Disparities In Women Research Articles

Traceback: A Proposed Framework to Increase Identification and Genetic Counseling of BRCA1 and BRCA2 Mutation Carriers Through Family-Based Outreach.

In May 2016, the Division of Cancer Prevention and the Division of Cancer Control and Population Sciences, National Cancer Institute, convened a workshop to discuss a conceptual framework for identifying and genetically testing previously diagnosed but unreferred patients with ovarian cancer and other unrecognized BRCA1 or BRCA2 mutation carriers to improve the detection of families at risk for breast or ovarian cancer. The concept, designated Traceback, was prompted by the recognition that although BRCA1 and BRCA2 mutations are frequent in women with ovarian cancer, many such women have not been tested, especially if their diagnosis predated changes in testing guidelines. The failure to identify mutation carriers among probands represents a lost opportunity to prevent cancer in unsuspecting relatives through risk-reduction intervention in mutation carriers and to provide appropriate reassurances to noncarriers. The Traceback program could provide an important opportunity to reach families from racial, ethnic, and socioeconomic groups who historically have not sought or been offered genetic counseling and testing and thereby contribute to a reduction in health disparities in women with germline BRCA mutations. To achieve an interdisciplinary perspective, the workshop assembled international experts in genetics, medical and gynecologic oncology, clinical psychology, epidemiology, genomics, cost-effectiveness modeling, pathology, bioethics, and patient advocacy to identify factors to consider when undertaking a Traceback program. This report highlights the workshop deliberations with the goal of stimulating research and providing a framework for pilot studies to assess the feasibility and ethical and logistical considerations related to the development of best practices for implementation of Traceback studies.

Racial/ethnic differences in life-course heavy drinking from adolescence to midlife

ABSTRACTInformation on heavy drinking over the life course might help to explain racial/ethnic disparities in alcohol-related problems, morbidity, and mortality. Using data from the 2009–2010 U.S. National Alcohol Survey (n = 3,026), we analyzed retrospective decades-based measures of heavy drinking during respondents’ teens, 20s, 30s, and 40s. Results indicate that Latino men and African American women have greater risk for persistent-high (vs. declining) heavy-drinking trajectories than Caucasian men and women, and that socioeconomic disadvantage partly accounts for this disparity in women. Prospective longitudinal studies are needed to confirm these results and to elucidate the relationship of life-course heavy-drinking patterns with health-related outcomes, and disparities in these.

Advancing Women's Health and Women's Leadership With Endowed Chairs in Women's Health.

Gender-based bias and conflation of gender and status are root causes of disparities in women's health care and the slow advancement of women to leadership in academic medicine. More than a quarter of women physicians train in internal medicine and its subspecialties, and women physicians almost exclusively constitute the women's health focus within internal medicine. Thus, internal medicine has considerable opportunity to develop women leaders in academic medicine and promote women's health equity.To probe whether holding an endowed chair-which confers status-in women's health may be an effective way to advance women leaders in academic medicine and women's health, the authors explored the current status of endowed chairs in women's health in internal medicine. They found that the number of these endowed chairs in North America increased from 7 in 2013 to 19 in 2015, and all were held by women. The perceptions of incumbents and other women's health leaders supported the premise that an endowed chair in women's health would increase women's leadership, the institutional stature of women's health, and activities in women's health research, education, and clinical care.Going forward, it will be important to explore why not all recipients perceived that the endowed chair enhanced their own academic leadership, whether providing women's health leaders with fundraising expertise fosters future success in increasing the number of women's health endowed chairs, and how the conflation of gender and status play out (e.g., salary differences between endowed chairs) as the number of endowed chairs in women's health increases.

Reducing health disparities for women through use of the medical home model

Background: Healthcare services can be difficult to access, particularly for low-income or underinsured women. One way of overcoming the barriers to quality, patient-centered care is through the use of the Medical Home Model (MHM). The MHM is a cost-effective approach to care that improves patient outcomes and improves access.Aim: The purpose of this article is to discuss barriers to healthcare, with an emphasis on reducing healthcare disparities for women.Method: Extant, contemporary literature has been reviewed and synthesized to develop this theoretical paper on the benefits of using the MHM to reduce disparities in the provision of healthcare for women.Conclusions: The MHM provides an example of how healthcare can be provided in a more coordinated and effective manner. Extension of this model into the area of women's health may be one way to reduce barriers to quality, accessible care for women.

Sexual orientation and sexual health services utilization among women in the United States

Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011–2013 and 2013–2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15–44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37–1.89), HIV (1.66; 1.29–2.14), and HPV (1.79; 1.41–2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76–1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10–1.86) and HIV (1.69; 1.24–2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47–0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07–0.28) and Pap (0.10; 0.03–0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.

Racial/ethnic disparities, body weight, and psychosocial antecedents that predict women’s failure to meet Pap test screening national recommendations

Background: The economic burden associated with cervical cancer in the U.S. is estimated 300–400 million dollars in direct costs. Healthy People 2020 Objective C-15 points the nation’s aim to increase the proportion of adult women who receive a cervical cancer screening to 93%. To identify the associated factors that can help increase Pap test, this study examined the predictors of failure to meet USPSTF Pap test recommendation among adult women. Methods: We analyzed the 2014 National Cancer Institute’s nationally representative Health Information National Trends Survey (HINTS) 4 Cycle 4 data (N=3,677). Adult women who were 21 to 65 years of age and not diagnosed with cervical cancer were included in this analysis. Stepwise multiple logistic regression was conducted to predict the behavioral and demographic factors associated with failure to meet USPSTF Pap test recommendation. Results: Women with the following characteristics tend to fail to meet the Pap test national recommendation with statistical significance: (I) being Asian or White ( vs . Hispanic); (II) being underweight or of normal weight ( vs . overweight/obese); (III) having more symptoms of depression and anxiety within the past two years; (IV) never being diagnosed with cancer; (V) fail to meet USPSTF mammography recommendation ( vs . met); (VI) having last routine check-up by a doctor more than 2 years ( vs . within 2 years); (VII) being older than 35 ( vs . aged 21–35); (VIII) being single, divorced/separated, or widowed ( vs . married/living as married); and (IX) having less education ( vs . college graduate or more). Conclusions: This study identified racial/ethnic disparities in women who failed to meet the Pap test screening national recommendation. Additionally, symptoms of depression and anxiety and being underweight or of normal weight ( vs . overweight) were identified as significant predictors to failing to meet Pap test screening national recommendations. These findings may be used to identify future cervical cancer screening priority populations and direction for further intervention.

Contraceptive method choice among women in slum and non-slum communities in Nairobi, Kenya.

BackgroundUnderstanding women’s contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women’s contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women.MethodsData were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15–49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System. Bivariate and multivariate logistic regression were used to explore the association between the outcome variable, contraceptive method choice, and explanatory variables.ResultsThe prevalence of contraceptive method choice was relatively similar across slum and non-slum settlements. 34.3 % of women in slum communities and 28.1 % of women in non-slum communities reported using short-term methods. Slightly more women living in the non-slum settlements reported use of long-term methods, 9.2 %, compared to 3.6 % in slum communities. Older women were less likely to use short-term methods than their younger counterparts but more likely to use long-term methods. Currently married women were more likely than never married women to use short-term and long-term methods. Compared to those with no children, women with three or more children were more likely to report using long term methods. Women working outside the home or those in formal employment also used modern methods of contraception more than those in self-employment or unemployed.ConclusionUse of short-term and long-term methods is generally low among women living in slum and non-slum contexts in Nairobi. Investments in increasing women’s access to various contraceptive options are urgently needed to help increase contraceptive prevalence rate. Thus, interventions that focus on more disadvantaged segments of the population will accelerate contraceptive uptake and improve maternal and child health in Kenya.

Disparities in Abortion Experience and Access to Safe Abortion Services in Ghana: Evidence from a Retrospective Survey.

In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in women's experiences of abortion and access to safe abortion care. Disparities in rates of abortion experience and access to safe abortion care were assessed using absolute (the difference in rates between groups), relative (the ratio of rates between selected and reference groups), and mean measures. Results suggest that 24% of women had at least one abortion in the five years preceding the survey. However, large gradients of socio-spatial disparities in abortion experience exist. The majority of abortions were also potentially unsafe: 53% of abortions occurred outside of any healthcare facility. Women themselves and medical doctors, respectively, performed 57% and 4% of all abortions. The majority of women also felt they could not get safe abortion even if they wanted one. Together, these results highlight the need for concerted multi-sectorial strategies, including legislative reform and provision of family planning services, to help transition from unsafe to safe abortions.

Nutritional Disparities Among Women in Urban India

Food inflation, meagre wages, cash-based economy, and involvement in strenuous manual work in informal/unorganized sector, unprotected by labour laws of maternity leave, heighten the risk of undernutrition among urban underprivileged women, thus adversely affecting their future and that of their children.National and state-level information about maternal nutrition situation among urban poor in India, based on representative datasets, is still not available. This study is among the first attempts to analyze large scale secondary data, such as from Demographic and Health Survey (DHS) to unmask the extent of disparities in nutritional status and access to services of Indian women belonging to the poorest wealth quartile of the country’s urban population compared to the rest of the urban population. The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/ severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. Night blindness or difficulty in seeing at dusk, a result of chronic vitamin A deficiency, was reportedby 7% women in the poorest urban quartile, which was 2.9 times higher than the rest of the urban population (2.4%).One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days. contamination of water is also high, increasing the risk of intestinal worm infestation and calling for expeditious efforts to improve access of the urban poor and deprived populations to safe drinking-water and measures to prevent helminthic infestations would also require to be strengthened, more so in slum settings where many women work or walk barefoot (and hence at a risk of hookworm infestation).Given the large proportion of undernourished urban poor women, there is a need to assess undernutrition among women either periodically by grassroots-level workers in the nutrition and health programmes as part of the Government or NGO outreach programmes, e.g. health and nutrition days, or by students from social work, public health nutrition institutions or medical schools as part of their practicum. Corrective/mitigation measures for women identified as undernourished need to be instituted. These could include providing an additional food supplement to such women (on similar lines as being done for severely-underweight children), enrolling undernourished women for behaviour promotion plus self-confidence enhancement sessions, improving their access to food subsidy and linkage to poverty alleviation programmes since such women often come from food-insecure families owing to irregular/low wages and poor access to food subsidy.

Are racial differences in obesity and insulin resistance related to aggressive breast cancer?

1568Background: Black women are more likely to die of breast cancer and have more aggressive type cancers than white women. Black women are also more likely to have obesity and insulin resistance than white women. Insulin resistance has been associated with faster tumor growth in mouse models of breast cancer, but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would have more aggressive breast cancer at presentation and this would be associated with obesity and insulin resistance. Methods: We recruited 281 (80% white, 20% black) women with a new primary breast cancer and measured pre-operative fasting blood glucose and insulin, BMI, waist circumference (WC), Nottingham prognostic index (NPI). We classified aggressive breast cancer as a NPI > 4.4. We calculated HOMA-IR (HOMA) scores and classified insulin resistance a HOMA > 2.8, the upper quartile of insulin resistance in the US population. Patients self-identified race. Res...

Stuck in the Basement: A Pathway Case Analysis of Female Recruitment in Hungary's 2010 National Assembly Elections

Women's legislative underrepresentation has emerged as perhaps the most stable feature of the postcommunist Hungarian political system, resisting Europeanization, changes in the electoral and party systems, and a new constitution. Early research on the decline in women's access to power in postcommunist transitional democracies focused on common legacies of communist rule, but those legacies cannot account for widening disparities in women's representation across the region over time or the persistent underrepresentation of women in Hungary. Using a pathway case analysis of Hungary's 2010 parliamentary elections, this research examines how cultural, structural, and institutional factors interacted to keep Hungary stuck in the basement with respect to women's legislative recruitment.

Racial/ethnic disparities in environmental endocrine disrupting chemicals and women's reproductive health outcomes: epidemiological examples across the life course.

Disparities in women's reproductive health outcomes across the life course have been well-documented. Endocrine disrupting chemicals may be one factor driving disparities, as studies suggest exposure to certain environmental endocrine disrupting chemicals, such as certain phthalates, bisphenol A, parabens and polybrominated diphenyl ethers are higher in non-whites. Yet, a limited amount of research has focused on these chemical exposures as a potential mediator of racial/ethnic differences in women's reproductive health outcomes, such as pubertal development, fibroids, infertility, and pregnancy complications. Given that race/ethnicity is a social construct, the purpose of this review was to present the current state of the literature on racial/ethnic disparities in both environmental endocrine disrupting chemicals, as well as associations between these chemicals and selected women's reproductive health outcomes. Our goal was to evaluate literature from populations based in the United States to: 1) characterize racial/ethnic differences in environmental endocrine disrupting chemicals and 2) systematically review literature on environmental endocrine disrupting chemicals and selected women's health outcomes in populations containing more than one racial/ethnic group. This review highlights the need for future work in determining whether higher exposures to some environmental endocrine disrupting chemicals might partly explain differences in women's reproductive health outcomes in these higher-exposure and high-risk groups.

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer.

Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. We used 2006-2012 SEER-Medicare data to evaluate the use of neurokinin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). The study included 1130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95% CI 0.51-0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95% CI 0.35-0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. We found racial disparities in women's use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among breast cancer patients.

292 Background: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, it can have serious implications for patients’ treatment outcomes, including quality of life. Guidelines recommend the use of an NK1 receptor antagonist to prevent CINV among patients beginning chemotherapy with a high risk of causing the side effect. However, barriers to use of oral NK1s (i.e., aprepitant) exist. In many cases, patients are required to fill a prescription for aprepitant at their home pharmacy. As well, the drug is expensive, costing over $500 under Medicare Part D, and patients may be responsible for a large portion of that cost. These barriers may contribute to racial disparities as they disproportionately affect minority patients. Methods: We used 2006-2012 SEER-Medicare data to evaluate the use of NK1s among black and white women initiating adjuvant chemotherapy with an anthracylcline and cyclophosphamide for early-stage breast cancer. NK1 use during the first chemotherapy cycle was measured using Medicare Part D and Part B claims. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 1,015 eligible women (911 white; 104 black), 38% of white and 28% of black women received any NK1 at the start of their chemotherapy regimen. In adjusted analyses, black women were 30% less likely than white women to receive any NK1 (aRR black vs. white: 0.70, 95% CI: 0.52-0.94). This disparity was driven by a 44% gap in orally administered NK1s (aprepitant) (aRR: 0.56 95% CI: 0.35-0.89). We did not observe disparities in intravenous fosaprepitant use (aRR: 0.77, 95% CI: 0.46-1.28, NS). After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions: Our study found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in women’s ability to afford the medication.

Psychosocial Variables Related to Why Women are Less Active than Men and Related Health Implications

This article reviews psychosocial influences on women’s participation in physical activity as they differ from men and how associated activity differences impact women’s risk for a number of chronic diseases. This topic directly aligns with the mission of this special edition related to disparities in women’s health as the typically lower level of physical activity in females directly impacts their health. On average, females participate in physical activity at lower rates than their male counterparts. These lower rates of physical activity are directly related to both incidence of and outcomes from cardiovascular disease, type 2 diabetes, and breast and gynecological cancers. The relationship between psychosocial factors that are understood to affect physical activity differs between men and women. Specifically, self-efficacy, social support, and motivation are empirically substantiated factors that found to impact physical activity participation among women differently than men. Understanding these relationships is integral to designing effective interventions to target physical activity participation in women so that the related health risks are adequately addressed.

ACOG Committee Opinion No. 649: Racial and Ethnic Disparities in Obstetrics and Gynecology.

Projections suggest that people of color will represent most of the U.S. population by 2050, and yet significant racial and ethnic disparities persist in women's health and health care. Although socioeconomic status accounts for some of these disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women's health outcomes. The American College of Obstetricians and Gynecologists is committed to the elimination of racial and ethnic disparities in the health and health care of women and encourages obstetrician-gynecologists and other health care providers to engage in activities to help achieve this goal.

Committee Opinion No. 649 Summary: Racial and Ethnic Disparities in Obstetrics and Gynecology.

Projections suggest that people of color will represent most of the U.S. population by 2050, and yet significant racial and ethnic disparities persist in women's health and health care. Although socioeconomic status accounts for some of these disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women's health outcomes. The American College of Obstetricians and Gynecologists is committed to the elimination of racial and ethnic disparities in the health and health care of women and encourages obstetrician-gynecologists and other health care providers to engage in activities to help achieve this goal.

Social disparities in hazardous alcohol use: self-report bias may lead to incorrect estimates.

Self-report bias in surveys of alcohol consumption is widely documented; however, less is known about the distribution of such bias by socioeconomic status (SES) and about the possible impact on social disparities. This study aims to assess social disparities in hazardous drinking (HD) and to analyze how correcting alcohol consumption data for self-report bias may affect estimates of disparities. National survey data from 13 countries, Canada, England, Finland, France, Germany, Hungary, Ireland, Japan, Korea, New Zealand, Spain, Switzerland and USA, are used to examine social disparities in HD by SES and education level. Defining HD as drinking above 3 drinks/day for men and 2 for women, social disparities were assessed by calculating country-level concentration indexes. Aggregate consumption data were used to correct survey-based estimates for self-report bias. Survey data show that more-educated women are more likely than less-educated women to engage in HD, while the opposite is observed in men in most countries. Large discrepancies in alcohol consumption between survey-based and aggregate estimates were found. Correcting for self-report bias increased estimates of social disparities in women, and decreased them in men, to the point that gradients were reversed in several countries (from higher rates in low education/SES men to an opposite pattern). This study provides evidence of a likely misestimation of social disparities in HD, in both men and women, due to self-report bias in alcohol consumption surveys. This study contributes to a better knowledge of the social dimensions of HD and to the targeting of alcohol policies.

Intimate Partner Violence, Gender and Lethality: A Case Analysis of Two Fatalities

Deaths caused by intimate partner violence (IPV) are an area of significant concern for advocates, practitioners, and experts. Aspart of collaborative community interventions to curb violence,the creation of multi-agency fatality review teams has shown effectiveness in reducing IPV and concomitant homicides. The following study is deviant case analysis of 2 female perpetrators within a multi-phasic fatality review of 22 felony cases of IPV resulting in homicide in a city in the southeastern United States. This study was designed to effectively gauge whether gender is avariable for those accused of felony murder as a result of IPV. Results indicate gender disparities for women, including inabilityto act as free agents within increasingly violent relationships; disparate characterization of violent women as more egregious than those of male counterparts within law enforcement and behavioral health and the pressing need for legal and therapeutic rehabilitative services provided to violent women offenders.

Do rural and urban women experience differing rates of maternal rehospitalizations?

Conditions such as postpartum complications and mental disorders of new mothers contribute to a relatively large number of maternal rehospitalizations and even some deaths. Few studies have examined rural-urban differences in hospital readmissions, and none of them have addressed maternal readmissions. This research directly compares readmissions for patients who delivered in rural versus urban hospitals. The data for this cross-sectional study were drawn from the 2011 California Healthcare Cost and Utilization Project. Readmission rates were reported to demonstrate rural-urban differences. Generalized estimating equation models were also used to estimate the likelihood of a new mother being readmitted over time. The 323 051 women who delivered with minor assistance and 158 851 women who delivered by cesarean section (C-section) were included in this study. Of those, seven maternal mortalities occurred after vaginal deliveries and 14 occurred after C-section procedures. Fewer than 1% (0.98% or 3171) women with normal deliveries were rehospitalized. The corresponding number for women delivering via C-section was 1.41% (2243). For both types of deliveries, women giving birth in a rural hospital were more likely to be readmitted. This is the first study examining rural-urban differences in maternal readmissions. The results indicate the importance of monitoring and potentially improving the quality of maternal care, especially when the delivery involves a C-section. More studies investigating rural health disparities in women's health are clearly necessary.