HD53 - Women's Health Status in Virginia


Executive Summary:
House Joint Resolution 173 requested the Department of Health to continue its review of women's health status in the Commonwealth to include an assessment of (a) the current data systems measuring the health of women, including gaps in existing systems and recommendations for revisions to such systems to improve data, (b) the health-related problems which disproportionately affect women, and (c) the incidence and effects of violence against women.

House Document No. 82, the "Statistical Profile of Women's Health Status in Virginia," served as the basis for identifying the health-related problems which disproportionately affect women. Specific issues, problems, and recommendations were identified and formulated through focus groups, review of the literature, and individual contacts. A Women's Health Task Force of persons with expertise in women's issues reviewed the findings and recommendations. Participation on this task force does not represent endorsement of the contents of the report for which the Department of Health is solely responsible.

Findings

Women's Health Status

The importance of focusing attention on women's health has been recognized both by Virginia and the nation. Women's health issues differ from men's. Women's health issues are closely related to age, are more common in particular social and ethnic groups, and are influenced by behavior, education, and economic status. For most disease conditions, the major research has focused on men, with treatment modalities utilized less aggressively for women, particularly minority women.

Current Data Systems

There are seven ongoing statewide data systems in Virginia that collect data which can be used to assess the status of women's health. From the survey of the existing surveillance systems, insufficient data are collected related to the health status of women to provide meaningful information for policy development. The absence of timely population estimates for the state and its political divisions prevents the department from being able to provide current analysis and reporting of health status indicators.

The data are available by age, race, and Hispanic ethnicity. The majority of the data are available at the local level. Trend data are reported or will be in the future.

Issues that emerge are:

• Reliability of data.
• Limitation of data due to the population base or methodology, i.e., phone surveys or public sector focus.
• Definition of race and ethnicity.
• Delays in publishing reports because of the difficulty in obtaining timely and detailed population estimates which are needed to determine rates.

Health Problems Which Disproportionately Affect Women

Breast Cancer

• Breast cancer is the leading cause of cancer deaths among women under age 65 in Virginia, and the rate is increasing in both white and minority women.

• Factors which increase the risk of breast cancer include age older than 50, personal history of breast cancer, maternal or sibling history, never having given birth or pregnancy before age 30, and a long menstrual history.

• Mammography is accepted as an effective early detection method for breast cancer in women over 50- years. There is controversy over the use and cost benefit of mammography for women under age 50 years, even though many national professional groups support routine screening of women 40-49 years. Black women and women over 50 years are least likely to obtain mammograms.

• The Virginia Division of the American Cancer Society, the Virginia Breast Cancer Foundation, the state universities, and the Virginia Department of Health have programs dedicated to the prevention, early detection, and treatment of breast cancer.

Lung Cancer

Lung cancer is the leading cause of cancer deaths among all women in Virginia, and the rate is increasing in both white and minority women.

• Cigarette smoking is the major risk factor for lung cancer, accounting for 75 percent of cases in women. Young women under the age of 23 are the fastest growing group of smokers. These young women tend to be poor, minority, and undereducated.

• Women with lung cancer experience more respiratory symptoms than men. Women develop cancer at an earlier age than men.

• Most interventions in the past, such as smoking cessation programs, have targeted men. Research now indicates that women's reasons for smoking and addiction differ from men.

• In Virginia, numerous public and private efforts address smoking prevention and smoking cessation in a variety of settings such as schools and the workplace, but few target women with the exception of those who are pregnant.

Cardiovascular Disease

• Coronary heart disease, a type of cardiovascular disease, is the leading cause of deaths for all women in Virginia, but the rate of death is decreasing in both white and minority women.

• Risk factors for coronary heart disease include hypertension, elevated serum cholesterol, smoking, diabetes mellitus, obesity, sedentary life style, menopause, and stress.

• Women who have coronary heart disease often delay obtaining medical evaluation, present with atypical symptoms, and receive fewer treatment services than men, especially black women.

• Private providers, state-assisted facilities, and Virginia Department of Health district health departments provide screening, education, counseling, referral, and follow-up for cardiovascular disease with efforts targeting minorities.

HIV/AIDS

• Although more men than women are infected with human immunodeficiency virus, the incidence is rapidly increasing in women and disproportionately affects minority women.

• The major risk factors for HIV/AIDS to which the increase among black women is attributed are heterosexual contact with IV drug users, multiple sex partners, limited education, and poor health.

• Women with AIDS have more medical complications than men, and therefore, their life span is shorter.

• Cooperative public and private services for women are provided in communities throughout the state but services are fragmented. Minority community-based organizations target black women through education.

Depression

• Women have twice the incidence of depression compared to men. Minority women report symptoms of depression more than white women.

• Risk factors for depression include family history of depression, poor self-esteem, female gender, chronic non-mood disorders (substance abuse, eating disorders), loss or death of significant other or object, and other stressful life events.

• Women may seek medical intervention, but symptoms are often not initially recognized as depression; as a result, depression may be underreported and undertreated. Utilization of appropriate care is lowest among minority women.

Reproductive Health

Major issues that impact on the health of women in the area of reproductive health include teen pregnancy, adult pregnancies which are unplanned, sexually transmitted diseases, and abortion. Pregnancies and births to single women are of particular concern as the major demographic indicators contributing to the destabilization of the family and why so many women find themselves in conditions of poverty today. In 1992, there were 27,520 births to single women in Virginia. Also, during 1992, there were 29,357 divorces and annulments, 48 percent of which involved children under 18 (14,945).

Children of divorce and those born to single women are at higher risk for death, illness, abuse, and neglect. The relationship of poverty to women's health is twofold. Low income is tied to reduced purchasing power. Commodities which promote good health (housing, food, and medications) are out of reach for many, and affordable health care is not readily available.

Teen Pregnancy

• Births to teens represent 11.3 percent of total births in Virginia. The birth rate for minority teens is twice that for white teens.

• Virginia ranks slightly below the nation for births to teenage mothers ages 17 and younger.

• Teen pregnancy prevention programs are occurring at the community level with organizations and agency cooperation and state assistance. All programs have not been evaluated for effectiveness.

Adult Pregnancy

• Eighty percent of Virginia women 18 years and older report that they have been pregnant. Of these women, 86 percent were married and 44 percent report that their last pregnancy was unplanned.

• Reproductive health services are available to women in Virginia through primary care physicians including obstetricians/gynecologists, HMOs, primary care centers, and local health departments.

• Adult women at risk for unplanned pregnancies are those over 40 years, those who are poor, and those not using contraception.

Sexually Transmitted Diseases

• The rate of sexually transmitted diseases (STDs) is steadily growing among women, especially in teens 15-19 and minority women.

• Risk factors for STDs, as with HIV/AIDS, are: having sex with infected person, using or being stuck with a needle or syringe that has been used by or for an infected person.

• Intervention strategies are the same for STDs and HIV/AIDS: Abstinence, mutually-faithful relationship with uninfected partner, education about prevention and signs and symptoms of STDs, and testing for STDs.

Abortion

• Women aged 20-24 are the largest group obtaining abortions in Virginia with teens being the third largest group.

Violence Against Women

Women are more likely than men to become victims of spouse homicide and abuse, rape, and other sexual assault.

Domestic Violence

• Women are more than twice as often assaulted by family members and friends than by strangers. Domestic homicides are generally preceded by a history of physical and emotional abuse directed at the woman.

• Risk factors for domestic violence are being abused as a child, poverty, and less than a college education.

• In addition to death and physical injury, victims of domestic violence suffer emotionally. When the woman is a mother and the violence takes place in front of her children, they also suffer, and the stage may be set for a cycle of violence that can be continued from generation to generation.

• Domestic violence is underreported, and health care providers and law enforcement officers may lack skills in recognizing and addressing abusive situations.

• There are 44 private, non-profit and public domestic violence programs in Virginia which provide emergency shelter for women seeking respite from domestic violence. Among programs for which data are available, over the past five years, 45 percent of women requesting emergency shelter were turned away due to lack of space.

Sexual Assault

• The number of reported cases of rape has increased over the past several years. Reported offenders are usually strangers to the victim. This may reflect reluctance of victims of acquaintance and date rape to report their experience.

• Women most at risk for rape are young, unmarried, and poor.

• Twenty-two Sexual Assault Crisis Centers serve 84 percent of the cities and counties in Virginia. Approximately half of the centers offer the full range of services.

Legislative Recommendations

General

• The Governor and the General Assembly support those policies and proposals that strengthen Virginia's families, (i.e., Resource Mother's, abstinence programs and fatherhood initiative programs) and eliminate or revise those that contribute to the numerous personal and societal problems stemming from family dissolution.

Breast Cancer

• The General Assembly supports a resolution that the Secretary of Health and Human Resources be requested to assess the impact and risk factors of breast cancer on the women of Virginia and to study the need for appropriate state policies to facilitate the development and implementation of primary intervention strategies to promote the control and the early detection of the disease.

Reproductive Health

• The General Assembly considers supporting parental notification for teens requesting abortion.

Violence

• Because violence is a significant public health problem, the General Assembly designates the State Health Commissioner as a member of the Family Violence Prevention Commission established by the 1994 Senate Joint Resolution No. 56.

Private and/or Public Strategic Recommendations

Data Collection, Information and Research

• The Virginia Department of Health, Center for Health Statistics should provide yearly detailed and timely population estimates by race, by gender, by age, by ethnicity, and by locality in order that the health status of Virginia women may be more clearly assessed.

• The Virginia Department of Health, Center for Health Statistics should expand its role in the collection and analysis of data concerning the status of women's health for planning, monitoring, and evaluation and policy development.

• The Virginia universities and colleges of leadership, public policy, research, and social studies disciplines should coordinate their research efforts to address these major issues relating to women's health. Focus of this research should be on family stability, male involvement, reproductive health, and violence prevention.

Breast Cancer

• Organizations participating in the National Breast and Cervical Cancer Early Detection Program should ensure that all women have education about breast self-exam, that all women over age 40 receive an annual clinical exam, and that women over age 50 have annual mammography. Mammography should begin earlier for women at high risk for breast cancer.

Lung Cancer

• Virginia schools, the American Cancer Society, the Virginia Lung Association, the Virginia Department of Social Services, the Virginia Department of Health, and other private/public agencies and organizations that work with low-income and minority girls and teens should coordinate and target education efforts to prevent lung cancer.

Cardiovascular Disease

• Health care providers should offer all women risk reduction support education on tobacco use, dietary fat and cholesterol intake, and inadequate physical activity, and routinely screen for these cardiovascular behavioral risk factors. They should also screen all women for high blood pressure and high serum cholesterol.

HIV/AIDS

• The Virginia Department of Health should review the recommendations on preventive services for women in House Document No. 17, 1992, "Report on the Task Force on AIDS on Development of Comprehensive HIV/AIDS Plan Pursuant to HJR436," and report to the Secretary of Health and Human Resources on those recommendations that should be implemented.

Depression

• The Department of Mental Health, Mental Retardation and Substance Abuse Services in collaboration with the Virginia Department of Health and private organizations concerned about women's health should continue discussions and increase efforts to identify reasons minority and low-income women fail to seek mental health services and develop a plan to increase public awareness and acceptance that with early detection and intervention may prevent a more serious condition.

• Department of Mental Health, Mental Retardation and Substance Abuse Services should work with health care professionals to increase their knowledge and skills in identifying symptoms of depression in women and make appropriate referrals to community resources for education, supportive counseling, family therapy, psychotherapy, and/or medical treatment.

• Private employers, community organizations, and churches should develop the awareness needed to identify members with depressive symptoms and provide the appropriate support and encouragement for them to seek intervention when necessary.

Reproductive Health

• Upon release of the evaluation of the seven teen pregnancy programs, programs showing positive outcomes should be replicated in other high-risk communities.

• The Secretary of Health and Human Resources should develop a consolidation plan for all state-level teen pregnancy prevention support and coordination activities.

• The Department of Medical Assistance should obtain a federal waiver to extend Medicaid coverage to two years past delivery for those women currently covered at 133 percent of poverty and for only 60 days postpartum.

• The Departments of Education, Health, Mental Health and Mental Retardation and Substance Abuse Services, and Social Services should increase staff training on abstinence skills development for teens and require all family life programs in these agencies to use abstinence skills education as a major part of their sex education program. Staff training should include themes consistent with Campaign for Our Children to coordinate efforts with this program.

• All participating partners should continue to work together to expand the Campaign for Our Children strategy to other media markets and enhance with teaching materials for communities.

• The Virginia Department of Health should provide consultation to localities on how to organize teen pregnancy prevention coalitions and develop local community-based programs that are known to work to prevent teen pregnancy.

• Health care providers in both private and public health settings should screen for high risk sexual practices and provide counseling to prevent unintended pregnancies and to help ensure that all women are prepared for pregnancy before it occurs.

• Providers of services and programs to parenting teens should target their efforts to prevent repeat pregnancies in this high risk group.

Violence

• The Virginia Department of Health, in conjunction with other state agencies and universities, should develop a comprehensive public health surveillance system to: (a) assess the magnitude and impact of death and injury due to violence, (b) determine the type and quantity of resources needed to respond to the problem, and (c) develop baseline information for evaluating the effectiveness of violence prevention programs and policies.

• The Department of Health should work with the Virginians Against Domestic Violence and health professional organizations to increase the knowledge and skills of hospital emergency departments, primary care clinics, private physicians, including obstetricians/gynecologists, and other health care providers for identifying, addressing, and preventing domestic violence.