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 © 2010 Published by Elsevier Inc. All rights reserved. Women's Health Issues1049-3867201January 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.whijournal.com/article/PIIS1049386709001534/abstract?rss=yesTable of Contents10.1016/S1049-3867(09)00153-4Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1iiiihttp://www.whijournal.com/article/PIIS1049386709001510/abstract?rss=yesEditorial Board10.1016/S1049-3867(09)00151-0Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1ivivhttp://www.whijournal.com/article/PIIS1049386709001303/abstract?rss=yesWith this issue, Women's Health Issues proudly begins a year-long celebration of its 20th year of publishing. Since its founding in 1990, the journal has endeavored to contribute to the mission of the Jacobs Institute of Women's Health to:The 20th Anniversary of Women's Health IssuesAnne Rossier Markus, D. Richard Mauery10.1016/j.whi.2009.10.004Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Editors' Note11http://www.whijournal.com/article/PIIS1049386709001315/abstract?rss=yesIn January 1953, the legendary Dr. Ralph Reis began his editorial tasks in the first issue of the fledgling journal Obstetrics and Gynecology with an “Apologia.” The term means a defense or a justification. In the latter sense, let me explain–why another journal?ApologiaWarren H. Pearse10.1016/j.whi.2009.10.005Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Editorial22http://www.whijournal.com/article/PIIS1049386709000541/abstract?rss=yesWomen's health issues, and women's studies in general, encompass a broad range of topics, however rigorous studies that examine the roles of, and effects on, women in public health emergencies remains a relatively unexplored area of empirical research.Women and Public Health Emergency PreparednessRebecca Katz, D. Richard Mauery10.1016/j.whi.2009.05.002Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Commentaries36http://www.whijournal.com/article/PIIS1049386709001340/abstract?rss=yesOn September 9, 2009, President Barack Obama spoke before a joint session of Congress on the imminent need for health care reform. In his speech, he addressed the contested social issue of abortion in two ways: by reaffirming the ongoing exclusion of abortion from federal health care financing and supporting health care providers' right to opt out of providing health care they find objectionable. “I want to clear up—under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place” (). His acceptance of the right to deny health care for ideological reasons directly contradicts the expectation most Americans share—that the care they receive will be consistent with the highest standards of scientific evidence, based on individual patient need, and with the goal of maximizing health and wellness.The Denial of Abortion Care Information, Referrals, and Services Undermines Quality Care for U.S. WomenTracy A. Weitz, Susan Berke Fogel10.1016/j.whi.2009.11.002Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Commentaries711http://www.whijournal.com/article/PIIS1049386709000966/abstract?rss=yesPurpose: Most states regulate abortion differently than other health care services. Examples of these regulations include mandating waiting periods and the provision of state-authored information, and prohibiting private and public insurance coverage for abortion. The primary purpose of this paper is to explore abortion patients' perspectives on these regulations.Methods: We recruited 20 participants from three abortion providing facilities located in two states in the U.S. South and Midwest. Using a survey and semistructured interview, we collected information about women's knowledge of abortion regulation and policy preferences. During the interviews, women weighed the pros and cons of abortion regulations. We used grounded theory analytical techniques and matrix analysis to organize and interpret the data.Results: We discovered five themes in these women's considerations of regulation: responsibility, empathy, safe and accessible health care, privacy, and equity. Women in the study generally supported policies that they felt protected women or informed decisions. However, most women also opposed laws mandating two-day abortion appointments for women who were traveling long distances. Women tended to favor financial coverage of abortion, arguing that it could help poor women afford abortion or reduce state expenditures.Conclusions: Overall the study participants' opinions on abortion policy reflect key values for advocates and policy makers to consider: responsibility, empathy, safe and accessible health care, privacy, and equity. Future work should examine abortion regulations in light of these shared values. Laws that promote misinformation or prohibit accommodations of unique circumstances are not consistent the positions articulated by the subjects in our study.Abortion Patients' Perceptions of Abortion RegulationKate Cockrill, Tracy A. Weitz10.1016/j.whi.2009.08.005Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles1219http://www.whijournal.com/article/PIIS1049386709001285/abstract?rss=yesBackground: Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (posttraumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and posttraumatic growth.Methods: We interviewed 222 pregnant southern Louisiana women and 292 postpartum women completed interviews at delivery and 8 weeks later. Resilience was measured by scores lower than a nonaffected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist. Posttraumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks for demographics, hurricane experience, and mental health resilience and perceived benefit.Findings: Thirty-five percent of pregnant and 34% of the postpartum women were resilient from depression, whereas 56% and 49% were resilient from posttraumatic stress disorder. Resilience was most likely among White women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage because of the storm was associated with increased report of some perceived benefits.Conclusion: Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit.Resilience After Hurricane Katrina Among Pregnant and Postpartum WomenEmily W. Harville, Xu Xiong, Pierre Buekens, Gabriella Pridjian, Karen Elkind-Hirsch10.1016/j.whi.2009.10.002Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles2027http://www.whijournal.com/article/PIIS1049386709001017/abstract?rss=yesBackground: The present study examined potential predictors of parents' willingness to vaccinate their children for human papillomavirus (HPV) and physicians' intentions to encourage parents to vaccinate their children, now that the U.S. Food and Drug Administration (FDA) has approved a highly effective vaccine.Methods: Parents (n=100) and physicians (n=100) were surveyed on-line in fall 2006, 4 months after the HPV vaccine, Gardasil, was approved by the FDA as a prophylactic vaccine for females ages 9–26 years.Results: Religiosity, perceiving their children as susceptible to HPV, and perceived negative consequences of HPV infection were significant predictors of parents' intent to vaccinate. Physician specialty and whether or not physicians would vaccinate their own children were significant predictors of physicians' intent to encourage parents to vaccinate their children.Conclusion: Campaigns aimed at increasing HPV vaccination should focus on educating parents about children's susceptibility to and the potential negative consequences of HPV infection. Furthermore, because there is now a significant body of evidence indicating that pediatricians and gynecologists have high intentions to encourage parents to vaccinate their children, the focus should be placed on strengthening the intentions of physicians in other specialties who serve children and their parents.Predictors of Parents' Willingness to Vaccinate for Human Papillomavirus and Physicians' Intentions to Recommend the VaccineJessica L. Barnack, Diane M. Reddy, Carolyne Swain10.1016/j.whi.2009.08.007Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles2834http://www.whijournal.com/article/PIIS1049386709001029/abstract?rss=yesObjective: We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis.Materials and Methods: Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes.Results: VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. $0.23 vs. $3.17), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. $3,198 per cancer case avoided and reduce cancer cases by 42%, versus U.S. $36,802 and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent.Conclusion: In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.Impact of Patient Adherence and Test Performance on the Cost-Effectiveness of Cervical Cancer Screening in Developing Countries: The Case of HondurasRebecca B. Perkins, Sarah M. Langrish, Linda J. Stern, James F. Burgess, Carol J. Simon10.1016/j.whi.2009.09.001Women's Health Issues 20, 1 (2010)2009-11-30Women's Health Issues2009-11-30201S1049-3867(09)X0007-1Articles3542http://www.whijournal.com/article/PIIS1049386709001054/abstract?rss=yesPurpose: Motivational interviewing (MI), a patient-centered behavioral counseling style, is a common behavioral intervention strategy. Because intervention outcomes are highly dependent on patient responsiveness to intervention strategy, we evaluated MI perceptions among rural African American women with type 2 diabetes before a physical activity intervention.Methods: Four moderator-led focus groups were conducted with patients aged 21–50 years who had never participated in a MI intervention and who receive diabetes care in a rural community health center. Patients were asked to share their perceptions of an MI consultation after viewing a DVD-based example. They were also asked to discuss their physical activity perceptions and readiness. A comprehensive content analysis based on grounded theory was performed by two raters in order to identify main themes.Main Findings: Although patients (n = 31) had an appreciation for physical activity benefits and high levels of physical activity readiness, themes related to physical activity barriers and lack of motivation were pervasive. Patients regarded the MI consultation as an effective health communication but the patient-centeredness of the approach was negatively perceived. Compared with MI, patients agreed that more traditional paternalistic approaches (i.e., physician-led interactions) were more representative of “good counseling” and more familiar to them. Patients shared deeply about personal experiences and provided words of encouragement to one another.Conclusion: Physical activity interventions including rural African-American women should include activities that focus on barrier management and increasing motivation. MI might be an appropriate behavioral counseling model when added to a more traditional cognitive–behavioral physical activity intervention that is group-based and tailored to patients' communication preferences and the clinical setting.Perceptions of Physical Activity and Motivational Interviewing Among Rural African-American Women with Type 2 DiabetesStephania T. Miller, Khensani N. Marolen, Bettina M. Beech10.1016/j.whi.2009.09.004Women's Health Issues 20, 1 (2010)2009-11-30Women's Health Issues2009-11-30201S1049-3867(09)X0007-1Articles4349http://www.whijournal.com/article/PIIS1049386709001273/abstract?rss=yesIntroduction and Background: This study explores variables associated with daily folic acid supplementation among nonpregnant women ages 18–24, in comparison with women ages 25–45. Health-related behaviors, reproductive status, health care access, and sociodemographic variables are included.Methods: Data are from a cross-sectional population-based survey of 2,002 women ages 18–45 in the Central Pennsylvania Women's Health Study. The analytic sample included 246 women ages 18–24 and 1,636 women ages 25–45 who were not pregnant at the time of survey.Results: Seventeen percent of women ages 18–24 and 27% of women ages 24–45 used daily folic acid supplements. In multiple logistic regression analysis, folic acid use was significantly associated with only two variables among younger women: fruit consumption at least daily and regular physical activity levels meeting recommended guidelines. Among older women, folic acid use was associated with these same two health-related behaviors in addition to not smoking, seeing an obstetrician-gynecologist, receiving diet/nutrition counseling, being married or living with a partner, and no prior pregnancy. Folic acid use was not associated with pregnancy intention in either age group.Conclusions and Discussion: Women ages 18–24 have significantly lower rates of folic acid supplementation compared with older women of reproductive age, but fewer variables are associated with folic acid use among younger women. Missed opportunities to educate younger women about the benefits of folic acid supplementation are identified.Folic Acid Supplementation in Younger and Older Nonpregnant Women of Reproductive Age: Findings from the Central Pennsylvania Women's Health Study (CePAWHS)Laura Evans, Carol S. Weisman10.1016/j.whi.2009.10.001Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles5057http://www.whijournal.com/article/PIIS1049386709001066/abstract?rss=yesPurpose: To assess the effects of premenstrual disorders on work productivity and absenteeism in the multinational Impact study.Methods: Women aged 15–45 years were screened for suspected premenstrual dysphoric disorders (PMDD) and premenstrual syndrome (PMS) and invited to participate in this web-based study. Based on the Daily Record of Severity of Problems (DRSP) questionnaire, symptoms were assessed prospectively over 2 months. Participants were categorized as having no perceived symptoms/mild PMS or moderate-to-severe PMS/PMDD based on a validated algorithm. Work productivity impairment and absenteeism were assessed retrospectively using the Premenstrual Symptoms Screening Tool (PSST) and a modified version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Work productivity impairment was also assessed prospectively over 2 months using the DRSP questionnaire.Results: Overall 1,477 women started the study—of these, 822 (56%) completed the study as planned and represent the full analysis set. Employed women with moderate-to-severe PMS/PMDD had higher rate of productivity impairment on the modified version of the WPAI questionnaire (values ≥7) relative to those with no perceived symptoms/mild PMS (adjusted odds ratio, 3.12; 95% confidence interval, 1.75–5.57). Similar outcomes were obtained for impairment of working productivity or efficiency using the PSST scale (value 4). The mean number of days on the DRSP with at least moderate reduction in productivity or efficiency in daily routine was higher for women with moderate-to-severe PMS/PMDD (5.6 vs. 1.1). Women with moderate-to-severe PMS/PMDD had a higher rate of absenteeism (>8hours per cycle; 14.2% vs. 6.0%).Conclusion: Moderate-to-severe PMS/PMDD seems to be associated with work productivity impairment and increased absenteeism, and thus poses a potential economic burden.Explorative Evaluation of the Impact of Severe Premenstrual Disorders on Work Absenteeism and ProductivityLothar A.J. Heinemann, Thai Do Minh, Anna Filonenko, Kerstin Uhl-Hochgräber10.1016/j.whi.2009.09.005Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles5865http://www.whijournal.com/article/PIIS1049386709001327/abstract?rss=yesBackground: Uninsured women with disabilities experience serious difficulties in accessing quality health care. Employment improves an individual's ability to access health insurance. The aim of Vocational Rehabilitation Services (VR) is to improve employment abilities for people with disabilities.Study Purpose: To examine gender differences in health insurance coverage for people who access VR and the factors that influence health insurance coverage for people with disabilities.Methods: The study analyzed VR case management data from 617,149 cases that were closed by VR in 2006 in the United States. Chi-square and t-tests were used to examine gender differences and multivariate analysis was used to assess factors that influence health insurance coverage.Principal Findings: The study found significant gender differences in access to VR employment-enhancing services and in insurance coverage. Women were more dependent on coverage from public sources.Conclusion: VR can improve health insurance coverage but is more effective with men than with women.Factors Affecting Reduction of Gender Differences in Health Care Coverage for Vocational Rehabilitation Clients with DisabilitiesAri Mwachofi, Allen W. Heinemann, Al Al-Assaf10.1016/j.whi.2009.10.006Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles6674http://www.whijournal.com/article/PIIS1049386709001030/abstract?rss=yesObjective: To determine the cost effectiveness of the utilization of over-the-counter yeast infection detection kits in the diagnosis of vaginal candidiasis.Methods: A cost–benefit analysis based on a group of 70 adult women from a previous prospective study who presented with vaginitis symptoms. By constructing two decision trees, one in which the kits are an option to the women and one in which they are not, we predict the cost for diagnosing vaginal candidiasis in this group of women.Results: For a group of 70 women presenting with vaginitis symptoms, the total cost of diagnosing their infections without the use of kits is predicted to be $7,051.10. For the same 70 women, the total of cost of diagnosing their infections with the use of kits is predicted to be $5,941.02.Conclusion: We conclude that the use of yeast infection detection kits could reduce the cost of diagnosis by 16%. The introduction of kits could save patients the time, money, and other resources involved in visiting a physician to confirm the diagnosis. Moreover, the sensitivity of yeast kits is superior to the traditional wet mount (77% vs. 52%), so there may be a role for the kits in the physician's office as well.A Cost-Effectiveness Analysis of Rapid Yeast Detection KitsSurabhi K. Gaur, Kevin D. Frick, Vani Dandolu10.1016/j.whi.2009.09.002Women's Health Issues 20, 1 (2010)2009-11-30Women's Health Issues2009-11-30201S1049-3867(09)X0007-1Articles7579http://www.whijournal.com/article/PIIS1049386709001297/abstract?rss=yesBackground: Reduction in maternal and child mortality has been a top priority in India, especially in light of the commitment on the part of the national government to the reach the Millennium Development Goals. Despite massive program efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high. Population-based estimates of MMR are lacking, and reliable evidence of role of socioeconomic determinants and program-related factors that mediate medical causes is not available. The present study was conducted to develop population-based estimates of MMR, and to evaluate the primary causes of maternal deaths and factors associated with excess risk of maternal mortality.Methods: The study was conducted in the state of Rajasthan in India, covering 25,926 households in 411 villages. It has two major components: a community-based household survey and a case-control study with cases and controls sampled from the same population. A total of 32 maternal deaths and 6,165 live births were identified. The group of women who died during pregnancy or delivery (cases) is compared with a group of women who gave birth and survived (controls).Results: MMR was estimated to be 519 (95% confidence interval [CI], 477–561). Hemorrhage was the chief cause (31%) of maternal deaths; the other causes were obstructed labor, severe anemia, puerperal sepsis, and abortion. Young age at child birth (odds ratio [OR], 2.6; 95% CI, 1.9–3.2) and poverty (OR, 2.5; 95% CI, 1.6–3.4) were independently associated with increased risk of maternal death. Presence of complications during antenatal period was an important predictor of maternal death (OR, 7.8; 95% CI, 6.8–8.8). Childbirth at home (OR, 4.4; 95% CI, 3.3–5.5) was associated with increased risk of maternal death. The study provides clear evidence for renewed program efforts and strategies for reducing complications and maternal deaths.Maternal Mortality Ratio and Predictors of Maternal Deaths in Selected Desert Districts in Rajasthan: A Community-Based Survey and Case Control StudyShiv D. Gupta, Anoop Khanna, Rajeshwari Gupta, Nand K. Sharma, Narottam D. Sharma10.1016/j.whi.2009.10.003Women's Health Issues 20, 1 (2010)2010-01-01Women's Health Issues2010-01-01201S1049-3867(09)X0007-1Articles8085