Womens Health Issues最新文献_第6页

Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+) 提高城市非裔美国妇女对暴露前预防的准备程度：妇女接触前预防强化计划试点研究》（WP3+）。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-05-01 DOI: 10.1016/j.whi.2023.11.001

Gail E. Wyatt PhD , Enricka Norwood-Scott BA , Michele Cooley-Strickland PhD , Muyu Zhang MA , Amber Smith-Clapham MA , Wilbert Jordan MD , Honghu Liu PhD , Alison B. Hamilton PhD, MPH

Background

African American women are disproportionately at risk for HIV infection. 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.

Methods

Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care–related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 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.

Results

Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p < .01) and in a typical week (p < .05); reduced PTS symptoms (p < .05); increased HIV knowledge (p < .0001) and awareness of PrEP (p < .001); and greater consideration of using PrEP (p < .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.

Conclusions

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.

背景：非裔美国妇女感染艾滋病毒的风险过高。为了提高女性考虑采取暴露前预防措施（PrEP）的意愿，我们开展了一项名为 "PrEP Plus 女性准备"（WP3+）的试点研究。WP3+ 改编自一项针对非裔美国夫妇的循证 HIV 风险降低干预措施，WP3+ 是一项针对未感染 HIV 的非裔美国女性设计的基于文化的团体项目：对妇女进行资格筛查；如果符合条件，则邀请她们参加为期四节课的 WP3+ 小组。参与者完成了基线调查（47 人）和实施后调查（28 人）；调查内容包括人口统计学、HIV 和 PrEP 知识、抑郁和创伤后应激 (PTS) 症状、药物使用、性风险行为、医疗相关歧视以及社会支持。在过程评估中，一部分妇女分别在基线（35 人）和实施后（18 人）完成了定性访谈；访谈的目的是与定量测量（如 HIV 和 PrEP 知识）相一致，并扩展定量测量（如 WP3+ 未测量的感知影响）。为了与定量数据进行三角测量，演绎定性分析主要集中在妇女对 PrEP 和 HIV 的知识和认识、她们的关系动态和挑战，以及与采取 PrEP 相关的考虑因素（如障碍、促进因素）；归纳分析主要集中在妇女在干预中的经历：结果：WP3+ 干预方案的参与者报告称：在过去 90 天内使用安全套的比例有所提高（PWP3+ 试点研究表明，作为一项针对非裔美国妇女的艾滋病预防计划，WP3+ 具有初步的有效性和可接受性。需要进行对照试验，以确认其对提高非裔美国妇女使用 PrEP 的有效性。

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引用次数: 0

Using Administrative Claims Data to Address Maternal Health Disparities: Benefits, Pitfalls, and Methodological Solutions 利用行政索赔数据解决孕产妇健康差异问题：益处、陷阱和方法论解决方案。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-05-01 DOI: 10.1016/j.whi.2024.04.002

Sara E. Heins PhD , Toyya A. Pujol PhD

引用次数: 0

Communication Preferences During Pregnancy Care Among Patients With Primary Spanish Language: A Scoping Review 母语为西班牙语的患者在孕期护理期间的沟通偏好：范围界定综述。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.08.008

Luis Rivera MD , Haylie Butler BA , Kevin E. Salinas MD , Carrie Wade MLIS , Maria Bazan MD, MPH , Elysia Larson ScD, MPH , Rose L. Molina MD, MPH

Background

Qualified language service providers (QLSPs)—professional interpreters or multilingual clinicians certified to provide care in another language—are critical to ensuring meaningful language access for patients. Designing patient-centered systems for language access could improve quality of pregnancy care.

Objective

We synthesized and identified gaps in knowledge about communication preferences during pregnancy care among patients with Spanish primary language.

Methods

We performed a scoping review of original research studies published between 2000 and 2022 that assessed communication preferences in Spanish-speaking populations during pregnancy care. Studies underwent title, abstract, and full-text review by three investigators. Data were extracted for synthesis and thematic analysis.

Results

We retrieved 1,539 studies. After title/abstract screening, 36 studies underwent full-text review, and 13 of them met inclusion criteria. Two additional studies were included after reference tracing. This yielded a total of 15 studies comprising qualitative (n = 7), quantitative (n = 4), and mixed-methods (n = 4) studies. Three communication preference themes were identified: language access through QLSPs (n = 7); interpersonal dynamics and perceptions of quality of care (n = 9); and information provision and shared decision-making (n = 8). Although seven studies reported a strong patient preference to receive prenatal care from Spanish-speaking clinicians, none of the included studies assessed clinician Spanish language proficiency or QLSP categorization.

Conclusions

Few studies have assessed communication preferences during pregnancy care among patients with primary Spanish language. Future studies to improve communication during pregnancy care for patients with primary Spanish language require intentional analysis of their communication preferences, including precision regarding language proficiency among clinicians.

背景：合格的语言服务提供商（QLSP）-专业口译员或多语言临床医生，经认证可以用另一种语言提供护理，这对于确保患者有意义地使用语言至关重要。设计以患者为中心的语言访问系统可以提高妊娠护理的质量。目的：我们综合并确定了西班牙语母语患者在孕期护理期间沟通偏好方面的知识差距。方法：我们对2000年至2022年间发表的原始研究进行了范围界定审查，这些研究评估了西班牙语人群在孕期护理期间的沟通偏好。三名研究人员对研究进行了标题、摘要和全文审查。提取数据进行综合和专题分析。结果：我们检索了1539项研究。在标题/摘要筛选后，36项研究进行了全文审查，其中13项符合纳入标准。参考文献追踪后纳入了另外两项研究。这一共产生了15项研究，包括定性研究（n=7）、定量研究（n=4）和混合方法研究（n=4）。确定了三个交流偏好主题：通过QLSP获得语言（n=7）；人际动态和对护理质量的感知（n=9）；以及信息提供和共同决策（n=8）。尽管有七项研究报告称，患者强烈倾向于接受西班牙语临床医生的产前护理，但没有一项纳入的研究评估临床医生的西班牙语水平或QLSP分类。结论：很少有研究评估母语为西班牙语的患者在孕期护理期间的沟通偏好。未来改善原发西班牙语患者妊娠期沟通护理的研究需要有意分析他们的沟通偏好，包括临床医生对语言熟练度的准确性。

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引用次数: 0

Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice 乳房再造中的财务毒性考虑因素：研究与实践建议》。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2024.01.005

Hannah Kinzer MPH , Clara N. Lee MD, MPP , Krista Cooksey BA , Terence Myckatyn MD , Margaret A. Olsen PhD, MPH , Randi Foraker PhD, MA, FAHA, FAMIA, FACMI , Anna Rose Johnson MD, MPH , Mary C. Politi PhD

引用次数: 0

Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence 亲密伴侣暴力女性幸存者的头部伤害、勒颈、心脏代谢健康和功能障碍之间的关系。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.11.002

Michelle M. Pebole PhD, MA , Katherine M. Iverson PhD , Catherine B. Fortier PhD , Kimberly B. Werner PhD , Jennifer R. Fonda PhD, MA , Alyssa Currao MPH , James W. Whitworth PhD , Regina E. McGlinchey PhD , Tara E. Galovski PhD

Objective

Head injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV.

Methods

Participants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1).

Results

Head injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06–.13; ds: 0.51–1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R² = 0.37, p < .01) and several of its associated domains: cognition (R² = 0.34, F(8,42) = 2.73, p = .01), mobility (R² = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R² = 0.33, F(8,42) = 2.59, p = .02).

Conclusions

Findings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.

目的：在亲密伴侣暴力（IPV）的情况下，头部受伤和勒死的情况非常普遍，但很少有研究探讨这些伤害对身体健康和功能状态的潜在影响。这项试验性研究探讨了伤害类型（头部伤害、勒颈）和严重程度（无伤害、亚撞击性头部伤害、创伤性脑损伤；无勒颈、勒颈、意识丧失的勒颈）与 IPV 女性幸存者的心脏代谢健康生物标志物和自我报告的功能相关程度：方法：51 名出生时即被指定为女性的幸存者在其一生中经历过 IPV，并在 DSM-5 的创伤后应激障碍核对表中筛查出可能患有创伤后应激障碍（PTSD）（平均年龄 = 32.6 岁，SD = 7.1）：结果：头部受伤与血糖水平的上升有显著的统计学关系（p = .01，d = 1.10）。高密度脂蛋白、低密度脂蛋白和腰臀比（PS：.06-.13；DS：0.51-1.30）也向更高风险值转变，其效应大小为中强。绞窄与胆固醇水平升高有关，影响程度适中（P = 0.20，D = 0.59）。考虑到年龄、教育程度、创伤后应激障碍症状、童年创伤、勒死和头部损伤的回归模型可预测功能性残疾状况（R2 = 0.37，P 2 = 0.34，F(8,42) = 2.73，P = .01）和行动能力（R2 = 0.47，F(8,42) = 4.82，P 2 = 0.33，F(8,42) = 2.59，P = .02）：研究结果表明，有必要针对有头部损伤史的 IPV 女性幸存者的身体健康合并症开发综合治疗方法，以改善其日常功能和生活质量。

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引用次数: 0

Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade 罗伊诉韦德案被推翻前在州外接受治疗的美国堕胎患者的特征。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.10.003

Sarah M. Axelson MSW , Riley J. Steiner PhD, MPH , Rachel K. Jones PhD

Context

In light of the Dobbs v. Jackson Women's Health Organization decision overturning Roe v. Wade, the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access.

Methods

We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state.

Results

Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61–0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20–0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33–0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29–2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15–0.47).

Conclusion

Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.

背景：鉴于多布斯诉杰克逊妇女健康组织案（Dobbs v. Jackson Women's Health Organization）的判决推翻了罗伊诉韦德案（Roe v. Wade），随着多个州实施堕胎禁令，需要到州外堕胎的人数正在增加。更好地了解在该判决之前在州外堕胎的患者的特征，可为今后的研究提供参考，并为改善堕胎途径提供依据：我们使用古特马赫研究所（Guttmacher Institute）管理的 2014 年堕胎患者调查数据，研究了在居住州外进行非医院堕胎的患者的患病率和特征。我们研究了所选特征与在州外进行人工流产之间的双变量和多变量关联：结果：6%的人工流产患者前往州外接受治疗。在州外堕胎的患者中，一半以上（56.9%）为非西班牙裔（NH）白人，26.6%为非西班牙裔黑人，10.2%为西班牙裔。五分之二（43.9%）居住在南方，三分之一（34.3%）居住在中西部，15%居住在东北部，7%居住在西部。超过三分之一（38.2%）的人家庭收入低于联邦贫困线（FPL）的 100%，三分之二（67.7%）的人自掏腰包，只有 3% 的人使用医疗补助。除年龄外，州外人工流产患者与州内人工流产患者的所有特征均有所不同。在调整后的分析中，与新罕布什尔州的白人患者相比，新罕布什尔州的黑人（调整后的几率比 [AOR]：0.76；95% 置信区间 [CI]：0.61-0.96）、新罕布什尔州的亚裔、南亚和亚太岛民（AOR：0.37；95% CI：0.20-0.67）以及西班牙裔（AOR：0.46；95% CI：0.33-0.64）患者出州旅行的几率较低。与使用私人保险支付人工流产费用的患者相比，自费患者出州旅行的几率更高（AOR：1.75；95% CI：1.29-2.37），而使用医疗补助支付的患者出州旅行的几率较低（AOR：0.27；95% CI：0.15-0.47）：鉴于观察到的种族/民族差异和堕胎付款方式的不同，随着越来越多的州禁止堕胎，有色人种和没有自费资源的人群可能会特别受益于支持通过州际旅行获得堕胎护理的努力。

{"title":"Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade","authors":"Sarah M. Axelson MSW , Riley J. Steiner PhD, MPH , Rachel K. Jones PhD","doi":"10.1016/j.whi.2023.10.003","DOIUrl":"10.1016/j.whi.2023.10.003","url":null,"abstract":"<div><h3>Context</h3><p>In light of the <span><em>Dobbs v. Jackson </em><span>Women's Health</span><em> Organization</em></span> decision overturning <em>Roe v. Wade,</em> the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access.</p></div><div><h3>Methods</h3><p>We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state.</p></div><div><h3>Results</h3><p>Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61–0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20–0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33–0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29–2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15–0.47).</p></div><div><h3>Conclusion</h3><p>Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 142-147"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812278","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

Early Childcare Precarity and Subsequent Maternal Health 早期儿童保育不稳定和随后的孕产妇健康。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.10.002

Carol Duh-Leong MD, MPP , Caitlin F. Canfield PhD , Anne E. Fuller MD, MS , Rachel S. Gross MD, MS , Nancy E. Reichman PhD

Purpose

We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.

Study Design

We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.

Results

Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11–2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23–2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13–2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22–2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B −0.45; 95% CI, −0.80 to −0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.

Conclusion

Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

目的:我们研究了早期儿童保育不稳定性或儿童保育安排的安全性和可靠性与随后的孕产妇健康之间的潜在关联。研究设计:我们对2,836名儿童母亲的调查反馈进行了二次分析，这些母亲参与了“家庭与儿童健康的未来”研究。我们评估了以下托儿措施:不安全托儿、不安全托儿与缺勤、不充分的托儿和紧急托儿支持。我们使用具有稳健标准误差的线性和逻辑回归模型来检验这些指标在儿童3岁时与儿童9岁后的母亲健康结果(整体健康、抑郁和养育压力)之间的关联。然后，我们检查了1岁和3岁儿童保育措施的附加经验对孕产妇健康结果的影响。结果:早期托儿不足增加了后来产妇整体健康状况不佳的几率(调整优势比[aOR]， 1.64;95%可信区间[CI]， 1.11-2.41)。所有早期儿童保育不稳定措施都增加了母亲抑郁的几率(儿童保育不安全[aOR, 1.64;95% ci, 1.23-2.18];不安全托儿与缺勤[aOR, 1.58];95% ci, 1.13-2.22];儿童保育不足[aOR, 1.75;95% ci, 1.22-2.51])。紧急托儿支持降低了孕产妇不良健康结局的几率(整体健康状况差[aOR, 0.65;95% CI, 0.48 ~ 0.88];抑郁[aOR, 0.73;95% CI, 0.54 ~ 0.99];父母压力[B -0.45];95% CI， -0.80 ~ -0.10])。与短时间体验相比，长时间体验与孕产妇健康有更强的关联。结论:早期托儿不稳定与孕产妇健康存在长期不良关联，紧急托儿支持似乎有利于孕产妇健康。对研究人员、临床医生和决策者来说，这些发现突出了儿童保育不稳定是妇女健康的一个社会决定因素。

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引用次数: 0

Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes 佐治亚州医疗补助计划生育豁免对妊娠特征和分娩结果的影响。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.11.004

Gery P. Guy Jr. PhD, MPH , E. Kathleen Adams PhD, MS , Sara K. Redd PhD, MSPH , Anne L. Dunlop MD, MPH

Introduction

Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes.

Materials and Methods

We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008–2009) and two post-periods (2012–2013; 2017–2019). We identified those likely eligible for P4HB in Georgia (n = 1,967) and 10 comparison states (n = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling.

Results

P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (p < .01) and an 11.4 pp decrease in the later post-period (p < .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (p < .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (p < .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (−3.9 pp; p < .05) but not for mothers of other races/ethnicities.

Discussion

Medicaid family planning waivers are an important structural policy intervention that can improve reproductive health care, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.

导言：医疗补助（Medicaid）计划生育减免计划可以增加获得医疗保健服务的机会，并与降低意外怀孕率有关，而意外怀孕与早产和低出生体重等不良出生结果的高风险有关。本研究的目的是测试佐治亚州医疗补助计划生育减免计划 "健康婴儿计划（P4HB）"对妊娠特征和出生结果的影响：我们使用了妊娠风险评估监测系统（PRAMS）在前期（2008-2009 年）和后期（2012-2013 年；2017-2019 年）的调查数据。我们在佐治亚州（n = 1,967）和 10 个对比州（n = 13,449）确定了可能符合 P4HB 条件的人群，并使用州和年份固定效应差分模型检验了效果：结果：P4HB 与紧随其后的意外怀孕率下降 13.3 个百分点（pp）有关（p 讨论）：医疗补助"（Medicaid）计划生育豁免是一项重要的结构性政策干预措施，可以改善生殖保健，尤其是在没有扩大 "医疗补助 "的州。这些豁免也有助于解决长期存在的种族/民族在获得生殖健康护理方面的差异，以及潜在的不良妊娠和分娩结果。然而，使用避孕药具的人群中怀孕人数的初步增加表明，必须注意确保受助人能够获得有效的避孕方法，并接受关于有效使用的咨询，以避免随着越来越多的人尝试避孕而产生意外后果。

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引用次数: 0

“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers "我没想到会问这个问题"：大学生健康中心对人工流产转介请求的回应。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.12.003

Priyanka Anand MD , Licia Bravo BS , Sarah Gutman MD, MSPH , Arden McAllister MPH , Shimrit Keddem PhD , Sarita Sonalkar MD, MPH

Background

Women 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers.

Procedures

We conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral.

Main Findings

A total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance; coercion; misleading language; questioning the caller's autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies.

Conclusions

Abortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.

背景：在所有年龄组中，18-24 岁女性意外怀孕的比例最高，因此是需要人工流产服务的重要人群。先前的研究表明，只有一半的大学生健康中心提供适当的人工流产转介服务。我们的目标是更好地了解大学生健康中心的转诊经验和人工流产转诊的障碍：2017 年 6 月至 2018 年 4 月期间，我们在宾夕法尼亚州的所有四年制大学开展了一项 "秘密来电 "研究，使用结构化脚本要求进行人工流产转介。我们对通话进行了转录，使用迭代开发的编码手册进行编码，并分析了与人工流产转介的障碍和促进因素相关的主题：共审查了 202 份完整的记录誊本。出现的主题包括对人工流产转介的了解、经验和舒适度；支持、同情和保证；胁迫；误导性语言；质疑来电者的自主权；以及反对转介的机构政策。大多数工作人员对人工流产转介缺乏了解，也不熟悉。虽然一些工作人员对来电者表示支持，但其他工作人员则使用胁迫性语言试图劝阻来电者不要堕胎。许多工作人员援引了反对堕胎转介的宗教机构政策，并表达了对此类政策的不同感受：学生健康中心的堕胎转介缺乏一致性。工作人员经常不具备提供适当人工流产转介所需的知识，在回应转介请求时使用胁迫性语言，并使人工流产污名化永久化。一些保健工作人员使用胁迫性或回避性语言，进一步污名化了来电者的堕胎转介请求。学院保健中心应改善有关堕胎转介的培训和资源，以确保他们提供适当、高质量的护理。

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引用次数: 0

Hispanic Women's Perceptions of Neural Tube Defects and Folic Acid Supplementation: A Qualitative Study 西班牙裔女性对神经管缺陷和叶酸补充剂的认知：一项定性研究。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.08.006

Roxanne Mirabal-Beltran PhD , Katherine Monogue-Rines RN , Kylie Riva RN , Nandi Dube , Pamela Donohue ScD, MS

Introduction

In the United States, the prevalence of neural tube defects (NTDs) is higher among infants born to Hispanic women compared with those born to non-Hispanic women. The purpose of this study is to investigate perceptions of NTDs and the use of folic acid and folate as a preventive measure among Hispanic women.

Methods

Purposive sampling was used to recruit Hispanic women from a prenatal clinic in a Northeastern metropolitan city. In-depth interviews were conducted by native Spanish-speaking researchers using a semistructured interview guide. Thematic analysis was used to develop themes related to a priori domains.

Findings

The study sample consisted of 26 Hispanic women representing nine countries of origin. Four themes were revealed: dietary sources of folic acid, awareness of folic acid supplementation and fortification, preferences for receiving health information, and factors in decision-making concerning an NTD diagnosis.

Conclusions

This study highlights the importance of early and targeted educational interventions sensitive to the cultural needs of this population. Results suggest that current NTD health education efforts may not be sufficient to increase our participants’ knowledge of NTD. Additionally, the disparity may be multimodal, potentially influenced by insufficient understanding of prenatal folic acid use and the role of religiosity in decision-making during pregnancy. If Hispanic women are more likely to continue pregnancies affected by NTDs, this factor could be a part of NTD disparities. Exploring factors beyond supplementation and fortification that might influence rates of NTDs at birth in the U.S. Hispanic population can help to inform prevention efforts.

引言：在美国，西班牙裔女性所生婴儿的神经管缺陷（NTD）患病率高于非西班牙牙裔女性。本研究的目的是调查西班牙裔妇女对NTD的认知以及叶酸和叶酸作为预防措施的使用情况。方法：采用目的性抽样方法，从东北大城市的一家产前诊所招募西班牙裔妇女。以西班牙语为母语的研究人员使用半结构化的访谈指南进行深度访谈。专题分析用于开发与先验领域相关的专题。研究结果：研究样本包括来自9个原籍国的26名西班牙裔女性。揭示了四个主题：叶酸的饮食来源、叶酸补充和强化的意识、接受健康信息的偏好以及NTD诊断决策中的因素。结论：本研究强调了对这一人群的文化需求敏感的早期和有针对性的教育干预的重要性。结果表明，目前的NTD健康教育工作可能不足以增加参与者对NTD的了解。此外，这种差异可能是多模式的，可能受到对产前叶酸使用和宗教信仰在妊娠决策中的作用了解不足的影响。如果西班牙裔女性更有可能因NTD而继续怀孕，这一因素可能是NTD差异的一部分。探索补充和强化之外可能影响美国西班牙裔人口出生时NTD发病率的因素，有助于为预防工作提供信息。

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引用次数: 0