Wellness Profile of Midlife Women with a Chronic Illness

Public Health Nursing Vol. 16 No. 5, pp. 341–3500737-1209/99/$14.00q Blackwell Science, Inc.

Wellness Profile of MidlifeWomen with a Chronic Illness

Lynn Paul, Ed.D., R.D., andClarann Weinert, S.C., Ph.D., R.N., FAAN

INTRODUCTIONAbstract Among issues important to women’s health are their

Women’s issues have recently emerged as a distinct prioritywellness profiles including indicators such as activity level,weight status, breakfast and snacking patterns, health status per- in health care, education, and research. Women’s healthceptions, and alcohol and tobacco use. This is particularly true issues impact public health and influence the spending offor midlife women with a long-term illness. The purpose of this health care dollars particularly on nonfatal chronic dis-study is to identify the wellness profile of a group of midlife eases, such as arthritis, osteoporosis, depression, and anxi-women with multiple sclerosis (MS), and to compare their life- ety disorders (Finn, 1997; U.S. Department of Health &style indicators with national health statistics. Overall, the women

Human Services (USDHHS), 1996b). Until recently,in the study group indicated a lower perception of their healthwomen were often ignored in the health research agenda.status and were less active. However, the women in this studyIn part, the recent focus on women’s health issues is agroup demonstrated healthier body weights, used less tobacco andbacklash reaction to the longstanding paucity of women’s-alcohol, had better breakfast patterns, and comparable snackingrelated health research (Craft, 1997; Kim, 1998).patterns, indicating that they may be more attuned to their bodies

than women without chronic illnesses. Identifying women’s well- Federal agencies and professional organizations haveness profiles can assist practitioners in addressing the issues of begun to address this paucity of research by enforcinghealth for women managing a long-term illness. stringent guidelines for the inclusion of women in research

studies (Kim, 1998; LaRosa, 1996). In addition, initiativesto address the goal of directing more attention to neglectedissues of women’s health and health care have been under-taken. The expanding research includes examining theprevalence of selected diseases such as HIV/AIDS amongwomen, exploring concerns about reproductive health thatare unique to women, and examining the effects of diseasessuch as osteoporosis and multiple sclerosis that affectwomen more frequently than men (Finn, 1997; Kim, 1998;USDHHS, 1996b).

As a result of this new focus on women’s health, the Officeof Research on Women’s Health (ORWH) was establishedby the National Institutes for Health (NIH) in 1990 and waslater mandated by Congress in 1993. Responsibilities of theORWH include increasing research into the diseases that af-Lynn Paul is an Assistant Professor, College of Education,

Health and Human Development, and Clarann Weinert is a Pro- fect women, ensuring that women are appropriately repre-fessor, College of Nursing, Montana State University, Bozeman, sented in biomedical research studies, and increasing theMontana. numbers of women in biomedical careers (LaRosa, 1996).Address correspondence to Lynn Paul, College of Education,

Following the initiative of NIH, many other health-relatedHealth & Human Development, Montana State University, Boze-man, MT 59717. E-mail: [email protected] federal agencies have established offices of women’s health.

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One example of a university-based research initiative is the women’s wellness profiles. These profiles are composed ofa cluster of health-related lifestyle behaviors and indicatorsWomen’s Health Research Center at the University of Wash-

ington School of Nursing. The center is funded by the Na- that have a significant impact on women’s health status.In general, wellness profiles have not been well-researchedtional Institute for Nursing Research to examine various

health problems that affect women. for women (Hofer & Katz, 1996; USDHHS, 1996b). Thislack of research is even more significant when consideringThe majorityof previouswomen’s health-related research

has focused on reproductive issues of younger women and midlife women with a chronic illness.The purposes of this study are to: (a) examine wellnessspecific disease states of elderly women; there have been

few studies on health issues of women in midlife (USDHHS, profiles (consisting of selected health-related lifestyle indi-cators) for a group of middle-aged women living with a1996b). (Midlife is usually considered as the years between

35and65yearsofage(Stevenson,1977).) Inparticular, there chronic illness, specifically multiple sclerosis (MS); and (b)compare these data to reported national statistics. Throughhasneverbeenanexaminationofwellnessprofilesofmidlife

women who are managing a chronic illness (Finn, 1997; identifying the profiles of women’s health lifestyle behav-iors, health care providers can better address the healthHays, 1990; Kim, 1998: LaRosa, 1996; USDHHS, 1996b).

While there are a variety of ways to conceptualize a wellness promotion and disease prevention needs of midlife womencoping with chronic illness.profile, commonly used indicators include activity and exer-

cise, food and nutrition practices, weight status, tobacco use,alcohol consumption, andan individual woman’s perception METHODSof her own current state of wellness and general health status

This research was part of a larger study, the Family Health(Hofer & Katz, 1996; Kujala, Kaprio, Sarna, & Koskenvuo,Study (FHS) (Weinert & Catanzaro, 1996). In the FHS, a1998; USDHHS, 1996b). A woman’s wellness profile maynationwide longitudinal 5-year panel design study, familiesprovide a window to overall health status and indicate at-living with MS were followed on an annual basis to assessrisk status for pending health problems. It may also addressa wide variety of psychosocial, health, and functioninga range of other issues, including her family’s health andparameters. The ‘‘Midlife Women’s Health and Healthwell-being, the use of health services, and family economicSeeking Behavior’’ project was a substudy. At a singleresources (Hofer & Katz, 1996).point in the parent project, women with MS and womenliving with someone with MS were asked to complete anChronic Illnessadditional questionnaire that contained a series of questions

When considering the overall wellness profile, the signifi- and scales related to aspects of wellness. Seven factorscance and impact of a chronic illness cannot be underesti- were examined as indicators of a wellness profile: activitymated. Chronic illness is defined as an altered health state level, weight status, eating breakfast, snacking, health sta-that cannot be cured by surgery or a short course of medica- tus perception, alcohol consumption, and tobacco use (seetion (Miller, 1993). Important criteria of a chronic illness Table 1). These self-reported data were generated using aare: (a) long-term nature of the illness; (b) uncertainty of mailed questionnaire.prognosis and episodic nature of illness; (c) effort to control

Samplepain, anxiety, grief, and depression; (d) multiplicity ofproblems affecting numerous body systems; (e) intrusion Of the 508 couples who were participating in the Familyon the lives of individual and family; (f) financial burdens; Health Study, 296 women participated in the supplemental(g) demands on health care system; (h) imposition of pre- survey. While data from women with MS and for womenscribed daily regimens to prevent and control frequently who were partners of men with the disease were available,changing symptoms; (i) attempts to normalize personaland work relationships; and (j) social isolation and stigma(Miller, 1993). The added complexities of a chronic illness

TABLE 1. Wellness Profilecompound the challenge of promoting health and pre-venting disease in midlife women. Indicator

Activity levelWellness Profiles Weight statusBreakfast patternPreviously, women’s health issues in midlife were focusedSnackingon menopause and the perimenopausal experience to theHealth perceptionsexclusion of a range of other important health-related fac-Alcohol consumptiontors at this life stage. Among important unexamined healthTobacco use

issues for midlife women and health care providers are

Paul and Weinert: Wellness and Chronic Illness 343

in this analysis, only the data from the 227 women with causes of death. As a result of the association betweenweight and disease, weight status is an important healthMS were analyzed. Ninety-nine percent were Caucasian

with a median age of 43.6 years, an average of 14 years indicator. Extremes in weight, either severe underweight oroverweight, are associated with increased mortality (Bray,of education, and were in their current marital relationship

for an average of 18.9 years. Seventy-four (33%) were 1996).Obesity, defined as an excess in body fat with Bodyemployed either full- or part-time, 49 (22%) were full-

time homemakers, and 104 (46%) were unemployed and Mass Index (BMI) above 27.3, is one of the most commondietary problems affecting adults. Obese adults are at in-did not list themselves as full-time homemakers. The aver-

age total family annual income was in the range of $45,000 creased risk for many chronic and acute medical problemssuch as hypertension, gallbladder disease, respiratory dis-to $50,000.ease, cancer, arthritis, and heart disease—the leading causeof death among women (CDC, 1997b; St. Jeor, 1996).Measurement

Much more is known about the health consequences ofThe wellness profile indicators—activity level, weight sta-

being severely overweight than underweight because thetus, breakfast and snacking patterns, health status percep-

latter condition is far less common. Severely underweighttion, alcohol consumption, and tobacco use—were assessed

is an identified health risk indicating undernutrition, butusing either individual or series of questions. These results

is not recognized as a public health problem. BMIs rangingwere then compared to rates from national samples for the

below 19 or 20 are considered to be associated with higherappropriate years from the Behavioral Risk Factor Surveil-

mortality (Bray, 1996; St. Jeor, 1996).lance Survey, Continuing Survey of Food Intake by Indi-

Women in the study recorded their height in inches andviduals, National Center for Health Statistics, National

their weight in pounds. These two indicators were used toHealth Interview Survey, and the Third National Health

calculate the BMI by dividing weight in kilograms byand Nutrition Examination Survey.

height in meters squared (St. Jeor, 1996). The BMI hasreplaced ideal body weight as the most common, usefulActivity Levelsindex of weight. Unlike ideal body weight, BMIs are asso-Physical activity is known to reduce the incidence andciated with health risks. Generally, BMIs are presented inimpact of chronic diseases, as well as to improve qualitya range rather than a target or single weight, as was typicalof life. The health benefits of physical activity includeof ideal weights. People with higher body fat generallyprotective effects for a variety of conditions including hearthave higher BMIs and are at greater risk of disease thandisease, osteoporosis, colon and breast cancer, noninsulin-those with a lower BMI and a greater percentage of muscledependent diabetes mellitus, depression, and anxiety (Cen-(St. Jeor, 1996).ters for Disease Control (CDC), 1996a). In addition, physi-

cal activity is known to benefit emotional health, functionalBreakfast Patternsindependence, and improved quality of life. Lack of suffi-Eating breakfast has been demonstrated to be an importantcient activity accounts for approximately 25% of all deathshealth promoting behavior (Haines, Guilkey, & Popkin,from chronic disease in the United States. Many midlife1996). This dietary behavior is linked to reduced mortalitywomen who are either at-risk or currently diagnosed with aand improved health status among older people, adoles-chronic disease could greatly benefit from regular physicalcents, and children. Currently, no research exists on theactivity (CDC, 1995a, 1996b; Kujala et al., 1998).health impact of breakfast among middle age adults, butActivity level was assessed with two questions that re-one can extrapolate results based on the findings of researchflected the amount and type of exercise. Women reportedin other age groups (Haines et al., 1996).the amount of vigorous activity during the past month.

Overall, there has been a gradual decline in breakfastAlso reported were a broad range of activities, includingconsumption. Frequency of breakfast consumption, how-aerobic exercise, strengthening, and stretching, from theever, tends to increase with age, with adults over 65 yearsprevious week.old being twice as likely to eat breakfast than those under30 years old. For women, breakfast contributes betweenWeight Status

Dietary factors have a significant impact on health and 17–23% of their daily caloric intake, but only 15–17% oftheir total fat intake, which means breakfast foods tendedare controllable lifestyle behaviors. Dietary practices are

associated with five major causes of death: coronary heart to be lower in total fat than foods eaten during other times.Thus, for those eating breakfast, this meal provides andisease, diabetes, cancer, stroke, and coronary artery dis-

ease (USDHHS, 1996c). An excessive caloric intake is important caloric contribution, with healthy lower fat foods(Haines et al., 1996).a dietary factor that contributes to obesity, a risk factor

associated with many of the diseases listed as the leading To assess frequency of breakfast consumption, partici-


pants were asked ‘‘Did you eat breakfast?’’ during the a chronic illness (LaCroix, Guralnik, Berkman, Wallace, &Satterfield, 1993; Miller, 1993).previous week. Women chose from the responses ‘‘al-

ways,’’ ‘‘most of the time,’’ ‘‘some of the time,’’ or ‘‘never/ It has recently been reported that there are psychologicaland cardiovascular health benefits from moderate alcoholrarely.’’consumption. The effect of moderate alcohol consumptionwas indicated as a factor in reducing the risk of coronarySnacking

According to national trends, snacks contribute an increas- heart disease (Garg et al., 1993). In light of these findings,several agencies have addressed recommendations foringly higher percentage of the total food intake (Bowman,

1997; Cross, Babicz, & Cushman, 1994). Most popular moderate alcohol consumption. Moderate alcohol intakeis defined for women as one drink per day, at a level thatchoices of snacks were crunchy foods high in calories

and salt, such as chips and crackers. Taste, versus other does not cause problems either for the drinker or for society(National Institute on Alcohol Abuse and Alcoholism,attributes such as nutritional quality, is an important criteria

for choosing a snack. Adults who consider nutrition or 1992). There are risks, however, associated with moderatedrinking, including stroke, motor vehicle accidents, inter-health as very important are more likely to eat fruit, or

fewer cookies, chips, and crackers. Snacks contribute ap- action with medication, and a shift to heavier drinking(National Institute on Alcohol Abuse and Alcoholism,proximately 16% of daily caloric intake, and unlike the

lower fat foods typically chosen at breakfast, snack foods 1992). This evidence indicates that adverse consequencesmay occur even at low levels of alcohol consumption.make a substantial contribution to the total fat intake of

most age-gender groups (Bowman, 1997; Cross et al., Although there are recognized health benefits associatedwith alcohol, health professionals do not recommend drink-1994).

To determine snacking patterns, the women were asked ing as a means to achieve these effects. There are manyother ways to achieve the same benefits without incurring‘‘How many times did you snack or eat between meals

yesterday?’’ Participants responded by choosing a number the risks. Overall, if a person does not drink, the advantageof moderate alcohol consumption is not sufficient reasonfrom one to seven and above.to start. If a person does drink, it should be moderate andwith a meal (National Institute on Alcohol Abuse andHealth Status Perceptions

Health-related quality of life measurements are often used Alcoholism, 1992).A series of four questions were asked about alcohol use.to assess how individuals perceive their own health status.

Mortality and morbidity, and how well individuals function They included a history of ever drinking, drinking in thepast 12 months, and current drinking. Current drinkersphysically, psychologically, and socially can be reliable

indicators. These indicators can also be used to assess were asked how many days in the last seven they had analcoholic beverage and, on the days that they drank, howdysfunction and disability, attributes not assessed by stan-

dard mortality and morbidity measures (CDC, 1995a). many drinks did they average.In this study, two health-related quality of life questions

were used to assess individuals’ perception of their health Tobacco UseCigarette smoking is the single most important preventablestatus. The two questions were: ‘‘In general, would you

say your health is excellent, good, fair, or poor?’’ and cause of morbidity and mortality. In the United States,cigarette smoking accounts for approximately 1 out of‘‘How healthy do you feel today?’’every 5 deaths, 87% of all lung cancer deaths, 82% of allCOPD deaths, and 21% of all heart-related deathsAlcohol Consumption

The harmful effects of excessive consumption of alcohol (USDHHS, 1996c). Using tobacco increases a woman’srisk of cancer, heart disease and stroke, induces early meno-are well-known and indisputable. Conversely, health bene-

fits from moderate alcohol consumption have been cited pause, and adversely affects her children’s health becauseof referred smoke. Most women who quit smoking gainin recent studies (Garg, Wagener, & Madans, 1993; Smith-

Warner et al., 1998; Thun et al., 1997). Long-term, exces- an average of 5 pounds (CDC, 1996b). The health benefitsof smoking cessation, however, far outweigh the healthsive alcohol consumption increases the risk of cirrhosis of

the liver and breast cancer (Smith-Warner et al., 1998; risk associated with mild weight gain. Cigarette smokingcontributes heavily to health care costs, with $50 billionThun et al., 1997). Alcohol’s short-term effects impact

mobility, and for those individuals whose mobility is al- in direct smoking-related illnesses reported in 1993 andapproximately $47 billion in indirect losses due to smokingready compromised by a chronic illness such as MS, exces-

sive alcohol intake poses a serious hazard. Excessive reported in 1990 (USDHHS, 1996c).Questions were included in the questionnaire to elicitalcohol can also exacerbate the challenges of dealing with


the women’s history of smoking. These included: age at women in the study group, 44% (n 4 100) reported ‘‘noonset of smoking, length of time they have smoked, activity’’ more often as compared to both the Nationalwhether they currently smoke, and the number of cigarettes Cohort of Midlife Women (28.4%) and the National Cohortthey smoked per day. with Chronic Illness other than arthritis causing disability

(38.5%) (CDC, 1995b, 1997a). Also, the study group re-ported less moderate/vigorous activity (n 4 35, 15%) lev-RESULTSels which represent the CDC recommendations, as

In this section, study group results are reported for the compared to the National Cohort of Midlife Womenentire sample of women, as well as a breakdown of more (28.9%) and the National Cohort with Chronic Illnessage-specific information for certain indicators. Age- (28.4%) (CDC, 1995b, 1997a). In comparison to thesespecific categories were determined by the age categories national groups, the study group engaged in less overallused in the specific national sample. Therefore various age activity, and less vigorous activity, with fewer womencategories were used depending on the national sample

meeting the CDC activity recommendations.used for comparison. Also, age groups may be designated

These findings are not unpredictable since all partici-by ‘‘younger’’ or ‘‘older’’ to differentiate among womenpants within the study group had multiple sclerosis, a dis-in the early phase of midlife life and as compared to womenease which can greatly impact an individual’s mobility toin the later phases of midlife.engage in pain-free, regular activity. Considering all sevenindicators comprising this wellness profile, this indicatorActivity Levelmay be impacted the most by this study group’s specific

Prior to 1995, the CDC activity recommendations specified chronic illness.vigorous aerobic activity for 20 consecutive minutes, 3 Those in the study group who reported vigorous activitytimes per week. In 1995, recommendations were modified were active 5.8 times/week for a total of 321.6 minutes/to include more moderate types of activity accumulated week, while those in the moderate group were active 8.3throughout the day, in addition to the more intense aerobic times/week for a total of 254.4 minutes/week. These aver-exercises. The newer recommendations also included en- ages well exceeded the CDC recommendation of 3 times/gaging in exercise 5 times a week for at least 30 minutes week for a total of 60 minutes for vigorous activity and 5of accumulated activity, such as walking, gardening, and times/week for a total of 150 minutes for moderate activity.housework. The change in the recommendation was a result Those reporting irregular activity were active 3.8 times/of recent research that indicated the significant benefits week for a total of 71.8 minutes/week. In order for thoseassociated with moderate levels of activity (CDC, 1995b). reporting irregular activity to meet the moderate activity

In the United States, inactivity rates continue to climb, recommendations, they need to add an additional 80although the benefits of a moderate activity program have minutes of activity per week, which could be divided intobeen conclusively demonstrated (CDC, 1995b). The newer 5 additional 15 minute segments of activity during therecommendations provide more realistic and less intimidat- week.ing activity levels that may encourage more Americans to

Recommendations based on these findings include pro-exercise, thus reversing the trend toward increasingviding support for the women who reported irregular activ-inactivity.ity, and who are physically capable of engaging in theActivity level in this study was classified into four dis-additional time necessary to meet the CDC recommenda-tinct categories: (1) vigorous activity, defined as those whotions. In addition, the barriers experienced by women whomet the CDC vigorous activity recommendation of at leastreported no activity should be examined. Feasible activities3 times a week of 20 minutes of aerobic activity; (2)and recommendations for these women can be made inmoderate activity, defined as meeting the most recent CDCorder to facilitate the gain in health benefits that accrueactivity guidelines of 5 times a week of 30 minutes offrom engaging in physical activity.accumulated activity per day; (3) irregular activity, defined

as some level of activity, but not meeting the CDC recom- Weight Statusmendations; and (4) no reported activity.

The weight status data were analyzed by two age groupsActivity levels of the study group were compared to two(younger and older) and four BMI categories. The fournational samples (see Table 2): the National Cohort ofBMI categories were: < 19, 19–25, > 25–27.3, $ 27.3.Midlife Women obtained from the 1994 Behavioral RiskResults of the calculated BMI indicated that generally theFactor Surveillance System (BRFSS) and the National Co-younger women in the study group had lower BMIs thanhort with Chronic Illness from the National Health Inter-

view Survey 1990–1991 (CDC, 1995b, 1997a). Of the 227 the older women (see Table 3). Fifteen percent of the


TABLE 2. Comparison of Activity Levels for Study Group, National Cohort of Midlife Women, National Cohort with Chronic Illness

National Cohort National CohortStudy Group Midlife Womena Chronic Illness b,c

Activity Level % % %

No activity 44 28.4 38.5Irregular activity 41 42.7 33.1Moderate/vigorous activity 15 28.9 28.4

a Source: Behavioral Risk Factor Surveillance System, 1994.b Source: National Health Interview Survey, United States 1990–1991.c All adults aged $ 18 years with a chronic illness other than arthritis.

TABLE 3. Percent of Women in BMI Categories

BMI

Age Total n <19 % (n) 19–25 % (n) 25–<27.3 % (n) $27.3 % (n)

Age 35–44 133 15 (20) 50 (66) 11 (14) 25 (33)Age 44 ` 88 7 (6) 45 (40) 14 (12) 34 (30)

younger women had BMIs lower than 19, indicating poten- Snackingtial risk for the health consequences of underweight.

For younger women in this study, 94% ate one or moreNationally, obesity rates continue to climb. Currently,

snacks per day. For older women, 91% had one or moredata from CDC’s Third National Health and Nutrition Ex-

snacks. Comparison of snacking frequency of study groupamination Survey (NHANES III) (1988–1994) indicates

women to national samples is difficult since snacking fre-36.4% of all women are obese in comparison to 28.5% of

quency data varies based on the definition of snacking.the study group (CDC, 1997b). When comparing the obe-

National statistics from the 1994–1995 CSFII indicate thatsity rates of younger women (# 44 years old) in this sample

75.7% of younger midlife women snack, while approxi-versus rates obtained from CDC’s National Center for

mately 74% of older midlife women snack (Wilson et al.,Health Statistics, only 25% were obese compared to 35.1%

1997). Another national research study (Cross et al., 1994),in CDC’s statistics. When comparing the obesity rates of

found that all the survey population snacked at one timeolder women (> 44 years old) in the study group to CDC’s

or another during the day. Only 2.1% of seniors reportedstatistics, 34% were obese as compared to 39.8% in the

no snacking while less than 1% of all other age groupsgeneral population (USDHHS, 1996a).

reported no snacking (Cross et al., 1994). Higher rates ofConsidering the impact of obesity on developing and

snacking in the national research study were comparablemanaging acute and chronic illnesses, these rates show a

to those of this study group.positive trend among this subgroup of women. It wouldbe important to identify those women with BMIs in the

Health Status Perceptionsobese and severe underweight categories to provide appro-priate assessment and intervention. In this study, both questions asking women to rate their

health status showed that older women consistently ratedBreakfast Patternstheir health status higher than younger women. In the studygroup, 60% of older women rated their overall generalIn this study group, 89% (n 4 48) of younger women and

84% (n 4 143) of older women reported eating breakfast health as good/excellent with only 44% of younger womenresponding in these categories (see Table 5). Both thein the combined categories of most of the time and always

(see Table 4). Both age groups in the study group reported younger and older women in the study group, however,reported a lower perceived health status than the 1993higher rates of breakfast consumption than results from

the 1989–1991 Continuing Surveys of Food Intake by Indi- BRFSS national sample of adults. In this national sample,86.6% assessed their general health status as good/excellentviduals (CSFII) national rates for adult women (74.8%)

(Haines et al., 1996). (CDC, 1995a). These results may indicate a lowered range


TABLE 4. Frequency of Breakfast Consumption

Frequency

Age Total n No/Rarely % (n) Some % (n) Most % (n) Always % (n)

Age <40 54 11 (6) 20 (11) 24 (13) 44 (24)Age $44 170 16 (2) 18 (30) 20 (34) 46 (79)

TABLE 5. Perception of General Health Status

Perception

Age Poor % (n) Fair % (n) Good % (n) Excellent % (n)

Age 35–44 13 (18) 42 (57) 41 (56) 3 (4)Age 44 ` 11 (10) 29 (27) 48 (44) 12 (11)

of physical, emotional, and social functioning. It is impera- light drinking. Thirteen percent of younger women and20% of older women reported moderate drinking, and 3%tive to conduct further research in this area to assess the

health status and needs of midlife women living with a of younger women and 2% of older women in the studygroup reported heavy drinking.chronic illness.

It would be important to identify, acknowledge, andAlcohol Consumption support the small group of women who reported heavy

drinking to assist them in lowering alcohol consumptionIn this study, 16% in the younger age category reportedlevels through appropriate interventions. This action is par-that they had never had an alcoholic beverage in their lives,ticularly essential with this group in order to reduce theirand 14% of older women reported never drinking. To assesseven greater risks for injury associated with excessive alco-the current level of drinking, women were divided into 3hol consumption (Garg et al., 1993).categories of drinkers: light (0–3 drinks per week), moder-

ate (4–13 drinks per week), heavy (14` drinks per week).All women in the study group who were currently drinking Tobacco Usereported less alcohol consumption than in a national sample

For the midlife women in this study, 49% never smoked,of women from the 1990 National Health Interview Studyas compared to 57% of women from the 1991 National(see Table 6) (USDHHS, 1996a). In the study group, 81.8%Health Interview Survey statistics. Even though the studyreported light drinking, compared to 75.5% of women ingroup had an initial higher percentage of women who hadthe national sample. Only 2.8% of the study group womenever smoked, only 17% were still smoking compared toreported heavy drinking compared to 3.4% of women fromnational data of 23.5%. In the study group, 33% had quitthe national sample.smoking, while in the national group only 19% had quitWhen comparing age differences within the study group,(CDC, 1994).84% of younger women and 78% of older women reported

In the study group, older women who were currentlysmoking had smoked an average of 27 years and an estimateof 185,639 cigarettes in their lifetime (see Table 7). TheTABLE 6. Amount of Drinking for Those Women Currentlyestimated number of cigarettes smoked in a lifetime wasDrinkingcalculated by multiplying the number of cigarettes smoked

Amount per day by 365, times the number of years smoked. Olderwomen, who had quit smoking, averaged 16.8 years smok-Light % Moderate % Heavy %ing using about 141,678 cigarettes in their lifetime.

Study Group 81.8 15.4 2.8 Younger women currently smoking had smoked for 20National Cohorta 75.5 21.1 3.4 years using approximately 154,465 cigarettes in their life-aSource: National Health Interview Survey, 1990. time. The study group had lower rates of current smoking


TABLE 7. Mean Number of Years Smoked and Cigarettes/Lifetime is Calculated for Former and Current Smokers

Ages 35–44 Ages 44`

Smoking Status Years Smoked Cig/Lifetime Years Smoked Cig/Lifetime

Former 10 85,807 16.8 141,678Current 20 154,465 27 185,639

(17%), compared to national rates of 23.5%, however, there ing or smoking reported less use than in national reports.In the case of smoking, there was a higher percentage ofwas a higher percentage of women in the study group who

had smoked at one time. women in the study group who had previously smoked.Both age groups in the study group reported higher ratesA notable finding was the number of women in the study

group who had quit smoking (n 4 76). Understanding of breakfast consumption than national rates. As comparedto several national samples, women in the study had compa-how this subgroup of women was successful at smoking

cessation may ultimately assist women in the study group, rable snacking patterns.as well as other women, to quit smoking. For those women Healthy lifestyles, reflected by the wellness profile, sig-in the study who were currently smoking, efforts need to be nificantly impact a woman’s health status as well as hermade to evaluate the effectiveness of current intervention family’s well-being, economic resources, and use of healthprograms for this population, and ultimately develop smok- services. This was particularly true of the middle ageing cessation programs that better meet their needs. women in this study diagnosed with the pre-existing

chronic disease, multiple sclerosis. The burden of chronicCONCLUSIONS diseases greatly impacts women; potential impacts include

increased mortality, prolonged illness and disability withMidlife women’s wellness profiles, comprised of health-pain and suffering, enormous financial costs, and reducedrelated lifestyle indicators, were compared to midlifequality of life. It is imperative that women with a pre-women with a chronic illness in this study. The sevenexisting chronic illness practice healthy behaviors that aug-healthy lifestyle indicators examined were: activity level,ment current health status, enhance quality of life, andweight status, breakfast pattern, snacking, health statusprevent or delay the onset of additional chronic disease.perceptions, alcohol consumption, and tobacco use.

Preventing or curtailing the many negative impacts ofAs compared to national results, the study group ofchronic diseases requires the adoption of specific health-midlife women indicated less activity and lower perceptionpromoting behaviors. While these behaviors have the great-of their overall health status. Specifically, study groupest impact at an early age, research supports that positivewomen were less active and engaged in less vigorous activ-changes in health promoting behaviors, at any age, canity. Older women in the study consistently rated their healthresult in improved health and reduced risk for health prob-status higher than the younger group, but both age groupslems (CDC, 1997c)reported lower health status as compared to the national

Developing a profile of women’s at-risk and health pro-statistics. A lower perception of health status is expectedmoting behaviors can assist public health nurses, familyconsidering the significant impact of multiple sclerosis. Anurse practitioners, and other community-based health carechronic disease impacts an individual’s physical, psycho-providers to address the impact of chronic disease. Healthlogical, social and economic status, thereby comprisingcare providers can have a great impact in reducing thetheir actual and perceived health status.negative effects of chronic diseases through promotingComponents of the wellness profile that indicate healthierpositive health behaviors, by providing education and di-lifestyles as compared to the national samples were health-rection for lifestyle adaptations. These measures will bene-ier body weights, less use of tobacco and alcohol, healthierfit women with chronic disease and will enhance health,breakfast patterns, and comparable snacking patterns. Thequality of life, and their families’ general well-being,incidence of obesity was lower in the older and youngerthereby contributing to healthier communities.women in the study group, as compared to the national sam-

Health care providers can most effectively accomplishple. The study group women followed the national trend ofthese goals through partnerships with community leaders,increased weight with aging, with the older women havingvoluntary and professional organizations, academic institu-higher rates of obesity and higher BMIs.tions, and government agencies. Practitioners who are inWith regard to alcohol consumption and tobacco use,

women in the study group who were currently either drink- a position to teach and reinforce positive health behaviors


tion opportunities: Reducing the health and economic burdenneed to assess the wellness profile and other importantof chronic disease. Atlanta, GA: CDC.challenges of midlife women with a chronic disease. It is

Craft, N. (1997). Women’s health is a global issue. British Medi-critical to stay current with the latest research in women’scal Journal, 315(1), 1154–1157.health issues and with the recommendations regarding

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This study was supported by a grant (number tive care. American Journal of Public Health, 86(12),1R01NR01852) from NIH/National Institute for Nursing 1755–1759.

Kim, S. (1998). Dietetics professionals and women’s health re-Research and Office of Research on Women’s Health.search at the National Institutes of Health. Journal of the

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Wellness Profile of Midlife Women with a Chronic Illness