Women

Publications

Alphabetical list. You can also view by publication date.

• Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Children, Maternal and child health, Poverty, Women
  Date: 2004
  This pilot study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program at improving pregnancy and birth outcomes. The home visitation program uses lay health workers to provide health education, referral, and social support to rural, low income, Medicaid-insured pregnant African American women and their infants.
• Breast and Cervical Cancer Screening: Is it Reaching Rural and Rural Minority Women?
  Research center: Southwest Rural Health Research Center
  Topics: Health promotion and disease prevention, Hispanics, Women
  Date: 04 / 2003
  Examines whether the Texas Breast and Cervical Cancer Control Program (BCCCP) is reaching rural women in general and rural minority women in particular. Findings indicate that Hispanic women, both in rural and non-rural, are over-represented among BCCCP clients as compared to race/ethnicity specific cancer incidence and mortality. In contrast, within race/ethnicity groups, Anglo women represent a higher proportion of the rural women being reached by the program. Findings also indicate that a severe shortage of local providers to contract with the program in rural Texas has been and will continue to be a major limitation. In addition, contracting requirements can be a burden and an obstacle to potential providers. Concludes that there is a need in Texas to target specific rural areas based on the incidence and mortality experience of the population. To accomplish this, the contracting process needs to be made more flexible to enable small providers, reimbursement rates may need to be raised, and administrative burdens may need to be lessened.
• Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals
  Author(s): Sarah B. Laditka, James N. Laditka, Kevin J. Bennett, Janice C. Probst
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Health services, Maternal and child health, Medicaid and S-CHIP, Women
  Citation: Journal of Rural Health, 21(2), 158-66
  Date: 2005
  Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
• Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
  Author(s): Elizabeth A. Erkel, Charity G. Moore, Yvonne Michel
  Research center: South Carolina Rural Health Research Center
  Topics: Health promotion and disease prevention, Maternal and child health, Women
  Date: 02 / 2004
  This pilot study successfully demonstrated that a retrospective, population-based, comparative design is a feasible method for evaluating the effectiveness of a community health worker program for women at risk for poor pregnancy and birth outcomes. Executive summary available online.
• Disability Burdens among Older Americans Associated with Gender and Race/Ethnicity in Rural and Urban Areas
  Author(s): James N. Laditka, Sarah B. Laditka, Bankole Olatosi, Keith T. Elder
  Research center: South Carolina Rural Health Research Center
  Topics: Disabilities, Minority health, Women
  Date: 09 / 2005
  No prior research has investigated differences in disability-free and disabled life expectancy associated with rural or urban residence. This report addresses this gap, and identifies differences in healthy life expectancy that may signal important policy needs. The authors examined total life expectancy, disability-free life expectancy, and disabled life expectancy, comparing people in rural and urban areas. These expectancy measures for subgroups of rural and urban areas were compared, distinguished by sex, race (white and African American) and educational attainment. The authors found that among a cohort of Americans aged 65 to 69 in 1982, in seven of the eight subgroups, individuals in rural areas lived longer lives than those in urban areas. Rural as compared to urban people lived (a) more disability-free years, (b) more disabled years, and (c) a notably greater percentage of their lives with a disability. There were striking differences among the high and low education groups, with individuals with more education living substantially longer, less disabled lives. Women lived longer, more disabled lives than men. For most subgroups, African Americans lived shorter, more disabled lives than whites. Executive summary available online.
• Distribution of Rural Female Generalist Physicians in the United States
  Author(s): Mark P Doescher, Kathrine E Ellsbury, Gary L Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Journal of Rural Health, 16(2), 111-118
  Date: 2000
  Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physician Masterfile. Percentages and numbers of female physicians by professional activity, specialty type, and geographic location are reported. Findings reveal there were fewer than 7,000 female allopathic physicians practicing in rural America in 1996. The proportion of generalist female physicians who practice in rural settings was significantly lower than the proportion who practice in urban locations. Although members of the most recent 10-year medical school graduation cohort of female generalist physicians were slightly more likely to practice in rural areas than members of earlier cohorts, female physicians remained significantly underrepresented in rural areas. States varied dramatically in rural female generalist underrepresentation. Should female generalists continue to be underrepresented in rural locations, the rural physician shortage will not be resolved quickly. Effective strategies to improve rural female physician placement and retention need to be identified and implemented to improve rural access to physician care.
• Effects of Race and Poverty on Perceived Stress Among Rural Women
  Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley
  Research center: South Carolina Rural Health Research Center
  Topics: Mental health, Minority health, Poverty, Women
  Citation: Coward RT, Davis LA et al, Eds., Rural women's health: Mental, behavioral and physical issues. p. 197-215. New York, NY: Springer Publishing Company
  Date: 2005
  
• Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
  Author(s): Katherine E Ellsbury, Laura-Mae Baldwin, Karin E Johnson, SJ Runyan, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women
  Report Number: No. 62
  Date: 02 / 2001
  Examines differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identifies the practice arrangements that attracted female generalist physicians to rural areas. Findings include: women were more likely than men to have been influenced in practice choice by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of childcare; women were more highly influenced by the interpersonal aspects of recruitment; and men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. Findings indicate that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues in the recruiting process if they want to achieve a gender-balanced physician workforce.
• Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
  Author(s): Ellsbury KE, Baldwin LM, Johnson KE, Runyan SJ, Hart LG
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Journal of the American Board of Family Practice, 15(5), 391-400
  Date: 09 / 2002
  Background: This study examines differences in the factors female and male physicians considered influential in their rural practice location choice and describes the practice arrangements that successfully recruited female physicians to rural areas.
  Methods: This cross-sectional study was based on a mailed survey of physicians successfully recruited between 1992 and 1999 to towns of 10,000 or less in six states in the Pacific Northwest.
  Results: Responses from 77 men and 37 women (response rate 61%) indicated that women were more likely than men to have been influenced in making their practice choice by issues related to spouse or personal partner, flexible scheduling, family leave, availability of childcare, and the interpersonal aspects of recruitment. Commonly reported themes reflected the respondents' desire for flexibility regarding family issues and the value they placed on honesty during recruitment.
  Conclusions: It is very important in recruitment of both men and women to highlight the positive aspects of the community and to involve and assist the physician's spouse or partner. If they want to achieve a gender-balanced physician workforce, rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse-partner, and interpersonal issues in the recruitment process.
• Impact Of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence On Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
  Author(s): Sarah B. Laditka, James N. Laditka, Kevin J. Bennett, Janice C. Probst
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Hispanics, Maternal and child health, Medicaid and S-CHIP, Women
  Date: 12 / 2004
  Complications of pregnancy affect the lives of many women and infants. This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications (PAMCs) as an indicator of access. Findings include: 1) Mothers delivering in rural hospitals had lower PAMC risks than those with urban deliveries.; 2) In rural hospitals, African American women had greater PAMC risks than white women.; and 3) In urban hospitals, adjusted PAMC risks were substantially lower for Hispanics and Asians than for whites. Executive summary available online.
• National Trends in the Perinatal and Infant Health of Rural American Indians (AIs) and Alaska Natives (ANs): Have the Disparities Between AI/ANs and Whites Narrowed?
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Children, Maternal and child health, Minority health, Women
  Date: 09 / 2007
  Brief overview of findings from a study examining trends in prenatal care receipt, low-birthweight rates, neonatal and postneonatal death rates, and cause of death among rural American Indians/Alaska Natives (AI/ANs) and whites between 1985 and 1997.
• Production of Rural Female Generalists by U.S. Medical Schools
  Author(s): Katherine E Ellsbury, Mark P Doescher, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Date: 05 / 1999
  Compares the production of rural female generalists among medical schools. Data from the 1996 AMA Physician Masterfile for the 1988-96 graduate cohort were analyzed to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school. Only a few schools contribute most of ht erural female generalists. These schools' admissions policies, curricula, extracurricular programs, and career advising efforts may serve as models of schools who make it a priority to encourage more of their female graduates to enter rural practice.
• Productivity of Washington State’s Obstetrician–Gynecologist Workforce: Does Gender Make a Difference?
  Author(s): Thomas J. Benedetti, Laura-Mae Baldwin, C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women
  Citation: Obstetrics and Gynecology, 103(3), 499-505
  Date: 2004
  Objective: To compare the practice productivity of female and male obstetrician–gynecologists in Washington State.
  Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner’s license renewal in 1998–1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
  Results: Of the 541 obstetrician–gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30–39 through the 50–59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40–49 age group.
  Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician–gynecologists in Washington State. Changing demographics and behaviors of the obstetrician–gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.
• Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State
  Author(s): Thomas J. Benedetti, Laura-Mae Baldwin, Susan M. Skillman, C. Holly A. Andrilla, Elise Bowditch, Katherine Camacho Carr, Susan J. Myers
  Research center: WWAMI Rural Health Research Center
  Topics: Allied health professionals, Physicians, Women
  Citation: Obstetrics & Gynecology, 107, 1238-1246
  Date: 2006
  Objective: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician–gynecologists, family physicians, certified nurse midwives, licensed midwives).
  Methods: All obstetrician–gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
  Results: Fewer family physicians provide obstetric services than obstetrician–gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician–gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers’ most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician–gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
  Conclusion: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington’s obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study’s results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
• Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
  Author(s): Sarah Laditka, James Laditka, Janice C. Probst
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Health disparities, Maternal and child health, Medicaid and S-CHIP, Minority health, Women
  Citation: Maternal and Child Health Journal, 10(4), 339-50
  Date: 2006
  Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
• Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Final Report)
  Author(s): Mark P. Doescher, J. Elizabeth Jackson
  Research center: WWAMI Rural Health Research Center
  Topics: Health promotion and disease prevention, Women
  Report Number: 121
  Date: 08 / 2008
  Reports on trends in breast cancer screening practices. Participation in mammography improved nationally, but women living in rural locations remained less likely to receive this test than those living in urban settings.
• Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Policy Brief)
  Author(s): Mark P. Doescher, J. Elizabeth Jackson
  Research center: WWAMI Rural Health Research Center
  Topics: Health promotion and disease prevention, Women
  Date: 08 / 2008
  Documents the receipt of timely breast and cervical cancer screening using a rural-urban classification system and nationally representative data.
• U.S. Medical Schools and the Rural Family Physician Gender Gap
  Author(s): Kathleen E. Ellsbury, Mark P. Doescher, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Fam Med. May 2000;32(5):331-337
  Date: 05 / 2000
  Background: Women comprise increasing proportions of medical school graduates. They tend to choose primary care but are less likely than men to choose rural practice.
  Methods: This study used American Medical Association masterfile data on 1988–1996 medical school graduates to identify the US medical schools most successful at producing rural family physicians and general practitioners of both genders.
  Results: The number of listed rural female family physician or general practitioner graduates among schools ranged from 0–27 (0% to 4.4% of each school’s 1988–1996 graduates). There were approximately twice as many male as female rural family physicians and general practitioners. Publicly funded schools produced more rural female family physicians and general practitioners than their privately funded counterparts.
  Conclusions: Our findings suggest that a few schools, most of them public, may serve as models for schools that aim to train women who later enter rural practice.

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