Associations between sexual and reproductive health communication and health service use among U.S. adolescent women

CONTEXT: An understanding of the association between adolescents’ sexual and reproductive health knowledge and their use of relevant services is needed to improve young people’s sexual and reproductive health. METHODS: Data from the National Survey of Family Growth were used to examine associations between sexual and reproductive health communication (parental and formal) and service use among 2,326 U.S. women aged 15–19 in 2002 and 2006–2008. Chi‐square tests and multivariate logistic regression were used to assess relationships between adolescents’ receipt of sexual and reproductive health communication from parents and formal (school, church, community) sources and their use of sexual and reproductive health services. RESULTS: The majority of adolescents had received parental (75%) and formal (92%) sexual and reproductive health communication; 43% reported recent service use. In unadjusted analyses, parental and formal communication were positively associated with service use. In regression models, overall parental communication remained positively associated with service use (odds ratio, 1.6); parental abstinence‐only communication, which was not significant in 2002, was associated with reduced odds of service use for the pooled sample (0.4) and in 2006–2008 (0.3). Formal communication was not associated with service use. CONCLUSIONS: Further research is needed to assess whether comprehensive sexual and reproductive health communication facilitates adolescents’ health care utilization. Examination of how communication sources, quality and content are related to service use is needed to understand adolescents’ sexual and reproductive health knowledge and needs.     

Managing pesticide chronic health risks: U.S. policies

This paper provides an overview of U.S. government pesticide risk management efforts over time and in recent years, relevant to chronic health risks of pesticides. Pesticides are in widespread usage in the U.S. With hundreds of active ingredients and thousands of products on the market, management of pesticide risks has been a daunting challenge. The first legislation providing federal authority for regulating pesticides was enacted in 1910. With the establishment of the U.S. Environmental Protection Agency in 1970 and amendments to the pesticide law in 1972, the federal government was for the first time given the authority to regulate health and environmental risks of pesticides. However, older pesticide risks were not addressed until legislation was enacted in 1988, requiring "reregistration" and 1996, requiring that pesticide food standards are safe for children. In result, the U.S. has seen an expansion of development of pesticide products that are registered as "reduced risk" or are biologicals. Additionally a large number of older pesticides have been cancelled or reduced from the market and/or from individual food uses. Through biomonitoring data, the U.S. may now be seeing trends in reduction of exposure to certain pesticides, the organophosphate insecticides. However, pesticide sales data through 2001 do not provide evidence for such trends.     

Facebook use and negative body image among U.S. college women

Young women increasingly spend time on social media, but the relationship of this exposure to body image is still in the initial stages of exploration. In this study the authors used social comparison theory to examine the relationship between time spent on Facebook and body image. A survey of 881 U.S. college women was conducted in April–May 2013. Findings showed that 10.1% had posted about weight, body image, exercise, or dieting, and 27.4% had commented on friends’ posts or photos. More time on Facebook related to more frequent body and weight comparisons, more attention to the physical appearance of others, and more negative feelings about their bodies for all women. For women who wanted to lose weight, more time on Facebook also related to more disordered eating symptoms.     

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.     

Preventive health behaviors and mammography use among urban older women

A cross-sectional survey of 610 low income women between the ages of 60 and 84 who attended community meal sites in Los Angeles was conducted to determine health behaviors associated with mammography use among urban community dwellers. Preventive practices that require women to take an active role and recurrent participation were positively associated with a current mammography, while services that are clinician-initiated were associated with ever having a mammography.     

Calcium and vitamin D use among older adults in U.S.: Results from national survey

Objective

This study was conducted to describe a 10-year trend of the supplement from 2000 to 2009 and to evaluate age, gender and racial disparities using a national level health data.

Design

Cross-sectional observational study.

Setting and Participants

Data collected from patient visit records to stand-alone US ambulatory care clinics. Visits made by men and women who were 40 years of age and older were included (n=175,830).

Measurements

Overall prevalence of recorded calcium and vitamin D use for osteoporosis prevention and treatment, and annual visit rates were estimated by age, gender, race, insurance types, physician specialties, geographical regions, and metropolitan status using chi square test. Multivariate logistic regression was conducted to determine potential predictive factors for calcium and vitamin D supplements.

Results

An increase in yearly trend of calcium and vitamin D supplements was observed. The increase was proportional to patients’ age (p<0.05) and female gender was a strong predictor of calcium and vitamin D supplement (p<0.0001).Visits made by blacks were significantly less likely to be associated with the supplement (p<0.05). Visits associated with self-pay and Medicaid was less likely to be recorded with vitamin D (p<0.05) but not calcium supplements. Osteoporosis diagnosis was an independent predictor of calcium and vitamin D records (p<0.0001).

Conclusions

In spite of the observed increases in the trend of visits associated with calcium and vitamin D supplements, variability in the access to the medications was observed. More focused strategies targeting elderly, men, or black population are needed to maintain and improve adequate calcium and vitamin D supplements.

     

Self-rated health among U.S. adolescents

PurposeThis article investigates the meaning of subjective health assessments for younger respondents by examining the temporal stability of self-rated health (SRH) among adolescents. Two competing understandings of SRH are tested: SRH as a spontaneous health assessment or as an enduring self-concept.MethodsUsing data from two waves of the National Longitudinal Study of Adolescent Health (n = 13,511), an intra-class correlation coefficient and a weighted Kappa estimate are calculated to assess the test-retest reliability for SRH. Self-rated health (T2) is then modeled as a function of SRH (T1), physical health (T1), and mental health (T1), and changes in physical and mental health (T2–T1).ResultsSRH is found to be moderately stable over repeated observations (K = .40; ρ = .55) among adolescents. Findings from multivariate analyses suggest that SRH (T2) is largely determined by SRH (T1) and less so by changes in physical or psychological health status (T2-T1).ConclusionsSRH among adolescents is in part a spontaneous health assessment but it is best understood as an enduring self-concept.     

Health risks of diving among U.S. Navy officers

The objectives were to compare hospitalization, medical board, and mortality rates of diving-related disorders and stress-induced diseases between U.S. Navy male diving officers (n = 1977) and a matched sample of nondiving officers (n = 1973). Less experienced diving officers had significantly higher hospitalization rates than more experienced diving officers for total admissions, stress-related disorders (primarily alcoholism), and cardiovascular disease. Diving officers had significantly higher hospitalization rates than controls for nervous system diseases and joint disorders; none of these hospitalized diving officers had a recorded incident of decompression sickness. To ensure the safety and overall excellent health status of diving officers, it is necessary to promote and continue adherence to the procedures developed for safe diving in the U.S. Navy diving community.     

Multistrategy health education program to increase mammography use among women ages 65 and older.

Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.     

Challenges of contraceptive use and pregnancy prevention among women in the U.S. Navy

In this article we present the results of a study to illuminate the explanatory factors related to unplanned pregnancies in the United States Navy, particularly with regard to female contraceptive training and practices, and occupational culture. The data set consists of 52 semistructured interviews with key informants, sailors, and enlisted personnel who were recruited via a quota sample stratified by gender, occupation, and location. The research team carried out semistructured interviews at seven different naval facilities in the mainland United States, the South Pacific, and Europe. Textual analysis of the interview data revealed four domains pertinent to unplanned pregnancies: (a) ineffective training for women regarding contraceptive options, proper dosing, and potentially negative side effects; (b) discrepancies between contraceptive knowledge and their proper use; (c) different foci of contraceptive training for men (sexually transmitted infection prevention) and women (pregnancy prevention); and (d) cultural norms that equate contraceptive use with promiscuity.     

Rural U.S. women: Traditions and transitions affecting health care

Warren (1972) proposed a means for determining differences between rural and urban social contexts that expands on the population definitions. Essentially, these differences are geographical, social, and economic in nature, and the health status of individuals in either setting may be affected by these variations. The health issues of women that evolve from these rural factors are the focus of this article.     

Factors associated with use of preventive dental and health services among U.S. adolescents

Purpose: To examine adolescents’ use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care.

Methods: Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents’ demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN.

Results: Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth.

Conclusions: Health insurance and family income are most consistently related to adolescents’ use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children’s Health Insurance Program.     

Tracking binge drinking among U.S. childbearing-age women

OBJECTIVE: The purpose of this analysis was to track the estimated prevalence of binge drinking for the years 2001-2003 among U.S. women of childbearing age in order to inform ongoing efforts to prevent alcohol-exposed pregnancies. METHOD: A total of 58,431, 64,181, and 65,678 women aged 18-44 for the years 2001, 2002, and 2003, respectively, participated in the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey. The estimated binge drinking prevalence for each survey year and changes in these estimates for the entire survey period were calculated for these women. RESULTS: The estimated binge drinking prevalence among childbearing-age women 18-44 years for the years 2001, 2002, and 2003 was 11.9%, 12.4%, and 13.0%, respectively. The estimated number of childbearing-age women who engaged in binge drinking rose from 6.2 million in 2001 to 7.1 million in 2003, an increase of 0.9 million. CONCLUSION: The results of this analysis provide support for enhancing efforts among healthcare providers to identify and intervene with childbearing-age women who engage in alcohol use that can increase their risks for various health problems, including an alcohol-exposed pregnancy.     

Pregnancy outcomes among U.S. women Vietnam veterans

BACKGROUND: Since the 1965-1975 Vietnam War, there has been persistent concern that women who served in the U.S. military in Vietnam may have experienced adverse pregnancy outcomes. METHODS: We compared self-reported pregnancy outcomes for 4,140 women Vietnam veterans with those of 4,140 contemporary women veterans who were not deployed to Vietnam. As a measure of association, we calculated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression adjusting for age at conception, race, education, military nursing status, smoking, drinking and other exposures during pregnancy. RESULTS: There was no statistically significant association between military service in Vietnam and index pregnancies resulting in miscarriage or stillbirth, low birth weight, pre-term delivery, or infant death. The risk of having children with "moderate-to-severe" birth defects was significantly elevated among Vietnam veterans (adjusted OR = 1.46, 95% CI = 1.06-2.02). CONCLUSIONS: The risk of birth defects among index children was significantly associated with mother's military service in Vietnam.