Probability Survey Research Articles

The Impact of Varying Incentives on Physician Survey Response Rates: An experiment in the context of COVID-19.

Since 2018, our research team has fielded national, probability surveys of internal medicine physicians. We expected our usually high response rates to fall in the 2021 iteration of the survey due to challenges related to the COVID-19 pandemic and our inability to offer all participants a $50 upfront incentive as we had previously. To understand the independent impacts of the lower incentive and surveying physicians in the context of the pandemic, we fielded an experiment varying the incentive amount physicians were offered. Our results suggest that while higher incentives still lead to higher response rates during COVID-19, the higher incentive did not achieve comparable pre-COVID response rates. We conclude with additional data on the impact of the incentives on survey cost, number of reminders needed, and the mode in which respondents chose to complete the survey.

Conceptual Overview (Portrayals of Sexuality in Pornography)

Conceptual Overview (Portrayals of Sexuality in Pornography)

Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Objectives: To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use. Methods: Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults. Results: The use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents. Conclusions: Sexual frequency should be considered when assessing condom/contraceptive use.

Enhancing estimation methods for integrating probability and nonprobability survey samples with machine-learning techniques. An application to a Survey on the impact of the COVID-19 pandemic in Spain.

Web surveys have replaced Face‐to‐Face and computer assisted telephone interviewing (CATI) as the main mode of data collection in most countries. This trend was reinforced as a consequence of COVID‐19 pandemic‐related restrictions. However, this mode still faces significant limitations in obtaining probability‐based samples of the general population. For this reason, most web surveys rely on nonprobability survey designs. Whereas probability‐based designs continue to be the gold standard in survey sampling, nonprobability web surveys may still prove useful in some situations. For instance, when small subpopulations are the group under study and probability sampling is unlikely to meet sample size requirements, complementing a small probability sample with a larger nonprobability one may improve the efficiency of the estimates. Nonprobability samples may also be designed as a mean for compensating for known biases in probability‐based web survey samples by purposely targeting respondent profiles that tend to be underrepresented in these surveys. This is the case in the Survey on the impact of the COVID‐19 pandemic in Spain (ESPACOV) that motivates this paper. In this paper, we propose a methodology for combining probability and nonprobability web‐based survey samples with the help of machine‐learning techniques. We then assess the efficiency of the resulting estimates by comparing them with other strategies that have been used before. Our simulation study and the application of the proposed estimation method to the second wave of the ESPACOV Survey allow us to conclude that this is the best option for reducing the biases observed in our data.

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border.

BackgroundMigrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico.MethodsWe conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors.ResultsAbout 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded.ConclusionThese findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.

Perceived Severity of COVID-19 in a Longitudinal Study in Detroit, Michigan.

To slow down the spread of SARS-CoV-2, many countries have instituted preventive approaches (masks, social distancing) as well as the distribution of vaccines. Adherence to these preventive measures is crucial to the success of controlling the pandemic but decreased perceptions of disease severity could limit adherence. The aim of our study was to observe changes in perceived personal severity and perceived community severity; the study also explored their predictors. In a longitudinal study from an address-based probability survey in Detroit, we asked participants to rate their perceived severity of COVID-19 for themselves and for their community. In our analysis, 746 participants were queried across 5 waves of the Detroit Metro Area Communities Study surveys from March 31 to October 27 in 2020. We tested for trends in changes of self-reported perceived severity for themselves and for their community; we assessed the effects of different predictors of the two severities through mixed effects logistic regression models. Our results highlight that the overall levels of perceived community and personal severity were decreasing over time even though both severities were fluctuating with rising confirmed case counts. Compared with non-Hispanic (NH) White Detroiters, NH Black Detroiters reported a higher perceived personal severity (OR: 5.30, 95% CI: 2.97, 9.47) but both groups reported similar levels of perceived community severity. We found steeper declines in perceived severity in NH White than NH Black Detroiters over time; the impact of education and income on perceived severity was attenuated in NH Black Detroiters compared with NH White Detroiters. Our findings suggested that perceived severity for COVID-19 decreased through time and was affected by different factors among varied racial/ethnic groups. Future interventions to slow the pace of the pandemic should take into account perceived personal and community severities among varied ethnic/racial subgroups.

Would the Brazilian population support the alcohol policies recommended by the World Health Organization?

ABSTRACTOBJECTIVE To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies.METHODS Data from 16,273 Brazilians, aged 12–65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies.RESULTS Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0–1.3), not having a religion (AOR = 1.4; 95%CI: 1.1–1.8), being catholic (AOR = 1.3; 95%CI: 1.1–1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1–2.4).CONCLUSIONS The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

Nationally representative social contact patterns among U.S. adults, August 2020-April 2021

The response to the COVID-19 pandemic in the U.S prompted abrupt and dramatic changes to social contact patterns. Monitoring changing social behavior is essential to provide reliable input data for mechanistic models of infectious disease, which have been increasingly used to support public health policy to mitigate the impacts of the pandemic. While some studies have reported on changing contact patterns throughout the pandemic, few have reported differences in contact patterns among key demographic groups and none have reported nationally representative estimates. We conducted a national probability survey of US households and collected information on social contact patterns during two time periods: August-December 2020 (before widespread vaccine availability) and March-April 2021 (during national vaccine rollout). Overall, contact rates in Spring 2021 were similar to those in Fall 2020, with most contacts reported at work. Persons identifying as non-White, non-Black, non-Asian, and non-Hispanic reported high numbers of contacts relative to other racial and ethnic groups. Contact rates were highest in those reporting occupations in retail, hospitality and food service, and transportation. Those testing positive for SARS-CoV-2 antibodies reported a higher number of daily contacts than those who were seronegative. Our findings provide evidence for differences in social behavior among demographic groups, highlighting the profound disparities that have become the hallmark of the COVID-19 pandemic.

Women's techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18-93.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 40% of women find ‘Anal Surfacing’ pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using ‘Anal Shallowing’: penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using ‘Anal Pairing’: touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Determinants of COVID-19 Vaccine Acceptance and Uptake in a Transborder Population at the Mexico-Guatemala Border, September-November 2021.

Assessing COVID-19 vaccination uptake of transborder populations is critical for informing public health policies. We conducted a probability (time-venue) survey of adults crossing from Mexico into Guatemala from September to November 2021, with the objective of describing COVID-19 vaccination status, willingness to get vaccinated, and associated factors. The main outcomes were receipt of ≥1 dose of a COVID-19 vaccine, being fully vaccinated, and willingness to get vaccinated. We assessed the association of outcomes with sociodemographic characteristics using logistic regressions. Of 6518 participants, 50.6% (95%CI 48.3,53.0) were vaccinated (at least one dose); 23.3% (95%CI 21.4,25.2) were unvaccinated but willing to get vaccinated, and 26.1% (95%CI 24.1,28.3) were unvaccinated and unwilling to get vaccinated. Those living in Mexico, independent of country of birth, had the highest proportion vaccinated. The main reason for unwillingness was fear of side effects of COVID-19 vaccines (47.7%, 95%CI 43.6,51.9). Education level was positively associated with the odds of partial and full vaccination as well as willingness to get vaccinated. People identified as Catholic had higher odds of getting vaccinated and being fully vaccinated than members of other religious groups or the non-religious. Further studies should explore barriers to vaccination among those willing to get vaccinated and the motives of the unwilling.

Ultraprocessed Food Consumption, Diet Patterns, and Perception of Diet Quality and Body Weight in the US

ObjectivesUltraprocessed foods (UPF) have recently been examined as a risk factor for diet-related disease in adults. Studies have demonstrated changes in trends in consumption patterns of UPF over the past several decades, but few studies have evaluated the association between UPF and perception of diet along with measured dietary intake. The objective of this study was to examine the association between UPF consumption, dietary intake patterns, and self-perceived diet quality in a nationally representative sample of US children and adults. MethodsData from the 2017–2018 NHANES was used for this study. Dietary intake information was collected using 24-hour recall; recalled foods were classified using the NOVA classification system and NOVA Category 4 (ultraprocessed) were identified. All data were analyzed using SAS 9.4 survey procedures to account for the unequal sampling probability and complex survey design of the. ResultsConsumption of ultraprocessed foods is associated with poor diet in US children and adults. In adults, higher consumption of ultraprocessed foods was is associated with higher dietary energy density (p = 0.0001), lower vegetable consumption (p = 0.002), greater intake of added sugars (p < 0.0001), and lower intake of plant-based protein foods (p < 0.0001). In children, consumption of ultraprocessed foods was associated with higher dietary energy density (p < 0.0001), lower consumption of vegetables (p < 0.0001) even when including fewer servings of white potatoes (p = 0.04). Interestingly, perception of diet quality was also strongly associated with ultraprocessed food consumption. Individuals who self-reported a ‘poor’ diet consumed 84% of daily calories from ultraprocessed foods, compared to individuals who self-reported an ‘excellent’ diet reporting 52% of daily calories from ultraprocessed foods, p < 0.0001. Adults who perceived themselves to be overweight also reported higher consumption of processed foods than adults who perceived themselves to be about the right weight (60% vs. 56%, p = 0.004). There was no association with processed food consumption and parent perception of child weight. ConclusionsUltraprocessed food consumption is associated with lower diet quality in US children and adults. Additionally, UPF consumption is associated with perception of diet quality and body weight. Funding SourcesNone.

Ultraprocessed Food Intake Is Associated With Poor Cardiovascular Fitness in US Children and Adolescents

ObjectivesUltraprocessed food intake is an established risk factor for cardiovascular disease in adults, however few studies have examined the association between intake of ultraproecssed foods during childhood and risk for cardiovascular disease. The objective of this study was to determine the association between eating patterns, specifically consumption of ultraprocessed foods, and markers of physical fitness in a nationally representative sample of children and youth. MethodsUsing data from NHANES National Youth Fitness Survey, the association between ultraprocessed food consumption and cardiovascular fitness level was evaluated. During the NNYFS, cardiovascular fitness was assessed in adolescents aged 12–15 y and locomotor development was assessed in children age 3–5. Dietary intake information was collected using 24-hour recall; recalled foods were classified using the NOVA classification system and NOVA Category 4 (ultraprocessed) were identified. Cardiovascular fitness level was categorized based on gender-age specific cut-points of estimated VO2max. All data were analyzed using SAS 9.4 survey procedures to account for the unequal sampling probability and complex survey design of the. ResultsIn older children, we observed a significant positive association between consumption of ultraprocessed foods and cardiovascular fitness level after controlling for age, sex, race, and household income. Children with cardiovascular fitness levels categorized as “high risk” consumed approximately 200kcal more/day of ultraprocessed foods than children in the “healthy fitness zone”, p = 0.002. In younger children, greater intake of ultraprocessed foods was associated with lower locomotor development score; children with the lowest locomotor development scores consumed 273kcal/more day of ultraprocessed foods than children with the highest locomotor development scores, p = 0.0006. ConclusionsThese findings expand on previous work from our group evaluating the association between childhood eating behaviors and fitness indicators. Interventions that aim to educate families about cost-effective methods of reducing ultraprocessed food intake may assist in decreasing risk for cardiovascular health problems in adulthood. Funding SourcesNone.

Corruption and Political Knowledge Erosion. A Cautionary Tale from Latin America

Abstract Previous research has shown that corruption diminishes citizens’ level of political support and engagement. We extend this line of reasoning and evaluate whether previous levels of perceived corruption can influence subsequent levels of political knowledge. We test this proposition with data from a two-wave panel probability survey applied in Chile between 2016 and 2017, just after a 2-year period in which an avalanche of corruption scandals shook the country. Our estimates confirm that perceived corruption reduces subsequent political knowledge, while controlling for prior knowledge. This pattern is particularly strong among non-ideologues and people ideologically distant from the incumbent government. Given the status of political knowledge as a democratically valuable trait, our results uncover some normatively disturbing consequences of corruption.

Methodology of Natsal-COVID Wave 2: A large, quasi-representative, longitudinal survey measuring the impact of COVID-19 on sexual and reproductive health in Britain.

The National Surveys of Sexual Attitudes and Lifestyles COVID study (Natsal-COVID) was designed to understand the impact of COVID-19 on Britain's sexual and reproductive health (SRH). Natsal-COVID Wave 1 survey and qualitative follow-up interviews were conducted in 2020. The Wave 2 survey was designed to capture one-year prevalence estimates for key SRH outcomes and measure changes over the first year of the pandemic. We describe the Wave 2 survey methodology and assess the sample representativeness. Natsal-COVID Wave 2 was conducted March-April 2021; approximately one year after the start of Britain's first national lockdown. Data were collected using an online web-panel survey administered by Ipsos. The sample comprised a longitudinal sample of Wave 1 participants who had agreed to re-contact plus a sample of participants residing in Britain, aged 18-59, including a boost sample comprising people aged 18-29. Questions covered reproductive health, relationships, sexual behaviour and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British population. Comparisons were made with recent national probability surveys, Natsal-3 (2010-12) and Natsal-COVID Wave 1 to understand bias. A total of 6,658 individuals completed the survey. In terms of gender, age, ethnicity, and rurality, the weighted Natsal-COVID Wave 2 sample was like the general population. Participants were less likely to be married or to report being in good health than the general population. The longitudinal sample (n=2,098) were broadly like participants who only took part in Wave 1 but were older. Among the sexually active, longitudinal participants were less likely to report multiple sexual partners or a new sexual partner in the past year compared to those who only took part in Wave 1. Natsal-COVID collected longitudinal, quasi-representative population data to enable evaluation of the population-level impact of COVID-19 on SRH and to inform policy.

How to estimate health service coverage in 58 districts of Benin with no survey data: Using hybrid estimation to fill the gaps.

The global movement to use routine information for managing health systems to achieve the Sustainable Development Goals, relies on administrative data which have inherent biases when used to estimate coverage with health services. Health policies and interventions planned with incorrect information can have detrimental impacts on communities. Statistical inferences using administrative data can be improved when they are combined with random probability survey data. Sometimes, survey data are only available for some districts. We present new methods for extending combined estimation techniques to all districts by combining additional data sources. Our study uses data from a probability survey (n = 1786) conducted during 2015 in 19 of Benin's 77 communes and administrative count data from all of them for a national immunization day (n = 2,792,803). Communes are equivalent to districts. We extend combined-data estimation from 19 to 77 communes by estimating denominators using the survey data and then building a statistical model using population estimates from different sources to estimate denominators in adjacent districts. By dividing administrative numerators by the model-estimated denominators we obtain extrapolated hybrid prevalence estimates. Framing the problem in the Bayesian paradigm guarantees estimated prevalence rates fall within the appropriate ranges and conveniently incorporates a sensitivity analysis. Our new methodology, estimated Benin's polio vaccination rates for 77 communes. We leveraged probability survey data from 19 communes to formulate estimates for the 58 communes with administrative data alone; polio vaccination coverage estimates in the 58 communes decreased to ranges consistent with those from the probability surveys (87%, standard deviation = 0.09) and more credible than the administrative estimates. Combining probability survey and administrative data can be extended beyond the districts in which both are collected to estimate coverage in an entire catchment area. These more accurate results will better inform health policy-making and intervention planning to reduce waste and improve health in communities.

COVID-19 Vaccine Hesitancy among Behavioral Risk Takers.

The COVID-19 pandemic has emerged as a major public health issue, with vaccines serving as a vital preventive strategy to lower the global burden. Yet, despite national and local mandates, key sectors of the population continue to demonstrate lower compliance rates. In the United States, young adults have the lowest vaccination rates among the adult population. The goal of our study was to utilize the largest state-health survey to assess the key determinants of such hesitancy in order to create targeted interventions for the most at-risk groups to ensure equitable outcomes in disease prevention. We utilized the latest available California Health Interview Survey, a population-based complex probability survey, to evaluate determinants of vaccine hesitancy among young adults. Survey-weighted descriptive statistics, bivariate statistics, and multivariable logistic regression analyses were conducted. All statistical tests used p less than 0.05 to determine statistical significance. A total of 1203 respondents, representative of 4,027,462 young adults (ages 18–25 years) were included in our study. Our primary findings note that 24% of participants reported they would not be willing to take the COVID-19 vaccination. Prevalence of vaccine hesitancy was also significantly higher among young adults who were current smokers (including electronic cigarettes), when compared to non-current smokers (36% vs. 22%). Further, the highest prevalence was also noted among young adults who identified as African-American (51%), had a high school degree or less (34%), those who were overweight or obese (28%), and reported a poor health status (22%). Multivariable regression analysis demonstrated that current smokers, as compared to non-current smokers, had more than double the odds of reporting COVID-19 vaccine hesitancy. African-American young adults or young adults with a high school degree or less were both independently associated with at least a three-fold increase in vaccine hesitancy. Participants with psychological distress, however, were more likely to be accepting of the vaccine. Public health efforts to improve vaccine compliance need targeted efforts, including building trust in the healthcare system for African-Americans and promoting easier access and knowledge of vaccines among those with a high school degree or less, as well as young-adults who are currently smoking, with such efforts targeting behavioral interventions focused on risk aversion.

Methodology of Natsal-COVID Wave 1: a large, quasi-representative survey with qualitative follow-up measuring the impact of COVID-19 on sexual and reproductive health in Britain.

Background: Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy. The COVID-19 pandemic disrupted many aspects of sexual lifestyles, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the impact of COVID-19 on the nation's SRH and assessed the sample representativeness. Methods: Natsal-COVID Wave 1 data collection was conducted four months (29/7-10/8/2020) after the announcement of Britain's first national lockdown (23/03/2020). This was an online web-panel survey administered by survey research company, Ipsos MORI. Eligible participants were resident in Britain, aged 18-59 years, and the sample included a boost of those aged 18-29. Questions covered participants' sexual behaviour, relationships, and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British general population. Participants meeting criteria of interest and agreeing to recontact were selected for qualitative follow-up interviews. Comparisons were made with contemporaneous national probability surveys and Natsal-3 (2010-12) to understand bias. Results: 6,654 participants completed the survey and 45 completed follow-up interviews. The weighted Natsal-COVID sample was similar to the general population in terms of gender, age, ethnicity, rurality, and, among sexually-active participants, numbers of sexual partners in the past year. However, the sample was more educated, contained more sexually-inexperienced people, and included more people in poorer health. Conclusions: Natsal-COVID Wave 1 rapidly collected quasi-representative population data to enable evaluation of the early population-level impact of COVID-19 and lockdown measures on SRH in Britain. Although sampling was less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022).

Overwhelming Support for Sexual Health Education in U.S. Schools: A Meta-Analysis of 23 Surveys Conducted Between 2000 and 2016

PurposeSurveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools. MethodsA systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys. ResultsA total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2–91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5–93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1–90.6) of respondents supported sexual health education. ConclusionThese findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction.

Effects of changes in perceived discrimination during BLM on the 2020 presidential election.

Few Americans change their choice of presidential candidate to a different political party from election to election. This study evaluates whether and in what direction the Black Lives Matter movement affected the small percentage of voters whose presidential votes changed from 2016 to 2020. Six waves of nationally representative probability surveys are used to establish that significant increases in the extent to which Americans perceived discrimination against Blacks and to which people favored more government efforts to address racial inequality both occurred in 2020. Using panel data, results suggest that increases in perceptions of racial inequality significantly increased the probability of vote switching toward the Democratic candidate. Attention to racial injustice also primed voters to rely more heavily on this issue when evaluating candidates.

Racial disparities in the management of emergency department patients presenting with psychiatric disorders

PurposeEmergency departments (ED) provide critical resources including stabilization, diagnosis of underlying medical precipitants and transfer to psychiatric hospitals for mental health emergencies. Our objective was to examine the association of race and/or ethnicity and the administration of chemcial sedation using a nationally representative sample of ED visits for psychiatric disorders. MethodsWe analyzed data from 2008 to 2018 through the National Hospital Ambulatory Medical Survey database, a national probability survey based on ED chart abstraction. All ED visits for psychiatric disorders were included. Our primary outcome variable was receipt of chemical sedation among patients presenting with a complaint related to a psychiatric condition. We defined receipt of chemical sedation by the receipt of a first or second-generation antipsychotic or ketamine that was given in the ED. Our secondary outcome was receipt of psychiatric treatment defined as admission to a mental health and/or detox unit at the same hospital or transfer to a psychiatric facility. We used logistic regression models and used marginal effects to report the average adjusted probability in outcomes for different patient characteristics. ResultsNationally after weighting, 76,200,000 of 1,480,102,130 total ED visits (5.1%, 95% CI 4.9%–5.4%) were designated to be for treatment of a psychiatric disorder. When controlling for patient age, sex, initial pulse, presence of chronic medical conditions, geographic region, EMS arrival and nightshift arrival, among patients presenting with psychiatric disorders, Black race was associated with a 2.2% point (95% CI 0.8–3.7, P < .01) greater probability of receiving chemical sedation than non-Hispanic (NH) white race and/or ethnicity (3.0%) and this difference remained significant when accounting for admission or transfer to psychiatric facilities. However, when accounting for the percent of hospital population that was Black (P < .01), individual patient race was no longer associated with a significant increase in receipt of chemical sedation. There was no significant association between race and/or ethnicity and admission or transfer to psychiatric facilities. ConclusionNationally, Black patients presenting to the ED are more likely to receive chemical sedation than NH-white patients for psychiatric complaints, and this appears to be because hospitals serving a high proportion of Black patients use more chemical sedation, suggesting structural racism is a potential root cause.