Journal of women's health
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Journal of women's health · Nov 2019
Breast Screening Utilization and Cost Sharing Among Employed Insured Women Following the Affordable Care Act: Impact of Race and Income.
Introduction: We assessed changes in screening mammography cost sharing and utilization before and after the Affordable Care Act (ACA) and the revised U. S. Preventive Services Task Force (USPSTF) recommendations by race and income. Methods: We used Optum™© Clinformatics™® Data Mart deidentified patient-level analytic files between 2004 and 2014. ⋯ However, screening utilization plateaued or showed a significant decline after the 2009 USPSTF recommendation revision in all income and racial groups except for African Americans in whom screening rates continued to increase after 2009. Conclusions: Impact of ACA cost-sharing elimination did not differ among various racial and income groups. Among our population of employer-based insured women, the racial gap in screening mammography use appeared to have closed and potentially reversed among African American women. Continued monitoring of screening utilization as health care policies and recommendations evolve is required, as these changes may affect race- and income-based disparities.
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Journal of women's health · Nov 2019
Intimate Partner Violence Before and During Pregnancy, and Prenatal Counseling Among Women with a Recent Live Birth, United States, 2009-2015.
Background: Intimate partner violence (IPV) is a leading cause of injury for reproductive-aged women. Clinical guidelines exist to assist providers in counseling women for IPV, but information on provider counseling among pregnant women from population-based sources is limited. Materials and Methods: Data for 2009-2015 from 37 states and New York City participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed (n = 258,263). ⋯ Conclusion: Almost 4% of women with a recent live birth reported physical IPV before and/or during pregnancy. Only half of women received counseling on IPV during prenatal care, with counseling rates varying widely among states. Increased adherence to guidelines for universal screening and counseling of women could ensure all women are offered appropriate support and referral.
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Journal of women's health · Nov 2019
Prevalence, Correlates, and Outcomes of Co-Occurring Depression and Hypertensive Disorders of Pregnancy.
Background: Depression and hypertensive disorders of pregnancy (HDP) are common morbidities during pregnancy. However, our knowledge about the national prevalence, correlates, and outcomes of co-occurring depression and HDP remains unknown. Materials and Methods: Using a multiyear (2002-2014) nationwide inpatient sample, we conducted a population-based, cross-sectional study. Cases, behavioral and clinical covariates, and outcomes were identified using International Classification of Disease, 9th Revision, Clinical Modification Codes. ⋯ Compared to pregnant women without depression and HDP, women with depression and HDP were 3.41 times (confidence interval [95% CI]: 3.15-3.68), 1.94 times (95% CI: 1.65-2.27), and 4.10 times (95% CI: 3.89-4.32) more likely to experience intrauterine growth restriction, stillbirth, and preterm labor, respectively, even after adjusting for potential demographic, socioeconomic, and clinical confounders. Depression- and HDP-related hospitalizations resulted in an additional cost of over $5 billion during the study period. Conclusion: Depression and HDP are associated with increased risk of adverse birth outcomes and significant health care cost, with HDP being the main driving factor. Screening for both HDP and depression followed by multidisciplinary care could alleviate the health and economic burden of HDP and depression.
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Journal of women's health · Nov 2019
Characteristics of Immigrants Obtaining Abortions and Comparison with U.S.-Born Individuals.
Background: Little information exists about individuals born outside of the United States who seek abortion services from U. S.-based providers. Baseline data are necessary to identify future changes in the profile of this population. Materials and Methods: Using the Guttmacher Institute's Abortion Patient Survey, we pooled two national samples of individuals obtaining abortions from 2008-2009 to 2013-2014 to provide data on 17,873 respondents, 16% of whom were immigrants. ⋯ S.-born respondents, a larger proportion of immigrants were older, uninsured, and had not completed high school. A smaller proportion of immigrants compared with nonimmigrants had their abortions after 12 weeks (8% vs. 11%) or traveled over 50 miles to obtain their abortion (9% vs. 16%). Conclusions: Particularly with the continued rise in both restrictive abortion and immigration policies in the United States, it is critical to monitor how immigrants' use of and access to abortion services are impacted in the changing environment. Ensuring that policies and clinical practices facilitate abortion access for immigrants will serve to better support the reproductive health needs of all women.
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Journal of women's health · Nov 2019
Gynecologic Health Care Providers' Willingness to Provide Routine Care and Papanicolaou Tests for Transmasculine Individuals.
Background: Transmasculine individuals who have a cervix may be at risk of cervical cancer, but they face a number of barriers to accessing care, including difficulty finding knowledgable and culturally sensitive providers who are willing to care for transgender patients. We examined gynecologic health care providers' willingness to provide routine care and Papanicolaou tests (Pap tests) to transmasculine individuals, including the role of personal, clinical, and professional factors. Materials and Methods: We surveyed attending physicians, advanced practitioners, and residents in the Women's Health department of a large, integrated Midwest health system (n = 60, 74.1% response rate). Results: A majority of participants were female (68.3%) and white (73.3%). Most had met a transgender person before (79.7%), and 40.7% had cared for a transgender patient in the past 5 years. ⋯ Bivariate analysis suggests that having met a transgender person (p = 0.028), higher empathy scores (p = 0.015), political views (p = 0.0130), and lower transphobia (p = 0.012) were associated with willingness to provide routine care to transmasculine individuals. Lower transphobia (p = 0.034) and political views (p < 0.001) were also associated with willingness to provide Pap tests to transmasculine people. Conclusions: Providers' willingness was not associated with barriers related to training or knowledge-only with personal biases and experiences. Transgender-inclusive health care training that addresses personal attitudes should be a routine part of training for all health professionals.