Women's Health Issues RSS feed: Current Issue. Women's Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women's health care and policy. As the official journal of the Jacobs Institute of Women's Health , it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women's health. http://www.whijournal.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Women's Health Issues1049-3867223May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.whijournal.com/article/PIIS1049386712000266/abstract?rss=yesContents10.1016/S1049-3867(12)00026-6Women's Health Issues 22, 3 (2012)2012-05-01Women's Health Issues2012-05-01223S1049-3867(11)X0012-9iiihttp://www.whijournal.com/article/PIIS1049386712000278/abstract?rss=yesEditorial Board10.1016/S1049-3867(12)00027-8Women's Health Issues 22, 3 (2012)2012-05-01Women's Health Issues2012-05-01223S1049-3867(11)X0012-9iiiiiihttp://www.whijournal.com/article/PIIS1049386711002556/abstract?rss=yesAbstract: Background: We investigated the impact of individual- and county-level contextual variables on women’s receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities.Methods: Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004–2005) were appended to prospective survey data from the Central Pennsylvania Women’s Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women’s preventive care. Multilevel analyses were performed.Results: We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations.Conclusions: Women’s receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women’s receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.Multilevel Analysis of the Determinants of Receipt of Clinical Preventive Services among Reproductive-Age WomenJennifer S. McCall-Hosenfeld, Carol S. Weisman, Fabian Camacho, Marianne M. Hillemeier, Cynthia H. Chuang10.1016/j.whi.2011.11.005Women's Health Issues 22, 3 (2012)2012-01-24Women's Health Issues2012-01-24223S1049-3867(11)X0012-9Articlese243e251http://www.whijournal.com/article/PIIS1049386712000035/abstract?rss=yesAbstract: Introduction and Background: Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time.Methods: From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding.Results: Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively.Conclusion and Discussion: Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities.Cluster Sampling with Referral to Improve the Efficiency of Estimating Unmet Needs among Pregnant and Postpartum Women after DisastersJennifer Horney, Marianne E. Zotti, Amy Williams, Jason Hsia10.1016/j.whi.2012.01.002Women's Health Issues 22, 3 (2012)2012-02-27Women's Health Issues2012-02-27223S1049-3867(11)X0012-9Articlese253e257http://www.whijournal.com/article/PIIS1049386712000163/abstract?rss=yesAbstract: Background: Mammography screening is essential for early detection of breast cancer and increased survival rates. Women, particularly those of low socioeconomic status, face barriers that impede their screening adherence. Although many studies have sought to identify these barriers, more research is needed on to address these obstacles in practice. The objective of this study is to divide mammography screening barriers into functional clusters using empirical evidence, which may guide the development of effective mammography screening promotion messages.Methods: A sample of 173 low-income White and Black women randomly selected from a managed care organization rated each of 21 potential mammography barriers on a scale ranging from “strongly agree” to “strongly disagree.” A maximum clustering similarity method was used to identify relevant clusters of screening barriers.Results: Five clusters were derived, with a high similarity index (0.881). Each cluster was named to reflect the shared theme of the barriers within it: Perceived Lack of Value in Health Care, Lack of Information, Mistrust/Skepticism, Medical Delay Behavior, and Anxiety/No Control. A dominant barrier within each cluster was identified, and bivariate correlation coefficients were reported.Conclusion: Cluster analysis yielded five distinct subgroups of mammography screening barriers.Clustering Very Low-Income, Insured Women’s Mammography Screening Barriers Into Potentially Functional SubgroupsNasar U. Ahmed, Kelly Winter, Ahmed N. Albatineh, Gillian Haber10.1016/j.whi.2012.02.001Women's Health Issues 22, 3 (2012)2012-03-30Women's Health Issues2012-03-30223S1049-3867(11)X0012-9Articlese259e266http://www.whijournal.com/article/PIIS104938671100257X/abstract?rss=yesAbstract: Background: This study evaluated the risk factors associated with racial disparities in female breast cancer mortality for African-American and Hispanic women at the census tract level in Texas from 1995 to 2005.Methods: Data on female breast cancer cases were obtained from the Texas Cancer Registry. Socioeconomic and demographic data were collected from Census 2000. Network distance and driving times to mammography facilities were estimated using Geographic Information System techniques. Demographic, poverty and spatial accessibility factors were constructed using principal component analysis. Logistic regression models were developed to predict the census tracts with significant racial disparities in breast cancer mortality based on racial disparities in late-stage diagnosis and structured factors from the principal component analysis.Results: Late-stage diagnosis, poverty factors, and demographic factors were found to be significant predictors of a census tract showing significant racial disparities in breast cancer mortality. Census tracts with higher poverty status were more likely to display significant racial disparities in breast cancer mortality for both African Americans (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.95–3.04) and Hispanics (OR, 5.30; 95% CI, 4.26–6.59). Spatial accessibility was not a consistent predictor of racial disparities in breast cancer mortality for African-American and Hispanic women.Conclusion: Physical access to mammography facilities does not necessarily reflect a greater utilization of mammogram screening, possibly owing to financial constraints. Therefore, a metric measuring access to health care facilities is needed to capture all aspects of access to preventive care. Despite easier physical access to mammography facilities in metropolitan areas, great resources and efforts should also be devoted to these areas where racial disparities in breast cancer mortality are often found.Identifying Risk Factors for Disparities in Breast Cancer Mortality among African-American and Hispanic WomenNancy Tian, Pierre Goovaerts, F. Benjamin Zhan, T. Edwin Chow, J. Gaines Wilson10.1016/j.whi.2011.11.007Women's Health Issues 22, 3 (2012)2012-01-24Women's Health Issues2012-01-24223S1049-3867(11)X0012-9Articlese267e276http://www.whijournal.com/article/PIIS1049386711002568/abstract?rss=yesAbstract: Background: Transactional sexual behavior has been demonstrated as an important factor underlying the HIV epidemic in sub-Saharan Africa. The aim of this study was to evaluate the relationship between having a history of transactional sexual relationships with condom use and STI risk.Methods: Participants completed a behavioral questionnaire in isiXhosa and provided self-collected vaginal swabs which were tested for Chlamydia trachomatis, Neisseria gonorrhea, and Trichomonas vaginalis. Multinomial logistic regression was used to compare condom use rates and sexually transmitted infection (STI) risk among women with a history of transactional sexual relationships to women with a history of casual sexual relationships and those with no history of casual sexual relationships.Results: Of the 446 respondents, 223 (50%) reported no history of casual sexual relationships, 94 (23.32%) indicated a history of casual sexual relationships, and among these 119 (26.68%) reported a history of transactional sexual relationships with casual partners. Participants with a history of transactional sexual relationships had a higher rate of condom use with a main partner and a lower prevalence of Chlamydia infection than participants with a history of casual relationships. Participants with a history of transactional sexual relationships were also less likely to have had a STI in the past compared with those who indicated no history of casual relationships.Conclusion: These results highlight attempts by women who report participation in transactional sex to use condoms. The results also point to possibly concealed risk to STI and HIV among women who indicate no history of transactional sex.Transactional Sexual Relationships, Sexually Transmitted Infection Risk, and Condom Use among Young Black Women in Peri-Urban Areas of the Western Cape Province of South AfricaDorina Onoya, Priscilla Reddy, Sibusiso Sifunda, Delia Lang, Gina M. Wingood, Bart van den Borne, Robert A.C. Ruiter10.1016/j.whi.2011.11.006Women's Health Issues 22, 3 (2012)2012-01-24Women's Health Issues2012-01-24223S1049-3867(11)X0012-9Articlese277e282http://www.whijournal.com/article/PIIS1049386712000059/abstract?rss=yesAbstract: Purpose: Sexually transmitted infections (STIs) are among the most common infections in the United States and are particularly prevalent in survivors of sexual violence. The purpose of this study is to examine co-occurring risk factors for sexual violence and STIs including mental health, alcohol use, drug use, and multiple partners as intersecting pathways to STIs for women who experienced sexual abuse in the past year.Methods: Secondary analyses were conducted on cross-sectional data from women originally recruited as respondents for an epidemiologic survey funded by the Centers for Disease Control and Prevention (CDC): Project CHOICES. The survey was administered to 2,672 women in six settings: A large, urban jail and residential alcohol and drug treatment facilities (Texas); a gynecology clinic (Virginia); two primary care clinics (Virginia and Florida); and media solicitation (Florida). Women were included in the current study if they were fertile, sexually active, and not pregnant or trying to get pregnant (n = 1,183). Structural equation modeling (SEM) was used to test the conceptual path model between sexual violence and STI occurrence.Results: In the SEM, there were no significant paths from mental health, alcohol severity, or drug use to STI occurrence contrary to the results of the initial bivariate analyses. Multiple sexual partners significantly mediated the relationship between sexual violence and STIs and between mental health and drug use and STIs.Conclusion: This study highlights the importance of providing effective treatment to survivors of sexual violence, which includes addressing risky sexual behaviors to reduce STI occurrence.An Examination of the Path Between Recent Sexual Violence and Sexually Transmitted InfectionsKirk von Sternberg, Jodi Berger Cardoso, Jina Jun, Joy Learman, Mary M. Velasquez10.1016/j.whi.2012.01.004Women's Health Issues 22, 3 (2012)2012-03-02Women's Health Issues2012-03-02223S1049-3867(11)X0012-9Articlese283e292http://www.whijournal.com/article/PIIS1049386712000175/abstract?rss=yesAbstract: Introduction and Background: The arsenal of interventions to reduce the disproportionate rates of HIV and sexually transmitted disease (STD) infection among Latinos in the United States lags behind what is available for other populations. The purpose of this project was to develop an intervention that builds on existing community strengths to promote sexual health among immigrant Latinas.Methods: Our community-based participatory research (CBPR) partnership engaged in a multistep intervention development process. The steps were to (1) increase Latina participation in the existing partnership, (2) establish an intervention team, (3) review the existing sexual health literature, (4) explore health-related needs and priorities of Latinas, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latinas’ lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention.Results: The MuJEReS intervention contains five modules to train Latinas to serve as lay health advisors (LHAs) known as “Comadres.” These modules synthesize locally collected data with other local and national data, blend health behavior theory with the lived experiences of immigrant Latinas, and harness a powerful existing community asset, namely, the informal social support Latinas provide one another.Conclusion: This promising intervention is designed to meet the sexual health priorities of Latinas. It extends beyond HIV and STDs and frames disease prevention within a sexual health promotion framework. It builds on the strong, preexisting social networks of Latinas and the preexisting, culturally congruent roles of LHAs.Using Community-Based Participatory Research (CBPR) to Develop a Community-Level HIV Prevention Intervention for Latinas: A Local Response to a Global ChallengeScott D. Rhodes, Casey Kelley, Florence Simán, Rebecca Cashman, Jorge Alonzo, Jamie McGuire, Teresa Wellendorf, Kathy Hinshaw, Alex Boeving Allen, Mario Downs, Monica Brown, Omar Martínez, Stacy Duck, Beth Reboussin10.1016/j.whi.2012.02.002Women's Health Issues 22, 3 (2012)2012-04-09Women's Health Issues2012-04-09223S1049-3867(11)X0012-9Articlese293e301http://www.whijournal.com/article/PIIS1049386712000205/abstract?rss=yesAbstract: African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.College Graduation Reduces Vulnerability to STIs/HIV among African-American Young Adult WomenJulia E. Painter, Gina M. Wingood, Ralph J. DiClemente, Lara M. DePadilla, LaShun Simpson-Robinson10.1016/j.whi.2012.03.001Women's Health Issues 22, 3 (2012)2012-05-01Women's Health Issues2012-05-01223S1049-3867(11)X0012-9Articlese303e310http://www.whijournal.com/article/PIIS1049386712000229/abstract?rss=yesAbstract: Objective: To better understand the behaviors associated with unintended pregnancy, including the frequency and reasons why women engage in unprotected intercourse (UI), to help guide efforts to prevent unintended pregnancy.Methods: We surveyed 1,392 women with no history of abortion in 13 family planning clinics across the United States regarding the frequency with which they engaged in UI, the reasons for engaging in UI, attitudes toward UI, and their knowledge about the risks of conception.Results: Nearly half (46%) of respondents engaged in UI within the past 3 months, mostly owing to barriers accessing birth control (49%), not planning to have sex (45%), and the belief that they could not get pregnant (42%). The most prevalent attitudes about UI were that it “feels better” (42%) or “more natural” (41%). Factors associated with an increased odds of having engaged in UI, included holding the views that UI is okay at certain times, feels better, and is more natural, underestimating the risk of conception from 1 year of UI, experiencing difficulty getting birth control prescriptions, having less than a college education, being ages 20 to 24, and being African American/Black.Conclusion: Compared with our research on abortion clients, family planning clients report high, yet somewhat lower, rates of UI, similar reasons for having UI, and misconceptions about the risk of conception from repeated acts of UI. Long-acting, reversible contraception may offer some of the benefits of UI in terms of spontaneity and pleasure, while reducing women’s pregnancy risk.Unprotected Intercourse among Women Wanting to Avoid Pregnancy: Attitudes, Behaviors, and BeliefsM. Antonia Biggs, Deborah Karasek, Diana Greene Foster10.1016/j.whi.2012.03.003Women's Health Issues 22, 3 (2012)2012-05-01Women's Health Issues2012-05-01223S1049-3867(11)X0012-9Articlese311e318http://www.whijournal.com/article/PIIS1049386711002647/abstract?rss=yesAbstract: Aim: The aim of this paper was to review the literature reporting on the relationship between ante- and postnatal maternal depressive symptoms and both maternal and childhood obesity.Method: Articles were sourced from Medline, PsychInfo, Health Source: Nursing/Academic Edition, Academic Search Premiere, and CINAHL. The search was limited to English papers published between January 2000 and June 2011 with key search terms including a combination of maternal, ante- and postnatal depression, obesity, and child. After screening, this resulted in 14 articles, 9 that addressed maternal depressive symptoms and maternal obesity and 5 that focused on maternal depressive symptoms and childhood obesity. GRADE guidelines were used to assess the quality of evidence on two outcomes: Maternal overweight/obesity (body mass index [BMI]) and childhood overweight/obesity (BMI).Results: Nine studies examined the association between postnatal depressive symptoms and maternal obesity; three were cross-sectional and six were longitudinal. None of the cross-sectional studies that examined the association between postnatal depressive symptoms and maternal obesity (BMI) reported a significant positive association. In contrast, of the six studies that used a longitudinal design, three found an association between depressive symptoms and maternal BMI. Five studies were found examining ante- and postnatal depressive symptoms and childhood obesity, four longitudinal and one cross-sectional. Three found a positive association—the cross-sectional study and two longitudinal studies. The quality of the evidence for the two outcomes—maternal and childhood obesity—was low.Conclusion: Research addressing perinatal maternal depressive symptoms and maternal obesity, as well as research addressing perinatal maternal depressive symptoms and childhood obesity, is limited, is of low quality as a body of evidence, and thus far findings have been inconclusive. Further longitudinal and prospective research, incorporating objective measures of BMI and validated measures of depression, is warranted.The Association Between Ante- and Postnatal Depressive Symptoms and Obesity in Both Mother and Child: A Systematic Review of the LiteratureJeannette Milgrom, Helen Skouteris, Tamara Worotniuk, Adele Henwood, Lauren Bruce10.1016/j.whi.2011.12.001Women's Health Issues 22, 3 (2012)2012-02-20Women's Health Issues2012-02-20223S1049-3867(11)X0012-9Articlese319e328http://www.whijournal.com/article/PIIS1049386712000047/abstract?rss=yesAbstract: Purpose: Well-educated, pregnant, African-American women are disproportionately at risk for adverse birth outcomes and depression linked to stress has been established as a significant contributor to poor birth outcomes. Since racial and gendered stress have been identified as threats to birth outcomes, a cross-sectional study was conducted that utilized the Jackson, Hogue, Phillips Contextualized Stress Measure (JHP), a measurement of racial and gendered stress, and the Perceived Stress Scale (PSS), an assessment of global stress, to detect their associations and predictions for depression as measured by the Beck Depression Inventory II (BDI-II).Method: We recruited 101 pregnant, well-educated, African-American women from ob-gyn offices who were administered the JHP, the PSS, and the BDI-II. Correlational, chi-square, and stepwise regression analyses were conducted with the measures and the demographic variables of relationship status, the presence of other children, and annual household income.Findings: The results revealed significant linear and covariate associations for the JHP, PSS, and BDI-II. Correspondingly, chi-square analysis found significant associations for the JHP and the BDI-II and the presence of other children, relationship status, and annual household income. Results from the regression models found that the contextualized and global stress measures were both predictive of depression. Demographic characteristics did not predict depression.Conclusion: The results argue for prenatal depression and stress screening. Furthermore, the link between contextualized stress and depression alerts health care providers and local communities to be responsive to the particular stressors that pose risks for pregnant African-American women and their babies.Contextualized Stress, Global Stress, and Depression in Well-Educated, Pregnant, African-American WomenFleda Mask Jackson, Diane L. Rowley, Tracy Curry Owens10.1016/j.whi.2012.01.003Women's Health Issues 22, 3 (2012)2012-03-02Women's Health Issues2012-03-02223S1049-3867(11)X0012-9Articlese329e336http://www.whijournal.com/article/PIIS1049386712000217/abstract?rss=yesAbstract: Research Objective: We examined rates of specific health conditions among female veteran patients and how the share of health care costs attributable to these conditions changed in the Veterans Affairs system between 2000 and 2008.Methods: Veterans’ Administration (VA)-provided and VA-sponsored inpatient, outpatient, and pharmacy utilization and cost files were analyzed for women veterans receiving care in 2000 and 2008. We estimated rates of 42 common health conditions and per-patient condition costs from a regression model and calculated the total population costs attributable to each condition and changes by year.Results: The number of female VA patients increased from 156,305 in 2000 to 266,978 in 2008; 88% were under 65 years of age. The rate of women treated for specific conditions increased substantially for many gender-specific and psychiatric conditions: For example, pregnancy increased 133%, diagnosed posttraumatic stress disorder increased 106%, and diagnosed depression increased 41%. Mean costs of care increased from $4,962 per woman in 2000 to $6,570 per woman in 2008. Psychiatric conditions accounted for more than one quarter of population health care costs in 2008. Gender-specific conditions and musculoskeletal diseases accounted for a rising share of population costs and rose to 8.2% and 8.7% of population costs in 2008, respectively.Conclusion: Gender-specific, cancer, musculoskeletal, and mental health and substance use disorders accounted for a greater share of overall costs during the study period and were primarily driven by higher rates of diagnosed conditions and, for several conditions, higher treatment costs.Trends in Rates and Attributable Costs of Conditions among Female VA Patients, 2000 and 2008Jean Yoon, Jennifer Y. Scott, Ciaran S. Phibbs, Susan M. Frayne10.1016/j.whi.2012.03.002Women's Health Issues 22, 3 (2012)2012-05-01Women's Health Issues2012-05-01223S1049-3867(11)X0012-9Articlese337e344