Coercive first intercourse and unintended first births.

Since research has shown that victims of violence are more likely to be involved in subsequent risky sexual behaviors, we hypothesized that coercive first intercourse would be associated with unintended first births. Using nationally representative data from the 2002 National Survey of Family Growth, we analyzed female respondents aged 18-44 years who reported a live birth (n = 4,136). Coercion was classified as none/minimal, mild, or significant based on self-report. In 2002, 13.7% of U.S. women aged 18-44 who had at least one live birth experienced mild coercion and 9.8% experienced significant coercion at first intercourse. Compared with women who experienced no coercion, the odds of reporting an unintended first birth was greater for women who experienced mild (OR: 1.9, 95% CI: 1.4-2.6) or significant coercion (OR: 2.3, 95% CI: 1.6-3.4).

Inpatient hysterectomy surveillance in the United States, 2000-2004.

OBJECTIVE: The objective of the study was to examine recent trends in hysterectomy rates and indications in the United States. STUDY DESIGN: Data on hysterectomy hospitalizations during 2000-2004 were obtained from the National Hospital Discharge Survey, an annual nationally representative survey of inpatient hospitalization records. RESULTS: The hysterectomy rate decreased slightly from 5.4 per 1000 in 2000 to 5.1 per 1000 in 2004 (P for trend < .05). The proportion of hysterectomies performed for uterine leiomyoma decreased from 44.2% in 2000 to 38.7% in 2004 (P for trend < .01). Concomitant bilateral oophorectomy accompanied 54% of hysterectomies; this proportion declined from 55.1% in 2000 to 49.5% in 2004 (P for trend < .001). CONCLUSIONS: Continued monitoring is needed to determine whether the observed trends persist and to evaluate impact on women's health. In the future, information on both inpatient and outpatient procedures may be important for hysterectomy surveillance.

Complementary and alternative medicine use among midlife women for reasons including menopause in the United States: 2002.

OBJECTIVE: The use of complementary and alternative medicine (CAM) has been examined previously for midlife women only in regional studies. The purpose of this study was to obtain national estimates of CAM use. DESIGN: Data were obtained from the 2002 National Health Interview Survey, which included a CAM supplementary questionnaire. The response rate was 74%. The analysis included 3,621 female respondents between 45 and 57 years of age who had answered all of the relevant questions. SUDAAN software was used to account for the complex sampling design. RESULTS: Forty-five percent of women 45 to 57 years of age had used some form of CAM within the last 12 months. Approximately 25% used biologics (e.g., herbs) or mind-body (e.g., biofeedback) modalities, whereas only 15% used body work (massage and chiropractic medicine). Use did not vary by age, but white race, higher education, and residence in the West were associated with increased use. Only 45% of CAM users mentioned its use to a medical provider. The most cited reason for using CAM involved treatment of pain, with only 3% mentioning menopause. However, the odds for use of CAM were almost twice as high for women with menopausal symptoms in the past year compared with women with no symptoms (odds ratio: 1.9, 95% CI: 1.6-2.2). CONCLUSIONS: CAM use among midlife U.S. women is high, although CAM is not used specifically for menopausal concerns. These data will be useful as a benchmark of the use of CAM as use of conventional menopause therapies are influenced by the Women's Health Initiative results.

Changes in U.S. prescribing patterns of menopausal hormone therapy, 2001-2003.

OBJECTIVE: In 2002, the combination estrogen-progestin hormone therapy (HT) treatment arm of the Women's Health Initiative was terminated early because cardiovascular and cancer risks were identified, while the estrogen-only therapy (ET) arm of this trial continued. We investigated hormone therapy prescription practice changes between 2001 and 2003 to explore the effects of the clinical trial results. METHODS: Data were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for the years 2001 through 2003. These nationally representative surveys sample medical encounters in nonfederally employed physician's offices and outpatient departments of nonfederal short-stay and general hospitals. The proportion and rate of visits with ET and HT prescriptions were calculated. Logistic regression was used to estimate change over time accounting for patient and provider characteristics. RESULTS: Between 2001 and 2003, the number of visits with menopausal hormone prescriptions fell from 26.5 million to 16.9 million. Almost three-quarters of hormone visits were for ET prescriptions. The decrease in the rate of visits was slightly larger for HT prescription visits (44%) than ET prescription visits (35%). The rate of decline was highest among women 50 years of age and over. After controlling for covariates, there was no significant difference in the decline by hormone type. CONCLUSION: These nationally representative data indicate substantial declines in menopausal hormone prescriptions coinciding with clinical trial results on HT. These declines occurred among all types of therapy and patient characteristics. LEVEL OF EVIDENCE: II-3.

Prevalence of estrogen or estrogen-progestin hormone therapy use.

OBJECTIVE: To use nationally representative data to produce prevalence estimates of combination estrogen-progestin therapy and estrogen-only therapy by covariates, and to evaluate differences between current use of short duration (less than 5 years) and current long-term use. METHODS: We analyzed data from female respondents 40 years of age and older (n = 9400) who were interviewed in the 1999 National Health Interview Survey. Hormone therapy use was categorized into four types: current estrogen-progestin therapy use, current estrogen-only therapy use, former hormone therapy use, and never use. We calculated the prevalence of hormone therapy by different levels of previously identified covariates of hormone therapy, as well as overall prevalence of hormone therapy use by length of use. RESULTS: Approximately 24% of women aged 40 years or older were current hormone users. Of these, 30% were taking estrogen-progestin therapy, and 70% were taking estrogen-only therapy. The prevalence of hormone use differed dramatically by hysterectomy status and age, and less so by many demographic, health-risk behavior, medical access, and medical history variables. Among women with no hysterectomy, the associations with many of the covariates were stronger for estrogen-progestin therapy use than for estrogen-only therapy use. Only 3% of women were estimated to be current estrogen-progestin therapy users for 5 or more years, whereas 10% were current estrogen-only therapy users for 5 or more years. CONCLUSION: Although many women at midlife and older were current hormone users, very few were long-term users of estrogen-progestin therapy.

Associations with menopause and menopausal transition in a nationally representative US sample.

OBJECTIVES: The purpose of this study was to assess sociodemographic and behavioral factors in relation to menopausal status in a representative sample of the United States population. METHODS: Data were taken from the 1999 National Health Interview Survey (NHIS), limited to women aged 40-54 years who had not undergone surgical menopause. Menopausal transition was defined as absence of menstrual cycles for at least 3 but no more than 11 months or cycles that had become irregular in the past 12 months. Postmenopause was defined as absence of a menstrual cycle for 12 or more months. We used age-adjusted three-level logistic regression to examine the association between menopausal status and smoking, race/ethnicity, education, body mass index, exercise, and alcohol use. RESULTS: Twenty percent of women in this sample had experienced natural menopause, 18% were in the menopausal transition and 61% were premenopausal. Using premenopause as the reference group, current cigarette smoking was strongly associated with being postmenopausal (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.7, 3.0) and weakly associated with being in the menopausal transition (OR 1.4, 95% CI 1.1, 1.8). Education level was associated with being postmenopausal (OR 0.4, 95% CI 0.3, 0.6 comparing women with a college degree to women who had not completed high school), and alcohol use was weakly associated with being postmenopausal, with no evidence of a dose-response. CONCLUSIONS: The associations with smoking were stronger for postmenopause than for the transition phase, suggesting that the effect of smoking may be to shorten the transition period. Education level may be a marker for other exposures that affect ovarian senescence.

Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women.

OBJECTIVES: We evaluated the relationship between breast and cervical cancer screening and a variety of variables across race/ethnicity groups. METHODS: Using logistic regression models, we analyzed data from the 1998 National Health Interview Survey to assess the relative importance of the independent variables in predicting use of cancer screening services. RESULTS: Having a usual source of care was the most important predictor of cancer screening use for all race/ethnicity groups. Health insurance was associated with an increased likelihood of cancer screening. Smoking was associated with a decreased likelihood of cancer screening. CONCLUSIONS: Regardless of race/ethnicity, most women follow mammography and cervical cancer screening guidelines. The identification of specific factors associated with adherence to cancer screening guidelines may help inform screening campaigns.

Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey.

OBJECTIVES: We investigated hysterectomy prevalence among Hispanic women. METHODS: We obtained data from 4684 Hispanic women and 20 604 non-Hispanic White women from the 1998-1999 National Health Interview Survey. We calculated nationally representative odds ratios of previous hysterectomy, controlling for confounders. RESULTS: Compared with non-Hispanic White women, the odds ratio for hysterectomy was 0.36 (95% confidence interval [CI] = 0.30, 0.44) for Hispanic women with no high school diploma, 0.57 (95% CI = 0.44, 0.74) for high school graduates, and 0.67 (95% CI = 0.42, 0.87) for college attenders. Country of origin had little influence on hysterectomy prevalence. Hysterectomy was positively associated with acculturation. CONCLUSIONS: Hispanic women undergo fewer hysterectomies than do non-Hispanic White women. The reasons for this, as well as information on ethnicity-specific appropriateness of hysterectomy, should be explored.