Womens Health Issues最新文献

{"title":"Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis","authors":"Martha Grace Cromeens JD, PhD, RN ,&nbsp;Kathleen Knafl PhD, FAAN ,&nbsp;Whitney R. Robinson PhD, MSPH ,&nbsp;Erin T. Carey MD, MSCR ,&nbsp;Zakiya Haji-Noor PhD, MPH ,&nbsp;Suzanne Thoyre PhD, RN, FAAN","doi":"10.1016/j.whi.2023.11.008","DOIUrl":"10.1016/j.whi.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p>Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal.</p></div><div><h3>Methods</h3><p>We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts’ rationales regarding endometriosis-related issues of appeal.</p></div><div><h3>Results</h3><p>Eighty-seven appeals addressed an endometriosis-related issue. Three themes—evidence, treatment, and time—were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants’ needs and preferences.</p></div><div><h3>Conclusions</h3><p>Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 221-231"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991498","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}

{"title":"Facilitators and Barriers to Breastfeeding Among Veterans Using Veterans Affairs Maternity Care Benefits","authors":"Jill Inderstrodt PhD, MPH ,&nbsp;Krysttel C. Stryczek MA ,&nbsp;Sara E. Vargas PhD ,&nbsp;Jennifer N. Crawford PhD ,&nbsp;Taylor Hooker MS, CTRS, NBC-HWC ,&nbsp;Aimee R. Kroll-Desrosiers PhD ,&nbsp;Valerie Marteeny MS ,&nbsp;Kate F. Wallace MPH ,&nbsp;Kristin Mattocks PhD, MPH","doi":"10.1016/j.whi.2023.12.005","DOIUrl":"10.1016/j.whi.2023.12.005","url":null,"abstract":"<div><h3>Introduction</h3><p><span>U.S. veterans of childbearing age represent one of the fastest growing populations using Veterans Affairs<span><span> (VA) health care. The VA does not provide </span>obstetric care<span><span><span> directly but pays for VA-enrolled veterans to obtain outside obstetric care. The VA also provides </span>maternity care coordination (MCC) services, including </span>lactation support. Breastfeeding benefits mothers and babies; however, previous research shows that veteran mothers quit </span></span></span>exclusive breastfeeding<span> earlier than the American Academy of Pediatrics<span> and World Health Organization recommendation of 6 months. This study aimed to understand facilitators and barriers to breastfeeding among a cohort of veterans who used VA maternity care benefits.</span></span></p></div><div><h3>Methods</h3><p>Qualitative data from an open-ended question from a national sample of postpartum veterans using VA pregnancy benefits were coded using deductive and inductive content analysis within a matrix framework. Quantitative data were used to contextualize the responses.</p></div><div><h3>Results</h3><p>Four themes emerged from the data: (1) impacts on health of baby/mother; (2) the ability to breastfeed; (3) early postnatal experiences breastfeeding; and (4) cost/convenience. Among those who responded to the open-ended breastfeeding question (329/669), most participants (<em>n</em><span> = 316; 96%) attempted breastfeeding their current baby. Respondents who did not initiate breastfeeding or who discontinued breastfeeding earlier than planned cited diverse reasons. These included low milk supply, poor latch, nipple pain, mental health factors, and low confidence in their ability to continue breastfeeding. Participants cited the MCC program as a facilitator to breastfeeding, and non-VA hospital experiences were mentioned as barriers.</span></p></div><div><h3>Conclusion</h3><p>Veterans in this cohort of 329 veterans who responded to an open-ended breastfeeding question wanted and attempted to breastfeed; however, barriers such as lactation challenges and unsupportive health care providers made it difficult to continue the practice. As the MCC program grows to include more lactation professionals, MCCs may address barriers such as lactation challenges and unsupportive non-VA health care providers. Further program development should focus on addressing these challenges prenatally.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 309-316"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703774","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}

{"title":"Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota","authors":"Julia D. Interrante PhD, MPH ,&nbsp;Alyssa H. Fritz MPH, RD, CLC ,&nbsp;Marcia B. McCoy MPH, IBCLC ,&nbsp;Katy Backes Kozhimannil PhD, MPA","doi":"10.1016/j.whi.2023.12.001","DOIUrl":"10.1016/j.whi.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>U.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis–St. Paul metropolitan area).</p></div><div><h3>Methods</h3><p>We used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs.</p></div><div><h3>Results</h3><p>Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects.</p></div><div><h3>Conclusions</h3><p>BFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 232-240"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404745","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}

{"title":"Awareness of the Maternal Health Benefits of Lactation Among U.S. Pregnant Individuals","authors":"Caidon Iwuagwu BS ,&nbsp;Melissa J. Chen MD, MPH ,&nbsp;Adrienne E. Hoyt-Austin DO, MAS ,&nbsp;Laura Kair MD, MAS ,&nbsp;Margaret Fix MPH ,&nbsp;Eleanor Bimla Schwarz MD, MS","doi":"10.1016/j.whi.2023.12.004","DOIUrl":"10.1016/j.whi.2023.12.004","url":null,"abstract":"<div><h3>Introduction</h3><p>We assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions.</p></div><div><h3>Methods</h3><p>We administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions.</p></div><div><h3>Results</h3><p>Of the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37).</p></div><div><h3>Conclusions</h3><p>Efforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 283-290"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723002153/pdfft?md5=10f474006a23dffdf19d5f72e4263fa0&pid=1-s2.0-S1049386723002153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Mental Health and Substance Use With Retention in HIV Care Among Black Women in Washington, District of Columbia","authors":"Bianca Stewart MPH ,&nbsp;Morgan Byrne MPH ,&nbsp;Matthew Levy PhD ,&nbsp;Michael A. Horberg MD, MAS, FACP, FIDSA ,&nbsp;Anne K. Monroe MD, MSPH ,&nbsp;Amanda D. Castel MD, MPH, FAAP, AAHIVS","doi":"10.1016/j.whi.2023.11.003","DOIUrl":"10.1016/j.whi.2023.11.003","url":null,"abstract":"<div><h3>Background</h3><p>Black women with HIV are impacted by mental health and substance use disorders alongside barriers to care. The impact of these disorders on retention in care, a crucial step of the HIV care continuum, has not been well-studied. We examined the association between these disorders and retention in care over a 2-year period.</p></div><div><h3>Methods</h3><p>Data from January 1, 2011, to June 30, 2019, were obtained from the DC Cohort, an observational HIV study in Washington, District of Columbia. We examined the associations between mental health (i.e., mood-related or trauma-related) or substance use disorders, separately, on not being retained in HIV care over a 2-year interval post-enrollment among non-Hispanic Black women with HIV. Multivariate logistic regression with adjusted odds ratios (aORs) for sociodemographic and clinical variables was used to quantify the association of 1) having a confirmed mental health or substance use disorder and 2) not being retained in care.</p></div><div><h3>Results</h3><p>Among the 2,181 women in this analysis, 690 (31.64%) were not retained in care. The prevalence of a mood-related disorder (39.84%) was higher compared with a substance use (16.19%) or trauma-related disorder (7.75%). Age per a 10-year increase (aOR 0.87; confidence interval [CI] 0.80, 0.94) and a mood-related disorder diagnosis (aOR 0.72; CI: 0.59, 0.88) were inversely associated with not being retained in care.</p></div><div><h3>Conclusion</h3><p>Mood-related disorders were prevalent among Black women with HIV in Washington, District of Columbia, but were not associated with worse retention in care. Future studies should examine key facilitators for Black women with HIV and coexisting mood-related disorders and how they impact retention in care.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 250-256"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111292","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}

{"title":"Posttraumatic Stress Disorder, Military Sexual Trauma, and Birth Experiences at the Veterans Health Administration","authors":"Katherine Musacchio Schafer PhD ,&nbsp;Kate F. Wallace MPH ,&nbsp;Aimee Kroll-Desrosiers PhD ,&nbsp;Kristin Mattocks PhD, MPH","doi":"10.1016/j.whi.2023.11.006","DOIUrl":"10.1016/j.whi.2023.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Women are a growing portion of the U.S. veteran population, and every year the Veterans Health Administration<span><span> (VHA) serves an increasing number of women seeking obstetrics services. Women veterans experience elevated rates of anxiety, depression, </span>posttraumatic stress disorder<span> (PTSD), and traumatic events, including military sexual trauma, as compared with women in the general population. It is possible that mental health disorders<span> may be associated with birth experiences.</span></span></span></p></div><div><h3>Objectives</h3><p>We investigated the link between anxiety, depression, PTSD, and military sexual trauma (MST; i.e., rape and sexual harassment) with perceived birth experience (i.e., Negative or Neutral vs. Positive).</p></div><div><h3>Methods</h3><p><span>Participants included 1,005 veterans who had recently given birth and were enrolled in the multisite, mixed methods study known as the Center for Maternal and Infant Outcomes Research in Translation study (COMFORT). Using χ</span>² tests, we investigated the relationship between mental health conditions including anxiety, depression, and PTSD and MST with birth experience (coded as Negative/Neutral vs. Positive).</p></div><div><h3>Results</h3><p>Findings indicated that participants who endorsed PTSD (39.5%), MST-rape (32.1%), or MST-harassment (51.4%; all <em>p</em> &lt; .05) were significantly more likely to report a Negative/Neutral birth experience (14.7%) versus a Positive birth experience (85.3%). Anxiety and depression were not associated with birth experience.</p></div><div><h3>Conclusions</h3><p><span>Veterans with PTSD and/or who experienced MST were more likely to report a negative or neutral birth experience. Thus, screening for PTSD and MST during obstetrics services as well as providing trauma-informed </span>obstetrics care during pregnancy, labor, birth, and recovery may be important among veterans seeking obstetric services.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 303-308"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832351","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}

{"title":"Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study","authors":"Rebecca B. Perkins MD, MSc ,&nbsp;Lindsay Fuzzell PhD ,&nbsp;Paige Lake MPH ,&nbsp;Naomi C. Brownstein PhD ,&nbsp;Holly B. Fontenot WHNP, PhD ,&nbsp;Alexandra Michel PhD ,&nbsp;Ashley Whitmer MPH, CPH ,&nbsp;Susan T. Vadaparampil PhD, MPH","doi":"10.1016/j.whi.2024.01.001","DOIUrl":"10.1016/j.whi.2024.01.001","url":null,"abstract":"<div><h3>Introduction</h3><p>National guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30–65 years.</p></div><div><h3>Methods</h3><p>We explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening.</p></div><div><h3>Results</h3><p>A national sample of clinicians (<em>N</em> = 1,251) completed surveys; a subset (<em>n</em> = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30–65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged &lt;40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician–gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records.</p></div><div><h3>Conclusions</h3><p>Most clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 257-267"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933582","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}

{"title":"Risk of Iron Deficiency in Women With Endometriosis: A Population-Based Prospective Cohort Study","authors":"Dereje G. Gete PhD ,&nbsp;Jenny Doust PhD ,&nbsp;Sally Mortlock PhD ,&nbsp;Grant Montgomery PhD ,&nbsp;Gita D. Mishra PhD","doi":"10.1016/j.whi.2024.03.004","DOIUrl":"10.1016/j.whi.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Endometriosis may be linked to the risk of iron deficiency through chronic systemic inflammation or heavy menstrual bleeding. No longitudinal studies, however, have examined the relationship between endometriosis and the risk of iron deficiency.</p></div><div><h3>Methods</h3><p>This study included 3,294 participants born from 1973 to 1978 and followed as part of the Australian Longitudinal Study on Women's Health from 2000 to 2018. Participants with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. During each survey, participants were also asked to report the diagnosis of iron deficiency, and we validated diagnoses using an administrative health database. Generalized estimating equations for binary responses with an autoregressive correlation matrix were used to examine the association between endometriosis and the risk of iron deficiency over the seven time points.</p></div><div><h3>Findings</h3><p>We found that women with endometriosis had a significantly higher risk of iron deficiency than those without endometriosis after adjusting for sociodemographic, lifestyle, reproductive, and nutrition factors (adjusted odds ratio [aOR] = 1.46; 95% confidence interval [CI] [1.29, 1.66]; <em>p</em> &lt; .0001). Women with a surgically confirmed diagnosis and those with clinically suspected endometriosis had a higher risk of iron deficiency (aOR = 1.38; 95% CI [1.17, 1.64] and aOR = 1.53; 95% CI [1.30, 1.81]), respectively. These associations, however, were slightly attenuated (by 8%) when adjusted for the presence of heavy menstrual bleeding.</p></div><div><h3>Conclusions</h3><p>Women with endometriosis are at a higher risk of developing iron deficiency than those without endometriosis. The findings suggest that iron deficiency should be concomitantly addressed during initial diagnosis and successive management of endometriosis.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 317-324"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000240/pdfft?md5=e4a06c474840fc1b45ea91d2b87256f6&pid=1-s2.0-S1049386724000240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternity Care Deserts in Louisiana and Breastfeeding Initiation","authors":"Chanell O. Haley PhD ,&nbsp;Lily E. King MPH ,&nbsp;Lauren Dyer MPH ,&nbsp;Melissa G. Evans PhD ,&nbsp;Katherine P. Theall PhD ,&nbsp;Maeve Wallace PhD","doi":"10.1016/j.whi.2023.11.010","DOIUrl":"10.1016/j.whi.2023.11.010","url":null,"abstract":"<div><h3>Background</h3><p>Breastfeeding provides physical, psychological, and immunological benefits to both the mother and infant, but breastfeeding rates are suboptimal. The purpose of this study was to examine whether residing in a maternity care desert (a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with lower breastfeeding rates among birthing people in Louisiana from 2019 to 2020.</p></div><div><h3>Methods</h3><p>Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all live births provided by the Louisiana Office of Vital Records (<em>n</em> = 112,151), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory geospatial analysis to examine the association between place of residence and breastfeeding initiation and racial disparities in initiation. We conducted a secondary within-group analysis by fitting the fully adjusted model stratified by race/ethnicity for non-Hispanic white and non-Hispanic Black birthing people.</p></div><div><h3>Results</h3><p>We found that residing in a parish with limited (odds ratio [OR] = 0.87; 95% confidence interval [CI] [0.77, 0.99]) to no access (OR = 0.88; 95% CI [0.80, 0.97]) was significantly associated with lower breastfeeding initiation rates. The within-group analysis determined that both non-Hispanic Black and non-Hispanic white birthing people residing in a parish with limited or no maternity care access had lower breastfeeding initiation rates.</p></div><div><h3>Conclusion</h3><p>Reducing rural and racial inequities in breastfeeding may require structural changes and investments in infrastructure to deliver pregnancy care.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 276-282"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723002116/pdfft?md5=7556f0e6ec68386cf136ee1e8581717b&pid=1-s2.0-S1049386723002116-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+)","authors":"Gail E. Wyatt PhD ,&nbsp;Enricka Norwood-Scott BA ,&nbsp;Michele Cooley-Strickland PhD ,&nbsp;Muyu Zhang MA ,&nbsp;Amber Smith-Clapham MA ,&nbsp;Wilbert Jordan MD ,&nbsp;Honghu Liu PhD ,&nbsp;Alison B. Hamilton PhD, MPH","doi":"10.1016/j.whi.2023.11.001","DOIUrl":"10.1016/j.whi.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>African American women are disproportionately at risk for HIV infection<span>. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV.</span></p></div><div><h3>Methods</h3><p>Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (<em>n</em> = 47) and post-implementation (<em>n</em><span><span> = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) </span>symptoms<span><span>, substance use, sexual risk behaviors, health care–related discrimination, and social support. In a process evaluation, a subset of women completed </span>qualitative interviews at baseline (</span></span><em>n</em> = 35) and post-implementation (<em>n</em> = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention.</p></div><div><h3>Results</h3><p>Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (<em>p</em> &lt; .01) and in a typical week (<em>p</em> &lt; .05); reduced PTS symptoms (<em>p</em> &lt; .05); increased HIV knowledge (<em>p</em> &lt; .0001) and awareness of PrEP (<em>p</em> &lt; .001); and greater consideration of using PrEP (<em>p</em> &lt; .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained.</p></div><div><h3>Conclusions</h3><p>The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 241-249"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547416","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}