Understanding America Study Research Articles

Within-person relationship between employment insecurity and mental health: a longitudinal analysis of the Understanding America Study

BackgroundEmployment insecurity is a socioeconomic factor influencing mental health, yet the empirical evidence supporting this claim has important limitations. The fluctuations in employment insecurity throughout the COVID-19 pandemic offered a...

The Understanding America Study (UAS)

PurposeThe Understanding America Study (UAS) is a probability-based Internet panel housed at the Center for Economic and Social Research at the University of Southern California (USC). The UAS serves as...

Visual-Motor Integration (VMI) Is Also Relevant for Computer, Smartphone, and Tablet Use by Adults: Introducing the Brief Box Clicking Test.

Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use. To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI. Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients. A total of 11,114 adults. Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation). Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals. The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use. Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.

Late-Life Hardship at the Intersection of Age and Gender

ABSTRACT Late-life material hardship captures older adults’ inability to afford necessities. Using data from the Understanding America Study, this study shows that while older women experienced higher levels of hardship than older men, the prevalence of hardship decreased as age increased. Older women had more hardship at an earlier age (65–69), highlighting the intersectional disadvantage experienced by older women. The chance of any hardship for older women was higher than that for older men in 2021–2022, concurring with recent rises in inflation and cost-of-living. Policies and interventions to alleviate deprivation should pay greater attention to older women’s disproportionate experience of material hardship.

Heterogeneous Trajectories in Post-Disaster Drug Use Across Different Race/Ethnicity and Income Strata: Focus on Natural Hazards During COVID-19.

During the COVID-19 pandemic, climate-related natural hazards, such as wildfires, storms/hurricanes, and others (e.g., earthquakes, tornadoes), further disrupted the normal functioning of US residents. The co-occurrence of natural disasters and COVID-19 created unprecedentedly elevated levels of stress, especially to the racial/ethnic minorities and lower-income households. This study examines how natural disasters related to recreational drug use during COVID-19 and whether the relation is heterogeneous across different subgroups categorized by race/ethnicity and household income. This study used the data from the biweekly online surveys of the Understanding America Study (UAS) and analyzed the drug use behaviors of 966 US adults between April 29 and December 31, 2020. This study found that middle-income adults (household income ranging from $50,000 to $149,999), serving as the reference group, generally exhibited a significant reduction in drug consumption during or after disaster events. However, compared to the middle-income group, White and Black adults with household income lower than $50,000 showed 142% and 88% more frequent drug use when experiencing storms/hurricanes. This disparity widened in the following weeks. Additionally, lower-income Hispanics showed 74% more frequent drug use compared to the middle-income group in the weeks following wildfire incidents. The study's findings shed light on the risk of drug misuse during the co-occurrence of climate and public health crises, emphasizing the disproportionate risk among lower-income racial/ethnic minorities amid the pandemic and natural disasters.

Perceived discrimination, transit use, and walking behavior during the COVID-19 pandemic: Evidence from the Understanding America Study

A rise in reporting and media coverage of negative social interactions and experiences of racism in transit and other public environments suggests that perceived discrimination may have affected the travel behavior and health of people of color during the COVID-19 pandemic. In this study, to examine relationships between race, perceived discrimination, transit use, and walking behavior, we draw on data collected in 20 waves of the Understanding America Study (UAS) COVID-19 tracking survey, fielded July 2020–July 2021. Importantly, we find that transit use among minorities continued during the pandemic at higher rates, especially among Black and Hispanic respondents, despite non-White respondents reporting more frequent perceptions of discrimination. Our linear mixed-effect model results further indicate that non-White respondents were notably more likely to use transit. Examining walking behavior, we find that White and Asian respondents consistently reported more walking than Black and Hispanic respondents, even when controlling for income. Crucially, we found that in the presence of controls, while large disparities were observed in both walking and transit behavior based on race, perceived discrimination had little to no effect. While disparities in travel behavior based on race are evidently better explained by structural factors as opposed to overt, individual-level discrimination, planners, policymakers, and designers should nevertheless give greater consideration to micro- and macro-scale interventions that facilitate safe transit use and walking for racial and ethnic minorities.

Disparate Patient Advocacy When Facing Unaffordable and Problematic Medical Bills

People in the US face high out-of-pocket medical expenses, yielding financial strain and debt. To understand how households respond to medical bills they disagree with or cannot afford. A retrospective cohort study was carried out using a survey fielded between August 14 and October 14, 2023. The study included a random sample of adult (aged ≥18 years) survey respondents from the Understanding America Study (UAS). Participant responses were weighted to be nationally representative. The analysis took place from November 3, 2023, through January 8, 2024. Respondents reported if their household received a medical bill that they could not afford or did not agree with in the prior 12 months, and if anyone contacted the billing office regarding their concerns. Those who did reach out were asked about their experience and those who did not were asked why. The survey was sent to 1233 UAS panelists, of which 1135 completed the survey, a 92.1% cooperation rate. Overall, 1 in 5 of the 1135 respondents received a medical bill that they disagreed with or could not afford. Leading bill sources were physician offices (66 [34.6%]), emergency room or urgent care (22 [19.9%]), and hospitals (31 [15.3%]), and 136 respondents (61.5%) contacted the billing office to address their concern. A more extroverted and less agreeable personality increased likelihood of reaching out. Respondents without a college degree, lower financial literacy, and the uninsured were less likely to contact a billing office. Among those who did not reach out, 55 (86.1%) reported that they did not think it would make a difference. Of those who reached out, 37 (25.7%) achieved bill corrections, better understanding (16 [18.2%]), payment plans (18 [15.5%]), price drop (17 [15.2%]), financial assistance (10 [8.1%]), and/or bill cancellation (6 [7.3%]), while 32 (21.8%) said that the issue was unresolved and 23.8% reported no change. These outcomes aligned well with respondents' billing concerns with financial relief for 75.8% of respondents reaching out about an unaffordable bill, bill corrections for 73.7% of those who thought there was mistake, and a price drop for 61.8% of those who negotiated. This cross-sectional survey of a representative sample of patients in the US found that most respondents who self-advocated achieved bill corrections and payment relief. Differences in self-advocacy may be exacerbating socioeconomic inequalities in medical debt burden, as those with less education, lower financial literacy, and the uninsured were less likely to self-advocate. Policies that streamline the administrative burden or shift it from patients to the billing clinician may counter these disparities.

Support for Partisan Violence among the Political Fringe: The Case of Antifa and QAnon Supporters

ABSTRACT Recent surveys have shown that significant numbers of partisans in the United States harbor violent attitudes towards out-party politicians and out-party members. This finding has corresponded with the increased visibility of political fringe groups, such as Antifa on the political left and QAnon on the political right. Fringe groups such as these take ideologically extreme political positions and defy political norms, including prohibitions on political violence. Are partisan supporters of these fringe groups more likely to hold violent political attitudes? Using survey data from the Understanding America Study (UAS), we test whether Antifa supporters and QAnon supporters are more likely to report violent attitudes compared to non-fringe group supporters. We find supporters of both groups are more likely to wish harm towards out-party members, support violent protest, and support various forms of interpersonal violence towards out-party members. The results hold even when controlling for ideological extremity, personality, and affective partisanship.

Gender differences in COVID-19 preventative measures and vaccination rates in the United States: A longitudinal survey analysis

BackgroundPandemics present challenges for individuals as they face uncertainties, risks, and decisions which influence their attitudes towards public health interventions. This study investigates gender differences in attitudes towards COVID-19 preventive measures and vaccination intentions in the United States, focusing on the link between risk perception and attitudes towards public health guidelines. MethodsWe utilised data from the Understanding America Study, a nationally representative longitudinal survey of U.S. adults from March 2020 to March 2022 to assess how gender differences in health risk perception were associated with attitudes, behaviours, and vaccination intentions, while also evaluating how these gender effects changed over time. We used multilevel logistic regression models to adjust for age, level of education, employment status and income. ResultsWomen had a higher risk perception of COVID-19 and exhibited greater compliance with preventive measures compared to men. Women also showed higher agreement with COVID-19 restraining public policy measures. However, this contrasted with attitudes towards the COVID-19 vaccine, where men displayed more positive views and a higher intention to receive the vaccine. This gender effect was persistent over time. ConclusionsThis seemingly paradoxical outcome suggests that while women’s heightened risk perception relative to men’s leads to greater adherence to non-pharmaceutical COVID-19 preventative public health interventions, it may also result in more negative views towards the novel COVID-19 vaccine. Understanding the complex interactions between risk perception, behaviour, and gender can inform policymakers and health authorities to tailor interventions that address the diverse needs of the population.

Food and Nutrition Insecurity: Experiences That Differ for Some and Independently Predict Diet-Related Disease, Los Angeles County, 2022

BackgroundNational surveillance shows that food insecurity affects ∼1 in 10 Americans each year. Recently, experts have advocated for surveillance of nutrition insecurity alongside food insecurity. Nutrition security refers to the nutritional adequacy of accessible food and factors that impact one’s ability to meet food preferences. ObjectivesThis study presents representative estimates of food insecurity and nutrition insecurity for Los Angeles County, CA, United States; compares predictors of these constructs; and examines whether they independently predict diet-related health outcomes. MethodsIn December 2022, a representative sample of Los Angeles County adults participating in the Understanding America Study (N = 1071) was surveyed about household food insecurity and nutrition insecurity over the past 12 months. Data were analyzed in 2023. ResultsReported rates were similar for food insecurity (24%) and nutrition insecurity (25%), but the overlap of these subgroups was less than 60%. Logistic regression models indicated that non-Hispanic Asian individuals had higher odds of nutrition insecurity but not food insecurity. Moreover, nutrition insecurity was a stronger predictor of diabetes compared with food insecurity, and both constructs independently predicted poor mental health. ConclusionsFood and nutrition insecurity affect somewhat different populations. Both constructs are valuable predictors of diet-related health outcomes. Monitoring nutrition insecurity in addition to food insecurity can provide new information about populations with barriers to healthy diets.

Middle-Aged and Older Adult Employment and the Perceived Risk of Running Out of Money During COVID-19: A Dynamic Panel Data Analysis.

The coronavirus disease of 2019 (COVID-19) adversely affected the health of middle-aged and older adults and altered their economic outlook. Several national polls revealed older adults felt stress about money and many reported difficulties in paying expenses during 2021. Although such descriptive reports have raised awareness, peer-reviewed studies utilizing panel data can offer additional insight. As such, the purpose of this study was to contribute to this growing literature by examining the demographic, economic, and health factors associated with employment and the perceived risk of running out of money for middle-aged and older adults during the pandemic. This study utilized the April-May 2020, April-May 2021, and March 2022 waves of the Understanding America Study. Next, a dynamic panel data model was formulated to account for reverse causality and unobserved heterogeneity with a sample of 2,302 adults between the ages of 50 and 74. Employment (-2.77, p < .05) was negatively associated with the perceived risk of running out of money. Male, higher education levels, currently married, and health insurance status also exhibited a negative association. Meanwhile, a positive association was found for non-White (6.79, p < .01). Financial well-being is an important consideration in later life and what role employment played during the COVID-19 pandemic is a worthwhile examination. A better understanding of which factors may be associated with the perceived risk of running out of money during the pandemic can be useful when devising policies which address financial security for middle-aged and older adults.

Social Impacts of the COVID-19 Pandemic on Women's Health in the Greater Los Angeles Area.

Background: Since the COVID-19 pandemic started, women have experienced more job loss owing to an increase in household and caregiving responsibilities. Gender inequities coupled with pandemic-related stressors have resulted in poor health outcomes among women. Globally, women have reported higher levels of anxiety, depression, and stress in response to the pandemic. Evidence suggests that social determinants of health have contributed to women's poor health outcomes. Materials and Methods: We used the Understanding America Study to describe the social impacts women have experienced during the COVID-19 pandemic when compared with men and to explore the association between partnership status and social impacts in Los Angeles. We hypothesize that women experienced greater social impacts than men and that partnership status modified these social impacts. Results: In a sample of predominantly racial and ethnic minorities, we found that women experienced more social impacts related to housing insecurity compared with men. When exploring how partnership status modified these social impacts, we found that women without partners experienced more social impacts specific to financial hardships when compared with women who were in a partnership. Conclusions: It is likely that the COVID-19 relief efforts helped women mitigate social impacts but not housing or financial security. The overall goal is to inform policies so that better measures can be implemented to prepare for the next public health disaster or global health threat.

Socio-ecological factors linked with changes in adults' dietary intake in Los Angeles County during the peak of the coronavirus 2019 pandemic.

Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors. We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages. Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County. 903 adults representative of Los Angeles County households. Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change. Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy.

Have heads cooled? Changes in radical partisanship from 2020–2022

ABSTRACT Recent polling shows significant levels of radical partisanship among the US public in the form of violent partisan schadenfreude and violent partisan attitudes. Previous research shows that the partisan intensity underlying these sentiments increases around presidential elections and when political actors use violent rhetoric. Has lethal mass partisanship declined in the years after the 2020 election, especially now that one of the main purveyors of violent rhetoric has left office? This paper uses panel data from the Understanding America Study (UAS) to show how levels of radical partisanship have changed from the post-election period of 2020 to the same time period in 2021 and 2022. The results demonstrate that rates of violent partisan attitudes have declined in 2021 and 2022 compared to 2020, especially amongst those who were most supportive of former President Donald Trump. However, changes in partisan schadenfreude have no discernable pattern. The results demonstrate both that radical partisanship is not on a uniformly upward trajectory but likely decreases and increases with changes in political context, and that elements of radical partisanship do not vary in parallel.

COVID-19-Associated Food Insecurity and Mental Health Symptoms Among Latinx Adults in the United States.

Introduction: U.S. Latinx adults were disproportionately burdened by COVID-19 infection, as well as food insecurity compared to their non- Hispanic white adults. It is less clear if within-group variations among U.S. Latinx adults exist in food insecurity and mental health outcomes. Methods: We conducted a secondary data analysis of repeated cross-sectional survey waves from the Understanding America Study (UAS) study (N = 182,865). We computed multivariable generalized linear regression models to examine associations between food insecurity, demographic characteristics, and depressive symptoms. Results: Participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity (21.1% compared to 5.23%, p < .0001). Mexican participants reported a significantly higher prevalence of depression compared to Latino participants of Puerto Rican, Central American, or another Latino ethnicity (8.94% compared to 2.84%, 1.76%, and 2.91%, respectively, p < .0001). Associations of self-reported food insecurity among men and women varied by asthma status. Conclusions: Our study demonstrates that participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity. Our findings also illuminate the importance of disaggregating U.S. Latinx adults when examining associations between food insecurity and mental health.

Characteristics associated with attitudes and behaviors towards mask wearing during the COVID-19 pandemic: The Trojan Pandemic Response Initiative

BackgroundAttitudes and behaviors towards mask wearing may influence the ability to reduce transmission of COVID-19 and other diseases.MethodsUniversity students, staff, and faculty (N = 9653) responded to an email invitation to complete electronic surveys (November 2021 and April 2022). Surveys included 19 items measuring attitudes and behaviors towards mask wearing from the Understanding America Study. Linear mixed models including variables for sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, were used to estimate the mean difference of the mean score for attitudes and behavior between Time 1 (November 2021) and Time 2 (April 2022).ResultsParticipants were mostly female (62.1%), students (70.6%), White (39.5%) and Asian (34.7%). More than half identified their political affiliation as Democrat (65.5%). Characteristic variable-by-time interactions for difference in mean mask attitude scores difference were significant at Time 1 (T1) and Time 2 (T2) between Black and White participants (B = 0.18 (0.05), 95% CI: 0.07, 0.28, p = 0.001), Asian and White participants (B = 0.07 (0.02), 95% CI: 0.03–0.12, p = 0.001), participants with self-reported history of COVID-19 and no history of COVID-19 (B= -0.13 (0.02), 95% CI: -0.07, -0.18, p < 0.0001), females and males (B = 0.07 (0.02), 95% CI: 0.03, 0.11, p = 0.001), Republicans and Democrats (B= -0.18 (0.04), 95%CI: -0.26, -0.10, p < 0.0001) and Independents and Democrats (B= -0.10 (0.03), 95%CI: -0.15, -0.05, p < 0.0001). Mean difference in mean scores for mask behaviors at Time and Time 2 were significant between participants with COVID-19 and participants who did not have COVID-19 (B= -0.12 (0.04), 95% CI: -0.19, -0.04, p = 0.004), students compared to faculty and staff (B=-0.22 (0.05), -0.32, -0.12, p < 0.0001), between Republicans and Democrats (B-= -0.16 (0.07), 95% CI: -0.28, -0.03, p = 0.020, and between Independents and Democrats (B=-0.08 (0.04), 95% CI: -0.16, -0.002, p = 0.04).ConclusionRace and ethnicity, political affiliation, and division may affect attitudes and behaviors in mask wearing. Further investigation into how characteristics influence public health measures such as mask wearing is needed to contain the spread of the COVID-19 virus, other infectious diseases, and future pandemics.

COVID-19 vaccination: lower intention and coverage among entrepreneurs compared to employees

PurposeLockdowns and the forced closure of certain industries during the COVID-19 pandemic severely impacted workers, particularly entrepreneurs, who were financially and emotionally involved in their businesses. Two studies have shown that entrepreneurs have a lower willingness to get vaccinated against COVID-19 than employees. In this study, the authors try to replicate the vaccination gap between the two groups. Second, the authors study whether the difference persists when controlling for demographics, vaccination attitudes and the COVID-19 context, including the financial impact of the pandemic, its effect on the wellbeing of workers, and government attitudes. Third, the authors study whether there are differences in how the context of the pandemic relates to vaccination willingness for entrepreneurs and employees.Design/methodology/approachThe authors conduct regression analyses using three large datasets. The authors study vaccination status (February 2022) in a 27-country Eurobarometer sample, vaccination intention (December 2020) in a Dutch sample from the LISS panel and vaccination status (July 2021) in a sample from the Understanding America Study (UAS).FindingsAll datasets confirm that entrepreneurs have lower vaccination intention and coverage than employees. Even when controlling for the variables described in the LISS and UAS datasets, this negative difference remains. The study results also indicate that demographics, especially vaccination attitudes, are much more important than contextual influences in the decision to get vaccinated against COVID-19.Originality/valueThe authors are the first to dive further into the vaccination differences between entrepreneurs and employees. They advise further research into the drivers of this gap, specifically relating to the role of personality and social normative influences.

Earlier-life individual and spatial socioeconomic conditions and later-life physical activity.

This study investigated the association between earlier-life (before age 16) individual and spatial socioeconomic conditions and later-life (mean age 61) physical activity (PA), and the role of later-life characteristics. Contemporary and historical Census data as well as three bi-annual waves of nationally representative panel data from the Understanding America Study (N=1,981) were used. Multilevel growth curve models were estimated to address the research questions. Father's education in respondents' earlier life was positively associated with light and moderate PA in respondents' later life. Growing up in a higher-poverty area was negatively associated with moderate and vigorous later-life PA. Findings underscore the long-term ramifications of earlier-life circumstances for later-life PA. Consideration should be given to socioeconomic conditions at both individual and spatial levels over the life course to promote PA at older ages.

Real Time Measurement of Household Financial Electronic Transactions in a Population Representative Panel: A Pilot Study

From September 2016 to September 2018, we piloted the collection of financial transaction and account balance data in the Understanding America Study (UAS), a probability-based Internet panel representative of the U.S. adult population. Unlike previous studies relying on electronic transaction information from financial aggregators, which typically contain very little information on consumer characteristics, our data allow us to explore heterogeneity in consumer behavior as driven by demographics, cognitive ability, and financial literacy, among others. In this article, we describe the results of this pilot project, documenting selectivity issues and the major barriers associated with participation in the study. We carry out illustrative exercises to highlight how the combination of surveys and electronic financial records can lead to methodological advances in the measurement of individuals’ spending and saving behavior.

Risk preferences, preventive behaviour, and the probability of a loss: Empirical evidence from the COVID-19 pandemic

A theoretical model of optimal choice under risk, in which an individual chooses the level of prevention to avoid a loss, has the ambiguous prediction that a higher risk-taking preference increases the probability of a loss. To empirically investigate the prediction in the case of COVID-19 with individual-level survey data. Survey data from the Understanding America Study (UAS). The UAS Coronavirus Tracking Survey followed 8628 respondents from March 2020 until July 2021 (29 survey waves) and data was gathered on having contracted COVID-19, vaccination, and preventive behaviour. Separate UAS modules gathered data on individuals' risk preferences; twice before and once during the COVID-19 pandemic. UAS also gathered data on pre-pandemic health and socio-economic status. Combining these data, and dropping missing observations, provided longitudinal data for 4335 respondents (96,370 observations) of whom 530 contracted COVID-19. In support of the theoretical prediction, the empirical findings show that a one-standard deviation higher risk-taking preference is associated with about a one-third higher probability of contracting COVID-19 within two weeks. Furthermore, the findings show that individuals' risk-taking preference is negatively associated with the preventive behaviour of social distancing and not associated with getting vaccinated. There is, however, no support for preventive behaviour being associated with the probability of contracting COVID-19. The exception is for being vaccinated, which is negatively associated with the probability of contracting COVID-19. The findings, therefore, do not support that the positive association of the risk-taking preference with the probability of contracting COVID-19 is mediated through observed preventive behaviour. The findings support the importance of individuals' risk-taking behaviour for contracting COVID-19 and, more generally, the importance of loss prevention as a risk management tool for individuals.