Population Research Center (PRC)

Permanent URI for this communityhttps://hdl.handle.net/2152/41676

The University of Texas at Austin Population Research Center (PRC) aims to provide outstanding infrastructure resources and sustain a dynamic interdisciplinary culture geared toward facilitating the highest level of population-related research among its faculty members and graduate and undergraduate trainees. The PRC supports research that moves well beyond the bounds of traditional demography to the cutting edge of population research. Our researchers' projects focus primarily on health disparities, parenting, partnering and human development, educational inequality and opportunity, and socioeconomic inequality and work.

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Cutting Family Planning in Texas
(2012-09-27) White, K.; Grossman, D.; Hopkins, K.; Potter, J.
Recently, efforts to expand access to contraception through the Affordable Care Act ignited a broad debate regarding the proper role of government in this sphere, and proposals have been put forth to eliminate Title X. In 2011, Texas cut funding for family planning services by two thirds. The Texas legislature also imposed new restrictions on abortion care and reauthorized the exclusion of organizations affiliated with abortion providers from participation in the state Medicaid waiver program, the Women's Health Program (WHP). To implement the legislation and funding cuts, the Texas Department of State Health Services reduced the number of funded family planning organizations from 76 to 41. As part of a comprehensive 3-year evaluation of the legislative changes to family planning policy in Texas, we interviewed 56 leaders of organizations throughout the state that provided reproductive health services using Title X and other public funding before the cuts went into effect. We found that funding cuts led to the closure of 53 clinics and reduced hours at an additional 38. In addition, we found that providers restricted access to the most effective contraceptive methods and implemented systems that require clients to pay for services if they do not qualify for the WHP. Ostensibly, the purpose of the law was to defund Planned Parenthood in an attempt to limit access to abortion, even though federal and state funding cannot be used for abortion care. Instead, these policies are limiting women's access to a range of preventive reproductive health services and screenings
Hypertension among Oral Contraceptive Users in El Paso, Texas
(2013) White, Kari; Potter, Joseph E.; Amastae, Jon; Grossman, Daniel
On the U.S.-Mexico border, residents frequently cross into Mexico to obtain medications or medical care. We previously reported relatively high prevalence of hypertension among Latina oral contraceptive users in El Paso, particularly those obtaining pills over the counter (OTC) in Mexico. Here, we examine factors associated with having hypertension among 411 OTC users and 399 clinic users. We also assess hypertension awareness and interest in using blood pressure kiosks. Women age 35 to 44 and who had BMI ≥ 30 kg/m2 had higher odds of having hypertension. 59% of hypertensive women had unrecognized hypertension, and 77% of all participants would use a blood pressure kiosk; there were no significant differences between clinic and OTC users. Alternative approaches to increase access to health screenings are needed in this setting, where OTC pill use among women with unrecognized hypertension confers unique health risks
Attitudes Surrounding Contraceptive Responsibility: Do Latino Youth Differ from Other Groups?
(2013) White, Kari; Hopkins, Kristine; Schiefelbein, Emily
Recent estimates demonstrate that more than 75% of young women and men ages 15 to 19 used contraception at first sex and their most recent intercourse. However, there are notable disparities in contraceptive use by race/ethnicity. Female and male Latino adolescents are less likely than African American and white teens to report contraceptive use at first sex. In addition, Latino adolescents are less likely to report using condoms at last intercourse (54.9%) compared to African Americans (62.4%) and whites (63.3%) and were also less likely than whites to state they used hormonal methods (14.0% compared to 29.3% among whites). These lower rates of contraceptive use may be due, in part, to differences in attitudes about contraceptive decision-making. Several studies have noted that Latinos report that women are primarily responsible for contraception and preventing pregnancy, which is associated with less effective method use compared to when both partners are responsible for deciding on contraception. However, it is not clear whether attitudes placing responsibility for contraceptive use on women are more widely endorsed among Latinos compared to other racial/ethnic groups. Some of these studies have only included Latinos, and others that assessed attitudes across racial/ethnic groups found few differences. Additionally, little is known about the underlying beliefs and values that shape ideas about which partner or partners have responsibility for contraception and how these might vary by race/ethnicity. Such information is important in order to identify target areas for interventions that promote shared decision-making, and therefore increase effective use of contraception. In this study, we explore youths’ attitudes toward contraceptive responsibility. The specific questions we address are: Which partner is usually responsible for contraception and why? How do these attitudes and beliefs vary, if at all, across racial/ethnic groups and gender? To answer these questions we used data collected from focus groups with Latino, African American and white young women and men. Focus groups are particularly well-suited for the study of this topic because they highlight values and norms within groups sharing similar characteristics, as well as identify beliefs underlying attitudes and behaviors.
DEMOGRAPHIC RESEARCH
(2013-06-11) White, Kari L.; Potter, Joseph E.
Background: Mexican women in the United States (US) have higher rates of fertility compared to other ethnic groups and women in Mexico. Whether variation in women’s access to family planning services or patterns of contraceptive use contributes to this higher fertility has received little attention. Objective: We explore Mexican women’s contraceptive use, taking into account women’s place in the reproductive life course. Methods: Using nationally representative samples from the US (National Survey of Family Growth) and Mexico (Encuesta National de la Dinámica Demográfica), we compared the parity-specific frequency of contraceptive use and fertility intentions for non-migrant women, foreign-born Mexicans in the US, US-born Mexicans, and whites. Results: Mexican women in the US were less likely to use IUDs and more likely to use hormonal contraception than women in Mexico. Female sterilization was the most common method among higher parity women in both the US and Mexico, however, foreign-born Mexicans were less likely to be sterilized, and the least likely to use any permanent contraceptive method. Although foreign-born Mexicans were slightly less likely to report that they did not want more children, differences in method use remained after controlling for women’s fertility intentions
Medicaid Policy on Sterilization — Anachronistic or Still Relevant?
(2014) Borrero, Sonya; Zite, Nikki; Potter, Joseph E.; Trussell, James
Female sterilization, typically accomplished by means of tubal ligation, is a widely used method of contraception that is highly effective at preventing unintended pregnancy. Yet there appears to be unmet demand for the procedure in certain segments of the U.S. population. Specifically, low-income women and women from minority racial and ethnic groups may face substantial system-level barriers to obtaining a desired sterilization procedure. One such barrier is the federal policy regarding Medicaid-funded sterilizations. Although this policy was designed to protect vulnerable populations, we believe that it does not effectively fulfill that intention — in fact, it restricts the reproductive autonomy of the women it intends to serve. With the upcoming Medicaid expansions, the number of women affected by these barriers could increase substantially.
Recent Advances in Contraception
(2014) Aiken, Abigail R.A.; Trussell, James
Focusing on intrauterine contraceptives (IUC), contraceptive implants, and emergency contraceptives, we review recent advances in contraceptive development and discuss progress in policies to improve access to the most effective methods. We report on the shift in practice towards routinely providing IUCs and implants to young and nulliparous women, prompted in part by the reduced diameter of the insertion tube for the Mirena IUC and the development of a smaller IUC called Skyla. Additionally, we describe the new SCu300A intrauterine ball and the development of an implant called Nexplanon, which comes with a preloaded inserter. We also discuss the efficacy of ulipristal acetate versus levonorgestrel for emergency contraception, especially for women who weigh more than 75 kg. Finally, in light of the increasing interest in providing IUCs and implants to women in the immediate postpartum and post-abortion periods, we consider the rationale for this change in practice and review the progress that has been made so far in the United States.
Changes in Use of County Public Health Services Following Implementation of Alabama’s Immigration Law
(2014) White, Kari; Blackburn, Justin; Manzella, Bryn; Welty, Elisabeth; Menachemi, Nir
Several states have enacted legislation restricting undocumented immigrants' access to publicly funded health benefits not protected by federal law. Using electronic health records from 140,856 county health department visits, we assessed the monthly change in Latino patients' visits compared to non-Latinos 12 months before and after implementation of Alabama's immigration law. We used ICD-9 diagnosis codes to determine whether visits included services exempt under the law: immunizations, testing and treatment for sexually transmitted infections (STIs) and communicable diseases, and family planning. Differences between groups in the mean percent change were assessed with t-tests. Among children younger than 18 years, there were no significant differences by ethnicity. Visits among Latino adults decreased by 28% for communicable diseases, 25% for STIs, and 13% for family planning; this was significantly different from changes among non-Latino adults (p <.05). State-level legislation may reduce immigrants' access to protected benefits, which could adversely affect the broader public's health.
Rapidly Changing Access to Abortion in Texas
(2014-06) The University of Texas at Austin, Texas Policy Evaluation Project
Women’s Experiences Seeking Publicly Funded Family Planning Services in Texas
(2015-01-30) Hopkins, Kristine; White, Kari; Linkin, Fran; Hubert, Celia; Grossman, Daniel; Potter, Joseph E.
Little is known about low-income women's and teenagers’ experiences accessing publicly funded family planning services, particularly after policy changes are made that affect the cost of and access to such services. Eleven focus groups were conducted with 92 adult women and 15 teenagers in nine Texas metropolitan areas in July–October 2012, a year after legislation that reduced access to subsidized family planning was enacted. Although most women were not aware of the legislative changes, they reported that in the past year, they had had to pay more for previously free or low-cost services, use less effective contraceptive methods or forgo care. They also indicated that accessing affordable family planning services had long been difficult, that applying and qualifying for programs was a challenge and that obtaining family planning care was harder than obtaining pregnancy-related care. As a result of an inadequate reproductive health safety net, women experienced unplanned pregnancies and were unable to access screening services and follow-up care. Teenagers experienced an additional barrier, the need to obtain parental consent. Some women preferred to receive family planning services from specialized providers, while others preferred more comprehensive care. Women in Texas have long faced challenges in obtaining subsidized family planning services. Legislation that reduced access to family planning services for low-income women and teenagers appears to have added to those challenges.
Abortion Wait Times in Texas: The Shrinking Capacity of Facilities and the Potential Impact of Closing Non-ASC Clinics
(2015-10-05) The University of Texas at Austin, Texas Policy Evaluation Project
TxPEP-Research-Brief-KnowledgeOpinionExperience
(2015-11-17) Grossman, D.; White, K.; Fuentes, L.; Hopkins, K.; Stevenson, A.; Yeatman, S.; Potter, J.
Texas Women's Experiences Attempting Self-Induced Abortion in the Face of Dwindling Options
(2015-11-17) The University of Texas at Austin, Texas Policy Evaluation Project
Perceived Interest in Vasectomy among Mexican-Origin Women and Their Partners in a Community with Limited Access to Female Sterilization
(2016) Hubert, Celia; White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E.
The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners’ perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners’ perceived interest. Additionally, we conducted two focus groups on men’s knowledge and attitudes about vasectomy with partners of a subsample of these women. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men.
Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts?
(2016) Aiken, Abigail R.A.; Borrero, Sonya; Callegari, Lisa S.; Dehlendorf, Christine
Approximately half of pregnancies occurring each year in the United States are unintended: They either occurred too soon or were not intended at any time. This commonly cited statistic is testament to the dominance of unintended pregnancy as a public health benchmark for measuring and improving women's reproductive health. In addition to its use as a public health metric, this timing-based definition of unintended pregnancy is reflected in pregnancy planning paradigms in clinical practice. According to these paradigms, women are expected to map out their intentions regarding whether and when to conceive, and to formulate specific plans to follow through on their intentions. What can researchers, public health practitioners and clinicians engaged in efforts to reduce unintended pregnancy and improve pregnancy outcomes do in response to these limitations? As a first step, we propose a conceptual model that integrates insights from recent research and provides a framework for informing women-centered approaches to preventing undesired pregnancies and improving outcomes
Effect of Removal of Planned Parenthood from the Texas Women's Health Program
(2016-02-03) Stevenson, A.; Flores-Vazquez, I.; Allgeyer, R.; Schenkkan, P.; Potter, J.
Background: Texas is one of several states that have barred Planned Parenthood affiliates from providing health care services with the use of public funds. After the federal government refused to allow (and courts blocked) the exclusion of Planned Parenthood affiliates from the Texas Medicaid fee-for-service family-planning program, Texas excluded them from a state-funded replacement program, effective January 1, 2013. We assessed rates of contraceptive-method provision, method continuation through the program, and childbirth covered by Medicaid before and after the Planned Parenthood exclusion. Methods: We used all program claims from 2011 through 2014 to examine changes in the number of claims for contraceptives according to method for 2 years before and 2 years after the exclusion. Among women using injectable contraceptives at baseline, we observed rates of contraceptive continuation through the program and of childbirth covered by Medicaid. We used the difference-in-differences method to compare outcomes in counties with Planned Parenthood affiliates with outcomes in those without such affiliates. Results: After the Planned Parenthood exclusion, there were estimated reductions in the number of claims from 1042 to 672 (relative reduction, 35.5%) for long-acting, reversible contraceptives and from 6832 to 4708 (relative reduction, 31.1%) for injectable contraceptives (P<0.001 for both comparisons). There was no significant change in the number of claims for short-acting hormonal contraceptive methods during this period. Among women using injectable contraceptives, the percentage of women who returned for a subsequent on-time contraceptive injection decreased from 56.9% among those whose subsequent injections were due before the exclusion to 37.7% among those whose subsequent injections were due after the exclusion in the counties with Planned Parenthood affiliates but increased from 54.9% to 58.5% in the counties without such affiliates (estimated difference in differences in counties with affiliates as compared with those without affiliates, −22.9 percentage points; P<0.001). During this period in counties with Planned Parenthood affiliates, the rate of childbirth covered by Medicaid increased by 1.9 percentage points (a relative increase of 27.1% from baseline) within 18 months after the claim (P = 0.01). Conclusions: The exclusion of Planned Parenthood affiliates from a state-funded replacement for a Medicaid fee-forservice program in Texas was associated with adverse changes in the provision of contraception. For women using injectable contraceptives, there was a reduction in the rate of contraceptive continuation and an increase in the rate of childbirth covered by Medicaid.
Density of abortion facilities in the four largest US cities
(2016-02-29) The University of Texas at Austin, Texas Policy Evaluation Project
Change in number of physicians providing abortion care in Texas after HB2
(2016-02-29) The University of Texas at Austin, Texas Policy Evaluation Project
Impact of HB2 Abortion Clinic Closures on Texas Women
(2016-03) The University of Texas at Austin, Texas Project Evaluation Project
How Can Improving Data Collection and Reporting Advance the Civil Rights of LGBT Students?
(University of Texas at Austin Population Research Center, 2016-03) Russell, Stephen
How Do Potential New Employers Evaluate Workers in Part-Time Jobs, “Temp” Jobs, or Jobs Beneath Their Skill Level?
(University of Texas at Austin Population Research Center, 2016-04) Pedulla, David

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