Showing papers in "Womens Health Issues in 2010"

How Much Does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers?

Abstract: Objective To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms. Design Quantitative, secondary analysis, repeated measures, descriptive design. Setting Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California. Participants A sample of 198 first-time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at 1, 2, and 3 months postpartum. Main Outcome Measure Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. Results Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms. Conclusion Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample.

Women's perspectives on screening for alcohol and drug use in prenatal care.

Abstract: Background Screening for alcohol and drug use in prenatal care is widely promoted in the United States as a public health strategy for reducing alcohol and drug use during pregnancy. However, the published literature does not consider women's perspectives or the potential negative ramifications of screening. Methods Twenty semistructured interviews and two focus groups ( n = 38) were conducted with a racially/ethnically diverse sample of low-income pregnant and parenting women using alcohol and/or drugs in a northern California county. Results Most women were averse to having drug but not alcohol use identified and were mistrustful of providers' often inconspicuous efforts to discover drug use. Women expected psychological, social, and legal consequences from being identified, including feelings of maternal failure, judgment by providers, and reports to Child Protective Services. Women did not trust providers to protect them from these consequences. Rather, they took steps to protect themselves. They avoided and emotionally disengaged from prenatal care, attempted to stop using substances that could be detected by urine tests before prenatal care visits, and shared strategies within social networks for gaining the benefits of prenatal care while avoiding its negative consequences. Conclusion Considerations of the public health impact of screening for drug use in prenatal care should account for the implications of women's physical avoidance of and emotional disengagement from prenatal care, specifically the direct effects of late, limited, and no prenatal care on pregnancy outcomes and missed opportunities for health promoting interventions.

Pregnancy: A Screening Test for Later Life Cardiovascular Disease

Abstract: Cardiovascular disease is the major cause of death in women. Heart disease presents special problems to women, as first events are more likely to be fatal. These observations have led to attempts to increase recognition of risk for the disease by care providers and women and to identify women at risk. In 2007, the American Heart Association updated their Evidence Based Guidelines for Cardiovascular Disease Prevention in Women (Mosca et al., 2007). In it, they presented guidelines for evaluating risk for cardiovascular disease in women. Interestingly, in the text, tables, and flow charts there is no mention of obtaining a pregnancy history. In the text there is mention: ‘‘preeclampsia may be an early indicator of CVD risk.’’ In this presentation, we point out there is no doubt that preeclampsia is associated with later life cardiovascular disease and mortality; in some subsets, the risk is increased to the same degree as with cigarette smoking. Other pregnancy events, gestational diabetes, being the mother of a fetal growth–restricted baby or a preterm infant, breast feeding, and even pregnancy itself, are informative with regard to risk for cardiovascular disease in later life. We emphasize that a pregnancy history is an enormously important addition to the assessment of cardiovascular risk in women. The most well-established relationship of pregnancy related events to later life cardiovascular disease is for the pregnancy disorder, preeclampsia. Preeclampsia occurs in about 3% of pregnancies. It is diagnosed by new-onset hypertension and proteinuria and begins to abate with the delivery of the placenta. For many years it was considered merely pregnancy-induced hypertension. However, it is clear that the disorder is far more than this (Roberts & Gammill, 2005). It shares many pathophysiologic features with atherosclerosis. Like atherosclerosis, it is characterized by endothelial dysfunction resulting in vasoconstriction, activation of the coagulation cascade, and loss of

Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System

Abstract: Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care.

Preconception predictors of weight gain during pregnancy: prospective findings from the Central Pennsylvania Women's Health Study.

Abstract: Objectives. We examined preconception (prepregnancy) predictors of pregnancy weight gain and weight gain that exceeds the 2009 Institute of Medicine (IOM) recommendations based on pre-pregnancy body mass index (BMI), in a prospective study. Methods. Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2 years later. The analytic sample includes 103 women who were not pregnant at baseline and gave birth to full-term singletons during the follow-up period. Preconception maternal weight category as well as health behaviors, psychosocial stress, parity, and age were examined as predictors of pregnancy weight gain and of weight gain in excess of the IOM recommendations using multiple linear and logistic regression analysis. Results. Pregnancy weight gain averaged 33.01 pounds, with 51% of women gaining weight in excess of the 2009 IOM recommendations for their preconception weight category. Preconception overweight (BMI ¼ 25–29.9) increased the odds of excessive pregnancy weight gain nearly threefold, whereas preconception physical activity levels meeting activity guidelines reduced the odds of excessive weight gain but was marginally statistically significant. Conclusion. Although future research examining the role of physical activity in relation to pregnancy weight gain is needed, preconception overweight and physical activity levels are prime targets for interventions to avoid excessive pregnancy weight gain.

Perceived Discrimination and Health Outcomes: A Gender Comparison Among Asian-Americans Nationwide

Abstract: Objectives We examined whether similarities and differences exist in the association between perceived discrimination and poor mental and physical health among Asian-American adult women and men. We also tested whether Asian-American women would have a lower perceived discrimination threshold for developing negative health outcomes than Asian-American men.

2020 Vision for A High-Quality, High-Value Maternity Care System

Abstract: A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system. We put forth the "2020 Vision for a High-Quality, High-Value Maternity Care System" to serve as a positive starting place for a fruitful collaborative process to develop specific action steps for broad-based maternity care system improvement.

Young Women’s Knowledge, Attitudes, and Behaviors Related to Long-Acting Reversible Contraceptives

Abstract: BACKGROUND: The present study explored 18- to 30-year-old womens knowledge and perceptions of the long-acting reversible contraceptives (LARCs) Mirena and Implanon in a Midwestern state in the United States METHODS: A telephone survey (n = 543) and 18 focus groups (n = 106) were conducted with women across a rural Midwestern state During the telephone survey women answered questions related to their awareness and knowledge of two LARCs During the focus groups participants were asked to respond to questions related to their awareness knowledge behaviors and perceptions of LARCs RESULTS: In the telephone survey half of the women reported hearing of Mirena Only 80% of women had heard of Implanon In the focus groups most women reported knowing little about LARCs Benefits associated with other contraceptives were not associated with LARCs Women were concerned about potential side effects and problems stemming from using a contraceptive that is new to them CONCLUSION: Increased use of LARCs would likely reduce the unintended pregnancy rate As described although some young women are aware of these long-term contraceptive options there is still a need to educate women on their availability use and potential benefit Copyright (c) 2010 Jacobs Institute of Womens Health Published by Elsevier Inc All rights reserved

Predictors of Parents' Willingness to Vaccinate for Human Papillomavirus and Physicians' Intentions to Recommend the Vaccine

Abstract: Background The present study examined potential predictors of parents' willingness to vaccinate their children for human papillomavirus (HPV) and physicians' intentions to encourage parents to vaccinate their children, now that the U.S. Food and Drug Administration (FDA) has approved a highly effective vaccine. Methods Parents (n = 100) and physicians (n = 100) were surveyed on-line in fall 2006, 4 months after the HPV vaccine, Gardasil, was approved by the FDA as a prophylactic vaccine for females ages 9–26 years. Results Religiosity, perceiving their children as susceptible to HPV, and perceived negative consequences of HPV infection were significant predictors of parents' intent to vaccinate. Physician specialty and whether or not physicians would vaccinate their own children were significant predictors of physicians' intent to encourage parents to vaccinate their children. Conclusion Campaigns aimed at increasing HPV vaccination should focus on educating parents about children's susceptibility to and the potential negative consequences of HPV infection. Furthermore, because there is now a significant body of evidence indicating that pediatricians and gynecologists have high intentions to encourage parents to vaccinate their children, the focus should be placed on strengthening the intentions of physicians in other specialties who serve children and their parents.

Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Findings from a Population-Based Survey

Abstract: Purpose We sought to explore racial/ethnic disparities in the prevalence of gestational diabetes mellitus (GDM) in a population-based sample. Methods Data from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), a stratified, random sample of postpartum women who delivered in Oregon in 2004 and 2005 ( n = 3,883; weighted response rate, 75.2%) and linked birth certificates were analyzed. Hispanic, non-Hispanic Black, non-Hispanic American Indian, and non-Hispanic Asian/Pacific Islander (API) women were oversampled. We categorized women as having had GDM if they gave an affirmative answer on the birth certificate or the PRAMS survey. Results Non-Hispanic API women had the highest prevalence of GDM (14.8%); this was true for women with both a normal and a high body mass index (BMI). Asian women were more likely to have had GDM than Pacific Islander women. On multivariate analysis, non-Hispanic APIs were significantly more likely to have a pregnancy complicated by GDM (adjusted odds ratio, 2.26; 95% confidence interval, 1.23–4.13) than non-Hispanic White women. Conclusion Non-Hispanic API women, especially Asian women with both normal and high BMI, have increased risk of GDM. Future research should examine the unique risk factors experienced by Asians and health practitioners should be vigilant in screening for GDM regardless of BMI.

Explorative evaluation of the impact of severe premenstrual disorders on work absenteeism and productivity.

Abstract: Purpose To assess the effects of premenstrual disorders on work productivity and absenteeism in the multinational Impact study. Methods Women aged 15–45 years were screened for suspected premenstrual dysphoric disorders (PMDD) and premenstrual syndrome (PMS) and invited to participate in this web-based study. Based on the Daily Record of Severity of Problems (DRSP) questionnaire, symptoms were assessed prospectively over 2 months. Participants were categorized as having no perceived symptoms/mild PMS or moderate-to-severe PMS/PMDD based on a validated algorithm. Work productivity impairment and absenteeism were assessed retrospectively using the Premenstrual Symptoms Screening Tool (PSST) and a modified version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Work productivity impairment was also assessed prospectively over 2 months using the DRSP questionnaire. Results Overall 1,477 women started the study—of these, 822 (56%) completed the study as planned and represent the full analysis set. Employed women with moderate-to-severe PMS/PMDD had higher rate of productivity impairment on the modified version of the WPAI questionnaire (values ≥7) relative to those with no perceived symptoms/mild PMS (adjusted odds ratio, 3.12; 95% confidence interval, 1.75–5.57). Similar outcomes were obtained for impairment of working productivity or efficiency using the PSST scale (value 4). The mean number of days on the DRSP with at least moderate reduction in productivity or efficiency in daily routine was higher for women with moderate-to-severe PMS/PMDD (5.6 vs. 1.1). Women with moderate-to-severe PMS/PMDD had a higher rate of absenteeism (>8 hours per cycle; 14.2% vs. 6.0%). Conclusion Moderate-to-severe PMS/PMDD seems to be associated with work productivity impairment and increased absenteeism, and thus poses a potential economic burden.

Dentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women

Abstract: Purpose The purpose of the study was to understand US dentists' attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely. Methods In 2006 and 2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists' attitudes toward providing care to pregnant women, dentists' knowledge about the safety of dental procedures, and dentists' current practice patterns. Results Dentist's perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 ( p = .12; n = 772; df = 52) and a Bentler-Bonett normed fit index of .98 and a comparative fit index of .993. The root mean square error of approximation is .02. Conclusion Findings suggest that attitudes are significant determinants of accurate knowledge and current practice. Multidimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second, and third trimesters, dentists' knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.

Cost of cervical cancer treatment: implications for providing coverage to low-income women under the Medicaid expansion for cancer care.

Abstract: Background To date, no study has reported on the cost of treating cervical cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the cost effectiveness of screening interventions for low-income women and the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Methods Administrative data from the North Carolina Medicaid program linked with cancer registry data were used to analyze total Medicaid costs for these patients and the incremental costs of cervical cancer care at 6 and 12 months from diagnosis. We compared 207 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 414 controls. Findings Total Medicaid costs at 6 months after diagnosis were $3,807, $23,187, $35,853, and $45,028 for in situ, local, regional, and distant cancers, respectively. The incremental cost of cancer treatment for local and regional cancers was $13,935 and $26,174 and by 12 months increased to $15,868 and $30,917, respectively. Conclusion Medicaid coverage may be required for many months after diagnosis to ensure the provision of comprehensive care, especially for women with late-stage cancers. Given the great differences in cost of early versus late-stage cancers, interventions aimed at increasing screening among low-income women are likely to be cost effective.

Perceptions of Physical Activity and Motivational Interviewing Among Rural African-American Women with Type 2 Diabetes

Abstract: Purpose Motivational interviewing (MI), a patient-centered behavioral counseling style, is a common behavioral intervention strategy. Because intervention outcomes are highly dependent on patient responsiveness to intervention strategy, we evaluated MI perceptions among rural African American women with type 2 diabetes before a physical activity intervention. Methods Four moderator-led focus groups were conducted with patients aged 21–50 years who had never participated in a MI intervention and who receive diabetes care in a rural community health center. Patients were asked to share their perceptions of an MI consultation after viewing a DVD-based example. They were also asked to discuss their physical activity perceptions and readiness. A comprehensive content analysis based on grounded theory was performed by two raters in order to identify main themes. Main Findings Although patients ( n = 31) had an appreciation for physical activity benefits and high levels of physical activity readiness, themes related to physical activity barriers and lack of motivation were pervasive. Patients regarded the MI consultation as an effective health communication but the patient-centeredness of the approach was negatively perceived. Compared with MI, patients agreed that more traditional paternalistic approaches (i.e., physician-led interactions) were more representative of “good counseling” and more familiar to them. Patients shared deeply about personal experiences and provided words of encouragement to one another. Conclusion Physical activity interventions including rural African-American women should include activities that focus on barrier management and increasing motivation. MI might be an appropriate behavioral counseling model when added to a more traditional cognitive–behavioral physical activity intervention that is group-based and tailored to patients' communication preferences and the clinical setting.

Resilience After Hurricane Katrina Among Pregnant and Postpartum Women

Abstract: Background Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (posttraumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and posttraumatic growth. Methods We interviewed 222 pregnant southern Louisiana women and 292 postpartum women completed interviews at delivery and 8 weeks later. Resilience was measured by scores lower than a nonaffected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist. Posttraumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks for demographics, hurricane experience, and mental health resilience and perceived benefit. Findings Thirty-five percent of pregnant and 34% of the postpartum women were resilient from depression, whereas 56% and 49% were resilient from posttraumatic stress disorder. Resilience was most likely among White women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage because of the storm was associated with increased report of some perceived benefits. Conclusion Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit.

Who's responsible? Correlates of partner involvement in contraceptive decision making.

Abstract: Objectives: Researchers have begun looking at joint responsibility for contraceptive decision making as a mechanism to increase effective contraceptive use. This analysis identifies correlates of partner involvement in contraceptive decision making. Methods: Participants were first-time users of either oral contraceptives or Depo-Provera recruited from 10 family planning clinics in Texas (n ¼ 481). Participants completed a self-administered questionnaire that was available in both English and Spanish. Chi-square statistics were used to compare demographics, relationship characteristics, and condom use before and after initiation of the new hormonal method by who is responsible for birth control use. Characteristics that were significant in bivariate testing were then included in a multivariate logistic regression model. Results: Forty-five percent of women reported sole responsibility for contraceptive use and 55% reported joint responsibility with their partners. In multivariate models, consistent condom use before and after the initiation of hormonal contraception and duration of sexual activity with main partner for less than 2 years were associated with increased likelihood of joint responsibility for contraceptive decision making. Women whose partners were classified as high risk had reduced the odds of joint responsibility for contraceptive decision making. Conclusion: Women at increased risk for sexually transmitted diseases (high-risk partners) and their partners may represent a target population for interventions aimed at increasing joint responsibility for contraception use. Continuous engagement in contraceptive decision making among long-term couples should also be encouraged. Copyright 2010 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.

Abortion patients' perceptions of abortion regulation.

Abstract: Purpose Most states regulate abortion differently than other health care services. Examples of these regulations include mandating waiting periods and the provision of state-authored information, and prohibiting private and public insurance coverage for abortion. The primary purpose of this paper is to explore abortion patients' perspectives on these regulations. Methods We recruited 20 participants from three abortion providing facilities located in two states in the U.S. South and Midwest. Using a survey and semistructured interview, we collected information about women's knowledge of abortion regulation and policy preferences. During the interviews, women weighed the pros and cons of abortion regulations. We used grounded theory analytical techniques and matrix analysis to organize and interpret the data. Results We discovered five themes in these women's considerations of regulation: responsibility, empathy, safe and accessible health care, privacy, and equity. Women in the study generally supported policies that they felt protected women or informed decisions. However, most women also opposed laws mandating two-day abortion appointments for women who were traveling long distances. Women tended to favor financial coverage of abortion, arguing that it could help poor women afford abortion or reduce state expenditures. Conclusions Overall the study participants' opinions on abortion policy reflect key values for advocates and policy makers to consider: responsibility, empathy, safe and accessible health care, privacy, and equity. Future work should examine abortion regulations in light of these shared values. Laws that promote misinformation or prohibit accommodations of unique circumstances are not consistent the positions articulated by the subjects in our study.

The Role of Medicaid in Promoting Access to High-Quality, High-Value Maternity Care

Abstract: One of the most challenging aspects of health care improvement and reform is ensuring that individuals, particularly those who are vulnerable and low income, have access to care. Just as challenging is the imperative to ensure that the care accessed is of the highest quality possible. The Institute of Medicine (IOM) report, Crossing the Quality Chasm, identified the primary goal of any high-quality heath care system: The ability to furnish the right care, in the right setting, at the right time. This aim must also be the primary goal of Medicaid in regard to providing access to high-quality care for women throughout the reproductive cycle. Nationwide, Medicaid is a large purchaser of maternity care; in 2006, the program paid for 43% of all births and maternity costs represented 29% of all hospital charges to Medicaid. Under current federal law, state Medicaid agencies have to fulfill several obligations related to assessing, ensuring, and improving the quality of care, particularly for enrollees who receive services through managed care arrangements. The main purpose of this article is to analyze and describe the role of Medicaid in facilitating access to care for pregnant women and ensuring high-quality maternity care that is affordable. It first summarizes the federal Medicaid requirements regarding eligibility, coverage of benefits, financing, and service delivery, with a special emphasis on existing quality provisions. Then, it discusses current issues and recommends several Medicaid reforms, particularly in the area of quality assessment and improvement. All reforms, including Medicaid reforms, should seek to support the IOM-identified aims. Much of the emphasis in Medicaid policy development has been focused on access to care and great need for reform remains in the area of quality assurance and improvement, and disparity reduction because the program can play a significant role in this regard as well. More broadly, health care reform may provide an opportunity to revisit key issues around access to and quality of maternity care, including the benefit package, the content of services covered in the package, the frequency with which these services should be furnished, and the development of meaningful measures to capture whether women of childbearing age, including pregnant women, regardless of insurance status, indeed receive efficient, timely, effective, safe, accessible, and woman-centered maternity care.

Maternal mortality ratio and predictors of maternal deaths in selected desert districts in rajasthan a community-based survey and case control study.

Abstract: Background Reduction in maternal and child mortality has been a top priority in India, especially in light of the commitment on the part of the national government to the reach the Millennium Development Goals. Despite massive program efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high. Population-based estimates of MMR are lacking, and reliable evidence of role of socioeconomic determinants and program-related factors that mediate medical causes is not available. The present study was conducted to develop population-based estimates of MMR, and to evaluate the primary causes of maternal deaths and factors associated with excess risk of maternal mortality. Methods The study was conducted in the state of Rajasthan in India, covering 25,926 households in 411 villages. It has two major components: a community-based household survey and a case-control study with cases and controls sampled from the same population. A total of 32 maternal deaths and 6,165 live births were identified. The group of women who died during pregnancy or delivery (cases) is compared with a group of women who gave birth and survived (controls). Results MMR was estimated to be 519 (95% confidence interval [CI], 477–561). Hemorrhage was the chief cause (31%) of maternal deaths; the other causes were obstructed labor, severe anemia, puerperal sepsis, and abortion. Young age at child birth (odds ratio [OR], 2.6; 95% CI, 1.9–3.2) and poverty (OR, 2.5; 95% CI, 1.6–3.4) were independently associated with increased risk of maternal death. Presence of complications during antenatal period was an important predictor of maternal death (OR, 7.8; 95% CI, 6.8–8.8). Childbirth at home (OR, 4.4; 95% CI, 3.3–5.5) was associated with increased risk of maternal death. The study provides clear evidence for renewed program efforts and strategies for reducing complications and maternal deaths.

The Association Between Self-Reported Major Life Events and the Presence of Uterine Fibroids

Abstract: Purpose Uterine fibroids are the most common benign tumors in reproductive-age women. Factors associated with this condition such as psychosocial stress are still being elucidated. This paper explores the association between major life events (MLE) stress and fibroids. Methods Prevalence ratios (PR) and 95% confidence intervals (CI) were used to determine the association between MLE stress (number of events and stress intensity) and fibroids in 556 Black and 373 White women in the Uterine Fibroid Study, 1996–1999. Main Findings Fibroids were prevalent in 74% and 50% of the Black and White women, respectively. The mean number of MLE reported by each race group was two. Among White women, the PR for those who reported at least one event compared with those with no events were significant after adjusting for age and study identified fibroid risk factors (PR [1 and 2 events], 1.7; 95% CI, 1.2–2.5), (PR [3 events], 1.9; 95% CI, 1.3–2.7), and (PR [4 events], 1.5; 95% CI, 1.0–2.1), respectively. At all levels of stress compared with no events, significant associations with fibroids were found among White women. For Black Women, the PR for fibroids was only significant in the high stress group compared with those without an experienced event, after adjusting for fibroid risk factors (PR, 1.2; 95% CI, 1.1–1.4). Conclusion Examining the number and stress intensity of MLE enriched our understanding of this stressor and fibroids. Further research is needed to understand the role of stress on fibroids among women.

Adherence to mammography and colorectal cancer screening in women 50-80 years of age the role of psychological distress.

Abstract: Purpose The purpose of this study was to examine the impact of women's attitudes and health beliefs regarding breast and colorectal cancer screening practices. Methods Nine hundred five women, 50 to 80 years of age, were recruited from 63 randomly selected physician offices within the greater Los Angeles area. The Health Belief Model was used to evaluate potential predictor variables associated with patients' breast and colorectal cancer screening practices. Results The study results revealed that mammographic screening compliance was relatively high (70%), whereas only 29% of the patients were compliant with fecal occult blood test (FOBT) screening guidelines. Women were far more likely to obtain regular mammography screening than an FOBT. Psychological distress had one of the strongest, negative associations with breast cancer and colorectal cancer screening, and was also a prevalent predictor for many of the variables examined. Conclusion Psychological distress seems to negatively impact a patient's decision to adhere to breast cancer and colorectal cancer screening recommendations, although participants were far more likely to obtain regular mammography screening than an FOBT.

Pregnancy Motivations and Contraceptive Use: Hers, His, or Theirs?

Abstract: Context Studies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations. Methods We used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations. Results We observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use. Conclusion Providers and those developing interventions must recognize that some women who are “not trying to get pregnant” have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies.

Health Behaviors and Health Care Utilization of Southern Lesbians

Abstract: Purpose Lesbian women are more likely to experience negative physical and mental health outcomes compared with heterosexual women, although most research on this population has relied on small convenience samples. This study compared health behaviors and health care utilization among lesbian women living in the South to representative subsamples of women from the general population. Methods We conducted a Web-based survey of 1,141 self-identified lesbian women aged 19 and older living in the South. We compared descriptive results from our study to the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. We also calculated adjusted logistic regression models to further explore correlates of Southern lesbian women's physical and mental health. Main Findings Southern lesbians were less likely to be in poor physical health, but more likely to experience recent depression than women in the general population. Lesbians reported more risky health behaviors relative to other Southern and non-Southern women. Southern lesbians and other Southern women experienced similar barriers to routine health care, including lack of health insurance, not having a regular provider, and having to forgo care owing to cost. Many of these health behaviors and barriers to care were associated with poor physical and mental health among Southern lesbians. Conclusion Southern lesbians' patterns of health behaviors and utilization of care may place them at increased risk for negative health outcomes relative to the general population.

Selected cultural factors associated with physical activity among latino women

Abstract: Background In the United States, Latinos are the largest ethnic group after non-Hispanic whites. Latinos currently represent 15% of the U.S. population and their numbers are growing in nontraditional areas. Latino women (Latinas) disproportionately experience chronic disease risk factors and report low levels of leisure time physical activity. This study examined cultural factors associated with leisure time physical activity among Latinas living in a new Latino destination in northeastern New York. Methods Community-based participatory research, a collaborative approach in which community members are equitably and actively involved in the research process, was employed for this study. The Latina Health Survey was administered in Spanish and English to 289 Latina adults through snowball sampling. Results Women reported that their national origin was predominantly Puerto Rican (58.7%) or Dominican (18.2%). Only 6.6% of women met American College of Sports Medicine's physical activity recommendations of exercising 5 days a week; 25% participated in physical activity two or more times per week. Acculturation and religious service attendance at least once a week was positively associated and fast food consumption one or more times a week was negatively associated with physical activity. Discussion This study implicates the need for physical activity promotion efforts among Latinas who are culturally responsive and that address fast food consumption. In addition to acculturation, other, more specific cultural factors need to be examined to understand physical activity correlates among Latinas. Research among Latinas living in new Latino destinations is important for understanding behavior and tailoring health interventions among Latinos living in nontraditional areas.

Defining new categories of pregnancy intention in African-American women

Abstract: OBJECTIVE: Half of all U.S. pregnancies are categorized as unintended at conception but concerns persist that existing measures of pregnancy intention do not adequately reflect the complexities of reproductive desires and preferences. We explored new strategies for categorizing viewpoints toward future pregnancy focusing on young low-income African-American women and assessed the stability of these viewpoints over time. For pregnancies that occurred during the study we examined the utility of the newly derived categories for predicting retrospective measures of intendedness. METHODS: Data were collected using Q-methodology a technique for eliciting subjective viewpoints and identifying shared patterns among individuals. African-American women ages 15 to 25 and at risk for pregnancy were recruited at clinics serving low-income populations. The women sorted statements reflecting attitudes and preferences regarding future pregnancy into a distribution on a continuum from "least true for me" to "most true for me." We used by-person factor analysis to derive latent viewpoints. RESULTS: We identified six factors each reflecting a unique viewpoint about future pregnancy. These were a pregnancy seeking factor one reflecting both ambivalence and low reproductive control and four reflecting pregnancy avoidance with distinctions around social support reproductive control and desired pregnancy timing. Distribution of factors differed by age group as well as by retrospective categorization of pregnancy intention for those women who became pregnant during the study. CONCLUSION: Our categories provide a nuanced reflection of womens points of view about future pregnancies and with further validation may prove useful for predicting or preventing contraceptive nonuse undesired conceptions and associated adverse outcomes. Copyright (c) 2010 Jacobs Institute of Womens Health. Published by Elsevier Inc. All rights reserved.

Parents’ Opinions of Mandatory Human Papillomavirus Vaccination: Does Ethnicity Matter?

Abstract: Objective To explore parents’ opinions of school-entry requirements for human papillomavirus (HPV) vaccination. Methods We interviewed parents of vaccine-eligible girls attending medical appointments in an urban academic medical center and an affiliated community health center. We used qualitative methods to explore parents’ opinions about mandating routine childhood vaccines and HPV vaccine, as well as their feelings about vaccinating their own daughters against HPV. Results We included 19 Caucasian, 18 African-American, 12 Afro-Caribbean, 3 African, and 21 Latino parents. Nearly all parents had allowed their children to receive routine vaccinations and expressed support for mandating these vaccines. Most parents also vaccinated their daughters against HPV: 100% of Caucasian parents, 90% of African-American parents, 73% of Afro-Caribbean/African parents, and 90% of Latino parents. Only 11% of Caucasian parents supported HPV vaccine mandates, however, compared with 78% of African-American, 60% of Afro-Caribbean/African, and 90% of Latino parents. Immigrants supported mandates more frequently than U.S.-born parents. Most Caucasian parents opposed mandatory HPV vaccination because they believed the HPV vaccine should be an individual decision because the virus can only be spread by sexual contact. African-American, Afro-Caribbean, African, and Latino parents generally viewed mandates as the most effective way to protect their daughters from cervical cancer. Latino parents gave special importance to protecting their daughters from sexually transmitted infections. Conclusion Parents from different racial and ethnic backgrounds expressed unique perspectives about mandatory HPV vaccination. Caucasians were less likely than parents of other races/ethnicities to support vaccine mandates.

Cigarette smoking women of reproductive age who use oral contraceptives: results from the 2002 and 2004 behavioral risk factor surveillance systems.

Abstract: Background Despite health warnings about the increased risk of cerebrovascular disease among women who smoke while using oral contraceptives (OCs), prior research suggests that OC use is still prevalent among women who smoke cigarettes. Our objective was to investigate the prevalence of OC use among cigarette smoking women of reproductive age in the United States. Study Design We extracted data from the 2002 and 2004 Behavioral Risk Factor Surveillance System surveys of 76,544 women between 18 and 44 years of age who reported using some form of contraception. OC use, or self-reported use of “the pill,” was examined among those who currently smoke, either everyday or some days. Multivariable logistic regression models were used to compare OC use between smoking and nonsmoking women. Results One fourth (26.9%) of U.S. women who smoke compared with 34.6% of nonsmoking women reported currently using OCs. After adjusting for age, race/ethnicity, marital status, education level, binge drinking, and health care coverage, women who smoke were 0.6 (95% confidence interval [CI], 0.6–0.7) times as likely to use OCs as nonsmoking women. Among women aged 35 to 44 years, the odds of OC use among smokers was even further reduced (odds ratio [OR], 0.3; 95% CI, 0.3–0.4) compared with nonsmokers. Conclusion Among U.S. women of reproductive age who use contraception, particularly among women aged 35 to 44 years, those who smoke cigarettes are significantly less likely to use OCs than those who do not.

Multiparity is associated with high motivation to change diet among overweight and obese postpartum women.

Abstract: Background Pregnancy is associated with weight gain and obesity. The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women. Study Design Active Mothers Postpartum is a randomized, controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, body mass index category, and breastfeeding status. Results Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared with primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding. Conclusion Although risk for obesity is incurred starting with a woman's first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding.

Impact of patient adherence and test performance on the cost-effectiveness of cervical cancer screening in developing countries: the case of Honduras.

Abstract: Objective We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis. Materials and Methods Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes. Results VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. $0.23 vs. $3.17), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. $3,198 per cancer case avoided and reduce cancer cases by 42%, versus U.S. $36,802 and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent. Conclusion In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.

Military women's attitudes toward menstruation and menstrual suppression in relation to the deployed environment: development and testing of the MWATMS-9 (short form).

Abstract: Purpose To determine military women's attitudes toward menstruation and menstrual suppression with oral contraceptives in the deployed environment. Methods A cross-sectional descriptive design with the administration of the Menstrual Attitude Questionnaire (MAQ) and the 55-item Military Women's Attitudes Towards Menstrual Suppression Scale (MWATMS) to a convenience sample ( n = 278) of women in the U.S. Army with deployment experience. Findings The MAQ's five subscales' mean scores ranged from 3.4 (±1.11) to 5.1 (±1.06), indicating neutral to moderate attitudes toward menstruation. Measurement development on the MWATMS produced a nine-item scale with three components: stress effects, benefits to self, and environmental barriers. Conclusion Menstrual attitudes were generally neutral in this sample; however, military women favor menstrual suppression during deployment owing to the effects of stress during deployment, benefits that suppression would provide, and the barriers to menstrual hygiene in the deployed environment. Women who perceived menstruation as bothersome and debilitating had positive attitudes toward menstrual suppression. These findings can contribute to appropriate predeployment women's health care and improve the readiness for deployment in female soldiers. Providers should educate women on the risks and benefits of menstrual suppression methods and provide guidance on impact that the deployed environment can have on their menstrual experiences.