Statewide Representative Survey Research Articles

Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States

Health insurance remains an important dimension of contraceptive access. This study investigated the role of insurance in contraceptive use, access, and quality in South Carolina and Alabama. The study used a cross-sectional statewide representative survey that assessed reproductive health experiences and contraceptive use among reproductive-age women in South Carolina and Alabama. The primary outcomes were current contraceptive method use, barriers to access (inability to afford wanted method, delay/trouble obtaining wanted method), receipt of any contraceptive care in the past 12 months, and perceived quality of care. The independent variable was insurance type. Generalized linear models were applied to estimate prevalence ratios for each outcome's association with insurance type while adjusting for potentially confounding variables. Nearly 1 in 5 women (17.6%) was uninsured, and 1 in 4 women (25.3%) reported not using a contraceptive method at the time of the survey. Compared with women with private insurance, women with no insurance had a lower likelihood of current method use (adjusted prevalence ratio 0.75; 95% confidence interval 0.60-0.92) and receipt of contraceptive care in the past 12 months (adjusted prevalence ratio 0.61; 95% confidence interval 0.45-0.82). These women also were more likely to experience cost barriers to access care. The insurance type was not significantly associated with the interpersonal quality of contraceptive care. Findings highlight the need for expanding Medicaid in states that did not do so under the Patient Protection and Affordable Care Act, interventions to increase the number of providers who accept Medicaid patients, and protections to Title X funding as key elements for enhancing contraceptive access and population health outcomes.

The association of doula support and patient experiences with hospital staff during birth in a sample of California women: An exploratory analysis.

Research suggests that doula support improves birth outcomes, contributing to lower rates of preterm birth, low birthweight, and nonindicated cesarean delivery. Few studies investigate whether doula support is associated with the quality of patient-reported birth experiences in hospital settings. This study uses data from Listening to Mothers in California, a statewide representative survey of women who gave birth in 2016 in Californian hospitals. The analytic sample included 1345 English-speaking participants. We used multivariable logistic regression to test for associations between doula support and self-reported unfair treatment, abuse, and rapport with delivery staff. We also examined associations between these experiences and openness to doula support in a future birth. Models adjusted for maternal sociodemographic characteristics and views about medical intervention in birth. Just over 9% of women had doula support during birth. During their hospital stay, 6.3% reported unfair treatment, 11.5% reported abuse by providers, and 5.7% reported no rapport with delivery room staff. There were no statistically significant relationships between doula support and unfair treatment, abuse, or delivery staff rapport in our models. Participants who reported no rapport with hospital staff were more likely to express openness to doula support in a future birth (AOR: 2.59; 95% CI: 1.15, 5.79). Despite their best efforts, doulas may not be able to mitigate all negative interactions between their clients and hospital staff. These experiences may also influence desires for additional support from doulas in future births. Hospital policies and practices should include doulas as valuable members of the care team to help ensure positive experiences during birth.

The Fruits of Labor: Home Food Procurement and Mental Health in the Time of COVID-19

ABSTRACT We examine the relationship of home food procurement (HFP) during COVID-19 to emotional eating and stress using a statewide representative survey (n = 600) in Vermont. Women and people with a job change since COVID-19 were more likely to experience higher stress and emotional eating. Engaging in HFP, especially gardening, is associated with less emotional eating. However, people who fished, hunted, or canned more since the pandemic began were more likely to eat for emotional reasons and experience higher stress. These results suggest that gardening, even during a pandemic, may contribute to stress reduction, more so than other nature-based food production activities.

When Sexual Identity and Sexual Behaviors Do Not Align: The Prevalence of Discordance and its Physical and Psychological Health Correlates.

Although scholarly work on the complexity of human sexuality has increasingly been a focus of scholarship, comparatively little research has focused on the phenomenon of mismatch, or discordance, between different aspects of sexuality. This study used secondary data of sexually active adults (N=116,950) from a statewide representative survey which included both a measure of sexual identity (i.e., identifying as "heterosexual", "bisexual", etc.) and a measure of sexual behaviors (i.e., indicating the sex of your sexual partners). Using these data, we examined the prevalence and correlates of sexual identity-behavior discordance (IBD), and also included data from bisexual-identified individuals. In support of our hypotheses, we found that sexual IBD was particularly prevalent among young-adult women. However, we did not find sex differences in the prevalence of IBD overall. Furthermore, individuals who were categorized as IBD also tended to report poorer physical health and psychological functioning than both heterosexual- and gay/lesbian-identified concordant individuals, as well as more negative behaviors typically associated with poor psychological functioning (i.e., binge drinking and suicidal ideation.) Our findings highlight the need for more sensitive instruments and measures assessing sexual orientation in both research and practice, as well as the need for continued study into the area of discordance, and particularly across other dimensions of sexuality (e.g., attraction).

The Food Bank and Food Pantries Help Food Insecure Participants Maintain Fruit and Vegetable Intake During COVID-19.

Charitable food services, including food banks and pantries, support individual and households' food access, potentially maintaining food security and diet quality during emergencies. During the COVID-19 pandemic, the use of food banks and pantries has increased in the US. Here we examine perceptions of food banks and food pantries and their relationship to food security and fruit and vegetable (FV) intake during the first 6 months of the COVID-19 pandemic, using a statewide representative survey (n = 600) of residents of Vermont. The utilization of food pantries was more common among food insecure households and households with children. Among food insecure respondents, those who did not use a food pantry were significantly more likely to report consuming less FV during the pandemic. Further, we find respondents who are food insecure and using a food pantry report consuming more FV since the onset of the COVID-19 pandemic. We found that respondents who were both food insecure and reported not using a food pantry were significantly more likely to report both a reduction in fruit consumption (b = −0.58; p = 0.001) and a reduction in vegetable consumption (b = −0.415; p = 0.012). These results indicate that these services may support food access and one important dimension of diet quality (FV intake) for at-risk populations during emergencies.

Home food procurement impacts food security and diet quality during COVID-19

BackgroundHome food procurement (HFP) (i.e. gardening, fishing, foraging, hunting, backyard livestock and canning) have historically been important ways that people obtain food. Recently, some HFP activities have grown (e.g. gardening), while other activities (e.g. hunting) have become less common in the United States. Anecdotally, COVID-19 has sparked an increase in HFP evidenced by increased hunting licenses and shortages in seeds and canning supplies. HFP may have positive benefits for food security and diet quality, though research beyond gardening is especially limited in high-income countries.MethodsWe examine HFP activities since the COVID-19 pandemic began, and their relationship to food security and dietary quality using multivariable logit models and matching analysis with a statewide representative survey (n = 600) of residents of Vermont, United States.ResultsWe find 29% of respondent households classified as food insecure since COVID-19, and higher prevalence of food insecurity among those experiencing a negative job change since COVID-19, households earning less than $50,000 annually, Hispanic and multi-race respondents. Nearly 35% of respondents engaged in HFP activities since the COVID-19 pandemic began; the majority of those gardened, and more than half pursued HFP activities more intensely than before the pandemic or for the first time. Food insecure households were more likely to pursue HFP more intensely, including more gardening, fishing, foraging, and hunting. Respondents who were food insecure, Black, Indigenous, People of Color, those with a negative job disruption, and larger households all had greater odds of increased intensity of HFP during the COVID-19 pandemic. HFP was significantly associated with eating greater amounts of fruits and vegetables; however, this effect was only significant for food secure households.ConclusionOverall, these results suggest that HFP activities have increased since the start of the COVID-19 pandemic, and may be an important safety net for food insecure households. However, HFP for food insecure households does not translate into the same higher fruit and vegetable intake as found among food secure HFP households, suggesting this population may be trying to maintain intake, or that they may have potential important resource or technical assistance needs. Long-term, HFP activities may have important food security and diet quality impacts, as well as conservation implications, which should be more thoroughly explored. Regardless, the increased interest and intensity of HFP demonstrates opportunities for educational and outreach efforts.

Exploring the causal effects of bicycling for transportation on mental health

Few studies have investigated how transportation-related bicycling might contribute to better mental health. We investigated the effects of utilitarian bicycling frequency on psychological distress and life satisfaction, and explored the possible causal mechanisms, using large and state-wide representative survey data from Victoria, Australia. Propensity score methods were applied to balance treatment and control groups, effectively reducing the selection bias that potentially confounds the causal effects. This study finds that occasional bicycling was not significantly associated with mental health, while regular bicycling was negatively associated with psychological distress and positively associated with life satisfaction. This study also finds that physical activity levels, physical health conditions, and neighborhood physical environment do not fully mediate the effects of utilitarian bicycling on mental wellbeing. These findings support the policies of promoting transportation bicycling to improve population mental health, and highlight the potential role of regular bicycling in combating psychological distress and improving life satisfaction.

Your Money or Your (Wild) Life? Political Ideology, Deference to Authority, and Media Attention as Predictors of Support for Interventionist Conservation Policies

ABSTRACT This study examines support for interventionist conservation policies directed at natural resource-using industries in Wisconsin, a U.S. state heavily dependent on natural resources for economic vitality. We use measures, or variations of measures, common in science and environmental communication research: personal predispositions (i.e. religiosity and political ideology), deference to authority, and individual media use, to determine what effect these variables have on individual levels of support for interventionist conservation policies. Using a statewide representative survey and OLS regression, this study finds that religiosity, deference to business and industry leaders, attention to economic news, attention to Fox News, and attention to talk radio are negatively related to support for interventionist conservation policies. Age, liberal political ideology, deference to economists, attention to natural resource and environmental news, and attention to network news (ABC/NBC/CBS) are positively related to support for interventionist conservation policies.

P27 Awareness and support for state funding of crisis pregnancy centers in Georgia: Findings from a statewide representative survey of registered voters

P27 Awareness and support for state funding of crisis pregnancy centers in Georgia: Findings from a statewide representative survey of registered voters

Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys. To examine e-cigarette and JUUL use among adolescents in New Jersey. Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12. Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise. Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use. This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.

Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth

PurposePartner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. MethodsThis study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. ResultsOut of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. ConclusionsLGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.

Parenting Today: A State-Wide Representative Survey of Contemporary Parenting Experiences

This article describes the study design of Parenting Today in Victoria: a representative survey of contemporary parenting experiences, behaviours, concerns and needs of parents. The aims of the study, sample design, survey content development processes, including pilot survey administration, data collection procedures and demographic characteristics of the sample are described. The survey was administered via computer assisted telephone interviewing using random dialling of landline and mobile phone numbers in 2016 to parents of children aged 0–18 years who were living in Victoria, Australia. The response rate was 57% with 2600 parents surveyed (40% fathers). The sample was broadly representative of the Victorian population on major demographic characteristics when compared to data from the Australian Census of Population and Housing (Australian Bureau of Statistics, 2011). However, adjustments were made for over representation of younger parents (16–34 years), more highly educated parents and for those living outside major cities. This survey provides rigorously collected, accurate and up-to-date information about the experiences, preferences and concerns of a large and representative sample of parents. Findings will provide vital new insights to inform policy decision making, service planning and future research aimed at understanding parents’ attitudes and behaviours, and the psychology behind their help-seeking.

Gender inequities in curative and preventive health care use among infants in Bihar, India.

BackgroundIndia has the highest rate of excess female infant deaths in the world. Studies with decade-old data suggest gender inequities in infant health care seeking, but little new large-scale research has examined this issue. We assessed differences in health care utilization by sex of the child, using 2014 data for Bihar, India.MethodsThis was a cross-sectional analysis of statewide representative survey data collected for a non-blinded maternal and child health evaluation study. Participants included mothers of living singleton infants (n = 11 570). Sex was the main exposure. Outcomes included neonatal illness, care seeking for neonatal illness, hospitalization, facility-based postnatal visits, immunizations, and postnatal home visits by frontline workers. Analyses were conducted via multiple logistic regression with survey weights.FindingsThe estimated infant sex ratio was 863 females per 1000 males. Females had lower rates of reported neonatal illness (odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.6–0.9) and hospitalization during infancy (OR = 0.4, 95% CI = 0.3–0.6). Girl neonates had a significantly lower odds of receiving care if ill (80.6% vs 89.1%; OR = 0.5; 95% CI = 0.3–0.8) and lower odds of having a postnatal checkup visit within one month of birth (5.4% vs 7.3%; OR = 0.7, 95% CI = 0.6–0.9). The gender inequity in care seeking was more profound at lower wealth and higher numbers of siblings. Gender differences in immunization and frontline worker visits were not seen.InterpretationGirls in Bihar have lower odds than boys of receiving facility–based curative and preventive care, and this inequity may partially explain the persistent sex ratio imbalance and excess female mortality. Frontline worker home visits may offer a means of helping better support care for girls.

Women's Knowledge of and Support for Abortion Restrictions in Texas: Findings from a Statewide Representative Survey.

States have passed numerous laws restricting abortion, and Texas passed some of the most restrictive legislation between 2011 and 2013. Information about women's awareness of and support for the laws' provisions could inform future debates regarding abortion legislation. Between December 2014 and January 2015, some 779 women aged 18-49 participated in an online, statewide representative survey about recent abortion laws in Texas. Poisson regression analysis was used to assess correlates of support for a law that would make obtaining an abortion more difficult. Women's knowledge of specific abortion restrictions in Texas and reasons for supporting these laws were also assessed. Overall, 31% of respondents would support a law making it more difficult to obtain an abortion. Foreign-born Latinas were more likely than whites to support such a law (prevalence ratio, 1.5), and conservative Republicans were more likely than moderates and Independents to do so (2.3). Thirty-six percent of respondents were not very aware of recent Texas laws, and 19% had never heard of them. Among women with any awareness of the laws, 19% supported the requirements; 42% of these individuals said this was because such laws would make abortion safer. Many Texas women of reproductive age are unaware of statewide abortion restrictions, and some support these requirements because of misperceptions about the safety of abortion. Advocates and policymakers should address these knowledge gaps in efforts to protect access to legal abortion.

TWO SONS AND A DAUGHTER: SEX COMPOSITION AND WOMEN'S REPRODUCTIVE BEHAVIOUR IN MADHYA PRADESH, INDIA

This article examines how the sex composition of women's current children at the start of a pregnancy interval influences both fertility desires and the full range of reproductive actions women may take to realize them, including temporary contraception, abortion and sterilization, in Madhya Pradesh, India, where popular notions of ideal family size and sex composition are dominated by son preference. The analysis is conducted using a dataset of 9127 individual pregnancy intervals from a 2002 statewide representative survey of 2444 women aged 15-39 with at least one child. The results indicate that women's preferences go beyond a singular preference for male children, with the preferred composition of children being two boys and one girl. Women with this composition are 90% less likely to report having wanted another pregnancy (OR 0.097, p < 0.01) relative to those with two girls. These preferences have significant implications for reproductive actions. While sex composition has no statistically significant effect on the use of temporary contraception, those with the preferred sex composition are twice as likely to attempt abortion (OR 2.436, p < 0.01) and twelve times more likely to be sterilized (OR 12.297, p < 0.01) relative to those with two girls only.

Stressful life events and physical abuse among pregnant women in North Carolina.

This study estimates the prevalence of stressful life events and physical abuse among North Carolina women prior to infant delivery, and examines potential associations between abuse and the other stressors. Data were from the North Carolina Pregnancy Risk Assessment Monitoring System, a statewide representative survey of over 2,600 postpartum women. The survey assessed women's sociodemographic characteristics and their experiences of physical abuse and 13 other stressful life events before delivery. The prevalences of each life event and abuse were estimated. Logistic regression modeled the probability of women having high levels of stressful life events in relation to physical abuse and sociodemographics. Most women were married, white, high school graduates, aged 20 or older. The most common stressful life events were residential moves, increased arguing with husbands/partners, family member hospitalizations, financial hardship, and deaths of loved ones. Fourteen percent of women had high levels of stressful events (5 or more), and almost 9% were physically abused. Abuse was positively associated with increased arguing with husbands/partners, physical fighting, having someone close with an alcohol/drug problem, becoming separated/divorced, and financial hardship. Logistic regression analysis showed that a high level of stressful life events was significantly more likely among women abused both before and during pregnancy (OR = 11.94) and among women abused before but not during pregnancy (OR = 14.19). The high frequency of multiple stressful events and abuse in women's lives suggests that women's care providers should ask their patients about these issues, and offer appropriate referral/interventions to those in need.