Development of methods to assess geographic variation in reproductive health behaviors and outcomes over the life course

开发评估生命历程中生殖健康行为和结果的地理差异的方法

• 批准号: 10732184
• 负责人: Heide Marie Jackson
• 金额: $ 15.6万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10732184
• 关键词: Abortion Rates; Age; Alabama; Awareness; Benchmarking; Characteristics; Data; Delaware; Developing Countries; Development; Disparity; Education; Eligibility Determination; Enrollment; Ethnic Origin; Goals; Health; Health Insurance; Health behavior and outcomes; Incidence; Income; Individual; Iowa; Knowledge; Laws; Legal; Life Cycle Stages; Low income; Maryland; Measures; Medicaid; Methodology; Methods; Midwestern United States; National Institute of Child Health and Human Development; Ohio; Patient Self-Report; Pattern; Policies; Population; Pregnancy; Public Health; Race; Records; Reporting; Reproductive Health; Research; Sampling; Self Direction; South Carolina; Survey Methodology; Surveys; Testing; Time; United States; Variant; Woman; Women' s Health; abortion; barrier to care; black women; cohort; experience; experimental study; geographic difference; health care availability; health care disparity; health organization; improved; interest; member; method development; reproductive; residence; sociodemographic disparity; sociodemographics; statistics; trend

Abortion is a common reproductive health experience in the U.S. Annual abortion rates are known to vary by both socio-demographic characteristics and state contexts. Annual incidence of abortion has changed substantially over time and differentially by state. Little is known, however, about cumulative lifetime abortion incidence and its socio-demographic associations at the state level. The main substantive goal of this study is to fill these knowledge gaps using data through 2019 for six states that subsequently experienced radically different policy and legal changes after the Dobbs versus Jackson Women’s Health Organization decision. The study states consist of two with relatively liberal abortion policies, located in the Mid-Atlantic (Delaware and Maryland), and four with more restrictive laws and policies respectively in the Midwest (Iowa and Ohio) and the Southeast (Alabama and South Carolina). A first methodological goal is the successful development and testing of an indirect question method, the “abortion list experiment”, thereby overcoming severe survey underreporting of abortion in direct self-report questions. A second methodological goal is the estimation of state level cumulative lifetime abortion incidence of abortion for real cohorts. Real-cohort measures are especially important when levels are changing over time, as they have been in the U.S. over recent decades, and are very likely to do so under the new policy and legal context post-Dobbs. The aims of the study are to advance understanding: 1) of cumulative lifetime abortion incidence through the end of the reproductive ages for real cohorts at the state level; 2) of state-specific abortion differentials by variables for which there are reliable external denominator data available such as for race/ethnicity, education, and income; 3) of state-specific abortion differentials by theoretically-important variables for which there are no reliable external denominator data available, such as for perceived and experienced barriers to health care access and enrollment in Medicaid and other health insurance types; and 4) of how state contexts, laws, and policies are associated with differences in patterns of socio-demographic and health- care disparities by state. This research will develop and validate methodologies that can subsequently be applied to post-Dobbs v. Jackson Women’s Health Organization state-level data, and will develop pre-Dobbs estimates against which to evaluate life-course and socio- demographic levels and differentials of abortion by state and groups of states post-Dobbs.

在美国，堕胎是一种常见的生殖健康经历。 众所周知，这因社会人口特征和国家背景而异。年发病率 随着时间的推移，堕胎的情况发生了很大变化，各州的情况也各不相同。我们所知甚少， 然而，关于终生累计堕胎率及其社会人口学关联， 在州一级。本研究的主要实质性目标是填补这些知识空白， 截至2019年，六个州的数据随后经历了完全不同的政策， 在多布斯对杰克逊妇女健康组织的决定之后，法律的变化。研究 位于大西洋中部的两个州拥有相对自由的堕胎政策 （特拉华州和马里兰州），以及四个分别在 中西部（爱荷华州和俄亥俄州）和东南部（亚拉巴马和南卡罗来纳州）。第一 方法目标是成功开发和测试间接问题方法， “堕胎名单实验”，从而克服了堕胎调查严重漏报的问题 直接的自我报告问题。第二个方法论目标是估计状态水平 真实的队列的终生累计流产率。真实队列测量是 尤其重要的是，当水平随着时间的推移而变化时，就像在美国一样， 近几十年来，很可能在新的政策和法律的背景下这样做后多布斯。 这项研究的目的是促进对以下问题的了解：1）终生累积流产率 在州一级，真实的群体的生育年龄结束; 2）各州特有的 按有可靠外部分母数据的变量分列的堕胎差异 可用的，如种族/民族，教育和收入; 3）国家特定的堕胎 理论上重要的变量的差异，没有可靠的外部 可用的分母数据，例如感知和经历的获得卫生保健的障碍 以及在医疗补助和其他健康保险类型中的注册;以及4）州环境， 法律和政策与社会人口和健康模式的差异有关， 国家的照顾差异。这项研究将开发和验证方法， 随后适用于多布斯诉杰克逊妇女健康组织州一级 数据，并将制定多布斯之前的估计，以评估生命过程和社会影响 多布斯之后各州和各州集团的人口堕胎水平和差异。