Womens Health Issues最新文献

{"title":"Integrating Payor-Segregated Outpatient OBGYN Care Models: The Clinician Perspective","authors":"Arina Chesnokova MD, MPH, MSHP ,&nbsp;Allison Schachter BA ,&nbsp;Elizabeth Clement MD ,&nbsp;Sarita Sonalkar MD, MPH ,&nbsp;Marilyn Schapira MD, MPH ,&nbsp;Florencia Polite MD ,&nbsp;Abike James MD, MPH ,&nbsp;Sindhu Srinivas MD, MSCE ,&nbsp;Elizabeth Howell MD, MPP ,&nbsp;Rebecca Hamm MD, MSCE","doi":"10.1016/j.whi.2025.04.002","DOIUrl":"10.1016/j.whi.2025.04.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Significant and unacceptable racial disparities in maternal health and gynecologic outcomes exist in the United States, with ambulatory care being a potential contributor. In many academic medical centers (AMCs), publicly insured and uninsured patients receive care in clinics staffed primarily by residents under attending supervision, whereas those with private insurance see attending physicians at a different site. This segregation by payor can translate to de facto racial segregation. This study explores clinician perspectives on payor-segregated care delivery by resident and attending sites in a major AMC and their opinions on integrating these sites.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with attending physicians and advanced practice providers (APPs) from both sites. The interview guide focused on: 1) perceived value of the current care model, 2) attitudes toward care integration, and 3) barriers and facilitators to integration. Interviews were conducted from October 2022 to January 2023 until thematic saturation was achieved. Data analysis involved an integrated approach with grounded theory, with 20% of transcripts double-coded (k = .90).</div></div><div><h3>Results</h3><div>We interviewed 15 clinicians (10 attendings, five APPs). Although clinicians recognized some value in the existing segregated system, they supported ending it as a moral imperative to combat inequity. They also highlighted challenges and expressed concerns about feasibility of integration. Concerns encompassed maintaining patient-clinician continuity, acceptance of trainees by privately insured patients, potential erosion of mission-driven care, and the risk of racist interactions if a safe space for a vulnerable community is disrupted. Clinicians stressed the need for resources and small-scale trials before full-scale integration.</div></div><div><h3>Conclusion</h3><div>Although clinicians expressed unity around the concept of integrating ambulatory care delivery, a path toward implementing an alternative model of care remains unclear. This study provides initial insights into disparities in ambulatory OBGYN care and may guide health systems considering care integration.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 267-275"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182724","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}

{"title":"Menopause-Related Service Needs in Veterans Health Administration Medical Centers: Findings From the Women's Health Practice-Based Research Network Menopause Practice Scan","authors":"Susan J. Diem MD, MPH ,&nbsp;Haley A. Miles-McLean PhD ,&nbsp;Diane V. Carney MA ,&nbsp;Jeanette E. Shekelle MPH ,&nbsp;Francesca Nicosia PhD ,&nbsp;Susan M. Frayne MD, MPH ,&nbsp;Elizabeth M. Yano PhD, MSPH ,&nbsp;Carolyn J. Gibson PhD, MPH, MSCP","doi":"10.1016/j.whi.2025.04.004","DOIUrl":"10.1016/j.whi.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Information about the state of menopause-related care in the Veterans Health Administration (VA) is needed to identify targets for intervention and resource development across the national VA Health Care System.</div></div><div><h3>Procedures</h3><div>A brief electronic key informant survey designed to assess current menopause-related services, resources, and needs in VA primary care was distributed to all active VA Women's Health Practice-Based Research Network (WH-PBRN) Site Leads. The survey included structured items, with responses summarized with descriptive statistics, and open-ended prompts, with answers analyzed using directed content analysis.</div></div><div><h3>Findings</h3><div>Key informant surveys were completed by 60 of 73 active WH-PBRN sites (response rate 82%). Most sites reported a range of available resources; 88% reported having VA-based consultants (e.g., gynecologists, pharmacists, and/or endocrinologists) available to assist primary care providers with pharmacological management of menopause symptoms. However, sites named a need for educational materials, menopause-focused classes or groups, and resources or support for a variety of menopause-associated issues. Sites overwhelmingly reported that menopause care was made easier by the availability and/or integration of menopause-trained specialty providers in the primary care setting, adequate menopause training for primary care providers, and time in appointments to address complex care issues.</div></div><div><h3>Conclusions</h3><div>In this survey of primary care settings at WH-PBRN sites across the VA Health Care System, sites highlighted the importance of available resources, time in appointments, training for primary care providers, and the availability and integration of menopause-informed specialty care services for comprehensive menopause care in the VA setting. Improving the VA's care model for menopause also has the potential to inform efforts to improve services in other health systems.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 283-291"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217304","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}

{"title":"Birth-Intention Time Horizon as a Predictor of Contraceptive Method Effectiveness","authors":"Yuko Hara PhD ,&nbsp;Michael S. Rendall PhD","doi":"10.1016/j.whi.2025.04.006","DOIUrl":"10.1016/j.whi.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Both contraceptive method research and contraceptive program designs have given more attention to if a woman currently wants to have a child than to when she wants a child. We examine how predictive is a woman's intended duration to a (next) birth for her type of contraceptive method currently used, ranked by the method's effectiveness. We hypothesize that a longer intended duration will be associated with choosing a more effective method.</div></div><div><h3>Methods</h3><div>We pooled observations of women (<em>n</em> = 7,324 in total) across the two population-representative surveys in Delaware and Maryland: the Behavioral Risk Factor Surveillance System and the Survey of Women. We classified birth-timing intentions into wanting a child in less than 2 years, wanting a child but being uncertain when, wanting a child in 2 or more years, and not wanting (additional) children. Contraceptive method was classified as highly effective (intrauterine devices and implants), moderately effective (e.g., contraceptive pills), less effective (e.g., condoms), and no method. We used multinomial logistic regression to estimate relative risk ratios and predicted probabilities of using each method type, and no method, adjusting for sociodemographic characteristics.</div></div><div><h3>Results</h3><div>As a woman's birth-timing intention horizon lengthens, her probability of using a highly effective method increases, and her probability of using no method decreases. Being uncertain about birth timing is associated with a substantially lower probability of using any type of contraceptive method relative to having clear intentions.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the importance for contraceptive counseling and contraceptive access program design of considering birth-timing intentions beyond the year immediately ahead.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 292-299"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250323","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}

{"title":"Military Exposures and Early Menopause: Findings From the Gulf War Era Cohort Study (GWECS)","authors":"Carolyn J. Gibson PhD, MPH ,&nbsp;Guichan Cao MS ,&nbsp;Sabra Inslicht PhD ,&nbsp;Allison D. Altman PhD ,&nbsp;Caitlin E. Haas BS, BA ,&nbsp;Aaron Schneiderman PhD, MPH, RN ,&nbsp;Erin Dursa PhD, MPH","doi":"10.1016/j.whi.2025.05.001","DOIUrl":"10.1016/j.whi.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>Traumatic and environmental exposures during military service may affect reproductive health and ovarian aging, putting women veterans at risk for early menopause. We examined relationships between military exposures and possible early menopause among women 1990–1991 Gulf War veterans.</div></div><div><h3>Methods</h3><div>This is a longitudinal analysis of data from the Gulf War Era Cohort Study. Women Gulf War veterans who completed baseline (1995) and follow-up assessments (2012) and were aged ≤45 at follow-up were included. Military exposures (Gulf War deployment, military environmental exposures [MEEs], Gulf War Illness, military sexual trauma [MST]) and posttraumatic stress disorder (PTSD) were assessed at baseline. Participants were categorized as having possible early menopause if in response to follow-up survey questions about menstruation they indicated menopause or having no periods for 1 year. Associations among military exposures, PTSD, and possible early menopause were examined with logistic regression models.</div></div><div><h3>Results</h3><div>The analytic sample included 668 women veterans. Among Gulf War–deployed veterans (<em>n</em> = 384), 63% reported MEEs and 26% reported MST during deployment. Within the total sample, 57% met criteria for Gulf War Illness, and 23% met criteria for probable PTSD. At follow-up, 15% had possible early menopause. In adjusted analyses, Gulf War Illness (odds ratio [OR] 1.83; 95% confidence interval [CI] [1.14, 2.95]) and probable PTSD (OR 2.45; 95% CI [1.54, 3.90]) were significantly associated with possible early menopause.</div></div><div><h3>Conclusion</h3><div>Women veterans may be vulnerable to early menopause (under age 45), which brings additional care considerations for health promotion and symptom management. Menopause care in the Department of Veterans Affairs should include consideration of PTSD and comorbid chronic conditions such as Gulf War Illness, key veteran-centric clinical correlates that may influence the onset and experience of menopause.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 276-282"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337157","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}

{"title":"Perceived Infertility and Contraceptive Use Among Reproductive-Aged Women in Ohio","authors":"Kayla M. Alvis MS, PhD ,&nbsp;Jess Keesee MD ,&nbsp;Marta Bornstein MPH, PhD ,&nbsp;Abigail Norris Turner PhD ,&nbsp;Meredith Pensak MD, MPH ,&nbsp;Priya R. Gursahaney MD, MS","doi":"10.1016/j.whi.2025.02.007","DOIUrl":"10.1016/j.whi.2025.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study examines the association between sociodemographic factors and perceived infertility, as well as between perceived infertility, contraceptive use, and contraceptive method type.</div></div><div><h3>Study Design</h3><div>We analyzed the Ohio Survey of Women baseline data collected in 2018–2019 (<em>N</em> = 2,568). Using logistic regression, we assessed the association between sociodemographic characteristics and perceived infertility. We then used multivariate logistic regression and multinomial regression to estimate the association between perceived infertility and any contraceptive use and contraception method type (long-acting reversible, hormonal short-acting reversible, and coital-dependent methods).</div></div><div><h3>Results</h3><div>Age, race, marital status, household income, and prior pregnancies were associated significantly with odds of perceived infertility. Of those who said they were not at all likely to be infertile, 73% reported using any contraception compared to 63% of those who said they were somewhat to very likely to be infertile. In multivariable analyses, those who reported perceived infertility had 31% lower odds of using contraception than those who did not (adjusted odds ratio = 0.7; 95% confidence interval [0.5, 1.0]). Those with perceived infertility had twice the odds of using no contraception than using long-acting reversible methods compared with those without perceived infertility.</div></div><div><h3>Conclusions</h3><div>Reproductive-aged women in Ohio who perceive they may have difficulty becoming pregnant or be infertile have lower odds of using contraception, particularly long-acting reversible methods, compared with those who do not perceive they may be infertile. Improved education on infertility may be warranted to support individuals, particularly in groups with higher odds of perceived infertility, in making informed choices about contraception.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 180-187"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744262","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}

{"title":"Contraception Coverage Policy in the United States: History and Current Challenges","authors":"Carol S. Weisman PhD ,&nbsp;Diana Velott MPA, MS ,&nbsp;Amy Zheng MD ,&nbsp;Sarah Horvath MD, MSHP ,&nbsp;Douglas Leslie PhD ,&nbsp;Cynthia H. Chuang MD, MSc","doi":"10.1016/j.whi.2025.03.002","DOIUrl":"10.1016/j.whi.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>State and federal policies have aimed to expand access to contraception by providing coverage of its costs in both public and private health insurance. Yet barriers to contraception coverage remain and are expected to increase after the 2022 U.S. Supreme Court decision in <em>Dobbs v. Jackson Women's Health Organization</em>. This paper describes the history of these policies and current challenges.</div></div><div><h3>Methods</h3><div>We constructed a chronology of federal and state policies providing coverage of the cost of contraception in both public and private health insurance, from establishment of the federal right to contraception through 2024, using published sources and public datasets. We aligned the chronology with the history of the development of contraception technology and practices, as described by historians and social scientists, and with political and legal challenges.</div></div><div><h3>Results</h3><div>Following establishment of a federal right to contraception after nearly a century of restrictions under the 1873 Comstock Act, three waves of contraception coverage policymaking sought to increase access to contraception by making it more affordable to consumers. These waves included options for states to expand coverage for contraception within the Medicaid program; passage of state contraception coverage equity laws to ensure parity for contraceptive coverage in private health plans; and the Affordable Care Act's national contraceptive coverage requirement and its subsequent modifications, clarifications, and codifications. Post-<em>Dobbs</em>, challenges to contraception coverage include efforts to redefine certain contraceptives as abortifacients and to resurrect some of the restrictions of the Comstock Act. The requirement of no-cost coverage of preventive services is also threatened.</div></div><div><h3>Conclusion</h3><div>Contraception coverage policy will be impacted by ongoing challenges to contraception and abortion access, as well as changing contraceptive technology and modes of delivery.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 151-158"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040948","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}

{"title":"Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals","authors":"Stephanie V. Hall PhD, MPH ,&nbsp;Andrea Pangori MS ,&nbsp;Anca Tilea MPH ,&nbsp;Kara Zivin PhD, MS, MA, MFA ,&nbsp;Anna Courant MFA, MSN, RN, CPNP-PC ,&nbsp;Amy Schroeder MA ,&nbsp;A. Mark Fendrick MD ,&nbsp;Vanessa K. Dalton MD, MPH","doi":"10.1016/j.whi.2025.02.003","DOIUrl":"10.1016/j.whi.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.</div></div><div><h3>Objectives</h3><div>In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.</div></div><div><h3>Methods</h3><div>This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.</div></div><div><h3>Results</h3><div>The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).</div></div><div><h3>Discussion</h3><div>Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 143-150"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693946","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}

{"title":"The State of VA-funded Women Veterans’ Health Systems Research","authors":"Amanda E. Borsky DrPH, MPP ,&nbsp;Aimee Kroll-Desrosiers PhD ,&nbsp;Adriana Rodriguez PhD ,&nbsp;Karissa Fenwick PhD, MSW ,&nbsp;Jessica K. Friedman PhD, MPH, MSc ,&nbsp;Elizabeth M. Yano PhD, MSPH","doi":"10.1016/j.whi.2025.02.006","DOIUrl":"10.1016/j.whi.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Women veterans are the fastest-growing population of new users within the Department of Veterans Affairs (VA) health care delivery system. This paper aims to characterize the scope of women's health research funded by VA Health Systems Research (HSR) over the past 10 years.</div></div><div><h3>Methods</h3><div>Ten years of data (2014–2023) were obtained from a VA financial database that captures research projects that started on or after January 1, 2014. Projects were coded for topical areas and study types.</div></div><div><h3>Results</h3><div>VA HSR funded 91 women's health studies over the past 10 years. The number of active projects grew from 7 in 2014 to 50 in 2023, with a parallel increase in total funding amount for women's health-focused research projects (nearly $570,000 in 2014 and $8.1 M in 2023). Descriptive or epidemiological studies were the most prominent study type (55% of active projects) and there was a steady increase in intervention and implementation studies. The most common topics were mental health and/or substance use (22% of projects), followed by reproductive health (13%), access/rural health (13%), other chronic conditions (12%), violence and trauma exposure (10%), primary care and prevention (8%), pain (7%), other (5%), comorbidities (3%), post-deployment health (3%), aging and long-term care (2%), and cancer (2%).</div></div><div><h3>Conclusions</h3><div>Overall, our findings indicate that HSR funding for studies focused on women veterans' health has grown over the last decade, and those studies have diversified in topics and types of study designs. As a learning health system, VA can use these findings to prioritize its future women's health research funding to meet the health needs of women veterans.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 205-218"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744265","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}

{"title":"Financial, Social, and Demographic Factors Associated With Obtaining an Abortion: A Longitudinal Study in Indiana in 2021–2022","authors":"Alexandra Wollum PhD, MPH ,&nbsp;Bria Goode MPH ,&nbsp;Caitlin McKenna ,&nbsp;Megan Jeyifo ,&nbsp;Lizz Perkins ,&nbsp;Meg Sasse Stern ,&nbsp;Qudsiyyah Shariyf ,&nbsp;Tracey A. Wilkinson MD, MPH ,&nbsp;Heidi Moseson PhD, MPH","doi":"10.1016/j.whi.2025.03.001","DOIUrl":"10.1016/j.whi.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to 1) characterize those who did and did not obtain an abortion and reasons why, and 2) evaluate the association between various facilitators, including financial and social support, and accessing an abortion.</div></div><div><h3>Methods</h3><div>Between June 2021 and April 2022, we recruited pregnant Indiana residents considering abortion through online posts, abortion funds, and abortion clinics. Respondents completed an online baseline survey and a follow-up survey 1 month later. Surveys collected information on sociodemographic characteristics, barriers and facilitators to abortion, and pregnancy outcome.</div></div><div><h3>Results</h3><div>Among 221 participants, 77% obtained an abortion within 1 month. Among online and abortion fund recruits, those who identified as Black or African American or Hispanic/Latinx and those without insurance were less likely to have had an abortion than were white and insured participants. Financial support from abortion funds and clinics and social support from peer networks were associated with higher odds of accessing abortion care 1 month later. Among participants still seeking abortion at 1 month or who had given birth, 64% reported that needing to gather money to pay for the abortion or travel expenses/lodging was a barrier to care. Among those who were no longer considering abortion at 1 month and planned to continue their pregnancy, 28% reported doing so because they did not have the money for an abortion.</div></div><div><h3>Conclusions</h3><div>In a restrictive state policy environment, receipt of financial and social support was associated with greater likelihood of obtaining abortion within a month of reporting considering or seeking it among a sample of pregnant people in Indiana.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 159-168"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052289","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}

{"title":"Sex Differences in Suicide, Lethal Means, and Years of Potential Life Lost Among Veterans With Substance Use Disorder","authors":"Amar D. Mandavia MA, PhD ,&nbsp;Anne N. Banducci PhD ,&nbsp;Tracy L. Simpson PhD ,&nbsp;Brian P. Marx PhD ,&nbsp;Sage E. Hawn PhD ,&nbsp;Justeen Hyde PhD ,&nbsp;Victoria E. Ameral PhD ,&nbsp;Rebecca E. Sistad Hall PhD ,&nbsp;Clara E. Roth BA ,&nbsp;Alexis A. Sarpong MPH ,&nbsp;Michael Davenport MA ,&nbsp;Frank Meng PhD ,&nbsp;Michael D. Stein MD ,&nbsp;Nicholas A. Livingston PhD","doi":"10.1016/j.whi.2025.02.002","DOIUrl":"10.1016/j.whi.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Veterans with substance use disorders (SUDs) are at elevated risk of dying by suicide. We examined sex and age differences in rates and means of suicide death among veterans with alcohol (AUD) and/or opioid use disorder (OUD) diagnoses.</div></div><div><h3>Methods</h3><div>We studied a cohort of veterans with AUD and/or OUD diagnoses who received Veterans Health Administration care and died of any cause between January 2016 and December 2020. We assessed the risk of suicide death and lethal means by sex, age, and their interaction.</div></div><div><h3>Results</h3><div>Among veterans with AUD and/or OUD, 119,693 died of any cause during the study period. Suicides represented 4.5% of all deaths (<em>n</em> = 5,419), with women being 2.25 times (95% confidence interval [CI], 1.97–2.55) more likely to die by suicide than men and dying at significantly younger ages than men. Suicide deaths accounted for 21.28 and 32.25 years of potential life lost for men (mean age, 52.92 ± 14.81 years) and women (mean age, 47.65 ± 11.52 years), respectively. Intentional poisoning was the most common means of suicide death for both men and women. Women were 2.08 times (95% CI, 1.61–2.71) more likely to die by poisoning-related suicide than men. Men were 1.73 times (95% CI, 1.13–2.77) more likely to die by firearms-related suicide than women.</div></div><div><h3>Conclusion</h3><div>Among veterans diagnosed with AUD and/or OUD, women were more likely to die by suicide, at a younger age, than men. Poisoning was the primary means of suicide death for men and women. These national-level data highlight the urgency of suicide risk assessment and prevention among women veterans with substance use disorder.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 196-204"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671420","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}