Shivani Kochhar | Wesleyan University (original) (raw)

Papers by Shivani Kochhar

Research paper thumbnail of Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment (Preprint)

Research paper thumbnail of Determinants of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults

medRxiv (Cold Spring Harbor Laboratory), May 15, 2021

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent ... more We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy

Research paper thumbnail of Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study

American Journal of Epidemiology, Jan 5, 2022

We estimated the trends and correlates of vaccine hesitancy and its association with subsequent v... more We estimated the trends and correlates of vaccine hesitancy and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the Communities, Households, and SARS-CoV-2 Epidemiology COVID (CHASING COVID) Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in 8 interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared with non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (for NH Black, aOR = 2.0 (95% confidence interval (CI): 1.5, 2.7), and for Hispanic, 1.3 (95% CI: 1.0, 1.7)) and vaccine refusal (for NH Black, aOR = 2.5 (95% CI: 1.8, 3.6), and for Hispanic, 1.4 (95% CI: 1.0, 2.0)) in June 2021. COVID-19 vaccine hesitancy, compared with vaccine-willingness, was associated with lower odds of subsequent vaccine uptake (for vaccine delayers, aOR = 0.15, 95% CI: 0.13, 0.18; for vaccine refusers, aOR = 0.02; 95% CI: 0.01, 0.03), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Research paper thumbnail of Household factors and the risk of severe COVID-like illness early in the U.S. pandemic

PLOS ONE, Jul 21, 2022

Objective To investigate the role of children in the home and household crowding as risk factors ... more Objective To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. Methods We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. Results In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings.

Research paper thumbnail of “I stretch them out as long as possible:” U.S. women’s experiences of menstrual product insecurity during the COVID-19 pandemic

BMC Women's Health

Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender... more Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women’s menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. Methods This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud’s ‘systematic text condensation’, an inductive thematic analysis method, w...

Research paper thumbnail of “I stretch them out as long as possible:” U.S. women’s experiences of menstrual product insecurity during the COVID-19 pandemic

BMC Women's Health, Apr 15, 2023

Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender... more Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. Methods This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation' , an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. Results Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. Conclusions Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.

Research paper thumbnail of Psychosocial Stressors and Maternal Mental Health in the U.S. During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Analysis

Maternal and Child Health Journal

Research paper thumbnail of Understanding Contraceptive Failure: An Analysis of Qualitative Narratives

Women's Reproductive Health

Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are ... more Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are common. Guided by the Health Belief Model (HBM), we conducted a secondary qualitative analysis of interviews with women who described experiencing a contraceptive failure (n ¼ 69) to examine why and how this outcome occurs. We found three primary drivers of contraceptive failures (health literacy and beliefs, partners and relationships, and structural barriers), and we identified pathways through which these drivers led to contraceptive failures that resulted in pregnancy. These findings have implications for how individuals can be better supported to select their preferred contraception during clinical contraceptive discussions.

Research paper thumbnail of Publicly Supported Family Planning Services in the United States: Likely Need, Availability and Impact, 2016

■ ■ While Title X–funded sites continued to serve the largest segment of women receiving publicly... more ■ ■ While Title X–funded sites continued to serve the largest segment of women receiving publicly supported care, their patient load fell by 25%, from 4.7 million in 2010 to 3.5 million in 2016. The number of contraceptive patients served by other public clinics that do not receive Title X funding rose by 29% and the number of women receiving Medicaid-funded contraceptive services from private providers rose by 19%.

Research paper thumbnail of SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

Clinical Infectious Diseases

Background Prospective cohort studies of SARS-CoV-2 incidence complement case-based surveillance ... more Background Prospective cohort studies of SARS-CoV-2 incidence complement case-based surveillance and cross-sectional seroprevalence surveys. Methods We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6,738 U.S. adults, enrolled March-August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using LASSO regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups ≥ 10, and no masking in gyms/salons. Results Among 4,510 individuals with ≥1 serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and retested during November 2020-January 2021, 161 seroconverted over 1,646 person-years of follow-up (9.8 per 100 person-years [95%CI 8.3-11.5])...

Research paper thumbnail of Pregnancy Desires and Pregnancies at the State Level: Estimates for 2014

This report was prepared by Kathryn Kost, Isaac Maddow-Zimet and Shivani Kochhar, and edited by L... more This report was prepared by Kathryn Kost, Isaac Maddow-Zimet and Shivani Kochhar, and edited by Lisa Melhadoall of the Guttmacher Institute. Guttmacher colleagues Megan Kavanaugh and Rebecca Wind provided comments on drafts, as did members of the PRAMS Working Group and staff from California's Maternal and Infant Health Assessment team. We relied greatly on the work of staff of the PRAMS Working Group and the CDC PRAMS Team at the Applied Sciences Branch, Division of Reproductive Health of the Centers for Disease Control and Prevention, who collected, compiled and published much of the surveillance data used in this report. We also gratefully acknowledge staff of state health departments throughout the United States, who provided tabulations of state-level data upon request. Without their cooperation, expertise and dedicated work, the estimates provided in this report would not be possible.

Research paper thumbnail of Determinants and trends of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults: A longitudinal study

American Journal of Epidemiology, Jan 5, 2022

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent ... more We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Research paper thumbnail of Commentary on the Article “A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results” by McCormick et al

Research paper thumbnail of Cumulative incidence of sars-cov-2 infection and epidemic metrics, united states

Topics in antiviral medicine, 2021

Research paper thumbnail of Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020

American Journal of Public Health, 2022

Objectives. To identify key effects of the pandemic and its economic consequences on menstrual pr... more Objectives. To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Methods. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Results. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Conclusions. Pandemic-related income loss was a st...

Research paper thumbnail of Testing, Testing: What SARS-CoV-2 testing services do adults in the United States actually want? A discrete choice experiment. (Preprint)

Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the d... more Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider's office or urgent care clinic with results in >5 days. Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.

Research paper thumbnail of Risk Profile of Thanksgiving Gatherers and Subsequent SARS-CoV2 Testing and Diagnosis

ABSTRACTBackgroundDuring Fall 2020 in the United States (U.S.), despite high COVID-19 case number... more ABSTRACTBackgroundDuring Fall 2020 in the United States (U.S.), despite high COVID-19 case numbers and recommendations from public health officials not to travel and gather with individuals outside one’s household, millions of people gathered for Thanksgiving. The objective of this study was to understand if individuals’ behaviors and risk perceptions influenced their decision to gather, and if they did gather, their subsequent test seeking and diagnoses.MethodsParticipants were part of the CHASING COVID Cohort study - a U.S. national prospective cohort. The study sample consisted of participants who completed routine questionnaires before and after Thanksgiving. Non-pharmaceutical interventions (NPIs) use informed behavioral risk scores and a score of perceived risk of COVID-19 were assigned to each participant. Multinomial logistic regression models were used to assess the association between higher risk behaviors and gathering with other households, and the association of gatheri...

Research paper thumbnail of Spread and sources of information and misinformation about COVID-19 early during the pandemic in a U.S. national cohort study

Background: Early in the pandemic, misinformation about COVID-19 was spread on social media. The ... more Background: Early in the pandemic, misinformation about COVID-19 was spread on social media. The purpose of this study was to describe trusted sources of COVID-19 information and claims seen and believed about COVID-19 early in the pandemic among U.S. adults. Then, we assessed the impact of believing such claims on engaging in personal protective actions (PPA). Methods: We used baseline data from the CHASING COVID Cohort (n = 7,070) collected March 28, 2020 to April 20, 2020 to describe trusted sources of COVID-19 information as well as claims circulating on social media that had been seen and believed. We used Poisson regression to determine the association of believing certain claims with engaging in a higher number of PPA. Results: The top three trusted sources of COVID-19 information were the CDC (67.9%), the WHO (53.7%), and State Health Departments (53.0%). Several COVID-19 claims circulated on social media had been seen, e.g., that the virus was created in a laboratory (54.8%...

Research paper thumbnail of Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment

JMIR Public Health and Surveillance, 2021

Background Inadequate screening and diagnostic testing in the United States throughout the first ... more Background Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. Objective This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. Methods We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identif...

Research paper thumbnail of SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

ABSTRACTBackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via ... more ABSTRACTBackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys.MethodsWe estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion.FindingsAmong the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by Ja...

Research paper thumbnail of Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment (Preprint)

Research paper thumbnail of Determinants of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults

medRxiv (Cold Spring Harbor Laboratory), May 15, 2021

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent ... more We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy

Research paper thumbnail of Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study

American Journal of Epidemiology, Jan 5, 2022

We estimated the trends and correlates of vaccine hesitancy and its association with subsequent v... more We estimated the trends and correlates of vaccine hesitancy and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the Communities, Households, and SARS-CoV-2 Epidemiology COVID (CHASING COVID) Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in 8 interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared with non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (for NH Black, aOR = 2.0 (95% confidence interval (CI): 1.5, 2.7), and for Hispanic, 1.3 (95% CI: 1.0, 1.7)) and vaccine refusal (for NH Black, aOR = 2.5 (95% CI: 1.8, 3.6), and for Hispanic, 1.4 (95% CI: 1.0, 2.0)) in June 2021. COVID-19 vaccine hesitancy, compared with vaccine-willingness, was associated with lower odds of subsequent vaccine uptake (for vaccine delayers, aOR = 0.15, 95% CI: 0.13, 0.18; for vaccine refusers, aOR = 0.02; 95% CI: 0.01, 0.03), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Research paper thumbnail of Household factors and the risk of severe COVID-like illness early in the U.S. pandemic

PLOS ONE, Jul 21, 2022

Objective To investigate the role of children in the home and household crowding as risk factors ... more Objective To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. Methods We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. Results In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings.

Research paper thumbnail of “I stretch them out as long as possible:” U.S. women’s experiences of menstrual product insecurity during the COVID-19 pandemic

BMC Women's Health

Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender... more Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women’s menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. Methods This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud’s ‘systematic text condensation’, an inductive thematic analysis method, w...

Research paper thumbnail of “I stretch them out as long as possible:” U.S. women’s experiences of menstrual product insecurity during the COVID-19 pandemic

BMC Women's Health, Apr 15, 2023

Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender... more Background A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. Methods This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation' , an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. Results Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. Conclusions Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.

Research paper thumbnail of Psychosocial Stressors and Maternal Mental Health in the U.S. During the First Wave of the COVID-19 Pandemic: A Cross-Sectional Analysis

Maternal and Child Health Journal

Research paper thumbnail of Understanding Contraceptive Failure: An Analysis of Qualitative Narratives

Women's Reproductive Health

Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are ... more Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are common. Guided by the Health Belief Model (HBM), we conducted a secondary qualitative analysis of interviews with women who described experiencing a contraceptive failure (n ¼ 69) to examine why and how this outcome occurs. We found three primary drivers of contraceptive failures (health literacy and beliefs, partners and relationships, and structural barriers), and we identified pathways through which these drivers led to contraceptive failures that resulted in pregnancy. These findings have implications for how individuals can be better supported to select their preferred contraception during clinical contraceptive discussions.

Research paper thumbnail of Publicly Supported Family Planning Services in the United States: Likely Need, Availability and Impact, 2016

■ ■ While Title X–funded sites continued to serve the largest segment of women receiving publicly... more ■ ■ While Title X–funded sites continued to serve the largest segment of women receiving publicly supported care, their patient load fell by 25%, from 4.7 million in 2010 to 3.5 million in 2016. The number of contraceptive patients served by other public clinics that do not receive Title X funding rose by 29% and the number of women receiving Medicaid-funded contraceptive services from private providers rose by 19%.

Research paper thumbnail of SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

Clinical Infectious Diseases

Background Prospective cohort studies of SARS-CoV-2 incidence complement case-based surveillance ... more Background Prospective cohort studies of SARS-CoV-2 incidence complement case-based surveillance and cross-sectional seroprevalence surveys. Methods We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6,738 U.S. adults, enrolled March-August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using LASSO regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups ≥ 10, and no masking in gyms/salons. Results Among 4,510 individuals with ≥1 serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and retested during November 2020-January 2021, 161 seroconverted over 1,646 person-years of follow-up (9.8 per 100 person-years [95%CI 8.3-11.5])...

Research paper thumbnail of Pregnancy Desires and Pregnancies at the State Level: Estimates for 2014

This report was prepared by Kathryn Kost, Isaac Maddow-Zimet and Shivani Kochhar, and edited by L... more This report was prepared by Kathryn Kost, Isaac Maddow-Zimet and Shivani Kochhar, and edited by Lisa Melhadoall of the Guttmacher Institute. Guttmacher colleagues Megan Kavanaugh and Rebecca Wind provided comments on drafts, as did members of the PRAMS Working Group and staff from California's Maternal and Infant Health Assessment team. We relied greatly on the work of staff of the PRAMS Working Group and the CDC PRAMS Team at the Applied Sciences Branch, Division of Reproductive Health of the Centers for Disease Control and Prevention, who collected, compiled and published much of the surveillance data used in this report. We also gratefully acknowledge staff of state health departments throughout the United States, who provided tabulations of state-level data upon request. Without their cooperation, expertise and dedicated work, the estimates provided in this report would not be possible.

Research paper thumbnail of Determinants and trends of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults: A longitudinal study

American Journal of Epidemiology, Jan 5, 2022

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent ... more We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Research paper thumbnail of Commentary on the Article “A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results” by McCormick et al

Research paper thumbnail of Cumulative incidence of sars-cov-2 infection and epidemic metrics, united states

Topics in antiviral medicine, 2021

Research paper thumbnail of Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020

American Journal of Public Health, 2022

Objectives. To identify key effects of the pandemic and its economic consequences on menstrual pr... more Objectives. To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Methods. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Results. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Conclusions. Pandemic-related income loss was a st...

Research paper thumbnail of Testing, Testing: What SARS-CoV-2 testing services do adults in the United States actually want? A discrete choice experiment. (Preprint)

Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the d... more Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider's office or urgent care clinic with results in >5 days. Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.

Research paper thumbnail of Risk Profile of Thanksgiving Gatherers and Subsequent SARS-CoV2 Testing and Diagnosis

ABSTRACTBackgroundDuring Fall 2020 in the United States (U.S.), despite high COVID-19 case number... more ABSTRACTBackgroundDuring Fall 2020 in the United States (U.S.), despite high COVID-19 case numbers and recommendations from public health officials not to travel and gather with individuals outside one’s household, millions of people gathered for Thanksgiving. The objective of this study was to understand if individuals’ behaviors and risk perceptions influenced their decision to gather, and if they did gather, their subsequent test seeking and diagnoses.MethodsParticipants were part of the CHASING COVID Cohort study - a U.S. national prospective cohort. The study sample consisted of participants who completed routine questionnaires before and after Thanksgiving. Non-pharmaceutical interventions (NPIs) use informed behavioral risk scores and a score of perceived risk of COVID-19 were assigned to each participant. Multinomial logistic regression models were used to assess the association between higher risk behaviors and gathering with other households, and the association of gatheri...

Research paper thumbnail of Spread and sources of information and misinformation about COVID-19 early during the pandemic in a U.S. national cohort study

Background: Early in the pandemic, misinformation about COVID-19 was spread on social media. The ... more Background: Early in the pandemic, misinformation about COVID-19 was spread on social media. The purpose of this study was to describe trusted sources of COVID-19 information and claims seen and believed about COVID-19 early in the pandemic among U.S. adults. Then, we assessed the impact of believing such claims on engaging in personal protective actions (PPA). Methods: We used baseline data from the CHASING COVID Cohort (n = 7,070) collected March 28, 2020 to April 20, 2020 to describe trusted sources of COVID-19 information as well as claims circulating on social media that had been seen and believed. We used Poisson regression to determine the association of believing certain claims with engaging in a higher number of PPA. Results: The top three trusted sources of COVID-19 information were the CDC (67.9%), the WHO (53.7%), and State Health Departments (53.0%). Several COVID-19 claims circulated on social media had been seen, e.g., that the virus was created in a laboratory (54.8%...

Research paper thumbnail of Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment

JMIR Public Health and Surveillance, 2021

Background Inadequate screening and diagnostic testing in the United States throughout the first ... more Background Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. Objective This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. Methods We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identif...

Research paper thumbnail of SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

ABSTRACTBackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via ... more ABSTRACTBackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys.MethodsWe estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion.FindingsAmong the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by Ja...