Womens Health Issues最新文献_第4页

“Am I Truly Invisible?”: A Qualitative Study on Black Women's Experiences of and Coping With Intersectional Invisibility in Uterine Fibroid Treatment “我真的隐形吗？”黑人妇女在子宫肌瘤治疗中交叉性隐形的经历与应对。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.05.005

Arianne N. Malekzadeh MA , Ami R. Zota ScD, MS , Myla Lyons BA , Tamara Taggart PhD, MPH

Background

Black women are disproportionately burdened by uterine leiomyomas (fibroids) and face intersectional invisibility wherein their needs are ignored in health care settings due to sexism and racism. Our objective was to elucidate Black women's experiences in fibroid treatment and the strategies they use to protect their health and counter their intersectional invisibility.

Methods

We recruited participants from the Fibroids Observational Research on Genes and the Environment (FORGE) Study. We conducted semistructured individual interviews (average length 45 minutes) on Black women's experiences in fibroid treatment. We analyzed the transcripts using a thematic analytical approach and intersectionality, a critical analytical framework that allows for the examination of how sexism and racism intersect to influence health inequities.

Results

Participants were 16 Black women aged 30–52 years who were seeking fibroid treatment in Washington, DC. Our analysis revealed that participants experience gendered racism (the intersection of sexism and racism) in fibroid treatment, mirroring a historical and ongoing pattern of how Black women are treated in health care settings, and that they manage their intersectional invisibility by engaging in strategies characteristic of the superwoman schema: projecting strength, suppressing emotions, resisting being dependent, and striving to succeed despite limited resources. Participants also highlighted that their ideal fibroid-related care would include a holistic approach and social support.

Conclusions

Our findings emphasize that Black women's intersectional invisibility extends to fibroid treatment, reflecting the social-structural inequities that they face in health care settings more broadly. Attendance to Black women's voices in research and practice can help decrease their intersectional invisibility and subsequently improve their fibroid treatment and related health outcomes.

背景：由于性别歧视和种族歧视，黑人妇女的子宫平滑肌瘤（肌瘤）负担过重，她们的需求在卫生保健机构中被忽视。我们的目的是阐明黑人妇女在子宫肌瘤治疗中的经验，以及她们用来保护自己的健康和对抗交叉隐形的策略。方法：我们招募了来自子宫肌瘤基因与环境观察研究（FORGE）研究的参与者。我们对黑人妇女的肌瘤治疗经历进行了半结构化的个人访谈（平均时长45分钟）。我们使用主题分析方法和交叉性分析了转录本，交叉性是一种关键的分析框架，可以检查性别歧视和种族主义如何交叉影响健康不平等。结果：参与者是16名年龄在30-52岁的黑人女性，她们在华盛顿特区寻求肌瘤治疗。我们的分析显示，参与者在子宫肌瘤治疗中经历了性别种族主义（性别歧视和种族主义的交集），这反映了黑人妇女在医疗保健机构中如何被对待的历史和持续模式，并且他们通过参与超人模式特征的策略来管理交叉隐形：投射力量，压抑情绪，抵制依赖，尽管资源有限但仍努力取得成功。参与者还强调，他们理想的肌瘤相关护理将包括整体方法和社会支持。结论：我们的研究结果强调，黑人妇女的交叉性不可见性延伸到肌瘤治疗，反映了她们在更广泛的医疗保健环境中面临的社会结构不平等。在研究和实践中关注黑人妇女的声音可以帮助减少她们在交叉领域的不可见性，并随后改善她们的肌瘤治疗和相关的健康结果。

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引用次数: 0

Experiences and Perspectives of Sexual and Reproductive Health Among Women in Recovery From Opioid Use Disorder 从阿片类药物使用障碍中恢复的妇女性健康和生殖健康的经验和观点。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.07.003

Nicole M. Mattson PhD, RN, CNS-BC, Aleigha Barry RN, BSN, Jessica Zemlak PhD, MSN, RN

Background

Women in recovery from opioid use disorder (OUD) have unmet sexual and reproductive health (SRH) needs resulting in health disparities such as unintended pregnancy and sexually transmitted infections/HIV infection compared with women without OUD. The purpose of this qualitative descriptive study was to explore the perceptions and experiences of co-occurring multiple social-ecologic influences (individual, interpersonal, community, society) on SRH among women in recovery from OUD.

Methods

Purposive sampling was used to recruit cis-gender women aged 18–49 who self-identify as being in recovery from OUD and speak English. We conducted one 45- to 60-minute audio-recorded semistructured telephone interview with each participant.

Results

In our sample (N = 22), 59% identified as white and the mean age was 34.7 years (SD = 6.8). We identified themes related to SRH across social-ecological levels. Holistic Definition of SRH: Participants described an evolution of their knowledge and behaviors related to SRH during recovery to include preventive health, emotional well-being, and healthy relationships. Reevaluation of Relationships: Participants described undergoing a critical appraisal of their relationships and identified relationships that strengthened or threatened their recovery. Built and Lived Community: Participants described a rebuilding and restructuring of both social and physical domains of community. Shadow of Stigma: Participants described experiencing stigmatizing behaviors related to the interconnectedness of their childbearing capacity, SRH, and recovery.

Conclusions

Women's expansive descriptions of SRH in recovery extend beyond access to contraception and sexually transmitted infection/HIV screening. Interventions focused on SRH must account for the complex multilevel influences on the health of women in recovery from OUD.

背景：与没有阿片类药物使用障碍的妇女相比，从阿片类药物使用障碍（OUD）中恢复的妇女的性健康和生殖健康（SRH）需求未得到满足，导致意外怀孕和性传播感染/艾滋病毒感染等健康差异。本定性描述性研究的目的是探讨多重社会生态影响（个人、人际、社区、社会）共同发生对OUD康复妇女SRH的感知和体验。方法：采用目的抽样方法，招募年龄在18-49岁、自我认同为OUD恢复期、会说英语的顺性女性。我们对每个参与者进行了一次45到60分钟的录音半结构化电话采访。结果：本组22例患者中，59%为白种人，平均年龄34.7岁（SD = 6.8）。我们在社会生态层面确定了与SRH相关的主题。性健康和生殖健康的整体定义：参与者描述了他们在康复期间与性健康和生殖健康相关的知识和行为的演变，包括预防健康、情绪健康和健康的关系。关系的重新评估：参与者描述了对他们的关系进行的批判性评估，并确定了加强或威胁他们恢复的关系。建立和生活的社区：参与者描述了社区的社会和物理领域的重建和重组。污名化的阴影：参与者描述了与生育能力、性生殖健康和康复相关的污名化行为。结论：恢复期女性对性健康生殖健康的广泛描述超出了获得避孕和性传播感染/艾滋病毒筛查的范围。以性健康和生殖健康为重点的干预措施必须考虑到对妇女产后康复健康的复杂多层次影响。

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引用次数: 0

Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal 在堕胎合法的州，多布斯诉杰克逊案最高法院判决前后，远程医疗对药物流产的需求。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.003

Anna E. Fiastro PhD, MPH, MEM , Elissa Brown MPH , Rebecca Gomperts MD, MPP, PhD , Emily M. Godfrey MD, MPH

Objective

The provision of medication abortion through telehealth accounts for an increasing share of total abortions in the United States, offering a private and affordable option for patients in both restrictive and supportive states. This study compares demand for telehealth medication abortion before and after the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs) in states where abortion access is protected, to understand how patients seeking care in supportive states may have been impacted by the landmark decision.

Methods

We compared the volume of patients receiving medication abortion from a U.S.-based telehealth service in 18 states, the sociodemographic characteristics of patients, and self-reported reasons for choosing telehealth before and after the Dobbs decision using electronic medical records from March 24, 2022–September 24, 2022. All states examined support legal access to abortion; results were stratified to compare two levels of protective abortion policies.

Results

A total of 6,296 patients received medication abortion through telehealth during the study period. Daily demand increased by 74%, from an average of 25.0 patients per day in the pre-Dobbs period to 43.4 patients per day post-Dobbs (difference 18.4; 95% confidence interval [15.4, 21.5]; p < .001). No sociodemographic differences were observed between patient populations before and after the Dobbs decision. Comfort and privacy were the most frequently selected reasons for choosing telehealth in both time periods. Concern over legal restrictions was more frequently cited after the Dobbs decision. A larger increase in demand (88%) was observed in states with fewer protections post-Dobbs compared with states with the most protective policies (68%) (p < .001).

Conclusions

Demand for telehealth medication abortion increased after the Dobbs decision in states where abortion remained legal. Telehealth provides an essential pathway to access safe and effective abortion care for a broad range of patients across different policy environments.

目的：通过远程保健提供药物流产在美国流产总数中所占的份额越来越大，为限制性和支持性州的患者提供了一种私人和负担得起的选择。本研究比较了美国最高法院在多布斯诉杰克逊妇女健康组织（多布斯）一案中堕胎权受到保护的各州对远程医疗药物堕胎的需求，以了解在支持州寻求护理的患者如何受到具有里程碑意义的决定的影响。方法：从2022年3月24日至2022年9月24日，我们比较了美国18个州的远程医疗服务中接受药物流产的患者数量，患者的社会人口统计学特征，以及在多布斯决定前后使用电子病历报告选择远程医疗的原因。所有被调查的州都支持合法堕胎；将结果分层比较两个级别的保护性堕胎政策。结果：研究期间共6296例患者通过远程医疗接受了药物流产。每日需求增加了74%，从多布斯之前的平均每天25.0名患者增加到多布斯之后的每天43.4名患者(差异18.4；95%置信区间[15.4,21.5]；P < 0.001)。在Dobbs决定之前和之后，没有观察到患者群体之间的社会人口统计学差异。在这两个时期，舒适和隐私是选择远程保健的最常见原因。在多布斯案判决之后，人们更频繁地提到了对法律限制的担忧。在多布斯之后，与保护政策最多的州（68%）相比，在保护较少的州（88%）观察到更大的需求增长（p < 0.001）。结论：在堕胎仍然合法的州，对远程医疗药物流产的需求在多布斯判决后增加。远程保健为不同政策环境下的广大患者提供了获得安全有效堕胎护理的重要途径。

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引用次数: 0

Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients 远程医疗药物流产患者人工流产前超声检查的应用。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.002

Sylvie T. Wilson MSPH , Lisa Peters MPH , Leah R. Koenig PhD, MSPH , Suzanne O. Bell PhD, MPH , Ushma D. Upadhyay PhD, MPH

Background

Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.

Objective

This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.

Study Design

Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.

Results

Among 1,775 participants, 11% (n = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.

Conclusion

Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.

背景：自2020年以来，一些临床医生为符合条件的患者提供了不需要超声筛查的远程医疗药物流产护理。然而，一些远程医疗药物流产患者仍然接受超声检查。目的：了解远程医疗药物流产患者术前超声检查情况、超声检查原因及超声检查地点。研究设计：使用加州远程医疗家庭堕胎（CHAT）研究的数据，这是一项针对2021年和2022年使用远程医疗堕胎服务的患者的队列研究，参与者被问及他们是否有堕胎前超声成像，超声成像的原因，以及他们在哪里获得的超声成像。我们使用卡方检验、Fisher精确检验和多变量逻辑回归分析这些反应。结果：在1775名参与者中，11% （n = 194）在流产前进行了超声检查。在多变量模型中，年龄较小、食物不安全、怀孕持续时间为35天（5周）或更长，或不确定其怀孕持续时间的参与者更有可能获得流产前超声检查。超声检查最常见的原因是评估妊娠期（69%）。大多数参与者在诊所（41%）或急诊室或医院（27%）接受了影像学检查，尽管有些人在危重妊娠中心（14%）接受了影像学检查。在接受超声检查的人中，8%是由远程保健提供者介绍的；其余的则主动寻求超声检查。结论：医院、诊所和影像机构可以制定政策，为希望或需要进行流产前超声检查的患者增加超声检查的可及性。

{"title":"Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients","authors":"Sylvie T. Wilson MSPH , Lisa Peters MPH , Leah R. Koenig PhD, MSPH , Suzanne O. Bell PhD, MPH , Ushma D. Upadhyay PhD, MPH","doi":"10.1016/j.whi.2025.06.002","DOIUrl":"10.1016/j.whi.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.</div></div><div><h3>Objective</h3><div>This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.</div></div><div><h3>Study Design</h3><div>Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 1,775 participants, 11% (<em>n</em> = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.</div></div><div><h3>Conclusion</h3><div>Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 376-382"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Differences in Contraceptive Method Discontinuation and Contraceptive Method Preferences by Disability Status 残疾状况对避孕方法停药和避孕方法偏好的影响。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.004

Zoe H. Pleasure MPH , Laura D. Lindberg PhD

Background

Contraceptive care delivery to people with disabilities must be contextualized within the U.S. history of stratified reproduction and eugenics. Significant sexual and reproductive health inequities have been documented between people with disabilities and those without disabilities in family planning service receipt and contraceptive method use. Little research has examined how discontinuation of contraception or dissatisfaction with contraceptive methods may differ for people with disabilities.

Objective

This study assesses differences in contraceptive desires and experiences between disabled and nondisabled individuals.

Methods

Our sample included self-identified female respondents from the 2011–2019 National Survey of Family Growth. We examined demographic and sexual and reproductive health differences between disabled and nondisabled respondents based on self-report of disabilities. Unadjusted and adjusted logistic regression models estimated differences in contraceptive method discontinuation due to dissatisfaction and method choice based on cost.

Results

Differences by disability status were found for reports of fecundity and the contraceptive method used in the past 12 months. In both unadjusted and adjusted models, significantly more disabled people than nondisabled people reported having discontinued their method because of dissatisfaction and having wanted to use a different method if cost were not an issue.

Conclusions

Self-reported disabilities are associated with contraceptive method dissatisfaction and unmet contraceptive preferences. Efforts are needed to tailor person-centered clinical care that is responsive to this population's reproductive wants and needs.

背景：向残疾人提供避孕护理必须在美国分层生殖和优生学的历史背景下进行。有记录表明，残疾人和非残疾人在接受计划生育服务和使用避孕方法方面存在严重的性健康和生殖健康不平等。很少有研究调查停止避孕或对避孕方法不满意对残疾人有何不同。目的：本研究评估残疾人和非残疾人在避孕欲望和体验方面的差异。方法：我们的样本包括2011-2019年全国家庭增长调查中自我认定的女性受访者。我们根据残疾自我报告检查了残疾和非残疾受访者之间的人口统计学和性健康和生殖健康差异。未调整和调整的逻辑回归模型估计了由于不满意和基于成本的方法选择而停止避孕方法的差异。结果：在过去12个月的生育能力和使用的避孕方法的报告中发现残疾状况的差异。在未调整和调整的模型中，残疾人比非残疾人报告说，由于不满意而停止使用他们的方法，并且如果成本不是问题，他们想使用不同的方法。结论：自我报告的残疾与避孕方法不满意和未满足的避孕偏好有关。需要努力调整以人为本的临床护理，以满足这一人群的生殖需求。

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引用次数: 0

A Qualitative Analysis of the Lived Experiences of Active-Duty Servicewomen Receiving Perinatal Care Within the Military Health System 军队卫生系统现役女军人围产期护理生活体验的定性分析。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.07.001

Caitlin Russell PhD, MBE, MSHP, WHNP-BC , Emily Balog PhD, OTR/L, FNAP , Anne Teitelman PhD, FNP-BC, FAANP, FAAN , Rosemary Polomano PhD, RN, FAAN

Objectives

We explored the lived experiences of active-duty servicewomen (ADSW) accessing and receiving care during the perinatal period (from discovery of pregnancy to 1 year postpartum) within the Military Health System.

Study Design

Using qualitative methods, we conducted semi-structured interviews between September 2022 and February 2023 with 23 ADSW participants who were pregnant or within their first year postpartum. Data were analyzed using inductive coding and thematic analysis techniques.

Results

Participants reported bureaucratic hurdles and long wait times for accessing care, too little choice in providers, and inadequate coordination between civilian and military care providers. Those who experienced perinatal complications perceived that the military health system did not adequately address their concerns. Some participants described disjointed and depersonalized perinatal care, whereas others reported positive experiences with their providers.

Conclusions

Opportunities exist for the Military Health System to improve the perinatal care experience by increasing access to perinatal care, providing more autonomy to ADSW in choosing providers and birth settings, and developing policies and procedures to improve inter-specialty communication.

目的：探讨现役妇女（ADSW）在围产期（从发现怀孕到产后1年）在军队卫生系统内获得和接受护理的生活经历。研究设计：采用定性方法，我们在2022年9月至2023年2月期间对23名怀孕或产后一年内的ADSW参与者进行了半结构化访谈。数据分析采用归纳编码和专题分析技术。结果：参与者报告了官僚主义障碍和获得护理的漫长等待时间，提供者的选择太少，民用和军事护理提供者之间的协调不足。那些经历过围产期并发症的人认为军队卫生系统没有充分解决他们的问题。一些参与者描述了脱节和去个性化的围产期护理，而其他人则报告了与他们的提供者的积极经历。结论：军队卫生系统存在改善围产期护理体验的机会，可以通过增加围产期护理的可及性，在选择提供者和分娩环境方面给予ADSW更多的自主权，并制定政策和程序来改善专科间的沟通。

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引用次数: 0

Changes in Reproductive and Sexual Health Diagnoses of Women Veterans Using Department of Veterans Affairs Health Care Between FY2010 and FY2018 2010财年至2018财年，使用退伍军人事务部卫生保健服务的女性退伍军人生殖和性健康诊断的变化

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.07.004

Jessica K. Friedman PhD, MPH, MSc , Amanda M. Johnson MD, FACOG , Erica V. Tartaglione BS , Jacob R. Eleazer PhD , Susan M. Frayne MD, MPH , Kristin O. Haeger MPH, MAT , Alexandra K.R. Schule JD , Claudine Offer MPH , Ciaran S. Phibbs PhD , Danielle Rose PhD, MPH , Fay Saechao MPH , Megha Shankar MD , Jonathan G. Shaw MD, MS , Elizabeth M. Yano PhD, MSPH , Alicia Y. Christy MD, MHSCH, FACOG , Jodie G. Katon PhD, MS

Background

Women veterans are the fastest growing group of new Veterans Health Administration (VA) users, with more than half a million women veterans using VA care in 2018. VA has implemented policies and programs to meet the reproductive and sexual health (RSH) needs of women veterans who increasingly rely on VA to provide comprehensive care.

Objective

We aimed to describe changes in the prevalence of RSH diagnosis categories among women veterans using VA care in fiscal year (FY) 2010 and FY2018.

Methods

Repeated cross-sectional VA administrative data were used to identify women veterans using VA care in FY2010 and FY2018. RSH diagnosis categories were identified from International Classification of Diseases (ICD), Ninth (FY2010) and 10th (FY2018) revision codes for all VA-covered health care encounters. Standardized incidence ratios (SIRs) were used to adjust for age and compare the rates of 15 reproductive health diagnoses in FY2010 and FY2018.

Results

Women veterans using VA for RSH care increased by 61% between FY2010 (n = 317,122) and FY2018 (n = 520,179). Prevalence of common RSH diagnoses remained consistent across fiscal years, including urinary conditions (SIR = 1.02; 95% CI [1.02, 1.03]) and reproductive organ conditions (SIR = .96; 95% CI [.95, .97]). Conversely, there were larger than expected increases in diagnoses of female infertility (SIR = 1.71; 95% CI [1.70, 1.76]) and sexual dysfunction (SIR = 1.51; 95% CI [1.47, 1.54]).

Conclusion

As VA continues to build capacity to provide RSH care to women veterans, understanding changing needs is important for evaluating the impact of programs and policies designed to improve access to care.

背景：女性退伍军人是退伍军人健康管理局（VA）新用户中增长最快的群体，2018年有超过50万人使用VA护理。退伍军人事务部实施了政策和计划，以满足越来越依赖退伍军人事务部提供全面护理的女退伍军人的生殖和性健康（RSH）需求。目的：我们旨在描述2010财年和2018财年使用VA护理的女性退伍军人中RSH诊断类别患病率的变化。方法：使用重复的横截面VA管理数据来识别2010财年和2018财年使用VA护理的女性退伍军人。RSH诊断类别是从国际疾病分类（ICD）第九（2010财年）和第十（2018财年）修订代码中确定的，适用于所有va覆盖的卫生保健遭遇。标准化发病率（SIRs）用于调整年龄，并比较2010财年和2018财年15种生殖健康诊断的比率。结果：2010财年（n = 317,122）至2018财年（n = 520,179），使用VA进行RSH护理的女性退伍军人增加了61%。常见RSH诊断的患病率在各个财政年度保持一致，包括泌尿系统疾病（SIR = 1.02; 95% CI[1.02, 1.03]）和生殖器官疾病(SIR = 0.96; 95% CI[。95 .97点)。相反，女性不育症（SIR = 1.71; 95% CI[1.70, 1.76]）和性功能障碍（SIR = 1.51; 95% CI[1.47, 1.54]）的诊断率高于预期。结论：随着退伍军人事务部继续建设为女性退伍军人提供RSH护理的能力，了解不断变化的需求对于评估旨在改善护理机会的项目和政策的影响至关重要。

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引用次数: 0

Beneath the Incision: Variation in Low-Risk Cesareans Among Asian and Pacific Islander Subgroups in the United States 切口下：美国亚洲和太平洋岛民亚群中低风险剖宫产的差异。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.05.003

Louise Marie Roth PhD , Jennifer Hyunkyung Lee MA , Theresa M. Morris PhD

Background

Quality initiatives aim to reduce primary cesarean rates in pregnancies with low clinical risk. These cesarean rates vary significantly by race-ethnicity in the United States. This study analyzes differences in low-risk primary cesareans between Asian/Pacific Islander (API) individuals and other pan-ethnic groups and among API subgroups in the United States.

Methods

We used data on all recorded births in the United States from 2010 to 2020 to analyze primary cesareans in the lowest risk NTSV (nulliparous, term, singleton, vertex) and MTSV (multiparous, term, singleton, vertex) pregnancies by race-ethnicity. We used logistic regression to compare API births with births among other pan-ethnic groups (N = 22,212,076) and to analyze variation across API subgroups (N = 1,663,167).

Results

API births had lower risk-adjusted odds of a primary cesarean than most other pan-ethnic groups. Among API subgroups, Indian and some Pacific Islander groups had higher adjusted odds of a primary cesarean, whereas Chinese, Korean, Filipino, and, especially, Japanese groups had lower odds. Foreign-born API birthing people had higher odds than U.S.-born API birthing people (NTSV odds ratio [OR] = 1.17, 95% confidence interval [CI] [1.16, 1.19], and MTSV OR = 1.11, 95% CI [1.10, 1.13]).

Conclusions

Although odds of a low-risk primary cesarean were slightly lower in API births than in births among most other pan-ethnic groups, this concealed significant variation among API subgroups and between foreign-born and U.S.-born API birthing people. These disparities suggest inequities in access to quality care and possible discrimination against some API groups, leading to unnecessary overtreatment. Efforts to reduce disparities should recognize differences across subgroups and potential barriers to culturally appropriate care.

背景：质量倡议旨在降低低临床风险妊娠的原发性剖宫产率。在美国，这些剖宫产率因种族而有很大差异。本研究分析了美国亚裔/太平洋岛民（API）个体与其他泛种族群体以及API亚群之间低风险原发性剖宫产的差异。方法：我们使用2010年至2020年美国所有记录的分娩数据，按种族分析最低风险NTSV（无产、足月、单胎、顶点）和MTSV（多产、足月、单胎、顶点）妊娠的初次剖宫产。我们使用逻辑回归比较API出生与其他泛民族的出生（N = 22,212,076），并分析API亚组之间的差异（N = 1,663,167）。结果：与大多数其他泛民族相比，API出生的原发性剖宫产的风险调整几率较低。在API亚群中，印度人和一些太平洋岛民群体原发性剖宫产的调整后几率较高，而中国人、韩国人、菲律宾人，尤其是日本人的调整后几率较低。在国外出生的API出生的人比在美国出生的API出生的人有更高的几率（NTSV比值比[OR] = 1.17, 95%可信区间[CI] [1.16, 1.19]， MTSV比值比= 1.11,95% CI[1.10, 1.13]）。结论：尽管API出生的低风险原发性剖宫产的几率略低于大多数其他泛种族群体，但这掩盖了API亚组之间以及外国出生和美国出生的API出生人群之间的显著差异。这些差异表明，在获得高质量护理方面存在不平等，可能存在对一些API群体的歧视，从而导致不必要的过度治疗。减少差异的努力应认识到亚群体之间的差异以及文化上适当的护理的潜在障碍。

{"title":"Beneath the Incision: Variation in Low-Risk Cesareans Among Asian and Pacific Islander Subgroups in the United States","authors":"Louise Marie Roth PhD , Jennifer Hyunkyung Lee MA , Theresa M. Morris PhD","doi":"10.1016/j.whi.2025.05.003","DOIUrl":"10.1016/j.whi.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Quality initiatives aim to reduce primary cesarean rates in pregnancies with low clinical risk. These cesarean rates vary significantly by race-ethnicity in the United States. This study analyzes differences in low-risk primary cesareans between Asian/Pacific Islander (API) individuals and other pan-ethnic groups and among API subgroups in the United States.</div></div><div><h3>Methods</h3><div>We used data on all recorded births in the United States from 2010 to 2020 to analyze primary cesareans in the lowest risk NTSV (nulliparous, term, singleton, vertex) and MTSV (multiparous, term, singleton, vertex) pregnancies by race-ethnicity. We used logistic regression to compare API births with births among other pan-ethnic groups (N = 22,212,076) and to analyze variation across API subgroups (N = 1,663,167).</div></div><div><h3>Results</h3><div>API births had lower risk-adjusted odds of a primary cesarean than most other pan-ethnic groups. Among API subgroups, Indian and some Pacific Islander groups had higher adjusted odds of a primary cesarean, whereas Chinese, Korean, Filipino, and, especially, Japanese groups had lower odds. Foreign-born API birthing people had higher odds than U.S.-born API birthing people (NTSV odds ratio [OR] = 1.17, 95% confidence interval [CI] [1.16, 1.19], and MTSV OR = 1.11, 95% CI [1.10, 1.13]).</div></div><div><h3>Conclusions</h3><div>Although odds of a low-risk primary cesarean were slightly lower in API births than in births among most other pan-ethnic groups, this concealed significant variation among API subgroups and between foreign-born and U.S.-born API birthing people. These disparities suggest inequities in access to quality care and possible discrimination against some API groups, leading to unnecessary overtreatment. Efforts to reduce disparities should recognize differences across subgroups and potential barriers to culturally appropriate care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 359-367"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Addressing Racism and Discrimination in the Design of Physical Activity Interventions for Black Women: Insights and Recommendations From an Academic and Community Partnership 解决黑人妇女体育活动干预设计中的种族主义和歧视：来自学术和社区伙伴关系的见解和建议。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.001

Rodney P. Joseph PhD , LaTanya Mathis MSN , Iyana Harris BA , Shawntele M. Howie-Carlson , Kanika Jones BSW , Darlene Little EdD , Dawn Augusta DNP, MBA

引用次数: 0

Safety Net Clinic Utilization for Sexual and Reproductive Health Services Among U.S.- and Foreign-Born Mexican-Origin Women 美国和国外出生的墨西哥裔妇女性健康和生殖健康服务的安全网诊所使用情况。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.05.004

Blair G. Darney PhD, MPH , Biani Saavedra-Avendaño PhD, MSc , Emily R. Boniface MPH , Laura E. Jacobson PhD, MPH , Kate Coleman-Minahan PhD, FNP-BC , Evelyn Fuentes-Rivera MSc , Fernando Riosmena PhD

Objective

We describe utilization of sexual and reproductive health (SRH) services at safety net clinics (Title X and other publicly funded health care organizations) and private health care settings among U.S.- and foreign-born Mexican-origin women living in the United States. We also test whether nativity is associated with source of SRH care, adjusting for other factors.

Data Sources and Study Setting

We pooled four waves of the National Survey of Family Growth (NSFG)—2011–2013, 2013–2015, 2015–2017, and 2017–2019—and included in our sample women who received SRH services in the previous 12 months.

Study Design

We compared SRH service utilization and source (safety net clinics [Title X and non-Title X public] vs. private) between U.S.-born and foreign-born Mexican-origin women. We used multivariable regression to test whether nativity was associated with source of care.

Principal Findings

Our sample included n = 1,923 (N = 4,446,577) Mexican-origin women aged 15–44, 42.9% of whom were foreign born. Foreign-born women of Mexican origin were more likely to be uninsured (43.8% vs. 13.4% among the U.S. born) and had a significantly higher adjusted probability of using safety net clinics to access preventive SRH services compared with Mexican-American women (42.2%; 95% CI [35.5, 48.9%] vs. 27.6%; 95% CI [22.9, 32.2%]).

Conclusions

Safety net clinics such as Title X and other publicly funded health care organizations play an important role in access to preventive SRH care among Mexican-origin women living in the United States, especially for foreign-born women.

目的：我们描述了生活在美国的美国和外国出生的墨西哥裔妇女在安全网诊所（第十条和其他公共资助的卫生保健组织）和私人卫生保健机构使用性健康和生殖健康（SRH）服务的情况。我们还测试了出生是否与SRH护理来源有关，并对其他因素进行了调整。数据来源和研究背景：我们汇集了2011-2013年、2013-2015年、2015-2017年和2017-2019年四波全国家庭增长调查（NSFG），并将在过去12个月内接受过性健康生殖健康服务的女性纳入我们的样本。研究设计：我们比较了美国出生和外国出生的墨西哥裔妇女的生殖健康服务利用率和来源（安全网诊所[第十条和非第十条公共]与私人）。我们使用多变量回归来检验出生是否与护理来源有关。主要发现：我们的样本包括n = 1,923 （n = 4,446,577）名年龄在15-44岁的墨西哥裔女性，其中42.9%是外国出生的。外国出生的墨西哥裔妇女更有可能没有保险（43.8% vs.美国出生的13.4%），与墨西哥裔美国妇女相比，使用安全网诊所获得预防性性健康生殖健康服务的调整概率显着更高(42.2%；95% CI[35.5, 48.9%]对27.6%；95% ci[22.9, 32.2%])。结论：安全网诊所，如Title X和其他公共资助的卫生保健组织，在获得居住在美国的墨西哥裔妇女，特别是外国出生的妇女的预防性性健康和生殖健康保健方面发挥了重要作用。

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引用次数: 0