Journal of women's health
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Journal of women's health · Jul 2019
Pregnancy Prevention on the Fly: An Exploratory Study of Contraceptive Lapse Among Young Women Traveling Internationally.
Background: International travel is increasingly popular, and women comprise half of all outbound travel from the United States (almost 46 million trips in 2017). The implications of international travel for women's reproductive health are not fully clear due to lack of data on travelers' contraceptive use. Methods: Women attending a U. S. university (n = 340) completed a cross-sectional survey in 2016-2017 about their sexual and reproductive health during recent international travel. ⋯ Multivariable correlates of lapse were the following: using the pill (PR 4.51, 95% confidence interval [CI] 2.57-7.94) compared to other or no contraception; trip duration of >30 days versus 1-7 days (PR 2.02, 95% CI 1.14-3.57); having trouble communicating with a male partner about contraception (PR 1.79, 95% CI 1.16-2.75); a high perceived impact of language barriers (PR 1.77, 95% CI 1.02-3.08); and perceiving local access to abortion as difficult (PR 1.67, 95% CI 1.22-2.27). There was a trend toward increased lapse prevalence among participants who had difficulty maintaining their contraceptive schedule while traveling across time zones (PR 1.38, 95% CI 1.00-1.91). Conclusions: During international travel, prevalence of contraceptive lapse varied by young women's chosen contraceptive method as well as travel-specific factors. Pretravel counseling by clinicians can help women anticipate contraceptive challenges and reduce the likelihood of unintended pregnancy.
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Journal of women's health · Jul 2019
Overview of Centers for Disease Control and Prevention's Case Investigation of Cervical Cancer Study.
Background: Despite advances in cervical cancer screening, a significant number of women in the United States have not received adequate screening. Studies have suggested that approximately half of the women who developed cervical cancer were not adequately screened. The Centers for Disease Control and Prevention (CDC) Case Investigation of Cervical Cancer (CICC) Study took a unique approach to reconstruct the time before a woman's cervical cancer diagnosis and understand the facilitators and barriers to screening and care. ⋯ Of these, 1,730 participants were eligible for participation, 28% (n = 481) enrolled in the study and 23% (n = 400) consented to the medical chart abstraction. Conclusion: The CICC Study is unique in that it addresses, with medical record verification, the medical history of woman 5 years before their cervical cancer diagnosis as well as provides information from the woman on her health care behaviors. This study provides data on a general population of cervical cancer survivors in three states that could be used to guide interventions to increase cervical cancer screening.
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Journal of women's health · Jul 2019
Endogenous Sex Hormones and Endothelial Function in Postmenopausal Women and Men: The Multi-Ethnic Study of Atherosclerosis.
Background: The relationship of endogenous sex hormones (SH) with vascular endothelial function and with cardiovascular disease (CVD) is incompletely understood. We examined the associations between SH and endothelial function measured by brachial artery flow-mediated dilation (FMD). Materials and Methods: We included 1368 postmenopausal women and 1707 men, free of clinical CVD, participating in MESA Visit 1 (2000-2002). ⋯ Conclusions: A more androgenic SH profile of higher free testosterone and lower SHBG was associated with worse %FMD in postmenopausal women. Changes in SH with aging and menopause may result in vascular changes in women. Further studies are needed to assess longitudinal changes in SH levels and their association with vascular function.
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Journal of women's health · Jul 2019
The Impact of CenteringPregnancy Group Prenatal Care on Birth Outcomes in Medicaid Eligible Women.
Background: CenteringPregnancy group prenatal care (GPNC) has been shown to reduce rates of preterm birth (PTB). We evaluated the impact of GPNC on spontaneous PTB (sPTB) as a first step in exploring the possible mechanism by which GPNC may decrease rates of PTB. We also evaluated whether attending more than five GPNC sessions affected PTB risk and examined all differences by race/ethnicity. ⋯ Conclusion: Participation in GPNC demonstrated a decreased risk for sPTB, as well as other adverse birth outcomes. In addition, participation in more than five GPNC sessions demonstrated a decreased risk for adverse birth outcomes. Prospective longitudinal studies are needed to further explore mechanisms associated with these findings.
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Journal of women's health · Jul 2019
Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women.
Background: Because cost may be a barrier to receiving mammography screening, cost sharing for "in-network" screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act. We examined prevalence of out-of-pocket payments for screening mammography after elimination in many plans. Materials and Methods: Using 2015 National Health Interview Survey data, we examined whether women aged 50-74 years who had screening mammography within the previous year (n = 3,278) reported paying any cost for mammograms. Logistic regression models stratified by age (50-64 and 65-74 years) examined out-of-pocket payment by demographics and insurance (ages 50-64 years: private, Medicaid, other, and uninsured; ages 65-74 years: private ± Medicare, Medicare+Medicaid, Medicare Advantage, Medicare only, and other). Results: Of women aged 50-64 years, 23.5% reported payment, including 39.1% of uninsured women. ⋯ For women aged 65-74 years, 11.9% reported payment, including 22.5% of Medicare-only beneficiaries. Compared with private ± Medicare beneficiaries, payment was less likely for Medicare+Medicaid beneficiaries (adjusted OR 0.21 [95% CI 0.06-0.73]) and more likely for Medicare-only beneficiaries (1.83 [1.01-3.32]) (p = 0.005 across groups). Conclusions: Although most women reported no payment for their most recent screening mammogram in 2015, some payment was reported by >20% of women aged 50-64 years or aged 65-74 years with Medicare only, and by almost 40% of uninsured women aged 50-64 years. Efforts are needed to understand why many women in some groups report paying out of pocket for mammograms and whether this impacts screening use.