Women's Health Issues

Editorial Board

2013-05-01

Political and News Media Factors Shaping Public Awareness of the HPV Vaccine

2013-04-04

Abstract: Background: In 2006, the U.S. Food and Drug Administration licensed a vaccine for the human papillomavirus (HPV) that prevents the strains of HPV that cause 70% of cervical cancers. Within months, many states introduced legislation requiring the vaccine for girls, prompting controversy and heightened political and media attention to the issue. Previous research has shown differences in HPV vaccine awareness by individual-level characteristics such as race/ethnicity, income, and education levels. We examined how individual political orientation and exposure to media coverage can also shape awareness of the vaccine.Methods: Using data from a 2009 Internet survey of 1,216 nationally representative adult respondents linked to data on state-specific news coverage, we assessed how political orientation, media exposure, and state political context predicted HPV vaccine awareness.Results: Younger people, women, and those with more education were significantly more likely to be aware of the vaccine. Even after controlling for these characteristics, we found that exposure to news media was associated with higher HPV vaccine awareness. Whereas liberals and conservatives were both more aware of the vaccine compared with moderates, the data are suggestive that liberals were more sensitive to news coverage.Conclusion: These findings suggest that individual-level political identities and their interaction with the informational environment may be important factors to consider in evaluating the determinants of individuals' attitudes and behaviors related to politically charged women's health issues.

Receipt of Cervical Cancer Screening in Female Veterans: Impact of Posttraumatic Stress Disorder and Depression

2013-05-01

Abstract: Purpose: We evaluated receipt of cervical cancer screening in a national sample of 34,213 women veterans using Veteran Health Administration facilities between 2003 and 2007 and diagnosed with 1) posttraumatic stress disorder (PTSD), or 2) depression, or 3) no psychiatric illness.Methods: Our study featured a cross-sectional design in which logistic regression analyses compared receipt of recommended cervical cancer screening for all three diagnostic groups.Results: Cervical cancer screening rates varied minimally by diagnostic group: 77% of women with PTSD versus 75% with depression versus 75% without psychiatric illness were screened during the study observation period (p < .001). However, primary care use was associated with differential odds of screening in women with versus without psychiatric illness (PTSD or depression), even after adjustment for age, income and physical comorbidities (Wald Chi-square (2): 126.59; p < .0001). Specifically, among low users of primary care services, women with PTSD or depression were more likely than those with no psychiatric diagnoses to receive screening. Among high users of primary care services, they were less likely to receive screening.Conclusion: Psychiatric illness (PTSD or depression) had little to no effect on receipt of cervical cancer screening. Our finding that high use of primary care services was not associated with comparable odds of screening in women with versus without psychiatric illness suggests that providers caring for women with PTSD or depression and high use of primary care services should be especially attentive to their preventive healthcare needs.

Obstetrics and Gynecology Practices and Patient Insurance Type

Greta B. Raglan, Britta L. Anderson, Hal Lawrence, Jay Schulkin — 2013-04-05

Abstract: Background: Despite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician–gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients.Methods: A questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network.Findings: A 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance (“private group”) and the 105 reported providing care to mostly publicly insured or uninsured patients (“non-private group”) were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18.Conclusion: Results reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.

The HIV Risk Reduction Needs of Homeless Women in Los Angeles

Julie A. Cederbaum, Suzanne L. Wenzel, Mary Lou Gilbert, Elizabeth Chereji — 2013-04-01

Abstract: Background: Substance use, housing instability, and transactional sex all contribute to HIV risk engagement among homeless women. Because of the increased risk of HIV among homeless women, this study sought to understand the context of sexual behaviors and condom use among homeless women and elucidate modifiable factors that can be targeted by interventions.Methods: Homeless women (n = 45) participated in focus groups (n = 6) at shelters throughout Los Angeles County. Thematic analyses revealed that similar to other high-risk women, homeless women engage in sex with multiple types of partners (steady, casual, and transactional).Findings: Our findings indicate that, similar to use among other high-risk women, condom use by homeless women varied by type of partner. Substance use also contributed to condom non-use. In a departure from previous research, homeless women reported overarching feelings of hopelessness. Participants spoke of hopelessness contributing to risk engagement, specifically the number of ongoing stressors experienced because of homelessness contributing to despair. Without acknowledgement of this unique quality of homelessness, women felt their risk reduction needs would never truly be understood.Conclusions: Interventions involving homeless women should include self-esteem building, acknowledgment and use of inherent resilience qualities gained during homelessness, respect for current knowledge and skills, and an exploration of when women choose to trust their partners and how they make safer sex choices.

At What Cost? Payment for Abortion Care by U.S. Women

Rachel K. Jones, Ushma D. Upadhyay, Tracy A. Weitz — 2013-05-01

Abstract: Background: Most U.S. abortion patients are poor or low-income, yet most pay several hundred dollars out of pocket for these services. This study explores how women procure these funds.Methods: iPad-administered surveys were implemented among 639 women obtaining abortions at six geographically diverse healthcare facilities. Women provided information about insurance coverage, payment for service, acquisition of funds, and ancillary costs incurred.Findings: Only 36% of the sample lacked health insurance, but at least 69% were paying out of pocket for abortion care. Women were twice as likely to pay using Medicaid (16% of abortions) than private health insurance (7%). The most common reason women were not using private insurance was because it did not cover the procedure (46%), or they were unsure if it was covered (29%). Among women who did not use insurance for their abortion, 52% found it difficult to pay for the procedure. One half of patients relied on someone else to help cover costs, most commonly the man involved in the pregnancy. Most women incurred ancillary expenses in the form of transportation (mean, $44), and a minority also reported lost wages (mean, $198), childcare expenses (mean, $57) and other travel-related costs (mean, $140). Substantial minorities also delayed or did not pay bills such as rent (14%), food (16%), or utilities and other bills (30%) to pay for the abortion.Conclusions: Public and private health insurance plan coverage of abortion care services could ease the financial strain experienced by abortion patients, many of whom are low income.

Health Indicators, Social Support, and Intimate Partner Violence Among Women Utilizing Services at a Community Organization

Akiko Kamimura, Asha Parekh, Lenora M. Olson — 2013-05-01

Abstract: Purpose: Intimate partner violence (IPV) against women is a significant public health concern. This study examines the physical and mental health status and relationship to social support for women seeking services to end IPV at a walk-in community organization that serves the community at large, including a shelter for abused women.Methods: One hundred seventeen (117) English-speaking women between the ages of 18 and 61 years participated in a self-administered survey. Physical, mental, and oral health, social support, and IPV homicide lethality were measured using standardized instruments.Results: Social support was the most important factor related to better health. The participants who had more social support reported better physical (p < .05), mental (p < .01), and oral health (p < .05), and a lower level of psychological distress (p < .01) and depression (p < .01) compared with participants who reported less social support. The participants living in the shelter reported worse physical health (p < .05) but better mental health (p < .05) than the participants not living in a shelter. Older age and low income were related to oral health problems, whereas older age, low education level, and unemployment were related to poor mental health.Conclusion: The present study adds to the evidence that social support contributes to improving physical and mental health for women who experience IPV. The findings also suggest the importance of providing or referring women to mental health services.

Use of a Prenatal Risk Screen to Predict Maternal Traumatic Pregnancy-Associated Death: Program and Policy Implications

2013-05-01

Abstract: Background: Motor vehicle crashes, homicide, suicide, and drug abuse are among the leading causes of pregnancy-associated deaths. To prevent such deaths, identifying women for intervention is required. The universally offered Florida Healthy Start Prenatal Risk Screen was evaluated to identify women at increased risk for traumatic pregnancy-associated death.Methods: Florida’s Enhanced Maternal Mortality Reporting Database for 1999 through 2005 was linked with Florida’s Healthy Start Prenatal Risk Screen to identify traumatic pregnancy-associated death as the outcome. Distribution of Healthy Start risk scores among women who died were compared with the screened population. Traumatic death estimates per 100,000 births were drawn for each risk score, along with estimates of the relative risk (RR) of traumatic death for each score. The RR of women with scores greater than or equal to 4 were compared with the risk of women scoring 0 to 3.Findings: Almost 20% of the 620,959 women who did not die of traumatic death had a risk score of 0, compared with only 3% of the 144 women who did die of traumatic death. As risk scores increased, the chance of traumatic deaths sharply increased. A woman with a score of 4 had 11.78 times (confidence interval [CI], 4.63–29.69) the risk of traumatic death compared with a woman with a risk score of 0.Conclusions: The implementation of prenatal risk screening to identify women at increased risk for traumatic pregnancy-associated death would help to ensure that policies to reduce infant risk factors also address maternal risk factors.

Women's Health Issues

Editorial Board

Contents

Political and News Media Factors Shaping Public Awareness of the HPV Vaccine

Receipt of Cervical Cancer Screening in Female Veterans: Impact of Posttraumatic Stress Disorder and Depression

Obstetrics and Gynecology Practices and Patient Insurance Type

The HIV Risk Reduction Needs of Homeless Women in Los Angeles

At What Cost? Payment for Abortion Care by U.S. Women

Health Indicators, Social Support, and Intimate Partner Violence Among Women Utilizing Services at a Community Organization

Use of a Prenatal Risk Screen to Predict Maternal Traumatic Pregnancy-Associated Death: Program and Policy Implications