Pub Date : 2024-03-01DOI: 10.1016/j.whi.2023.12.002
Melissa E. Dichter PhD, MSW , Aneeza Z. Agha MA , Lindsey L. Monteith PhD , Lauren S. Krishnamurti PhD , Katherine M. Iverson PhD , Ann Elizabeth Montgomery PhD
Objective
Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans’ experiences with and recommendations for strengthening VCL services for women.
Method
We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants’ concerns around contacting the VCL and recommendations for strengthening the service.
Results
Interviews revealed women veterans’ concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from VCL calls, and raising awareness about and maintaining options for caller anonymity.
Conclusions
This study uniquely focused on women veterans’ experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.
{"title":"“Something Has to Be Done to Make Women Feel Safe”: Women Veterans’ Recommendations for Strengthening the Veterans Crisis Line for Women Veterans","authors":"Melissa E. Dichter PhD, MSW , Aneeza Z. Agha MA , Lindsey L. Monteith PhD , Lauren S. Krishnamurti PhD , Katherine M. Iverson PhD , Ann Elizabeth Montgomery PhD","doi":"10.1016/j.whi.2023.12.002","DOIUrl":"10.1016/j.whi.2023.12.002","url":null,"abstract":"<div><h3>Objective</h3><p>Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans’ experiences with and recommendations for strengthening VCL services for women.</p></div><div><h3>Method</h3><p>We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants’ concerns around contacting the VCL and recommendations for strengthening the service.</p></div><div><h3>Results</h3><p>Interviews revealed women veterans’ concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from VCL calls, and raising awareness about and maintaining options for caller anonymity.</p></div><div><h3>Conclusions</h3><p>This study uniquely focused on women veterans’ experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 180-185"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418296","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}
Pub Date : 2024-03-01DOI: 10.1016/j.whi.2023.10.004
Kathryn M. Curtis PhD, Aniket D. Kulkarni MBBS, MPH, Antoinette T. Nguyen MD, MPH, Lauren B. Zapata PhD, Katherine Kortsmit PhD, MPH, Ruben A. Smith PhD, Maura K. Whiteman PhD
Objective
We describe changes in commercial insurance claims for contraceptive services during the beginning of the COVID-19 pandemic.
Methods
We analyzed commercial insurance claims using IQVIA PharMetrics Plus data from more than 9 million U.S. females aged 15–49 years, enrolled during any month, January 2019 through September 2020. We calculated monthly rates of outpatient claims for intrauterine devices (IUDs), implants, and injectable contraception and monthly rates of pharmacy claims for contraceptive pills, patches, and rings. We used Joinpoint regression analysis to identify when statistically significant changes occurred in trends of monthly claims rates for each contraceptive method. We calculated monthly percentages of claims for contraceptive counseling via telehealth.
Results
Monthly claims rates decreased for IUDs (−50%) and implants (−43%) comparing February 2020 with April 2020 but rebounded by June 2020. Monthly claims rates for injectables decreased (−19%) comparing January 2019 with September 2020, and monthly claims rates for pills, patches, and rings decreased (−22%) comparing July 2019 with September 2020. The percentage of claims for contraceptive counseling occurring via telehealth was low (<1%) in 2019, increased to 34% in April 2020, and decreased to 9–12% in June–September 2020.
Conclusions
Substantial changes in commercial insurance claims for contraceptive services occurred during the beginning of the COVID-19 pandemic, including transient decreases in IUD and implant claims and increases in telehealth contraceptive counseling claims. Contraceptive claims data can be used by decision makers to identify service gaps and evaluate use of interventions like telehealth to improve contraceptive access, including during public health emergencies.
{"title":"Changes in Commercial Insurance Claims for Contraceptive Services During the Beginning of the COVID-19 Pandemic—United States, January 2019–September 2020","authors":"Kathryn M. Curtis PhD, Aniket D. Kulkarni MBBS, MPH, Antoinette T. Nguyen MD, MPH, Lauren B. Zapata PhD, Katherine Kortsmit PhD, MPH, Ruben A. Smith PhD, Maura K. Whiteman PhD","doi":"10.1016/j.whi.2023.10.004","DOIUrl":"10.1016/j.whi.2023.10.004","url":null,"abstract":"<div><h3>Objective</h3><p>We describe changes in commercial insurance claims for contraceptive services during the beginning of the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p><span><span><span>We analyzed commercial insurance claims using IQVIA PharMetrics Plus data from more than 9 million U.S. females aged 15–49 years, enrolled during any month, January 2019 through September 2020. We calculated monthly rates of outpatient claims for intrauterine devices (IUDs), implants, and </span>injectable contraception and monthly rates of pharmacy claims for </span>contraceptive pills, patches, and rings. We used Joinpoint </span>regression analysis<span> to identify when statistically significant changes occurred in trends of monthly claims rates for each contraceptive method. We calculated monthly percentages of claims for contraceptive counseling via telehealth.</span></p></div><div><h3>Results</h3><p>Monthly claims rates decreased for IUDs (−50%) and implants (−43%) comparing February 2020 with April 2020 but rebounded by June 2020. Monthly claims rates for injectables decreased (−19%) comparing January 2019 with September 2020, and monthly claims rates for pills, patches, and rings decreased (−22%) comparing July 2019 with September 2020. The percentage of claims for contraceptive counseling occurring via telehealth was low (<1%) in 2019, increased to 34% in April 2020, and decreased to 9–12% in June–September 2020.</p></div><div><h3>Conclusions</h3><p><span>Substantial changes in commercial insurance claims for contraceptive services occurred during the beginning of the COVID-19 pandemic, including transient decreases in IUD and implant claims and increases in telehealth contraceptive counseling claims. Contraceptive claims data can be used by decision makers to identify service gaps and evaluate use of interventions like telehealth to improve contraceptive access, including during </span>public health emergencies.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 186-196"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812276","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}
Pub Date : 2024-03-01DOI: 10.1016/j.whi.2023.10.005
Shelly-Ann M. Love PhD, MS , Jason M. Collins MPH , Kurtis M. Anthony MPH , Sophie F. Buchheit , Eboneé N. Butler PhD, MPH , Ganga S. Bey PhD, MPH , Rahul Gondalia PhD, MPH , Kathleen M. Hayden PhD, MA , Anthony S. Zannas MD, PhD, MSc , Alexander G. Bick MD, PhD , JoAnn E. Manson MD, DrPH, MPH , Pinkal M. Desai MD, MPH , Pradeep Natarajan MD, MMSC , Romit Bhattacharya MD , Siddhartha Jaiswal MD, PhD , Ana Barac MD, PhD , Alex Reiner MD, MSc , Charles Kooperberg PhD , James D. Stewart MA , Eric A. Whitsel MD, MPH
Background
Clonal hematopoiesis of indeterminate potential (CHIP), the expansion of leukemogenic mutations in white blood cells, has been associated with increased risk of atherosclerotic cardiovascular diseases, cancer, and mortality.
Objective
We examined the relationship between individual- and neighborhood-level socioeconomic status (SES) and CHIP and evaluated effect modification by interpersonal and intrapersonal resources.
Methods
The study population included 10,799 postmenopausal women from the Women's Health Initiative without hematologic malignancy or antineoplastic medication use. Individual- and neighborhood (Census tract)-level SES were assessed across several domains including education, income, and occupation, and a neighborhood-level SES summary z-score, which captures multiple dimensions of SES, was generated. Interpersonal and intrapersonal resources were self-reports. CHIP was ascertained based on a prespecified list of leukemogenic driver mutations. Weighted logistic regression models adjusted for covariates were used to estimate risk of CHIP as an odds ratio (OR) and 95% confidence interval (95% CI).
Results
The interval-scale neighborhood-level SES summary z-score was associated with a 3% increased risk of CHIP: OR (95% CI) = 1.03 (1.00–1.05), p = .038. Optimism significantly modified that estimate, such that among women with low/medium and high levels of optimism, the corresponding ORs (95% CIs) were 1.03 (1.02–1.04) and 0.95 (0.94–0.96), pInteraction < .001.
Conclusions
Our findings suggest that reduced risk of somatic mutation may represent a biological pathway by which optimism protects contextually advantaged but at-risk women against age-related chronic disease and highlight potential benefits of long-term, positive psychological interventions.
{"title":"Individual and Neighborhood-level Socioeconomic Status and Somatic Mutations Associated With Increased Risk of Cardiovascular Disease and Mortality: A Cross-Sectional Analysis in the Women's Health Initiative","authors":"Shelly-Ann M. Love PhD, MS , Jason M. Collins MPH , Kurtis M. Anthony MPH , Sophie F. Buchheit , Eboneé N. Butler PhD, MPH , Ganga S. Bey PhD, MPH , Rahul Gondalia PhD, MPH , Kathleen M. Hayden PhD, MA , Anthony S. Zannas MD, PhD, MSc , Alexander G. Bick MD, PhD , JoAnn E. Manson MD, DrPH, MPH , Pinkal M. Desai MD, MPH , Pradeep Natarajan MD, MMSC , Romit Bhattacharya MD , Siddhartha Jaiswal MD, PhD , Ana Barac MD, PhD , Alex Reiner MD, MSc , Charles Kooperberg PhD , James D. Stewart MA , Eric A. Whitsel MD, MPH","doi":"10.1016/j.whi.2023.10.005","DOIUrl":"10.1016/j.whi.2023.10.005","url":null,"abstract":"<div><h3>Background</h3><p>Clonal hematopoiesis<span> of indeterminate potential (CHIP), the expansion of leukemogenic mutations in white blood cells, has been associated with increased risk of atherosclerotic cardiovascular diseases, cancer, and mortality.</span></p></div><div><h3>Objective</h3><p>We examined the relationship between individual- and neighborhood-level socioeconomic status (SES) and CHIP and evaluated effect modification by interpersonal and intrapersonal resources.</p></div><div><h3>Methods</h3><p><span><span>The study population included 10,799 postmenopausal women from the </span>Women's Health<span> Initiative without hematologic malignancy<span> or antineoplastic medication use. Individual- and neighborhood (Census tract)-level SES were assessed across several domains including education, income, and occupation, and a neighborhood-level SES summary </span></span></span><em>z</em><span>-score, which captures multiple dimensions of SES, was generated. Interpersonal and intrapersonal resources were self-reports. CHIP was ascertained based on a prespecified list of leukemogenic driver mutations. Weighted logistic regression models adjusted for covariates were used to estimate risk of CHIP as an odds ratio (OR) and 95% confidence interval (95% CI).</span></p></div><div><h3>Results</h3><p>The interval-scale neighborhood-level SES summary <em>z</em>-score was associated with a 3% increased risk of CHIP: OR (95% CI) = 1.03 (1.00–1.05), <em>p</em> = .038. Optimism significantly modified that estimate, such that among women with low/medium and high levels of optimism, the corresponding ORs (95% CIs) were 1.03 (1.02–1.04) and 0.95 (0.94–0.96), <em>p</em><sub><em>Interaction</em></sub> < .001.</p></div><div><h3>Conclusions</h3><p><span>Our findings suggest that reduced risk of somatic mutation may represent a biological pathway by which optimism protects contextually advantaged but at-risk women against age-related </span>chronic disease and highlight potential benefits of long-term, positive psychological interventions.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 197-207"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812287","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}
Pub Date : 2024-03-01DOI: 10.1016/j.whi.2023.11.009
Klaira Lerma MPH , Whitney Arey PhD , Eva Strelitz-Block BA , Sacheen Nathan MD, MPH , Kari White PhD, MPH
Objectives
We assessed Mississippi abortion clients’ perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere.
Methods
We conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option.
Results
Of the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy.
Conclusions
Mississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.
{"title":"Abortion Clients’ Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi","authors":"Klaira Lerma MPH , Whitney Arey PhD , Eva Strelitz-Block BA , Sacheen Nathan MD, MPH , Kari White PhD, MPH","doi":"10.1016/j.whi.2023.11.009","DOIUrl":"10.1016/j.whi.2023.11.009","url":null,"abstract":"<div><h3>Objectives</h3><p>We assessed Mississippi abortion clients’ perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere.</p></div><div><h3>Methods</h3><p>We conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option.</p></div><div><h3>Results</h3><p>Of the 25 participants interviewed, nearly all (<em>n</em><span> = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (</span><em>n</em> = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy.</p></div><div><h3>Conclusions</h3><p>Mississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of <em>Roe v. Wade</em>.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 156-163"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049579","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}
Pub Date : 2023-12-14DOI: 10.1016/j.whi.2023.11.005
{"title":"Gibbs Leadership Prize: Best Manuscripts of 2023 in Women's Health Issues","authors":"","doi":"10.1016/j.whi.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.whi.2023.11.005","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 1-2"},"PeriodicalIF":3.2,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723002062/pdfft?md5=d78d25b19fe3e149f9065b0c377b02e1&pid=1-s2.0-S1049386723002062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138656632","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}
Pub Date : 2023-11-10DOI: 10.1016/j.whi.2023.10.001
Rebecca Wells PhD , Nicole K. Smith PhD, MPH , Maria I. Rodriguez MD
Introduction
Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients’ use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers.
Methods
This article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months’ supply for those using oral contraceptives.
Results
In 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p = .004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [p = .023] and AOR, 2.59 in 2017–2019 [p = .003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [p = .007] and AOR, 3.04 in 2017–2019 [p = .001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [p = .008] and AOR, 2.61 in 2017–2019 [p = .043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal.
Conclusions
Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time.
{"title":"Contraception Use by Title X Clients and Clients of Other Providers, 2015–2019","authors":"Rebecca Wells PhD , Nicole K. Smith PhD, MPH , Maria I. Rodriguez MD","doi":"10.1016/j.whi.2023.10.001","DOIUrl":"10.1016/j.whi.2023.10.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients’ use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers.</p></div><div><h3>Methods</h3><p>This article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months’ supply for those using oral contraceptives.</p></div><div><h3>Results</h3><p>In 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; <em>p</em> = .004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [<em>p</em> = .023] and AOR, 2.59 in 2017–2019 [<em>p</em> = .003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [<em>p</em> = .007] and AOR, 3.04 in 2017–2019 [<em>p</em> = .001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [<em>p</em> = .008] and AOR, 2.61 in 2017–2019 [<em>p</em> = .043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal.</p></div><div><h3>Conclusions</h3><p>Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 59-65"},"PeriodicalIF":3.2,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001603/pdfft?md5=bcbdb5b801070aa06efa05a2b9442def&pid=1-s2.0-S1049386723001603-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89719963","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}
Pub Date : 2023-11-07DOI: 10.1016/j.whi.2023.09.001
Emily S. Unger MD, PhD , Margaret McConnell PhD , S. Bryn Austin ScD , Meredith B. Rosenthal PhD , Madina Agénor ScD, MPH
Introduction
Sexually transmitted infection (STI) rates are rising among women in the United States, increasing the importance of routine STI testing. Beginning in 2014, some states expanded Medicaid under the Affordable Care Act, providing health coverage to most individuals in and near poverty. Here, we investigate whether Medicaid expansion changed rates of STI testing among U.S. women.
Methods
We analyzed nationally representative 2011–2017 National Survey of Family Growth data from U.S. women ages 15–44. Using difference-in-differences analysis, we assessed whether Medicaid expansion was associated with within-state changes in the prevalence of STI testing in the past 12 months, among women overall and by race/ethnicity and sexual orientation, during each year following Medicaid expansion. Models were adjusted for individual- and state-level demographic and socioeconomic factors.
Results
Our sample included 14,196 U.S. women. Medicaid expansion was associated with higher STI testing rates, which increased over time. By 3 years post-expansion, expansion states had increased STI testing by 12.7 percentage points more than nonexpansion states (95% confidence interval [CI] [2.5, 23.0], p = .016). This association was imprecisely estimated within racial/ethnic and sexual orientation subgroups, but trended strongest among white, Latina, and heterosexual women, followed by Black and bisexual women (who tested more often at baseline).
Conclusions
Medicaid expansion is associated with increased STI testing among U.S. women; these benefits grew over time but varied by both race/ethnicity and sexual orientation. State governments that fail to expand Medicaid may harm their residents’ health by allowing more spread of STIs.
{"title":"Examining the Association Between Affordable Care Act Medicaid Expansion and Sexually Transmitted Infection Testing Among U.S. Women","authors":"Emily S. Unger MD, PhD , Margaret McConnell PhD , S. Bryn Austin ScD , Meredith B. Rosenthal PhD , Madina Agénor ScD, MPH","doi":"10.1016/j.whi.2023.09.001","DOIUrl":"10.1016/j.whi.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Sexually transmitted infection (STI) rates are rising among women in the United States, increasing the importance of routine STI testing. Beginning in 2014, some states expanded Medicaid under the Affordable Care Act, providing health coverage to most individuals in and near poverty. Here, we investigate whether Medicaid expansion changed rates of STI testing among U.S. women.</p></div><div><h3>Methods</h3><p>We analyzed nationally representative 2011–2017 National Survey of Family Growth data from U.S. women ages 15–44. Using difference-in-differences analysis, we assessed whether Medicaid expansion was associated with within-state changes in the prevalence of STI testing in the past 12 months, among women overall and by race/ethnicity and sexual orientation, during each year following Medicaid expansion. Models were adjusted for individual- and state-level demographic and socioeconomic factors.</p></div><div><h3>Results</h3><p>Our sample included 14,196 U.S. women. Medicaid expansion was associated with higher STI testing rates, which increased over time. By 3 years post-expansion, expansion states had increased STI testing by 12.7 percentage points more than nonexpansion states (95% confidence interval [CI] [2.5, 23.0], <em>p</em> = .016). This association was imprecisely estimated within racial/ethnic and sexual orientation subgroups, but trended strongest among white, Latina, and heterosexual women, followed by Black and bisexual women (who tested more often at baseline).</p></div><div><h3>Conclusions</h3><p>Medicaid expansion is associated with increased STI testing among U.S. women; these benefits grew over time but varied by both race/ethnicity and sexual orientation. State governments that fail to expand Medicaid may harm their residents’ health by allowing more spread of STIs.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 14-25"},"PeriodicalIF":3.2,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001561/pdfft?md5=9141892cb00d520b040121f75b0071ad&pid=1-s2.0-S1049386723001561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72015728","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}
Pub Date : 2023-11-07DOI: 10.1016/j.whi.2023.09.002
Sabrina Karim PhD, MPH, MBBS , Jihong Liu ScD , Sara Wilcox PhD , Bo Cai PhD , Anwar T. Merchant ScD, MPH, DMD
Introduction
Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity.
Methods
Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks’ gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression).
Results
Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01–0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01–0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months.
Conclusions
Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.
{"title":"Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity","authors":"Sabrina Karim PhD, MPH, MBBS , Jihong Liu ScD , Sara Wilcox PhD , Bo Cai PhD , Anwar T. Merchant ScD, MPH, DMD","doi":"10.1016/j.whi.2023.09.002","DOIUrl":"10.1016/j.whi.2023.09.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity.</p></div><div><h3>Methods</h3><p>Data came from the Health in Pregnancy and Postpartum study (<em>N</em> = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks’ gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression).</p></div><div><h3>Results</h3><p>Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01–0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01–0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months.</p></div><div><h3>Conclusions</h3><p>Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 72-79"},"PeriodicalIF":3.2,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001573/pdfft?md5=025a25f35d47721f6abfb7eb631ec15c&pid=1-s2.0-S1049386723001573-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522982","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}
Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported.
Objective
We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3.
Study Design
In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF.
Results
A total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p < .001), indicating a 3.2 times (p = .001) and 2.5 times (p = .041) odds ratio for NEBF, respectively.
Conclusions
SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.
{"title":"Breastfeeding-related Pain, Sensory Over-responsiveness, and Exclusive Breastfeeding at 6 Months: A Prospective Cohort Study","authors":"Adi Freund-Azaria PhD , Orit Bart PhD , Rivka Regev MD , Tami Bar-Shalita PhD","doi":"10.1016/j.whi.2023.09.004","DOIUrl":"10.1016/j.whi.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported.</p></div><div><h3>Objective</h3><p>We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3.</p></div><div><h3>Study Design</h3><p>In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF.</p></div><div><h3>Results</h3><p>A total of 164 participants were reached at T3: EBF (<em>n</em> = 105) and NEBF (<em>n</em> = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; <em>p</em> = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (<em>p</em> = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (<em>p</em> < .001), indicating a 3.2 times (<em>p</em> = .001) and 2.5 times (<em>p</em> = .041) odds ratio for NEBF, respectively.</p></div><div><h3>Conclusions</h3><p>SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 80-89"},"PeriodicalIF":3.2,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001597/pdfft?md5=03a4f98a2e723bb9cd415df224dba54e&pid=1-s2.0-S1049386723001597-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522983","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}
Pub Date : 2023-11-06DOI: 10.1016/j.whi.2023.08.007
Cynthia H. Chuang MD, MSc , Carol S. Weisman PhD , Guodong Liu PhD , Sarah Horvath MD, MSHP , Diana L. Velott MPA, MS , Amy Zheng BS , Douglas L. Leslie PhD
Background
In the years immediately following the Affordable Care Act (ACA)'s contraceptive coverage requirement, out-of-pocket costs fell for all Food and Drug Administration–approved contraceptive methods and use of long-acting reversible contraception (LARC) increased. This analysis examines whether these trends have continued through 2020 for privately insured women.
Methods
Using 2006–2020 MarketScan data, we examined trends in prescription contraceptive use and out-of-pocket costs among women 13 to 49 years old. Multivariable analyses model the likelihood of contraceptive use and paying $0 post-ACA requirement (vs. pre-ACA requirement) for contraception, controlling for age group, U.S. region, urban versus rural, and cohort year.
Results
The likelihood of LARC insertion increased post-ACA requirement (adjusted odds ratio [aOR] 1.127, 95% confidence interval [CI] 1.121–1.133), with insertion rates peaking at 3.73% for intrauterine devices (IUDs) and 1.08% for implants in 2019, before declining with the onset of the COVID-19 pandemic in 2020. Although the likelihood of paying $0 for LARC increased after the ACA requirement (IUD: aOR 5.495, 95% CI 5.278–5.716; implant: aOR 7.199, 95% CI 6.992–7.412), the proportion of individuals paying $0 declined to 69% for IUDs and 73% for implants in 2020, after having peaked at 88% in 2014 and 90% in 2016, respectively. For oral contraceptives, both use (aOR 1.028, 95% CI 1.026–1.030) and paying $0 (aOR 20.399, 95% CI 20.301–20.499) increased significantly after the ACA requirement.
Conclusion
With the exception of oral contraceptives, the proportion of individuals paying $0 for all contraceptive methods declined after peaking in 2014 for IUDs, 2016 for the implant, and 2019 for non-LARC methods. Future monitoring is needed to understand the continuing impact of the ACA requirement on prescription contraceptive use and costs.
{"title":"Impact of the Affordable Care Act on Prescription Contraceptive Use and Costs Among Privately Insured Women, 2006–2020","authors":"Cynthia H. Chuang MD, MSc , Carol S. Weisman PhD , Guodong Liu PhD , Sarah Horvath MD, MSHP , Diana L. Velott MPA, MS , Amy Zheng BS , Douglas L. Leslie PhD","doi":"10.1016/j.whi.2023.08.007","DOIUrl":"10.1016/j.whi.2023.08.007","url":null,"abstract":"<div><h3>Background</h3><p>In the years immediately following the Affordable Care Act (ACA)'s contraceptive coverage requirement, out-of-pocket costs fell for all Food and Drug Administration–approved contraceptive methods and use of long-acting reversible contraception (LARC) increased. This analysis examines whether these trends have continued through 2020 for privately insured women.</p></div><div><h3>Methods</h3><p>Using 2006–2020 MarketScan data, we examined trends in prescription contraceptive use and out-of-pocket costs among women 13 to 49 years old. Multivariable analyses model the likelihood of contraceptive use and paying $0 post-ACA requirement (vs. pre-ACA requirement) for contraception, controlling for age group, U.S. region, urban versus rural, and cohort year.</p></div><div><h3>Results</h3><p>The likelihood of LARC insertion increased post-ACA requirement (adjusted odds ratio [aOR] 1.127, 95% confidence interval [CI] 1.121–1.133), with insertion rates peaking at 3.73% for intrauterine devices (IUDs) and 1.08% for implants in 2019, before declining with the onset of the COVID-19 pandemic in 2020. Although the likelihood of paying $0 for LARC increased after the ACA requirement (IUD: aOR 5.495, 95% CI 5.278–5.716; implant: aOR 7.199, 95% CI 6.992–7.412), the proportion of individuals paying $0 declined to 69% for IUDs and 73% for implants in 2020, after having peaked at 88% in 2014 and 90% in 2016, respectively. For oral contraceptives, both use (aOR 1.028, 95% CI 1.026–1.030) and paying $0 (aOR 20.399, 95% CI 20.301–20.499) increased significantly after the ACA requirement.</p></div><div><h3>Conclusion</h3><p>With the exception of oral contraceptives, the proportion of individuals paying $0 for all contraceptive methods declined after peaking in 2014 for IUDs, 2016 for the implant, and 2019 for non-LARC methods. Future monitoring is needed to understand the continuing impact of the ACA requirement on prescription contraceptive use and costs.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 7-13"},"PeriodicalIF":3.2,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001548/pdfft?md5=c4714bbdd0007bb35aa156b79de8e840&pid=1-s2.0-S1049386723001548-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522984","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}
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