The impact of abortion bans on short-term housing needs

OBJECTIVES

State-level abortion bans in the United States have created a complex legal landscape that forces many prospective patients to travel long distances to access abortion care. The financial strain and logistical difficulties associated with travelling out of state for abortion care may present an insurmountable barrier to some individuals, especially to those with limited resources. Tracking the impact of these abortion bans on travel and housing is crucial for understanding abortion access and economic changes following the Dobbs U.S. Supreme Court decision.

STUDY DESIGN

This study used occupancy data from an average of 2,349,635 (standard deviation = 111,578) U.S. Airbnb listings each month from October 1st, 2020, through April 30th, 2023, to measure the impact of abortion bans on travel for abortion care and the resulting economic effects on regional economies.

METHODS

The study used a synthetic difference-in-differences design to compare monthly-level occupancy rate data from 1-bedroom entire-place Airbnb rentals within a 30-min driving distance of abortion clinics in states with and without abortion bans.

RESULTS

The study found a 1.4 percentage point decrease in occupancy rates of Airbnbs around abortion clinics in states where abortion bans were in effect, demonstrating reductions in Airbnb use in states with bans. In the 6-month period post Dobbs, this decrease translates to 16,548 fewer renters and a $1.87 million loss in revenue for 1-bedroom entire-place Airbnbs within a 30-min catchment area of abortion facilities in states with abortion restrictions.

CONCLUSION

This novel use of Airbnb data provides a unique perspective on measuring demand for abortion and healthcare services and demonstrates the value of this data stream as a tool for understanding economic impacts of health policies.

Travel Time and Costs for Abortion for Military Service Members After the Dobbs Decision

This study quantifies the change in travel times for military service personnel to abortion facilities following the US Supreme Court Dobbs decision and estimates the cost of an abortion-related travel reimbursement policy.

The online language of work-personal conflict

With the blurring of boundaries in this digital age, there is increasing concern around work-personal conflict. Assessing and tracking work-personal conflict is critical as it not only affects individual workers but is also a vital measure among broader well-being and economic indices. This inductive study examines the extent to which work-personal conflict corresponds to individuals' language use on social media. We apply an open-vocabulary analysis to the posts of 2810 Facebook users who also completed a survey for an established work-personal conflict scale. It was found that the language-based model can predict personal-to-work conflict (r = 0.23) and work-to-personal conflict (r = 0.15) and provide important insights into such conflicts. Specifically, we found that high personal-to-work conflict was associated with netspeak and swearing, while low personal-to-work conflict was associated with language about work and positivity. We found that high work-to-personal conflict was associated with negative emotion and negative tone, while low work-to-personal conflict was associated with positive emotion and language about birthdays.

Parental compliance and reasons for COVID-19 Vaccination among American children

COVID-19 vaccination rates among children have stalled, while new coronavirus strains continue to emerge. To improve child vaccination rates, policymakers must better understand parental preferences and reasons for COVID-19 vaccination among their children. Cross-sectional surveys were administered online to 30,174 US parents with at least one child of COVID-19 vaccine eligible age (5-17 years) between January 1 and May 9, 2022. Participants self-reported willingness to vaccinate their child and reasons for refusal, and answered additional questions about demographics, pandemic related behavior, and vaccination status. Willingness to vaccinate a child for COVID-19 was strongly associated with parental vaccination status (multivariate odds ratio 97.9, 95% confidence interval 86.9-111.0). The majority of fully vaccinated (86%) and unvaccinated (84%) parents reported concordant vaccination preferences for their eligible child. Age and education had differing relationships by vaccination status, with higher age and education positively associated with willingness among vaccinated parents. Among all parents unwilling to vaccinate their children, the two most frequently reported reasons were possible side effects (47%) and that vaccines are too new (44%). Unvaccinated parents were much more likely to list a lack of trust in government (41% to 21%, p < .001) and a lack of trust in scientists (34% to 19%, p < .001) as reasons for refusal. Cluster analysis identified three groups of unwilling parents based on their reasons for refusal to vaccinate, with distinct concerns that may be obscured when analyzed in aggregate. Factors associated with willingness to vaccinate children and reasons for refusal may inform targeted approaches to increase vaccination.

Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women's Health Decision

IMPORTANCE

Abortion facility closures resulted in a substantial decrease in access to abortion care in the US.

OBJECTIVES

To investigate the changes in travel time to the nearest abortion facility after the Dobbs v Jackson Women's Health Organization (referred to hereafter as Dobbs) US Supreme Court decision.

DESIGN, SETTING, AND PARTICIPANTS

Repeated cross-sectional spatial analysis of travel time from each census tract in the contiguous US (n = 82 993) to the nearest abortion facility (n = 1134) listed in the Advancing New Standards in Reproductive Health database. Census tract boundaries and demographics were defined by the 2020 American Community Survey. The spatial analysis compared access during the pre-Dobbs period (January-December 2021) with the post-Dobbs period (September 2022) for the estimated 63 718 431 females aged 15 to 44 years (reproductive age for this analysis) in the US (excluding Alaska and Hawaii).

EXPOSURES

The Dobbs ruling and subsequent state laws restricting abortion procedures. The pre-Dobbs period measured abortion access to all facilities providing abortions in 2021. Post-Dobbs abortion access was measured by simulating the closure of all facilities in the 15 states with existing total or 6-week abortion bans in effect as of September 30, 2022.

MAIN OUTCOMES AND MEASURES

Median and mean changes in surface travel time (eg, car, public transportation) to an abortion facility in the post-Dobbs period compared with the pre-Dobbs period and the total percentage of females of reproductive age living more than 60 minutes from abortion facilities during the pre- and post-Dobbs periods.

RESULTS

Of 1134 abortion facilities in the US (at least 1 in every state; 8 in Alaska and Hawaii excluded), 749 were considered active during the pre-Dobbs period and 671 were considered active during a simulated post-Dobbs period. Median (IQR) and mean (SD) travel times to pre-Dobbs abortion facilities were estimated to be 10.9 (4.3-32.4) and 27.8 (42.0) minutes. Travel time to abortion facilities in the post-Dobbs period significantly increased (paired sample t test P <.001) to an estimated median (IQR) of 17.0 (4.9-124.5) minutes and a mean (SD) of and 100.4 (161.5) minutes. In the post-Dobbs period, an estimated 33.3% (sensitivity interval, 32.3%-34.8%) of females of reproductive age lived in a census tract more than 60 minutes from an abortion facility compared with 14.6.% (sensitivity interval, 13.0%-16.9%) of females of reproductive age in the pre-Dobbs period.

CONCLUSIONS AND RELEVANCE

In this repeated cross-sectional spatial analysis, estimated travel time to abortion facilities in the US was significantly greater in the post-Dobbs period after accounting for the closure of abortion facilities in states with total or 6-week abortion bans compared with the pre-Dobbs period, during which all facilities providing abortions in 2021 were considered active.

Impact of Vax-a-Million Lottery on COVID-19 Vaccination Rates in Ohio

BACKGROUND

A decrease in coronavirus disease 2019 (COVID-19) vaccination rates has led some states to consider various incentives to boost demand for vaccines. On May 13, 2021, Ohio announced a free weekly lottery for individuals who received at least 1 COVID-19 vaccination. This study seeks to rigorously quantify the impact of Ohio's vaccination lottery.

METHODS

A synthetic control consisting of a weighted combination of other states was used to approximate the demographic characteristics, new cases, and vaccination rates in Ohio prior to the lottery announcement. The difference in vaccination rates in Ohio and the synthetic control following the lottery announcement was then used to estimate the lottery's impact.

RESULTS

Prior to the lottery announcement, Ohio and synthetic Ohio had similar demographic characteristics and new case rates. Ohio and synthetic Ohio also had identical first vaccination rates. By the final lottery enrollment date of June 20, the percentage of the population with first vaccinations increased to 47.41% in Ohio and 46.43% in synthetic Ohio for a difference of 0.98% (95% confidence interval [CI] 0.42-1.54).

CONCLUSION

An additional 114,553 Ohioans received vaccinations as a result of the Vax-a-Million program (95% CI 49,094-180,012) at a cost of approximately $49 per Ohioan vaccinated (95% CI $31-$114). However, a majority of Ohioans remained unvaccinated by the end of the lottery, indicating that additional efforts are needed to address barriers to vaccination. This synthetic control approach may also be useful to evaluate other COVID-19 incentive programs.

A Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies

Evaluating Department of Motor Vehicles (DMV) locations based on the percent of patrons who register as donors does not account for individual characteristics that may influence willingness to donate. We reviewed the driver's licenses of 2997 randomly selected patients at an urban medical system to obtain donor designation, age, gender, and DMV location and linked patient addresses with census tract data on race, ethnicity, income, and education. We then developed a Standardized Donor Designation Ratio (SDDR) (ie, the observed number of donors at each DMV divided by the expected number of donors based on patient demographic characteristics). Overall, 1355 (45%) patients were designated as donors. Donor designation was independently associated with younger age, female gender, nonblack race, and higher income. Across 18 DMVs, the proportion of patients who were donors ranged from 30% to 68% and SDDRs ranged from 0.82 to 1.17. Among the 6 facilities in the lowest tertile by SDDR, 3 were in the lowest tertile by percent donation. In conclusion, there is a great deal of variation across DMVs in rates of organ donor designation. SDDRs that adjust for DMV patron characteristics are distinct measures that may more accurately describe the performance of DMVs in promoting organ donation.

Is Signature Size Associated With Organ Donor Designation on Driver's Licenses?

INTRODUCTION

Previous studies suggest that large signature size is associated with narcissistic characteristics. By contrast, organ donation is an indicator of altruism. Because altruism and narcissism may be viewed as opposites, we sought to determine if smaller signature size is associated with willingness to be an organ donor.

METHODS

Using a cross-sectional study design, we reviewed the health records of 571 randomly selected primary care patients at a large urban safety-net medical system to obtain their demographic and medical characteristics. We also examined driver's licenses that were scanned into electronic health records as part of the patient registration process. We measured signature sizes and obtained the organ donor designation from these driver's licenses.

RESULTS

Overall, 256 (45%) patients were designated as donors on their driver's licenses. Signature size averaged 113.3 mm(2) but varied greatly across patients (10th percentile 49.1 mm(2), 90th percentile 226.1 mm(2)). On multivariate analysis, donor designation was positively associated with age 18-34 years, non-black race, having private insurance, and not having any comorbid conditions. However, signature size was not associated with organ donor designation.

CONCLUSIONS

Signature size is not associated with verified organ donor designation. Further work is needed to understand the relationship between personality types and willingness to be an organ donor.

The Relationship Between Verified Organ Donor Designation and Patient Demographic and Medical Characteristics

Previous studies on the correlates of organ donation consent have focused on self-reported willingness to donate and on self-reported medical suitability to donate. However, these may be subject to social desirability bias and inaccurate assessments of medical suitability. The authors sought to overcome these limitations by directly verifying donor designation on driver's licenses and by abstracting comorbid conditions from electronic health records. Using a cross-sectional study design, they reviewed the health records of 2070 randomly selected primary care patients at a large urban safety-net medical system to obtain demographic and medical characteristics. They also examined driver's licenses that were scanned into electronic health records as part of the patient registration process for donor designation. Overall, 943 (46%) patients were designated as a donor on their driver's license. On multivariate analysis, donor designation was positively associated with age 35-54 years, female sex, nonblack race, speaking English or Spanish, being employed, having private insurance, having an income >$45 000, and having fewer comorbid conditions. These demographic and medical characteristics resulted in patient subgroups with donor designation rates ranging from 21% to 75%. In conclusion, patient characteristics are strongly related to verified donor designation. Further work should tailor organ donation efforts to specific subgroups.