Womens Health Issues最新文献_第5页

Impacts of Medicaid Expansion on Contraceptive Use Among Women in Neighborhoods of Racialized Socioeconomic Deprivation in the United States 医疗补助扩大对美国种族化社会经济剥夺社区妇女避孕药具使用的影响。

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.2025.07.002

Alice F. Cartwright PhD, MPH , Gustavo Angeles PhD , Jessica Su PhD , Maeve Wallace PhD, MPH , Siân Curtis PhD , Ilene S. Speizer PhD

Introduction

Medicaid expansion has the potential to increase access to contraception and improve women's health, although existing research examining state-level variation provides mixed evidence. The neighborhood context plays a crucial role in understanding the effects of Medicaid expansion on contraceptive use, as structural inequalities within neighborhoods may shape access to health care and reproductive services.

Materials and Methods

We used a unique restricted dataset of 13,224 female respondents ages 15–44 years interviewed in the 2011–2019 waves of the National Survey of Family Growth (NSFG). We merged these data with indicators of state Medicaid expansion status and respondents’ neighborhood context, operationalized as Index of Concentration at the Extremes (ICE) scores. We used quasi-experimental difference-in-differences models to assess if Medicaid expansion impacted provider-dependent contraceptive use and method type differentially by neighborhood-level context. We used multivariable linear probability and multinomial logistic regression models adjusting for individual and community covariates and state/region fixed effects.

Results

Living in a Medicaid expansion state was associated with significant increases in provider-dependent contraceptive method use among respondents in the most deprived neighborhoods (17.9 percentage points, 95% CI [9.0, 26.9], by 2017–2019). Specifically, long-acting reversible contraception (LARC) use increased 7.6 percentage points (95% CI [0.6–14.7]) and use of no method or barrier/coital methods declined 17.5 percentage points (95% CI [−26.3, −8.7]) among those in the most deprived neighborhoods by 2017–2019.

Conclusions

Changes in state-level policies can have major impacts on health systems, but the example of Medicaid expansion underscores the differential impacts on people with less access to health resources, such as those living in structurally disadvantaged neighborhoods. Ultimately, further expansion of Medicaid could facilitate access to the full range of contraceptive methods and advance population health equity in additional U.S. states.

简介：医疗补助扩大有可能增加获得避孕和改善妇女健康，尽管现有的研究检查国家层面的变化提供了混合的证据。社区背景在理解医疗补助扩大对避孕药具使用的影响方面起着至关重要的作用，因为社区内部的结构性不平等可能会影响获得医疗保健和生殖服务的机会。材料和方法：我们使用了一个独特的限制性数据集，其中包括2011-2019年全国家庭增长调查（NSFG）中采访的13224名年龄在15-44岁的女性受访者。我们将这些数据与州医疗补助扩张状况指标和受访者的社区背景合并，作为极端集中指数（ICE）分数进行操作。我们使用准实验差异中差异模型来评估医疗补助计划的扩张是否影响了依赖于提供者的避孕方法的使用和方法类型在社区水平上的差异。我们使用多变量线性概率和多项逻辑回归模型来调整个体和社区协变量以及州/地区固定效应。结果：生活在医疗补助扩张州与最贫困社区受访者中依赖提供者的避孕方法的使用显著增加有关（17.9个百分点，95% CI[9.0, 26.9]，到2017-2019年）。具体而言，2017-2019年，在最贫困社区中，长效可逆避孕（LARC）的使用增加了7.6个百分点（95% CI[0.6-14.7]），无方法或屏障/性交方法的使用下降了17.5个百分点（95% CI[-26.3, -8.7]）。结论：州级政策的变化可能对卫生系统产生重大影响，但医疗补助扩张的例子强调了对卫生资源获取较少的人群的不同影响，例如生活在结构不利社区的人群。最终，进一步扩大医疗补助计划可以促进获得全方位的避孕方法，并促进美国其他州的人口健康平等。

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引用次数: 0

Examining Veterans', Doulas', and VA Maternity Care Coordinators’ Perceptions and Experiences With a Community-based Doula Pilot Program 以社区为基础的导乐试点项目考察退伍军人、导乐和VA产科护理协调员的看法和经验。

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.2025.08.001

Kristin M. Mattocks PhD, MPH , Valerie Marteeny MS , Lorrie Walker MA , Karen M. Goldstein MD, MSPH , Stephanie Condon-Perry PA-C , Kathryn Berrien RN, BSN, MS , Danielle Weber RN , Lisa L. Shenette MS , Kate Wallace MPH , Michaela A. Ayisi MPH , Akila Sanjay BS , Aimee Kroll-Desrosiers PhD

Objective

Racial disparities in maternal morbidity and mortality are well-documented and remain a pressing public health problem in the United States. Racial disparities in maternal health have also been noted among veterans receiving community-based maternity care benefits from the Department of Veterans Affairs (VA). Previous studies of doula care among minoritized racial groups have indicated lower rates of preterm and cesarean births, more positive feelings about childbirth experiences, and lower admissions to the neonatal intensive care unit. To assess whether doula care might be beneficial for veterans enrolled in VA care, we launched a small pilot study at two VA medical centers working in conjunction with community-based doula agencies. Therefore, the overarching objective of this study was to assess veterans', doulas', and VA maternity care coordinators’ (MCC) perceptions and experiences with a community-based doula program aimed at improving maternal outcomes.

Methods

Telephone or video interviews were conducted with veterans, doulas, and VA MCCs who had participated in the doula care program. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived from the analyses.

Results

Twenty-eight veterans, seven doulas, and two VA MCCs enrolled in the doula study and participated in interviews. Four major themes were identified: 1) veterans’ previous negative birth experiences promoted desire for doula care, 2) veterans had positive pregnancy experiences with doula care, 3) doulas empowered veterans to advocate for themselves during pregnancy, and 4) VA MCCs welcomed doula partnerships.

Conclusion

Veterans expressed high levels of satisfaction with the doula care program. VA MCCs noted that a doula care program was an important addition to the existing VA MCC program and allowed MCCs to feel that they had an additional partner in caring for pregnant veterans.

目的：在美国，孕产妇发病率和死亡率的种族差异是有案可查的，并且仍然是一个紧迫的公共卫生问题。在从退伍军人事务部领取社区产妇保健福利的退伍军人中，也注意到产妇保健方面的种族差异。先前对少数族裔的助产师护理的研究表明，少数族裔的早产和剖宫产率较低，对分娩经历的感觉更积极，新生儿重症监护病房的入院率较低。为了评估导乐护理是否对退伍军人有好处，我们在两个退伍军人医疗中心与社区导乐机构合作开展了一项小型试点研究。因此，本研究的总体目标是评估退伍军人、助产师和退伍军人事务部的产妇护理协调员（MCC）对以社区为基础的助产师项目的看法和经验，该项目旨在改善产妇的结局。方法：对参加过导乐护理计划的退伍军人、导乐师和退伍军人事务部mcc进行电话或视频访谈。访谈记录，转录，并使用内容分析技术进行分析。从分析中得出了主要的主题和代表性的语录。结果：28名退伍军人、7名导乐师和2名退伍军人事务部mcc参加了导乐研究并参加了访谈。研究确定了四个主要主题：1)退伍军人之前消极的分娩经历促进了对导乐护理的渴望；2)退伍军人在怀孕期间对导乐护理有积极的体验；3)导乐赋予了退伍军人在怀孕期间为自己辩护的权利；4)VA mcc欢迎与导乐合作。结论：退伍军人对导乐护理方案的满意度较高。VA MCC指出，助产师护理计划是对现有VA MCC计划的重要补充，并使MCC感到他们在照顾怀孕退伍军人方面有了额外的合作伙伴。

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引用次数: 0

Diagnostic Evaluation for Abnormal Uterine Bleeding at Emergency Departments in the United States 美国急诊科异常子宫出血的诊断评价

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.2025.07.008

Wanyi Huang MPH , Xiaomei Ma PhD , Mitchell Clark MD, MPH , Xiao Xu PhD

Objectives

We aimed to examine patterns of diagnostic evaluations for abnormal uterine bleeding (AUB) in a national sample of emergency department (ED) visits and identify potential racial and ethnic differences.

Methods

Using the 2014–2021 National Hospital Ambulatory Medical Care Survey data, we identified 1,049 (unweighted; 7,900,653 weighted) women age

\geq

18 years without previous cancer diagnosis who visited EDs for non–pregnancy-related AUB. The primary outcomes were whether an ultrasound was provided/ordered and whether referral/follow-up consultation was recommended. The association of race and ethnicity with these outcome measures was examined using multivariable logistic regressions adjusting for other patient/provider characteristics.

Results

Multivariable regression analysis showed that non-Hispanic Black patients were less likely than non-Hispanic white patients to receive or have an ultrasound ordered (adjusted odds ratio [aOR] = .58, 95% confidence interval [CI] [.36, .92]). Non-Hispanic Black patients also had a lower likelihood of receiving referral or recommendation for follow-up consultation, compared with non-Hispanic white patients (aOR = .54, 95% CI [.31, .94]). Hispanic patients did not differ significantly from non-Hispanic white patients in these measures. Perimenopausal age (45–54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation.

Conclusions

Among women presenting with AUB at EDs, diagnostic evaluation varied by race, suggesting a need to improve equity in care.

目的：我们的目的是在全国急诊科（ED）就诊样本中检查异常子宫出血（AUB）的诊断评估模式，并确定潜在的种族和民族差异。方法：利用2014-2021年全国医院门诊医疗调查数据，我们确定了1049名（未加权；7900,653名加权）年龄≥18岁、既往无癌症诊断、因非妊娠相关AUB前往急诊科的女性。主要结果是是否提供/订购超声检查以及是否推荐转诊/随访咨询。使用多变量逻辑回归对其他患者/提供者特征进行校正，检验种族和民族与这些结果测量的关系。结果：多变量回归分析显示，非西班牙裔黑人患者接受或接受超声检查的可能性低于非西班牙裔白人患者（调整优势比[aOR] = 0.58, 95%可信区间[CI]）。36岁,.92])。与非西班牙裔白人患者相比，非西班牙裔黑人患者接受转诊或推荐随访会诊的可能性也较低（aOR = 0.54, 95% CI）。31日.94])。在这些测量中，西班牙裔患者与非西班牙裔白人患者没有显著差异。围绝经期年龄（45-54岁）和在非大都市地区的位置与进行超声检查/预约或推荐转诊/随访咨询的可能性较低有关。在急诊科就诊时，咨询医生的参与增加了进行超声检查的可能性，同时减少了转诊/建议后续咨询的可能性。结论：在急诊科出现AUB的女性中，诊断评价因种族而异，表明需要提高护理的公平性。

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引用次数: 0

Corrigendum to: An Exploratory Analysis of Factors Associated With Spontaneous Preterm Birth Among Pregnant Veterans With Post-Traumatic Stress Disorder [Women's Health Issues 33 (2023) 191-198] 创伤后应激障碍怀孕退伍军人自发性早产相关因素的探索性分析[妇女健康问题33(2023)191-198]。

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.2025.09.003

Danielle M. Panelli MD , Caitlin S. Chan SM , Jonathan G. Shaw MD, MS , Megha Shankar MD , Rachel Kimerling PhD , Susan M. Frayne MD, MPH , Tiffany C. Herrero MD , Deirdre J. Lyell MD , Ciaran S. Phibbs PhD

引用次数: 0

Patterns of Antepartum Care in Ontario Before and During a Time of COVID-19 and Virtual Care: A Population-Based Study 安大略省在COVID-19之前和期间的产前护理模式和虚拟护理：一项基于人群的研究

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.2025.05.002

Stephanie C. Lapinsky MD, MSc , Nancy N. Baxter MD, PhD , Rinku Sutradhar PhD , Karl Everett PhD , Joan Porter MSc , Mark H. Yudin MD, MSc , Eliane M. Shore MD, MSc , Howard Berger MD , Douglas M. Campbell MD, MSc , John W. Snelgrove MD, MSc , Andrea N. Simpson MD, MSc

Background

The COVID-19 pandemic resulted in changes to the way health care was delivered, including expansion of virtual care. We aimed to understand differences in antepartum care delivery prior to and during the pandemic.

Methods

We conducted a population-based retrospective cohort study of people 15–50 years with an in-hospital birth at 20+ weeks’ gestation in Ontario, Canada, across two time periods: December 1, 2020–November 30, 2022 (pandemic), and December 1, 2017–November 30, 2019 (pre-pandemic). Outcomes were total number and timing of antepartum visits, ultrasounds, and acute care encounters. Outcomes were compared between cohorts, and between those who did and did not receive virtual care during the pandemic. Regression modeling was used to examine associations between pregnancy during the pandemic and rates of outcomes.

Results

A total of 228,551 pandemic and 218,126 pre-pandemic births were included. Median number of antepartum visits was 10 (6–13) in the pandemic period and 9 (4–12) pre-pandemic (standardized difference (StD): 0.32), corresponding to a relative rate of 1.21 (95% CI [1.20, 1.21]). Significantly more individuals in the pandemic had >11 visits, with no differences in acute care encounters and only a small increase in health care costs (<10%). Those in the pandemic cohort were more likely to have their initial visit during the first trimester (79.3% vs. 66.5%, StD: 0.29). Those receiving virtual care were more likely to live in an urban area and be more materially advantaged.

Interpretation

Pregnancy during the pandemic was associated with in an increased rate of ambulatory antepartum visits and increased care in the first trimester.

背景：2019冠状病毒病大流行导致卫生保健提供方式发生变化，包括虚拟医疗的扩大。我们的目的是了解大流行前和大流行期间产前护理的差异。方法：我们对加拿大安大略省15-50岁妊娠20周以上住院分娩的人群进行了一项基于人群的回顾性队列研究，跨越两个时间段：2020年12月1日至2022年11月30日（大流行时期）和2017年12月1日至2019年11月30日（大流行前）。结果是产前就诊、超声检查和急诊就诊的总次数和时间。结果在队列之间以及在大流行期间接受和未接受虚拟护理的人群之间进行了比较。回归模型用于检查大流行期间怀孕与结局率之间的关系。结果：共纳入228,551名大流行新生儿和218,126名大流行前新生儿。大流行期间产前就诊中位数为10次（6-13次），大流行前为9次（4-12次）（标准化差异（StD）： 0.32），相对率为1.21 （95% CI[1.20, 1.21]）。在大流行期间，有更多的人进行了bbb11次就诊，在急诊就诊方面没有差异，医疗保健费用仅略有增加（解释：大流行期间怀孕与产前门诊就诊率增加和妊娠早期护理增加有关）。

{"title":"Patterns of Antepartum Care in Ontario Before and During a Time of COVID-19 and Virtual Care: A Population-Based Study","authors":"Stephanie C. Lapinsky MD, MSc , Nancy N. Baxter MD, PhD , Rinku Sutradhar PhD , Karl Everett PhD , Joan Porter MSc , Mark H. Yudin MD, MSc , Eliane M. Shore MD, MSc , Howard Berger MD , Douglas M. Campbell MD, MSc , John W. Snelgrove MD, MSc , Andrea N. Simpson MD, MSc","doi":"10.1016/j.whi.2025.05.002","DOIUrl":"10.1016/j.whi.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic resulted in changes to the way health care was delivered, including expansion of virtual care. We aimed to understand differences in antepartum care delivery prior to and during the pandemic.</div></div><div><h3>Methods</h3><div>We conducted a population-based retrospective cohort study of people 15–50 years with an in-hospital birth at 20+ weeks’ gestation in Ontario, Canada, across two time periods: December 1, 2020–November 30, 2022 (pandemic), and December 1, 2017–November 30, 2019 (pre-pandemic). Outcomes were total number and timing of antepartum visits, ultrasounds, and acute care encounters. Outcomes were compared between cohorts, and between those who did and did not receive virtual care during the pandemic. Regression modeling was used to examine associations between pregnancy during the pandemic and rates of outcomes.</div></div><div><h3>Results</h3><div>A total of 228,551 pandemic and 218,126 pre-pandemic births were included. Median number of antepartum visits was 10 (6–13) in the pandemic period and 9 (4–12) pre-pandemic (standardized difference (StD): 0.32), corresponding to a relative rate of 1.21 (95% CI [1.20, 1.21]). Significantly more individuals in the pandemic had >11 visits, with no differences in acute care encounters and only a small increase in health care costs (<10%). Those in the pandemic cohort were more likely to have their initial visit during the first trimester (79.3% vs. 66.5%, StD: 0.29). Those receiving virtual care were more likely to live in an urban area and be more materially advantaged.</div></div><div><h3>Interpretation</h3><div>Pregnancy during the pandemic was associated with in an increased rate of ambulatory antepartum visits and increased care in the first trimester.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 330-341"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601906","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

Engaging Rural Women Veterans in Mental Health Research: A Call to Action 让农村妇女退伍军人参与心理健康研究：行动呼吁。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.03.004

Alexandra B. Caloudas PhD , Juinell B. Williams PhD , Giselle Day MPH , Rajinder Sonia Singh PhD , Mary Shapiro PhD , Amanda McCorkindale PsyD , Deleene Menefee PhD , Jan A. Lindsay PhD , Derrecka Boykin PhD

引用次数: 0

Perception of Having Enough Information to Make Contraceptive Decisions: A Novel Metric of Person-Centered Contraceptive Access 感知有足够的信息作出避孕决定：以人为中心的避孕获得的新指标。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.003

Ariana H. Bennett DrPH, MPH , Alex Schulte BA, BSPH , Jennet Arcara PhD, MPH, MPP , Jamie Bardwell MPP , Denicia Cadena BA , Aisha Chaudhri MA , Laura Davis MA , Brittni Frederiksen PhD, MPH , Catherine Labiran MA , Raegan McDonald-Mosley MD, MPH , Ellen Pliska MHS , Whitney Rice DrPH, MPH , Ena Suseth Valladares MPH , Cassondra Marshall DrPH, MPH , Anu Manchikanti Gomez PhD, MSc

Introduction

Information is a critical component of contraceptive access. This study presents a new person-centered metric of contraceptive access: perception of having sufficient information to choose a contraceptive method.

Methods

Between January and March 2022, we fielded a nationally representative online survey among 15- to 44-year-olds assigned female sex at birth using NORC's AmeriSpeak panel. We describe whether respondents felt they had enough information for contraceptive decision making and types of information needed. We investigate bivariate associations between perception of having enough information and key respondent characteristics. We use logistic regression to investigate whether past experiences of sexual and reproductive health (SRH) care and contraceptive self-efficacy are associated with feeling one has enough information.

Results

Of the analytic sample (unweighted n = 3,037), 73.5% felt they had enough information to decide about contraception, 11.8% did not, and 14.7% were unsure. Those who did not feel they had enough information (unweighted n = 687) most commonly needed information about side effects (33.4%). In bivariate analyses, respondents who were younger, were gay/lesbian, had lower educational attainment, and were uninsured were less likely to feel they had adequate information. Regression analyses indicated a positive association between feeling one had enough information and past experiences of high-quality SRH care and contraceptive self-efficacy.

Implications and Conclusions

Our data indicate inequities in who felt they had enough information to make contraceptive decisions. Perception of having enough information is related to quality of care and perceived future ability to access contraception. This paper supports the importance of recognizing information as a key part of person-centered contraceptive access.

信息是获取避孕药具的关键组成部分。本研究提出了一种新的以人为中心的避孕方法：感知有足够的信息来选择一种避孕方法。方法：在2022年1月至3月期间，我们使用NORC的AmeriSpeak小组对15至44岁的女性进行了全国代表性的在线调查。我们描述受访者是否觉得他们有足够的信息避孕决策和所需的信息类型。我们调查了具有足够信息的感知和关键应答者特征之间的双变量关联。我们使用逻辑回归来调查过去的性健康和生殖健康（SRH）护理和避孕自我效能感是否与感觉自己有足够的信息有关。结果：在分析样本（未加权n = 3037）中，73.5%的人认为自己有足够的信息来决定避孕，11.8%的人没有，14.7%的人不确定。那些认为自己没有获得足够信息的人（未加权n = 687）最需要的是有关副作用的信息（33.4%）。在双变量分析中，年轻、男同性恋/女同性恋、受教育程度较低、没有保险的受访者不太可能觉得自己掌握了足够的信息。回归分析表明，感觉自己有足够的信息与过去的高质量生殖健康护理经验和避孕自我效能之间呈正相关。含义和结论：我们的数据表明，在那些认为自己有足够信息来做出避孕决定的人身上存在不平等。获得足够信息的感觉与护理质量和未来获得避孕措施的能力有关。本文支持认识信息的重要性，作为一个关键部分，以人为本的避孕获取。

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引用次数: 0

Adolescent and Young Adult Perspectives on Contraception Post-Dobbs: “The Next Closest Step to Having Control Over My Own Body” 青少年和年轻人对避孕的看法后多布斯：“下一个最接近控制自己身体的步骤”。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.001

Lauryn King PhD, MPP , Julia Strasser DrPH, MPH , Sara Luckenbill MPH , Ellen Schenk MPP , Danielle Tsevat MD, MSCR , Julie Maslowsky PhD

Purpose

Adolescents and young adults (AYAs) face unique barriers to contraceptive care that may be exacerbated by the June 2022 Dobbs v. Jackson Women's Health Organization decision that removed federal protections for abortion rights. We examined AYA perspectives on contraception and measured changes in AYA contraceptive use pre- and post-Dobbs.

Materials and Methods

This study used a mixed-methods design. We analyzed qualitative data from the MyVoice project, an SMS-based survey among AYAs ages 14–24 in the United States. The research team analyzed open-ended responses to questions about the influence of changes to abortion access on AYA contraceptive decision making. We analyzed quantitative data from the IQVIA Longitudinal Pharmacy and Medical Claims data for patients ages 15–26. We identified monthly new contraceptive prescriptions and services for intrauterine device insertion and implant placement in 2021 and 2022. We used segmented regression analyses to test for changes in prescriptions and services post-Dobbs.

Main Findings

Our qualitative analysis identified themes of risk aversion, urgency and fear, and access concerns in response to the Dobbs decision. Our quantitative analysis demonstrated a slight increase in both prescriptions and services in the months immediately after Dobbs, but there were no significant changes in the slope for monthly services post-Dobbs for any age group or method type. We also identified an overall decreasing trend for all age groups and all method types during the full study period of January 2021–December 2022.

Conclusions

Limited changes in contraceptive use despite AYA expressions of fear, feelings of lost agency, and concerns over access may reflect continued (or worsened) barriers to contraceptive access post-Dobbs.

目的：青少年和年轻人（AYAs）在避孕护理方面面临着独特的障碍，这种障碍可能会因2022年6月多布斯诉杰克逊妇女健康组织的决定而加剧，该决定取消了联邦对堕胎权的保护。我们研究了阿雅对避孕的看法，并测量了阿雅避孕药使用前后的变化。材料与方法：本研究采用混合方法设计。我们分析了来自MyVoice项目的定性数据，这是一项针对美国14-24岁青少年的短信调查。研究小组分析了对堕胎途径变化对AYA避孕决策影响的问题的开放式回答。我们分析了IQVIA纵向药房和医疗索赔数据中15-26岁患者的定量数据。我们确定了2021年和2022年每月新的避孕处方和宫内节育器插入和植入放置服务。我们使用分段回归分析来检验多布斯后处方和服务的变化。主要发现：我们的定性分析确定了风险规避、紧迫性和恐惧以及对多布斯决定的访问关注等主题。我们的定量分析表明，在多布斯之后的几个月里，处方和服务都有轻微的增加，但在多布斯之后，任何年龄组或方法类型的每月服务斜率都没有显著变化。我们还发现，在2021年1月至2022年12月的整个研究期间，所有年龄组和所有方法类型的总体下降趋势。结论：尽管AYA表达了恐惧、丧失能动性的感觉和对获取的担忧，但避孕药具使用的有限变化可能反映了多布斯事件后避孕药具获取的持续（或恶化）障碍。

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引用次数: 0

Patient Language and Differences in Administration of Analgesia for Pelvic Pain 盆腔疼痛患者语言及镇痛给药差异。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.05.006

Tierney Wolgemuth MD , Annie Gauf MD , Denise Monti MD, MPH , Dhara Amin MD , Julia Geynisman-Tan MD

Objectives

Patient-provider language discordance is known to impact medical care; however, whether patient language is associated with differences in analgesia administration has not been well studied. This study aimed to evaluate the association between patients’ primary language and analgesia administration among women seeking emergency care for acute pelvic and abdominal pain.

Study Design

We conducted a retrospective cohort study to assess the association between patient language and differences in administration of analgesic medications to non-pregnant adult women presenting to the emergency department (ED) with a primary diagnosis of abdominal or pelvic pain. The primary outcome was the receipt of any analgesic medication. Secondary outcomes were receipt of opioid medications, receipt of intravenous analgesia, and association between diagnosis and receipt of analgesia.

Results

Among 817 patients, 427 spoke English and 390 spoke another primary language. More than half (53.7%) were given some form of pain medication, with 211 (25.8%) receiving an opioid and 228 (27.9%) receiving only non-opioids. On bivariate analysis, there is no difference between whether any analgesic was administered between those with and without English as their primary language (52.9% and 54.6%, respectively, p = .65). However, those who spoke English as a primary language were more likely to receive an opioid analgesic (53.1% vs. 42.7%, p = .038). Among individuals who received at least one analgesic, those with English as a primary language had an adjusted odds ratio [95% confidence interval] of 1.49 [1.02, 2.20], p = .04, for receipt of an opioid when adjusted for highest pain score. Patients with abdominal pain were more likely to receive any analgesic (55.6% vs. 45.0%, p = .049) and more likely to receive opioid pain medication compared with those with pelvic pain (52.4% vs. 22.1%, p < .001).

Conclusions

Abdominal and pelvic pain in women may be undertreated in the ED setting, particularly among those for whom English is not the primary language and those presenting with the primary diagnosis of pelvic pain.

目的：已知医患语言失调会影响医疗；然而，患者语言是否与镇痛给药的差异有关还没有得到很好的研究。本研究旨在评估因急性盆腔和腹部疼痛寻求急诊护理的女性患者的主要语言与镇痛给药之间的关系。研究设计：我们进行了一项回顾性队列研究，以评估初诊为腹部或盆腔疼痛的未怀孕成年急诊科（ED）女性患者语言与镇痛药物给药差异之间的关系。主要结局是接受任何镇痛药物。次要结局是接受阿片类药物治疗、接受静脉镇痛以及诊断与接受镇痛之间的关系。结果：817例患者中，427例说英语，390例说其他主要语言。超过一半（53.7%）的患者接受了某种形式的止痛药治疗，其中211人（25.8%）接受了阿片类药物治疗，228人（27.9%）只接受了非阿片类药物治疗。在双变量分析中，以英语和非英语为主要语言的患者是否使用止痛剂没有差异（分别为52.9%和54.6%,p = 0.65）。然而，那些以英语为主要语言的人更有可能接受阿片类镇痛药（53.1%比42.7%,p = 0.038）。在接受至少一种镇痛药的个体中，以英语为主要语言的个体在接受阿片类药物时，调整后的优势比[95%置信区间]为1.49 [1.02,2.20],p = 0.04。与盆腔疼痛患者相比，腹痛患者更有可能接受任何止痛药（55.6%比45.0%,p = 0.049），更有可能接受阿片类止痛药（52.4%比22.1%,p < 0.001）。结论：女性腹部和盆腔疼痛在急诊科可能没有得到充分的治疗，特别是那些英语不是主要语言的患者和那些以盆腔疼痛为主要诊断的患者。

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引用次数: 0

Promoting Improved Access to Tailored Hormonal Contraceptive Regimens for Menstrual Suppression 促进更好地使用定制的激素避孕方案来抑制月经。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.02.009

Beth Sundstrom PhD, MPH , Angela Dempsey MD, MPH

引用次数: 0