Womens Health Issues最新文献

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Black Women Benefit From Psychotherapies for Insomnia, but Experience Adherence Challenges: Results of a Comparative Effectiveness Trial in Women Veterans. 黑人妇女受益于失眠症的心理治疗,但经历了坚持的挑战:一项在女性退伍军人中比较有效的试验结果。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-10-13 DOI: 10.1016/j.whi.2025.08.003
Kimiko J May, Alexander J Erickson, Gwendolyn C Carlson, Monica R Kelly, Yeonsu Song, Kaddy Y Revolorio, Michael N Mitchell, Donna L Washington, Elizabeth M Yano, Cathy A Alessi, Sarah Kate McGowan, Constance H Fung, Jennifer L Martin
{"title":"Black Women Benefit From Psychotherapies for Insomnia, but Experience Adherence Challenges: Results of a Comparative Effectiveness Trial in Women Veterans.","authors":"Kimiko J May, Alexander J Erickson, Gwendolyn C Carlson, Monica R Kelly, Yeonsu Song, Kaddy Y Revolorio, Michael N Mitchell, Donna L Washington, Elizabeth M Yano, Cathy A Alessi, Sarah Kate McGowan, Constance H Fung, Jennifer L Martin","doi":"10.1016/j.whi.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.whi.2025.08.003","url":null,"abstract":"<p><strong>Background: </strong>Black women and veterans experience disproportionally high rates of insomnia. Few studies have examined how treatment adherence and outcomes vary by racial identity. We found that cognitive behavioral therapy for insomnia (CBT-I) and an acceptance and commitment therapy (ACT)-based insomnia treatment similarly improve sleep outcomes for women veterans, and this analysis examined differences in adherence and outcomes of these treatments based on racial identity groups.</p><p><strong>Purpose: </strong>Analyses examined differences in adherence and treatment outcomes in Black compared with white women veterans who engaged in CBT-I or an ACT-based insomnia treatment (i.e., acceptance and the behavioral changes to treat insomnia [ABC-I]).</p><p><strong>Methods: </strong>As part of a larger clinical trial (NCT02076165), 40 Black and 51 white women veterans with insomnia disorder completed 5-sessions of CBT-I or ABC-I. The Insomnia Severity Index (ISI) and sleep diaries were completed at baseline, posttreatment, and 3-month follow-up. The Credibility and Expectancy Questionnaire was completed at the end of the first treatment session. Multiple and fractional regression models were used to evaluate the association between race group and change in ISI, sleep diary sleep efficiency, and adherence to weekly sleep schedule prescriptions in CBT-I and ABC-I.</p><p><strong>Results: </strong>Treatment benefits were comparable between Black and white women veterans; however, Black women had transiently lower adherence to sleep restriction time in bed recommendations in the week immediately after sleep restriction therapy was introduced in both treatments. There were no other differences between the groups.</p><p><strong>Conclusions: </strong>Future research is needed to understand potential barriers to early adherence to recommendations experienced by Black women veterans and seek to identify treatment adaptations to meet their needs.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Invisible Tethers: The Role of Social Networks in Intimate Partner Violence and Mental Health Among Adult Women. 看不见的束缚:社会网络在成年妇女亲密伴侣暴力和心理健康中的作用。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-10-10 DOI: 10.1016/j.whi.2025.09.001
Marina Katague, Trace Kershaw, Laurel Sharpless, Kamila A Alexander, Tiara C Willie
{"title":"Invisible Tethers: The Role of Social Networks in Intimate Partner Violence and Mental Health Among Adult Women.","authors":"Marina Katague, Trace Kershaw, Laurel Sharpless, Kamila A Alexander, Tiara C Willie","doi":"10.1016/j.whi.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.whi.2025.09.001","url":null,"abstract":"<p><strong>Introduction: </strong>Intimate partner violence (IPV) is associated with high rates of posttraumatic stress disorder (PTSD) and depression, and women experiencing IPV often face social isolation that may exacerbate mental health concerns. This study examines the relationship among IPV, social networks, and mental health outcomes in women. It aims to understand how social network characteristics relate to the presence of PTSD and depression among women with and without experiences of IPV.</p><p><strong>Methods: </strong>We collected data on IPV experiences, participants' social networks, and PTSD and depression symptomatology from women aged 18-35 in Connecticut who reported risk indicators for pre-exposure prophylaxis candidacy (N = 204). Multivariable logistic regression models were used to assess the relationship between IPV and mental health, while adjusting for demographic factors and covariates. We also examined whether social network characteristics moderated this relationship.</p><p><strong>Results: </strong>Women experiencing IPV had fewer men in their networks, more network members who had experienced IPV, and more network members with violence-acceptable attitudes compared with women without IPV experiences. IPV experience was also significantly associated with higher PTSD symptomatology. IPV moderated two associations between network characteristics and depression: among women experiencing IPV, greater network closeness was associated with less severe depression symptoms, whereas among women without IPV experience, a higher percentage of men in the network was associated with less severe depression symptoms.</p><p><strong>Conclusion: </strong>There are significant differences in social network characteristics among women with and without IPV experiences. Trauma-informed interventions and services should acknowledge how network members might influence depression when engaging with women experiencing IPV.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence of Ectopic Pregnancy and Diagnostic Accuracy of Ectopic Pregnancy Screening Criteria Among People Seeking Versus Not Seeking Abortion: A Retrospective Case-Control Study. 异位妊娠的发生率和异位妊娠筛查标准在寻求与不寻求流产人群中的诊断准确性:一项回顾性病例对照研究。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-10-06 DOI: 10.1016/j.whi.2025.08.006
M Antonia Biggs, Mary Anne Armstrong, Lue-Yen Tucker, Shelly Kaller, Juleon Rabbani, Justine W Lee, Giulia Chillemi, Daniel Grossman
{"title":"Incidence of Ectopic Pregnancy and Diagnostic Accuracy of Ectopic Pregnancy Screening Criteria Among People Seeking Versus Not Seeking Abortion: A Retrospective Case-Control Study.","authors":"M Antonia Biggs, Mary Anne Armstrong, Lue-Yen Tucker, Shelly Kaller, Juleon Rabbani, Justine W Lee, Giulia Chillemi, Daniel Grossman","doi":"10.1016/j.whi.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.whi.2025.08.006","url":null,"abstract":"<p><strong>Objectives: </strong>We estimated the incidence of ectopic pregnancy, associated risk factors, and accuracy of three history-based screening criteria for medication abortion (history of ectopic pregnancy, tubal surgery, and intrauterine device [IUD] in place) in detecting ectopic pregnancies among people seeking versus not seeking abortion.</p><p><strong>Study design: </strong>We conducted a retrospective case-control study by reviewing electronic health records of a random sample of 2,201 ectopic and 1,153 intrauterine pregnancies of people enrolled at Kaiser Permanente Northern California (2016-2021). After classifying pregnancies as those to people seeking or not seeking abortion, we used logistic regression weighted to the total sample of pregnancies (N = 385,081) to estimate the incidence of ectopic pregnancies, associated risk factors, and accuracy of three history-based screening criteria.</p><p><strong>Results: </strong>The adjusted incidence of ectopic pregnancy was significantly lower for people seeking abortion (.39%; 95% confidence interval [CI] [.30%, .47%]) than for people not seeking abortion (1.74%; 95% CI [1.55%, 1.94%]). People seeking abortion received ectopic pregnancy treatment earlier in pregnancy than those not seeking abortion (53 vs. 55 days gestation, p = .04). Among people seeking abortion, combined history of IUD use, ectopic pregnancy, and tubal surgery had low sensitivity (17.6%; 95% CI [12.4%, 23.8%]), high specificity (93.5%; 95% CI [90.2%, 96.0%]), and a low area under the receiver operating characteristic curve value (55.5%; 95% CI [52.5%, 58.6%]).</p><p><strong>Conclusions: </strong>The incidence of ectopic pregnancy among people seeking abortion is extremely low and lower than among people not seeking abortion. The three history-based screening criteria we evaluated had very low sensitivity and performed poorly in accurately identifying ectopic pregnancies, suggesting they may have limited clinical utility and may create barriers to access to no-test abortion. Further research is needed to refine protocols to better identify, evaluate, and monitor people for possible ectopic pregnancies in the context of no-test provision of medication abortion.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Contribution of Maternal Age to Increasing Severe Maternal Morbidity During Birth and Up to 1 Year Postpartum. 产妇年龄对分娩期间和产后1年内严重产妇发病率增加的贡献。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-30 DOI: 10.1016/j.whi.2025.08.005
Samuel H Nyarko, Lucy T Greenberg, Scott A Lorch, Jeannette Rogowski, Jeffrey S Buzas, Ciaran S Phibbs, George R Saade, Molly Passarella, Nansi S Boghossian
{"title":"Contribution of Maternal Age to Increasing Severe Maternal Morbidity During Birth and Up to 1 Year Postpartum.","authors":"Samuel H Nyarko, Lucy T Greenberg, Scott A Lorch, Jeannette Rogowski, Jeffrey S Buzas, Ciaran S Phibbs, George R Saade, Molly Passarella, Nansi S Boghossian","doi":"10.1016/j.whi.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.whi.2025.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>We examined whether increasing severe maternal morbidity (SMM) rates are driven by changes in maternal age distribution or age-specific SMM rates.</p><p><strong>Methods: </strong>In a retrospective cohort study across three states, we analyzed data from two time points (2008-2009 to 2019-2020). We used Kitagawa decomposition analysis to determine the contributions of changes in maternal age distribution and age-specific SMM rates to SMM rates both with and without transfusion during birth and up to 1 year postpartum, stratified by race/ethnicity. We examined the following racial/ethnic groups: non-Hispanic white, non-Hispanic Black, Hispanic, and non-Hispanic Asian/Pacific Islander.</p><p><strong>Results: </strong>Between 2008-2009 and 2019-2020, SMM and non-transfusion SMM rates increased from 213.6 to 260.5 and from 109.6 to 154.8 per 10,000 births, respectively. Across all racial and ethnic groups, the proportion of younger birthing individuals (<25 years) decreased and the proportion of older individuals (≥30 years) increased. The decomposition analysis showed that increases in SMM and non-transfusion SMM were primarily due to increases in age-specific SMM rates (100.0% and 94.6%, respectively), particularly among younger birthing individuals. Changes in maternal age distribution had a minimal overall contribution. However, when stratified by race/ethnicity, changes in maternal age distribution had a greater contribution to SMM (28.9%) and non-transfusion SMM (22.7%) rates among non-Hispanic Black individuals, with little to no contribution observed in the other groups.</p><p><strong>Conclusion: </strong>The increasing rates of birth-related and postpartum SMM rates stem from increasing rates of SMM in every age group rather than shifts in maternal age distribution.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Media Descriptions of Pain and Pain Management During Intrauterine Device Insertion: "Women's Pain is Not Taken Seriously". 社交媒体对宫内节育器插入过程中疼痛和疼痛管理的描述:“女性的疼痛没有被认真对待”。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-22 DOI: 10.1016/j.whi.2025.08.002
Gabrielle Schweitzer, Azza Elrashid, Lakshmi Sundaresan, Kathleen Mehari, Lauren Owens, Lauren D Oshman
{"title":"Social Media Descriptions of Pain and Pain Management During Intrauterine Device Insertion: \"Women's Pain is Not Taken Seriously\".","authors":"Gabrielle Schweitzer, Azza Elrashid, Lakshmi Sundaresan, Kathleen Mehari, Lauren Owens, Lauren D Oshman","doi":"10.1016/j.whi.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.whi.2025.08.002","url":null,"abstract":"<p><strong>Introduction: </strong>Intrauterine devices (IUDs) are a highly effective and safe method of contraception, yet IUD insertion can be painful. Social media is a trusted source of health information for reproductive-age adults and accounts of painful and traumatic insertion are prevalent on social media. The aim of this study was to explore the experiences of social media users with pain, trauma, and pain management during IUD insertion.</p><p><strong>Methods: </strong>We identified common IUD-related hashtags or search terms on TikTok, Instagram, and Twitter; identified the top posts (defined as the posts at the top of each search) and their comments for each hashtag or search term on each platform; performed directed qualitative content analysis; and summarized code frequency under each theme with descriptive statistics.</p><p><strong>Results: </strong>Analysis of a total of 214 total posts and comments identified three major themes describing user experiences: 1) Severe pain experiences were more common than tolerable or mild experiences, 2) some participants shared traumatic and negative emotional responses, and 3) negative or dismissive health care professional responses to painful IUD insertion were more frequent than positive and supportive responses.</p><p><strong>Conclusion: </strong>Health care professionals should be aware of common narratives on social media and provide trauma-informed pain management to ensure that all patients have appropriate counseling for IUDs.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study. 与指南一致的宫颈癌筛查退出相关的因素:一项混合方法研究。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-08 DOI: 10.1016/j.whi.2025.07.006
Abigael Olson, Lindsay Fuzzell, Naomi C Brownstein, Holly B Fontenot, Alexandra Michel, Paige Lake, Susan T Vadaparampil, Rebecca B Perkins
{"title":"Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study.","authors":"Abigael Olson, Lindsay Fuzzell, Naomi C Brownstein, Holly B Fontenot, Alexandra Michel, Paige Lake, Susan T Vadaparampil, Rebecca B Perkins","doi":"10.1016/j.whi.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.whi.2025.07.006","url":null,"abstract":"<p><strong>Background: </strong>More than 20% of cervical cancers are diagnosed in women older than 65 years. Guidelines recommend screening exit at age 65 for average-risk patients only if certain criteria are met, yet most women aged 64-66 years in the United States are inadequately screened. In this mixed methods study, we explored clinician knowledge of exit criteria.</p><p><strong>Methods: </strong>We explored factors associated with clinician-reported guideline-concordant screening exit, as well as facilitators and barriers to appropriate cervical cancer screening exit. Guideline concordance required that clinicians be aware that patients can exit screening if they have received a hysterectomy for benign reasons or had either three consecutive negative Pap tests or two consecutive negative human papilloma virus tests-and that they should not exit screening if they have a history of precancer treatment in the prior 25 years.</p><p><strong>Results: </strong>In 2021, a national sample of 1,251 clinicians completed surveys; a subset (n = 55) completed qualitative interviews. Although most (>70%) correctly identified criteria related to hysterectomy and prior negative screening requirements, only 35% of participants (n = 434) responded correctly to all screening exit items. In logistic regression models, male clinicians, OB/GYNs, and those in academic or hospital-based practices were more likely to respond correctly. Interview responses indicated variable understanding of the nuances of exit criteria. Those who continued screening patients past age 65 cited concerns related to new sexual partners and missing cancers. Several providers noted difficulty accessing adequate records.</p><p><strong>Conclusions: </strong>Clinicians who routinely perform cervical cancer screening have knowledge gaps around exit criteria and also describe difficulty applying the criteria in practice. As fewer women undergo hysterectomy and life expectancy increases, the number of individuals older than 65 at risk for cervical cancer will continue to rise. Adjusting guidelines to decrease the complexity of exit criteria should be considered.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“Am I Truly Invisible?”: A Qualitative Study on Black Women's Experiences of and Coping With Intersectional Invisibility in Uterine Fibroid Treatment “我真的隐形吗?”黑人妇女在子宫肌瘤治疗中交叉性隐形的经历与应对。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.05.005
Arianne N. Malekzadeh MA , Ami R. Zota ScD, MS , Myla Lyons BA , Tamara Taggart PhD, MPH
{"title":"“Am I Truly Invisible?”: A Qualitative Study on Black Women's Experiences of and Coping With Intersectional Invisibility in Uterine Fibroid Treatment","authors":"Arianne N. Malekzadeh MA ,&nbsp;Ami R. Zota ScD, MS ,&nbsp;Myla Lyons BA ,&nbsp;Tamara Taggart PhD, MPH","doi":"10.1016/j.whi.2025.05.005","DOIUrl":"10.1016/j.whi.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Black women are disproportionately burdened by uterine leiomyomas<span> (fibroids) and face intersectional invisibility wherein their needs are ignored in health care settings due to sexism and racism. Our objective was to elucidate Black women's experiences in fibroid treatment and the strategies they use to protect their health and counter their intersectional invisibility.</span></div></div><div><h3>Methods</h3><div>We recruited participants from the Fibroids Observational Research on Genes and the Environment (FORGE) Study. We conducted semistructured individual interviews (average length 45 minutes) on Black women's experiences in fibroid treatment. We analyzed the transcripts using a thematic analytical approach and intersectionality, a critical analytical framework that allows for the examination of how sexism and racism intersect to influence health inequities.</div></div><div><h3>Results</h3><div>Participants were 16 Black women aged 30–52 years who were seeking fibroid treatment in Washington, DC. Our analysis revealed that participants experience gendered racism (the intersection of sexism and racism) in fibroid treatment, mirroring a historical and ongoing pattern of how Black women are treated in health care settings, and that they manage their intersectional invisibility by engaging in strategies characteristic of the superwoman schema: projecting strength, suppressing emotions, resisting being dependent, and striving to succeed despite limited resources. Participants also highlighted that their ideal fibroid-related care would include a holistic approach and social support.</div></div><div><h3>Conclusions</h3><div>Our findings emphasize that Black women's intersectional invisibility extends to fibroid treatment, reflecting the social-structural inequities that they face in health care settings more broadly. Attendance to Black women's voices in research and practice can help decrease their intersectional invisibility and subsequently improve their fibroid treatment and related health outcomes.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 342-349"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal 在堕胎合法的州,多布斯诉杰克逊案最高法院判决前后,远程医疗对药物流产的需求。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.003
Anna E. Fiastro PhD, MPH, MEM , Elissa Brown MPH , Rebecca Gomperts MD, MPP, PhD , Emily M. Godfrey MD, MPH
{"title":"Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal","authors":"Anna E. Fiastro PhD, MPH, MEM ,&nbsp;Elissa Brown MPH ,&nbsp;Rebecca Gomperts MD, MPP, PhD ,&nbsp;Emily M. Godfrey MD, MPH","doi":"10.1016/j.whi.2025.06.003","DOIUrl":"10.1016/j.whi.2025.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>The provision of medication abortion through telehealth accounts for an increasing share of total abortions in the United States, offering a private and affordable option for patients in both restrictive and supportive states. This study compares demand for telehealth medication abortion before and after the U.S. Supreme Court decision in <em>Dobbs v. Jackson Women's Health Organization (Dobbs)</em> in states where abortion access is protected, to understand how patients seeking care in supportive states may have been impacted by the landmark decision.</div></div><div><h3>Methods</h3><div>We compared the volume of patients receiving medication abortion from a U.S.-based telehealth service in 18 states, the sociodemographic characteristics of patients, and self-reported reasons for choosing telehealth before and after the <em>Dobbs</em> decision using electronic medical records from March 24, 2022–September 24, 2022. All states examined support legal access to abortion; results were stratified to compare two levels of protective abortion policies.</div></div><div><h3>Results</h3><div>A total of 6,296 patients received medication abortion through telehealth during the study period. Daily demand increased by 74%, from an average of 25.0 patients per day in the pre-<em>Dobbs</em> period to 43.4 patients per day post-<em>Dobbs</em> (difference 18.4; 95% confidence interval [15.4, 21.5]; <em>p</em> &lt; .001). No sociodemographic differences were observed between patient populations before and after the <em>Dobbs</em> decision. Comfort and privacy were the most frequently selected reasons for choosing telehealth in both time periods. Concern over legal restrictions was more frequently cited after the <em>Dobbs</em> decision. A larger increase in demand (88%) was observed in states with fewer protections post-<em>Dobbs</em> compared with states with the most protective policies (68%) (<em>p</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Demand for telehealth medication abortion increased after the <em>Dobbs</em> decision in states where abortion remained legal. Telehealth provides an essential pathway to access safe and effective abortion care for a broad range of patients across different policy environments.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 324-329"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients 远程医疗药物流产患者人工流产前超声检查的应用。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.002
Sylvie T. Wilson MSPH , Lisa Peters MPH , Leah R. Koenig PhD, MSPH , Suzanne O. Bell PhD, MPH , Ushma D. Upadhyay PhD, MPH
{"title":"Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients","authors":"Sylvie T. Wilson MSPH ,&nbsp;Lisa Peters MPH ,&nbsp;Leah R. Koenig PhD, MSPH ,&nbsp;Suzanne O. Bell PhD, MPH ,&nbsp;Ushma D. Upadhyay PhD, MPH","doi":"10.1016/j.whi.2025.06.002","DOIUrl":"10.1016/j.whi.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.</div></div><div><h3>Objective</h3><div>This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.</div></div><div><h3>Study Design</h3><div>Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 1,775 participants, 11% (<em>n</em> = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.</div></div><div><h3>Conclusion</h3><div>Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 376-382"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Differences in Contraceptive Method Discontinuation and Contraceptive Method Preferences by Disability Status 残疾状况对避孕方法停药和避孕方法偏好的影响。
IF 2.5 2区 医学
Womens Health Issues Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.004
Zoe H. Pleasure MPH , Laura D. Lindberg PhD
{"title":"Differences in Contraceptive Method Discontinuation and Contraceptive Method Preferences by Disability Status","authors":"Zoe H. Pleasure MPH ,&nbsp;Laura D. Lindberg PhD","doi":"10.1016/j.whi.2025.06.004","DOIUrl":"10.1016/j.whi.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Contraceptive care delivery to people with disabilities must be contextualized within the U.S. history of stratified reproduction and eugenics. Significant sexual and reproductive health inequities have been documented between people with disabilities and those without disabilities in family planning service receipt and contraceptive method use. Little research has examined how discontinuation of contraception or dissatisfaction with contraceptive methods may differ for people with disabilities.</div></div><div><h3>Objective</h3><div>This study assesses differences in contraceptive desires and experiences between disabled and nondisabled individuals.</div></div><div><h3>Methods</h3><div>Our sample included self-identified female respondents from the 2011–2019 National Survey of Family Growth. We examined demographic and sexual and reproductive health differences between disabled and nondisabled respondents based on self-report of disabilities. Unadjusted and adjusted logistic regression models estimated differences in contraceptive method discontinuation due to dissatisfaction and method choice based on cost.</div></div><div><h3>Results</h3><div>Differences by disability status were found for reports of fecundity and the contraceptive method used in the past 12 months. In both unadjusted and adjusted models, significantly more disabled people than nondisabled people reported having discontinued their method because of dissatisfaction and having wanted to use a different method if cost were not an issue.</div></div><div><h3>Conclusions</h3><div>Self-reported disabilities are associated with contraceptive method dissatisfaction and unmet contraceptive preferences. Efforts are needed to tailor person-centered clinical care that is responsive to this population's reproductive wants and needs.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 5","pages":"Pages 350-358"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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