1. Predictors of Depressive Symptoms and Obesity in African-American Women Transitioning from Welfare to Work Mayola Rowser PhDc, DNP, FNP-BC, PMHNP

2. Background Rates of depression and obesity increasing in the U.S. Rates of depression and obesity increasing in the U.S. Rates are higher among welfare recipients Rates are higher among welfare recipients 39% of recipients are African-American women 39% of recipients are African-American women African American women have more health problems African American women have more health problems than women of other races than women of other races

3. Background Depression and obesity associated with many chronic diseases Depression and obesity associated with many chronic diseases Employment outcomes negatively impacted Employment outcomes negatively impacted Depression and obesity associated with increased health care costs Depression and obesity associated with increased health care costs Few studies on depression and obesity among African- American women leaving welfare Few studies on depression and obesity among African- American women leaving welfare

4. Conceptual Framework Adaptation of Dr. Rice’s Health Assessment Status model Adaptation of Dr. Rice’s Health Assessment Status model Rice’s model influenced by the Health Promotion model Rice’s model influenced by the Health Promotion model Components of the model for the current study include Components of the model for the current study include –health risk behaviors –personal risk factors –perceived health status –situational influences

5. Conceptual Model Personal Risk Factors Demographic Age  Education Biological  Body mass index Perceived Health Status Health Risk Behaviors Physical inactivity  Poor nutrition  Smoking  Alcohol consumption Situational Influences Transition from welfare to work Depressive Symptoms Obesity

6. Significance Welfare benefits are time limited Welfare benefits are time limited Recipients forced to find jobs Recipients forced to find jobs 90% of recipients have one or more barriers to work 90% of recipients have one or more barriers to work Depression and obesity are barriers to sustained employment Depression and obesity are barriers to sustained employment

7. Research Questions 1. What is the prevalence of depressive symptoms in African-American women transitioning from welfare to work? African-American women transitioning from welfare to work? 2. What is the prevalence of obesity in African-American women transitioning from welfare to work? transitioning from welfare to work? 3. What is the association between depressive symptoms and obesity in African-American women transitioning from welfare to obesity in African-American women transitioning from welfare to work? work?

8. Research Questions 4. What is the prevalence of health risk behaviors in African-American women transitioning from in African-American women transitioning from welfare to work? welfare to work? 5. To what extent do health risk behaviors, personal risk factors, and perceived health status predict depressive symptoms ? 6. To what extent do health risk behaviors, personal risk factors, and perceived health status predict obesity?

9. Methodology Design Retrospective cross-sectional, descriptive, correlation study Retrospective cross-sectional, descriptive, correlation study Sample and Setting Convenience sample of 162 welfare recipients Convenience sample of 162 welfare recipients UTHSC Health Works Program participants UTHSC Health Works Program participants Data obtained from health assessments Data obtained from health assessments

10. Criteria African-American women African-American women 18 years of age or older 18 years of age or older Able to speak and read English Able to speak and read English Enrolled in the UTHSC Health Works Program Enrolled in the UTHSC Health Works Program

11. Instruments The Healthier People Network Health Risk Appraisal The Healthier People Network Health Risk Appraisal The Health Self Report The Health Self Report The Center for Epidemiologic Studies Depression Scale (CES-D) The Center for Epidemiologic Studies Depression Scale (CES-D)

12. Data Analysis Statistical Package for Social Sciences (SPSS) Descriptive Statistics Descriptive Statistics Pearson Correlation Pearson Correlation Stepwise Multiple Regression Stepwise Multiple Regression Logistic Regression Logistic Regression

13. Sample Characteristics N = 162 N = 162 Ages ranged from 18 – 55 Ages ranged from 18 – 55 Mean age 28.87 Mean age 28.87 32% completed high school 32% completed high school 24% reported “some college” 24% reported “some college” 37% rated their health poor-fair 37% rated their health poor-fair

14. Prevalence of Depressive Symptoms in African-American Women Transitioning from Welfare to Work

15. Prevalence of Obesity in African- American Women Transitioning from Welfare to Work

16. Association between Depressive Symptoms and Obesity in African-American Women Transitioning from Welfare to Work

17. Correlation Analysis between Sample Characteristics and Depressive Symptoms and Obesity Depressive Symptoms Obesity Age-.077.167*.167* †Perceived health status -.302**.005 † Physical activity (n=157) *p≤.05 *p≤.05**p≤.01

18. Prevalence of Health Risk Behavior in African-American Women Transitioning from Welfare to Work

19. Predictors of Depressive Symptoms in African-American Women Transitioning from Welfare to Work Table 4. Optimal Regression of Depressive Symptoms Independent Variable Betap-value Perceived health -.355.000 BMI 30 kg/m² or higher -.153.049

20. Predictors of Obesity in African-American Women Transitioning from Welfare to Work Table 6. Analysis of Maximum Likelihood Estimates ParameterEstimate Standard Error Wald Chi- Square p-value Intercept1.0551.4010.5670.452 Perceived health -0.2250.1014.9630.026 Depressive symptoms -0.9230.4224.7770.029

21. Predictors of Obesity in African-American Women Transitioning from Welfare to Work Table 6. Odds Ratio Estimates Effect Point Estimate 95% Wald Confidence Limits Perceived health 0.798 0.655 – 0.973 Depressive Symptoms 0.397 0.174 – 0.909

22. Conclusions High levels of education among the women High levels of education among the women Age correlated with obesity Age correlated with obesity No correlation between depressive symptoms and obesity No correlation between depressive symptoms and obesity Perceived health correlated with depressive symptoms and obesity Perceived health correlated with depressive symptoms and obesity

23. Limitations Instrumentation Instrumentation Convenience sample Convenience sample Cross sectional design Cross sectional design

24. Strengths Limited studies conducted on African-American women on welfare Limited studies conducted on African-American women on welfare Few studies on depressive symptoms and obesity in African-American women preparing for work Few studies on depressive symptoms and obesity in African-American women preparing for work Predictors of depressive symptoms and obesity examined Predictors of depressive symptoms and obesity examined

25. Practice and Policy Implications Recognition of depressive symptoms among African-American women Recognition of depressive symptoms among African-American women Unmet need for mental health services Unmet need for mental health services Awareness of sociocultural influence on perceptions of weight Awareness of sociocultural influence on perceptions of weight Funding for programs to address barriers to work Funding for programs to address barriers to work

26. Implications for Future Research Prospective studies needed to determine causal relationships Prospective studies needed to determine causal relationships Qualitative studies to address perceptions of health Qualitative studies to address perceptions of health Risk reduction interventions Risk reduction interventions

27. Questions

28. Thank you!!!