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Ajayi KV, Flores S, Fan Q, Ezenwanne F, Garney W, Wachira E. Prevalence, correlates, and sources of women's health information-seeking behaviors in the United States. PATIENT EDUCATION AND COUNSELING 2023; 111:107703. [PMID: 36905765 DOI: 10.1016/j.pec.2023.107703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate the prevalence, correlates, and sources of women's health information-seeking behaviors in the United States using the Andersen Behavioral Model. METHODS The 2012-2019 Health Information National Trends Survey data were used to analyze how and where women seek health theoretically. Weighted prevalence, descriptive analysis, and separate multivariable logistic regression models were computed to test the argument. RESULTS The overall prevalence of seeking health information from any source was (83%, 95% CI: 0.82-0.84). Between 2012 and 2019, the analysis revealed a downward trend in health information seeking from any source (85.2-82.4%), health care provider (19.0-14.8%), family/friends (10.4-6.6%), and traditional channels (5.4-4.8%). Interestingly, there was an increase in Internet usage from 65.4% to 73.8%. CONCLUSIONS We found statistically significant relationships between the predisposing, enabling, and need factors of the Andersen Behavioral Model. Specifically, age, race/ethnicity, income levels, educational status, perceived health status, having a regular provider, and smoking status predicted women's health information-seeking behaviors. PRACTICE IMPLICATIONS Our study concludes that several factors influence health information-seeking behaviors, and disparities exist in the channels through which women seek care. The implications for health communication strategies, practitioners, and policymakers are also discussed.
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Affiliation(s)
- Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA.
| | - Sara Flores
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Qiping Fan
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Folakemi Ezenwanne
- Department of Epidemiology, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Whitney Garney
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, TX 77843, USA
| | - Elizabeth Wachira
- Department of Health and Human Performance, Texas A&M University Commerce, TX 75428, USA
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Li K, Lorgelly P, Jasim S, Morris T, Gomes M. Does a working day keep the doctor away? A critical review of the impact of unemployment and job insecurity on health and social care utilisation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:179-186. [PMID: 35522390 PMCID: PMC9985560 DOI: 10.1007/s10198-022-01468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
While the negative impact of unemployment on health is relatively well established, the extent to which that impact reflects on changes in health and social care utilisation is not well understood. This paper critically reviews the direction, magnitude and drivers of the impact of unemployment and job insecurity on health and social care utilisation across different care settings. We identified 28 relevant studies, which included 79 estimates of association between unemployment/job insecurity and healthcare utilisation. Positive associations dominated mental health services (N = 8 out of 11), but not necessarily primary care (N = 25 out of 43) or hospital care (N = 5 out of 22). We conducted a meta-analysis to summarise the magnitude of the impact and found that unemployed individuals were about 30% more likely to use health services compared to those employed, although this was largely driven by mental health service use. Key driving factors included financial pressure, health insurance, social network, disposable time and depression/anxiety. This review suggests that unemployment is likely to be associated with increased mental health service use, but there is considerable uncertainty around primary and hospital care utilisation. Future work to examine the impact across other settings, including community and social care, and further explore non-health determinants of utilisation is needed. The protocol was registered in PROSPERO (CRD42020177668).
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Affiliation(s)
- Keyi Li
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Paula Lorgelly
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sarah Jasim
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Tiyi Morris
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Manuel Gomes
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
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3
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Disparities in Sexually Transmitted Infection/HIV Testing, Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities. J Adolesc Health 2023; 72:214-221. [PMID: 36369111 DOI: 10.1016/j.jadohealth.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Sexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity. METHODS Our sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011-2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method. RESULTS Service receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s). DISCUSSION There is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.
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Headen IE, Dubbin L, Canchola AJ, Kersten E, Yen IH. Health care utilization among women of reproductive age living in public housing: Associations across six public housing sites in San Francisco. Prev Med Rep 2022; 27:101797. [PMID: 35656210 PMCID: PMC9152803 DOI: 10.1016/j.pmedr.2022.101797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/21/2022] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Housing is a key social determinant of health and health care utilization. Although stigmatized due to poor quality, public housing may provide stability and affordability needed for individuals to engage in health care utilization behaviors. For low-income women of reproductive age (15-44 y), this has implications for long-term reproductive health trajectories. In a sample of 5,075 women, we used electronic health records (EHR) data from 2006 to 2011 to assess outpatient and emergency department (ED) visits across six public housing sites in San Francisco, CA. Non-publicly housed counterparts were selected from census tracts surrounding public housing sites. Multivariable regression models adjusted for age and insurance status estimated incidence rate ratios (IRR) for outpatient visits (count) and odds ratios (OR) for ED visit (any/none). We obtained race/ethnicity-specific associations overall and by public housing site. Analyses were completed in December 2020. Public housing was consistently associated with health care utilization among the combined Asian, Alaskan Native/Native American, Native Hawaiian/Pacific Islander, and Other (AANHPI/Other) group. Public housing residents had fewer outpatient visits (IRR: 0.86; 95% Confidence Interval [CI]: 0.81, 0.93) and higher odds of an ED visit (OR: 1.81; 95% CI: 1.32, 2.48). Black women had higher odds of an ED visits (OR: 1.32; 95% CI: 1.07, 1.63), but this was driven by one public housing site (site-specific OR: 2.34; 95% CI: 1.12, 4.88). Variations by race/ethnicity and public housing site are integral to understanding patterns of health care utilization among women of reproductive age to potentially improve women's long-term health trajectories.
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Affiliation(s)
- Irene E. Headen
- Drexel University Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market St., Nesbitt Hall Rm 451, Philadelphia, PA 19104, USA
| | - Leslie Dubbin
- University of California, San Francisco, Department of Social and Behavioral Sciences, School of Nursing, 490 Illinois St., San Francisco, CA 94158, USA
| | - Alison J. Canchola
- University of California, San Francisco, Department of Epidemiology and Biostatistics, 550 16th. Street, San Francisco CA 94158, USA
| | - Ellen Kersten
- Washington State Department of Social and Health Services, Research and Data Analysis Division (RDA), 14th & Jefferson St, PO Box 45204, Olympia, WA 98504, USA
| | - Irene H. Yen
- University of California, Merced, School of Social Sciences Humanities and Arts, Department of Public Health, 5200 N Lake Rd, Merced, CA 95343, USA
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5
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Leath S, Wright P, Charity-Parker B, Stephens E. Exploring Black Women's Pathways to Motherhood Within a Reproductive Justice Framework. QUALITATIVE HEALTH RESEARCH 2022; 32:694-709. [PMID: 34984946 DOI: 10.1177/10497323211066869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amidst the increasing push to address racial disparities in maternal health equity, fewer studies have considered Black women's perspectives on their needs, concerns, and priorities regarding family planning care. Such evidence might help address the lack of support and information that many Black women report in patient-provider encounters, and broaden empirical knowledge on the contextual factors that influence Black women's reproductive decisions. In the present qualitative study, we explored Black women's pathways to motherhood within a reproductive justice framework. We drew on individual, semi-structured interview data from 31 Black mothers (25-50 years, Mage = 35 years) across the United States. Using consensual qualitative research methods, we elaborated on three themes: (1) intentional family planning, (2) unintended pregnancy, and (3) othermothering. The findings challenge deficit-based stereotypes of Black mothers' reproductive choices and illuminate how health practitioners can facilitate humanizing conversations that prioritize Black women's family planning goals and decision-making.
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Affiliation(s)
- Seanna Leath
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
| | - Patrice Wright
- Sociology Department, 2358University of Virginia, Charlottesville, VA, USA
| | | | - Erica Stephens
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
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Logan RG, Daley EM, Vamos CA, Louis-Jacques A, Marhefka SL. "When Is Health Care Actually Going to Be Care?" The Lived Experience of Family Planning Care Among Young Black Women. QUALITATIVE HEALTH RESEARCH 2021; 31:1169-1182. [PMID: 33622078 PMCID: PMC8114454 DOI: 10.1177/1049732321993094] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While family planning care (FPC) visits may serve as opportunities to address gaps in knowledge and access to limited resources, young Black women may also face structural barriers (i.e., racism, discrimination, bias) to engaging in care due to the intersections of racial identity, age, and socioeconomic status. Findings from interviews with 22 Black women, ages 18 to 29 years, about the lived experience of FPC highlighted dynamic patient-provider encounters. Women's narratives uncovered the following essences: silence around sex impedes engagement in care, patient-provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience, decision making excludes discussion and deliberation, medical mistrust is pervasive and a part of Black consciousness, and meaningful and empathic patient-provider encounters are elusive. Health systems should prioritize developing and enhancing young Black women's relationship with FPC providers to help mitigate persistent inequities that perpetuate disadvantage among this population.
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7
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Hall KS. Advancing Intersectional Approaches for Integrated Women's Health Care and Health Equity: The Unrealized Potential of Family Planning Settings. J Womens Health (Larchmt) 2021; 30:1213-1215. [PMID: 33534643 DOI: 10.1089/jwh.2020.9005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelli Stidham Hall
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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8
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Abstract
Decades of research have attempted to understand the paradox of stubbornly high unintended pregnancy rates despite widespread use of contraception. Much of this research has focused on socioeconomic disparities in rates of unintended pregnancy, finding that economically disadvantaged women tend to use less effective contraceptive methods and use them less consistently. Building on this research, this study examines how material hardship is associated with less consistent contraceptive use among women who do not desire to become pregnant. Using the Relationship Dynamics and Social Life (RDSL) Study, a weekly longitudinal survey, I find lower levels of contraceptive use and less consistent use of contraception among women experiencing material hardship, relative to those without hardship experiences. I also investigate the extent to which this association is explained by access barriers and lower contraceptive efficacy among women experiencing hardship. Using structural equation modeling, I find that these mediators significantly explain the relationship between hardship and risky contraceptive behaviors, suggesting that hardship creates mental and resource constraints that impede successful implementation of contraception. However, net of these mediators, material hardship remains associated with riskier contraceptive behaviors among young women, calling for further research on how hardship exposes women to greater risk of unintended pregnancies.
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Affiliation(s)
- Elly Field
- Department of Sociology and Population Studies Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 2267, Ann Arbor, MI, 48106-1248, USA.
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9
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Starting Health Disparities Education During Resident Orientation: Our Patients, Our Community. Obstet Gynecol 2019; 132:1153-1157. [PMID: 30303918 DOI: 10.1097/aog.0000000000002911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disparities in women's reproductive health outcomes are persistent and prevalent. Cultural competency education of trainees is central to reducing patient-, system-, and practitioner-level factors that promote disparate health outcomes. Such issues include health literacy, access to health care, and unconscious bias. We suggest that recognizing and reducing health disparities should be a longitudinal theme in resident education, first introduced during intern orientation and continued with dedicated didactics, experiential learning opportunities, grand rounds, and journal clubs built into the residency curricula. In this commentary, we present various methods of introducing health disparities education and commencing a larger conversation about inequity and race in medicine. We hope to encourage other training programs to incorporate this important topic earlier into their educational curriculum.
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10
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Murray Horwitz ME, Pace LE, Ross-Degnan D. Trends and Disparities in Sexual and Reproductive Health Behaviors and Service Use Among Young Adult Women (Aged 18-25 Years) in the United States, 2002-2015. Am J Public Health 2019; 108:S336-S343. [PMID: 30383434 DOI: 10.2105/ajph.2018.304556] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe trends in sexual and reproductive health behaviors and service utilization among young women in the United States. METHODS We analyzed data from 8835 female respondents aged 18 to 25 years from 4 cycles of the National Survey of Family Growth, a nationally representative cross-sectional survey, from 2002 to 2015. We used bivariate and multivariable logistic regression to compare rates of self-reported sexual activity, sexually transmitted infection-related care, and contraception use over time and by race/ethnicity. RESULTS Sexually transmitted infection-related care and human papilloma virus vaccination increased from 2002 to 2013-2015, whereas sexual activity and contraception use remained stable. Compared with White women, racial/ethnic minority women were less likely to report effective contraception use, and Black women were less likely to report human papilloma virus vaccination; these differences did not change over time. CONCLUSIONS Sexual and reproductive health service utilization increased from 2002 to 2015 among young women, whereas sexual activity remained stable. Overall, rates of recommended care were low, and racial and ethnic disparities persisted. Public Health Implications. Young women could benefit from clinical interventions and health policies to increase recommended care and reduce disparities.
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Affiliation(s)
- Mara E Murray Horwitz
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
| | - Lydia E Pace
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
| | - Dennis Ross-Degnan
- Mara E. Murray Horwitz and Dennis Ross-Degnan are with the Department of Population Medicine, Harvard Medical School, and the Harvard Pilgrim Health Care Institute, Boston, MA. Lydia E. Pace is with the Division of Women's Health, Brigham and Women's Hospital, and Harvard Medical School, Boston
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11
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Connecting Urban Food Plans to the Countryside: Leveraging Denver’s Food Vision to Explore Meaningful Rural–Urban Linkages. SUSTAINABILITY 2019. [DOI: 10.3390/su11072022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cities are increasingly turning to food policy plans to support goals related to food access, food security, the environment, and economic development. This paper investigates ways that rural farmers, communities, and economies can both support and be supported by metropolitan food-focused initiatives. Specifically, our research question asked what opportunities and barriers exist to developing food policies that support urban food goals, particularly related to local procurement, as well as rural economic development. To address this question, we described and analyzed a meeting of urban stakeholders and larger-scale rural producers related to Colorado’s Denver Food Vision and Plan. We documented and explored “findings” gleaned from a supply chain diagraming and data compilation process that were then used to inform an event that brought together diverse supply chain partners. Three findings stand out. First, facilitating dialog between urban food policymakers and rural producers to understand potential tensions, mitigate such tensions, and capitalize on opportunities is essential. Second, perceptions and expectations surrounding “good food” are nuanced—a timely finding given the number of preferred procurement programs emerging across the county. Third, critical evaluation is needed across a diverse set of value chain strategies (e.g., conventional and alternative distribution) if food policy intends to support heterogeneous producers, their communities, and urban food policy goals.
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12
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Nowotny KM, Frankeberger J, Rodriguez VE, Valdez A, Cepeda A. Behavioral, Psychological, Gender, and Health Service Correlates to Herpes Simplex Virus Type 2 Infection among Young Adult Mexican-American Women Living in a Disadvantaged Community. Behav Med 2019; 45:52-61. [PMID: 29558260 PMCID: PMC6148393 DOI: 10.1080/08964289.2018.1447906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.
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Affiliation(s)
- Kathryn M Nowotny
- a Department of Sociology , University of Miami , Coral Gables , FL , USA
| | - Jessica Frankeberger
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Victoria E Rodriguez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Avelardo Valdez
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Alice Cepeda
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
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Handler A, Henderson V, Johnson R, Turino C, Gordon M, Franck M, Peacock N, Pecha D. The Well-Woman Project: Listening to Women's Voices. Health Equity 2018; 2:395-403. [PMID: 30623168 PMCID: PMC6323588 DOI: 10.1089/heq.2018.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The U.S. Affordable Care Act (ACA) of 2010 included the Well-Woman Visit (WWV) as one of the preventive services, which must be covered without cost sharing. Despite concerted efforts to increase access to the WWV, data from the early years of the ACA demonstrated ongoing barriers, including insufficient consumer and provider awareness of the ACA's no cost-sharing provision for preventive services. As such, 2 years after full implementation of the ACA, the Well-Woman Project (WWP) used qualitative methods to learn about women's perceptions of the WWV and barriers that affect their ability to be healthy and seek well-woman care. Methods: Women's voices were captured by Listening Sessions in eight cities and through stories from women across the United States posted to a WWP Website, or reported over a WWP toll-free phone line. Thematic analysis of Listening Sessions and stories was conducted using Dedoose software. Results: In 2016, Listening Sessions (17) were held with 156 women; in addition, stories were collected from 102 women across the United States. Women are aware of the importance of preventive care, but report multiple barriers to seeking such care. However, they are able to articulate a variety of system and policy strategies that mitigate the complexity of navigating the health care system; help women prioritize their health and accessing health care; promote positive relationships with providers; empower women to advocate for themselves and others; promote positive mental health as well as access to safe environments, healthy food, and social support systems; decrease barriers related to lack of transportation and childcare; and support the provision of trauma informed care in the health care delivery system. Conclusion: To improve women's health status and reduce inequities, making the preventive well-care visit available without cost-sharing is necessary, but not a sufficient strategy.
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Affiliation(s)
- Arden Handler
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Vida Henderson
- Cancer Center, University of Illinois, Chicago, Illinois
| | - Regan Johnson
- CityMatCH, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cristina Turino
- CountyCare, Cook County Health and Hospitals System, Chicago, Illinois
| | - Megan Gordon
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Megan Franck
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois
| | - Nadine Peacock
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Denise Pecha
- CityMatCH, University of Nebraska Medical Center, Omaha, Nebraska
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Chor J, Garcia-Ricketts S, Young D, Hebert LE, Hasselbacher LA, Gilliam ML. Well-woman Care Barriers and Facilitators of Low-income Women Obtaining Induced Abortion after the Affordable Care Act. Womens Health Issues 2018; 28:387-392. [PMID: 29747908 PMCID: PMC6143410 DOI: 10.1016/j.whi.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/06/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act. METHODS We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12 months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti. RESULTS Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient-provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support. CONCLUSIONS Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care.
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Affiliation(s)
- Julie Chor
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
| | | | - Danielle Young
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Luciana E Hebert
- Section of Family Planning and Contraceptive Research and Ci3, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Melissa L Gilliam
- Section of Family Planning and Contraceptive Research and Ci3, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Daniel H, Erickson SM, Bornstein SS, Kane GC, Gantzer HE, Henry TL, Lenchus JD, Li JM, McCandless BM, Nalitt BR, Viswanathan L, Murphy CJ, Azah AM, Marks L. Women's Health Policy in the United States: An American College of Physicians Position Paper. Ann Intern Med 2018; 168:874-875. [PMID: 29809243 DOI: 10.7326/m17-3344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this position paper, the American College of Physicians (ACP) examines the challenges women face in the U.S. health care system across their lifespans, including access to care; sex- and gender-specific health issues; variation in health outcomes compared with men; underrepresentation in research studies; and public policies that affect women, their families, and society. ACP puts forward several recommendations focused on policies that will improve the health outcomes of women and ensure a health care system that supports the needs of women and their families over the course of their lifespans.
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Affiliation(s)
- Hilary Daniel
- American College of Physicians, Washington, DC (H.D., S.M.E.)
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16
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Cohen SA, Cook SK, Sando TA, Sabik NJ. What Aspects of Rural Life Contribute to Rural-Urban Health Disparities in Older Adults? Evidence From a National Survey. J Rural Health 2017; 34:293-303. [DOI: 10.1111/jrh.12287] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/30/2017] [Accepted: 10/19/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Steven A. Cohen
- Health Studies Program, Department of Kinesiology; University of Rhode Island; Kingston Rhode Island
| | - Sarah K. Cook
- Department of Family Medicine and Population Health; Virginia Commonwealth University School of Medicine; Richmond Virginia
| | - Trisha A. Sando
- Division of Epidemiology, Department of Family Medicine and Population Health; Virginia Commonwealth University School of Medicine; Richmond Virginia
| | - Natalie J. Sabik
- Health Studies Program, Department of Kinesiology; University of Rhode Island; Kingston Rhode Island
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17
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Sawyer AN, Kwitowski MA, Benotsch EG. Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use. Am J Health Promot 2017; 32:906-915. [PMID: 29121792 DOI: 10.1177/0890117117736091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN Cross-sectional online survey. SETTING Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.
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Affiliation(s)
- Ashlee N Sawyer
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa A Kwitowski
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric G Benotsch
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers. Womens Health Issues 2016; 27:196-205. [PMID: 27825589 DOI: 10.1016/j.whi.2016.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe women's preferences for reproductive health providers as sources of primary and mental health care. METHODS This is secondary data analysis of the Women's Health Care Experiences and Preferences Study, an Internet survey conducted in September 2013 of 1,078 women aged 18 to 55 randomly sampled from a U.S. national probability panel. We estimated women's preferred and usual sources of care (reproductive health providers, generalists, other) for various primary care and mental health care services using weighted statistics and multiple logistic regression. MAIN FINDINGS Among women using health care in the past 5 years (n = 981), 88% received primary and/or mental health care, including a routine medical checkup (78%), urgent/acute (48%), chronic disease (27%), depression/anxiety (21%), stress (16%), and intimate partner violence (2%) visits. Of those, reproductive health providers were the source of checkup (14%), urgent/acute (3%), chronic disease (6%), depression/anxiety (6%), stress (11%), and intimate partner violence (3%) services. Preference for specific reproductive health-provided primary/mental health care services ranged from 7% to 20%. Among women having used primary/mental health care services (N = 894), more women (1%-17%) preferred than had received primary/mental health care from reproductive health providers. Nearly one-quarter (22%) identified reproductive health providers as their single most preferred source of care. Contraceptive use was the strongest predictor of preference for reproductive health-provided primary/mental health care (odds ratios range, 2.11-3.30). CONCLUSIONS Reproductive health providers are the sole source of health care for a substantial proportion of reproductive-aged women-the same groups at risk for unmet primary and mental health care needs. Findings have implications for reproductive health providers' role in comprehensive women's health care provision and potentially for informing patient-centered, integrated models of care in current health systems.
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Bird M, Wright RL, Frost CJ. Enhancing women's health: A call for social work research. SOCIAL WORK IN HEALTH CARE 2016; 55:732-751. [PMID: 27700861 DOI: 10.1080/00981389.2016.1205706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article presents a critical synthesis of the social work empirical literature on women's health. In light of recent policy changes that directly affect women's health and social work, the authors conducted a literature review of recent publications (2010-2015) regarding social work and women's health nationally. Despite frequent accounts cited in the literature, there has been no comprehensive review of issues involving women's health and social work in the United States. The purpose of this review is to examine the current social work literature addressing women's health at the national (U.S.) level. This research presents a summary description of the status of the social work literature dealing with women's health, specifically 51 articles published between 2010 and 2015. Our search highlights the need for social work research to fill gaps and more fully address the needs of women across the lifespan.
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Affiliation(s)
- Melissa Bird
- a School of Social Work , University of Southern California , Los Angeles , California , USA
| | - Rachel L Wright
- b Department of Social Work , Appalachian State University , Boone , North Carolina , USA
| | - Caren J Frost
- c College of Social Work , University of Utah , Salt Lake City , Utah , USA
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Malmartel A, Rigal L. Suivi gynécologique, médecin impliqué et dépistage du cancer du col utérin : une accumulation de disparités sociales. ACTA ACUST UNITED AC 2016; 45:459-66. [DOI: 10.1016/j.jgyn.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/27/2016] [Accepted: 02/05/2016] [Indexed: 11/15/2022]
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Hall KS, Patton EW, Crissman HP, Zochowski MK, Dalton VK. A population-based study of US women's preferred versus usual sources of reproductive health care. Am J Obstet Gynecol 2015; 213:352.e1-14. [PMID: 25935780 DOI: 10.1016/j.ajog.2015.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/01/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We characterized US women's preferred and usual sources of reproductive health care. STUDY DESIGN Data were drawn from the Women's Health Care Experiences and Preferences Study, an Internet survey of 1078 women aged 18-55 years randomly sampled from a national probability panel. We described and compared women's preferred and usual sources of care (women's health specialists including obstetricians-gynecologists and family-planning clinics, primary care, other) for Papanicolaou/pelvic examination, contraception, and sexually transmitted infection (STI) services using χ(2), logistic regression, and kappa statistics. RESULTS Among women reporting health service utilization (n = 984, 92% overall; 77% Papanicolaou/pelvic; 33% contraception; 8% STI), women's health specialists were the most used sources of care for Papanicolaou/pelvic (68%), contraception (74%), and STI (75%) services. Women's health specialists were also the most preferred care sources for Papanicolaou/pelvic (68%), contraception (49%), and STI (35%) services, whereas the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (P < .05). Preference for women's health specialists was the strongest predictor of women's health specialist utilization for Papanicolaou/pelvic (adjusted odds ratio, 48.8; 95% confidence interval, 25.9-91.8; P < .001) and contraceptive (adjusted odds ratio, 194.5; 95% confidence interval, 42.3-894.6; P < .001) services. Agreement between preferred and usual-care sources was high for Papanicolaou/pelvic (85%, kappa, 0.63) and contraception (86%; kappa, 0.64) services; disagreement (range, 15-22%) was associated with insurance, employment, income, race, and religion (P < .05). CONCLUSION Women's preferences for and use of women's health specialists for reproductive health care has implications for efforts to define the role of obstetricians-gynecologists and family planning clinics in current health systems.
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Affiliation(s)
- Kelli Stidham Hall
- Department of Obstetrics and Gynecology, Institute for Social Research, University of Michigan, Ann Arbor, MI.
| | - Elizabeth W Patton
- Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI
| | | | - Melissa K Zochowski
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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22
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Upadhya KK, Burke AE, Marcell AV, Mistry K, Cheng TL. Contraceptive service needs of women with young children presenting for pediatric care. Contraception 2015. [PMID: 26197265 DOI: 10.1016/j.contraception.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary objective of this study is to characterize the need for contraceptive services and contraceptive method use among women with young children presenting to child health clinics. A secondary objective is to characterize the factors, including access to care and health needs, that exist in this population and to evaluate their association with contraceptive method use. STUDY DESIGN This is a cross-sectional study of women with children under age 36 months presenting to four child health practices in the Baltimore, Maryland, area. Participating women completed a survey to assess desire for pregnancy, contraceptive method use and related characteristics. RESULTS A total of 238 participants (82%) were in need of contraceptive services (fertile and not desiring pregnancy). Overall, 59 (25%) of women in need were not using a contraceptive method (unmet need) and 79 (33%) were using a highly effective method (implant or intrauterine device). Factors associated with lower odds of unmet need for contraceptive services included attendance at a routine postpartum visit and visiting a healthcare provider to discuss contraception after pregnancy. Approximately half of index pregnancies were unintended and this was the only health factor associated with greater odds of using of a highly effective contraceptive method. CONCLUSIONS Most women presenting with young children for pediatric care indicated that they were not currently trying to become pregnant and reported current methods of pregnancy prevention that ranged from none to highly effective. Women who had not sought postpregnancy contraceptive care were more likely to have unmet need for contraceptive services. IMPLICATIONS Child health clinics may be a novel site for providing contraceptive care to women with children as part of a strategy to reduce unplanned pregnancies.
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Affiliation(s)
- Krishna K Upadhya
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21287, USA; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Arik V Marcell
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Kamila Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA; Office of Extramural Research, Education and Priority Populations, Agency for Healthcare Research and Quality, 540 Gaither Road, Room 2034, Rockville, MD 20850, USA.
| | - Tina L Cheng
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21287, USA.
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23
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Hall KS, Nadella SP, Zochowski MK, Patel D, Dalton VK. Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act. J Womens Health (Larchmt) 2015; 24:730-9. [PMID: 26125483 DOI: 10.1089/jwh.2014.5175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. METHODS Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18-55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. RESULTS Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17-0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10-0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35-0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12-32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. CONCLUSIONS Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.
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Affiliation(s)
- Kelli Stidham Hall
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Samantha Paturu Nadella
- 2 L4000 Women's Hospital , Ann Arbor, Michigan.,3 Department of Obstetrics and Gynecology, The Ohio State University , Columbus Ohio
| | - Melissa K Zochowski
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Divya Patel
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
| | - Vanessa K Dalton
- 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan
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24
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Screening for cervical cancer: What are the determinants among adults with disabilities living in institutions? Findings from a National Survey in France. Health Policy 2015; 119:794-801. [DOI: 10.1016/j.healthpol.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/18/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
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Hall KS, Fendrick AM, Zochowski M, Dalton VK. Women's health and the Affordable Care Act: high hopes versus harsh realities? Am J Public Health 2014; 104:e10-3. [PMID: 24922171 DOI: 10.2105/ajph.2014.302045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Our population-based survey of 1078 randomly sampled US women, aged 18 to 55 years, sought to characterize their understanding of and attitudes toward the Affordable Care Act (ACA). Most women, especially socially disadvantaged groups, had negative or uncertain attitudes toward the ACA and limited understanding of its health benefits, including its relevance for their own health service coverage and utilization. Our findings are important for continued research, policy, and practice, with implications for whether, when, and how improved coverage will translate to improved access and outcomes for US women.
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Affiliation(s)
- Kelli Stidham Hall
- Kelli Stidham Hall is with the Department of Obstetrics and Gynecology and the Institute for Social Research, University of Michigan, Ann Arbor. A. Mark Fendrick is with the Department of Internal Medicine and the Department of Health Management and Policy, University of Michigan. Melissa Zochowski is with the Department of Obstetrics and Gynecology, University of Michigan. Vanessa K. Dalton is with the Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research and the Institute for Healthcare Policy and Innovation, University of Michigan
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