The meat you eat

First, a little wave hello to all the newcomers to PreventionRD. I loved reading your feedback on Greek yogurt...and for correcting my spelling! Hate misspelled words!! I appreciate all who read and contribute to my blogging experience with your whit and wisdom -- you make my day! Sap, sap, sap!

I made a most delectable breakfast which I must share

(I'm always envious of all you fancy oats people!)...

Flaxseed Waffle

Flax Matters sent me this mix and let me tell you, it is PHENOMENAL!! I'll be honest in saying I'm not a huge fan of whole wheat when it comes to waffles, but these just tasted hearty and earthy...almost nutty. Mmmm! This was a huge treat, I will DEFINITELY be buying more of this mix! AND, it's reasonably priced!!!

Each waffle worked out to be ~300 calories, 5 grams of fat, 7 grams of protein, and 6 grams of fiber!

Ohhhhhhhhh yeaaaaa, yummy! And showing off the best Kitchen Aid waffle maker ever! If you're drawing a blank on what you want from Santa...waffle maker! Just sayin, you won't regret it...

The flaxseed bars Flax Matters sent are also WONDERFUL! They make a great high-protein, high-fiber snack that keeps you full for hours. I love'em!

A lucky winner may win some if they enter into the Prevention Cookbook!!!!

The emails of recipes are rolling in -- I am so excited!

All the details are here!

Don't delay, enter before January 1st to receive your cookbook and chances to win!

Annnnnnnnnnyways....THE MEAT YOU EAT!!!!

Reading Food, Inc. has really lit a fire in me! I've dealt with the back-handed comments from my husband and father for years regarding free-range this and grass-fed that. Just call me a little hippie child from the big city, okay?! And I'm not gunna lie, "clean" dairy, meat, eggs, and produce come with a hefty price tag and limited availability. And until recently (yesterday, in all honesty), my lack of knowledge surrounding the US food supply has enabled me to easily turn my head and "work with what we've got" -- the standard hormone-pumped, mass produced, grain-fattened meat and animal products comprising the vast majority of our food supply. Would you like that steak rare, medium, or well-done, right? Bleck.

I spent my lunch break looking up local farmers who sell eggs, beef, chicken, pork, etc. I’ve always “known” that free-range and grass-fed animals were “better,” but I feel like I’m learning why. If you don't know why, keep reading.

As I’ve ventured through the first few chapters of Food, Inc., I’d like to share with you quotes and summaries of points which I not only find interesting, but valuable knowledge for ALL. What is being revealed through solid research is that our food supply is dangerous, monopolized, and harmful to our health and economy.

Quotes from Food, Inc.:

“According to a study by the Union of Concerned Scientists, beef and milk produced from cattle raised entirely on pasture (where they ate only grass) have higher levels of beneficial fats, including omega-3 fatty acids, which may prevent heart disease and strengthen the immune system. This study also found that meat from grass-fed cattle was lower in total fat than meat from feedlot-raised cattle.”

rBGH stands for recombinant bovine growth hormone. This hormone is injected into dairy cattle to increase milk production by8-17%. Canada, Australia, Japan, and the European Union have all prohibited the use of rBGH in their food supply!!!

“So we’ve created a perverse system in which the food is cheap at fast food restaurants because they employ cheap labor, sell products that are heavily subsidized by the government, and sell them to consumers whose wages have been kept low. We’re walking about a race to the bottom.”

“An estimated two-thirds of all U.S. cattle raised for slaughter are injected with growth hormones” – half of these hormones are synthetic and half are natural.

“Meat packing used to be one of the best-paid jobs in the country…they had well-paid union jobs. They earned good wages, before the fast food companies came along.”

Question: “How much resistance did you encounter in researching and reporting the book?” Answer: “A lot. None of the major meat packing companies allowed me to visit their facilities. McDonald’s was not helpful at all.”

“The Center for Disease Control and Prevention estimate that one-third of all American children born in the year 2000 will develop diabetes as a result of poor diet and lack of exercise.”

“Factory farm operators typically manage what animals eat in order to promote their growth and keep overall costs of production low. However, what animals are fed directly affects the quality and safety of the meat and dairy we consume.”

“Scientists believe that ‘mad cow disease,’ or bovine spongiform encephalopathy (BSE), is spread when cattle eat nervous system tissues, such as the brain and spinal cord, of other infected animals.”

“A researcher from Cornell University found that cattle fed hay for the five days before slaughter had dramatically lower levels of acid-resistant E. coli bacteria in their feces that escape during the slaughter can lead to the bacteria contaminating the meat.”

More to come as I plow through this book (husband and puppy are beating me to the holidays and taking off for the north tomorrow - *daaaaaance*), stay tuned.

What can YOU do?

Lots! There are so many resources out there to help you access safe, healthy, sustainably-grown food!

To access information and contact information on FARMS, STORE, or RESTAURANTS offering sustainably raised meat and dairy products, check out this site.

To find a local farmer's market near you, go here.

Do you buy free-range, hormone-free meat? If no, is cost a major barrier?

Are you a vegetarian or vegan? If so, what is your motivation behind your decision?

While I'm 100% omnivore and intend to remain that way, I am making a commitment to consume safer, healthier, more sustainable meat and meat products.

I am a "single" woman as of tomorrow at 5pm -- expect me to be blogolicious tomorrow night and for the weeks to come, getting back to ALL the blogs I wish to read. Hello, vacation! 

2 quick little lesssons

A lesson in southern dining:

A refrigerator is referred to as an “ice box”

Lunch is called “dinner” and dinner is called “supper”…but lunch is dinner, too.

Beans (carb) are a meal, so long as cornbread (carb) is the side.

Black eyed peas are to be eaten on New Years Day in order to bring luck your way for the year.

Okra, beets, squash, and turnips are popular vegetables.

Pickles and okra are best when fried.

Potatoes are the favorite vegetable among all. They’re best when fried.

There’s a great way to prepare every meat – chicken fried steak, fried chicken, fried pork chops, fried catfish, etc.

All beef in the country is lean “because you take it to the butcher to be prepared”…

When pecan trees are producing, you make pecan pie. Constantly.

Goulash is a meal that’s prepared NUMEROUS ways, but staple ingredients include ground beef, tomatoes, and rice.

Tea is sweetened, with sugar, unless otherwise specified. 
Milk is assumed to be whole. If you buy low-fat milk, it’s 2%. 
A “hot sandwich” is an open-faced burger on top of fries, piled with gravy. 
An order of biscuits and gravy consists of TWO biscuits, halved, and swimming in gravy.
There’s chicken fried chicken and chicken fried steak – pounded meat dipped in batter and deep-fat fried and smothered in gravy.

A lesson in Greek yogurt:

Q: What makes Greek yogurt "Greek"?

A: Greek yogurt found in the US is made from pasteurized cow’s milk, versus the raw goat’s or sheep’s milk in “real” Greek yogurt. Greek yogurt, known for its thick texture, is due to the extensive straining that removes most of the yogurt’s liquid whey. With the removal of whey, the lactose and sugar content are lower, leaving a thicker, highly concentrated, tart product containing almost twice the protein of regular yogurt. Greek yogurt also causes fewer side effects for those suffering from lactose intolerance.

Q: What makes Greek yogurt so versatile?

A: Due to the thickness of the yogurt, it is easier to cook with and is less likely to “break up” when heated in cooking.

Q: Which Greek yogurt is the best? There’s so many out there!
A: According to the Chicago Tribune’s blind taste test….the 0% fat Greek yogurts (best to worst):

1. Fage
2. Okios
3. Chobani
4. Siggis Icelandic Yogurt
5. Trader Joe’s

A huge thanks to Kristina at Stonyfield Farm who sent me Okios coupons for free 16 ounce Okios Greek yogurt! Thank you, Kristina! While I will have to keep a coupon or 2 to try new flavors, you have a chance to win a FREE 16 OUNCE OKIOS COUPON (among many other things) by entering into the Prevention Cookbook. It's a win-win, I'm tellin' ya!

Another huge thanks to Shari at Chobani for sending samples to try! I don't think there's a flavor out there I won't get to sample. So excited -- thank you, Chobani (and Shari!)!

Complete coincidence on both Chobani and Okios fun arriving today. While I've tried Okios, I am yet to try Chobani. I will give a full review once I've formed a solid opinion.

Yogurt lovers: Have you tried Greek yogurt? Do you like it better than regular yogurt? Do you have a preference for one brand over the other?

For those wonderful individuals who have already entered into the Prevention Cookbook, your recipes look delectable! If you haven't heard about the Prevention Cookbook, please go here! Wouldn't YOU like to start the new year with a bundle of healthy new recipes to try!? 

I thought so!


*!*!*!*!*!*! HELP *!*!*!*!*!*!
  
Google Readers: Is there a way to respond to leave comments on blogs from Google Reader? I am kind of slow when it comes to this stuff, and work has officially blocked everything fun (gmail, blogs, everything - AH!). Thanks in advance!


Also, preventionrd.com / preventionrd.blogspot.com is in the works! My projected switch date to Wordpress is December 23rd! Trying to keep you all in the loop so we don't lose touch!

Slow day...post day...

You know work is slow when it's a double-post kinda day... : )

 Mari asked me a wonderful question about PCOS and what type of diet is best for women suffering from PCOS. Great question, Mari...I hope this is helpful!

Women with polycystic ovarian syndrome (PCOS) are at increased risk for heart disease and diabetes. Many women with PCOS have insulin resistance, causing the pancreas to secrete more and more insulin in order to transport glucose (sugar) out of the blood and into muscle, fat, and liver cells where it is converted to energy or stored as fat. Elevated insulin levels can cause polycystic ovaries, weight gain or difficult losing weight, increased risk of heart disease (elevated LDL-cholesterol and triglyceride levels and decreased HDL-cholesterol levels), and increased clotting factors. The risk of the developing diabetes in women with PCOS can be up to 40% by the age of 40. Most women (50-60%) with PCOS are obese (BMI greater than 30). Weight loss, even as little as 5% can lead to decreased insulin levels which is critical due to the fact that elevated insulin levels promote fat storage [1].

In researching how much carbohydrate a woman with PCOS should consume, I found varying recommendations. Before prescribing a standard 50-55% carbohydrate diet or a low (40% or less) carbohydrate diet, I would want to know a PCOS patient’s fasting blood sugar and HbA1c – a lab value indicating an average blood glucose reading representing 6-8 weeks. Agreeably, women with a higher BMI are statistically more likely to have insulin resistance, in which case a lower (less than 50-55%) carbohydrate diet is probably advisable.

I am of the opinion that to prevent diabetes, one should eat like a diabetic. For most women of normal to overweight size, this would include 30-45 grams of carbohydrates at meal times and 15-30 grams of carbohydrate + 1-2 ounces of protein before bedtime. Emphasis should be placed on complex, low-glycemic index carbohydrates, as well as a diet low in saturated (13 grams or less per day) and trans fat (none, preferably). For women with a BMI greater than 30, carbohydrate and energy needs go up – consult a Registered Dietitian for recommendations.

For example, a 180-pound (81.8 kilograms) female requires roughly 1230-1640 calories a day to lose weight (15-20 calories per kilogram of body weight. In order to find your weight in kilograms, divide your weight in pounds by 2.2). At minimum (30 grams of carbohydrate per meal with a 15-gram carbohydrate evening snack), carbohydrate comprises 26-34% of the daily intake. At maximum (45 grams of carbohydrate per meal with a 30-gram carbohydrate evening snack), carbohydrate comprises 40-54% of the daily energy intake. 

(Note: one gram of carbohydrate contains 4 calories – this is needed for calculations).

Other diet-related suggestions for women suffering from PCOS [1]:

-         Pair carbohydrate-rich foods and snacks with a lean protein or fat high in mono and/or polyunsaturated fatty acids.

-         Consume foods with a lower glycemic index – these foods are typically high in fiber

-         Space carbohydrates out throughout the day. Consuming consistent, moderate carbohydrate levels is best for blood sugar control

-         Consume plenty of decaffeinated, sugar-free beverages, especially water

-         Exercise on a regular basis -- aerobic and anerobic

-         Take a multi-vitamin mineral supplement daily

[1]. McKittrick, Martha. PCOS and Diet. OBGYN.net Publications.

The above information was provided by the above source. The author, Martha McKittrick is a Registered Dietitian and Certified Diabetes Educator. In other words, she is a wonderful resource!

Cookie Taste-Test Results!

The preferred cookie in yesterday's cookie taste testing was the Oatmeal Cranberry White Chocolate Chip Cookies. Hands down. There were only 2 votes NOT for the Oatmeal Cranberry White Chocolate Chip Cookies and they were for the Chocolate Peanut Butter Cookies and the Peppermint Cheesecake Brownies.

P.S. I had 2 late-comers who wanted in so the total participation was 18 employees!

Last night I made deer meat tacos for dinner!

My father-in-law is a bow hunter and provides us with deer meat. Yum!

I had 1 deer meat taco, a dollop of fat-free refried beans, and a bed of shredded lettuce with deer meat, salsa, corn, and homemade guacamole. Mmmm!

 Nutritional comparison of deer/venison vs. ground beef

(values represent a 1 ounce, raw portion)

- deer meat is 40 calories versus the 72 in ground beef*

- deer meat contains 0.8 grams of fat compared to 5.7 grams in ground beef*

- deer meat contains 7.6 grams of protein compared to 4.9 grams in ground beef

*this is standard 70-80% lean (does not specify)

Question: Have you tried deer meat? Did you like it? Did it taste "game-y" to you?

The sad truth about luncheon meat...

Wonder why that pre-packaged turkey breast has an expiration date 6 weeks away? Me too.

The deli meat business brought in roughly $17 billion dollars in 2004 according to a report by Packaged Facts. There are 3 types of deli meats out there: whole cuts of meat (roast beef, turkey breast), sectioned and formed prodcuts (cooked hams), and processed products (bologna). Most all lunch meats contain nitrites and nitrates which are preservatives, coloring, and flavoring additives which have been linked to some forms of cancer, such as stomach, liver, esophagus, mouth, and larynx [1].

Processed meat consumption has been associated with an increased risk of stomach cancer in some epidemiological studies among Swedish women according to the National Institute of Environmental Medicine, published in the International Journal of Cancer in 2006. The culprit to blame? Nitrosamines, it seems. The study prospectively examined the association between intakes of processed meat, other meats, and N-nitrosodimethylamine (most frequently found in nitrosamine-containing foods). A total of 61,433 women were included in the study. After an 18-year follow-up, there were 156 incidences of stomach cancer which appeared more prevalently in those women consuming higher levels of processed meats, but not of other meats such as red meat, fish, and poultry. Stomach cancer risk was 2-fold higher among women in the top quintile of N-nitrosodimethylamine intake when compared with the bottom quintile. And thus, high consumption of processed meats may lead to an increased risk of stomach cancer [2].

When shopping for lunch meats, you may have seen some verbage along the lines of, "contains up to 10% added moisture". Many lunchmeats, including ham, roast beef, and turkey contain added solutions of water, sodium, and water with spices [1], which can drastically increase the sodium content of these meat products [1].

According to one source, cold cuts will last only 3 to 5 days after being opened while deli cuts will only last one to three days [1]. Consume safely!

Monosodium glutamate (MSG), a flavor enhancer, is also found in various lunch meats. MSG is recognized by the Food and Drug Administration (FDA) as "GRAS" (generally recognized as safe). Long-standing research has made no definitive link between MSG and serious health risks, including Alzheimer's disease and various cancers. Noted, however, are short-term reactions to MSG ingestion, such as: headache, flushing, sweating, sense of facial pressure or tightness, numbness, tingling, or burning around the mouth, fluttering heartbeats, chest pain, shortness of breath, nausea, and weakness. Symptoms reported are generally mild, according to Mayo Clinic [3].

[1]. 15 Things You NEver Thought You Needed to Know About Lunchmeat. SixWise.

[2]. Larsson, SC, Bergkvist, L., Wolk, A. International Journal of Cancer. Processed Meat Consumption, Dietary Nitrosamides and Stomach Cancer Risk in a Cohort of Swedish Women. August 15, 2006.

[3]. Zeratshy, Katherine. Nutrition and Healthy Eating: Monosodium Glutamate (MSG): Is it harmful? Mayo Clinic.

Omega-3 Show-Down!

Know that omega-3’s are good for you…but that’s about it? Bruce Watkins, Purdue University professor of nutrition and director of the International Omega-3 Learning and Education Consortium for Health and Medicine helped in developing a website devoted to teaching consumers about types of omega-3’s, benefits of omega-3’s, and where to find them in the diet. They created this site in the process. The site answers basic questions about omega-3 fatty acids. Also included for doctors, medical providers, and veterinarians is a fact sheet and patient handout [1] – check it out!

Additionally, the site includes a database of foods containing omega-3’s as well as the amounts. I know Gina and I have a discussion back about the feasibility of consuming adequate omega-3’s for cardio-protective benefits through the diet alone. There is also a chart showing how much and what types of omega-3’s men and women of varying ages and with differing health histories should consume [1]. Sign-up to receive their monthly newsletter, too! Jackpot!

Omega-3’s for asthma? Heart disease? Cancer? Maternal Health? Cognitive function? Transplantation? Mental health? Eye health? Diabetes? Go here!

The run-down (per 100 grams/~3.5 ounces):

Highest overall omega-3 content (fresh fish) = salmon, Atlantic, farm-raised (2507 mg omega-3’s)

Highest ALA content (fresh fish) = salmon, wild (295 mg ALA)

Highest EPA content (fresh fish) = salmon, Atlantic, farm-raised (862 mg EPA)

Highest DHA content (fresh fish) = salmon, wild (1115 mg DHA)

Okay…salmon takes the cake for the fresh fish. Other great options include: swordfish, trout, tuna (bluefin), whitefish, halibut, catfish, and anchovies.

Highest overall omega-3 content (shellfish) = shrimp (540-601 mg omega-3’s)

Highest ALA content (shellfish) = crayfish, wild (32 mg ALA)

Highest EPA content (shellfish) = shrimp (293 mg EPA)

Highest DHA content (shellfish) = squid (342 mg DHA)

So, shrimp are a GREAT option for omega-3's. Other shellfish sources of omega-3’s include: blue crab, Dungeness crab, queen crab, spiny lobster, mussels (yum!), and scallops!

And FYI: canola oil and flaxseed oil contain omega-3’s! Per 100 grams there are 9137 mg omega-3’s in canola oil and 53,300 mg omega-3’s in FLAXSEED OIL! I must ask, who knew that canola and flaxseed oils had so many omega-3’s!? You can boast your intelligence, it’s alright!

What do YOU need?

- If you have no documented coronary heart disease, eat a variety of fish at least twice a week. Try to focus on fattier fish such as salmon. Use other products such as flaxseed and canola oil, as well as flaxseeds and walnuts.

- If you HAVE documented coronary heart disease, consume about 1 gram of EPA + DHA per day, preferably from fatty fish. Supplementation may be recommended by a physician.

- If you have elevated triglycerides, take 2-4 grams of EPA+DHA per day through a supplement provided under a physician’s care.

As always, purchase and use supplements with caution. Supplements are not FDA-regulated and are not tested for purity or potency.

All the nutrition facts are provided by the US Department of Agriculture’s National Nutrient Database for Standard Reference, Release 21.

[1]. New Web Site Aims To Deepen Public Knowledge of Omega-3s. Purdue University. August 21, 2009.

Omega-3's: How much?

Depends on the research.

A new analysis could lead to a heated debate on omega-3's having its own recommended daily intake levels. Heart-protective benefits of fish oil have been discussed for centuries, but how much do we need? Some cardiologists would like to see an established RDA for omega-3's. Dr. Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at Ochsner Heart and Vascular Institute in New Orleans, advocates such. He recommends people consume at least 500 milligrams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily. This recommendation was published in Monday's release of the Journal of the American College of Cardiology. Those with known cardiovascular disease should look to comsume 800-1,000 milligrams of EPA daily [1].

Dr. Steven Nissen, director of cardiovascular medicine at the Cleveland Clinic, says that Dr. Lavie's recommended may be premature and that wide-spread usage of omega-3's does not have compelling evidence in support.

Dr. Robert Bonow paves the way by recommending an increase in fish oil and deems this "good advice" while explaining that the strongest results from fish oil usage are seen in those with pre-established heart disease.

Lavie's recommendation is largely supported by recent research involving 40,000 participants ranging in health status, which revealed a number of potential advantages to omega-3's. For example, in men who had recently experienced a heart attack, those consuming omega-3's were 29% more likely to be alive in two years than their counterparts.

Dr. Rubenfire, director of preventative cardiology at the University of Michigan, explains that he would like to see a "trial in the modern era in patients on other evidence-based treatments such as aspirin, [blood pressure] control, statin and non smoking" to confirm benefits of omega-3's [1]. Fabulous suggestion, in my opinion.

MOST importantly, consumers MUST understand that supplements are not regulated. Therefore, a 1,000 milligram "fish oil" capsule can contain as little as 300 milligrams of EPA+DHA. Buy supplements that are 3rd party tested and approved for use by the U.S. Pharmacopeia (USP). These products may be hard to find, but they are available to consumers for purchase.

What does the boss say? Well, the American Heart Association is on board with omega-3's. The AHA's current recommendation includes 1,000 milligrams a day of combined DHA+EPA for those with confirmed coronary heart disease. For healthy adults, the AHA recommends consuming 500 milligrams a day, approximately the amount found in two servings of fatty fish a week [1]. Fatty fish include: salmon, mackerel, sardines, herring, lake trout, and albacore tuna.

[1]. Peck, P. and Childs, D. Recommended Daily Dose for Omega-3's May Be On the Way. ABC News. August 4, 2009.

Flexitarianism

I would consider myself a "Flexitarian" by definition. Mainly because the definition is so broad. While being a flexitarian provides plentiful flexibility, the premise of the "diet" definitely encourages reduced meat consumption while increasing plant consumption, particularly vegetables [1]. Do you consume your 5-9 a day? Hmm?

Typically, when people think of meat, beef is brainstormed ahead of chicken, pork, and seafood. While all are meats, red meat is of particular interest as it is highest in saturated fat, cholesterol, and calories. Sure, red meat provides an excellent source of certain minerals, such as iron. However, there is no necessity for red meat in the diet. So naturally, red meat is an American classic, and many are not willing to omit it from their diet. Being a red-meat-eating "flexitarian" would consist of decreased red meat consumption and encouraged healthier options: chicken, pork, seafood, nuts, seeds, and vegetables. With a heavy emphasis on the last one there...vegetables (and fruit) [1].

A Chicago author by the name of Dawn Jackson Blatner wrote the book "The Flexitarian Diet". I read it cover-to-cover, completely impressed with the research and feasibility of the proposed eating plan...simply because it is flexible [1]. Definitely check her out! She's an RD super-star in my book: mother, wife, author, counselor, workshop host, spokesperson, cooking class instructor, and a genuine, caring, and helpful woman. After reading her book I felt inspired to write to her, thanking her for her publication and acknowledging a job well-done by a fellow dietitian and nutrition guru. She was sincerely flattered and grateful for the praise, offering her brain to pick at any time.

If you're one of those people, like myself, that puts down a diet book and says, "Well, fabulous...what do I eat now?" -- Dawn's book is definitely one in which to invest. She includes hundreds of recipes that are not only easy, but delicious. Plus you can ease into the veggie movement. Dawn gives alternatives to ingredients for those who opt for chicken and seafood, for example.

Statistically, the Flexitarian Diet holds credibility, as well. Flexitarians weigh 15% less than those not limiting meat in the diet, have lower incidences of heart disease and diabetes, and also live an average of 3.6 years longer [1]. The stars are aligning in support of this diet plan, dontcha think?

And as you can guess, American meat consumption has been on a steady upward climb over the past 50+ years. In 2001-2002, the US Department of Agriculture turned out some data regarding US meat consumption. See table below [2]. It is of no surprise that heart disease and stroke continue to fall into the top 3 leading causes of death in the US for both men and women [3]. Research shows us with much certainty that 1) high meat consumption leads to increased risk of heart disease and stroke, and 2) high consumption of fruits and vegetables is linked to decreased risks of many forms of cancer. Increase the right one, decrease the other one, and you've got yourself a chronic disease prevention diet. Dawn is on to something, don't you see?


Check out "The Flexitarian Diet" and consider supplementing your meat intake with other protein-rich foods such as beans, lentils, tofu, soy, and similar products while increasing your fruit and vegetable consumption. I double-dog dare you to try!

Here's a great place to start with recipes and ides: Fruits and Veggies: More Matters.

Happy 4th of July! Resist the hot dog! Boom.

[1] Jackson-Blatner, Dawn. The Flexitarian Diet. McGraw Hill. September 10, 2008.
[2] United States Department of Agriculture. Profiling Food Consumption in America. Agriculture Facts Book 2001-2002, Chapter 2.
[3] U.S. Department of Health and Human Services, Health Resources and Service Administration, Maternal and Child Health Bureau. Women's Health USA 2008. Rockville, Maryland: U.S. Department of Health and Human Services, 2008.