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.

堕胎是美国常见的生殖健康经历。每年堕胎率为 已知因社会人口特征和州背景而异。 随着时间的推移，堕胎的情况发生了很大的变化，而且各州的情况有所不同，但我们知之甚少。 然而，关于终生累积堕胎发生率及其社会人口统计学关联 这项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截然不同的政策和 多布斯与杰克逊妇女健康组织的研究决定后的法律变化。 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），四个州分别有更严格的法律和政策 中西部（爱荷华州和俄亥俄州）和东南部（阿拉巴马州和南卡罗来纳州）。 方法论目标是成功开发和测试间接问题方法， “堕胎清单实验”，克服了堕胎调查严重漏报的问题 直接自我报告问题的第二个方法目标是对状态水平的估计。 真实队列的累积终生堕胎发生率是真实队列测量值。 当水平随着时间的推移而变化时尤其重要，就像美国的情况一样 近几十年来，并且很可能在后多布斯时代的新政策和法律背景下这样做。 该研究的目的是加深对以下方面的了解：1) 终生累积堕胎率 2) 各州实际群体的生育年龄结束； 有可靠外分母数据的变量的堕胎差异 例如种族/民族、教育和收入；3) 各州特定的堕胎情况； 理论上重要的变量的差异，但没有可靠的外部变量 可用的分母数据，例如感知和经历的医疗保健获取障碍的数据 以及医疗补助和其他健康保险类型的注册；以及 4) 各州的情况如何， 法律和政策与社会人口和健康模式的差异有关。 这项研究将开发和验证可以的方法。 随后适用于多布斯诉杰克逊妇女健康组织后的州级 数据，并将制定前多布斯估计，以评估生命历程和社会 后多布斯时代各州和各州集团的人口水平和堕胎差异。