Medicaid Expansion and Perinatal Health Outcomes: A Quasi-Experimental Study.

OBJECTIVE: There has been little evidence of the impact of preventive services during pregnancy covered under the Affordable Care Act (ACA) on birthing parent and infant outcomes. To address this gap, this study examines the association between Medicaid expansion under the ACA and birthing parent and infant outcomes of low-income pregnant people. METHODS: This study used individual-level data from the 2004-2017 annual waves of the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is a surveillance project of the Centers for Disease Control and Prevention and health departments that annually includes a representative sample of 1,300 to 3,400 births per state, selected from birth certificates. Birthing parents' outcomes of interest included timing of prenatal care, gestational diabetes, hypertensive disorders of pregnancy, cigarette smoking during pregnancy, and postpartum care. Infant outcomes included initiation and duration of breastfeeding, preterm birth, and birth weight. The association between ACA Medicaid expansion and the birthing parent and infant outcomes were examined using difference-in-differences estimation. RESULTS: There was no association between Medicaid expansion and the outcomes examined after correcting for multiple testing. This finding was robust to several sensitivity analyses. CONCLUSIONS FOR PRACTICE: Study findings suggest that expanded access to more complete insurance benefits with limited cost-sharing for pregnant people, a group that already had high rates of insurance coverage, did not impact the birthing parents' and infant health outcomes examined.

Decreasing reproductive and abortion care barriers: findings on the student health center's role from a student survey.

BACKGROUND: College-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care. METHODS: To examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests. RESULTS: The majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%-61%; access barriers 68%; 95% CI 62-73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67-78%), emergency contraception pills (72%; 95% CI 66-78%) and medication abortion (60%; 95% CI 54-66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need. CONCLUSIONS: Our study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.

Long-Term Effects of Local-Area New Deal Work Relief in Childhood on Educational, Economic, and Health Outcomes Over the Life Course: Evidence From the Wisconsin Longitudinal Study.

The economic characteristics of one's childhood neighborhood have been found to determine long-term well-being. Policies enacted during childhood may change neighborhood trajectories and thus impact long-term outcomes for children. We use individual-level data from the Wisconsin Longitudinal Study to examine the enduring consequences of childhood exposure to local-area New Deal emergency employment work-relief activity. Our outcomes include adolescent cognition, educational attainment, midlife income, health behaviors, late-life cognition, and mortality. We find that children (ages 0-3) living in neighborhoods with moderate work-relief activity in 1940 had higher adolescent IQ scores, had higher class rank, and were more likely to obtain at least a bachelor's degree. We find enduring benefits for midlife income and late-life cognition for males who grew up in areas with a moderate amount of work relief. We find mixed results for males who grew up in the most disadvantaged areas with the highest levels of work-relief activity. These children had similar educational outcomes as those in the most advantaged districts with the lowest work-relief activity but had higher adult smoking rates. Our findings provide some of the first evidence of the long-term consequences of New Deal policies on children's long-term life course outcomes.

Ten simple rules for an inclusive summer coding program for non-computer-science undergraduates.

Since 2015, we have run a free 9-week summer program that provides non-computer science (CS) undergraduates at San Francisco State University (SFSU) with experience in coding and doing research. Undergraduate research experiences remain very limited at SFSU and elsewhere, so the summer program provides opportunities for many more students beyond the mentoring capacity of our university laboratories. In addition, we were concerned that many students from historically underrepresented (HU) groups may be unable to take advantage of traditional summer research programs because these programs require students to relocate or be available full time, which is not feasible for students who have family, work, or housing commitments. Our program, which is local and part-time, serves about 5 times as many students as a typical National Science Foundation (NSF) Research Experiences for Undergraduates (REU) program, on a smaller budget. Based on our experiences, we present 10 simple rules for busy faculty who want to create similar programs to engage non-CS HU undergraduates in computational research. Note that while some of the strategies we implement are based on evidence-based publications in the social sciences or education research literature, the original suggestions we make here are based on our trial-and-error experiences, rather than formal hypothesis testing.

Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies.

Objectives. To test whether paid family leave policies in California and New Jersey improved breastfeeding practices, overall and among key subgroups.Methods. We conducted difference-in-differences analyses, comparing pre-post policy changes in California and New Jersey with changes in states where no paid family leave policies were implemented. We examined a large, diverse sample of children born during 2001 to 2013 (n = 306 266), drawn from the 2003 to 2015 National Immunization Survey waves. Outcomes included ever breastfed, breastfed exclusively at 3 and 6 months, and still breastfed at 6 and 12 months, as well as duration of any breastfeeding and exclusive breastfeeding. We examined heterogeneity in policy response by maternal characteristics.Results. Paid family leave policies resulted in a modestly greater likelihood of exclusively breastfeeding at 6 months. Subgroup analyses were mixed, although several breastfeeding outcomes were consistently improved among married, White, higher-income, and older mothers.Conclusions. Exclusive breastfeeding improved after implementation of paid family leave policies in the overall sample, and additional benefits were noted for more advantaged mothers. This contributes critical evidence to an ongoing policy discussion, suggesting that subsequent paid family leave policies should be designed to target more vulnerable mothers.

The #MeToo Movement in the United States: Text Analysis of Early Twitter Conversations.

BACKGROUND: The #MeToo movement sparked an international debate on the sexual harassment, abuse, and assault and has taken many directions since its inception in October of 2017. Much of the early conversation took place on public social media sites such as Twitter, where the hashtag movement began. OBJECTIVE: The aim of this study is to document, characterize, and quantify early public discourse and conversation of the #MeToo movement from Twitter data in the United States. We focus on posts with public first-person revelations of sexual assault/abuse and early life experiences of such events. METHODS: We purchased full tweets and associated metadata from the Twitter Premium application programming interface between October 14 and 21, 2017 (ie, the first week of the movement). We examined the content of novel English language tweets with the phrase "MeToo" from within the United States (N=11,935). We used machine learning methods, least absolute shrinkage and selection operator regression, and support vector machine models to summarize and classify the content of individual tweets with revelations of sexual assault and abuse and early life experiences of sexual assault and abuse. RESULTS: We found that the most predictive words created a vivid archetype of the revelations of sexual assault and abuse. We then estimated that in the first week of the movement, 11% of novel English language tweets with the words "MeToo" revealed details about the poster's experience of sexual assault or abuse and 5.8% revealed early life experiences of such events. We examined the demographic composition of posters of sexual assault and abuse and found that white women aged 25-50 years were overrepresented in terms of their representation on Twitter. Furthermore, we found that the mass sharing of personal experiences of sexual assault and abuse had a large reach, where 6 to 34 million Twitter users may have seen such first-person revelations from someone they followed in the first week of the movement. CONCLUSIONS: These data illustrate that revelations shared went beyond acknowledgement of having experienced sexual harassment and often included vivid and traumatic descriptions of early life experiences of assault and abuse. These findings and methods underscore the value of content analysis, supported by novel machine learning methods, to improve our understanding of how widespread the revelations were, which likely amplified the spread and saliency of the #MeToo movement.

Gendered impact of solid fuel use on acute respiratory infections in children in China.

BACKGROUND: Indoor Air Pollution (IPA) is a serious environmental problem that can have detrimental effects on child health. In China, the major sources of indoor pollution are biomass fuel or solid cooking fuels and familial smoking. Previous studies posit that the effects of IAP on health outcomes may be worse for female children, but the empirical evidence has been mixed. METHODS: In this paper we use the China Health and Nutrition Survey to examine the association of solid fuel use and paternal smoking on acute respiratory infections (ARIs) in children focusing on child gender differences. We used conditional logistic regression to examine gender differences in incidents of ARIs in the 4 weeks prior to the survey collection. We modeled gender difference by including an interaction between child gender and solid fuel use and child gender and paternal smoking. We also conducted stratified analyses by child gender. RESULTS: When examining both genders together, female children exposed to solid fuel had an elevated risk of a ARIs, but the coefficient was not statistically significant. When using a stratified models by gender, female children had a higher risk of having ARIs in the past 4 weeks when exposed to solid fuels (OR=3.28; 95% CI 1.34-8.03) and paternal smoking (OR=2.27; 95% CI 1.08-4.77). Whereas neither exposure to solid fuel nor parental smoking had any significant influence on ARIs for male children. CONCLUSION: While many have hypothesized that female children may be more vulnerable to IAP, the empirical evidence has been limited. In our study we found empirical support for gender difference in the effects of solid cooking fuel use on ARIs. Gender differences in ARIs suggest that realized exposures, as opposed to ambient exposures, are likely higher for female children and are important to consider.

The mental health of youth and young adults during the transition to adulthood in Egypt.

BACKGROUND: There has been growing interest in the stalled transition to adulthood in the Middle East and North Africa (MENA) and its consequences for young people's socioeconomic outcomes. However, little is known about how important life transitions relate to youth psychosocial well-being in the region. OBJECTIVE: Drawing on a life course framework, we estimate the associations between making transitions in education, employment, and marriage with changes in mental health among young people in Egypt. METHODS: We descriptively analyze mental health scores, measured via the Self-Reporting Questionnaire-20 and disaggregated by gender, for a panel of young people first surveyed in 2009 at ages 13-29 and followed up in late 2013 and early 2014. We regress change in mental health scores against indicators of making different transitions. RESULTS: Young women experience worse mental health than young men overall. Lower school achievement was associated with poorer mental health; being out of the labor force was an additional risk factor for young men. While average mental health scores improved over time, over a quarter of the sample experienced worsening mental health, related to failure to marry and find a job among older men, and failure to finish schooling among younger women. CONCLUSIONS: Mental health is an important but often overlooked component of youth well-being during the transition to adulthood in MENA, and potentially other low- and middle-income countries. CONTRIBUTION: This is the first paper to empirically examine the relationship between psychosocial well-being and achieving important socioeconomic milestones among a nationally representative cohort of young people in MENA.

Psychological well-being during the great recession: changes in mental health care utilization in an occupational cohort.

OBJECTIVES: We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured. METHODS: We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects. RESULTS: Mental health inpatient and outpatient visits and the yearly supply of mental health-related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs. CONCLUSIONS: The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress.

Early-Life State-of-Residence Characteristics and Later Life Hypertension, Diabetes, and Ischemic Heart Disease.

OBJECTIVES: We examined how state characteristics in early life are associated with individual chronic disease later in life. METHODS: We assessed early-life state of residence using the first 3 digits of social security numbers from blue- and white-collar workers from a US manufacturing company. Longitudinal data were available from 1997 to 2012, with 305 936 person-years of observation. Disease was assessed using medical claims. We modeled associations using pooled logistic regression with inverse probability of censoring weights. RESULTS: We found small but statistically significant associations between early-state-of-residence characteristics and later life hypertension, diabetes, and ischemic heart disease. The most consistent associations were with income inequality, percentage non-White, and education. These associations were similar after statistically controlling for individual socioeconomic and demographic characteristics and current state characteristics. CONCLUSIONS: Characteristics of the state in which an individual lives early in life are associated with prevalence of chronic disease later in life, with a strength of association equivalent to genetic associations found for these same health outcomes.

SMS messages increase adherence to rapid diagnostic test results among malaria patients: results from a pilot study in Nigeria.

BACKGROUND: The World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector. METHODS: The Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice. RESULTS: Adherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS. CONCLUSIONS: SMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from privately owned drug retailers in Nigeria and may be a simple and cost-effective means for boosting adherence to RDT results if and when RDTs are introduced as a commercial retail product.

How do risk preferences relate to malaria care-seeking behavior and the acceptability of a new health technology in Nigeria?

BACKGROUND: To reduce the burden of disease from malaria, innovative approaches are needed to engender behavior change. One unobservable, but fundamental trait-preferences for risk-may influence individuals' willingness to adopt new health technologies. We explore the association of risk preferences with malaria care-seeking behavior and the acceptability of malaria rapid diagnostic tests (RDTs) to inform RDT scale-up plans. METHODS: In Oyo State, Nigeria, adult customers purchasing anti-malarial medications at selected drug shops took surveys and received an RDT as they exited. After an initial risk preference assessment via a simple lottery game choice, individuals were given their RDT result and treatment advice, and called four days later to assess treatment adherence. We used bivariable and multivariable regression analysis to assess the association of risk game choices with malaria care-seeking behaviors and RDT acceptability. RESULTS: Of 448 respondents, 63.2% chose the lottery game with zero variance in expected payout, 27.9% chose the game with low variance, and 8.9% chose the game with high variance. Compared to participants who chose lower variance games, individuals choosing higher variance games were older, less educated, more likely to be male, and were more likely to patronize lower quality drug shops, seek care immediately, and report complete disability due to their illness. In contrast, individuals choosing lower variance games were more likely to follow the correct treatment directions and were more likely to report an increase in their willingness to pay for an RDT compared to other risk groups, our two measures of RDT acceptability. Differences in estimated associations between risk game choices and selected care-seeking behaviors remained after controlling sociodemographic confounders. CONCLUSIONS: The uptake of health diagnostic information in terms of translating the RDT experience into willingness to pay for an RDT and treatment adherence to test results may vary according to risk preferences. Hence, health promotion communications may want to be crafted bearing in mind differences in uptake among people of different risk preferences to encourage wider RDT adoption and more rational malaria treatment. Estimates will serve as the basis for power calculations for an expanded study.

Exploration of pathways related to the decline in female circumcision in Egypt.

BACKGROUND: There has been a large decline in female genital circumcision (FGC) in Egypt in recent decades. Understanding how this change has occurred so rapidly has been an area of particular interest to policymakers and public health officials alike who seek to further discourage the practice elsewhere. METHODS: We document the trends in this decline in the newest cohorts of young girls and explore the influences of three pathways--socioeconomic development, social media messages, and women's empowerment--for explaining the observed trends. Using the 2005 and 2008 Egypt Demographic and Health Surveys, we estimate several logistic regression models to (1) examine individual and household determinants of circumcision, (2) assess the contributions of different pathways through which these changes may have occurred, and (3) assess the robustness of different pathways when unobserved community differences are taken into account. RESULTS: Across all communities, socioeconomic status, social media messages, and women's empowerment all have significant independent effects on the risk of circumcision. However, after accounting for unobserved differences across communities, only mother's education and household wealth significantly predict circumcision outcomes. Additional analyses of maternal education suggest that increases in women's education may be causally related to the reduction in FGC prevalence. CONCLUSIONS: Women's empowerment and social media appear to be more important in explaining differences across communities; within communities, socioeconomic status is a key driver of girls' circumcision risk. Further investigation of community-level women's educational attainment for mothers suggests that investments made in female education a generation ago may have had echo effects on girls' FGC risk a generation later.

Job insecurity during recessions: effects on survivors' work stress.

BACKGROUND: Previous studies show a variety of negative health consequences for the remaining workforce after downsizing events. This study examined self-reported work stress from 2009-2012 in the context of a large multi-site aluminum manufacturing company that underwent severe downsizing in 2009. METHODS: This study examined the association between work stress and working at a work site that underwent severe downsizing. We assessed the level of downsizing across thirty plants in 2009 and categorized seven as having undergone severe downsizing. We linked plant-level downsizing information to individual workers' responses to an annual work engagement survey, which included three work stress questions. From 2009 to 2012 over 14, 000 employees were asked about their experience of work stress. Though the surveys were anonymous, the surveys captured employees' demographic and employment characteristic as well as plant location. We used hierarchical logistic regressions to compare responses of workers at severely downsized plants to workers at all other plant while controlling for demographic and plant characteristics. Responses to the work stress questions and one control question were examined. RESULTS: In all yearly surveys salaried workers consistently reported having more work stress than hourly workers. There was no differential in work stress for workers at severely downsized plants in 2009. In 2010 to 2012, salaried workers who remained at severely downsized plants reported significantly higher work stress than salaried workers at all other plants across multiple work stress questions. Examination of the 2006 survey confirmed that there were no pre-existing differences in work stress among salaried employees working at plants that would eventually experience severe downsizing. In addition, there was no difference in responses to the control question at severely downsized plants. CONCLUSION: Salaried workers at plants with high layoffs experienced more work stress after 2009 than their counterparts at non-high layoff plants. Increased work stress is important to monitor and may be a mediating pathway through which the external economic environment leads to adverse health outcomes.

Associations between employee and manager gender: impacts on gender-specific risk of acute occupational injury in metal manufacturing.

BACKGROUND: Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one's manager could in theory affect injury rates among male and female employees through their managers' response to an employee's psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee's manager's gender modifies the effect of employee gender with regards to risk of acute injury. METHODS: A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year. RESULTS: The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601). CONCLUSIONS: Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee's manager(s).

Associations of local area level new deal employment in childhood with late life cognition: evidence from the census-linked health and retirement study.

BACKGROUND: Emergency employment programmes during the 1930s and 1940s invested income, infrastructure and social services into communities affected by the Great Depression. We estimate the long-term associations of growing up in an area exposed to New Deal emergency employment in 1940 with cognitive functioning in later life. METHODS: Members of the Health and Retirement Study cohort (N=5095; mean age 66.3 at baseline) who were age 0-17 in 1940 were linked to their census record from that year, providing prospective information about childhood contextual and family circumstances. We estimated the association between subcounty-level emergency employment participation in 1940 and baseline cognition and rate of cognitive decline between 1998 and 2016. RESULTS: Compared with those living in the lowest emergency employment quintile in 1940, those who were exposed to moderate levels of emergency employment (third quintile) had better cognitive functioning in 1998 (b=0.092 SD, 95% CI 0.011 to 0.173), conditional on sociodemographic factors. This effect was modestly attenuated after adjusting for respondents' adult education, finances and health factors. There were no significant effects of area-level emergency employment on rate of cognitive decline. CONCLUSIONS: Exposure to New Deal employment policies during childhood is associated with long-term cognitive health benefits. This is partially explained by increases in educational attainment among those with greater levels of emergency employment activity in the place where they were raised. Future research should investigate which types of New Deal investments may most be related to long-term cognitive health, or if the associations we observe are due to co-occurring programmes.

Medication abortion: State of information on Student Health Center websites.

Objective: To document the information on medication abortion on university Student Health Center (SHC) websites. Study Sample: Four-year bachelors granting public universities' Student Health Center websites. Methods: We conduct thematic content analysis for medication abortion-related information on 547 SHC websites in the United States as of August 2022 using computer-assisted software. We validate the software with human annotation. Results: Medication abortion is mentioned on 23 (4%) university SHC websites, and in 13 (57%) of these websites, it is only mentioned to exclude it from definitions of emergency contraception. Only two websites, 6% of the California public schools included in the sample, advertise medication abortion services through their SHC websites. One hundred fifteen (21%) university websites provide links to Planned Parenthood that gives information on how to navigate abortion access across all 50 states. Conclusion: There is inadequate information on SHC websites regarding medication abortion services and how to access them.

The economic benefits of malaria elimination: do they include increases in tourism?

BACKGROUND: Policy makers have speculated that one of the economic benefits of malaria elimination includes increases in foreign direct investment, particularly tourism. METHODS: This study examines the empirical relationship between the demand for travel and malaria cases in two countries with large tourism industries around the time in which they carried out malaria-elimination campaigns. In Mauritius, this analysis examines historical, yearly tourist arrivals and malaria cases from 1978-1999, accounting for the background secular trend of increasing international travel. In Dominican Republic, a country embarking upon malaria elimination, it employs a time-series analysis of the monthly, international tourist arrivals from 1998-2010 to determine whether the timing of significant deviations in tourist arrivals coincides with malaria outbreaks. RESULTS: While naïve relationships exist in both cases, the results show that the relationships between tourist arrivals and malaria cases are relatively weak and statistically insignificant once secular confounders are accounted for. CONCLUSIONS: This suggests that any economic benefits from tourism that may be derived from actively pursuing elimination in countries that have high tourism potential are likely to be small when measured at a national level. Rather, tourism benefits are likely to be experienced with greater impact in more concentrated tourist areas within countries, and future studies should seek to assess these relationships at a regional or local level.

Social Media Activism and Convergence in Tweet Topics After the Initial #MeToo Movement for Two Distinct Groups of Twitter Users.

Online social media movements are now common and support cultural discussions on difficult health and social topics. The #MeToo movement, focusing on the pervasiveness of sexual assault and harassment, has been one of the largest and most influential online movements. Our study examines topics of conversation on Twitter by supporters of the #MeToo movement and by Twitter users who were uninvolved in the movement to explore the extent to which tweet topics for these two groups converge over time. We identify and collect one year's worth of tweets for supporters of the #MeToo movement (N = 168 users; N = 105,538 tweets) and users not involved in the movement (N = 147 users; N = 112,301 tweets referred to as the Neutral Sample). We conduct topic frequency analysis and implement an unsupervised machine learning topic modeling algorithm, latent Dirichlet allocation, to explore topics of discussion on Twitter for these two groups of users before and after the initial #MeToo movement. Our results suggest that supporters of #MeToo discussed different topics compared to the Neutral Sample of Twitter users before #MeToo with some overlap on politics. The supporters were already discussing sexual assault and harassment issues six months before #MeToo, and discussion on this topic increased 13.7-fold in the six months after. For the Neutral Sample, sexual assault and harassment was not a key topic of discussion on Twitter before #MeToo, but there was some limited increase afterward. Results of bigram frequency analysis and topic modeling showed a clear increase in topic related to gender for the supporters of #MeToo but gave mixed results for the Neutral Sample comparison group. Our results suggest limited shifts in the conversation on Twitter for the Neutral Sample. Our methods and results have implications for measuring the extent to which online social media movements, like #MeToo, reach a broad audience.

Contraception information on the websites of student health centers in the United States.

OBJECTIVE: As University Student Health Centers are considered reputable sources of information by many young adults, we evaluate the presence of contraceptive information on their websites. STUDY DESIGN: We used a software tool (Quantitative Measures of Online Health Information), designed for public health research to examine online information access on four broad categories of contraception and reproductive health (LARC/injectables, Contraception, Condom, Pap test) on student health center websites from all (591) public four-year universities across the United States between July to September 2020. Using a logistic regression model, we documented factors that are associated with information disparities. RESULTS: Our sample consisted of 545 public universities after excluding those for which information was unavailable. In 357 (66%) of the universities in our sample, we found evidence of some information related to contraception. A one percentage point increase in the student population that are Pell grant recipients, an indicator of the proportion of low-income students enrolled, is associated with a 3% to 6% (0.01