The Effectiveness of "Push-to-Web" as an Option for a Survey of New Mothers.

INTRODUCTION: With shifting demographics and declining response rates, state and national health surveys are considering mixed mode approaches. Most states field the Pregnancy Risk Assessment Monitoring System (PRAMS) surveillance project, but few have studied the effect of encouraging online responses. METHODS: Like PRAMS, the 2016 Ohio Pregnancy Assessment Survey interviewed new mothers 2-4 months after delivery (n = 3382). Fielding included a traditional mailed paper questionnaire with telephone follow-up protocol and two experiments: a rotating web invitation added a web survey link at different points during the mail protocol, and a push-to-web protocol asked women to complete the survey online before mailing a questionnaire. This analysis examined the responses rates and tested for unweighted demographic differences using Pearson's chi-square. RESULTS: The unweighted response rate was highest with the traditional contact protocol (30.0%) and slightly lower among the rotating web invite (27.4%) and the push-to-web (25.5%) groups. Nearly two-thirds (64%) of push-to-web protocol respondents completed the survey online, with 70% of those web surveys submitted before the first paper questionnaire was mailed. Women who responded to the web versus mail surveys were similar on most characteristics, although in both experimental groups, women who completed the web version were more likely to be college educated. Among the push-to-web group, 60% of web and 36% of mail respondents had a 4-year college degree (p < .001). DISCUSSION: Given the potential for push-to-web to shift respondents to an online survey without greatly impacting response rates, researchers should continue to examine the utility of incorporating a web mode in surveys of new mothers.

Ohio's Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age.

Objective To examine changes in the prevalence and odds of unmet healthcare needs and healthcare utilization among low-income women of reproductive age (WRA) after Ohio's 2014, ACA-associated Medicaid expansion, which extended coverage to non-senior adults with a family income ≤ 138% of the federal poverty level. Methods We analyzed publically available data from the 2012 and 2015 Ohio Medicaid Assessment Survey (OMAS), a cross-sectional telephone survey of Ohio's non-institutionalized adult population. The study included 489 low-income women in 2012 and 1273 in 2015 aged 19-44 years who were newly eligible for Medicaid after expansion in January 2014. Four unmet healthcare need and three healthcare utilization measures were examined. We fit survey-weighted logistic regression models adjusted for race/ethnicity, working status, and educational attainment to determine whether the odds of each measure differed between 2012 and 2015. Results In 2015, low-income WRA had a significantly lower odds of reporting an unmet dental care need (ORadj = 0.72, 95% CI 0.54, 0.95), unmet vision care need (ORadj = 0.68, 95% CI 0.50, 0.93), unmet mental health need (ORadj = 0.57, 95% CI 0.39, 0.83), and unmet prescription need (ORadj = 0.39, 95% CI 0.45, 0.80) compared to 2012. There were no significant differences in the odds of seeing a doctor or dentist in the past year or of having a usual source of care for low-income WRA in 2012 and 2015. Conclusions for Practice After Ohio's 2014 Medicaid expansion the odds of low-income WRA having unmet healthcare needs was reduced. Future research should examine outcomes after a longer period of follow-up and include additional measures, such as self-rated health status.

The epidemiology of family meals among Ohio's adults.

OBJECTIVE: The epidemiology of family meals among adults at a population level is poorly characterized and whether living with children impacts this health behaviour is uncertain. We determined the prevalence of family meals among US adults in a mid-western state whose families did and did not include minor children and described how it varied by sociodemographic characteristics. DESIGN: The cross-sectional 2012 Ohio Medicaid Assessment Survey is representative of Ohio adults and included questions on their sociodemographic characteristics and the frequency with which they eat family meals at home. SETTING: Trained interviewers administered landline and cell phone surveys to adults sampled from Ohio's non-institutionalized population. SUBJECTS: We analysed data from 5766 adults living with minor children and 8291 adults not living alone or with children. RESULTS: The prevalence of family meals was similar for adults who did and did not live with minor children: 47 % (95 % CI 46, 49 %) of adults living with and 51 % (95 % CI 50, 53 %) of adults living without children reported eating family meals on most (six or seven) days of the week. Family meal frequency varied by race/ethnicity, marital and employment status in both groups. Non-Hispanic African-American adults, those who were not married and those who were employed ate family meals less often. CONCLUSIONS: Adults in Ohio frequently shared meals with their family and family meal frequency was not strongly related to living with children. Broadening the scope of future studies to include adults who are not parents could enhance our understanding of the potential health benefits of sharing meals.

Local Income Inequality, Individual Socioeconomic Status, and Unmet Healthcare Needs in Ohio, USA.

Purpose: Income inequality has been implicated as a potential risk to population health due to lower provision of healthcare services in deeply unequal countries or communities. We tested whether county economic inequality was associated with individual self-report of unmet healthcare needs using a state health survey data set. Methods: Adults residents of Ohio responding to the 2015 Ohio Medicaid Assessment Survey were included in the analysis. Ohio's 88 counties were classified into quartiles according to the Gini coefficient of income inequality. The primary outcome was a composite of self-reported unmet dental care, vision care, mental healthcare, prescription medication, or other healthcare needs within the past year. Unmet healthcare needs were compared according to county inequality quartile using weighted logistic regression. Results: The analytic sample included 37,140 adults. The weighted proportion of adults with unmet healthcare needs was 28%. In multivariable logistic regression, residents of counties in the highest (odds ratio [OR]=1.13, 95% confidence interval [CI]: 1.01-1.26; p=0.030) and second-highest (OR=1.16, 95% CI: 1.04-1.30; p=0.010) quartiles of income inequality experienced more unmet healthcare needs than residents of the most equal counties. Conclusion: Higher county-level income inequality was associated with individual unmet healthcare needs in a large state survey. This finding represents novel evidence for an individual-level association that may explain aggregate-level associations between community economic inequality and population health outcomes.

Television, Home-Cooked Meals, and Family Meal Frequency: Associations with Adult Obesity.

BACKGROUND: Adults, regardless of whether they are parents, regularly eat meals with family at home, but few studies have analyzed large, population-based samples to examine how mealtime practices or family meal frequency are associated with health. OBJECTIVE: The aim of this study was to evaluate associations between the frequency of family meals eaten at home, watching television or videos during family meals, and consumption of meals that were cooked and eaten at home and the odds of being obese in adults. DESIGN: This was an analysis of the cross-sectional 2012 Ohio Medicaid Assessment Survey (OMAS), a telephone survey of Ohio's population. PARTICIPANTS/SETTING: The study sample was adult Ohio residents responding to the 2012 OMAS who ate at least one family meal in the past week (n=12,842). MAIN OUTCOME MEASURES: Obesity (body mass index [BMI] ≥30), calculated from self-reported height and weight, was the outcome. STATISTICAL ANALYSES PERFORMED: Logistic regression models were used to examine the association between obesity and family meal practices, adjusted for respondents' employment status, marital status, race/ethnicity, educational attainment, and age. RESULTS: Family meal frequency was not associated with odds of obesity: those who ate family meals most (6-7) days were as likely as those who ate family meals few (1-2) days to be obese (adjusted odds ratio [ORadj]=1.01, 95% CI=0.86, 1.18). Thirty-six percent of adults never watched television or videos while eating family meals, and 62% ate family meals that were all home-cooked. Adults who never watched television or videos during family meals had 37% lower odds of obesity compared with those who always did (95% CI=0.54, 0.73), regardless of family meal frequency. Adults whose family meals were all home-cooked had 26% lower odds of obesity than those who ate some or no home-cooked family meals (95% CI=0.62, 0.88). This association was more pronounced among adults who ate few family meals. CONCLUSIONS: Family meal practices may be associated with obesity in adults, even if they eat few family meals per week. Future research should examine more aspects of shared meals and investigate which specific practices may impact obesity risk.

Family Meal Frequency and Association with Household Food Availability in United States Multi-Person Households: National Health and Nutrition Examination Survey 2007-2010.

OBJECTIVE: Family meals are associated with a healthier diet among children and adolescents, but how family meal frequency varies in the U.S. population overall by household food availability and sociodemographic characteristics is not well characterized. DESIGN: The U.S. National Health and Nutrition Examination Survey 2007-2010 assessed the frequency of family meals eaten at home in the past week and the household availability of fruits, dark green vegetables, salty snacks, and sugar-sweetened beverages. SETTING: Computer-assisted face-to-face interviews with a selected adult (≥18 years) who owned or rented the home (i.e., the household reference person). SUBJECTS: We analyzed information on family meal frequency for 18,031 participants living in multi-person households in relation to sociodemographic characteristics and food availability. RESULTS: Among the U.S. population living in households of two or more individuals, the prevalence (95% confidence interval) of having 0-2, 3-6 and ≥7 family meals/week was 18.0% (16.6-19.3), 32.4% (31.0-33.9), and 49.6% (47.8-51.4), respectively. Greater household availability of fruits and dark green vegetables and less availability of salty snacks and sugar-sweetened beverages was associated with more frequent family meals. Family meals were more prevalent in low-income households and those in which the reference person was ≥65 years, married, or had less than high school education. CONCLUSIONS: About half of the US population living in households of 2 or more people shares meals frequently with their family at home. Family meal frequency was positively associated with a healthier pattern of household food availability.

Association between body mass index and the timing of pregnancy recognition and entry into prenatal care.

OBJECTIVE: To assess whether prepregnancy body mass index (BMI) is independently associated with the timing of pregnancy recognition and initiation of prenatal care. METHODS: Data from 2009 to 2010 were obtained from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System. The 30 participating states contacted sampled mothers 2-4 months after delivery and had them complete the standardized Pregnancy Risk Assessment Monitoring System questionnaire. Prepregnancy BMI was calculated from the participants' self-reported prepregnancy weight and height. Timing of pregnancy recognition and initiation of prenatal care were also self-reported on the questionnaire. RESULTS: Among the 72,913 participants, 69,872 (96%) met the eligibility criteria for analysis. After adjustment for maternal race, ethnicity, smoking status in the 3 months before pregnancy, pregnancy intentions, insurance status, maternal age, marital status, maternal education, and parity, there was no association between prepregnancy BMI status and the week of pregnancy recognition. Obese women initiated prenatal care 0.20 weeks earlier on average compared with normal-weight women, although the difference was not clinically important (mean difference -0.20, 95% confidence interval [CI] -0.38 to -0.03). When examining the odds of receiving late or no prenatal care, there was no association with prepregnancy BMI. Uninsured women, however, reported initiating prenatal care almost 3 weeks later on average than privately insured women (mean difference 2.83, 95% CI 2.27-3.38) and had a more than fourfold increased odds of receiving late or no prenatal care (odds ratio 4.04, 95% CI 3.13-5.23). CONCLUSION: Prepregnancy BMI was not meaningfully associated with a delay in pregnancy recognition or with increased odds of receiving late or no prenatal care.