Alanna Hirz | University of California, Los Angeles (original) (raw)
Papers by Alanna Hirz
Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (S... more Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (SES), reserve capacity, and negative emotions as determinants of pain in patients with Rheumatoid Arthritis (RA). Methods The study used cross-sectional baseline data from 106 adults in a clinical trial comparing behavioral treatments for RA. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness, self-efficacy, social support) and negative emotions (stress and depressive symptoms) on pain, and the indirect effects of SES as mediated by reserve capacity and negative emotions. Results Results showed that low SES contributed to greater pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. Conclusions The findings indicate that interventions that target negative emotions in patients with low SES may facilitate better pain...
Health Services Research, 2023
The United States has a long history of undermining the reproductive autonomy of people with chro... more The United States has a long history of undermining the reproductive autonomy of people with chronic conditions. This includes people with disabilities that are seen or unseen, and related or not related to health. The Dobbs decision, a June 2022 Supreme Court ruling which reversed the long-held constitutional right to an abortion, carries tremendous impact on all people. However, people managing chronic health conditions are particularly at risk of harm by the constellation of abortion bans and restrictions emerging across the United States. For example, people with disabilities experience disproportionate exposure to sexual violence, higher rates of unwanted pregnancy, and are at greater risk of maternal and infant mortality and morbidity.
Before Dobbs, comprehensive and medically accurate pregnancy-options counseling, inclusive of abortion, was standard of care, but the shifting legal landscape has greatly limited choice for both patients and providers. When examining states with the highest prevalence of chronic health conditions, it is concerning that these are also among the states with some of the most severe abortion restrictions. For people with chronic health conditions, reproductive autonomy is rarely prioritized in state policy, health care institutions or clinical practice; therefore, health services researchers invested in making quality care attainable for this population must weigh the implications of a present and future health care system where abortion is no longer an option.
This commentary examines the intersecting and compounding issues of ableism, racism, and sexism in producing reproductive health challenges for people with chronic health conditions in a post-Dobbs United States. We, the authors, define chronic health conditions as long term and persistent health challenges that require medical treatment or routine accommodation and recognize that although many chronic health conditions are disabilities, not all disabilities are chronic health conditions. Furthermore, people with chronic health conditions, like all people, deserve reproductive justice—“the human right to maintain personal bodily autonomy, have children, not have children, and parent the children they have in safe and sustainable communities”. Health services research as a discipline has a role to play in supporting these rights and in interrogating the systems which diminish them.
Objective: To understand beliefs about unintended pregnancy and abortion and perceptions about ma... more Objective: To understand beliefs about unintended pregnancy and abortion and perceptions about male roles related to pregnancy decision-making among men in the Philippines.
Methods: Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being “afraid or troubled” or “afraid and planned to terminate” in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method.
Results: In-depth interview data from 15 men—each interviewed twice—and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the “sin” of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an
induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the “sin” of induced abortion.
Conclusion: Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated “sin”. This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.
Background: Our objectives were to describe women's reasons for engaging in anal intercourse (AI)... more Background: Our objectives were to describe women's reasons for engaging in anal intercourse (AI), contextual factors surrounding AI, and how these vary by current rectal sexually transmitted infection (STI) status, and to assess women's knowledge and concerns about rectal infections.
Methods: Between January 2011 and June 2013, we conducted semistructured, qualitative interviews among 40 women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible if they were at least 18 years of age, reported AI in the past 90 days, and were tested for rectal Chlamydia trachomatis and Neisseria gonorrhoeae. Interviews, which were guided by the theory of gender and power, were transcribed and coded to explore contextual factors surrounding AI.
Results: On average, participants reported having 3 AI partners in their lifetime and most (n = 30) reported being in a serious relationship with a main/regular sex partner at the time of the interview. Motivations for engaging in AI and feelings about AI varied by rectal STI status. Women with a rectal STI more prominently conveyed the idea that AI was intended to please their sexual partner, whereas those who did not have a rectal STI reported AI more as a way to increase intimacy and personal sexual gratification. Almost all women (regardless of rectal STI status) reported limited to no knowledge about the risk of rectal STIs.
Conclusions: Among women, risk of acquiring rectal STIs may vary by reason for engaging in unprotected AI as well as other contextual factors. Providers should consider addressing these contextual factors to reduce risk.
Studies in Family Planning, 2011
This study draws on in-depth interviews and focus group discussions with young adults in a metrop... more This study draws on in-depth interviews and focus group discussions with young adults in a metropolitan area of the Philippines to examine perceptions and practices of illegal abortion. Study participants indicated that unintended pregnancies are common and may be resolved through eventual acceptance or through self-induced injury or ingestion of substances to terminate the pregnancy. Despite the illegality of abortion and the restricted status of misoprostol, substantial knowledge and use of the drug exists. Discussions mirrored broader controversies associated with abortion in this setting. Abortion was generally thought to invoke gaba (bad karma), yet some noted its acceptability under certain circumstances. This study elucidates the complexities of pregnancy decision making in this restrictive environment and the need for comprehensive and confidential reproductive health services for Filipino young adults.
Projects by Alanna Hirz
Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (S... more Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (SES), reserve capacity, and negative emotions as determinants of pain in patients with Rheumatoid Arthritis (RA). Methods The study used cross-sectional baseline data from 106 adults in a clinical trial comparing behavioral treatments for RA. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness, self-efficacy, social support) and negative emotions (stress and depressive symptoms) on pain, and the indirect effects of SES as mediated by reserve capacity and negative emotions. Results Results showed that low SES contributed to greater pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. Conclusions The findings indicate that interventions that target negative emotions in patients with low SES may facilitate better pain...
Health Services Research, 2023
The United States has a long history of undermining the reproductive autonomy of people with chro... more The United States has a long history of undermining the reproductive autonomy of people with chronic conditions. This includes people with disabilities that are seen or unseen, and related or not related to health. The Dobbs decision, a June 2022 Supreme Court ruling which reversed the long-held constitutional right to an abortion, carries tremendous impact on all people. However, people managing chronic health conditions are particularly at risk of harm by the constellation of abortion bans and restrictions emerging across the United States. For example, people with disabilities experience disproportionate exposure to sexual violence, higher rates of unwanted pregnancy, and are at greater risk of maternal and infant mortality and morbidity.
Before Dobbs, comprehensive and medically accurate pregnancy-options counseling, inclusive of abortion, was standard of care, but the shifting legal landscape has greatly limited choice for both patients and providers. When examining states with the highest prevalence of chronic health conditions, it is concerning that these are also among the states with some of the most severe abortion restrictions. For people with chronic health conditions, reproductive autonomy is rarely prioritized in state policy, health care institutions or clinical practice; therefore, health services researchers invested in making quality care attainable for this population must weigh the implications of a present and future health care system where abortion is no longer an option.
This commentary examines the intersecting and compounding issues of ableism, racism, and sexism in producing reproductive health challenges for people with chronic health conditions in a post-Dobbs United States. We, the authors, define chronic health conditions as long term and persistent health challenges that require medical treatment or routine accommodation and recognize that although many chronic health conditions are disabilities, not all disabilities are chronic health conditions. Furthermore, people with chronic health conditions, like all people, deserve reproductive justice—“the human right to maintain personal bodily autonomy, have children, not have children, and parent the children they have in safe and sustainable communities”. Health services research as a discipline has a role to play in supporting these rights and in interrogating the systems which diminish them.
Objective: To understand beliefs about unintended pregnancy and abortion and perceptions about ma... more Objective: To understand beliefs about unintended pregnancy and abortion and perceptions about male roles related to pregnancy decision-making among men in the Philippines.
Methods: Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being “afraid or troubled” or “afraid and planned to terminate” in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method.
Results: In-depth interview data from 15 men—each interviewed twice—and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the “sin” of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an
induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the “sin” of induced abortion.
Conclusion: Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated “sin”. This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.
Background: Our objectives were to describe women's reasons for engaging in anal intercourse (AI)... more Background: Our objectives were to describe women's reasons for engaging in anal intercourse (AI), contextual factors surrounding AI, and how these vary by current rectal sexually transmitted infection (STI) status, and to assess women's knowledge and concerns about rectal infections.
Methods: Between January 2011 and June 2013, we conducted semistructured, qualitative interviews among 40 women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible if they were at least 18 years of age, reported AI in the past 90 days, and were tested for rectal Chlamydia trachomatis and Neisseria gonorrhoeae. Interviews, which were guided by the theory of gender and power, were transcribed and coded to explore contextual factors surrounding AI.
Results: On average, participants reported having 3 AI partners in their lifetime and most (n = 30) reported being in a serious relationship with a main/regular sex partner at the time of the interview. Motivations for engaging in AI and feelings about AI varied by rectal STI status. Women with a rectal STI more prominently conveyed the idea that AI was intended to please their sexual partner, whereas those who did not have a rectal STI reported AI more as a way to increase intimacy and personal sexual gratification. Almost all women (regardless of rectal STI status) reported limited to no knowledge about the risk of rectal STIs.
Conclusions: Among women, risk of acquiring rectal STIs may vary by reason for engaging in unprotected AI as well as other contextual factors. Providers should consider addressing these contextual factors to reduce risk.
Studies in Family Planning, 2011
This study draws on in-depth interviews and focus group discussions with young adults in a metrop... more This study draws on in-depth interviews and focus group discussions with young adults in a metropolitan area of the Philippines to examine perceptions and practices of illegal abortion. Study participants indicated that unintended pregnancies are common and may be resolved through eventual acceptance or through self-induced injury or ingestion of substances to terminate the pregnancy. Despite the illegality of abortion and the restricted status of misoprostol, substantial knowledge and use of the drug exists. Discussions mirrored broader controversies associated with abortion in this setting. Abortion was generally thought to invoke gaba (bad karma), yet some noted its acceptability under certain circumstances. This study elucidates the complexities of pregnancy decision making in this restrictive environment and the need for comprehensive and confidential reproductive health services for Filipino young adults.