title: Lifetime sexual assault and cervical cytologic abnormalities among military women.
abstract: BACKGROUND
  Little is known about the reproductive health of military women. This study sought to determine women Veterans' competing risk factors, including life span sexual assault (LSA) exposures, associated with recent and lifetime cervical cytologic abnormalities.
  
  
  METHODS
  This cross-sectional study of a retrospective cohort of 999 Midwestern Veterans (enrolled in the VA) included computer-assisted telephone interviews and chart reviews.
  
  
  RESULTS
  Over half (57%) of participants self-reported lifetime abnormal cytology. Chart review demonstrated 16% had abnormal cytology in the preceding 5 years. Almost two thirds of participants (62%) reported LSA, and one third (32%) reported assault during military service. Women with completed LSA were more likely to self-report abnormal cytology than peers with no or attempted-only assaults (63% vs. 51%, p<0.01). In logistic regression models comparing competing risks for abnormal cytology, type of military service (Active Component [AC] or both AC and Reserve or National Guard) was significant even when human papillomavirus (HPV) was included. LSA was significant when well-established risk factors, except HPV, were included. Nearly all participants had health insurance (84%), and only one third (32%) used the VA for all care.
  
  
  CONCLUSIONS
  Military type and completed LSA are significant risk factors for abnormal cervical cytology and should be routinely assessed by women's care providers. LSA and gynecologic health risk factors are widespread in the female Veteran population. These findings have clinical implications for vigilant screening, gynecologic follow-up, and behavioral health interventions. Most participants had insurance and used only some or no VA care, so findings are relevant to all women's health providers.
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE), Mental Health Service Line, Iowa City VA Health Care System, Iowa City, IA 52246, USA. anne.sadler@va.gov
authors.forename: Anne G
authors.initials: AG
authors.lastname: Sadler
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mengeling
authors.forename: Craig H
authors.initials: CH
authors.lastname: Syrop
authors.forename: James C
authors.initials: JC
authors.lastname: Torner
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D002577:Uterine Cervical Diseases / Q000453:epidemiology* / Q000473:pathology; D014626:Vaginal Smears; D014728:Veterans / Q000706:statistics & numerical data*; D014931:Women, Working; D055815:Young Adult