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Booth BM (Little Rock REAP, Center for MH Care Outcomes and Research: Central Arkansas Veterans Health Care System), Mengeling MA
(University of Iowa), Torner JC
(Carver College of Medicine, University of Iowa), Syrop CH
(Carver College of Medicine, University of Iowa)
Objectives:
Since the Women’s Health Act of 1992 acknowledged women sexually victimized in the military as a priority care population, The Department of Veterans Affairs (DVA) has become a major health care provider for women. Unfortunately, the long-term gynecologic health or health services utilization of military women or sexually assaulted women has not been well studied.
Methods:
800 women participated in a cross-sectional study of current health and health care utilization of women with and without lifetime sexual assault exposure. Consenting women veterans seeking care from the Iowa City VAMC and clinics within the preceding 5 years ( < 51 years of age) completed a computer-assisted telephone interview assessing socio-demographic variables, rape exposures, gynecologic diagnoses, procedures and care utilization, and health status.
Results:
The average age of subjects is 39yo (sd=8.4) and median income is $21,000. 35% report getting all their health care at a VAMC, 55% report getting some, and 10% report getting none of their care at a VAMC. Lifespan sexual assault (attempted and completed) was reported by 63% (n=507), with almost half acknowledging sexual assault during military service (48%, n=243). Abnormal pap smears were reported by 56% of participants. Those reporting sexual assault were more likely to report abnormal pap smears (67% v. 33%, P < .01), to use the VAMC for all of their health care (39% vs 29%, P < .05), and to seek gynecologic care at the VAMC (29% vs 16%, P < .05). 40% of participants report private insurance coverage. Women without private insurance were significantly more likely to have had a pap smear at the VA than insured peers (75% vs 52%, P < .01).
Implications:
The frequency of lifetime sexual assault is high in this population. Women who experienced sexual assault are more likely to have abnormal pap smears and to use VAMC health services, particularly women with no private insurance.
Impacts:
Identification of women with high reproductive heath risks and high VAMC utilization could impact national resource allocation for a priority population and would have direct implications for DVA policies regarding women’s health care. More aggressive screening or interventions may be indicated. A subsequent population based study is needed.
