The Impact of the Affordable Care Act (ACA) on Unintended Pregnancy: Combining epidemiological and econometric methods.

项目总结/摘要 拟议的研究将为调查政策的影响提供一个方法框架（即，滞后- 时间，机制和公平）对人口健康的影响，同时有助于评估负担得起的医疗服务 通过评估ACA对生殖健康的一个方面，意外怀孕的影响。的 该项目的第一个具体目标是评估《反堕胎法》对意外怀孕的影响。在这一目标下，我 将a）估计ACA对意外怀孕的影响，并确定在此之前的滞后期 作用，和B）确定ACA对意外妊娠的作用是否由接触和/或 避孕药具的可负担性--如果是，受ACA影响更大。第二特定 该项目的目的是评估ACA对意外怀孕的影响是否公平， 比较ACA对不同种族/民族妇女意外怀孕的影响， 社会经济地位。目标1和2将通过使用多年的横截面数据来实现（即， 2006 - 2019年）的全国家庭增长调查，以及一种创新的分析方法， 流行病学、时间序列和计量经济学方法。这项工作意义重大，因为它将提供一个 未来研究的方法框架，以调查政策对健康的影响，同时也为当前的研究提供信息。 关于ACA的扩张，改革或废除的辩论。申请人Colleen MacCallum有一个 生物统计学硕士，目前正在攻读流行病学博士学位在密歇根州立大学，并在这方面的独特定位 奖学金，因为她以前的工作调查ACA避孕任务的影响， 意外怀孕，以及她强大的分析背景-在此基础上，她可以建立额外的技能， 计量经济学方法和中介分析。该F31奖项将为申请人提供跨学科的 培训：1）公共政策，2）政策评估的计量经济学方法，3）因果中介分析。 培训活动将包括课程、讲习班和系列研讨会。拟议的研究金将是 在密歇根州立大学流行病学和生物统计学系实施，这是一个理想的培训环境 由于该部门在妇女健康方面的优势及其强大的指导和跨学科历史， 协作该奖学金将由以下人员指导：Claire Margerison博士（赞助人，政策影响方面的专业知识， Claudia Holzman博士（共同发起人，具有妇女健康方面的专门知识， 罗伯特·凯斯特纳博士（合作者，卫生政策和计量经济学方面的专业知识）， 罗哲辉（合作者，擅长因果推理和计量经济学）和蒂姆·布鲁克纳博士（顾问， 时间序列建模和卫生政策分析方面的专门知识）。拟议的奖学金将为申请人提供装备 具有实现其长期目标所需的实质性知识，分析工具和专业能力 领导独立调查以评估政策对人口健康和健康公平的影响的目标。 1

Project Summary/Abstract The proposed research will provide a methodological framework for investigating the impact of policy (i.e., lag- time, mechanism, and equity) on population health while contributing to the evaluation of the Affordable Care Act (ACA) by assessing the impact of the ACA on one aspect of reproductive health, unintended pregnancy. The first specific aim of the project is to assess the impact of the ACA on unintended pregnancy. Within this aim, I will a) estimate the effect of the ACA on unintended pregnancy, and determine the lag period that precedes this effect, and b) determine whether the effect of the ACA on unintended pregnancy is mediated by access and/or affordability of contraceptives – and if so, which was more strongly impacted by the ACA. The second specific aim of the project is to assess whether the impact of the ACA on unintended pregnancy was equitable by comparing the effect of the ACA on unintended pregnancy between women of varying race/ethnicity and socioeconomic status. Aims 1 and 2 will be achieved by using cross-sectional data from multiple years (i.e., 2006-2019) of the National Survey of Family Growth, and an innovative analytic approach that combines epidemiological, time-series, and econometric methods. This work is significant because it will provide a methodological framework for future studies to investigate the health effects of policy while also informing current debates regarding the expansion, reformation, or repeal of the ACA. The applicant, Colleen MacCallum, has an MS in Biostatistics, is currently pursuing a PhD in Epidemiology at MSU, and is uniquely positioned for this fellowship because of her previous work investigating the impact of the ACA contraception mandate on unintended pregnancy, and her strong analytic background – on which she can build additional skills in econometric methods and mediation analysis. This F31 award will provide the applicant with interdisciplinary training in: 1) public policy, 2) econometric methods for policy evaluation, and 3) causal mediation analysis. Training activities will include courses, workshops, and seminar series. The proposed fellowship will be implemented in the Department of Epidemiology and Biostatistics at MSU, which is an ideal training environment due to the department’s strengths in women’s health and its strong history of mentoring and interdisciplinary collaboration. This fellowship will be mentored by: Dr. Claire Margerison (sponsor, expertise in policy impacts on women’s health), Dr. Claudia Holzman (co-sponsor, expertise in women’s health and long track record of successful mentoring), Dr. Robert Kaestner (collaborator, expertise in health policy and econometrics), Dr. Zhehui Luo (collaborator, expertise in causal inference and econometrics), and Dr. Tim Bruckner (consultant, expertise in time series modelling and health policy analysis). The proposed fellowship will equip the applicant with substantive knowledge, analytic tools, and professional competencies necessary to achieve her long-term goal of leading independent investigations to evaluate the impact of policy on population health and health equity. 1