A Web-Based Event History Calendar Approach for Measuring Contraceptive Use Behavior

Pandemic changes in U.S. contraceptive use: National survey estimates reveal significant differences by demographic subgroups

OBJECTIVES

The COVID-19 pandemic brought multiple simultaneous consequences, with high potential to change fertility-related behaviors. We use nationally representative sex and contraceptive use event history calendar measures to demonstrate person-specific changes in contraceptive use after the pandemic, showing differences across demographic subgroups.

STUDY DESIGN

We use data from the first nationally representative web survey of U.S. fertility, fielded in 2020-2022: the American Family Health Study (AFHS). Using responses from 1357 female-identifying respondents ages 18-49, we analyze 26,274 person-months of sex and contraceptive use data spanning directly before and after the beginning of the pandemic to detect change.

RESULTS

Individual-level hazard models of starting and stopping contraception revealed no pandemic-related changes in starting contraception, but significant reductions in the rate of stopping contraception for specific subgroups. Hispanic females reduced their rates of stopping contraceptive use during the pandemic (lowering their odds of stopping use by 71%), ultimately behaving more similarly to individuals from other racial or ethnic subgroups. Additionally, those aged 41 and older significantly reduced their rates of stopping contraceptive use (lowering their odds of stopping use by 78%) relative to other age groups.

CONCLUSIONS

Sudden large-scale health policy changes can produce significant changes in contraceptive use behaviors. The COVID-19 changes interacted with race, ethnicity, and age to produce different changes in contraceptive behaviors among different subgroups of the U.S.

POPULATION

Evaluating the performance of an AI-powered VBAC prediction system within a decision-aid birth choice platform for shared decision-making

Background

Vaginal birth after cesarean (VBAC) is generally regarded as a safe and viable birthing option for most women with prior cesarean delivery. Nonetheless, concerns about heightened risks of adverse maternal and perinatal outcomes have often dissuaded women from considering VBAC. This study aimed to assess the performance of an artificial intelligence (AI)-powered VBAC prediction system integrated into a decision-aid birth choice platform for shared decision-making (SDM).

Materials and Methods

Employing a retrospective design, we collected medical records from a regional hospital in northern Taiwan from January 2019 to May 2023. To explore a suitable model for tabular data, we compared two prevailing modeling approaches: tree-based models and logistic regression models. We subjected the tree-based algorithm, CatBoost, to binary classification.

Results

Forty pregnant women with 347 records were included. The CatBoost model demonstrated a robust performance, boasting an accuracy rate of 0.91 (95% confidence interval (CI): 0.86-0.94) and an area under the curve of 0.89 (95% CI: 0.86-0.93), surpassing both regression models and other boosting techniques. CatBoost captured the data characteristics on the significant impact of gravidity and the positive influence of previous vaginal birth, reinforcing established clinical guidelines, as substantiated by the SHapley Additive exPlanations analysis.

Conclusion

Using AI techniques offers a more accurate assessment of VBAC risks, boosting women's confidence in selecting VBAC as a viable birthing option. The seamless integration of AI prediction systems with SDM platforms holds a promising potential for enhancing the effectiveness of clinical applications in the domain of women's healthcare.

Visible Cash, a Second Incentive, and Priority Mail? An Experimental Evaluation of Mailing Strategies for a Screening Questionnaire in a National Push-to-Web/Mail Survey

In push-to-web surveys that use postal mail to contact sampled cases, participation is contingent on the mail being opened and the survey invitations being delivered. The design of the mailings is crucial to the success of the survey. We address the question of how to design invitation mailings that can grab potential respondents' attention and sway them to be interested in the survey in a short window of time. In the household screening stage of a national survey, the American Family Health Study, we experimentally tested three mailing design techniques for recruiting respondents: (1) a visible cash incentive in the initial mailing, (2) a second incentive for initial nonrespondents, and (3) use of Priority Mail in the nonresponse follow-up mailing. We evaluated the three techniques' overall effects on response rates as well as how they differentially attracted respondents with different characteristics. We found that all three techniques were useful in increasing the screening response rates, but there was little evidence that they had differential effects on sample subgroups that could help to reduce nonresponse biases.

Mães adolescentes, autocuidado e cuidado infantil: validação de conteúdo de um calendário histórico de eventos

RESUMO Objetivo: Validar o conteúdo da ferramenta Event History Calendar Mãe Adolescente: fortalecendo o autocuidado e o cuidado da criança. Método: Estudo metodológico com a técnica Delphi, realizado em duas rodadas, envolvendo 37 especialistas de enfermagem. Na coleta de dados, de dezembro/2019 a agosto/2020, foi utilizado um questionário semiestruturado composto por 47 itens relacionados às duas dimensões da ferramenta: Autocuidado e Cuidado da criança. O Índice de Validade de Conteúdo ≥ 0,80 foi utilizado para avaliar a concordância entre os especialistas. Elementos qualitativos foram analisados quanto à clareza e abrangência do conteúdo. Resultados: Na primeira rodada, 46 itens apresentaram Índice de Validade de Conteúdo ≥ 0,80. Os elementos qualitativos apontaram necessidade de maior clareza para o público adolescente. Após as alterações, a ferramenta apresentou 30 itens. Na segunda rodada, os 30 itens avaliados alcançaram Índice de Validade de Conteúdo ≥ 0,80. As considerações qualitativas foram traduzidas em modificações no conteúdo e sequência na versão final da ferramenta. Conclusão: A ferramenta validada obteve avaliação adequada dos itens de cada dimensão, relacionados ao autocuidado da mãe adolescente e cuidado da criança, com alto grau de compreensibilidade.

Adolescent mothers, self-care and childcare: content validation of an Event History Calendar

OBJECTIVE

To validate the content of the tool Event History Calendar Adolescent Mother: strengthening self-care and child care.

METHOD

Methodological study using the Delphi technique, conducted in two rounds, involving 37 nursing specialists. In data collection, from December/2019 to August/2020, a semi-structured questionnaire composed of 47 items related to the two dimensions of the tool: Self-care and Child Care was used. The Content Validity Index ≥ 0.80 was used to assess agreement among the experts. Qualitative elements were analyzed for clarity and comprehensiveness of content.

RESULTS

In the first round, 46 items showed Content Validity Index ≥ 0.80. The qualitative elements pointed out more clarity for the adolescent audience. After the changes, the tool presented 30 items. In the second round, the 30 items evaluated achieved Content Validity Index ≥ 0.80. The qualitative considerations were translated into modifications in the content and sequence in the final version of the tool.

CONCLUSION

The validated tool obtained adequate evaluation of the items of each dimension, related to adolescent mother self-care and child care, with a high degree of comprehensibility.