Journal of Community Health

, Volume 30, Issue 4, pp 281–297

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

  • Christine G. Unson
  • Richard Fortinsky
  • Karen Prestwood
  • Susan Reisine


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

Key words

osteoporosis African–American Health Belief Model hormone therapy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Barrett, JA, Baron, JA, Karagas, MR, Beach, ML 1999Fracture risk in the US Medicare populationJ Clin Epidemiol52243249CrossRefPubMedGoogle Scholar
  2. 2.
    Kellie, SE, Brody, JA 1990Sex-specific and race-specific hip fracture ratesAm J Public Health80326328PubMedGoogle Scholar
  3. 3.
    Adams-Campbell, L, Rosenberg, L, Washburn, RA, Rao, RS, Kim, KS, Palmer, S 2000Descriptive epidemiology of physical activity in African–American womenPrev Med304350CrossRefPubMedGoogle Scholar
  4. 4.
    Jackson, KA, Savaiano, , DA,  2001Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-AmericansJ Amer Coll Nutr20198S207SGoogle Scholar
  5. 5.
    Kotzan, JA, Martin, BC, Wade, WE 1999Persistence with estrogen therapy in a postmenopausal Medicaid populationPharmacotherapy19363369CrossRefPubMedGoogle Scholar
  6. 6.
    Brett, KM, Madans, JH. 1997Use of postmenopausal hormone replacement therapy: Estimates from a nationally representative cohort studyAm J Epidemiol145536545PubMedGoogle Scholar
  7. 7.
    Rosenstock, I, Strecher, VJ, Becker, MH. 1988Social learning theory and the health belief modelHealth Educ Quart15175185Google Scholar
  8. 8.
    Geller, SE, Derman, R 2001Knowledge, beliefs and risk factor for osteoporosis among African–American and Hispanic womenJ Natl Med Assoc931321PubMedGoogle Scholar
  9. 9.
    Unson, C, Dunbar, N, Curry, L, Kenyon, L, Prestwood, K. 2001The effects of knowledge, attitudes, and significant others on decisions to enroll in a clinical trial on osteoporosis: Implications for recruitment of older African–American womenJ Natl Med Assoc93392401PubMedGoogle Scholar
  10. 10.
    Unson, C, Siccion, E, Gaztambide, J, Gaztambide, S, Mahoney-Trella, P, Prestwood, K. 2003Non-adherence and treatment preferences among older women: A qualitative studyJ Womens Health1210371045CrossRefGoogle Scholar
  11. 11.
    Hsieh, C, Novielli, K, Diamond, J, Cheruva, D 2001Health beliefs and attitudes toward the prevention of osteoporosis in older womenMenopause8372376CrossRefPubMedGoogle Scholar
  12. 12.
    Grisso, JA, Kelsey, JL, Strom, BL,  et al. 1994Risk factors for hip fracture in black women. The Northeast Hip Fracture Study GroupN Engl J Med33015551559PubMedGoogle Scholar
  13. 13.
    Neuner, JM, McCarthy, EP, Davis, RB, Phillips, RS 2003Physician counseling on hormone replacement therapy and bone loss: Do socioeconomic and racial characteristics of women influence counseling?J Womens Health12495504CrossRefGoogle Scholar
  14. 14.
    Brown, AF, Perez-Stable, EJ, Whitaker, EE,  et al. 1999Ethnic differences in hormone replacement prescribing patternsJ Gen Intern Med14663669CrossRefPubMedGoogle Scholar
  15. 15.
    National Osteoporosis Foundation. Boning up on Osteoporosis: A guide to prevention and treatment. 1998Google Scholar
  16. 16.
    Hays, J, Ockene, JK, Brunner, R,  et al. 2003Effects of estrogen plus progestin on health-related quality of lifeN Engl J Med34818391854CrossRefPubMedGoogle Scholar
  17. 17.
    Speroff, L. 1998The heart and estrogen/progestin replacement study (HERS)Maturitas31914CrossRefPubMedGoogle Scholar
  18. 18.
    Miller, KJ, Conney, JC, Rasgon, NL, Fairbanks, LA, Small, GW. 2002Mood symptoms and cognitive performance in women estrogen users and nonusers and menJ Am Geriatr Soc5018261830CrossRefPubMedGoogle Scholar
  19. 19.
    Brincat, MP 2000Hormone replacement therapy and the skinMaturitas35107117CrossRefPubMedGoogle Scholar
  20. 20.
    Graziottin, A. 2000Libido: The biologic scenarioMaturitas34916CrossRefGoogle Scholar
  21. 21.
    Writing Group of the Women’s Health Initiative Investigators2002Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative Randomized Controlled TrialJAMA288321333Google Scholar
  22. 22.
    The Women’s Health Initiative Steering Committee.2004Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative Randomized Controlled TrialJAMA29117011712Google Scholar
  23. 23.
    Rogers, EM 1995Diffusion of Innovations4The Free PressNew YorkGoogle Scholar
  24. 24.
    Ettinger, B, Pressman, A, Silver, P 1999Effect of age on reasons for initiation and discontinuation of hormone replacement therapyMenopause6282289PubMedGoogle Scholar
  25. 25.
    Vihtamaki, T, Savilahti, R, Tuimala, R. 1999Why do postmenopausal women discontinue hormone replacement therapyMaturitas3399105CrossRefPubMedGoogle Scholar
  26. 26.
    Friedman-Koss, D, Crespo, CJ, Belanntoni, MF, Andersen, RE 2002The relationship of race/ethnicity and social class to hormone replacement therapy: Results from the Third National Health and Nutrition Examination SurveyMaturitas9264272Google Scholar
  27. 27.
    Finley, C, Gregg, EW, Solomon, LJ, Gay, E 2001Disparities in hormone replacement therapy use by socioeconomic status in a primary care populationJ Community Health263949CrossRefPubMedGoogle Scholar
  28. 28.
    Rosenberg, L, Palmer, JR, Rao, S, Adams-Campbell, I. 1998Correlates of postmenopausal female hormone use among black women in the United StatesObstet Gynecol91454458CrossRefPubMedGoogle Scholar
  29. 29.
    Weng, HH, McBride, CM, Bosworth, HB, Grambow, SC, Siegler, IC, Bastian, LA. 2001Racial differences in physician recommendation of hormone replacement therapyPrev Med33668673CrossRefPubMedGoogle Scholar
  30. 30.
    Kumanyika, S. 2001

    Minority populations

    Burke, LOckene, IS eds. Compliance in Healthcare and ResearchFutura Publishing Company, Inc.Armonk, NY195218
    Google Scholar
  31. 31.
    Clark, DO 1995Racial and educational differences in physical activity among older adultsGerontol35472480Google Scholar
  32. 32.
    Pratt, CA, Ha, L, Leviene, SR, Pratt, CB 2003Stroke knowledge and barriers to stroke prevention among African–Americans: Implications for health communicationJ Health Commun8369281CrossRefPubMedGoogle Scholar
  33. 33.
    Satterfield, T, Johnson, SM, Slovic, P, Neil, N, Schein, JR 2000Perceived risks and reported behaviors associated with osteoporosis and its treatmentWomen Health312140CrossRefGoogle Scholar
  34. 34.
    Blalock, SJ, DeVellis, RF, Giorgino, KB,  et al. 1996Osteoporosis prevention in premenopausal women: Using a stage model approach to examine the predictors of behaviorJ Health Psychol158493CrossRefGoogle Scholar
  35. 35.
    Gabriel, S, Kneeland, TS, Melton, LJ,III, Moncur, MM, Ettinger, B, Tosteson, ANA 1999Health-related quality of life in economic evaluations of osteoporosisMed Decision Making19141148Google Scholar
  36. 36.
    Fisher, W, Sand, M, Lewis, W, Boroditsky, , R,  2002Canadian menopause study-I: Understanding women’s intentions to utilize hormone replacement therapyMaturitas37114CrossRefGoogle Scholar
  37. 37.
    Robert, S, House, JS. 1996SES differentials in health by age and alternative indicators of SESJ Aging Health8359388PubMedGoogle Scholar
  38. 38.
    Knesebeck, O, Luschen, G, Cocerkham, WC, Siegrist, J 2003Socioeconomic status and health among the aged in the United States and Germany: A comparative cross-sectional studySoc Sci Med5716431652CrossRefPubMedGoogle Scholar
  39. 39.
    Ware, J, Snow, KK, Kosinski, M, Gandek, B 1993SF-36 Health Survey Manual and Interpretation GuideHealth Institute, New England Medical Center HospitalsBoston, MAGoogle Scholar
  40. 40.
    Bellantonio, S, Fortinsky, R, Prestwood, K. 2001How well are community-living women treated for osteoporosis after hip fracture?J Am Geriatr Soc491197204CrossRefPubMedGoogle Scholar
  41. 41.
    Quine, L, Rutter, DR, Arnold, L 2000

    Comparing the Theory of Planned Behavior and the Health Belief Model: The example of safety helmet use among schoolboy cyclists

    Norman, PAbraham, CConner, M eds. Understanding and Changing Health Behaviour: From Health Beliefs to Self-regulationHarwood Academic PublishersAmsterdam73100
    Google Scholar
  42. 42.
    Harrison, JA, Mullen, PD, Green, LW 1992A meta-analysis of studies of the Health Belief Model with adultsHealth Education Research7107116PubMedGoogle Scholar
  43. 43.
    Mauck, KF, Cuddihy, MT, Trousdale, RT, Pond, GR, Pankratz, VS, Melton, LJI 2002The decision to accept treatment for osteoporosis following hip fracture: Exploring the woman’s perspective using a Stage-of-Change ModelOsteoporosis Int13560564CrossRefGoogle Scholar
  44. 44.
    Chapurlat, RD, Bauer, DC, Nevitt, M, Stone, K, Cummings, SR 2003Incidence and risk factors for a second hip fracture in elderly women: The study of osteoporotic fracturesOsteoporosis Int14130136Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Christine G. Unson
    • 1
  • Richard Fortinsky
    • 2
  • Karen Prestwood
    • 2
  • Susan Reisine
    • 3
  1. 1.Communication DepartmentWestern Connecticut State UniversityDanburyUSA
  2. 2.Associate Professor, Center on Aging, School of MedicineUniversity of Connecticut Health CenterUSA
  3. 3.Department of Behavioral Science and Community Health, School of Dental MedicineWestern Connecticut State UniversityUSA

Personalised recommendations