Relinquishment of premarital births: evidence from national survey data.

According to 1982 and 1988 NSFG data, unmarried white women are far less likely than they were in the early 1970s to place their children for adoption. The levels of relinquishment among black women have remained low throughout this period, and relinquishment among Hispanic women may be virtually nonexistent. Multivariate analysis of the determinants of relinquishment among unmarried non-Hispanic white women suggests that having a well-educated mother, being in school at the time of conception, having no labor force experience, and being older are positively associated with placing a child for adoption. Sons were found to be less likely to be relinquished than daughters.     

The use of complementary and alternative medications by menopausal women in South East Queensland.

This study aimed to identify the prevalence and types of complementary and alternative medications (CAMs) used by women during menopause and explore potential associations between CAM use and menopausal symptoms. Analysis was undertaken with 886 randomly selected menopausal women aged 47-67 years who participated in a postal questionnaire on the menopause experience. The prevalence of CAM use was relatively high (82.5%), with nutrition most commonly cited (67%), followed by phytoestrogens (56%), herbal therapies (41%), and CAM medications (25%). Multivariate analysis adjusted for confounders revealed that women who consumed CAM medications were 17-23% more likely to report anxiety (p = .019) or vasomotor symptoms (p = .013). Women who used herbal therapies (p = .009) or phytoestrogens (p = .030) were 13-16% more likely to experience vasomotor symptoms. Women who used nutrition were 18% more likely to experience anxiety (p = .049). These results highlight the importance for health professionals to incorporate CAMs into their practice to better inform menopausal women of their treatment choices.     

Medical Pluralism of Chinese Women Living in the United States

This study provides national prevalence estimates for complementary and alternative (CAM) use, visits to doctors for health problems, and the effects of acculturation on health practices in Chinese women living in the United States. A national telephone survey of 3,172 women on their use of complementary and alternative medicine was conducted in 2001. This study focuses on a subsample of 804 Chinese-American women who were asked about health practices and service utilization. Interviews were conducted in Mandarin, Cantonese and English. Forty-one percent of Chinese-American women used some form of CAM in 2001. Socio-economic status, a common predictor of CAM use in other studies of the general population in the United States, did not predict use in this sample. Traditional Chinese medicine (TCM) is used across acculturation levels. As Chinese women adapt to American culture they tend to use a greater variety of healthcare practices and to adopt mainstream CAM practices, but they also continue to use TCM.     

Health Literacy and Complementary and Alternative Medicine Use Among Underserved Inpatients in a Safety Net Hospital

Little is known about the relationship between health literacy and complementary and alternative medicine (CAM) use in low-income racially diverse patients. The authors conducted a secondary analysis of baseline data from 581 participants enrolled in the Re-Engineered Discharge clinical trial. The authors assessed sociodemographic characteristics, CAM use, and health literacy. They used bivariate and multivariate logistic regression to test the association of health literacy with four patterns of CAM use. Of the 581 participants, 50% reported using any CAM, 28% used provider-delivered CAM therapies, 27% used relaxation techniques, and 21% used herbal medicine. Of those with higher health literacy, 55% used CAM. Although there was no association between health literacy and CAM use for non-Hispanic Black participants, non-Hispanic White (OR = 3.68, 95% CI [1.27, 9.99]) and Hispanic/other race (OR = 3.40, 95% CI [1.46, 7.91]) participants were significantly more likely to use CAM if they had higher health literacy. For each racial/ethnic group, there were higher odds of using relaxation techniques among those with higher health literacy. Underserved hospitalized patients use CAM. Regardless of race, patients with high health literacy make greater use of relaxation techniques.     

Use of complementary and alternative medicine among American women.

INTRODUCTION AND BACKGROUND: Although women are increasingly using complementary and alternative (CAM) therapies, a national profile characterizing women who use CAM has yet to be described. The purpose of this study is to provide prevalence estimates of recent CAM use among American women and to examine sociodemographic and other characteristics associated with use. METHODS: Data from the 1999 National Health Interview Survey are used for the analysis. Three operational definitions of recent CAM use are employed (any CAM, type-specific, and domain-specific use). All proportions and prevalence estimates are weighted and standard errors are adjusted to account for complex sample design; weighted logistic regression (with coefficient variance adjustment) is also used. RESULTS: Overall, 33.5% of American women used CAM in the past 12 months. Spiritual healing/prayer and herbal medicine are the most commonly used, and hypnosis, biofeedback, and energy healing are the least common. Multivariate results show that women who are older, have more education, poorer health, or live in the west or midwest (versus south) are more likely to use CAM. Compared to whites, blacks, Hispanics, and Asians are less likely to use CAM. Foreign-born women, those with lower income, or who live in the Northeast are also less likely to use CAM. Insurance status is not independently associated with CAM use. CONCLUSIONS AND DISCUSSION: This study provides one of the first comprehensive investigations of CAM use among American women. Future research examining the determinants of CAM use, incorporating attitudinal and health conditions, as well as clinical efficacy, effectiveness, and health outcome studies of specific CAM therapies are warranted.     

Assertiveness with physicians: does it predict mammography use?

In a prior study we found that women's self-reported assertiveness with their healthcare providers was associated with their use of mammography in a population-based cross-sectional sample of women. Women who reported being more assertive, by repeating information if they felt their doctor didn't hear them, asking their doctor to explain information they didn't understand, or reminding their doctor about screening tests, were more likely to have received a mammogram recently than those who reported being less assertive. Here we examined how women's self-reports of assertiveness predicted their use of mammography three years later. We examined this using a population-based sample of 781 women living in rural Washington State who were participating in a trial of mammography promotion. We found that assertive women were younger on average than less assertive women, but that even after controlling for age, education, income, and marital status, women who reported being assertive with their doctor in 1994 were more likely to receive regular mammograms in the next three years than those who did not (OR 2.1; CI 1.5, 2.9). If future studies also suggest that assertiveness predicts use of mammography or other preventive healthcare services, it would be valuable to examine the promotion of assertiveness as a means of improving public health.     

Medication use during pregnancy and lactation: an urgent call for public health action

Questions about medication use during pregnancy and lactation are a concern for women and healthcare providers. Unfortunately, there is little experience with the use of most medications in human pregnancy and lactation at the time they are marketed. Even when information is available, it may not be readily accessible to women and healthcare providers. Nevertheless, medication use by pregnant and breastfeeding women may be beneficial, and even essential, to ensure the health of both mother and child. In addition, almost half of pregnancies in the United States each year are unintended, and medication exposures may occur in the early weeks of gestation before a pregnancy is recognized. For these reasons, it is critical that up-to-date information about the effects of medication use during pregnancy and lactation and the management of maternal conditions be available to women and healthcare providers. A comprehensive, coordinated public health approach that builds on and expands existing activities is needed to generate information about medication use, make that information readily available, and translate it into safe and effective healthcare. Critical components of this system include a central source of up-to-date information, further development and coordination of monitoring and research activities, the availability of counseling services throughout the country, development of standard communication messages, and a panel of experts to provide oversight. This will require collaborative support from government agencies, nonprofit organizations, academic and public health professionals, and healthcare providers to ensure safe and beneficial use of medications during pregnancy and lactation.     

Annual health assessments for older Australian women: uptake and equity

OBJECTIVE: To measure utilisation of Enhanced Primary Care (EPC) health assessment items for women aged 75 years and over, and to describe health and socio-demographic characteristics of users and non-users. METHOD: Analysis of longitudinal survey and Medicare claims data from women in the Australian Longitudinal Study on Women's Health (ALSWH) aged 75 to 78 years when EPC items were introduced and who provided permission to access their Medicare records for the period 1999-2003 (n = 4,646). RESULTS: There was an increase in uptake of assessments over four years: from November 1999, 12% of eligible women had a health assessment during the following year; by October 2003, 49% had at least one health assessment ever. Few had repeat assessments. Women who visited a GP more often and who were satisfied with the number of GPs available were more likely to have an assessment in the first 12 months, and women who visited a GP more often, those taking more medications, and those caring for another were more likely to have at least one assessment in four years. Women in smaller rural and remote areas were less likely to have an assessment than women in urban areas. CONCLUSIONS: Most women are not having annual assessments and there is some geographic inequity.     

The role of the telephone in providing prenatal care.

To assess the role of telephone services in the health care of pregnant women, we evaluated the pregnancy healthline, Info-Grossesse (IG). We assessed the population of users, the reasons for their use, their reactions to the program, and their willingness to participate in follow-up surveys. During a 44-month period, there were 3,589 calls from women who were (or thought they were) pregnant. Overall, about half the calls related to teratogen information services, whereas the other half were for more general pregnancy-related information. Although women calling about medications were slightly older than the others, there were no major differences between groups defined by the primary reason for a call. Overall, about 17% of calls required a referral for formal risk counseling, with referrals most likely for calls about medications. Based on responses to a satisfaction questionnaire completed by over 80% of those asked to participate, IG decreased concerns for and answered all the questions of about three quarters of the respondents. Over 85% of eligible callers provided information on the outcome of their pregnancies, indicating that collecting these follow-up data is an acceptable and feasible program component. This study suggests that a pregnancy healthline such as IG can reach women worried about their pregnancies and that it can, thereby, reduce adverse conditions of pregnancy associated with "unnecessary" concerns or "inappropriate" use of services.     

Delivery complications and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999-2000

Maternal health services have a potentially critical role in the improvement of reproductive health. The use of health services is related to the availability, quality and cost of the services, as well as to social structure, health beliefs and the personal characteristics of the users. The present paper examined the factors that influence the use of maternal health services for some selected pregnancy-related complications (e.g. prolonged labour, excessive bleeding, high fever/discharge and convulsions) in Bangladesh by using data from the Bangladesh Demographic Health Survey, 1999-2000. It was found that younger mothers were significantly less likely to seek professional healthcare at the time of birth. The odds for rural women seeking healthcare services from a doctor, nurse and/or midwife were half those of urban women. The strong influence of the mothers' education and parity on the utilisation of healthcare services is consistent with findings from other studies. The possession of assets emerged as an important predictor of seeking care from health professionals at the time of birth. Another factor, i.e. a husband's concern about pregnancy complications, showed a significant and positive impact on the utilisation of healthcare services, which is very important for rural women when they are dependent on their spouses. It was observed that the respondents living in urban areas, who had higher levels of education and lower parity, and more assets (used as a proxy for income), visited trained healthcare providers more often and were more likely to use healthcare facilities provided by trained personnel at the time of delivery. This is a reflection of the fact that, irrespective of their needs, only people from higher economic or educational groups can afford to seek healthcare from trained personnel in Bangladesh. In other words, predisposing and enabling factors appear to have a strong association with women's healthcare utilisation during pregnancy.     

Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women’s Health

Objective : A trend analysis of associations with induced abortion. Methods : Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women’s Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. Results : New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less‐effective contraceptives (aOR2.18 CI 1.65–2.89); increased risky drinking (aOR1.65 CI 1.14–2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28–4.19); or recent partner violence (aOR2.42 CI 1.61–3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31–3.56) or illicit drugs <12 months (aOR2.69 CI 1.77–4.09). Women aspiring to be fully‐ (OR1.58 CI 1.37–1.83) or self‐employed (OR1.28 CI 1.04–1.57), with no children (OR1.41 CI 1.14–1.75) or further educated (OR 2.08 CI 1.68–2.57) were more likely to terminate than other women. Conclusions : Abortion remains strongly associated with factors affecting women’s control over reproductive health such as partner violence and illicit drug use. Implications for public health : Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.     

Gender and medication use: an exploratory, multi-site study

OBJECTIVE: This comparative study in four countries was designed to explore differences in women's and men's patterns of medication use. METHODS: A total of 539 individuals, 303 women and 236 men, aged 15 years and older, were interviewed in Mexico, the Philippines, Uganda, and the US. Country-specific variables and codes adapted questions and answers to local contexts, and the instrument alternated between closed- and open-ended questions. RESULTS: In all sites, women reported using medications more frequently than men. Differences in reported use between women and men over the month preceding the survey were significant in Mexico and Uganda, but not in the two countries with the highest medication use, the Philippines and the USA. Gender differences are explained in part by differences in the frequencies with which major symptoms/conditions are reported, as women were generally more likely to report these conditions then men, but not more likely to treat symptoms or conditions with medications. This analysis also found gendered patterns of communication and information about health: women are central to the process of communication about health and therapies and they appear to draw on a richer repertoire of knowledge, perceptions and attitudes regarding medications. CONCLUSIONS: This study documents differences in patterns of medication use, with women reporting higher use than men overall. It also finds gendered patterns of use, manifested in information and perceptions surrounding medications.     

How Does Acculturation Affect the Use of Complementary and Alternative Medicine Providers Among Mexican- and Asian- Americans?

Researchers have found that immigrants in the United States gradually relinquish cultural practices and adopt health behaviors similar to native born individuals as they acculturate. Few studies have looked at acculturation and Complementary and Alternative Medicine (CAM) use, particularly ethnic forms of CAM. This study uses data from the 2001 California Health Interview Survey—Complementary and Alternative Medicine (CHIS-CAM) supplement to estimate the prevalence of CAM provider use among Mexican- and Asian- Americans and examine the relationship of acculturation on use. Multinomial logistic regression models were used to predict the probability of provider use based on socio-demographic variables, health status and acculturation. Mexican- and Asian- Americans who have spent more time in the US were more likely to use chiropractors or massage therapists compared to no CAM provider. Both groups were less likely to use ethnic-specific CAM providers with more time in the US compared to chiropractors or massage therapists.     

Patterns of health services utilization by recent immigrants

This study was undertaken to analyze how the way young, recently immigrated, families utilize health services evolves over time. Twenty families participated in the study. They all included at least one child of preschool age, had immigrated less than 8 years previously, and had used primary healthcare services since their arrival. A triphasic pattern of utilization was observed, consisting of contact with one or more health services, selection of specific services from those available, and consolidation of choices. Families relied upon a variety of information sources in each of these phases. The primary attributes upon which the families based their evaluation, selection, and adoption of health services were geographical and temporal accessibility, interpersonal and technical quality of services, and language spoken by health professionals and staff. Perception of health services' attributes is influenced by the families' sociocultural referents and preemigration experience. Results indicate that utilization of primary healthcare services progressively changes over time, evolving from the ad hoc use of walk-in services to the adoption of regular sources of care.     

Health status and health care use of Massachusetts women reporting partner abuse

BACKGROUND: Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS: We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS: A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS: These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.     

Utilization of mental health services by low-income pregnant and postpartum women on medical assistance

This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the prenatal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period. About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services.