In the United States and abroad, the LGBTQ+ population has both historically and currently, suffered from a higher likelihood of poorer health outcomes than their heterosexual and cisgender counterparts due to stigma and discrimination (Alencar Albuquerque et al., 2016). While these health disparities have been well studied for the United States LGBTQ+ community as a whole, there is less understanding of what subgroups within this population may be disproportionately more susceptible to poorer health outcomes and risky behaviors, as well as, less understanding for the reasons behind such health outcomes and behaviors. One such subgroup is that of sexual minority women (SMW), or women who are sexually and/or romantically attracted to other women or who identify outside of heterosexual norms (Youatt, Harris, Harper, Janz, & Bauermeister, 2017). Preliminary studies have found that SMW are less likely than their sexual minority male and heterosexual female peers to have regular access to healthcare providers and are more likely to have negative experiences in healthcare settings, specifically in regards to sexual and reproductive healthcare (Riskind, Tornello, Younger, & Patterson, 2014). For these reasons, coupled with discrimination and risky sexual and health behaviors, SMW are a vulnerable population in need of social, political, and medical attention. This thesis aims to understand the causes and barriers SMW face when accessing sexual and reproductive health resources, as well as, provide direction for navigating such barriers on a multifactorial level. This research analyzes how hegemonic heteronormativity and sexism take root in (a) economic and political barriers in obtaining health insurance and health knowledge for SMW, (b) SMW patient ignorance of health risks and needs, (c) minimal to no medical provider training and understanding for SMW health risks, behaviors, and needs. Each barrier is addressed holistically; a novel approach necessary for the initial alleviation of such barriers to sexual and reproductive care and knowledge for SMW.

Thesis--Universität zu Köln, 1997.

Thesis--Universität zu Köln, 1997.

Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.

Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug use was self-reported and in situ and invasive breast cancer cases were confirmed by medical records for the WHI clinical trial (CT) and the WHI observational study (OS), from 1993 through 2018. We used Cox proportional hazards regression to model breast cancer risk against antipsychotic drug use while adjusting for dietary and lifestyle factors. Overall, antipsychotic users made up 0.41% of this population. There was no overall association between antipsychotic drug use and postmenopausal breast cancer risk (HR = 1.01, 95% CI = 0.73 – 1.40). Among typical antipsychotic drug users, there was a suggested two-fold increased risk in developing in situ breast cancer (HR = 2.02, 95% CI = 0.84, 4.86). Thus, antipsychotic drug use does not appear to increase breast cancer risk overall, but the potential association between antipsychotics and in situ breast cancer merits further study.

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

No description available.

This thesis is an investigation into women’s experiences of repeatedly attempting to lose weight and maintain a weight they find acceptable, and the implications of this for health education. This was an interpretivist inquiry which generated data through narrative interviews. The data was analysed using three different strategies to enable deeper understanding of the participants’ experiences. To set the context health education resources relating to body weight, healthy eating and activity were collected from local community and health settings. A former local practice nurse was also interviewed about her role in assisting women with weight loss. A literature review revealed an emphasis on research and policy that focuses on the dangers of overweight and obesity, prioritising individual behaviour and energy-deficit approaches to losing weight. A qualitative method was used to collect data from a convenience sample of five women. Data from interviews and autobiographical writing were recorded, transcribed and analysed within a narrative analysis framework. Analysis of the findings using three interpretive lenses are presented first as re-storied accounts of the women’s narratives, and secondly thematic analysis addressing issues of control, pleasure and pain, and embodiment and alienation. Finally a relational analysis reveals the ways in which participants position themselves in relation to themselves, other characters and the interviewer in order to build their desired identities. The data shows that the participants had followed a wide and diverse range of diets, eating and exercise plans, none of which had been successful in both reducing their weight and maintaining it at a level they were happy with, even after repeated attempts. Whilst biomedical literature suggests a dividing line between pathological eating disorders such as anorexia nervosa/bulimia and normality, the disordered eating and emotional difficulties described by the participants supports the view that a broad range of eating and body-image problems may be more culturally normative than is generally recognised. Dieting and weight cycling were common experiences. The findings of the thesis suggest that contrary to current public policy, the views of these women who are unhappy with their body weight are complex, idiosyncratic and demonstrate resistance to health messages that target individual responsibility for weight management. Their views are developed from personal experiences - the findings suggest that these women are stigmatised. However, one response to this can be to stigmatise other people whom they see as more overweight than themselves. Normative femininity is increasingly centred on appearance and women who do not comply with the requirements risk alienation and pain. The identities that the women construct are relevant for health education but not taken into account when national policy and strategies are developed to address overweight and obesity. The risks to health of weight cycling are also not addressed by policy. The implications of the thesis are discussed in relation to the embodied experiences and gendered roles of women, the role of health education and its relationship with biomedicine.

Two vaginal phylotypes of the genus Megasphaera (phylotype 1 and phylotype 2) were recently associated with bacterial vaginosis (BV), an infection characterized by vaginal dysbiosis. Through an analysis of 16S rRNA profiles of 3,986 women enrolled in the Vaginal Human Microbiome Project, we confirmed that while both phylotypes were associated with BV, Megaspheara phylotype 1 had higher specificity for the condition. Megasphaera phylotype 2 was strongly associated with trichomoniasis. Previous studies have reported that BV-associated organisms are excluded in pregnancy. We observed that Megasphaera phylotype 1, which has been associated with adverse pregnancy outcomes, exhibited a trend of increased prevalence in the pregnant cohort. We sequenced the genomes of isolates of the two phylotypes and performed comparative analyses. We demonstrate that these two phylotypes have distinct genomic features and unique potential for metabolic processes that reveal niche specialization. These findings may provide insight into their differential associations with vaginal infections.

Sex work is a crime in South Africa. With the prevalence and deleterious social and economic effects of HIV, in health literature sex work has often been understood in relation to the way that it intersects with the transmission of the epidemic. This positioning of sex work then inadvertently stigmatises sex workers who are often cast outside the rights-based discourses that characterise South Africa’s post-apartheid democracy. In order to address this problem, this study explored the perceived barriers and facilitators to sex workers’ accessing sexual and reproductive healthcare (SRHC), gaps in the current service offerings relating to sex worker’s sexual and reproductive health (SRH) and the general experiences of SRHC amongst 11 female sex workers in Johannesburg, South Africa. Semi-structured in-depth interviews were conducted with these sex workers, who were based in Johannesburg City Deep. The resultant data were transcribed and subjected to a thematic analysis. The study shows that various structural and individual level barriers are perceived to prevent access to SRH. In particular, the analysis suggests that the disease-specific focus on sex worker-specific projects poses a barrier to sex workers’ accessing a complete range of SRHC services. Violence enacted by healthcare professionals, police and clients fuelled a lack of trust in the healthcare sector and displaced the participants from their basic human rights. It is also worrying that religion posed a threat to effective SRHC because some religious discourses label sex workers as sinners who are perceived to be excluded from forgiveness and healing. Finally, motherhood proved to be a point at which the participants actively managed their health and engaged with and in broad-based SRHC. Participants frequently only sought SRHC at the point at which an ailment affected their livelihood and ability to provide for a family. Taken together, these findings seem to show a range of formidable challenges to sex workers’ understanding of themselves in a human rights discourse. This study’s findings are of particular importance to rethinking the legislation that criminalises sex work, as well as healthcare initiatives geared both towards sex workers and women in general.