Native Women Research Articles

Surveillance, Epidemiology, and End Results Data Show Increasing Rates of Distant-Stage Breast Cancer at Presentation in U.S. Women.

Background The incidence of distant-stage (metastatic) breast cancer at initial presentation has increased significantly in U.S. women under 40 years of age, but no clear trend in older women has been reported. Purpose To investigate trends in distant-stage breast cancer incidence using the latest available Surveillance, Epidemiology, and End Results (SEER) data, including the COVID-19 pandemic years 2020 and 2021. Materials and Methods In this retrospective study of 71 million to 80 million women annually, SEER 22 stage-specific breast cancer incidence rates from January 2004 to December 2021 were analyzed using Joinpoint software to evaluate trends in distant-stage disease in U.S. women overall, by age group, and by race and ethnicity. Results Distant-stage breast cancer incidence rates at presentation increased significantly for U.S. women overall, with an annual percentage change (APC) of 1.16% (95% CI: 0.92, 1.42; P < .001) over 2004-2021. Distant-stage disease increased consistently for women aged 20-39 years (APC, 2.91%; P < .001) and for women aged 75 years or older (APC, 1.44%; P < .001). For women aged 40-74 years, the distant-stage breast cancer incidence rate increased with an APC of 2.10% over 2004-2010 (P = .002) and an APC of 2.73% over 2018-2021 (P = 0.01). The interruption of care in 2020 due to COVID-19 affected distant-stage breast cancer detection, especially for older women from racial and ethnic minority groups. The incidence of distant-stage breast cancer increased over 2004-2021 for Asian women (APC, 2.90%; P < .001), Black women (0.86%; P = .008), and Hispanic women (1.56%; P < .001) and over 2004-2019 for Native American women (3.86%; P = .04). White women showed an increase over 2004-2012 (1.68%; P = .01) but no evidence of a trend over 2012-2021. Distant-stage cancer incidence rates were 55% higher in Black women than White women. Conclusion Distant-stage breast cancer incidence rates at presentation have increased significantly in U.S. women overall; in age groups 20-39 years, 40-74 years, and 75 years or older; and in Asian, Black, Hispanic, and Native American women. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kim and Moy in this issue.

Management of detected syphilis in pregnancy adheres to guideline recommendations, but the crisis of congenital syphilis persists.

Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018. This study evaluates the management of women diagnosed with syphilis in pregnancy in South-East Queensland (SEQ) after release of this guideline. This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline. Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early-stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage-appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four-fold reduction in rapid plasma reagin at time of delivery. Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women.

Intermarriage and mortality among Finnish migrants in Sweden: a prospective register study using binational data.

Conjugal ties may contribute to a convergence of health behaviours between migrants and natives, but the association between intermarriage and health outcomes remains understudied. We investigated mortality patterns among Finnish migrants in Sweden according to the spouse's country of birth and compared these patterns with those observed in the native populations of both Sweden and Finland. Leveraging register data from Sweden and Finland, we identified all married Finnish migrants aged 40-64 and their spouses in Sweden in 1999 and corresponding reference groups in both countries. We used a combination of direct matching and inverse probability weighting to adjust for sociodemographic differences between the groups. We followed individuals for all-cause, alcohol-related, smoking-related, and cardiovascular disease (CVD) mortality during 2000-17. Accounting for sociodemographic characteristics, Finnish migrant men married to Swedish-born as opposed to Finnish-born spouses showed lower all-cause [incidence rate ratio (IRR) 0.94, 95% confidence interval (CI) 0.90-0.98], and CVD mortality (IRR 0.88, 95% CI 0.81-0.95), levels more akin to native Swedes. Migrant women with Swedish-born spouses instead had higher smoking-related mortality (IRR 1.41, 95% CI 1.24-1.61) than those married to Finnish-born spouses, mirroring the higher smoking-related mortality of native Swedish women. Individual-level regression analysis on migrants further indicated lower alcohol-related mortality for intermarried men, adjusted for duration of marriage (IRR 0.74, 95% CI 0.56-0.98). These findings suggest that intermarriage with a native spouse can facilitate the convergence of health behaviours and behaviour-related mortality between migrants and natives.

Comparison of Epidemiology, Demography, Treatment (Surgery and Radiotherapy), and Survival Between Aboriginal and Torres Strait Islander and Non‐Indigenous Women With Cervical Cancer in NSW, Australia in 2009–2018

ABSTRACTBackgroundHealth outcomes for Aboriginal and Torres Strait Islander people in Australia are significantly worse than in the non‐Indigenous population.AimTo evaluate demographic factors and treatment (surgery and radiotherapy) rates for cervical cancer and to compare these between the Aboriginal and non‐Aboriginal populations to identify any differences in outcomes or modifiable treatment differences between the populations.MethodsRetrospective cohort analysis of all patients in the state of New South Wales, Australia, diagnosed with cervical cancer between 2009 and 2018 using linked registry, treatment, and death data.ResultsThe crude incidence rate for cervical cancer in Aboriginal women in NSW (17.29/100,000) was more than double the rate among non‐Aboriginal women (6.77/100,000). Aboriginal women were diagnosed with cervical cancer, including metastatic disease, at a younger age. There was no significant difference in presentation stage, surgery or radiotherapy treatment rates, or overall survival at 5 years between the two populations.ConclusionAlthough access to cancer care looks similar as an aggregate in Aboriginal versus non‐Aboriginal populations, there were disparities with reduced access to care (patients who did not receive either radiotherapy or surgery) among Aboriginal patients who were socioeconomically disadvantaged or residing in remote areas. The lower age of cancer diagnosis among Aboriginal women may have effects on survivorship, including negative effects on fertility, loss of income, and other personal, social, and economic consequences. Efforts to improve access to care, including screening, diagnosis, and treatment, should be targeted toward younger Aboriginal women and those who are socioeconomically disadvantaged or those residing in remote areas.

Investigating the frequency and intensity of menopausal symptoms and contributing factors in postmenopausal women in a Middle Eastern Nation

Introduction: Due to the hormonal changes that occur during the menopause period, postmenopausal women (PMW) experience symptoms that can affect their quality of life. This study aimed to investigate the prevalence of menopausal symptoms and its related factors in Iranian PMW. Methods: In this cross-sectional study, a total number of 300 participants from Neyshabur health centers were recruited, using stratified random sampling in 2022. Data were collected using the demographic characteristics and Menopause Rating Scales. Descriptive statistics, Pearson correlation test, and stepwise regression analysis were employed for data analysis using SPSS software version 22. Results: The mean (standard deviation) age of menopause was 49.4 (3.3). The most common menopausal symptoms were muscle or joint pain 239 (79.7%), hot flashes/sweating 232(77.3%), and anxiety 219 (73%), and sexual problems 214 (71.3%). Independent predictors of menopausal symptoms were: the spouse’s education level for physiological and total menopausal symptoms; chronic diseases for somatic total menopausal symptoms; age, economic status, and the number of children for uranological menopausal symptoms; and family structure for physiological menopausal symptoms (P&lt;0.05). Conclusion: Women education about menopause, including its associated symptoms and the underlying factors influencing symptomatology, is essential for enhancing their quality of life both during and after this transitional phase. Additionally, providing them with information on effective strategies and interventions for mitigating and managing menopausal symptoms can significantly contribute to improving women’s overall well-being during this life stage.

'They got my back': Thematic analysis of relationship building in nurse home visiting in Aboriginal communities.

The client-practitioner relationship is the cornerstone of nurse home-visiting programs. Little is understood about how relationship-based maternal and early childhood health care is perceived by women in remote Aboriginal communities. As part of an evaluation of nurse home-visiting in the Northern Territory, this research examines how relationships are established with clients, and what elements are valued most by women. Maternal Early Childhood Sustained Home-visiting (MECSH) is an Australian model of nurse-led home-visiting targeted at women facing adversity who need extra support. The model provides parenting information, health education and psychosocial support during pregnancy and the first 3 years of children's development. Interviews were conducted with 92 Aboriginal women and 11 practitioners including nurses, social workers and community workers. Qualitative semi-structured interviews were conducted with convenience samples of MECSH clients and practitioners. Data were analysed using a two-step process of structural coding and thematic analysis. Trust was the foundation of clients' positive perception of the relationship with their MECSH provider. Relationships took time to develop, often beginning with practical support to meet clients' basic needs. Practitioner dependability and flexibility to client priorities, communication, confidentiality and being helpful to the woman and her family was important. Clients emphasised emotional support and friendship. The relationship-based approach was valued and consistent with culturally safe and trauma informed ways of working with Aboriginal families. Effort is required to commit to the model to address ongoing healthcare engagement and health outcomes in remote Northern Territory communities.

Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022

Background: Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States. Methods: Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West. Results: We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]). Conclusion: Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.

DISP-05. SUPERVISED MACHINE LEARNING PREDICTION OF THERAPEUTIC CLINICAL TRIAL ENROLLMENT FOR MINORITY PATIENTS AND WOMEN IN NEURO-ONCOLOGY

Abstract BACKGROUND Despite changes in national policy, women and minority patients remain under-accrued in glioma clinical trials. Supervised machine learning may serve as a novel approach to understanding which variables and their complex interplay most influence enrollment for underrepresented patients. We aimed to design and externally validate machine learning models to predict therapeutic clinical trial enrollment for a) all patients, b) women, and c) NIH-designated minority patients with low- and high-grade glioma. METHODS In a 20-year retrospective cohort of 1042 adult patients with low- and high-grade glioma, boosted neural network (BNN) models for the whole, women, and minority cohorts were used to analyze the combined effects of demographic, socioeconomic, and oncologic variables on clinical trial enrollment. These models were validated using an external cohort (n=103). RESULTS In the development cohort (445 [42.7%] women; 151 [14.5%] minorities; median age, 51.5 [interquartile range: 39.4-62.5] years), 350 patients (33.6%) enrolled in a therapeutic clinical trial. The whole cohort BNN (AUC: 0.827, misclassification rate (MR): 0.175), the women cohort BNN (AUC: 0.895, MR: 0.125), and the minority cohort BNN (AUC: 0.983, MR: 0.053) models accurately predicted trial enrollment on external validation. For the whole cohort and women models, several demographic (race, ethnicity, minority status, sex), socioeconomic (insurance, employment status), and oncologic variables (seizure, chemotherapy, KPS, WHO grade, tumor lobe) were equally influential (Main effect (ME): 1.000, Total effect (TE): 1.000) on enrollment. For the minority model, socioeconomic variables including insurance status (ME: 0.089, TE: 0.417) and occupation classification (ME: 0.087, TE: 0.381) drove enrollment. CONCLUSION We designed and externally validated the first machine learning model for predicting therapeutic clinical trial enrollment for patients with diffuse glioma. Model features driving trial enrollment varied for underrepresented patients. These results may help prioritize personalized patient-specific initiatives to address barriers to equitable patient accrual.

Effect of cardiovascular fitness on performance metrics in Bangladeshi women cricket: a role-specific analysis employing the harvard step test

Background: Cardiovascular fitness is essential for sports performance, enabling players to endure intense training, delay fatigue, and reduce injury risk—all critical factors for achieving optimal results in competitive sports like cricket. Emphasizing inclusive health ensures that all athletes enhance their cardiovascular fitness and overall performance. Purpose: This study aimed to investigate the impact of cardiovascular fitness, assessed using the Harvard Step Test, on the performance indicators of Bangladeshi women cricketers across their respective playing roles. Method: 104 players, including 34 batters, 38 bowlers, and 32 all-rounders, were voluntarily selected from the “Bangladesh National Women’s Cricket League 2021-22”. Cardiovascular fitness was evaluated through the Harvard Step Test, and role-specific performance metrics such as strike rate, bowling economy, and dismissal rates were analyzed. Statistical analyses included descriptive statistics and one-way ANOVA to assess differences in aerobic fitness across player roles and correlation analyses to examine the relationships between performance metrics and Harvard Step Test scores. Results: The multi-group comparison did not reveal a statistically significant difference in aerobic fitness across the playing roles, F(2, 101) = 0.668, p = 0.515. Additionally, the Harvard Step Test scores showed a weak and statistically non-significant relationship with role-specific performance metrics: strike rate (r = 0.20, p = 0.06) for batters, bowling economy (r = -0.09, p = 0.51) for bowlers, and dismissals (r = 0.10, p = 0.38) for fielders. Conclusion: Cardiovascular efficiency is similar across batters, bowlers, and all-rounders among Bangladeshi women cricketers. The Harvard Step Test score is not directly associated with role-specific performance in women's cricket. These findings suggest that training programs should adopt a holistic physical fitness approach, incorporating role-specific training to enhance the overall abilities of female cricketers and contribute to the development of women's cricket in Bangladesh.

Honoring the Heartwork of Indigenous Scholars Through Lived Experiences: Voices from Native Women Scholars in New Mexico

This body of knowledge provides personal narratives of the lived experiences of Native women from an all-Native doctoral cohort. Through personal narratives, we aimed to highlight the unique learning experience created by strong and beautiful Indigenous scholars who honored Native identities, engaged learning with Indigenous knowledge systems, cultivated Native educational leadership, and mentorship necessary for student success, work-life balance, and giving back to tribal communities. Creating a learning community for an all-Native cohort disrupts colonial legacies and its ongoing practices, marking a significant step toward progress and change, and illuminates the voice and presence of Native American mothers, daughters, aunties, professionals, and scholars. Our experiences as Native women scholars are interconnected with our cultural values, family and community, and traditional teachings. Entering the academy with these embodied teachings and knowledge provided a foundation to engage with Indigenous frameworks and theories, relational practices with tribes and communities, and reclaim knowledge and ways of being that create new possibilities for Native futures. These experiences provide an understanding of the joy, compassion, successes, and negotiating life in the academy among two Native women scholars.

Changes in Breast Cancer Screening Prevalence in the US During the COVID-19 Pandemic, 2018-2022.

Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared to 2018 in the national prevalence of self-reported up-to-date mammography. Using 2018-2022 data from the Center for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (bi-annual mammography in women ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics. UTD BC screening declined for the first time since 2018 (2018 compared to 2022, from 78.7% to 76.6%; aPR, 0.97; 95% CI, 0.96-0.98), despite a small increase in past-year breast cancer screening from 2020 and 2022 (57.9% to 59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended BC screening in 2022 vs. 2018. UTD BC screening declines between 2018-2022 were largest for American Indian/Alaska Native women (74.8% to 62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1% to 65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48% to 42.9%; aPR, 0.85; 95% CI, 0.78-0.92). Previously noted pandemic-related declines in past-year BC screening now reflect in women reporting being UTD, with the largest declines in AI/AN and lower SES women. Future studies should monitor screening prevalence in relation to BC diagnostic stage, overall and by sociodemographic groups.

"Nobody Knew . . . What Was Gonna Happen": Indigenous Loss and Grief During the COVID-19 Pandemic.

Indigenous peoples have experienced higher rates of loss and death compared to the general population, partly due to historical loss. This qualitative inquiry focused on understanding Indigenous women's experiences of loss, grief, and death during the COVID-19 pandemic, involving 31 head-of-household Native American women from a southeastern US tribe. Reconstructive analysis of data from a community-based critical ethnography identified the following themes spanning the ecological levels of the FHORT: (a) loss of finances, (b) loss of structure and loss of self, (c) death due to COVID-19, (d) disrupted mourning and burial rituals, and (e) grief and extensive losses. Results indicate that the pandemic not only exacerbated historical loss, but interventions and models for working through grief and loss should not only be culturally tailored and promote healing across all ecological domains and include physical, mental, emotional, and spiritual aspects, but should also address historical trauma, collectivist values, and traditional ways.

Prevalence and risk factors for depression in native and immigrant pregnant women in a Health Region- retrospective cohort study.

Prevalence and risk factors for depression in native and immigrant pregnant women in a Health Region- retrospective cohort study.

Gynecologic cancers among American Indian and Alaska Native women living in the Upper Midwest

Gynecologic cancers among American Indian and Alaska Native women living in the Upper Midwest

Ambiguous Women

For five seasons, Yellowstone (2018) has been polarizing on many fronts and creating an ambiguous understanding of its political agenda and positioning. This article explores the depiction of female characters as one of these fronts. With a focus on Beth and Monica Dutton, the analysis seeks to point to the ways in which female characters are presented in ambiguous ways with regard to their gender performances and their correspondence to (racialised) stereotypes. As the characters evoke notions of potential empowerment for (Native American) women, it is crucial to examine them as sites in which gender and race are being contested. Beth and Monica Dutton mirror the ambiguous political nature of Yellowstone because while both characters appear progressive at times, they also reinforce antiquated notions about gender (and race). By conceptualising Beth as a female rendition of the action hero and Monica as a modern interpretation of the Celluloid Maiden trope, this paper addresses this ambiguity and debates in how far these representations can be considered progressive or empowering. While Beth appears empowering on the surface, her reversion into traditional gender roles and her internalised sexism inhibit such empowering effect. Moreover, because of her resemblance to the Celluloid Maiden trope, the lack of depth to her character, and her inauthentic casting, Monica does little to advance the fight for empowering representations of Native American women. Rooted in postcolonial feminist culture studies, this paper discusses what makes these characters ambiguous and whether or not they can be considered empowering at all.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

The Incarceration of First Nations Women: Theories of Violence

The Incarceration of First Nations Women: Theories of Violence

Migration and mental health: the case of postpartum depressive symptoms in Portugal

Abstract Background Postpartum depression (PPD) affects about 17% of healthy mothers within one year of childbirth. The etiology remains unknown, but PPD is influenced by a combination of genetic, physical, psychosocial, and obstetric factors, migration could influence the risk. Methods We analyzed data collected within the scope of baMBINO (Perinatal Health in Migrants: Barriers, Incentives, and Outcomes), a Portuguese prospective cohort study, aimed to investigate the maternity experiences and outcomes of migrant women, defined as foreign-born women, and compared to native women. Among the 5431 women enrolled at delivery, 3006 (55%) were considered eligible for this study and interviewed in their preferred language, within six months of recruitment. The Edinburgh Postnatal Depression Scale (EPDS) was administered during this interview, along with the Migrant-Friendly Maternity Care Questionnaire (MFMCQ). Results 2890 (96%) women were included in the analytical sample for this study. Among women included, 1475 (51%) were migrants or refugees. The proportions of women having EPDS scores ≥ 10 were overall greater among migrants than among native women (7.2% vs. 12.4%, p &amp;lt; 0.001) and the risk remained higher after multiple adjustment models. Conclusions Migration status, poor experience with maternal care and language proficiency increased the risk of PPDS and should be carefully addressed as part of perinatal care.

Vaginal self-sampling for HPV in the context of cervical cancer screening

Abstract Background Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer. Methods Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016. Results 48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations. Conclusions Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage. Key messages • The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations. • Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.

A Case for a Maternal Culturally Tailored Smoking Cessation Research Agenda.

Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons.