The Utah Women’s Health Review The Center of Excellence in Women’s Health UNIVERSITY OF UTAH Masthead Volume 1 Number 1 May 2019 Editor-in-Chief Jessica N. Sanders, PhD, MSPH Executive Editors Kathleen B. Digre, MD Michael Varner, MD Susan Schulman, MAT CCRA Center of Excellence Coordinator Leanne Johnston Staff Article Editor Medha Gho Editorial Board Brenda Ralls Caren Frost Sara Simonsen Lori Gawron Bethany Everett Nicole Mihalopoulos Karen Schliep Library Support Anne Morrow Allyson Roylance Table of Contents Page Letter from the Editor 3 Healthcare Coverage and Access (HCA) Rural-Urban Disparities in Health Outcomes and Access to Care among Women in Utah 5 Oral Health Care and Accessibility in Utah 14 Occupational and Economic Health (OCH) Intergenerational Poverty, Women and Children’s Health 19 Environmental Health (EH) The Impact of Living at Altitude on Depression and Antidepressant Function in Utah Women: The Need for Novel Antidepressants 23 Sexual and Reproductive Health (SRH) Sexual Violence in Utah: The Relationship between Sexual Education and Sexual Violence 34 Cost of Sexual Violence 38 Perinatal Health (PH) Data Snapshot: Postpartum Depression 43 Breastfeeding and Mothers Own Milk is Best for Babies 49 Breastfeeding Protects Mothers 52 Milk Banking 55 Adolescent Health (AH) Data Snapshot: Adolescent Pregnancy 59 Potential Anorexia among Adolescent Girls in Utah 64 A Complex Web: Exposure to Domestic Violence, Aggressive Behaviors and Suicidality in Utah Adolescents 68 1 Screening and Disease (SD) The Utah Women’s health Review Arthritis in Utah: Significant Differences for Women 74 Substance Use and Misuse (SUM) Select Alcohol-Attributable Emergency Department Visits and Inpatient Hospitalizations for Women 18-64 Years of Age 79 Health Disparities in Special Populations (HDSP) Women with Disabilities: An Important Health Disparity Population 85 Women’s Health in Utah’s Homeless Population 89 Sexual Minority Women’s Health in Utah 92 General Articles (GA) Food insecurity & 5 Fruits & Vegetables 97 Secondary data analysis of non-communicable diseases among adult female refugees arriving in Utah between 01/01/2012 and 12/31/2015 102 General State Health (GSH) Voting and Civic Engagement Among Utah Women 108 Utah Women and STEM 112 The Status of Women in Utah Politics: Congress, Statewide Executive Offices, and the State Legislature 117 The Status of Women in Utah Politics: Counties, Mayors, City Councils, and Boards of Education 125 Labor Force Participation Among Utah Women 134 2 The Utah Women’s health Review Letter from the Editor Foreword that thinking of health in these multiple dimensions more accurately portrays the women’s health chal- lenges in public health. Executive Summary Center of Excellence in Women’s Health The University of Utah’s Center of Excellence in Women’s Health, in collaboration with the Utah De- The Center for Excellence in Women’s Health (CoE) partment of Health and the Utah Women’s Health is a multidisciplinary group focused on enhanc- Coalition, has prepared an interdisciplinary publica- ing overall health and wellness for women. We are tion devoted to Women’s Health in Utah-The Utah founded on the 5 pillars of community outreach, Women’s Health Review. This review represents clinical care, research, education and leadership de- an overview of health situations and opportunities velopment. for improvement in community health in Utah. Our goal is to empower women of all ages with the The Utah Women’s Health Review is an opportu- knowledge to improve their health and the health of nity to highlight how far we have come in the last their families. The work of the CoE is based on: decade, since the Women’s Health in Utah update •Respect, caring, compassion, and integrity was last published (http://healthsciences.utah.edu/ •Being non-competitive, non-hierarchical, coe-womens-health/docs/coe-supplement-vol12. and collaborative pdf), and also to serve as a forum for updates. This •Evidence-based practices review also sheds light on gender differences and the We are supported in part by the Department of Ob- areas where gender disparities continue to exist, and stetrics and Gynecology, the Office of the Vice Presi- brings to light new and unresolved health concerns dent for Health Sciences, the Center for Clinical and that need to be addressed. In this publication we have Translational Science, the Office of Health Equity thoughtfully considered the intersection of physical and Inclusion, DHHS Office on Women’s Health, and reproductive health, social health, emotional and the Office of Research on Women’s Health. This health, occupational and financial health, environ- review has been made possible in part by the Educa- mental health, intellectual health and spiritual health. tional Resource Development Council at the Univer- sity of Utah. The goal of this publication is to update knowledge surrounding women’s health issues in our Utah com- The 7 Domains of Women’s Health munity and beyond, as well as to create a tool that can be used to improve health for years to come and Everything we do is based on our philosophy that to serve as an open access home for publishing re- health is not just physical health, but also encom- gion-specific research. The Utah Women’s Health passes psychological/emotional, environmental, so- Review also serves as a model for other Academic ciocultural, intellectual, economic, and spiritual – an institutions and states to bring together interdisci- approach we sum up as “The 7 Domains of Health”. plinary researchers, public health practitioners and We promote these domains through information, women’s health advocates to collaborate on a body of research, education, outreach programs and clinical 3 work that focuses on regional health issues. care. The COE provides a great opportunity for peo- ple with a wide range of philosophies to network and The broad spectrum of articles highlights the real- share and develop innovative projects together. ity that health is more than one dimension—and The Utah Women’s health Review HEALTHCARE COVERAGE AND ACCESS (ACA) 4 The Utah Women’s health Review Rural-Urban Disparities in Health Outcomes and Access to Care among Women in Utah Matt McCullough/ Utah Department of Health Office of Primary Care and Rural Health `Abstract Objectives: The aim of this research project is to enhance understanding of the current rural-urban dispar- ities in health outcomes among women in Utah. Methods: Percentages, confidence intervals and standard errors for fifteen health outcomes were calculated using age-adjusted data from the Utah Behavioral Risk Factor Surveillance System in order to compare rates for women in 63 rural, urban and frontier areas. Results: Women in rural areas had lower (better) percentages in all eight of the outcomes relating to gen- eral physical and mental health, as well as chronic conditions. Women in rural areas had higher (worse) percentages in all seven of the outcomes representing access to care and preventive services. Frontier areas had higher (worse) percentages than both rural and urban areas in eleven of the fifteen outcomes; five of them were significantly higher. Conclusion: Women in frontier areas in Utah have considerable challenges with both access to health care and preventive services, as well as general physical and mental health and chronic conditions. Women liv- ing in rural areas continue to struggle with access to care and preventive services, but have lower rates than urban areas in terms of a number of outcomes. Introduction ities exist among populations are complex and The purpose of this research is to examine the may affect access, quality of care and outcomes rural-urban disparities in health outcomes among (Egede & Bosworth, 2008; Institute of Medicine, women in Utah. Urban, rural and frontier areas are 2002). considered in our analysis. Urban areas are clas- Comparisons between health outcomes and dis- sified as having a population of over one hundred parities among different genders, races, ethnicities, people per square mile and make up only 5% of and socioeconomic situations are common in the land area in the State, although they contain health assessments; however, disparities by geo- approximately 75.5% of the total population. Rural graphic regions may also exist. areas are classified as having a population of six to Poverty and access to care are two of the main rea- ninety-nine people per square mile, make up 40% sons that disparities exist between women in rural of the land area in the state of Utah and contain and urban areas. Level of education, transportation 21% of the population. Frontier areas have fewer challenges and adequate health insurance are also than six people per square mile and cover 55% of contributing factors. Lack of financial stability the state but only contain 3.5% of the total pop- negatively affects access to health services and ulation. A majority, 801,081 (80%), of women 18 decreases health status. People who live in poverty and older reside in urban counties in Utah, while often have a higher incidence of chronic diseases, the remaining 206,426 women (20%) reside in the including mental illnesses such as depression and rural and frontier counties. anxiety. (Brown, 2015) 5 Health disparities are defined as the differences Understanding the disparities that women face is in care experienced by one population compared extremely important to society at large because to another population (Agency for Healthcare poor health in women often translates into poor Research and Quality, 2010). The reason dispar- health for families, as women are often the ones The Utah Women’s health Review responsible for meeting the physical and emotional plified in rural and frontier communities due to needs of family members (Cawthorne, 2008). In the lack of anonymity in these communities (New particular, obstetrics providers are in short sup- Freedom Commission on Mental Health, 2004).