Women's Health Issues

2012-01-01

Editorial Board

2012-01-01

Incidence of Sexually Transmitted Infections among Hazardously Drinking Women after Incarceration

Michael D. Stein, Celeste M. Caviness, Bradley J. Anderson — 2011-08-11

Abstract: Introduction and Background: At the time of incarceration, women have a high prevalence of sexually transmitted infections (STI). In the months after community release, women remain at high risk for new infections. This study assessed the rates and predictors of incident chlamydia, gonorrhea, and trichomoniasis in a sample of hazardously drinking women after incarceration.Methods: Self-reported behavioral data were collected from 245 incarcerated women. Vaginal swabs were collected at baseline, and 3- and 6-month time points and tested for chlamydia, gonorrhea, and trichomoniasis. Treatment was provided for all positive tests.Results: Participants’ mean age was 34.1 years of age; 175 (71.4%) were Caucasian, 47 (19.2%) were African American, 17 (6.9%) were Hispanic, and 6 (2.4%) were of other ethnic origins. The STI incidence rate was estimated to be 30.5 (95% confidence interval, 21.3–43.5) new infections per 100 person-years. Number of male sex partners reported during follow-up was a significant (z = 2.16; p = .03) predictor of STI; each additional male sex partner increased the estimated hazard of STI by 1.26.Conclusion: Incarcerated women who are hazardous drinkers are at high risk for STI in the months after their return to the community. In addition to testing and treatment during incarceration, post-release rescreening, education, partner treatment, and follow-up are recommended.

Sexual Risk Behaviors among African-American and Hispanic Women in Five Counties in the Southeastern United States: 2008–2009

2011-07-26

Abstract: Purpose: We examined sexual risk behaviors and unrecognized HIV infection among heterosexually active African-American and Hispanic women.Methods: Women not previously diagnosed with HIV infection were recruited in rural counties in North Carolina (African American) and Alabama (African American), and an urban county in southern Florida (Hispanic) using multiple methods. They completed a computer-administered questionnaire and were tested for HIV infection.Results: Between October 2008 and September 2009, 1,527 women (1,013 African American and 514 Hispanic) enrolled in the study. Median age was 35 years (range, 18–59), 33% were married or living as married, 50% had an annual household income of $12,000 or less, and 56% were employed full or part time. Two women (0.13%) tested positive for HIV. In the past 12 months, 19% had been diagnosed with a sexually transmitted infection (other than HIV), 87% engaged in unprotected vaginal intercourse (UVI), and 26% engaged in unprotected anal intercourse (UAI). In multivariate analysis, UAI was significantly (p < .05) more likely among those who reported ever being pregnant, binge drinking in the past 30 days, ever exchanging sex for things needed or wanted, engaging in UVI, or being of Hispanic ethnicity. UAI was also more likely to occur with partners with whom women had a current or past relationship as opposed to casual partners.Conclusion: A high percentage of our sample of heterosexually active women of color had recently engaged in sexual risk behaviors, particularly UAI. More research is needed to elucidate the interpersonal dynamics that may promote this high-risk behavior. Educational messages that explicitly address the risks of heterosexual anal intercourse need to be developed for heterosexually active women and their male partners.

Appalachian and Non-Appalachian Pediatricians’ Encouragement of the Human Papillomavirus Vaccine: Implications for Health Disparities

Janice L. Krieger, Mira L. Katz, Jennifer A. Kam, Anthony Roberto — 2011-09-12

Abstract: Background: In medically underserved regions such as Appalachia, cervical cancer incidence and mortality are higher than the general U.S. population; therefore, it is important for pediatricians to encourage parents to have their daughters vaccinated against the human papillomavirus (HPV). Unfortunately, little is known about the predictors of pediatricians’ encouragement of the HPV vaccine among medically underserved populations. The current study compared attitudes and behaviors of pediatricians with practices in Appalachia with those in non-Appalachia to identify potential strategies for reducing health disparities.Methods: A survey was conducted with 334 pediatricians located in Appalachia and non-Appalachia counties to examine how prior behavior, perceived susceptibility, severity, self-efficacy, response-efficacy, and behavioral intentions are related to self-reported vaccine encouragement.Results: Pediatricians in Appalachia perceived their patients to be less susceptible to HPV and reported lower rates of HPV encouragement than pediatricians in non-Appalachia. In addition, self-efficacy had a significant indirect association with vaccine encouragement for pediatricians in non-Appalachia.Conclusion: This study’s findings emphasize the importance of increasing Appalachian pediatricians’ awareness of their patients’ susceptibility to HPV. Broader efforts to increase encouragement of the HPV vaccine among pediatricians should focus on promoting self-efficacy to encourage the HPV vaccine to parents of young females.

The Relationship Between Social Roles and Self-Management Behavior in Women Living with HIV/AIDS

Allison R. Webel, Patricia A. Higgins — 2011-07-29

Abstract: Background: The social roles that women perform can be complicated and may affect their health. While there is some evidence describing traditional social roles of women, there is little evidence exploring the impact of those roles on how a woman manages a chronic condition. The purpose of this paper is to identify and examine the main social roles of 48 HIV infected women, and to explore how these roles relate to their self-management of HIV/AIDS.Methods: Forty-eight HIV infected, adult women were recruited from HIV clinics and AIDS service organizations in Northeast Ohio. All participants participated in one of 12 digitially recorded focus groups. All data were analyzed using qualitative description methodology.Results: The participants were predominantly middle-aged (mean = 42 years), African American (69%), and single (58%). Analysis revealed six social roles that these women experience and which affect their self-management. These social roles are: Mother/Grandmother, Believer, Advocate, Stigmatized Patient, Pet Owner, and Employee. These roles had both a positive and negative effect on a woman's self-management of her HIV disease and varied by age and time living with HIV.Conclusion: Women living with HIV/AIDS struggle to manage the many daily tasks required to live well with this disease. The social context in which this self-management happens is important, and the various social roles that women perform can facilitate or hinder them from completing these tasks. Healthcare and social service providers should learn about these roles in their individual patients, particularly how these roles can be developed to increase HIV/AIDS self-management.

Do Asian-American Women Who Were Maltreated as Children Have a Higher Likelihood for HIV Risk Behaviors and Adverse Mental Health Outcomes?

Hyeouk Chris Hahm, Eric Kolaczyk, Yookyong Lee, Jisun Jang, Lisa Ng — 2011-08-29

Abstract: Objectives: This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women.Methods: We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews.Results: Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners.Conclusion: There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.

Comparison of Screening and Referral Strategies for Exposure to Partner Violence

Joanne Klevens, Laura Sadowski, Romina Kee, William Trick, Diana Garcia — 2011-07-29

Abstract: Background: Although under debate, routine screening for intimate partner violence (IPV) is recommended in health care settings. This study explored the utility of different screening and referral strategies for women exposed to IPV in primary health care.Methods: Using a randomized controlled trial design we compared two screening strategies (health care providers [HCP] versus audio computer-assisted self-interviews [A-CASI]) and three referral strategies (HCP alone, A-CASI referral with HCP endorsement, and A-CASI alone). English-speaking women who were 18 years and older and were attending women's health clinics at a public hospital were eligible to participate. Participants were randomly assigned to one of three study groups (HCP screen and referral, A-CASI screen and referral with HCP referral endorsement, and A-CASI screen and referral). Women were reinterviewed by telephone 1 week later. The primary outcome was rate of IPV disclosure; secondary outcomes were screening mode preference, reactions to IPV screening, and use of referral resources.Results: Of the 129 eligible women, 126 women were enrolled (98%); 102 women (81% of those enrolled) completed the follow-up telephone interview. Disclosure rates were higher for women screened with A-CASI compared with HCP-screened women (21% vs. 9%; p = .07). Screening mode preference, impact of screening (positive and negative reactions), and rates of use of referral resources were similar between study groups.Conclusion: A-CASI tended to yield higher rates of IPV disclosure and similar rates of use of referral resources. A-CASI technology may be a practical way to screen for IPV.

Intimate Partner Violence/Abuse and Depressive Symptoms among Female Health Care Workers: Longitudinal Findings

Lareina N. La Flair, Catherine P. Bradshaw, Jacquelyn C. Campbell — 2011-08-26

Abstract: Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79–1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.

Gender Differences in Military Sexual Trauma and Mental Health Diagnoses among Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder

Shira Maguen, Beth Cohen, Li Ren, Jeane Bosch, Rachel Kimerling, Karen Seal — 2011-09-12

Abstract: Objective: We examined correlates of posttraumatic stress disorder (PTSD), including military sexual trauma (MST), in Iraq and Afghanistan veterans. We also compared mental health comorbidities by gender among veterans with PTSD, with and without MST.Methods: Retrospective data analyses were conducted using Department of Veterans Affairs (VA) administrative data from 213,803 Iraq and Afghanistan veterans and the subset diagnosed with PTSD from April 1, 2002, to October 1, 2008. We used descriptive statistics and multivariate logistic regression compared by gender to investigate independent correlates and mental health comorbidities associated with PTSD, with and without MST.Results: Among women with PTSD, 31% screened positive for MST; 1% of men with PTSD screened positive for MST. Among those with PTSD, veterans with MST had more comorbid mental health diagnoses than those without MST. Women with PTSD and MST were more likely to receive comorbid depression, anxiety, and eating disorder diagnoses, and men were more likely to receive comorbid substance use disorder diagnoses.Conclusions: MST is associated with an increased prevalence of mental health disorders comorbid with PTSD. Better understanding comorbidity patterns will allow for targeted evaluation and treatment of returning veterans with MST.

Internet Message Boards for Pregnancy Loss: Who’s On-Line and Why?

2011-09-12

Abstract: Background: Pregnancy loss is common, but its significance is often minimized by family, friends, and the community, leaving bereaved parents with unmet need for support. This study sought to describe demographics, usage patterns, and perceived benefits for women participating in Internet pregnancy loss support groups.Methods: We requested permission to post an anonymous Internet survey on large and active United States Internet message boards for women with miscarriages and stillbirths. The study purposefully oversampled stillbirth sites and included both closed- and open-ended questions. The University of Michigan Institutional Review Board approved the study. Closed-ended questions were summarized and evaluated with bivariate analysis. We performed a qualitative analysis of open-ended data using an iterative coding process to identify key themes.Results: Of 62 sites queried, 15 granted permission to post the survey on 18 different message boards. We collected 1,039 surveys, of which 1,006 were complete and eligible for analysis. Women were typically white, well educated, and frequent users. They noted message boards helped them to feel less isolated in their loss and grief and they appreciated unique aspects of Internet communication such as convenience, access, anonymity, and privacy. Pregnancy loss message boards are an important aspect of support for many bereaved mothers. African-American women seem to be substantially underrepresented on-line despite being at higher risk for stillbirth.Conclusion: Internet message boards serve a unique function in providing support for women with miscarriage and stillbirth. The benefits are often significantly different from those encountered in traditional face-to-face bereavement support.

Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008

2011-08-24

Abstract: Background: Advanced practice nurses (APNs) in the United States could expand access to high-quality health care, particularly for underserved populations. Yet, there has been limited synthesis of the evidence related to their effectiveness as compared with other providers. The study reported here, part of a larger study that examined all four types of APNs, compares the labor and delivery care outcomes of certified nurse-midwives (CNMs) and physicians.Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Proquest (for dissertations), were searched for the years 1990 through 2008.Study Eligibility Criteria: Only those articles where processes or outcomes of care were quantitatively compared between CNMs and physicians were included. For all APNs, 27,993 citations were reviewed. For CNMs, 21 articles representing 18 unique studies reported either infant or maternal outcomes.Methods: The systematic review followed established procedures (replicable search of relevant databases, sequential review to identify eligible studies, abstraction by two reviewers, assessment of quality, and grading of evidence).Results: For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians.Limitations: The review addressed only CNMs practicing in the United States and outcomes measured during labor and delivery. The majority of study designs were observational and the models of care ranged from independent to shared, limiting the control for bias. Moreover, all reviewers were nurses.Conclusion: Differences in practice between CNMs and MDs seem to be well documented, particularly in the use of technology. Yet, the findings provide evidence that care by CNMs is safe and effective. CNMs should be better utilized to address the projected health care workforce shortages.

Salary Discrepancies Between Practicing Male and Female Physician Assistants

Bettie Coplan, Alison C. Essary, Thomas B. Virden, James Cawley, James D. Stoehr — 2011-08-08

Abstract: Background: Salary discrepancies between male and female physicians are well documented; however, gender-based salary differences among clinically practicing physician assistants (PAs) have not been studied since 1992 (Willis, 1992). Therefore, the objectives of the current study are to evaluate the presence of salary discrepancies between clinically practicing male and female PAs and to analyze the effect of gender on income and practice characteristics.Methods: Using data from the 2009 American Academy of Physician Assistants’ (AAPA) Annual Census Survey, we evaluated the salaries of PAs across multiple specialties. Differences between men and women were compared for practice characteristics (specialty, experience, etc) and salary (total pay, base pay, on-call pay, etc) in orthopedic surgery, emergency medicine, and family practice.Findings: Men reported working more years as a PA in their current specialty, working more hours per month on-call, providing more direct care to patients, and more funding available from their employers for professional development (p < .001, all comparisons). In addition, men reported a higher total income, base pay, overtime pay, administrative pay, on-call pay, and incentive pay based on productivity and performance (p < .001, all comparisons). Multivariate analysis of covariance and analysis of variance revealed that men reported higher total income (p < .0001) and base pay (p = .001) in orthopedic surgery, higher total income (p = .011) and base pay (p = .005) in emergency medicine, and higher base pay in family practice (p < .001), independent of clinical experience or workload.Conclusion: These results suggest that certain salary discrepancies remain between employed male and female PAs regardless of specialty, experience, or other practice characteristics.

Can We Capture the Intersections? Older Black Women, Education, and Health

Susan W. Hinze, Jielu Lin, Tanetta E. Andersson — 2011-10-10

Abstract: Background: Race/ethnicity, gender, and socioeconomic status are the three most prominent factors to predict health outcomes. Despite the fact that persistent health inequalities are found between groups, we know little about how the interrelatedness of these social positions influences the health of older adults.Purpose: In this study, we apply a feminist intersectional approach to the study of health inequalities, treating social variables as multiplicative rather than additive to capture the mutually constitutive dimensions of race/ethnicity, gender, and education.Methods: This paper makes use of data from the National Social Life, Health and Aging Project, a nationally representative sample of 3,005 community-dwelling U.S. adults aged 57 to 85 years old, to explore intersections of race, gender, and education. We use a combination of stratified analysis with an interaction term to test multiplicative effects.Results: First, our findings confirm that Black women with less than a high school education have the poorest self-rated health. Second, at the bivariate level, we find highly educated White men are not the converse of lower educated Black women. Third, at the multivariate level, we find being Black and female has an effect on health beyond those already accounted for by race and gender.Conclusion: This research demonstrates the explanatory power of an intersectionality approach to deepen understanding of the overlapping, simultaneous production of health inequalities by race, class, and gender.

Predictors of Sleep Characteristics among Women in Southeast Texas

Alisa B. Kachikis, Carmen Radecki Breitkopf — 2011-08-29

Abstract: Purpose: This study examined psychological and sociodemographic predictors of self-reported sleep characteristics including sleep duration, quality, and perceived adequacy of sleep among Hispanic and non-Hispanic women of low socioeconomic status.Method: Cross-sectional survey data were analyzed from 2,670 women ages 18 to 55 (74% Hispanic, 18% non-Hispanic White, 8% non-Hispanic Black) participating in a cancer prevention study in southeast Texas.Results: Women reported sleeping 7.1 hours per night on average; however, nearly 45% were short (≤6; 35.3%) or long (≥9; 9.5%) sleepers. Sleep quality was rated less than “good” for 43.7% of the total sample, and 22.5% reported adequate sleep “none” or “a little” of the time. Multivariable analyses identified different demographic and psychological predictors for the sleep characteristics; decreased sleep adequacy was associated with parity, depressive symptoms, stress, and anxiety (R2 = 0.11); short sleep duration with age, education, and depressive symptoms (R2 = 0.07); and poor sleep quality with ethnicity, marital and employment status, public housing accommodation, smoking status, income, acculturation, social desirability, depressive symptoms, stress, and anxiety (R2 = 0.18). Separate analyses of the Hispanic subsample born in the United States versus elsewhere revealed differences in all sleep characteristics. In multivariable analyses, similar predictors of sleep quality and duration emerged, but only depressive symptoms, anxiety, and age were associated with sleep adequacy.Conclusion: Women of lower socioeconomic groups and Hispanic ethnicity may suffer poor quality sleep. A complex and distinct array of factors are associated with sleep quality, duration, and adequacy. The relationship between sleep and health and the growing U.S. Hispanic population highlight the importance of this and future research.

Health Care Access and Support for Disabled Women in Canada: Falling Short of the UN Convention on the Rights of Persons with Disabilities: A Qualitative Study

Barbara E. Gibson, Roxanne Mykitiuk — 2011-10-04

Abstract: Purpose: The United Nations Convention on the Rights of Persons with Disabilities and other international human rights conventions guarantee the fundamental human rights to physical, social, and psychological health. The purpose of this study was to examine whether these rights are being upheld in Canada for disabled women.Methods: An interpretive, qualitative, focus group design was employed. Participants were women 18 to 67 years of age with a self-identified physical, sensory, cognitive, and/or psychiatric impairment. Eleven focus groups were conducted with 74 disabled women from urban and rural settings in Northern Ontario, Manitoba, and Nova Scotia. The data were analyzed for themes using a flexible coding system derived from and consistent with the research objectives and the study’s human rights framework.Findings: Participants described multiple intersecting factors that impeded or facilitated access to health care. Services included both generic health services and impairment-specific services. Participants experienced a number of barriers accessing professionals, support programs, and services. These are described under three broad themes: 1) Labyrinthine health service ‘systems,’ 2) assumptions, attitudes, and discriminatory practices, and 3) inadequate sexual health or reproductive services and supports.Conclusion: The results suggest that Canada falls significantly short of guaranteeing disabled women’s human rights to access health care supports and services. Access barriers resulted from the inefficiencies and complexities of the multiple agencies and programs that disabled women had to navigate, difficulties accessing information on available services, and negative attitudes of some health and social service providers.