Women's health guidelines

Endnotes

1. All children 3 to 5 years are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity. 
2. Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults. 
3. Risk factors for hepatitis A should be discussed with your provider. 
4. Risk factors for hepatitis B should be discussed with your provider. 
5. For individuals born before 1957 with no evidence of immunity to measles, mumps, or rubella, consider 2-dose series at least 4 weeks apart for measles and mumps or at least 1 dose for rubella. Check with your doctor for details regarding pregnancy.  
6. Routine vaccination for individuals ages 9-16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection. Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau.  
7. Brief behavioral counseling interventions were found to reduce unhealthy alcohol use in adults 18 years or older, including pregnant women. Effective behavioral counseling interventions vary in their specific components, administration, length, and number of interventions.
8. Individuals at risk for meningococcal disease include international travelers and collegebound students. These individuals should discuss the risks and benefits of vaccination with their doctor. 
9. Colorectal cancer is the third leading cause of cancer death for both men and women. It is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. 
10. Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). 
11. Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use. 
12. Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior. 
13. Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence and quality of life. Women have higher rates of osteoporosis than men at any given age. 
14. Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation. 
15. People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap. 
16. Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others. 
17. The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose. 
18. Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart. 
19. Perform screening of abdominal aortic aneurysm (AAA) with ultrasonography in men who have a history of smoking. 
20. Your doctor will assess your personal or family history of breast, ovarian, tubal, or peritoneal cancer or family history of breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations. Women with a positive result on the risk assessment tool are recommended to receive genetic counseling and, if indicated after counseling, genetic testing.
21. There are several recommended screening tests for colorectal cancer. Your physician will consider a variety of factors to decide which test is best. Screenings include: 

- High sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year;
- Stool DNA-FIT every 1 to 3 years;
- Computed tomography colonography every 5 years;
- Flexible sigmoidoscopy every 5 years;
- Flexible sigmoidoscopy every 10 years with annual FIT; and
- Colonoscopy screening every 10 years.

22. Diabetes/prediabetes screening should be performed for adults ages 35 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood glucose. Individuals with prediabetes may be referred for preventive interventions.
    
23. Selection of conditions based upon “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA). 
24. Fluoride oral supplement should be discussed at preventive care visits if the primary water source is deficient in fluoride. 
25. Unhealthy drug use screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.
26. Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults at increased risk for sexually transmitted infections.
27. Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. Diabetes Prevention Program – part of Wellvolution® – is Blue Shield's lifestyle medicine program focused on diabetes prevention. 
28. Falls prevention counseling for older adults to exercise, or physical therapy to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls.
29. The Advisory Committee on Immunization Practices (ACIP) recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day. 
30. Hepatitis C screening for adults 18-79.
31. Lung cancer screening for adults ages 50 to 80 who have a 20 pack per year smoking history and currently smoke or quit within the last 15 years.
32. Coverage includes:
    - prescribed FDA-approved contraceptive drugs, devices, and products;

    - device insertion and removal;
    - sterilization procedures;
    - contraceptive education and counseling including for continued adherence;
    - related follow-up services; and management of side effects. For self-administered hormonal contraceptives, you may receive up to a 12-month supply.

33. Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection.
34. All women of reproductive age are at potential risk for IPV and should be screened. There are a variety of factors that increase risk of IPV, such as exposure to violence as a child, young age, unemployment, substance abuse, marital difficulties, and economic hardships. 
35. Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.
36. The Hib (Haemophilus influenzae type b) vaccine is usually given in a series of 2 or 3 primary doses, depending on brand. An additional booster dose at 12-15 months is recommended for children who completed the primary doses before their first birthday.