Long-acting Reversible Contraception Among Homeless Women Veterans With Chronic Health Conditions

A Retrospective Cohort Study

Bibliographic Data

ID9097676
AuthorsLori M Gawron (0000-0003-4431-9729, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, corresponding author), Andrew Redd (0000-0002-6149-2438, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, corresponding author), Ying Suo (0000-0002-3563-5300, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, corresponding author), Warren Pettey (0000-0002-4436-3319, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, corresponding author), David K Turok (0000-0002-6289-0542, Obstetrics and Gynecology), Adi V Gundlapalli (0000-0002-7423-7903, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, corresponding author)
Year2017
Volume55
IssueSuppl 2
PagesS111-S120
Publication date2017-09-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000765
PMID28806374
OpenAlexW2743793231
LanguageEN
Citations received4
References cited32

BACKGROUND: US women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long-acting reversible contraception (LARC) can assist in healthy pregnancy planning. OBJECTIVES: To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans. RESEARCH DESIGN: A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002-2015. SUBJECTS: We included 41,747 ever-homeless women Veterans age 18-44 years and 46,391 housed women Veterans matched by military service period. A subgroup of 7773 ever-homeless and 8674 matched housed women Veterans deployed in Iraq and Afghanistan [Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND)] conflicts comprised a second analytic cohort. MEASURES: Descriptive statistics compared demographic, military, health conditions, and LARC exposure in ever-homeless versus housed women Veterans. Multivariable logistic regression explored factors associated with LARC exposure in the OEF/OIF/OND subgroup. RESULTS: All health conditions were significantly higher in ever-homeless versus housed Veterans: mental health disorder in 84.5% versus 48.7% (P<0.001), substance abuse in 35.8% versus 8.6% (P<0.001), and medical conditions in 74.7% versus 55.6% (P<0.001). LARC exposure among all VHA users was 9.3% in ever-homeless Veterans versus 5.4% in housed Veterans (P<0.001). LARC exposure in the OEF/OIF/OND cohort was 14.1% in ever-homeless Veterans versus 8.2% in housed Veterans (P<0.001). In the OEF/OIF/OND cohort, homelessness along Veterans with medical and mental health indicators were leading LARC exposure predictors. CONCLUSIONS: The VHA is successfully engaging homeless women Veterans and providing LARC access. The prevalence of perinatal risk factors in ever-homeless women Veterans highlights a need for further programmatic enhancements to improve reproductive planning

Cohort · Cohort study · Environmental health · Family planning · Logistic regression · Military service · Millennium Cohort Study (United States) · Population · Psychiatry · Retrospective cohort study · Unintended pregnancy · Veterans Affairs · Demography · Food Security and Health in Diverse Populations · Homelessness and Social Issues · Internal Medicine · Maternal Mental Health During Pregnancy and Postpartum · Medicine

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