Persons with psychotic disorders and bipolar disorder reported markedly more difficulty in obtaining a primary care physician and greater barriers to care than the general population. Interventions are needed to improve provision of primary medical care to this population.

In this study, symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were modeled as intervening variables in the relationship between childhood traumatic stress and weight outcomes in civilian women in the United States. Of the 148 participants, 72 had current PTSD, 64 had current MDD, and 32 had neither disorder. In separate single indirect effect models, there were significant indirect effects of both PTSD and depressive symptoms on body mass index and waist-hip ratio. When models included both PTSD and depressive symptoms, an indirect effect of PTSD symptoms was evident in the relationship between childhood traumatic stress and waist-hip ratio. PTSD may play a particularly important role in the development of central adiposity.

Purpose: Because of limited knowledge regarding the sexual health of minority women, we described the types and frequency of sexual concerns among African American, Asian American, and white women.Methods: The sexual concerns of eligible women who received their health care at a large military health care facility in Washington State were determined from December 1992 through January 1993 through the use of a questionnaire on women's sexual health that was developed by one of the authors.Results: A high and similar prevalence of sexual concerns was reported among these women. The prevalence of certain sexual concerns among white, African American, and Asian American women differed significantly. A history of sexual coercion or physical/emotional abuse was strongly associated with a high prevalence of sexual concerns for each racial and ethnic group. Sexuality plays an integral role in health, quality of life, and general well-being. For women, the risk of unwanted pregnancy, sexually transmitted diseases, and sexual exploitation are threats to their sexual health. Family physicians must consider women's sexual concerns to provide comprehensive health services. In addition, family physicians must consider the variation in sexual concerns that may exist among different racial and ethnic groups of women.Nusbaum et al 1 found a high prevalence of sexual concerns among women seeking routine gynecological care at 2 outpatient military clinics including lack of interest in sex, difficulty with orgasm, inadequate lubrication, dyspareunia, body image concerns, unmet sexual needs, the need for information about sexual issues, physical and sexual abuse, and sexual coercion. However, this study did not explore possible differences in sexual concern across racial and/or ethnic groups. We found only one study, by Laumann, 2 that compared self-reported sexual dysfunction of a national probability sample of white, African American, Hispanic, and another category of women. Of the 5 reported categories of sexual dysfunction, compared with white women, African American and Hispanic American women were significantly less likely to report trouble with lubrication during intercourse. However, the limited categories of sexual concerns fails to provide a more comprehensive understanding of the sexual concerns of women from different racial and ethnic backgrounds. Based on limited knowledge of the diversity of sexual concerns among women of different racial/ ethnic backgrounds, physicians may generalize the sexual concerns of one group to all women thus providing suboptimal sexual health care. To address the limited knowledge and variation of sexual concerns among racial and ethnically diverse women, this study identified the types and preva-

This pilot residential smoking treatment program was designed to assist smokers who relapsed after outpatient treatment. Four days of residential smoking therapy successfully relieved smoking withdrawal. At 6 months after discharge, participants maintained an abstinence rate comparable to other medical therapies for smoking.