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Lenta M, Panadero S, Cabrera A, Vázquez JJ. Health situation and perceived health status among women experiencing homelessness: A longitudinal study in Spain. Public Health Nurs 2023; 40:9-16. [PMID: 36029140 PMCID: PMC10086823 DOI: 10.1111/phn.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 01/14/2023]
Abstract
The paper analyses the health situation and the perceived health status of a sample of women experiencing homelessness (n = 138) in Madrid, Spain. All participants were adults, and the night before the baseline interview, they had slept on the street, at a shelter or any facility provided to care for people living homeless. The information was collected using structured interviews, repeated twice a year for a 3-year follow-up period. The findings of this study show that women experiencing homelessness presented poor health, particularly in comparison with the general Spanish population. Over half of the women questioned claimed to have a diagnosed serious or chronic illness, with a correlation between these conditions and the age, time spent homeless or high levels of drug use. There was a positive correlation found between women's perceived health status and being younger and having access to independent accommodation, while having suffered a number of stressful life events and having spent long periods of time living homeless presented a negative correlation with a good perceived health status.
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Affiliation(s)
- Malena Lenta
- Department of Preventive Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sonia Panadero
- Department of Clinical Psychology, Universidad de Complutense de Madrid, Madrid, Spain
| | - Adrian Cabrera
- Department of Economy, Universidad de Alcalá, Alcalá de Henares (Madrid), Spain
| | - José Juan Vázquez
- Department of Social Psychology, Universidad de Alcalá, Alcalá de Henares (Madrid), Spain
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Downey MMB, Patteson Poehling C, O'Connell S. Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping Review. AJPM FOCUS 2022; 1:100032. [PMID: 37791245 PMCID: PMC10546546 DOI: 10.1016/j.focus.2022.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The objective of this review was to conduct a systematic evaluation of the measurement and operationalization of the social determinants of health in research on long-acting reversible contraception use in the U.S. To contribute to the ongoing refinement of the quality of social determinants of health and long-acting reversible contraception use research, this systematic scoping review examines how social determinants of health are measured and operationalized in studies that examine long-acting reversible contraception initiation and usage at the patient level. Methods A detailed search of 5 electronic databases (PubMed, Embase, Web of Science, CINAHL, and PsycINFO) was conducted between December 2020 and January 2021 according to PRISMA guidelines. Determinants were assessed using the Dahlgren and Whitehead model. The protocol and data extraction template were developed a priori. Results A total of 27 articles representing 26 studies were included in our study. A total of 12 studies were retrospective and cross-sectional in design; the remaining studies were a combination of designs. Healthcare services and health insurance were identified as the most frequently researched categories of determinants. There was wide variation in reported operationalization of race and ethnicity, limited engagement with sexuality, and uneven geographic representation across studies. Discussion This systematic scoping review is the first, to the best of our knowledge, to focus on the measurement and operationalization of social determinants of health and on current long-acting reversible contraception use research. Future research on the impact of social determinants of health on long-acting reversible contraception use must explore the full range of factors shaping contraceptive decision making and use and focus on equity-informed data collection methods and reporting.
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Affiliation(s)
| | - Catherine Patteson Poehling
- School of Social Work, College of Education and Human Sciences, the University of Southern Mississippi, Hattiesburg, Mississippi
| | - Samantha O'Connell
- Tulane University Office of Academic Affairs & Provost, New Orleans, Louisiana
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Conard PL, Keller MJ, Armstrong ML. The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless. Nurs Womens Health 2021; 25:471-481. [PMID: 34736917 DOI: 10.1016/j.nwh.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.
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Cheedalla A, Sufrin CB. Contraception Policies in U.S. Jails, Prisons, and Juvenile Detention Systems: A National Survey. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:226-231. [PMID: 34388036 DOI: 10.1089/jchc.19.07.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Contraception is an important health care service for incarcerated women, yet its availability in U.S. prisons, jails, and juvenile detention systems is unknown. We surveyed 6 jails, 22 state prisons, and 3 juvenile detention systems (N = 31 sites) on their contraception policies in 2016. Twenty (65%) sites had formal written contraception policies. All sites allowed people to continue a preincarceration contraceptive method with restrictions on the type of contraception and reason for use. Two sites (6%) did not allow continuation of oral contraceptive pills, 3 sites (10%) did not allow continuation of contraceptive injection, 21 sites (68%) did not allow continuation of contraceptive ring, and 23 sites (74%) did not allow continuation of contraceptive patch. Twenty-eight (90%) sites allowed people to initiate a contraceptive method in custody. Contraception policies in incarceration settings in the United States are varied and may restrict women's ability to continue or initiate the contraception of their choice.
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Affiliation(s)
- Aneesha Cheedalla
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hawkins KE, Montague-Johnstone E. Contraceptive usage in homeless women accessing a dedicated primary care service in Scotland, UK: a case note review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:49-54. [PMID: 32414876 DOI: 10.1136/bmjsrh-2019-200541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Of the 70 000 people experiencing homelessness in Scotland, at least 40% are women. Little is known about their contraceptive usage. Most pregnancies in homelessness are unintended and children are usually looked after in the care system. METHODS A case note review of women's current contraceptive usage in a primary care service serving women experiencing homelessness in Edinburgh, Scotland. The service electronic database was searched for keywords relating to contraception to determine current usage, but also reproductive health, wider demographics and previous pregnancies. RESULTS Of 174 women (16-55 years), 75 (43%) were recorded as using a contraceptive method. 49 (28%) were using long-acting reversible contraception (LARC), most of which was the contraceptive implant. However, 6/41 (15%) of the most effective LARC (intrauterine contraception and implant) was being used beyond its' expiry date. 34 (20%) had no mention of contraceptive use in their medical record and 32 (19%) were not using contraception despite being sexually active. 6 (3%) had been hysterectomised/female sterilisation. 26 (15%) were not sexually active. 179 of the 233 (77%) children mentioned in women's electronic records were recorded as being looked after out with their care. 138/174 (79%) had current/previous drug or alcohol misuse. 100/174 (57%) had a history of domestic violence or abuse. 22/174 (13%) were involved/had been involved in sex work. CONCLUSIONS Primary care services need to give greater attention to the contraceptive needs of homeless women to empower them to become pregnant when the time is right for them and prevent the consequences of unintended pregnancy and homelessness.
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Affiliation(s)
- Katie Eirian Hawkins
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Edinburgh Access Practice primary care service, Edinburgh, UK
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Gawron LM, Sanders JN, Sward K, Poursaid AE, Simmons R, Turok DK. Multi-morbidity and Highly Effective Contraception in Reproductive-Age Women in the US Intermountain West: a Retrospective Cohort Study. J Gen Intern Med 2020; 35:637-642. [PMID: 31701466 PMCID: PMC7080901 DOI: 10.1007/s11606-019-05425-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/20/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women with chronic health conditions benefit from reproductive planning and access to highly effective contraception. OBJECTIVE To determine the prevalence of and relationship between chronic health conditions and use of highly effective contraception among reproductive-age women. DESIGN Retrospective cohort study using electronic health records. PARTICIPANTS We identified all women 16-49 years who accessed care in the two largest health systems in the US Intermountain West between January 2010 and December 2014. MAIN MEASURES We employed administrative codes to identify highly effective contraception and flag chronic health conditions listed in the US Medical Eligibility Criteria for Contraceptive Use (US MEC) and known to increase risk of adverse pregnancy outcomes. We described use of highly effective contraception by demographics and chronic conditions. We used multinomial logistic regression to relate demographic and disease status to contraceptive use. KEY RESULTS Of 741,612 women assessed, 32.4% had at least one chronic health condition and 7.3% had two or more chronic conditions. Overall, 7.6% of women with a chronic health condition used highly effective contraception vs. 5.1% of women without a chronic condition. Women with chronic conditions were more likely to rely on public health insurance. The proportion of women using long-acting reversible contraception did not increase with chronic condition number (5.8% with 1 condition vs. 3.2% with 5 or more). In regression models adjusted for age, race, ethnicity, and payer, women with chronic conditions were more likely than those without chronic conditions to use highly effective contraception (aRR 1.4; 95% CI 1.4-1.5). Public insurance coverage was associated with both use of long-acting reversible contraception (aRR 2.2; 95% CI 2.1-2.3) and permanent contraception (aRR 2.9; 95% CI 2.7-3.1). CONCLUSIONS Nearly a third of reproductive-age women in a regional health system have one or more chronic health condition. Public insurance increases the likelihood that women with a chronic health condition use highly effective contraception.
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Affiliation(s)
- Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine Sward
- College of Nursing, University of Utah, Salt Lake City, UT, USA.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Rebecca Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Gawron LM, Simmons RG, Sanders JN, Myers K, Gundlapalli AV, Turok DK. The effect of a no-cost contraceptive initiative on method selection by women with housing insecurity. Contraception 2020; 101:205-209. [PMID: 31881219 PMCID: PMC7054141 DOI: 10.1016/j.contraception.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/25/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the sociodemographic characteristics of participants in a contraceptive initiative by housing security and determine the association between housing insecurity on contraceptive method selection before and after the removal of cost. STUDY DESIGN This cross-sectional assessment includes 4,327 reproductive-aged participants in the HER Salt Lake Contraceptive Initiative who sought new contraceptive services and reported housing status at enrollment. HER Salt Lake prospectively explored the impact of improved contraceptive access on socioeconomic outcomes in Salt Lake County (USA). For six months (September 2015-March 2016) we collected control data, which included clinic standard-of-care cost-sharing. The intervention started March 2016, and provided no-cost contraception services and unlimited opportunities for method switching over the subsequent three years. RESULTS There were 964 (22%) housing-insecure participants. Compared to those with stable housing, housing-insecure individuals more commonly identified as a sexual minority, received public assistance and lacked health insurance. Housing-insecure women preferentially selected long-acting reversible contraception during the control period (aOR 1.60; 95%CI 1.01-2.56), but method selection equalized across housing status during the intervention. CONCLUSIONS When cost is not a barrier, all women desire a comprehensive selection of contraceptive methods, regardless of housing security. Contraceptive clients in this vulnerable population need interventions which address access barriers to all methods to support reproductive planning. IMPLICATIONS Unintended pregnancy during housing insecurity may result in homelessness. This study found housing-insecure women desire access to all contraceptive methods, not just long acting reversible contraception. Integration of comprehensive family planning initiatives into efforts to address homelessness is essential to support this vulnerable population in their reproductive planning.
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Affiliation(s)
- Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Kyl Myers
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Adi V Gundlapalli
- Department of Internal Medicine, University of Utah School of Medicine and VA Salt Lake City Health Care System.
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
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Gawron LM, Pettey WB, Redd AM, Suo Y, Turok DK, Gundlapalli AV. Distance Matters: Geographic barriers to long acting reversible and permanent contraception for homeless women Veterans. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2019; 28:139-148. [PMID: 31656390 PMCID: PMC6814171 DOI: 10.1080/10530789.2019.1619242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 06/10/2023]
Abstract
Women Veterans who experience homelessness are at high risk of unintended pregnancy and adverse outcomes. Contraception could mitigate risks, yet access barriers exist across the Veterans Health Administration (VHA). We identified all US women Veterans, age 18-44y with evidence of homelessness in VHA administrative data between fiscal years 2002-2015, in order to document the geographic distribution of ever-homeless women Veterans in relation to VA Medical Centers (VAMCs) and assess geographic associations between long acting reversible contraceptives (LARC) or permanent contraception (PC) use. We calculated VAMC travel distance from last known ZIP Code. We used multivariate logistic regression models to explore contraceptive method associations. We included 41,722 ever-homeless women Veterans; 9.2% had LARC exposure and 7.5% PC. We found 29% of ever-homeless women Veterans resided >40miles from the nearest VAMC and increasing drive distance was negatively correlated with contraceptive exposure, especially for Veterans residing >100miles from a VAMC. Increasing distance to the nearest VAMC results in a geographic barrier to the most effective contraceptive options for women Veterans. The VHA is uniquely positioned to leverage its rural and homeless healthcare expertise to address geographic barriers and integrate comprehensive contraceptive services into established programs for high-risk Veterans.
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Affiliation(s)
- Lori M. Gawron
- Informatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System 500 N Foothill Dr. Salt Lake City, UT 84132 USA
- Departments of Obstetrics and Gynecology, University of Utah School of Medicine 30N 1900E Salt Lake City, UT 84132 USA
| | - Warren B.P. Pettey
- Informatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System 500 N Foothill Dr. Salt Lake City, UT 84132 USA
| | - Andrew M. Redd
- Informatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System 500 N Foothill Dr. Salt Lake City, UT 84132 USA
| | - Ying Suo
- Informatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System 500 N Foothill Dr. Salt Lake City, UT 84132 USA
| | - David K. Turok
- Departments of Obstetrics and Gynecology, University of Utah School of Medicine 30N 1900E Salt Lake City, UT 84132 USA
| | - Adi V. Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System 500 N Foothill Dr. Salt Lake City, UT 84132 USA
- Department of Internal Medicine University of Utah School of Medicine 30N 1900E Salt Lake City, UT 84132 USA
- Department of Biomedical Informatics University of Utah School of Medicine 30N 1900E Salt Lake City, UT 84132 USA
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Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV. Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans. Semin Reprod Med 2019; 36:361-370. [PMID: 31003251 DOI: 10.1055/s-0039-1678749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
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Affiliation(s)
- Lori M Gawron
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - April F Mohanty
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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van den Berk Clark C, Chang J, Servey J, Quinlan JD. Women’s Health and the Military. Prim Care 2018; 45:677-686. [DOI: 10.1016/j.pop.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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New Evidence Reflecting VA's Commitment to Achieve Health and Health Care Equity for All Veterans. Med Care 2017; 55 Suppl 9 Suppl 2:S1-S3. [PMID: 28806358 DOI: 10.1097/mlr.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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