Womens Health Issues最新文献_第8页

Military Exposures and Early Menopause: Findings From the Gulf War Era Cohort Study (GWECS) 军事暴露和早期绝经：来自海湾战争时期队列研究（GWECS）的发现。

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

Womens Health Issues

Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.05.001

Carolyn J. Gibson PhD, MPH , Guichan Cao MS , Sabra Inslicht PhD , Allison D. Altman PhD , Caitlin E. Haas BS, BA , Aaron Schneiderman PhD, MPH, RN , Erin Dursa PhD, MPH

Objective

Traumatic and environmental exposures during military service may affect reproductive health and ovarian aging, putting women veterans at risk for early menopause. We examined relationships between military exposures and possible early menopause among women 1990–1991 Gulf War veterans.

Methods

This is a longitudinal analysis of data from the Gulf War Era Cohort Study. Women Gulf War veterans who completed baseline (1995) and follow-up assessments (2012) and were aged ≤45 at follow-up were included. Military exposures (Gulf War deployment, military environmental exposures [MEEs], Gulf War Illness, military sexual trauma [MST]) and posttraumatic stress disorder (PTSD) were assessed at baseline. Participants were categorized as having possible early menopause if in response to follow-up survey questions about menstruation they indicated menopause or having no periods for 1 year. Associations among military exposures, PTSD, and possible early menopause were examined with logistic regression models.

Results

The analytic sample included 668 women veterans. Among Gulf War–deployed veterans (n = 384), 63% reported MEEs and 26% reported MST during deployment. Within the total sample, 57% met criteria for Gulf War Illness, and 23% met criteria for probable PTSD. At follow-up, 15% had possible early menopause. In adjusted analyses, Gulf War Illness (odds ratio [OR] 1.83; 95% confidence interval [CI] [1.14, 2.95]) and probable PTSD (OR 2.45; 95% CI [1.54, 3.90]) were significantly associated with possible early menopause.

Conclusion

Women veterans may be vulnerable to early menopause (under age 45), which brings additional care considerations for health promotion and symptom management. Menopause care in the Department of Veterans Affairs should include consideration of PTSD and comorbid chronic conditions such as Gulf War Illness, key veteran-centric clinical correlates that may influence the onset and experience of menopause.

目的：服役期间的创伤和环境暴露可能影响生殖健康和卵巢老化，使女性退伍军人面临提前绝经的风险。我们研究了1990-1991年海湾战争女性退伍军人的军事暴露与可能的提前绝经之间的关系。方法：这是对海湾战争时期队列研究数据的纵向分析。女性海湾战争退伍军人完成基线（1995年）和随访评估（2012年），随访时年龄≤45岁。军事暴露（海湾战争部署、军事环境暴露[MEEs]、海湾战争疾病、军事性创伤[MST]）和创伤后应激障碍（PTSD）在基线时进行评估。如果参与者在回答关于月经的后续调查问题时表示更年期或1年内没有月经，他们就被归类为可能提前绝经。用logistic回归模型检验了军事暴露、创伤后应激障碍和可能的早期绝经之间的关系。结果：分析样本包括668名女性退伍军人。在海湾战争中服役的退伍军人（n = 384）中，63%报告了MEEs， 26%报告了MST。在总样本中，57%符合海湾战争疾病的标准，23%符合可能的创伤后应激障碍的标准。在随访中，15%的人可能提前绝经。在校正分析中，海湾战争病(优势比[OR] 1.83；95%可信区间[CI][1.14, 2.95])和可能的PTSD (OR 2.45；95% CI[1.54, 3.90])与可能的提前绝经显著相关。结论：45岁以下的女性退伍军人可能容易出现提前绝经，这需要在健康促进和症状管理方面进行额外的护理。退伍军人事务部的更年期护理应包括考虑创伤后应激障碍和合并症慢性疾病，如海湾战争病，这些以退伍军人为中心的关键临床相关因素可能会影响更年期的发生和经历。

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引用次数: 0

Perceived Infertility and Contraceptive Use Among Reproductive-Aged Women in Ohio 俄亥俄州育龄妇女的不孕症和避孕药具使用。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.007

Kayla M. Alvis MS, PhD , Jess Keesee MD , Marta Bornstein MPH, PhD , Abigail Norris Turner PhD , Meredith Pensak MD, MPH , Priya R. Gursahaney MD, MS

Objective

This study examines the association between sociodemographic factors and perceived infertility, as well as between perceived infertility, contraceptive use, and contraceptive method type.

Study Design

We analyzed the Ohio Survey of Women baseline data collected in 2018–2019 (N = 2,568). Using logistic regression, we assessed the association between sociodemographic characteristics and perceived infertility. We then used multivariate logistic regression and multinomial regression to estimate the association between perceived infertility and any contraceptive use and contraception method type (long-acting reversible, hormonal short-acting reversible, and coital-dependent methods).

Results

Age, race, marital status, household income, and prior pregnancies were associated significantly with odds of perceived infertility. Of those who said they were not at all likely to be infertile, 73% reported using any contraception compared to 63% of those who said they were somewhat to very likely to be infertile. In multivariable analyses, those who reported perceived infertility had 31% lower odds of using contraception than those who did not (adjusted odds ratio = 0.7; 95% confidence interval [0.5, 1.0]). Those with perceived infertility had twice the odds of using no contraception than using long-acting reversible methods compared with those without perceived infertility.

Conclusions

Reproductive-aged women in Ohio who perceive they may have difficulty becoming pregnant or be infertile have lower odds of using contraception, particularly long-acting reversible methods, compared with those who do not perceive they may be infertile. Improved education on infertility may be warranted to support individuals, particularly in groups with higher odds of perceived infertility, in making informed choices about contraception.

目的：本研究探讨了社会人口学因素与不孕症之间的关系，以及不孕症、避孕药使用和避孕方法类型之间的关系。研究设计：我们分析了2018-2019年收集的俄亥俄州妇女基线调查数据（N = 2568）。使用逻辑回归，我们评估了社会人口学特征与感知不孕症之间的关系。然后，我们使用多元逻辑回归和多项回归来估计感知不孕症与任何避孕使用和避孕方法类型（长效可逆、激素短效可逆和性交依赖方法）之间的关联。结果：年龄、种族、婚姻状况、家庭收入和怀孕史与不孕症发生率显著相关。在那些说自己完全不可能不孕的人中，73%的人说自己采取了避孕措施，相比之下，63%的人说自己有点或很可能会不孕。在多变量分析中，那些认为自己不孕的人使用避孕措施的几率比那些没有使用避孕措施的人低31%(校正优势比= 0.7；95%置信区间[0.5,1.0])。与那些没有察觉到不孕症的人相比，那些觉察到不孕症的人不采取避孕措施的几率是使用长效可逆方法的两倍。结论：在俄亥俄州，认为自己可能难以怀孕或不孕的育龄妇女使用避孕措施的几率较低，特别是长效可逆方法，与那些不认为自己可能不孕的妇女相比。加强对不孕不育的教育可能是有必要的，以支持个人，特别是在认为不孕不育的可能性较高的群体中，对避孕作出知情的选择。

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引用次数: 0

Contraception Coverage Policy in the United States: History and Current Challenges 美国避孕覆盖政策：历史和当前的挑战。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.03.002

Carol S. Weisman PhD , Diana Velott MPA, MS , Amy Zheng MD , Sarah Horvath MD, MSHP , Douglas Leslie PhD , Cynthia H. Chuang MD, MSc

Background

State and federal policies have aimed to expand access to contraception by providing coverage of its costs in both public and private health insurance. Yet barriers to contraception coverage remain and are expected to increase after the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization. This paper describes the history of these policies and current challenges.

Methods

We constructed a chronology of federal and state policies providing coverage of the cost of contraception in both public and private health insurance, from establishment of the federal right to contraception through 2024, using published sources and public datasets. We aligned the chronology with the history of the development of contraception technology and practices, as described by historians and social scientists, and with political and legal challenges.

Results

Following establishment of a federal right to contraception after nearly a century of restrictions under the 1873 Comstock Act, three waves of contraception coverage policymaking sought to increase access to contraception by making it more affordable to consumers. These waves included options for states to expand coverage for contraception within the Medicaid program; passage of state contraception coverage equity laws to ensure parity for contraceptive coverage in private health plans; and the Affordable Care Act's national contraceptive coverage requirement and its subsequent modifications, clarifications, and codifications. Post-Dobbs, challenges to contraception coverage include efforts to redefine certain contraceptives as abortifacients and to resurrect some of the restrictions of the Comstock Act. The requirement of no-cost coverage of preventive services is also threatened.

Conclusion

Contraception coverage policy will be impacted by ongoing challenges to contraception and abortion access, as well as changing contraceptive technology and modes of delivery.

背景：州和联邦政策旨在通过在公共和私人健康保险中提供避孕费用的覆盖范围来扩大获得避孕的机会。然而，避孕覆盖的障碍仍然存在，预计在2022年美国最高法院对多布斯诉杰克逊妇女健康组织一案作出裁决后，这种障碍将会增加。本文描述了这些政策的历史和当前的挑战。方法：我们使用公开的来源和公共数据集，构建了从联邦避孕权建立到2024年，联邦和州在公共和私人健康保险中提供避孕费用覆盖的政策年表。按照历史学家和社会科学家的描述，我们将避孕技术和实践的发展史与政治和法律挑战结合起来。结果：在1873年《科姆斯托克法案》（Comstock Act）的限制下，经过近一个世纪的限制，联邦政府确立了避孕权，此后，三次避孕覆盖政策制定浪潮试图通过让消费者更负担得起避孕措施来增加避孕机会。这些浪潮包括各州在医疗补助计划中扩大避孕覆盖范围的选择；通过国家避孕保险公平法，以确保私人健康计划中避孕保险的平等；以及《平价医疗法案》的全国避孕覆盖要求及其随后的修改、澄清和编纂。多布斯案之后，对避孕措施覆盖范围的挑战包括努力将某些避孕措施重新定义为堕胎药，并恢复《科姆斯托克法案》的一些限制。免费提供预防服务的要求也受到威胁。结论：避孕覆盖政策将受到避孕和流产获取面临的持续挑战以及避孕技术和分娩方式的变化的影响。

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引用次数: 0

Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals 商业保险生育个体自付保险费用与心理治疗使用的关系。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.003

Stephanie V. Hall PhD, MPH , Andrea Pangori MS , Anca Tilea MPH , Kara Zivin PhD, MS, MA, MFA , Anna Courant MFA, MSN, RN, CPNP-PC , Amy Schroeder MA , A. Mark Fendrick MD , Vanessa K. Dalton MD, MPH

Background

Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.

Objectives

In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.

Methods

This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.

Results

The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).

Discussion

Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.

背景：围产期情绪和焦虑障碍（PMADs）是常见的、负担沉重的、昂贵的妊娠并发症，但很少有人得到治疗。自付费用（OOPCs）可能是PMAD治疗的重大障碍。目的：在有活产记录的商业保险参保人群中，我们试图确定OOPCs高于中位数的商业保险计划是否比OOPCs低于中位数的商业保险计划有更低的心理治疗使用率和数量，以及使用率是否因收入或心理健康状况而异。方法：本系列横断面研究使用Optum的去识别Clinformatics®数据集市数据库（2016-2020）。我们使用逻辑回归来检验预测心理治疗使用的关联。我们的样本包括来自38,512个保险计划的199,022名参保者的219,043名独特出生。我们将所有参保者的oopc分为低或高、收入低于联邦贫困线的400%或等于或高于联邦贫困线的400%，以及声称是否患有PMAD。结果：心理治疗的OOPC中位数从2016年的49美元上升到2020年的54美元。低OOPC计划的参与者使用心理治疗的可能性是高OOPC计划参与者的1.12倍，95%可信区间[1.10,1.15]。无论OOPC水平如何，低收入的ppmad患者接受心理治疗的次数相同（低OOPC计划和高OOPC计划分别为5次）。按OOPC计划水平划分，高收入参选者参加心理治疗的次数更多（低OOPC计划参选者7次，高OOPC计划参选者6次）。讨论：在高收入入组者中，较高的OOPC与较低的心理治疗使用率相关，而低收入入组者无论OOPC水平如何，都较少使用心理治疗。减少或取消pads的费用分摊可以改善获取和增强公平性。

{"title":"Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals","authors":"Stephanie V. Hall PhD, MPH , Andrea Pangori MS , Anca Tilea MPH , Kara Zivin PhD, MS, MA, MFA , Anna Courant MFA, MSN, RN, CPNP-PC , Amy Schroeder MA , A. Mark Fendrick MD , Vanessa K. Dalton MD, MPH","doi":"10.1016/j.whi.2025.02.003","DOIUrl":"10.1016/j.whi.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.</div></div><div><h3>Objectives</h3><div>In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.</div></div><div><h3>Methods</h3><div>This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.</div></div><div><h3>Results</h3><div>The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).</div></div><div><h3>Discussion</h3><div>Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 143-150"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693946","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

The State of VA-funded Women Veterans’ Health Systems Research 弗吉尼亚州资助的女性退伍军人健康系统研究。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.006

Amanda E. Borsky DrPH, MPP , Aimee Kroll-Desrosiers PhD , Adriana Rodriguez PhD , Karissa Fenwick PhD, MSW , Jessica K. Friedman PhD, MPH, MSc , Elizabeth M. Yano PhD, MSPH

Background

Women veterans are the fastest-growing population of new users within the Department of Veterans Affairs (VA) health care delivery system. This paper aims to characterize the scope of women's health research funded by VA Health Systems Research (HSR) over the past 10 years.

Methods

Ten years of data (2014–2023) were obtained from a VA financial database that captures research projects that started on or after January 1, 2014. Projects were coded for topical areas and study types.

Results

VA HSR funded 91 women's health studies over the past 10 years. The number of active projects grew from 7 in 2014 to 50 in 2023, with a parallel increase in total funding amount for women's health-focused research projects (nearly $570,000 in 2014 and $8.1 M in 2023). Descriptive or epidemiological studies were the most prominent study type (55% of active projects) and there was a steady increase in intervention and implementation studies. The most common topics were mental health and/or substance use (22% of projects), followed by reproductive health (13%), access/rural health (13%), other chronic conditions (12%), violence and trauma exposure (10%), primary care and prevention (8%), pain (7%), other (5%), comorbidities (3%), post-deployment health (3%), aging and long-term care (2%), and cancer (2%).

Conclusions

Overall, our findings indicate that HSR funding for studies focused on women veterans' health has grown over the last decade, and those studies have diversified in topics and types of study designs. As a learning health system, VA can use these findings to prioritize its future women's health research funding to meet the health needs of women veterans.

背景：女性退伍军人是退伍军人事务部（VA）卫生保健服务系统中增长最快的新用户群体。本文旨在描述过去10年由VA卫生系统研究（HSR）资助的妇女健康研究的范围。方法：从VA财务数据库中获取10年（2014-2023）的数据，该数据库捕获了2014年1月1日或之后开始的研究项目。项目按照主题领域和研究类型进行编码。结果：VA HSR在过去10年中资助了91项妇女健康研究。活跃项目的数量从2014年的7个增加到2023年的50个，以妇女健康为重点的研究项目的资助总额也相应增加（2014年近57万美元，2023年810万美元）。描述性或流行病学研究是最主要的研究类型（占活跃项目的55%），干预和实施研究稳步增加。最常见的主题是精神健康和/或药物使用（占项目的22%），其次是生殖健康（13%）、可及性/农村健康（13%）、其他慢性病（12%）、暴力和创伤暴露（10%）、初级保健和预防（8%）、疼痛（7%）、其他（5%）、合并症（3%）、部署后健康（3%）、老龄化和长期护理（2%）以及癌症（2%）。结论：总体而言，我们的研究结果表明，在过去十年中，高铁对女性退伍军人健康研究的资助有所增加，这些研究的主题和研究设计类型也有所多样化。作为一个学习型健康系统，VA可以利用这些发现来优先考虑其未来的女性健康研究资金，以满足女性退伍军人的健康需求。

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引用次数: 0

Financial, Social, and Demographic Factors Associated With Obtaining an Abortion: A Longitudinal Study in Indiana in 2021–2022 与堕胎相关的经济、社会和人口因素：印第安纳州2021-2022年的一项纵向研究

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.03.001

Alexandra Wollum PhD, MPH , Bria Goode MPH , Caitlin McKenna , Megan Jeyifo , Lizz Perkins , Meg Sasse Stern , Qudsiyyah Shariyf , Tracey A. Wilkinson MD, MPH , Heidi Moseson PhD, MPH

Objectives

We aimed to 1) characterize those who did and did not obtain an abortion and reasons why, and 2) evaluate the association between various facilitators, including financial and social support, and accessing an abortion.

Methods

Between June 2021 and April 2022, we recruited pregnant Indiana residents considering abortion through online posts, abortion funds, and abortion clinics. Respondents completed an online baseline survey and a follow-up survey 1 month later. Surveys collected information on sociodemographic characteristics, barriers and facilitators to abortion, and pregnancy outcome.

Results

Among 221 participants, 77% obtained an abortion within 1 month. Among online and abortion fund recruits, those who identified as Black or African American or Hispanic/Latinx and those without insurance were less likely to have had an abortion than were white and insured participants. Financial support from abortion funds and clinics and social support from peer networks were associated with higher odds of accessing abortion care 1 month later. Among participants still seeking abortion at 1 month or who had given birth, 64% reported that needing to gather money to pay for the abortion or travel expenses/lodging was a barrier to care. Among those who were no longer considering abortion at 1 month and planned to continue their pregnancy, 28% reported doing so because they did not have the money for an abortion.

Conclusions

In a restrictive state policy environment, receipt of financial and social support was associated with greater likelihood of obtaining abortion within a month of reporting considering or seeking it among a sample of pregnant people in Indiana.

目的：我们的目的是1)描述那些有和没有堕胎的人及其原因，2)评估各种促进因素之间的关系，包括经济和社会支持，以及获得堕胎。方法：在2021年6月至2022年4月期间，我们通过在线帖子、堕胎基金和堕胎诊所招募考虑堕胎的印第安纳州怀孕居民。受访者完成了在线基线调查和1个月后的随访调查。调查收集了有关社会人口特征、流产障碍和促进因素以及妊娠结局的信息。结果：221例患者中，77%在1个月内流产。在网上和堕胎基金的参与者中，那些被认定为黑人或非裔美国人或西班牙裔/拉丁裔以及没有保险的人比白人和有保险的参与者更不可能堕胎。来自堕胎基金和诊所的财政支持以及来自同伴网络的社会支持与1个月后获得堕胎护理的几率较高相关。在1个月后仍在寻求堕胎或已经分娩的参与者中，64%的人报告说需要筹集资金支付堕胎或旅行费用/住宿是护理的障碍。在那些在1个月时不再考虑堕胎并计划继续怀孕的人中，28%的人报告说他们这样做是因为他们没有钱堕胎。结论：在限制性的州政策环境中，在印第安纳州的孕妇样本中，接受经济和社会支持与在报告考虑或寻求堕胎的一个月内获得堕胎的可能性较大有关。

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引用次数: 0

Markers of Maternal Morbidity: Research Recommendations for Severe Perineal Lacerations, Severe Maternal Morbidity, and Other Complications 产妇发病率的标志：严重会阴撕裂伤、严重产妇发病率和其他并发症的研究建议。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.005

Suzan L. Carmichael PhD, MS , Peiyi Kan MS , Jonathan M. Snowden PhD

引用次数: 0

Title X Provider Experiences With and Perceptions of Contraception Guidelines Implementation in Georgia: A Qualitative Study 标题X：格鲁吉亚避孕指南实施的提供者经验和看法：一项定性研究。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.004

Sophia C. Garbarino MPH , Elizabeth Reisinger Walker PhD, MPH, MAT , Melissa J. Kottke MD, MPH, MBA , Hayat Mekonen BSPH , Jessica M. Sales PhD

Objectives

Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.

Study Design

From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.

Results

The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.

Conclusions

This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.

目标：乔治亚州第十项法案网站每年为超过16万名患者提供服务，提供关键的避孕药具。美国医疗资格标准和避孕使用选择实践建议（美国MEC SPR）旨在增加避孕的可及性，但很少有研究探索美国MEC SPR的实施。本定性研究旨在了解乔治亚州标题X提供者对美国MEC SPR实施的经验和态度。研究设计：从2023年3月到2023年12月，我们对20名乔治亚州标题X提供者进行了半结构化访谈。参与者还完成了一项简短的人口调查。转录本首先在谷歌Sheets中使用快速分析技术进行评估，然后在Dedoose中使用主题分析方法进行更彻底的分析。我们使用SAS计算人口统计学描述性统计。结果：样本在种族上存在差异，但在性别上没有差异；所有参与者都被认定为顺性别女性。采访显示，大多数参与者都是在医学院或护理学校了解到这些指导方针的。使用美国MEC SPR的显著好处包括促进患者避孕教育和建立提供者对其处方技能的信心。唯一报告的挑战是美国MEC的用户友好性有限，以及关于某些医疗条件的信息有限。参与者对临床领导优先使用美国MEC SPR有不同的经历，但报告了类似的患者护理障碍。结论：本研究表明，美国MEC SPR可以帮助标题X提供者为寻求避孕的客户提供服务，但广泛实施的障碍仍然存在。增加指南使用的努力应考虑提供者的需求和偏好以及影响患者获得避孕护理的因素。

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引用次数: 0

Sex Differences in Suicide, Lethal Means, and Years of Potential Life Lost Among Veterans With Substance Use Disorder 有药物使用障碍的退伍军人在自杀、致命手段和潜在生命损失年数方面的性别差异。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.002

Amar D. Mandavia MA, PhD , Anne N. Banducci PhD , Tracy L. Simpson PhD , Brian P. Marx PhD , Sage E. Hawn PhD , Justeen Hyde PhD , Victoria E. Ameral PhD , Rebecca E. Sistad Hall PhD , Clara E. Roth BA , Alexis A. Sarpong MPH , Michael Davenport MA , Frank Meng PhD , Michael D. Stein MD , Nicholas A. Livingston PhD

Background

Veterans with substance use disorders (SUDs) are at elevated risk of dying by suicide. We examined sex and age differences in rates and means of suicide death among veterans with alcohol (AUD) and/or opioid use disorder (OUD) diagnoses.

Methods

We studied a cohort of veterans with AUD and/or OUD diagnoses who received Veterans Health Administration care and died of any cause between January 2016 and December 2020. We assessed the risk of suicide death and lethal means by sex, age, and their interaction.

Results

Among veterans with AUD and/or OUD, 119,693 died of any cause during the study period. Suicides represented 4.5% of all deaths (n = 5,419), with women being 2.25 times (95% confidence interval [CI], 1.97–2.55) more likely to die by suicide than men and dying at significantly younger ages than men. Suicide deaths accounted for 21.28 and 32.25 years of potential life lost for men (mean age, 52.92 ± 14.81 years) and women (mean age, 47.65 ± 11.52 years), respectively. Intentional poisoning was the most common means of suicide death for both men and women. Women were 2.08 times (95% CI, 1.61–2.71) more likely to die by poisoning-related suicide than men. Men were 1.73 times (95% CI, 1.13–2.77) more likely to die by firearms-related suicide than women.

Conclusion

Among veterans diagnosed with AUD and/or OUD, women were more likely to die by suicide, at a younger age, than men. Poisoning was the primary means of suicide death for men and women. These national-level data highlight the urgency of suicide risk assessment and prevention among women veterans with substance use disorder.

背景：患有物质使用障碍（sud）的退伍军人死于自杀的风险较高。我们检查了患有酒精（AUD）和/或阿片类药物使用障碍（OUD）诊断的退伍军人自杀死亡率和方式的性别和年龄差异。方法：我们研究了一组在2016年1月至2020年12月期间接受退伍军人健康管理局护理并因任何原因死亡的AUD和/或OUD诊断的退伍军人。我们根据性别、年龄及其相互作用评估自杀死亡和致死方式的风险。结果：在患有AUD和/或OUD的退伍军人中，研究期间有119,693人死于任何原因。自杀占所有死亡人数的4.5% (n = 5,419)，其中女性死于自杀的可能性是男性的2.25倍（95%置信区间[CI]， 1.97-2.55），且死亡年龄明显低于男性。自杀死亡分别占男性（平均年龄52.92±14.81岁）和女性（平均年龄47.65±11.52岁）潜在寿命损失的21.28年和32.25年。对男性和女性来说，故意中毒是最常见的自杀死亡方式。女性死于中毒相关自杀的可能性是男性的2.08倍（95% CI, 1.61-2.71）。男性死于枪支相关自杀的可能性是女性的1.73倍（95% CI, 1.13-2.77）。结论：在诊断为AUD和/或OUD的退伍军人中，女性比男性更容易在年轻时自杀。中毒是男性和女性自杀死亡的主要手段。这些国家级的数据强调了对有药物使用障碍的女退伍军人进行自杀风险评估和预防的紧迫性。

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引用次数: 0

Assessing the Provision of Person-Centered Contraceptive Care at Publicly Supported Clinics Providing Contraceptive Services in the United States 评估在美国提供避孕服务的公共支持诊所提供以人为本的避孕护理。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.03.003

Jennifer Mueller MPH, Priscille Osias BA, Madeleine Haas BA, Alicia VandeVusse PhD

Introduction

We sought to understand the extent to which the contraceptive care provided at publicly supported family planning clinics in the United States aligns with aspects of person-centered care.

Materials and Methods

We conducted a descriptive study with a national sample of U.S. family planning clinics between November 2022 and December 2023. We measured person-centeredness by the scope of services offered, including the extent to which providers solicit and prioritize patients’ contraceptive intentions, preferences, and goals; the dispensing protocols for various contraceptive methods; and the availability of social services such as intimate partner violence screening and housing insecurity support. We fielded an online survey to a sample of 2,146 clinics, and our analytic sample was 422 clinics.

Results

Our results highlight that most publicly supported family planning clinics provide contraception using counseling protocols that support patient-centeredness, such as assessing patients’ contraceptive preferences during contraceptive counseling. However, we found statistically significant variation by clinic type within many of these measures, with a higher proportion of Planned Parenthood clinics following patient-centered protocols than other clinic types, particularly federally qualified health centers and community health centers.

Conclusions

Publicly supported family planning clinics provide contraception using some person-centered care protocols, although there is room for improvement. Furthermore, person-centered practices vary by clinic type. More research should be done with patients to assess additional elements of person-centered contraceptive care.

前言：我们试图了解在美国公共支持的计划生育诊所提供的避孕护理在多大程度上符合以人为本的护理。材料和方法：我们在2022年11月至2023年12月期间对美国计划生育诊所的全国样本进行了描述性研究。我们通过提供的服务范围来衡量以人为本，包括提供者征求和优先考虑患者避孕意图、偏好和目标的程度；各种避孕方法的配药方案；以及亲密伴侣暴力筛查和住房不安全支持等社会服务的可获得性。我们对2146家诊所进行了在线调查，分析样本为422家诊所。结果：我们的研究结果强调，大多数公开支持的计划生育诊所使用支持以患者为中心的咨询协议提供避孕，例如在避孕咨询期间评估患者的避孕偏好。然而，我们发现，在许多这些措施中，不同诊所类型的统计差异显著，计划生育诊所遵循以患者为中心的协议的比例高于其他诊所类型，特别是联邦合格的健康中心和社区健康中心。结论：公共支持的计划生育诊所使用一些以人为本的护理方案提供避孕，尽管仍有改进的余地。此外，以人为本的做法因诊所类型而异。应该对患者进行更多的研究，以评估以人为本的避孕护理的其他要素。

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引用次数: 0