Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study.

BACKGROUND: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. OBJECTIVE: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. METHODS: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. RESULTS: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. CONCLUSIONS: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care.

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.

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.

Slaveholder ancestry and current net worth of members of the United States Congress.

BACKGROUND: Whether and how much past slavery affects contemporary social and economic conditions in the United States is an area of active debate. Newly available data on which members of the United States Congress are descendants of slaveholders provides an opportunity to examine this topic. This study sought to determine the relationship between slaveholder ancestry and net worth among members of Congress. METHODS: Total assets and liabilities were collected from financial declarations of all members of Congress as of April 15, 2021. Net worth was estimated as the difference between total assets and liabilities. Information on slaveholder ancestry was obtained from a Reuters investigative series based on an extensive review of historical documents and verification by board-certified genealogists. Quantile regression was used to determine the association between net worth and slaveholder ancestry after adjustment for demographic factors. RESULTS: The median net worth of the 535 members of Congress was $1.28 million (interquartile range $0.11-5.87 million). On univariate analysis, net worth was associated with increased age, White race, increased education, and number of individuals enslaved by ancestors. On multivariate analysis, net worth was independently associated with age, White race, and number enslaved. Legislators whose ancestors enslaved 16 or more individuals had a $3.93 million (95% confidence interval 2.39-5.46) higher net worth compared to legislators whose ancestors were not slave owners after adjustment for age, sex, race, ethnicity, and education. CONCLUSIONS: Past slaveholding practices are independently associated with current wealth among members of Congress. Because members of Congress are a highly selected group, further work is needed to understand how slaveholder ancestry affects current wealth in the general population to inform efforts to reduce social and economic disparities.

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.

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.