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Wells R, Smith NK, Rodriguez MI. Contraception Use by Title X Clients and Clients of Other Providers, 2015-2019. Womens Health Issues 2024; 34:59-65. [PMID: 37951782 DOI: 10.1016/j.whi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients' use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers. METHODS This article draws on 2015-2017 and 2017-2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months' supply for those using oral contraceptives. RESULTS In 2015-2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p = .004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015-2017 [p = .023] and AOR, 2.59 in 2017-2019 [p = .003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015-2017 [p = .007] and AOR, 3.04 in 2017-2019 [p = .001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015-2017 [p = .008] and AOR, 2.61 in 2017-2019 [p = .043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal. CONCLUSIONS Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time.
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Affiliation(s)
- Rebecca Wells
- The University of Texas School of Public Health, Houston, Texas.
| | - Nicole K Smith
- Rural Institute for Inclusive Communities, University of Montana, Corbin Hall, Missoula, Montana
| | - Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Health Science University, Portland, Oregon
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Chatillon A, Vizcarra E, Kumar B, Dickman SL, Beasley AD, White K. Access to care following Planned Parenthood's termination from Texas' Medicaid network: A qualitative study. Contraception 2023; 128:110141. [PMID: 37597715 DOI: 10.1016/j.contraception.2023.110141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES This study aimed to explore Planned Parenthood Medicaid patients' experiences getting reproductive health care in Texas after the state terminated Planned Parenthood providers from its Medicaid program in 2021. STUDY DESIGN Between January and September 2021, we recruited Medicaid patients who obtained care at Planned Parenthood health centers prior to the state termination using direct mailers, electronic messages, community outreach, and flyers in health centers. We conducted baseline and 2-month follow-up semistructured phone interviews about patients' previous experiences using Medicaid at Planned Parenthood and other providers and how the termination affected their care. We qualitatively analyzed the data using the principles of grounded theory. RESULTS We interviewed 30 patients, 24 of whom completed follow-up interviews. Participants reported that Planned Parenthood reliably accepted different Medicaid plans, worked with patients to ameliorate the structural barriers they face to care, and referred them to other providers as needed. After Planned Parenthood's termination from the Texas Medicaid program, participants faced difficulties accessing care elsewhere, including same-day appointments and on-site medications. Consequences included delayed or forgone reproductive health care, including contraception, and emotional distress. CONCLUSIONS Planned Parenthood Medicaid patients found it difficult to connect with other providers for reproductive health care and to obtain evidence-based care following the organization's termination from Medicaid. Ensuring all Medicaid patients have freedom to choose providers would improve access to quality contraception and other reproductive health care. IMPLICATIONS Medicaid-funded reproductive health care access is restricted for people living on low incomes when providers do not reliably accept all Medicaid plans or cannot participate in Medicaid. This situation can lead to lower quality care, delayed or forgone care, and emotional distress.
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Affiliation(s)
- Anna Chatillon
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | | | - Bhavik Kumar
- Planned Parenthood Gulf Coast, Houston, TX, United States
| | | | - Anitra D Beasley
- Planned Parenthood Gulf Coast, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Kari White
- Population Research Center, University of Texas at Austin, Austin, TX, United States; Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States.
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Hopkins K, Yarger J, Rossetto I, Sanchez A, Brown E, Elmes S, Mantaro T, White K, Harper CC. Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage. PLoS One 2023; 18:e0290726. [PMID: 37651402 PMCID: PMC10470945 DOI: 10.1371/journal.pone.0290726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Young people's ability to use their preferred contraceptive method is an indicator of reproductive autonomy and healthcare access. State policies can hinder or facilitate access to a preferred contraceptive method. OBJECTIVE This study compared use of preferred contraceptive method in Texas and California, states with contrasting health policy contexts that impact health insurance coverage and access to subsidized family planning services. METHODS We used baseline survey data from an ongoing cluster randomized controlled trial of sexually active students, assigned female at birth, ages 18-25, at 29 community colleges in Texas and California (N = 1,974). We described contraceptive preferences and use, as well as reasons for nonuse of a preferred method. We conducted multivariable-adjusted mixed-effects logistic regression analyses for clustered data, and then calculated the predicted probability of using a preferred contraceptive method in Texas and California by insurance status. RESULTS More Texas participants were uninsured than Californians (30% vs. 8%, p<0.001). Thirty-six percent of Texas participants were using their preferred contraceptive method compared to 51% of Californians. After multivariable adjustments, Texas participants had lower odds of using their preferred method (adjusted odds ratio = 0.62, 95% confidence interval = 0.48-0.81) compared to those in California. Texas participants in all insurance categories had a lower predicted probability of preferred method use compared to California participants. In Texas, we found a 12.1 percentage-point difference in the predicted probability of preferred method use between the uninsured (27.5%) and insured (39.6%) (p<0.001). Texans reported financial barriers to using their preferred method more often than Californians (36.7% vs. 19.2%, p<0.001) as did the uninsured compared to the insured (50.9% vs. 18.7%, p<0.001). CONCLUSION These findings present new evidence that state of residence plays an important role in young people's ability to realize their contraceptive preference. Young people in Texas, with lower insurance coverage and more limited access to safety net programs for contraceptive care than in California, have lower use of preferred contraception. It has become urgent in states with abortion bans to support young people's access to their preferred methods.
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Affiliation(s)
- Kristine Hopkins
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jennifer Yarger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Irene Rossetto
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Audrey Sanchez
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Elisa Brown
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Odessa, Texas, United States of America
| | - Sarah Elmes
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Thaddeus Mantaro
- Health Services and Promotion, Dallas College, Dallas, Texas, United States of America
| | - Kari White
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Cynthia C. Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
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Increasing Access to Intrauterine Devices and Contraceptive Implants: ACOG Committee Statement No. 5. Obstet Gynecol 2023; 141:866-872. [PMID: 36961974 DOI: 10.1097/aog.0000000000005127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Indexed: 03/25/2023]
Abstract
Everyone who desires long-acting reversible contraception should have timely access to contraceptive implants and intrauterine devices. Obstetrician-gynecologists and other reproductive health care clinicians can best serve those who want to delay or avoid pregnancy by adopting evidence-based practices and offering all medically appropriate contraceptive methods. Long-acting reversible contraceptive devices should be easily accessible to all people who want them, including adolescents and those who are nulliparous and after spontaneous or induced abortion and childbirth. To achieve equitable access, the American College of Obstetricians and Gynecologists supports the removal of financial barriers to contraception by advocating for coverage and appropriate payment and reimbursement for all contraceptive methods by all payers for all eligible patients.
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VandeVusse A, Mueller J, Kirstein M, Castillo PW, Kavanaugh ML. The impact of policy changes from the perspective of providers of family planning care in the US: results from a qualitative study. Sex Reprod Health Matters 2022; 30:2089322. [PMID: 35791904 PMCID: PMC9262356 DOI: 10.1080/26410397.2022.2089322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In recent years, there have been several state and federal policies that have disrupted access to publicly supported family planning care in the United States, including the 2019 rule that altered the federal Title X family planning program. In late 2020, we conducted in-depth interviews with health care providers from 55 facilities providing family planning care in Arizona, Iowa, and Wisconsin with the aim of learning how sites were affected by policy changes. We identified perceived effects on clinic finances, patient confidentiality, contraceptive counselling and service provision, and options counselling resulting from state and federal policy changes. Some clinics lost funding and had to pass some of the cost of services on to patients, raising new confidentiality concerns and creating new burdens on staff to carry out financial counselling with patients. Other sites had to grapple with restrictions on the pregnancy options counselling that they could provide, concentrate counselling on fertility awareness-based methods, and increase efforts to include parents/guardians in the care of adolescent patients. State and federal policies impact how publicly supported family planning care is provided, and compromise efforts to provide patient-centred care.
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Vohra-Gupta S, Ela E, Vizcarra E, Petruzzi LJ, Hopkins K, Potter JE, White K. Evidence-based family planning services among publicly funded providers in Texas. BMC Health Serv Res 2022; 22:1498. [PMID: 36482413 PMCID: PMC9733229 DOI: 10.1186/s12913-022-08889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthy Texas Women (HTW) is a fee-for-service family planning program that excludes affiliates of abortion providers. The HTW network includes providers who participate in Title X or the state Family Planning Program (FPP) and primary care providers without additional family planning funding (HTW-only). The objective of this study is to compare client volume and use of evidence-based practices among HTW providers. METHODS Client volume was determined from administrative data on unduplicated HTW clients served in fiscal year (FY) 2017. A sample of 114 HTW providers, stratified by region, completed a 2018 survey about contraceptive methods offered, adherence to evidence-based contraceptive provision, barriers to offering IUDs and implants, and counseling/referrals for pregnant patients. Differences by funding source were assessed using t-tests and chi-square tests. RESULTS Although HTW-only providers served 58% of HTW clients, most (72%) saw < 50 clients in FY2017. Only 5% of HTW providers received Title X or FPP funding, but 46% served ≥ 500 HTW clients. HTW-only providers were less likely than Title X providers to offer hormonal IUDs (70% vs. 92%) and implants (66% vs 96%); offer same-day placement of IUDs (21% vs 79%) and implants (21% vs 83%); and allow patients to delay cervical cancer screening when initiating contraception (58% vs 83%; all p < 0.05). There were few provider-level differences in counseling/referrals for unplanned pregnancy (p > 0.05). CONCLUSIONS HTW-only providers served fewer clients and were less likely to follow evidence-based practices. Program modifications that strengthen the provider network and quality of care are needed to support family planning services for low-income Texans.
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Affiliation(s)
- Shetal Vohra-Gupta
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Elizabeth Ela
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Elsa Vizcarra
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Kristine Hopkins
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Joseph E. Potter
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Kari White
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
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Short SE, Zacher M. Women's Health: Population Patterns and Social Determinants. ANNUAL REVIEW OF SOCIOLOGY 2022; 48:277-298. [PMID: 38765764 PMCID: PMC11101199 DOI: 10.1146/annurev-soc-030320-034200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Women's health, and what we know about it, are influenced by social factors. From the exclusion of women's bodies in medical research, to the silence and stigma of menstruation and menopause, to the racism reflected in maternal mortality, the relevance of social factors is paramount. After a brief history of research on women's health, we review selected patterns, trends, and inequalities in US women's health. These patterns reveal US women's poor and declining longevity relative to those in other high-income countries, gaps in knowledge about painful and debilitating conditions that affect millions of women, and deep inequalities that underscore the need to redress political and structural features of US society that enhance health for some and diminish it for others. We close by describing the challenges and opportunities for future research, and the promise of a social determinants of health approach for advancing a multilevel, intersectional, and biosocial understanding of women's health.
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Affiliation(s)
- Susan E Short
- Department of Sociology, Brown University, Providence, Rhode Island, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
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Rapp KS, Volpe VV, Hale TL, Quartararo DF. State-Level Sexism and Gender Disparities in Health Care Access and Quality in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:2-18. [PMID: 34794351 DOI: 10.1177/00221465211058153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this investigation, we examined the associations between state-level structural sexism-a multidimensional index of gender inequities across economic, political, and cultural domains of the gender system-and health care access and quality among women and men in the United States. We linked administrative data gauging state-level gender gaps in pay, employment, poverty, political representation, and policy protections to individual-level data on health care availability, affordability, and quality from the national Consumer Survey of Health Care Access (2014-2019; N = 24,250). Results show that higher state-level sexism is associated with greater inability to access needed health care and more barriers to affording care for women but not for men. Furthermore, contrary to our hypothesis, women residing in states with higher state-level sexism report better quality of care than women in states with lower levels of sexism. These findings implicate state-level sexism in perpetuating gender disparities in health care.
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Where are the labor markets?: Examining the association between structural racism in labor markets and infant birth weight. Health Place 2022; 74:102742. [PMID: 35091167 PMCID: PMC8923951 DOI: 10.1016/j.healthplace.2022.102742] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 12/28/2021] [Accepted: 01/08/2022] [Indexed: 12/27/2022]
Abstract
Racist policies and practices that restrict Black, as compared to white workers, from employment may drive racial inequities in birth outcomes among workers. This study examined the association between structural racism in labor markets, measured at a commuting zone where workers live and commute to work, and low-birthweight birth. We found the deleterious effect of structural racism in labor markets among US-born Southern Black pregnant people of working age, but not among African- or Caribbean-born counterparts in any US region. Our analysis highlights the intersections of structural racism, culture, migration, and history of racial oppression that vary across regions and birth outcomes of Black workers.
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Matos JE, Balkaran BL, Rooney J, Crespi S. Preference for Contraceptive Implant Among Women 18-44 years old. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:622-632. [PMID: 35141710 PMCID: PMC8820401 DOI: 10.1089/whr.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
Introduction: This study aimed to understand women's preferences regarding the subdermal contraceptive implant and to assess the proportion of women who would be underserved (with increased unintended pregnancies as the consequence) by not providing implant access equal to that of uterine-based long-acting reversible contraceptive methods (LARCs). Methods: A total of 1,200 women aged 18-44 years old (mean: 30.42 ± 7.67 years) participated in a U.S. cross-sectional online survey. To qualify for the study, women had to be sexually active with a male and not pregnant or trying to get pregnant at the time of the study. Women who had undergone a hysterectomy, a bilateral salpingo-oophorectomy, or a tubal ligation, and women with general infertility or those with a vasectomized partner were excluded. Descriptive analyses were conducted and weighted estimates, projecting to the total U.S. population were also provided. Results: The majority of women (72.6%) reported that they would be willing to switch to a LARC, should it be readily available to them. Considering those women who already use an implant and those who would be willing to switch to it, 58% of women would be underserved by not being provided equal access to the subdermal implant. This reduced availability of this type of LARC may alone elevate the number of unintended pregnancies in the United States by ∼8% of all pregnancies per year. Conclusion: Thus, making all the available contraceptive methods and maintaining access to LARCs would help reduce unintended pregnancies and better serve women and their family planning needs.
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Protecting and Expanding Medicaid to Improve Women's Health: ACOG Committee Opinion, Number 826. Obstet Gynecol 2021; 137:e163-e168. [PMID: 33760779 DOI: 10.1097/aog.0000000000004383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT Medicaid, the state-federal health insurance program for individuals with low incomes, serves as a safety net for women throughout the life span. Historically, expansions of Medicaid have been associated with improved access to health care, less delay in obtaining health care, better self-reported health, and reductions in mortality. Compared with nonexpansion states, states that have participated in the Affordable Care Act's Medicaid expansion have experienced improvements in maternal and infant mortality and decreases in uninsured rates and have decreased racial inequities for these measures. In addition to supporting policies that expand access to Medicaid, the American College of Obstetricians and Gynecologists strongly supports education for its members, other obstetrician-gynecologists, and other health care practitioners regarding the complex system for regulation of Medicaid and encourages advocacy for policies that increase access to care for all women. This Committee Opinion has been revised to emphasize the importance of Medicaid to improving women's health, the history and growth of Medicaid, including the ACA's Medicaid expansion, and the mechanisms by which changes to the Medicaid program can occur, and it includes relevant examples for each.
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Post L, Mason M, Singh LN, Wleklinski NP, Moss CB, Mohammad H, Issa TZ, Akhetuamhen AI, Brandt CA, Welch SB, Oehmke JF. Impact of Firearm Surveillance on Gun Control Policy: Regression Discontinuity Analysis. JMIR Public Health Surveill 2021; 7:e26042. [PMID: 33783360 PMCID: PMC8103291 DOI: 10.2196/26042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Public mass shootings are a significant public health problem that require ongoing systematic surveillance to test and inform policies that combat gun injuries. Although there is widespread agreement that something needs to be done to stop public mass shootings, opinions on exactly which policies that entails vary, such as the prohibition of assault weapons and large-capacity magazines. OBJECTIVE The aim of this study was to determine if the Federal Assault Weapons Ban (FAWB) (1994-2004) reduced the number of public mass shootings while it was in place. METHODS We extracted public mass shooting surveillance data from the Violence Project that matched our inclusion criteria of 4 or more fatalities in a public space during a single event. We performed regression discontinuity analysis, taking advantage of the imposition of the FAWB, which included a prohibition on large-capacity magazines in addition to assault weapons. We estimated a regression model of the 5-year moving average number of public mass shootings per year for the period of 1966 to 2019 controlling for population growth and homicides in general, introduced regression discontinuities in the intercept and a time trend for years coincident with the federal legislation (ie, 1994-2004), and also allowed for a differential effect of the homicide rate during this period. We introduced a second set of trend and intercept discontinuities for post-FAWB years to capture the effects of termination of the policy. We used the regression results to predict what would have happened from 1995 to 2019 had there been no FAWB and also to project what would have happened from 2005 onward had it remained in place. RESULTS The FAWB resulted in a significant decrease in public mass shootings, number of gun deaths, and number of gun injuries. We estimate that the FAWB prevented 11 public mass shootings during the decade the ban was in place. A continuation of the FAWB would have prevented 30 public mass shootings that killed 339 people and injured an additional 1139 people. CONCLUSIONS This study demonstrates the utility of public health surveillance on gun violence. Surveillance informs policy on whether a ban on assault weapons and large-capacity magazines reduces public mass shootings. As society searches for effective policies to prevent the next mass shooting, we must consider the overwhelming evidence that bans on assault weapons and/or large-capacity magazines work.
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Affiliation(s)
- Lori Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maryann Mason
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lauren Nadya Singh
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainsville, FL, United States
| | - Hassan Mohammad
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Cynthia A Brandt
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Francis Oehmke
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Bossick AS, Brown J, Hanna A, Parrish C, Williams EC, Katon JG. Impact of State-Level Reproductive Health Legislation on Access to and Use of Reproductive Health Services and Reproductive Health Outcomes: A Systematic Scoping Review in the Affordable Care Act Era. Womens Health Issues 2020; 31:114-121. [PMID: 33303355 DOI: 10.1016/j.whi.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We systematically reviewed the literature to understand the associations between state-level reproductive health policies and reproductive health care outcomes and describe policy impacts on reproductive health outcomes among women aged 18 and older. We focused on research conducted after the implementation of the Patient Protection and Affordable Care Act to understand the influence of state-level policies in the context of existing federal policy. METHODS Standard search terms were used to search PubMed for studies published between March 10, 2010, and August 31, 2019. Studies were included that reflected original U.S.-based research testing associations between state-level policies (i.e., laws related to family planning, maternity care, and abortion) and reproductive health outcomes related to those services (e.g., prenatal care use) among adults. Reference lists of systematic reviews were searched to improve the identification of relevant studies. Studies were excluded if they were reviews, qualitative or mixed-methods studies, or descriptive studies, or if a state was not the unit of analysis. After dual review, agreement on inclusion of studies was 100%. RESULTS Search results returned 1,529 articles; 56 (3.59%) met the inclusion criteria for a full review based on title and abstract review. After dual independent review, eight were selected for inclusion. Two included all 50 states and Washington, DC; one included Oregon and Washington; and the remaining studies included single states (Texas, Arizona, Ohio, and Utah). One-half of the studies (n = 4) focused solely on restrictive abortion legislation. Restricting access to family planning and abortion services (e.g., mandatory waiting periods) were associated with negative outcomes (e.g., additional interventions for medication abortion). Expanding maternity care through Medicaid reform and autonomous midwifery laws were associated with positive outcomes (e.g., prenatal care use). CONCLUSIONS Our review identified eight studies that were largely focused on only one key aspect of reproductive health policy. Findings suggest that state-level legislation could have considerable impact on the reproductive health care that women have access to and receive, as well as the related outcomes. Research in this area remains limited. Rigorous evaluations of the relationship between the breadth of reproductive health policies and related health outcomes are needed, as is an exploration of barriers to the conduct of this type of research.
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Affiliation(s)
- Andrew S Bossick
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.
| | - Jennifer Brown
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ami Hanna
- Department of Health Services, University of Washington, Seattle, Washington
| | - Canada Parrish
- Department of Health Services, University of Washington, Seattle, Washington
| | - Emily C Williams
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington
| | - Jodie G Katon
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington
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Roberts SC, Schroeder R, Joffe C. COVID-19 and Independent Abortion Providers: Findings from a Rapid-Response Survey. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:217-225. [PMID: 33289197 PMCID: PMC7753746 DOI: 10.1363/psrh.12163] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 05/04/2023]
Abstract
CONTEXT The ways in which the COVID-19 pandemic has affected abortion providers and abortion care, and the strategies clinics are adopting to navigate the pandemic, have not been well documented. METHODS In April-May 2020, representatives from 103 independent abortion clinics (i.e., those not affiliated with Planned Parenthood) completed a survey that included close-ended questions about how the pandemic, the public health response, and designations of abortion as a nonessential service had affected their clinic, as well as open-ended questions about the pandemic's impact. Analyses were primarily descriptive but included an exploration of regional variation. RESULTS All U.S. regions were represented in the sample. At 51% of clinics, clinicians or staff had been unable to work because of the pandemic or public health responses. Temporary closures were more common among clinics in the South (35%) and Midwest (21%) than in the Northeast and West (5% each). More than half of clinics had canceled or postponed nonabortion services (e.g., general gynecologic care); cancelation or postponement of abortion services was less common (25-38%, depending on type) and again especially prevalent in the South and Midwest. Respondents reported the pandemic had had numerous effects on their clinics, including disrupting their workforce, clinic flow and work practices; increasing expenses; and reducing revenues. State laws (including designations of abortion as nonessential) had exacerbated these difficulties. CONCLUSIONS Although independent abortion clinics have faced considerable challenges from the pandemic, most continued to provide abortion care. Despite this resiliency, additional support may be needed to ensure sustainability of these clinics.
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Affiliation(s)
- Sarah C.M. Roberts
- Advancing New Standards in Reproductive HealthUniversity of CaliforniaSan Francisco
| | - Rosalyn Schroeder
- Bixby Center for Global Reproductive HealthUniversity of CaliforniaSan Francisco
| | - Carole Joffe
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Francisco
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15
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Abstract
The United States is the only industrialized nation with an increasing maternal mortality. Many factors contribute to this worrisome US trend; among them, social and demographic factors, and congenital and acquired cardiac conditions. Cardiovascular disease is the leading cause of maternal mortality, and adverse outcomes related to cardiovascular disease disproportionately affect black and Hispanic mothers. This article addresses knowledge gaps related to the treatment of heart disease in pregnancy, initiatives to address these gaps, and guidelines and best practices surrounding the care of women affected by cardiovascular disease and their babies affected by cardiovascular disease.
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Affiliation(s)
- Anna Grodzinsky
- Saint Luke's Mid America Heart Institute and Muriel Kauffman Women's Heart Center, 4401 Wornall Road, Kansas City, MO 64111, USA.
| | - Laura Schmidt
- Saint Luke's Mid America Heart Institute and Muriel Kauffman Women's Heart Center, 4401 Wornall Road, Kansas City, MO 64111, USA
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Darney BG, Biel FM, Rodriguez MI, Jacob RL, Cottrell EK, DeVoe JE. Payment for Contraceptive Services in Safety Net Clinics: Roles of Affordable Care Act, Title X, and State Programs. Med Care 2020; 58:453-460. [PMID: 32049877 PMCID: PMC7148195 DOI: 10.1097/mlr.0000000000001309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
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Affiliation(s)
- Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
- National Institute of Public Health, Population Research Center (INSP/CISP), Cuernavaca, Morelos, Mexico
- OHSU-PSU School of Public Health
| | - Frances M Biel
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | | | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
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Anderson ML, Dobkin C, Gorry D. The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality: An Observational Study With a Regression Discontinuity Design. Ann Intern Med 2020; 172:445-452. [PMID: 32120383 DOI: 10.7326/m19-3075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Observational studies using traditional research designs suggest that influenza vaccination reduces hospitalizations and mortality among elderly persons. Accordingly, health authorities in some countries prioritize vaccination of this population. Nevertheless, questions remain about this policy's effectiveness given the potential for bias and confounding in observational data. OBJECTIVE To determine the effectiveness of the influenza vaccine in reducing hospitalizations and mortality among elderly persons by using an observational research design that reduces the possibility of bias and confounding. DESIGN A regression discontinuity design was applied to the sharp change in vaccination rate at age 65 years that resulted from an age-based vaccination policy in the United Kingdom. In this design, comparisons were limited to individuals who were near the age-65 threshold and were thus plausibly similar along most dimensions except vaccination rate. SETTING England and Wales. PARTICIPANTS Adults aged 55 to 75 years residing in the study area during 2000 to 2014. INTERVENTION Seasonal influenza vaccine. MEASUREMENTS Hospitalization and mortality rates by month of age. RESULTS The data included 170 million episodes of care and 7.6 million deaths. Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons. The estimates were precise enough to rule out results from many previous studies. LIMITATION The study relied on observational data, and its focus was limited to individuals near age 65 years. CONCLUSION Current vaccination strategies prioritizing elderly persons may be less effective than believed at reducing serious morbidity and mortality in this population, which suggests that supplementary strategies may be necessary. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Michael L Anderson
- University of California, Berkeley, Berkeley, California, and National Bureau of Economic Research, Cambridge, Massachusetts (M.L.A.)
| | - Carlos Dobkin
- University of California, Santa Cruz, Santa Cruz, California, and National Bureau of Economic Research, Cambridge, Massachusetts (C.D.)
| | - Devon Gorry
- Clemson University, Clemson, South Carolina (D.G.)
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18
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Affiliation(s)
- Lisa H Harris
- From the Department of Obstetrics and Gynecology and the Department of Women's Studies, University of Michigan, Ann Arbor (L.H.H.); and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), and the Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco (D.G.)
| | - Daniel Grossman
- From the Department of Obstetrics and Gynecology and the Department of Women's Studies, University of Michigan, Ann Arbor (L.H.H.); and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), and the Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco (D.G.)
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Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study. Am J Prev Med 2020; 58:165-174. [PMID: 31859173 DOI: 10.1016/j.amepre.2019.09.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recent increases in maternal mortality and persistent disparities have led to speculation about why the U.S. has higher rates than most high-income countries. The aim was to examine the impact of changes in state-level factors plausibly linked to maternal mortality on overall rates and by race/ethnicity. METHODS This quasi-experimental, population-based, difference-in-differences study used 2007-2015 National Vital Statistics System microdata mortality files from 38 states and DC. The primary exposures were 5 state-level sexual and reproductive health indicators and 6 health and economic conditions. Maternal mortality rate was defined as number of deaths of women while pregnant or within 42 days of termination of pregnancy per 100,000 live births. A difference-in-differences zero-inflated negative binomial regression model was estimated using the race/ethnicity-age-state-year population as the denominator and adjusting for race/ethnicity, age, state, and year. Data were analyzed in 2017-2018. RESULTS There were 4,767 deaths among women up to age 44 years, resulting in a maternal mortality rate of 17.9. Reducing the proportion of Planned Parenthood clinics by 20% from the state-year mean increased the maternal mortality rate by 8% (incidence rate ratio, 1.08; 95% CI=1.04, 1.12). States that enacted legislation to restrict abortions based on gestational age increased the maternal mortality rate by 38% (incidence rate ratio, 1.38; 95% CI=1.03, 1.84). Planned Parenthood clinic closures negatively impacted all women, increasing mortality by 6%-15% across racial/ethnic groups, whereas gestational limits primarily increased mortality among white women. CONCLUSIONS Recent fiscal and legislative changes reducing women's access to family planning and reproductive health services have contributed to rising maternal mortality rates.
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Drake C, Jarlenski M, Zhang Y, Polsky D. Market Share of US Catholic Hospitals and Associated Geographic Network Access to Reproductive Health Services. JAMA Netw Open 2020; 3:e1920053. [PMID: 31995216 PMCID: PMC6991305 DOI: 10.1001/jamanetworkopen.2019.20053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. OBJECTIVE To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. MAIN OUTCOMES AND MEASURES The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. RESULTS The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. CONCLUSIONS AND RELEVANCE In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.
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Affiliation(s)
- Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Yuehan Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel Polsky
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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ROSENBAUM SARA. A Catastrophe for Public Health and Law. Milbank Q 2019; 97:910-913. [PMID: 31544278 PMCID: PMC6904254 DOI: 10.1111/1468-0009.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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22
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Choi Y, Park H, Hampp C, Brumback B, Meissner HC, Li Y, Roussos-Ross D, Zhu Y, Henriksen C, Winterstein AG. Usability of encounter data for Medicaid comprehensive managed care vs traditional Medicaid fee-for-service claims among pregnant women. Pharmacoepidemiol Drug Saf 2019; 29:30-38. [PMID: 31737976 DOI: 10.1002/pds.4923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The completeness of medical encounters capture among Medicaid enrollees in comprehensive managed care (CMC) has been shown to vary across states and years. CMC penetration has grown, and CMC encounter capture specific to pregnancy care is understudied. OBJECTIVES To compare the completeness of encounter data for pregnant beneficiaries in CMC versus traditional fee-for-service (FFS) in Texas and Florida between 2007 and 2010. METHODS Using Medicaid Analytic eXtract (MAX) data linked to Florida and Texas birth certificate records, for each state and study year, we compared proportions using seven themes: (a) delivery; (b) prenatal visits; (c) dispensed prescriptions during pregnancy; (d) gestational diabetes and blood glucose testing; (e) antidiabetics and diagnosis of diabetes mellitus; (f) antibiotics for urinary tract infection and outpatient encounter; and (g) bacterial vaginosis and dispensing for metronidazole or clindamycin. We considered CMC data to be acceptable if proportions were no less than 10% below the corresponding (2007 to 2010) FFS control values. RESULTS Pregnancy-related characteristics of FFS vs CMC denominators were comparable. Proportions for the seven measures among FFS controls ranged from 26% to 98%. In Texas, CMC encounter data met the thresholds for all measures between 2007 and 2010. Florida had usable CMC encounter data starting from 2009 with incomplete medical and pharmacy records in 2007 and 2008. CONCLUSIONS The quality of CMC encounter data in MAX files for pregnant women varied in Florida and Texas and improved over time. Use of pregnancy-specific measures can aid researchers in selecting states and years with acceptable encounter data quality.
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Affiliation(s)
- Yoonyoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Christian Hampp
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Babette Brumback
- Biostatistics, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL, USA
| | - H Cody Meissner
- Tufts University School of Medicine and the Department of Pediatrics, Tufts Medical Center, Boston, MA, USA
| | - Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yanmin Zhu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Taylor YJ, Liu TL, Howell EA. Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study. J Womens Health (Larchmt) 2019; 29:29-37. [PMID: 31397625 DOI: 10.1089/jwh.2019.7658] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. We compared health care use and adverse birth outcomes by insurance status among women giving birth in a large health system in a Medicaid nonexpansion state. Materials and Methods: We conducted a population-based retrospective cohort study using data for 9,613 women with deliveries during 2014-2015 at six hospitals associated with a large vertically integrated health care system in North Carolina. Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes). Results: Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23-0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64-3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03-1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics. Conclusions: Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care.
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Affiliation(s)
- Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
| | - Tsai-Ling Liu
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Department of Obstetrics, Gynecology, and Reproductive Science, and the Blavatnik Family Women's Health Research Institute at the Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Campbell-Salome G. "Yes they have the right to know, but…": Young Adult Women Managing Private Health Information as Dependents. HEALTH COMMUNICATION 2019; 34:1010-1020. [PMID: 29565677 DOI: 10.1080/10410236.2018.1452092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored how young adult women manage privacy regarding their health information as dependents on a parent's insurance policy. Under current and proposed health care reform in the United States, young adults between the ages of 18 and 26 years can remain on a parent's policy as a dependent, which can improve young adult's access to health care services. Although dependent expansion provisions can improve coverage for young adults, it may also threaten their privacy by giving a parent access to adult-child's private health information. Using Communication Privacy Management, this study investigated how dependent young adult women conceptualize and negotiate information ownership with parents in a forced disclosure situation. Results revealed young adult women either felt they alone should own and control their health information or believed a parent as the policy hold should have access to the information. However, all preferred to be in control of the disclosure and used core and catalyst criteria to manage the privacy dilemma current health care policy creates. Specifically, the threat of a parent seeing an adult-child used a stigmatized health service motivated young adult women to engage in deception, pay out of pocket for services covered by insurance, and put off or avoid health care. Results of this study complicate assumptions about privacy management and demonstrate how health care policy affects family communication.
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Grodzinsky A, Florio K, Spertus JA, Daming T, Schmidt L, Lee J, Rader V, Nelson L, Gray R, White D, Swearingen K, Magalski A. Maternal Mortality in the United States and the HOPE Registry. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:42. [DOI: 10.1007/s11936-019-0745-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type. Med Care 2019; 57:437-443. [PMID: 30973473 DOI: 10.1097/mlr.0000000000001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion. OBJECTIVES To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. RESEARCH DESIGN A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states. SUBJECTS Administrative data from Family Planning Annual Reports that describe Title X clients who sought services. MEASURES Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15-44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type. RESULTS We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification. CONCLUSIONS Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.
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Redd SK, Hall KS. Medicaid Family Planning Expansions: The Effect of State Plan Amendments on Postpartum Contraceptive Use. J Womens Health (Larchmt) 2019; 28:551-559. [PMID: 30484739 PMCID: PMC6482903 DOI: 10.1089/jwh.2018.7129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the effect of state Medicaid family planning (FP) programs transitioning from a Section 1115 waiver to a State Plan Amendment (SPA) on reproductive health outcomes. MATERIALS AND METHODS Data were from the Pregnancy Risk Assessment Monitoring System on 75,082 women who had a live birth between 2007 and 2013 and were living in one of nine states. We performed a difference-in-differences analysis to quantify the effect of the transition on postpartum contraceptive (PPC) use and unintended births (UBs). RESULTS Over 80% of the sample reported using PPC; half reported an UB. The odds of PPC use among women who were living in a study state and gave birth after the transition were 1.14 times that of women who were living in a comparison state and/or gave birth before the transition (95% confidence interval: 1.04-1.24). CONCLUSIONS Findings suggest that women living in states that transitioned from a waiver to SPA experienced an increased likelihood of PPC compared with those living in comparison states.
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Affiliation(s)
- Sara K. Redd
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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28
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White K, Hopkins K, Grossman D, Potter JE. Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence. Health Serv Res 2018; 53 Suppl 1:2770-2786. [PMID: 29053179 PMCID: PMC6056580 DOI: 10.1111/1475-6773.12783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. DATA SOURCES Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. STUDY DESIGN Interviews addressed organizational capacities to expand family planning and integrate services with primary care. DATA EXTRACTION Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. PRINCIPAL FINDINGS Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. CONCLUSIONS Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided.
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Affiliation(s)
- Kari White
- Department of Health Care Organization and PolicyUniversity of Alabama at BirminghamBirminghamAL
| | - Kristine Hopkins
- Population Research Center and the Department of SociologyThe University of Texas at AustinAustinTX
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH)Bixby Center for Global Reproductive HealthDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoOaklandCA
| | - Joseph E. Potter
- Population Research Center and the Department of SociologyThe University of Texas at AustinAustinTX
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Farkas AH, Vanderberg R, McNeil M, Rothenberger S, Contratto E, Dolan BM, Tilstra S. The Impact of Women's Health Residency Tracks on Career Outcomes. J Womens Health (Larchmt) 2018; 27:927-932. [DOI: 10.1089/jwh.2017.6739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy H. Farkas
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Rachel Vanderberg
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott Rothenberger
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erin Contratto
- Department of Internal Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Brigid M. Dolan
- Department of Internal Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine Northwestern University, Chicago, Illinois
| | - Sarah Tilstra
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Hopkins K, Hubert C, Coleman-Minahan K, Stevenson AJ, White K, Grossman D, Potter JE. Unmet demand for short-acting hormonal and long-acting reversible contraception among community college students in Texas. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:360-368. [PMID: 29405858 PMCID: PMC6692077 DOI: 10.1080/07448481.2018.1431901] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To identify preferences for and use of short-acting hormonal (e.g., oral contraceptives, injectable contraception) or long-acting reversible contraception (LARC) among community college students in Texas. PARTICIPANTS Female community college students, ages 18 to 24, at risk of pregnancy, sampled in Fall 2014 or Spring 2015 (N = 966). METHODS We assessed characteristics associated with preference for and use of short-acting hormonal or LARC methods (i.e., more-effective contraception). RESULTS 47% preferred short-acting hormonal methods and 21% preferred LARC, compared to 21% and 9%, respectively, who used these methods. A total of 63% of condom and withdrawal users and 78% of nonusers preferred a more effective method. Many noted cost and insurance barriers as reasons for not using their preferred more-effective method. CONCLUSIONS Many young women in this sample who relied on less-effective methods preferred to use more-effective contraception. Reducing barriers could lead to higher uptake in this population at high risk of unintended pregnancy.
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Affiliation(s)
- Kristine Hopkins
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- b Population Research Center, University of Texas at Austin , Austin , Texas , USA
| | - Celia Hubert
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- c Cátedras CONACYT - National Institute of Public Health , Ciudad de México , Mexico
| | - Kate Coleman-Minahan
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- d College of Nursing, University of Colorado Denver , Aurora , Colorado , USA
| | - Amanda Jean Stevenson
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- e Department of Sociology , University of Colorado Boulder , Boulder , Colorado , USA
| | - Kari White
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- f Health Care Organization and Policy, University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Daniel Grossman
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- g Advancing New Standards in Reproductive Health, University of California San Francisco , Oakland , California , USA
| | - Joseph E Potter
- a Texas Policy Evaluation Project, University of Texas at Austin , Austin , Texas , USA
- b Population Research Center, University of Texas at Austin , Austin , Texas , USA
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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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MacDorman MF, Declercq E, Thoma ME. Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015. Birth 2018; 45:169-177. [PMID: 29314209 PMCID: PMC5980674 DOI: 10.1111/birt.12330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/02/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Maternal mortality is a sentinel indicator of health care quality. Our purpose was to analyze trends in Texas maternal mortality by demographic characteristics and cause of death, and to evaluate data quality. METHODS Maternal mortality data were initially analyzed by single years, but then were grouped into 5-year averages (2006-2010 and 2011-2015) for more detailed analyses. Rates were computed per 100 000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences. RESULTS The Texas maternal mortality rate increased from 18.6 in 2010 to 38.7 in 2012, and then declined nonsignificantly to 32.5 in 2015. The 2011-2015 rate (34.2) was 87% higher than the 2006-2010 rate (18.3). In 2011-2015, the maternal mortality rate for women ≥40 years (558.8) was 27 times higher than for women <40 years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women ≥40 years and by 55% for women <40 years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40 years for specific causes increased by 36%. CONCLUSIONS The observed increase in maternal mortality in Texas from 2006-2010 to 2011-2015 is likely a result of both a true increase in rates and increased overreporting of maternal deaths, as indicated by implausibly high and increasing rates for women aged ≥40 years and among nonspecific causes of death. Efforts are needed to strengthen reporting of death certificate data, and to improve access to quality maternal health care services.
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Affiliation(s)
- Marian F. MacDorman
- Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Eugene Declercq
- Department of Community Health, Boston University School of Public Health, Boston, MA, USA
| | - Marie E. Thoma
- Department of Family Science, University of Maryland, College Park, MD, USA
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Gawron L, Pettey WBP, Redd A, Suo Y, Turok DK, Gundlapalli AV. The "Safety Net" of Community Care: Leveraging GIS to Identify Geographic Access Barriers to Texas Family Planning Clinics for Homeless Women Veterans. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:750-759. [PMID: 29854141 PMCID: PMC5977597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Veterans Healthcare Administration (VHA) is developing a civilian referral system to address specialty access issues to VHA healthcare. Homeless women Veterans may not have the resources to navigate referral systems when travel to VHA Medical Centers (VAMCs) is limited, especially for family planning needs. Recent Texas legislation restricted funding to civilian, publically-funded family planning clinics, limiting comprehensive services. This study's goal was to assess geographic availability of VAMCs and family planning clinics for homeless Texan women Veterans. We identified 3,246 Texan women Veterans, age 18-44y with administrative homelessness evidence anytime between 2002-2015. Significant clusters of homeless women Veterans were near VHA facilities, yet mean travel distance was 24.1 miles (range 0-239) to nearest family planning clinic compared to 82.6 miles (range 0.8316.4) to nearest VAMC. Community clinics need ongoing civilian funding support if the VHA is to rely on their geographic availability as a safety net for vulnerable Veterans.
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Affiliation(s)
- Lori Gawron
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, UT
- Departments of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Warren B P Pettey
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, UT
- Departments of Internal Medicine University of Utah School of Medicine, Salt Lake City, UT
| | - Andrew Redd
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, UT
- Departments of Internal Medicine University of Utah School of Medicine, Salt Lake City, UT
| | - Ying Suo
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, UT
- Departments of Internal Medicine University of Utah School of Medicine, Salt Lake City, UT
| | - David K Turok
- Departments of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, UT
- Departments of Internal Medicine University of Utah School of Medicine, Salt Lake City, UT
- Departments of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
- US Department of Veterans Affairs National Center for Homelessness Among Veterans, Philadelphia, PA
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Ronen S, Lee J, Patel P, Patel P. A Comparison of Childbirth Costs for Adolescents and Adults From 2001 to 2010. J Adolesc Health 2018; 62:59-62. [PMID: 29146155 DOI: 10.1016/j.jadohealth.2017.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Although teenage birth rates in America have fallen to a historic low of 26.2 births per 1,000 teenagers, the U.S. remains behind the rest of the industrialized world. Adolescent pregnancy is relatively well discussed in today's literature, with ever more detailed estimates constantly emerging to quantify the cost of children born to America's teenagers. This study, however, describes the financial cost of childbirth in the U.S. with a specific focus on understanding the impact of adolescent childbirth in comparison to that of adult women and of annual childbirth as a whole. METHODS This retrospective cohort study used data from the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), a uniform, multistate database containing information regarding approximately 8 million hospital inpatient stays per year of data. Data were analyzed involving payment type, length of stay, and aggregate cost of all childbirths to adolescent girls (under 18 years of age) and to adult women. RESULTS This study found that Medicaid pays for the majority (70%) of births to adolescent girls, whereas private insurance pays for the majority (53%) of births to adult women. This was in contrast to the Medicaid coverage of 41% of all childbirths within the study time frame. Furthermore, the aggregate cost of childbirths to adolescent girls paid for by Medicaid was $670 million. CONCLUSIONS Beyond their social impact, births to adolescent mothers place a financial burden on the national economy. Stronger efforts must be made to decrease adolescent childbirth.
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Affiliation(s)
- Smadar Ronen
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Seoul, South Korea
| | - Parin Patel
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Pooja Patel
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
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Gold RB, Hasstedt K. Lessons From Texas: Widespread Consequences of Assaults on Abortion Access. Am J Public Health 2017; 106:970-1. [PMID: 27153009 DOI: 10.2105/ajph.2016.303220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Benson Gold
- Rachel Benson Gold and Kinsey Hasstedt are with the Guttmacher Institute, Washington, DC
| | - Kinsey Hasstedt
- Rachel Benson Gold and Kinsey Hasstedt are with the Guttmacher Institute, Washington, DC
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36
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Rosenbaum L. Understanding the Planned Parenthood Divide - Albert Lasker and Women's Health. N Engl J Med 2017; 377:2409-2411. [PMID: 29091553 DOI: 10.1056/nejmp1713518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lisa Rosenbaum
- Dr. Rosenbaum is a national correspondent for the Journal
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38
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Packham A. Family planning funding cuts and teen childbearing. JOURNAL OF HEALTH ECONOMICS 2017; 55:168-185. [PMID: 28811119 DOI: 10.1016/j.jhealeco.2017.07.002] [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] [Received: 10/12/2016] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
Publicly funded family planning clinics provide low-cost and free contraception to nearly 1.5 million teens each year. In recent years, several states have considered legislation to defund family planning services, although little is known about how these cuts affect teen pregnancy. This paper fills this knowledge gap by exploiting a policy change in Texas that reduced funding for family planning services by 67% and resulted in over 80 clinic closures. I estimate the effects of the funding cuts on teen health outcomes using a difference-in-differences approach that compares the changes in teen birth rates in Texas counties that lost family planning funding to changes in counties outside of Texas with publicly funded clinics. I find that reducing funding for family planning services in Texas increased teen birth rates by approximately 3.4% over four years with effects concentrated 2-3 years after the initial cuts.
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Affiliation(s)
- Analisa Packham
- Miami University, Department of Economics, 800 E. High St., Oxford, OH 45056, United States.
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39
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Adolescent Reproductive Health Without Planned Parenthood. J Pediatr Adolesc Gynecol 2017; 30:445-446. [PMID: 28552564 DOI: 10.1016/j.jpag.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Silver D, Kapadia F. Planned Parenthood Is Health Care, and Health Care Must Defend It: A Call to Action. Am J Public Health 2017; 107:1040-1041. [PMID: 28541710 DOI: 10.2105/ajph.2017.303867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Diana Silver
- Diana Silver is associate professor of public health policy at New York University's College of Global Public Health, New York. Farzana Kapadia is associate professor of public health and population health at New York University's College of Global Public Health and Department of Population Health
| | - Farzana Kapadia
- Diana Silver is associate professor of public health policy at New York University's College of Global Public Health, New York. Farzana Kapadia is associate professor of public health and population health at New York University's College of Global Public Health and Department of Population Health
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Gaffney A, McCormick D. The Affordable Care Act: implications for health-care equity. Lancet 2017; 389:1442-1452. [PMID: 28402826 DOI: 10.1016/s0140-6736(17)30786-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/17/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access-particularly for poorer Americans, women, and minorities-its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform-especially following the 2016 presidential election-is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.
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Affiliation(s)
- Adam Gaffney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Danny McCormick
- Division of Social and Community Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet 2017; 389:1431-1441. [PMID: 28402825 DOI: 10.1016/s0140-6736(17)30398-7] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/19/2016] [Accepted: 01/06/2017] [Indexed: 11/29/2022]
Abstract
Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.
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Affiliation(s)
- Samuel L Dickman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - David U Himmelstein
- City University of New York School of Urban Public Health at Hunter College, New York, NY, USA; Harvard Medical School, Boston, MA, USA.
| | - Steffie Woolhandler
- City University of New York School of Urban Public Health at Hunter College, New York, NY, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Over the past two decades, births to U.S. teenagers have fallen and no longer follow overall fertility patterns. Yet the unique challenges faced by teenage mothers and their families justify continued research. Across disciplines, newer work has furthered our understanding of teenage motherhood today. In this article, I highlight four areas of progress: processes of selection into teenage motherhood, the broader consequences of teenage childbearing beyond the socioeconomic realm, heterogeneity of effects, and the application of life course principles. Emerging societal trends such as complex family structures, a stalled recovery from the recession for families of low socioeconomic status, and a rapidly evolving political environment for reproductive health care continue to challenge the lives of teenage mothers. Given that the consequences for teenagers of becoming mothers may change, continued research is needed. Shifts in policy to favor supporting teenage mothers and addressing the causes of both teenage pregnancy and social disadvantage may help improve the lives of these mothers and their families.
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MacDorman MF, Declercq E, Cabral H, Morton C. Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues. Obstet Gynecol 2016; 128:447-455. [PMID: 27500333 PMCID: PMC5001799 DOI: 10.1097/aog.0000000000001556] [Citation(s) in RCA: 285] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop methods for trend analysis of vital statistics maternal mortality data, taking into account changes in pregnancy question formats over time and between states, and to provide an overview of U.S. maternal mortality trends from 2000 to 2014. METHODS This observational study analyzed vital statistics maternal mortality data from all U.S. states in relation to the format and year of adoption of the pregnancy question. Correction factors were developed to adjust data from before the standard pregnancy question was adopted to promote accurate trend analysis. Joinpoint regression was used to analyze trends for groups of states with similar pregnancy questions. RESULTS The estimated maternal mortality rate (per 100,000 live births) for 48 states and Washington, DC (excluding California and Texas, analyzed separately) increased by 26.6%, from 18.8 in 2000 to 23.8 in 2014. California showed a declining trend, whereas Texas had a sudden increase in 2011-2012. Analysis of the measurement change suggests that U.S. rates in the early 2000s were higher than previously reported. CONCLUSION Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington, DC, increased from 2000 to 2014; the international trend was in the opposite direction. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year.
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Affiliation(s)
- Marian F. MacDorman
- Research Professor, Maryland Population Research Center, 2015 Morrill Hall, University of Maryland, College Park, MD 20742, Phone: 301-565-3811
| | - Eugene Declercq
- Professor and Assistant Dean for Doctoral Education, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Howard Cabral
- Professor of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Christine Morton
- Research Sociologist, California Maternal Quality Care Collaborative, Stanford University Medical School, Palo Alto CA 94305
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Rostadmo M. Bortfall av støtte til prevensjonsklinikker har konsekvenser. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016. [DOI: 10.4045/tidsskr.16.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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