41.

There was a high rate of overweight and of high blood pressure among BWHS participants with high levels of education. This was also the case among women with less education. Overweight was strongly associated with an increased risk of high blood pressure at all educational levels.
Rosenberg L, Palmer JR, Rao RS, Adams-Campbell L. Risk factors for coronary heart disease in African-American women. Am J Epidemiol 1999;150:904-9.

BWHS data suggest that important risk factors of coronary heart disease in black and white women are similar. These include smoking, high blood pressure, diabetes, high cholesterol, family history of heart attack, and obesity. Because most of these factors can be modified (for example, women can give up smoking and they can take medication for high blood pressure), it is possible for many black women to reduce their risk of developing heart disease.
Russell CW, Palmer JR, Adams-Campbell LL, Rosenberg L. The Black Women’s Health Study: Methods for maintaining follow-up in a mobile population. (Abstract) Am J Epidemiol 1999;149:S17.

There was a high rate of changing addresses in the BWHS between enrollment and completion of the first follow-up. Moving was strongly related to age, with the youngest women moving most often. Methods used to maintain contact include Newsletters, use of the national change of address file, the postal service, and friends and relatives of participants.
Palmer JR, Rao RS, Adams-Campbell LL, Rosenberg L. Height in relation to breast cancer risk in the Black Women’s Health Study. (Abstract) Am J Epidemiol 1999;149:S53.

As in many studies of other populations, increased height was associated with a small increase in the risk of breast cancer.
Rosenberg L, Adams-Campbell LL, Kim KS, Palmer JR. Physical activity and breast cancer among African-American women. (Abstract) Am J Epidemiol 1999;149:S53.

In these preliminary analyses, there was a trend of decreasing risk of breast cancer with increasing exercise during early reproductive life.
Palmer JR, Rao RS, Adams-Campbell LL, Rosenberg L. Correlates of hysterectomy among African-American women. Am J Epidemiol 1999;150;1309-15.

Women who lived in the South or who had lower levels of education were more likely to have had an early hysterectomy than women with higher levels of education or who lived in other regions. Different rates of medical conditions that lead to hysterectomy did not explain the differences. The associations with region and education suggest that some women are not being told of possible alternatives to hysterectomy.
Adams-Campbell LL, Rosenberg L, Washburn RA, Rao RS, Kim KS, Palmer JR. Descriptive epidemiology of physical activity in African-American women. Prev Med 2000;30:43-50.

BWHS participants generally reported low levels of physical activity. Greater participation in strenuous exercise was related to higher levels of education. Participation in exercise was also greater among women who had exercised in high school, suggesting that educational efforts to increase levels of physical activity should start at early ages.
Kumanyika S, Rosenberg L, Palmer JR, Rao RS, Adams-Campbell LL. Demographic and personal factors associated with obesity in the Black Women's Health Study (BWHS) cohort. (Abstract) Am J Epidemiol 2000;151:S52.

Obesity as an adult was strongly associated with obesity at age 18 and with physical inactivity. These findings suggest a need to emphasize obesity prevention in childhood and adolescence and to promote participation in physical activity.
Rosenberg L, Palmer JR, Rao RS, Corwin M. Risk factors for preterm birth among women in the Black Women's Health Study. (Abstract) Am J Epidemiol 2000;151:S13.

In these preliminary analyses, preterm birth was most strongly associated with having had a previous preterm birth, the mother having been preterm herself, and the mother having had no previous children. Preterm birth was less common among women with higher levels of education.
Cozier Y, Jones C, Palmer JR, Rao RS, Adams-Campbell LL, Rosenberg L. Perceptions and experiences of racism among African-American women. (Abstract) Am J Epidemiol 2000;151:S24.

The frequency of reporting experiences and perceptions of racism was greater among younger women. The frequency was also higher among women with higher levels of education. The latter suggests that experiences and perceptions of racism do not diminish with increasing socioeconomic status as measured by level of education.
Formica MK, McAlindon TE, Palmer JR, Rosenberg L. Discoid lupus erythematosus and smoking among African-American women. (Abstract) Am J Epidemiol 2000;151:S88.

Discoid lupus is a form of lupus that affects the face and scalp. These data suggest that cigarette smoking may increase the risk.
Lancaster KJ, Smiciklas-Wright H, Kumanyika SK, Mitchell DC, Mauger D, Palmer JR. Food diary response rates in a sample of African-American women: respondent characteristics and nutrient intake. J Am Diet Assoc 2000;100(12):1532-5.

A diet validation study was carried out within the BWHS, in which participants were asked to provide 24-hour recalls of food intake by telephone, and also to keep 3-day food diaries, which they mailed in. This paper reports on characteristics of women who kept food diaries and those who did not. There were some differences, such as women who did not keep food diaries having more child-care responsibilities than those who kept diaries, but the nutrient intakes of the two groups were similar.
McAlindon TE, Formica MK, Palmer JR, Rosenberg L. Is childhood smoke exposure a risk factor for SLE? Results from the Black Women’s Health Study (BWHS). (Abstract) Arthritis Rheum 2000;43(S):S237.

Adult smoking and exposure to the smoke of others were assessed in relation to systemic lupus erythematosus (SLE, lupus), based on 46 BWHS participants who developed the illness. Both smoking in adulthood and childhood exposure to smoke were associated with an increased risk of lupus. The collection of further data will permit more informative analyses of this possibility.
Palmer JR, Rao RS, Adams-Campbell LL, Rosenberg L. Height and breast cancer risk: results from the Black Women’s Heath Study. Cancer Causes Control 2001;12:343-8.

BWHS data indicate that taller women have a slightly higher risk of developing breast cancer than shorter women. The difference in risk between tall and short women is too small to be of any importance to individuals, but it is of scientific interest because it may provide some clues about the causes of breast cancer. One theory is that taller women have more breast cells, providing more opportunity for a mutation to occur that leads to cancer. Another theory involves hormones that affect both height and cell division.
Cozier Y, Palmer JR, Rosenberg L, Adams-Campbell LL. Recent mammography use among African-American women. Ethn Dis 2001;11:188-91.

In the past, lower rates of mammography use among black women may have resulted in later diagnosis of breast cancer, leading to higher mortality rates than among white women. In 1997, the National Cancer Institute and American Cancer Society changed their mammography guidelines to recommend annual screening mammograms for women aged 40 and older. Information provided by BWHS participants in 1995 indicates that their rates of mammography use are high, and that a high proportion of women 40-49 made use of mammography even before the new guidelines were introduced.
Adams-Campbell LL, Rosenberg L, Rao RS, Palmer JR. Strenuous physical activity and breast cancer risk in African-American women. J Natl Med Assoc 2001;93:267-75.

In recent years evidence from studies of white women has suggested that exercise may reduce the occurrence of breast cancer. Results from the BWHS are the first concerning black women. Based on cases of breast cancer that participants reported when they entered the BWHS in 1995, strenuous physical activity in young adulthood was associated with reduced breast cancer risk. While the results suggest a protective effect of strenuous exercise, they are not definitive because it is necessary to demonstrate this with newly occurring cases of breast cancer. It will be possible to assess exercise in relation to newly occurring breast cancer in the BWHS after further years of follow-up.
Russell C, Palmer JR, Adams-Campbell LL, Rosenberg L. Follow-up of a large cohort of Black women. Am J Epidemiol 2001;154:845-53.

High retention rates in follow-up studies like the BWHS are essential for valid results. Participants in the BWHS are highly mobile, with 56% having moved at least once during the first follow-up period. Multiple sources of information were used to locate participants whose addresses were unknown, including the postal service, participants themselves through postcards, telephone calls, and emails, and contacts of participants. Adequate follow-up was attained, with the most cost-effective method for eliciting completed questionnaires being multiple mailings of questionnaires.
Palmer JR, Rao RS, Adams-Campbell LL, Rosenberg L. Age at attainment of adult height in relation to risk of breast cancer in Black Women’s Health Study. (Abstract) Am J Epidemiol 2001;153:S33.

The hypothesis has been raised that later age at reaching adult height may be related to a reduced risk of breast cancer, because height may be a marker for later exposure to growth hormones and other hormones. BWHS data do not provide material support for this theory.
Rosenberg L, Rao RS, Palmer JR, Adams-Campbell LL. Age at natural menopause among African-American women. (Abstract) Am J Epidemiol 2001;153:S92.

Age at menopause influences the occurrence of osteoporosis, breast cancer, and other illnesses. Current smoking and a measure of racism (how often women thought about their race) were associated with an earlier natural menopause in preliminary analyses. The present results suggest that black and white women share an important determinant of the age at natural menopause, cigarette smoking.
Cozier YC, Palmer JR, Rosenberg L. Comparison of methods for collection of DNA samples by mail in the Black Women’s Health Study. (Abstract) Am J Epidemiol 2001;153:S95.

Participation rates of women who were invited to provide cheek cell samples by means of mouthwash (swished in the mouth for about 45 seconds) were similar to those of women who were invited to provide cheek cell samples though swabs (rubbed on the inside of the cheek). However, the yield of DNA from the cheek cells was much greater from the mouthwash samples. Thus, cheek samples will be collected from BWHS participants by means of mouthwash.
Wise LA, Palmer, JR, Adams-Campbell LL, Rosenberg L. Reproductive factors, hormone use, and risk of uterine leiomyomata in black women. (Abstract) Am J Epidemiol 2002;155:S64.
In preliminary results, the occurrence of uterine fibroids was greater among women who began to menstruate at a young age and among women who had their first child at an older age. Risk was reduced if a woman had a recent pregnancy. These results indicate that the occurrence of uterine fibroids is strongly influenced by reproductive factors.
Palmer JR, Wise LA, Adams-Campbell LL, Rosenberg L. Childbearing and breast cancer risk in black women. (Abstract) Am J Epidemiol 2002;155:S73.

These preliminary results suggest that parity has a dual effect on the occurrence of breast cancer, depending upon a woman’s age. Before 45 years of age, women who have had several children appear to have a higher risk of breast cancer than women who have had few children. At older ages, however, the incidence among women who have had several children is lower than among women with few children or none at all.
Rosenberg L, Palmer JR, Wise LA, Horton NJ. Perceived racism in relation to preterm birth in the Black Women’s Health Study. (Abstract) Am J Epidemiol 2002;155:S95.

The 1997 BWHS questionnaire contained 9 questions about experiences of racism. In preliminary analyses, responses to most of the questions were unrelated to preterm birth overall. However, among women with lower levels of education, some of the variables were related to an increased risk.
Rosenberg L, Palmer JR, Rao RS, Adams-Campbell LL. Patterns and correlates of alcohol consumption among African-American women. Ethn Dis 2002;12:548-54.

Heavy drinking is related to many illnesses, such as liver disease. Most BWHS participants drink alcohol moderately if at all. Among those who drink more heavily, the strongest predictor was having begun drinking at an early age and having drunk greater quantities at that time. Consumption of alcohol was also strongly related to smoking.
Rosenberg L, Palmer JR, Wise LA, Horton NJ, Corwin MJ. Perceptions of racial discrimination in relation to preterm birth in the Black Women’s Health Study. Epidemiology 2002;13:646-52.

Black babies are more often born preterm (premature or early) than white babies. These analyses were based on births reported on the 1997 and 1999 questionnaires: the mothers of 422 preterm babies were compared to the mothers of 4544 full term babies. Overall, the risk of preterm birth was not related to responses to 7 of 9 questions about experiences of racism, but risk was slightly higher for women who reported unfair treatment on the job and that people acted afraid of them at least once a week. Among women with 12 years or less education, there were increased risks of preterm birth for 4 of the questions about racism. These data are suggestive. It will be important to reassess the question of whether experiences of racism increase preterm birth based on births reported by BWHS participants on the questionnaires.
Kumanyika SK, Mauger D, Mitchell DC, Phillips B, Wright H, Palmer JR. Relative validity of food frequency questionnaire nutrient estimation in the Black Women’s Health Study. Ann Epidemiol 2003;13:111-18.

This paper presents the results of the BWHS diet validation study. There was a good correlation between the reporting of most nutrients on the BWHS 1995 questionnaire with food diaries and 24-hour diet recalls provided by BWHS participants in the diet validation study. These results give promise that analyses of diet in relation to various illnesses will be informative.
Palmer JR, Rosenberg L, Wise LA, Horton, NJ, Adams-Campbell LL. Onset of natural menopause in African-American women. Am J Public Health 2003;93:299-306.

Age at menopause affects the occurrence of breast cancer, osteoporosis, and other illnesses. Factors related to the onset of natural menopause in black women have not received much study. These analyses of BWHS data were based on follow-up of participants from 1995 to 1999. Overweight women had a later menopause than thinner women and women who used oral contraceptives had a later menopause than nonusers. However, the strongest determinant of the occurrence of natural menopause was cigarette smoking – current and ex-smokers reached menopause earlier than nonsmokers. Factors not significantly related to the onset of natural menopause were age at start of menstrual periods, education, childbearing, physical activity, and experiences of racism.
Palmer JR, Wise LA, Horton, NJ, Adams-Campbell LL, Rosenberg L. Dual effect of parity on breast cancer risk in African-American women. J Natl Cancer Inst 2003; 95:478-83.

Black women have a higher incidence of breast cancer than white women before age 45, and a lower incidence after age 45. BWHS results indicate that parity has a dual effect on the occurrence of breast cancer, depending upon a woman’s age. Before 45 years of age, women who have had several children appear to have a higher risk of breast cancer than women who have had few children. At older ages, however, the incidence among women who have had several children is lower than among women with few children or none at all. These results will be useful in helping to explain the mechanism of breast cancer occurrence, and they also help explain the black-white crossover in breast cancer incidence.
Rosenberg L, Palmer JR, Wise LA, Adams-Campbell LL. A prospective study of female hormone use and breast cancer incidence among African-American women. (Abstract). Am J Epidemiol 2003;157:S98.

Hormone replacement therapy has been used by millions of women. Data on white women indicate that hormone supplements increase the risk of breast cancer. BWHS data are the first concerning black women. They indicate that breast cancer risk is increased among women who use hormone supplements, especially estrogen together with progesterone, that the risk increases as the duration of use increases, and that the effect is more evident in thinner women.
Wise LA, Palmer JR, Adams-Campbell LL, Rosenberg L. Body size and risk of uterine leiomyomata in premenopausal black women. (Abstract). Am J Epidemiol 2003;157:S91.

Uterine fibroids occur commonly among premenopausal African-American women. In an assessment of BWHS data on newly occurring fibroids, we found that fibroids occurred more often in women who were overweight, and that weight gain since age 18 was also associated with a greater occurrence.
Wise LA, Palmer JR, Adams-Campbell LL, Rosenberg L. Risk of uterine leiomyomata in relation to alcohol, caffeine, and tobacco use in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2003;157:S101.

Alcohol consumption and caffeine consumption have been suggested to be risk factors for uterine fibroids. Preliminary analysis of BWHS data suggested a slightly greater risk of fibroids in drinkers, but little difference according to caffeine consumption. Smokers had a slightly lower risk of uterine fibroids than nonsmokers.
Cozier YC, Palmer JR, Horton NJ, Rosenberg L. Perceptions of racial discrimination and the incidence of hypertension in African-American women. (Abstract). Am J Epidemiol 2003;157:S93.

Experiences of racial discrimination may act as stressors that increase the occurrence of hypertension. We assessed this possibility using BWHS data. There were some small increases in risk of hypertension associated with responses to some of the questions about discrimination, but mostly the results suggest no association.
Formica MK, Palmer JR, Rosenberg L, McAlindon TE. Smoking, alcohol consumption and risk of systemic lupus erythematosus in the Black Women’s Health Study. J Rheumatol 2003;30(6):1222-6.

Systemic lupus erythematosus (lupus) occurs more commonly in African-American than white women. BWHS data indicate that cigarette smoking is associated with an increased occurrence of lupus. Previous studies suggested that alcohol consumption might be protective. Those studies had flaws that were overcome in the BWHS. BWHS data indicate that there is no relation between alcohol consumption and lupus. The data on smoking provide yet another reason for women to not smoke.
McAlindon TE, Formica M, Palmer JR, Lafyatis R, Rosenberg L. Assessment of strategies for identifying cases of systemic lupus erythematosus through self-report. Lupus 2003;12:754-759.

Systemic lupus erythematosus (lupus) affects black women more frequently than other women in the U.S. The assessment of potential causes of lupus has been hindered by the difficulty in identifying women with the illness. We assessed whether use of a symptom list filled out by BWHS participants on the 1997 questionnaire might be helpful in distinguishing between women with and without lupus. The study involved review of medical records of women with and without symptoms who reported having received a diagnosis of lupus. The symptom list was not helpful, but we found that women reported lupus with a satisfactory degree of accuracy, particularly those taking medications for the illness. A paper based on BWHS data has linked smoking to an increased risk of lupus, and other studies are in progress.
Rosenberg L, Palmer JR, Wise LA, Horton NJ, Kumanyika SK, Adams-Campbell LL. A prospective study of the effect of childbearing on weight gain in African-American women. Obesity Res 2003;11:1526-1535.

Overweight and obesity have increased greatly in the U.S. in recent decades and are a particular problem for black women. We used BWHS data on weight and childbearing collected during the first four years of follow-up, 1995 to 1999, to assess whether having a child was associated with increased long-term weight gain. We found that women who had a first child gained more weight than women who had a second or later child, and that the weight gain of all three groups was more than that of women who did not have a child. The difference in weight gain between women who had a child and women who did not was greatest for women who were overweight to begin. The results indicate that childbearing is an important contributor to weight gain among black women.
Cozier YC, Palmer JR, Rosenberg L. Comparison of methods for collection of DNA samples by mail in the Black Women’s Health Study. Ann Epidemiol 2004;14(2):117-122.
Genetic polymorphisms may influence the occurrence of some diseases. To test hypotheses concerning genetic polymorphisms, DNA samples are needed. Cheek cells are an excellent source of DNA. A study in which over 1000 BWHS participants took part demonstrated that it is feasible to collect cheek cell samples by mail. Two collection methods were tested—swishing the mouth with mouthwash, and swabbing the cheek with a soft brush. Both methods were acceptable to participants but the mouthwash method yielded much larger amounts of DNA. Cheek cell samples through mouthwash are being collected from all BWHS participants willing to provide them.
Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL. Rosenberg L. Reproductive factors, hormonal contraception, and the risk of leiomyomata in African American women: A prospective study. Am J Epidemiol, 2004;159:113-123.

Uterine fibroids occur 2-3 times more commonly in black women than white women. During follow-up of BWHS participants through 2001, over 2000 women developed uterine fibroids. Based on data on reproductive history and other factors, we found that risk of fibroids was lower for women who had a later age at start of menstruation, a later age at the birth of their first child, more children, or a recent birth. Women who used progestin-only injectable contraceptives also appeared to have a reduced risk. This is the largest follow-up study of uterine fibroids in black women yet conducted. The results confirm that reproductive history plays an important role in the occurrence of fibroids and are useful for elucidating mechanisms of occurrence.
Palmer JR, Wise LA, Adams-Campbell LL, Rosenberg L. A prospective study of induced abortion and breast cancer in African-American women. Cancer Causes Control 2004;15:105-111.

There has been controversy about whether having an abortion might increase the risk of breast cancer, although the weight of evidence from large and well-conducted studies indicates that there is no effect. There has been very little study of abortion and breast cancer in African-American women. Based on data collected in the BWHS, induced abortion was not associated with the occurrence of breast cancer. Also, the number of abortions or the age at which the abortion occurred did not influence the risk of breast cancer. These results from the BWHS indicate clearly that induced abortion does not increase the risk of breast cancer in African-American women.
Williams CD, Adams-Campbell LL, Taylor TR, Palmer JR, Rosenberg L. Depressive symptoms by socio-demographic characteristics in The Black Women’s Health Study. (Abstract). Ann Behav Med 2004;24(Suppl):S146.

On the 1999 BWHS health survey, participants completed 20 questions, the “CES-D” scale which is a measure of feelings of depression. The present analysis found that older and younger women differed in the types of symptoms they reported, and that depression scores were lower for older women, married women, and those with higher levels of education. The relation of depression scores to the occurrence of various illnesses will be assessed in future analyses.
Taylor TR, Makambi K, Adams-Campbell LL, Harrell JP, Rosenberg L, Palmer JR. Racial discrimination and breast cancer in Black women: The Black Women’s Health Study. (Abstract). Ann Behav Med 2004;24(Suppl):S181.

On the 1997 BWHS health survey, participants completed 9 questions about unfair treatment in everyday life and experiences of racial discrimination on the job, in housing and in police encounters. Preliminary analyses show no relationship of these experiences to the occurrence of breast cancer. The relationship of racial discrimination to the stage at which breast cancer is diagnosed will be assessed in future analyses.
Cozier YC, Palmer JR, Horton NJ, Fredman L, Rosenberg L. Neighborhood socioeconomic status and risk of hypertension in Black women. (Abstract). Am J Epidemiol 2004;159:S73.

Neighborhoods have characteristics that could affect health (e.g., by affecting stress levels or the ability to exercise). We assessed whether neighborhood socioeconomic status (SES) is associated with the occurrence of hypertension (high blood pressure) in the BWHS. Information on the SES of neighborhoods was obtained from the U.S. Census. During 1995-2001 4,895 BWHS participants reported having been diagnosed with hypertension for the first time. After taking into account individual characteristics such as age, weight, education, smoking, and exercise, we found that lower neighborhood SES was associated with a higher occurence of hypertension. This suggests that neighborhood environment may be contributing to the excess of hypertension among black women in the U.S.
Wise LA, Palmer JR, Adams-Campbell LL, Rosenberg L. Age-specific incidence rates for uterine leiomyomata in The Black Women’s Health Study. (Abstract). Am J Epidemiol 2004;159:S92.

Although uterine fibroids are a major problem among black women, there is relatively little information on age-specific rates of occurrence. The BWHS provides the most informative information to date on this question. Based on 2,279 new occurrences of fibroids confirmed by ultrasound or hysterectomy that were reported by BWHS participants on the 1999 and 2001 health questionnaires, the incidence rate was 17.8 per 1000 women per year at ages <30, peaked at 39.8 per 1000 women per year at ages 40-44, and then decreased.
Datta GD, Subramanian SV, Rosenberg L. A multilevel assessment of individual and neighborhood characteristics associated with smoking among Black women. (Abstract). Am J Epidemiol 2004;159:S74.

We assessed whether characteristics of the neighborhood in which BWHS participants live are associated with cigarette smoking, as reported in 1995. Information on the poverty level of the census tracts in which BWHS participants live was obtained from the U.S. Census. After taking into account women’s age, education, marital status, and occupation, it was found that the percent of women who were current smokers increased as the percent of residents below the poverty level increased. These findings suggest that characteristics of women’s neighborhoods play a role in smoking behavior above and beyond individual characteristics.
Rosenberg L, Wise LA, Palmer JR. Hair relaxer use and risk of preterm birth in The Black Women’s Health Study. (Abstract). Am J Epidemiol 2004;159:S91.

We assessed whether hair relaxer use is associated with preterm birth (baby born at least 3 weeks early) in the BWHS. We compared 497 babies born preterm because of premature rupture of membranes or premature labor for no known reason with 5633 full-term babies, whose births were reported on the 1997, 1999, and 2001 health questionnaires. There were no differences in hair relaxer use between mothers of the preterm and full-term babies, suggesting that hair relaxer use does not influence the occurrence of preterm birth.
Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL, Rosenberg L. Risk of uterine leiomyomata in relation to tobacco, alcohol, and caffeine consumption in the Black Women’s Health Study. Hum Reprod 2004;19:1746-54.

Fibroids in the uterus (womb) affect black women 2-3 times more often than white women. They can cause pain and bleeding and can lead to hysterectomy. Tobacco, alcohol, and caffeine consumption could influence the risk of uterine fibroids through changes in female hormones. We assessed this possibility with data from the BWHS collected during 1997 through 2001. During that time period, 2,177 premenopausal women reported the occurrence of a uterine fibroid diagnosed through ultrasound or hysterectomy. The risk of fibroids was not associated with cigarette smoking but it was associated with alcohol consumption, particularly consumption of beer. Women who drank at least 7 beers a week had a greater risk of fibroids than nondrinkers. Fibroids were not associated with coffee drinking in women overall, but among women under 35 years of age those who drank at least 3 cups a day appeared to have a higher risk of fibroids than nondrinkers. These findings are new and require confirmation in further studies. If confirmed, modifiable risk factors for fibroids--alcohol and coffee consumption-- will have been identified.
Wise LA, Palmer JR, Stewart EA, Rosenberg L. Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women’s Health Study. Obstetrics and Gynecology 2005;105(3):563-568.

Data reported on uterine fibroids by BWHS participants from 1997 to 2001 were used to calculate incidence rates. The overall incidence rate of uterine fibroids was 34 per 1000 women per year—that is, 34 women out of each 1000 who had not had fibroids before developed uterine fibroids. The incidence rate was highest among women who were 40-44 years of age. The incidence rate of uterine fibroids in U.S. black women is 2 to 3 times higher than the rate in white women; reasons for the difference are unknown.
Wise LA, Palmer JR, Spiegelman D, Harlow BL, Stewart EA, Adams-Campbell LL, Rosenberg L. Influence of body size and body fat distribution on risk of uterine leiomyomata in African-American women. Epidemiology 2005 May;16(3):346-54.
Uterine fibroids occur 2-3 times more often in black women than white women. They can cause pain and bleeding and lead to hysterectomy. We assessed the influence of body size and body fat distribution on the occurrence of uterine fibroids, using data from the BWHS collected from 1997 to 2001. During that time period, 2,146 premenopausal women reported having been diagnosed with a fibroid through ultrasound or hysterectomy. All women with a body mass index (BMI) of 20 or greater had a higher risk of fibroids than women with a BMI <20. (BMI <20 is defined as thin, 20-24.9 as appropriate weight, 25-29.9 as overweight, and 30 or greater as obese). The risk of having a fibroid increased as BMI increased, to a peak at BMI 27.5-29.9 and then decreased. Weight gain since age 18 was positively associated with risk among women who had had children but not among women who had never had a child. Waist and hip circumference were not associated with risk of fibroids. These finding indicate that there is a complex relationship between BMI and risk of uterine fibroids, but that risk is lowest for thin women.
Palmer JR, Wise LA, Adams-Campbell LL, Rosenberg L. Cigarette smoking and risk of breast cancer in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2005;161:S55.
A few studies have reported that women who smoke heavily and who started smoking at a young age may have an increased risk of breast cancer. In analyses of BWHS data collected from 1995 to 2003, cigarette smoking was not associated with breast cancer risk overall. However, there was a suggestion in the data that risk might be increased for women who smoked for many years and began at a young age. Further data will need to be collected to confirm whether this is so.
Rosenberg L, Wise LA, Palmer JR, Adams-Campbell LL. A multilevel prospective study of regular mammography use in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2005;161:S43.
Little is known about factors that influence whether women return for mammography screening on a regular basis. We assessed data on mammography use and other factors reported by BWHS participants on the 1997, 1999, and 2001 health surveys. The most important predictor of regular attendance for mammography screening in the BWHS was having health insurance.
Wise LA, Palmer JR, Adams-Campbell LL, Rosenberg L. Leisure-time physical activity in relation to depressive symptoms in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2005;161:S121.
Physical activity has beneficial effects on many conditions, but its effect on depression is less clear. In 1999, BWHS participants filled out 20 questions about how they were feeling, the CES-D scale, which measures symptoms of depression. Women who exercised vigorously had fewer symptoms than women who did not exercise, which suggests that leisure-time physical activity may reduce depressive symptoms.
Cozier YC, Palmer JR, Rosenberg L. The risk of hypertension associated with very high BMI in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2005;161:S51.
Obesity is a known cause of hypertension but few studies have evaluated the effects of very high levels of obesity. Based on BWHS data, we found that the incidence of hypertension increased as women’s body mass index increased. The incidence of hypertension in women with a body mass index of 45 or more was 7.7 times greater than that among women with a body mass index of 20-22. A body mass index of 20-24 is considered to be a “healthy” weight; 25-29 is considered to be “overweight”; and 30 or greater is “obese”.
Krishnan S, Palmer JR, Djousse L, Rosenberg L. Obesity and the risk of type 2 diabetes in U.S. black women. (Abstract). Am J Epidemiol 2005;161:S53.
Type 2 (or adult onset) diabetes is increasing and is twice as high among black women as white women. Based on data collected in the BWHS, women with a body mass index of 45 or greater developed diabetes 21 times more often than women with a body mass index less than 23. These results clearly show the large harmful impact of overweight and obesity on the occurrence of diabetes.
Rosenberg L, Wise LA, Palmer JR. Hair-relaxer use and risk of preterm birth among African-American women. Ethn Dis 2005;15:768-772.
Black babies are born preterm (premature) more frequently than white babies and known causes do not explain the difference. Hair relaxers are often used by black women, and these preparations contain unknown substances that might be harmful and possibly lead to premature birth. Based on reports of babies born to BWHS participants from 1995 to 2001, we assessed whether hair relaxer use was related to the occurrence of preterm birth. We found that use was not related to preterm birth, even use that had lasted many years and was frequent.
Rosenberg L, Wise LA, Palmer JR, Horton NJ, Adams-Campbell LL. A multilevel study of socioeconomic predictors of regular mammography use among African-American women. Cancer Epidemiol Biomarkers Prev 2005;14(11):2628-2633.

Current recommendations are that women go for screening mammograms for breast cancer on a regular basis once they reach age 40. The hope is that finding breast cancers early will result in more effective treatment and better survival. We used information reported on the 1997, 1999, and 2001 health surveys to find out what factors affect regular mammography use in the BWHS. Having health insurance was the most important predictor of whether women went for mammograms on a regular basis. The loss of health insurance is an increasing problem; women who do not have insurance may be able to find federal or state programs to pay for their screening mammogram.
Agurs-Collins T, Makambi K, Palmer JR, Rosenberg l, Adams-Campbell LL. Dietary patterns and breast cancer risk in women participating in the Black Women’s Health Study. (Abstract). Frontiers in Cancer Prevention Research. AACR Meeting, Baltimore MD, October 30-Novermber 2, 2005: A69, p 87.

On the 1995 health survey, BWHS participants answered more than 60 questions on what they ate. Preliminary analyses of this information suggest that women who ate a more “prudent” diet, which is high in fruits and vegetables, whole grains, fish and poultry , may have a lower risk of developing breast cancer, and women who ate more of a “Western” diet, high in meat, refined grains, and sweets, may have a higher risk.
Datta G, Colditz GA, Kawachi I, Subramanian SV, Palmer JR, Rosenberg L. Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women . Cancer 2006;106(3):664-9.
Pap smears are a screening tool for the early detection of cervical cancer. We studied whether neighborhood socioeconomic factors influence whether women in the BWHS go for Pap smear screening. We found that women who lived in neighborhoods with high levels of poverty were less likely to go for screening than women who lived in wealthier neighborhoods. There may be barriers to Pap screening in the poorer neighborhoods, such as difficulties with obtaining medical care or transportation, that need to be addressed in order that all women have access to Pap screening.
Palmer JR, Adams-Campbell LL, Boggs DA, Wise LA, Rosenberg L. The relation of overall and central obesity to risk of breast cancer in African-American women. (Abstract). Proc Am Assoc Cancer Res 2006;47:2024.

Many studies of white women have found that women who are overweight at age 18 have a lower risk of breast cancer before menopause compared to thinner women. The studies also show that women who are overweight after the menopause have a higher risk of breast cancer compared to thinner postmenopausal women. Preliminary results in the BWHS show that women who were overweight at age 18 have a lower risk of breast cancer later in life, whether before or after the menopause. Overweight after the menopause was not related to an increased risk of breast cancer.
Rosenberg L, Palmer JR, Wise LA, Adams-Campbell LL. A prospective study of female hormone use and breast cancer among black women. Arch Intern Med 2006;166:760-5.

Millions of women in the U.S. have used menopausal female hormone supplements. Epidemiologic studies have found that women who use female hormone supplements have an increased risk of breast cancer. Most of the women in those studies were white women. We investigated the effect of female hormone use on breast cancer occurrence in the BWHS. From 1995 to 2003, 615 participants were diagnosed with breast cancer. The incidence of breast cancer was 58% greater in women who used female hormone supplements for 10 or more years and were still using them than among nonusers. The increases in breast cancer risk appeared to be greater for women who had taken estrogen with progesterone than for women who took estrogen alone, and the increases were more apparent in thinner women than in heavier women. These data strengthen the evidence that use of female hormones increases the risk of breast cancer. Current recommendations are that women who use female hormone supplements for the relief of menopausal symptoms should do so for the shortest time possible.
Wise LA, Adams-Campbell LL, Palmer JR, Rosenberg L. Leisure-time physical activity in relation to depressive symptoms in the Black Women’s Health Study. Ann Behav Med 2006;32(1):68-76.

Researchers looked at two types of physical activity: walking for exercise and vigorous exercise (e.g., aerobics, running, swimming, and basketball). Results showed that women who took part in vigorous exercise in high school or adulthood, but not both, had fewer symptoms of depression than women who were never active. Women who exercised vigorously both in high school and adulthood had the fewest symptoms of depression of all. Walking for exercise lowered the risk of depression among women who were very overweight (Body Mass Index of 30 or higher) but not among women who were less overweight or of normal weight. The BWHS results suggest that increasing levels of physical activity may improve mental health.
Wise LA, Palmer JR, Rosenberg L, Adams-Campbell LL. Anthropometric risk factors for colorectal polyps in African-American women (Abstract). Am J Epidemiol 2006;163(Suppl):S104.

BWHS participants who gained weight were more likely to develop colorectal polyps than women whose weight was stable. Also, carrying the overweight in the waist was associated with a higher risk of polyps than carrying it in the hips.
Rosenberg L, Boggs D, Wise LA, Palmer JR, Roltsch MH, Makambi KH, Adams-Campbell LL. A follow-up study of physical activity and incidence of colorectal polyps in African-American women (Abstract). Am J Epidemiol 2006;163 (Suppl):S72.

BWHS participants who exercised were less likely to develop colorectal polyps than women who were inactive. The exercise included walking and vigorous activity such as jogging.
Palmer JR, Boggs D, Krishnan S, Hu F, Rosenberg L. Soft drink consumption and risk of Type 2 diabetes in African-American women (Abstract). Am J Epidemiol 2006;163(Suppl):S181.

The risk of diabetes increased with increasing consumption of sugar-sweetened soft drinks, suggesting that risk could be reduced by decreasing intake of sugared soft drinks.
Cozier YC, Palmer JR, Rosenberg L. The relation of physical activity to risk of hypertension in the Black Women’s Health Study (Abstract). Am J Epidemiol 2006;163(Suppl):S42.

Participation in vigorous physical activity was associated with a decreased occurrence of hypertension among BWHS participants. The effect of walking was much weaker.
Wise LA, Palmer JR, Cozier YC, Stewart EA, Rosenberg L. Perceptions of racial discrimination and risk of uterine leiomyomata (Abstract). Am J Epidemiol 2006;163 (Suppl):S58.

Fibroids in the womb (uterine leiomyomata) occurred more often in BWHS participants who reported frequent experiences of racism than in women who reported fewer experiences.
Krishnan S, Rosenberg L, Palmer JR. Glycemic load, glycemic index, cereal fiber and risk of Type 2 diabetes in African-American women (Abstract). Am J Epidemiol 2006;163 (Suppl):S184.

Intake of foods with a high glycemic index or load (e.g., potatoes) was associated with a higher risk of diabetes, whereas intake of foods high in cereal fiber was associated with a lower risk.
Datta GD, Colditz GA, Kawachi I, Subramanian SV, Palmer JR, Rosenberg L. Individual, neighborhood, and state-level predictors of smoking among U.S. black women: A multilevel analysis. Soc Sci Med 2006;63:1034-1044.

We looked at whether the economic level of the neighborhoods in which BWHS participants live affects whether they smoke. To do so, we obtained information from the U.S. Census Bureau on what percent of people in particular neighborhoods are living below the “poverty level”, as defined by the federal government. BWHS participants who lived in neighborhoods with high levels of poverty were more often smokers than women who lived in neighborhoods with lower levels of poverty. Taking into account personal factors like educational level did not change this finding. We conclude that the surroundings in which women live play a role in whether they smoke. There are many possible reasons for this. As an example, more cigarette advertising is aimed a people who live in neighborhoods with higher poverty levels.
Rosenberg L, Boggs D, Wise LA, Palmer JR, Roltsch MH, Makambi KH, Adams-Campbell LL. A follow-up study of physical activity and incidence of colorectal polyps in African-American women. Cancer Epidemiol Biomarkers Prev 2006;15(8):1438-1442.

Some types of colorectal polyps are thought to lead to colon cancer. We investigated the effect of physical activity from walking or vigorous exercise on colon polyps in an analysis that included 1,390 cases of colon polyps reported by BWHS participants. We found that the incidence of colon polyps was reduced among women who exercised, and the reduction was greatest for women who exercised the most. These results contribute to the large body of evidence that exercise has many health benefits.
Cozier YC, Palmer JR, Horton NJ, Fredman L, Wise LA, Rosenberg L. Racial discrimination and the incidence of hypertension in U.S. black women.Ann Epidemiol 2006;16:681-687.

The occurrence of hypertension (high blood pressure) is 2-3 times greater in black women than white women, and the condition increases the risk of heart disease and other serious illnesses. Stressors, such as experiences of racial discrimination, may increase the risk of hypertension. To see if this was happening in the BWHS, we studied the experiences of racism reported by BWHS participants on the 1997 BWHS health survey in relation to the occurrence of hypertension in the following years. Overall, the occurrence of hypertension was similar in women who did and did not experience racial discrimination. However, in the foreign born women, those who reported more experiences of discrimination also developed more hypertension. If confirmed, this finding may mean that foreign born women have a different response to experiences of racism than women born in the United States.
Carter-Nolan PL, Adams-Campbell LL, Makambi K, Lewis S, Palmer JR, Rosenberg L. Validation of physical activity instruments: Black Women's Health Study. Ethn Dis 2006;16:943-947.

Physical activity may prevent some illnesses. To study whether this is so, we need accurate information on physical activity. BWHS participants in the Washington D.C. area took part in a physical activity validation study at Howard University organized by Dr. Adams-Campbell. For a week the women wore “actigraphs”, which look like watches and which measure movement. During that week the women also wrote down their activities in diaries. We compared the actigraph measures, the diary reports, and what the women reported about physical activity on the BWHS survey. Women who had the highest actigraph measures also tended to report the most activity in their diaries and the most physical activity on the BWHS survey. These results show that physical activity information given by BWHS participants on the health surveys will be useful in studies of exercise and disease. We are grateful to the women who took part in this study.
Van Dam RM, Hu FB, Rosenberg L, Krishnan S, Palmer JR. Dietary calcium and magnesium, major food sources, and risk of type-2 diabetes in U.S. black women. Diabetes Care 2006;29 (10):2238-43.

Studies in white populations indicate that dietary magnesium may reduce the risk of developing type 2 (adult onset) diabetes. We assessed this possibility in the BWHS. Based on 1,964 women who reported having been newly diagnosed with the illness during 1995-2003 and using dietary information reported by participants on the 1995 questionnaire, we found that higher levels of magnesium, low-fat dairy, and whole grains were all associated with a reduced risk of diabetes. These findings suggest that diets high in magnesium-rich foods, particularly whole grains, lower the risk of diabetes in U.S. black women. This is important because it is possible to increase whole grain intake in the diet by simple measures, such as substituting whole grain bread for white bread or whole grain cereal for other cereals.
Cozier YC, Palmer JR, Horton NJ, Fredman L, Wise LA, Rosenberg L. Relation between neighborhood median housing value and hypertension risk among black women in the United States. Am J Public Health 2007;97(4):718-24.

High blood pressure affects many African American women. It is well established that personal factors, like lack of exercise and overweight, are associated with increased risk. We studied whether characteristics of the neighborhoods in which women live affect the risk of high blood pressure.
Taylor TR, Williams CD, Makambi KH, Mouton C, Harrell JP, Cozier Y, Palmer JR, Rosenberg L, Adams-Campbell AA. Racial discrimination and breast cancer incidence in U.S. black women: The Black Women’s Health Study. Am J Epidemiol 2007:166(1):46-54.

Experiences of racism could affect health adversely. We assessed the relation between experiences of racism reported on the 1997 BWHS health survey to the occurrence of breast cancer in the following 6 years. The incidence of breast cancer was higher among women who reported more everyday and major (in the workplace, in housing, and by police) experiences of racism. The increase in breast cancer incidence among women who reported discrimination in the workplace was statistically significant, and the associations were stronger among women under age 50. This is the first study to find racism to be associated with an increased risk of breast cancer and the results require confirmation.
Williams CD, Taylor TR, Makambi K, Harrell J, Palmer JR, Rosenberg L, Adams-Campbell LL. CES-D four-factor structure is confirmed, but not invariant, in a large cohort of African American women. Psychiatry Res 2007;150:173-180.

The CES-D is a set of 20 questions used to measure symptoms of depression. It has been used in various population studies to determine whether depression is associated with various illnesses. BWHS participants completed the CES-D scale on the 1999 BWHS health survey. Our analyses indicate that the CES-D scale is appropriate for use in African-American women. We have already found, with use of the CES-D, that BWHS participants who exercise have fewer symptoms of depression that participants who are inactive (See #69).
Wise LA, Palmer JR, Stewart EA, Rosenberg L. Polycystic ovary syndrome and uterine leiomyomata. Fertil Steril 2007;87:1108-15.

The relation of polycystic ovary syndrome (PCOS) to risk of uterine fibroids was examined using data collected through 2003. 275 women reported having been newly diagnosed with PCOS and 3,631 reported a new diagnosis of fibroids. The incidence of fibroids was higher among women with PCOS than among women without that condition. This finding, which has biologic plausibility, is new and requires confirmation.
Rosenberg L, Boggs DA, Adams-Campbell LL, Palmer JR. Hair relaxers not associated with breast cancer risk: Evidence from the Black Women’s Health Study. Cancer Epidemiol Biomarkers Prev 2007;16(5):1035-7.

Hair relaxers have been used by millions of African American women, often at young ages and for many years. Because these products may contain unknown harmful ingredients, we studied their use in relation to the occurrence of breast cancer. Based on information provided on relaxer use on the 1997 BWHS heath survey and and follow-up through 2003, we found no increases in breast cancer incidence among users, regardless of the length of use, the intensity of use, or the age at starting use. These findings indicate that hair relaxer use does not affect the risk of developing breast cancer.
Cozier Y, Palmer J, Rosenberg L, Serlin DM, Berman JS. Frequency and characteristics of sarcoidosis in African American women: the Black Women’s Health Study (BWHS) (Abstract). Am J Respir Crit Care Med 2007;175:A361.

Sarcoidosis is an illness that affects African American women more than other women. The causes are largely unknown. The BWHS has begun to study this illness, and a comparison of medical records with reports of the illness by BWHS participants shows a high level of accuracy of reporting by participants.
Adams-Campbell LL, Makambi KH, Palmer JR, Rosenberg L. Diagnostic Accuracy of the Gail Model in the Black Women’s Health Study. Breast J 2007;13:332-6.

The Gail model is a formula used to predict a woman’s risk of developing breast cancer, based on her age and several characteristics, such as the age of beginning to menstruate. The model is used to determine whether women are eligible to enter treatment trials for breast cancer. Our analysis of BWHS data shows that the Gail model and a modification derived for African American women have poor accuracy. Better models need to be developed for use among black women.
Wise LA, Palmer JR, Poser CM, Ronthal M, Rosenberg L. Geographic variation of MS incidence in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2007;165:S68.

In preliminary analyses, the incidence of multiple sclerosis (MS) in the BWHS is higher in northern regions than in southern regions, based on 149 new diagnoses of MS reported by BWHS participants from 1995 to 2005. This finding is in agreement with observations made in other racial/ethnic groups.
Cozier YC, Wise LA, Palmer JR, Rosenberg L. The association between experiences and perceptions of racism and cumulative weight gain in U.S. black women. (Abstract). Am J Epidemiol 2007;165:S78.

Experiences of racism may affect various aspects of health. In preliminary analyses, we found that women who reported frequent experiences of racism in 1997 gained more weight in the following 8 years than women who reported fewer experiences.

Costa MV, Cozier YC, Rosenberg L, Palmer JR. Response to cheek cell collection in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2007;165:S65.

More than 26,000 BWHS participants have provided mouthwash samples. The response rate was greater among women who were asked to swish once than among women who were asked to swish twice, but both rates were high.
Cozier YC, Albert MA, Palmer JR, Rosenberg L. Relation between neighborhood socioeconomic characteristics and mortality in U.S. black women. (Abstract). Am J Epidemiol 2007;165:S78.

Significant racial differences in mortality exist in the U.S. In preliminary analyses, we found that the risk of dying among BWHS participants who lived in disadvantaged neighborhoods was slightly higher than the risk among women who lived in wealthier neighborhoods after taking into account personal factors and habits, such as education and smoking.
Krishnan S, Rosenberg L, Palmer JR. Physical activity and risk of type 2 diabetes in U.S. black women. (Abstract). Am J Epidemiol 2007;165:S13.

Type 2 (adult onset) diabetes is a serious problem among African American women. Our preliminary analyses show that the incidence of type 2 diabetes is lower among women who exercise vigorously than among women who do not.
Rosenberg L, Boggs D, Palmer JR, Adams-Campbell LL. The influence of life-style factors on mortality in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2007;165:S84.

Mortality rates from many causes are higher in African-American women than white women. Our preliminary analyses show that mortality is increased in women who smoke and drink heavily, and it is decreased in women who exercise vigorously.
Wise LA, Palmer JR, Rosenberg L. Childhood violence victimization and age at menarche in the Black Women’s Health Study. (Abstract). Am J Epidemiol 2007;165:S24.

Abuse suffered during childhood has been associated with earlier age at starting to menstruate. In the BWHS, women who reported sexual abuse during childhood began to menstruate earlier than those who did not experience abuse during childhood.
Boggs DA, Palmer JR, McAlindon T, Wise LA, Formica M, Fraser PA, Rosenberg L. Reproductive factors and risk of systemic lupus erythematosus in African-American women. (Abstract). Am J Epidemiol 2007;165:S28.

Lupus (systemic lupus erythematosus) occurs more often in women than men, suggesting that female hormones may be involved. In the BWHS, we found positive associations of lupus with earlier age at starting to menstruate, shorter time between menstrual cycles, and use of postmenopausal female hormone supplements.
Palmer JR, Krishnan S, Wise LA, Adams-Campbell LL, Rosenberg L. Neighborhood socioeconomic characteristics and weight gain in U.S. black women. (Abstract). Am J Epidemiol 2007;165:S76.

Understanding the determinants of adult weight gain may lead to more effective interventions. Our preliminary results suggest that adverse neighborhood characteristics contribute to weight gain over and above personal characteristics.
Krishnan S, Rosenberg L, Djousse L, Cupples LA, Palmer JR. Overall and central obesity and risk of type 2 diabetes in U.S. black women. Obesity 2007;15(7):1860-66.

The occurrence of type 2 diabetes (adult onset) has increased in the U.S. as has the proportion of women who are overweight or obese (body mass index ≥ 30). During 8 years of follow-up of BWHS participants, 2,472 new occurrences of type 2 diabetes were reported. The incidence of type 2 diabetes was more than 20 times greater in women in the highest category of body mass index considered (≥ 45) than among lean women. A reduction in weight would lead to a reduction in the risk of developing diabetes.
Palmer JR, Adams-Campbell LL, Boggs DA, Wise LA, Rosenberg L. A prospective study of body size and breast cancer in black women. Cancer Epidemiol Biomarkers Prev 2007;16(9):1795-1802.
Hunt MO, Wise LA, Jipguep MC, Cozier YC, Rosenberg L. Neighborhood racial composition and perceptions of racial discrimination: Evidence from the Black Women’s Health Study. Soc Psychol Q 2007;70(3):272-289.

On the 1997 BWHS health survey, participants provided information on how often they experienced racial discrimination in everyday life and on the job, in housing, and by police. We obtained information on the racial composition of their neighborhoods from the U.S. Census Bureau and then studied how the racial composition of participants’ neighborhoods was related to their experiences of racism. Women in neighborhoods with the highest percent of black residents reported the least discrimination, while women in more mixed neighborhoods reported intermediate amounts of racism and women in neighborhoods with the lowest percent of black residents reported the most discrimination. While racial integration can have social and economic benefits, these results indicate that there is a price to pay in terms of racial discrimination.
Wise LA, Palmer JR, Cozier YC, Hunt MO, Stewart EA, Rosenberg L. Perceived racial discrimination and risk of uterine leiomyomata. Epidemiology 2007;18:747-57.

Uterine fibroids (fibroids in the womb) occur 2-3 times more commonly in black women than in white women and the reasons for the difference are unknown. We studied whether experiences of racism, reported on the 1997 BWHS health survey, were related to the development of uterine fibroids. The analysis was based on 22,000 premenopausal participants followed in the BWHS from 1997 through 2003. During that time period 3,440 women reported having been diagnosed with uterine fibroids. We found that the condition occurred more often in BWHS participants who reported higher levels of racial discrimination than in those who reported lower levels. There was a suggestion in the data that the increased occurrence of fibroids among women who experienced racism might be smaller or absent among those who had skills for coping with stress, such as getting support from friends or family. This is the first study to suggest that racism may contribute to an increased occurrence of uterine fibroids.
Krishnan S, Rosenberg L, Singer M, Hu FB, Djoussé L, Cupples LA, Palmer JR. Glycemic index, glycemic load, cereal fiber intake and risk of type 2 diabetes in U.S. black women. Arch Intern Med 2007;167(21):2304-9.

We studied several aspects of the diet -- gycemic load, glycemic index, and cereal fiber content -- in relation to the occurrence of type 2 (adult onset) diabetes in the BWHS. Glycemic load and index are measures of the type or carbohydrate in the diet. The analysis was based on 8 years of follow-up of BWHS participants, during which time1,938 participants reported that they had been diagnosed with diabetes. We found that women whose dietary intake had a high glycemic index were at higher risk of diabetes, and women whose diet was high in cereal fiber had a reduced risk. The importance of the findings is that women can reduce their risk of diabetes by making changes in their diet -- that is, by increasing the amount of cereal fiber in their diets. The way to do this is to substitute unprocessed foods for processed foods—for example, eat whole wheat bread instead of white bread, shredded wheat instead of corn chex, and brown rice instead of white rice. The January 2008 BWHS newsletter gives the cereal fiber content of a number of commonly eaten foods.

Palmer JR, Adams-Campbell LL, Boggs DA, Rosenberg L. Familial breast cancer in a cohort of 59,000 African-American women: The Black Women's Health Study. [Abstract]. In: American Association for Cancer Research Annual Meeting: Proceedings; 2007; Los Angeles, CA. Philadelphia (PA): AACR;2007. Abstract #2500.

The occurrence of breast cancer in the BWHS was greater among women who have a mother or sister with breast cancer than among women whose relatives have not been affected by breast cancer. The risk of breast cancer was greatest for women whose relative had the breast cancer at a young age.
Wise LA, Rosenberg L, Palmer JR, Adams-Campbell LL. Anthropometric risk factors for colorectal polyps in African-American women. Obesity 2008;16(4):859-68.

In a study based on 1,189 newly occurring cases, we found that BWHS participants who were obese or who had gained a great deal of weight during adulthood were at increased risk of developing polyps in the colon or rectum. In future studies, we will assess the type of polyp affected, because a certain type of polyps, adenomatous polyps, is thought to be a predictor of the occurrence of colorectal cancer.
Cozier YC, Albert MA, Palmer JR, Rosenberg L. Neighborhood socioeconomic status in relation to serum biomarkers in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S520.

We examined the relation between neighborhood socioeconomic status and certain markers in the blood that are thought to be predictors of heart disease. Based on blood samples given by 486 BWHS participants, we found that women living in the most disadvantaged neighborhoods had the least favorable levels of HDL cholesterol, triglycerides, and C-reactive protein.
Boggs DA, Palmer JR, Adams-Campbell LL, Rosenberg L. Change in diet patterns in relation to weight gain in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S398.

We examined changes in dietary patterns in relation to weight gain, based on food intake information that BWHS participants provided in 1995 and 2001. Two diet patterns, "prudent"(high in fruits and vegetables) and "western" (high in meat and high-fat dairy) were assessed. Decreased intake of a prudent diet and increased intake of a western diet were associated with more weight gain.
Coogan PF, Palmer JR, O'Connor GT, Rosenberg L. The relation of body mass index to asthma incidence in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S120.

We found that the occurrence of newly-diagnosed asthma increased with increasing weight, and women with a body mass index of 40 or more had almost three times the risk of asthma as women with a body mass index of 20-24.
Coogan PF, White LF, Palmer JR, Rosenberg L. The influence of urban form on walking in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S409.

For three cities, Los Angeles, Chicago, and New York, we obtained detailed data on "urban form", such as the presence of sidewalks and the distance to bus stops. We found that BWHS participants in those cities who lived in pedestrian-friendly neighborhoods spent more time walking for transport (to work, shops, church, etc) than women in less pedestrian-friendly neighborhoods. Results such as these are important for persuading city planners to ensure that neighborhoods are constructed to be pedestrian-friendly.
Krishnan S, Rosenberg L, Palmer JR. Fast food consumption and risk of type 2 diabetes in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S313.

We found that frequent consumption of food from restaurants was associated with increased incidence of diabetes, based on 2,846 newly occurring cases. Fast food consumption has increased greatly in the U.S. in recent years, and it is likely that a large proportion of these restaurant meals were from fast food restaurants.
Wise LA, Palmer JR, Heffner LJ, Rosenberg L. Maternal anthropometric risk factors for preterm birth in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S79.

Based on information given by BWHS participants on 7,324 births, we found that the risk of spontaneous preterm birth was increased among women who were thin (body mass index less than 20) or obese (body mass index of 30 or more) before the pregnancy, compared with women who had a body mass index of 20-24.
Palmer JR, Boggs DA, Adams-Campbell LL, Rosenberg L. Glycemic index, sweets, and breast cancer risk in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S235.

Studies of diet and breast cancer have given conflicting results on whether intake of foods high in sugar increases breast cancer risk. In our study based on 1,091 cases of breast cancer in the BWHS, there was weak evidence of an association. Women who ate at least one sweet a week had a higher risk of developing breast cancer than women who ate few sweets but there was not a trend of increasing risk with increasing sweet consumption.
Rosenberg L, Boggs DA, Palmer JR, Adams-Campbell LL. Meat, fat, and dairy intake in relation to breast cancer incidence in the Black Women's Health Study. Am J Epidemiol 2008;167(Suppl):S360.

Meat and animal fat consumption have been associated with increased risk of breast cancer in some studies. Based on BWHS data, we found little evidence for an association of intake of red meat, total fat, saturated fat, or dairy products with the overall incidence of breast cancer. There were some associations with a subtype of breast cancer called estrogen receptor negative cancer, but these were based on small numbers and need to be confirmed with a larger sample.
Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med 2008;168(14):1487-92.

Type 2 ("adult onset") diabetes is a serious and common health problem for African American women. In an analysis based on 2,713 newly-diagnosed cases of diabetes in the BWHS, we found that the risk of developing diabetes was 30% greater in women who drank two or more sugar-sweetened soft drinks of sugar-sweetened fruit drinks per day than in women who rarely drank these drinks. There is increasing public awareness of the adverse health effects of soft drinks but little attention has been given to sugar-sweetened fruit drinks, which are often marketed as a healthy alternative.

Krishnan S, Rosenberg L, Palmer JR. Physical activity and television watching in relation to risk of type-2 diabetes in the Black Women's Health Study. Am J Epidemiol 2009; 169(4):428-434.

Based on 2,928 newly-diagnosed cases of diabetes in the BWHS, we found that the incidence of the disease was reduced among women who participated in vigorous physical activity compared with inactive women, in agreement with many studies of white women. In addition, brisk walking was also associated with reduce risk of diabetes in the BWHS-this is good news because it may be possible for many women to fit brisk walking into a busy schedule. On the other hand, risk of diabetes was increased among women who spent five or more hours a day watching television, regardless of their physical activity. Women who do not wish to cut down on their TV viewing should consider limiting the snacks that often go along with TV watching.
Coogan PF, Palmer JR, O'Connor G, Rosenberg L. Body mass index and asthma incidence in the Black Women's Health Study. J Allergy Clin Immunol 2009;123(1):89-95.

Studies of white women suggest that obesity is associated with increased occurrence of new-onset asthma. We found this to be so in the BWHS as well. There were 1,068 women who reported newly-occurring asthma together with medications for asthma. The occurrence of asthma increased with as body mass index increased: the risk was 2.85 times greater among women with a body mass index of 40 than in women with a body mass index of 20-24, which is the recommended body mass index for good health.
Makambi KH, Williams CD, Taylor TR, Rosenberg L, Adams-Campbell LL. An assessment of the CES-D scale factor structure in black women: The Black Women's Health Study. Psychiatry Res, in press.

The CES-D scale is a set of 20 questions used to classify women as having symptoms of depression. In this analysis, the scale was shown to be appropriate for use among African American women

Wise LA, Palmer JR, Rothman EF, Rosenberg L. Childhood abuse and early menarche: findings from the Black Women's Health Study. Am J Public Health, in press.

In the BWHS, approximately 50% of participants reported having been subjected to childhood abuse. We found that a higher proportion of women who reported sexual abuse during childhood started menstruating at an early age than women who reported no abuse. There was a weak association of age at start of menstruation with physical abuse during childhood. Because the age at which a girl's periods start is a predictor of various health outcomes later in life, an effect of childhood abuse on the age of onset is important

Cozier YC, Wise LA, Palmer JR, Rosenberg L. Perceived Racism in Relation to Weight Change in the Black Women's Health Study. Ann Epidemiol, in press.