APHA 2021

Crawford, B.L., Jozkowski, K.N., Turner, R.C., Lo, W., LaRoche, K.J., Handley, M.N., Solon, M. (2021, October 24 - October 27). Saying "abortion should not be legal" doesn't mean it should be illegal: The importance of question wording. American Public Health Association (APHA) Annual Meeting, Virtual.

Background: Whenever legislation regarding abortion is proposed, public opinion polls regarding abortion legality are often cited by politicians and media. However, given the complex nature of abortion attitudes, polling data may provide an incomplete picture. The purpose of this study is to assess item wording-- whether asking if abortion should be legal may elicit different responses than asking if abortion should be illegal.

Method: We administered a survey containing two versions of 17 dif ferent abortion questions that asked if abortion should be legal or illegal, and then what the punishment should be for obtaining an illegal abortion to a national sample of English and Spanish speaking adults in the U.S. (N=3000). After identifying concordant and dissonant response pairings across the legality and illegality questions, we compared the severity of endorsed punishments to contextualize our findings.

Results: Between 34-42% of answer pairs for each question were dissonant. Overall, people were more likely to say that abortion should not be legal than to say abortion should be illegal. Compared with concordant answer pairs, people who responded with dissonant pairs indicated less severe punishment.

Conclusion: Our findings suggest that even among those who say abortion should not be legal, there are varying levels of support for making abortion illegal. Furthermore, those who indicate abortion should not be legal but also not illegal endorsed less severe punishments than those who said abortion should be illegal. This suggests that public support for making abortion illegal may vary depending on how the question is phrased. 

Hadfield, J.I., LaRoche, K.J., Jozkowski, K.N., Crawford, B.L., Turner, R.C., Lo, W. (2021, October 24 - October 27). Examining racial and ethnic differences in attitudes toward legal abortion in cases of endangered mental health for pregnant women: Insights from a US national survey. American Public Health Association (APHA) Annual Meeting, Virtual.

Abstract: Little research has investigated the attitudes of U.S. adults toward abortion when the pregnant person's mental health is threatened. To address this gap, we explored how race-ethnicity, alongside other demographic characteristics, are associated with attitudes in this circumstance. We administered a web-based survey in English and Spanish to a national sample of 1,583 participants. The outcome variable asked if abortion should be legal when a woman's mental health is at risk and was measured by five response options ("definitely legal" to "definitely illegal"); we used race, education, and religious attendance as predictor variables. Ordinal logistic regression with partial proportional odds model was used to examine perception of whether people agree with abortion being legal when a woman's mental health is at risk during pregnancy. Overall, 63.5% of the sample thought abortion should be "definitely" or "probably" legal when a woman's mental health is endangered. Participants with higher educational attainment and lower participation in religious services have higher agreement that abortion should be legal when a woman's mental health is at risk, and participants identifying as white have significantly lower endorsement compared with participants identifying as Black, Hispanic, or Asian in this circumstance. Demographic characteristics associated with support for legal abortion when there is a threat to mental health are largely consistent with what previous research has associated with support for legal abortion in general. However, subgroup differences by race-ethnicity might shed light on previously inconsistent findings about race and abortion attitudes.

Hadfield, J.I., Turner, R.C., Lo, W., Valdez, D., Crawford, B.L., Jozkowski, K.N. (2021, October 24 - October 27). Examining how reproductive health experiences and socio-demographics effect US latinx beliefs regarding abortion when the woman's mental health is endangered. American Public Health Association (APHA) Annual Meeting, Virtual.

Abstract: Reproductive health experiences shape abortion attitudes, have been associated with mental health outcomes, and may impact support for legal abortion when a woman's mental health is at risk. The U.S. Latinx perception of mental health may differ from other populations and in turn may impact health and beliefs. This study analyzes how Latinx socio-demographic factors and reproductive health experiences relate to U.S. Latinx abortion beliefs towards support for abortion when a woman's mental health is endangered. We administered a web-based survey in English and Spanish to a national sample of n=521 Latinx participants. The outcome variable asked participants if abortion should be legal when the woman's mental health is at risk. We used reproductive health experience measures and Latinx socio-demographic factors as predictor variables. Multinomial logistic regression was used to investigate perceptions of whether abortion should be legal in situations where a woman's mental health is endangered. Demographic factors of gender, age, and educational attainment were not significantly related to support for abortion in this circumstance, nor were Latinx-related variables of country of birth and cultural group identity. The two variables significantly related to abortion legality in situations of mental health endangerment were religious attendance and prior abortion experience. These factors have previously been associated with support for abortion in other subpopulations. However, their relationship with abortion support in the context of endangered mental health among US Latinx may illuminate salient factors toward abortion and mental health within the largest ethnic-minority population in the US.

*Jackson, F., Montenegro, M.S., Lo, W., Maier, J.M., Marcantonio, T.L., Turner, R.C., Crawford, B.L., Jozkowski, K.N. (2021, October 24 - October 27). Examining social attitudes toward government's involvement in abortion. American Public Health Association (APHA) Annual Meeting, Virtual.

Abstract: In 2019, many states restricted or expanded access to abortion in the U.S. Despite this increase in abortion legislation, how U.S. adults perceive the government's involvement in abortion is unclear. Data were collected from a representative sample of English and Spanish-speaking adults living in the U.S. (N = 1359). We examine whether government involvement in abortion should be more, less, or remain the same. The independent variables were demographic factors (e.g., language and living location), attitudes toward abortion, and circumstances related to whether participants support or oppose abortion laws. An ordinal logistic regression was used to determine which characteristics were associated with U.S. adults' perception of government involvement in abortion. Rural and suburban residents as well as participants endorsing pro-choice positions were less likely to support government involvement than urban dwellers and participants identifying as pro-lifers. Compared with English-speaking adults, Spanish speakers were twice as likely to support government involvement (RR = 2.18). As participants' support for more restrictive abortion laws increased, they were more likely to support more government involvement. Not surprisingly, as participants' support for more protective abortion laws increased, they were more likely to support less government involvement. Language, place of residence, and abortion identity appear to have an effect on participants' attitudes toward government involvement in abortion. Participants' views of current abortion legislation influence their belief about the level of government involvement in abortion. Researchers may examine how perceptions toward the government's involvement in abortion influence abortion attitudes.

Jozkowski, K.N., LaRoche, K.N., Crawford, B.L., Handley, M.N., Solon, M., Turner, R.C Lo, W. (2021, October 24 - October 27). Attitudes toward abortion: Differential response patterns when assessing abortion legality, illegality, and having to continue a pregnancy. American Public Health Association (APHA) Annual Meeting, Virtual.

Background: Abortion attitudes are commonly assessed by asking whether people believe abortion should be legal under different circumstances. However, item wording can significantly impact response patterns. The purpose of this study was to compare response patterns in abortion attitudes when assessing: (1) abortion legality, (2) abortion illegality, and (3) if a woman should have to continue a pregnancy.

Method: We administered three sets of sixteen abortion attitude items modified from items on the General Social Survey to a national sample of English- and Spanish-speaking US adults (N=3000). We compared responses to sets whose question stems asked about abortion legality, abortion illegality, and whether a woman who does not want to remain pregnant should have to continue the pregnancy, respectively. Participants were randomly assigned to which block of questions they received first.

Results: Disregarding circumstance, approximately 30% of participants indicated that a woman should have to remain pregnant. Participants were least likely to support abortion in this condition compared with item sets asking about abortion legality and illegality. The most permissive attitudes occurred in response to the legality items, however there was greater variability across circumstances for this item set than the other two.

Conclusion: Our findings suggest people are more inclined to think a woman should have to remain pregnant than they are to endorse restricting legal abortion. Such findings may support discourse that abortion is considered unfavorable but should remain legal. Continued legislative efforts to restrict abortion may not reflect public sentiment and potentially result in negative health outcomes.

Jozkowski, K.N., LaRoche, K.N., Solon, M., Montenegro, M.S., Maier, J.M., Crawford, B.L., Turner, R.C., Lo, W. (2021, October 24 - October 27) Using the reasoned action approach to guide measurement of abortion beliefs. American Public Health Association (APHA) Annual Meeting, Virtual.

According to the Reasoned Action Approach (RAA), the most readily accessible beliefs regarding a behavior are important to identify via a salient belief elicitation (SBE). SBE is a formative, open-ended research technique used to elicit people's top of the mind behavioral (i.e., perceived positive and negative consequences of doing a behavior), normative (i.e., influence of important people and peers regarding a behavior), and control (i.e., perceived facilitators and barriers associated with a behavior) beliefs regarding a particular behavior. Using RAA's framework, we administered a SBE to English- and Spanish-speaking US adults to better understand people's beliefs regarding abortion. Because this procedure has not been used to assess abortion, we first piloted our instrument with an online survey (N=172) and cognitivenitive interviews (N = 72). We then administered the revised SBE to a nationally representative, probability-based sample of US adults (N = 609). We used inductive content and thematic analyses to assess data. We found that people tended to provide negative consequences (behavioral beliefs) and barriers (control beliefs) more readily such as negative emotions (e.g., shame, guilt). However, people also mentioned positive consequences of abortion (behavioral beliefs) focused on autonomy (e.g., control family size). Personal autonomy also emerged as a salient issue regarding normative beliefs as people commonly indicated the person seeking abortion as a salient referent. This finding contrast research regarding other health behaviors in which people rarely indicate the person engaging in the behavior as a referent. We will discuss implications for improved measurement of abortion beliefs.

LaRoche, K.J., Jozkowski, K.N., Crawford, B.L., *Haus, K.R., Turner, R.C., Lo, W. (2021, October 24 - October 27) "because we can't tell the truth over telemedicine": Documenting US adults' perceptions of using telemedicine for medication abortion during COVID-19. American Public Health Association (APHA) Annual Meeting, Virtual.

Objectives: Global evidence has demonstrated that medication abortion can safely and effectively be provided via telemedicine, and that this modality is highly acceptable to patients. Yet, little research has focused on how the general public perceives this modality of abortion provision. Influenced by the onset of the COVID-19 pandemic, we aimed to explore public opinion about, providing medication abortion through telemedicine.

Study design: In a nationally representative, web-based survey of US adults (n=715), we asked participants open- and closed-ended questions about using telemedicine to prescribe medication abortion during the pandemic. We conducted content and thematic analyses on the open-ended data to explore factors that influenced participants' opinions.

Results: Fully, 44% of participants supported the use of telemedicine for medication abortion during the pandemic; 35% opposed, and 21% were unsure. In the open-ended responses, 36% specifically mentioned telemedicine; responses were equally split about whether telemedicine was equivalent or inferior to in-person care. Participants identified that telemedicine may facilitate faster access to care, but thought that services may be less personal or emotionally supportive. Some (8%) participants were opposed to the use of telemedicine for abortion specifically, and many open-ended responses indicated a lack of knowledge about telemedicine processes for abortion.

Conclusions: More participants supported the use of telemedicine for medication abortion during the pandemic than opposed it. As the use of telemedicine becomes more commonplace for a variety of medical services, developing strategies to ensure that virtual visits feel equally legitimate and supportive to patients as in-person visits appear warranted.

Learning objectives:
• Describe how telemedicine can be used for to provide medication abortion care
• Discuss attitudes of US adults' toward using telemedicine to provide medication abortion during the COVID-19 pandemic
• Identify concerns US adults may have about using this health service delivery strategy

Montenegro, M.S., Maier, J.M., Marcantonio, T.L., Crawford, B.L., Turner, R.C., Lo, W., Jozkowski, K.N., Valdez, D. (2021, October 24 - October 27). "distinct and separate issues": Examining US adults' attitudes toward abortion during COVID-19. American Public Health Association (APHA) Annual Meeting, Virtual.

Background: The COVID-19 pandemic has reshaped people's social realities, including access to abortion. It is unclear if public abortion attitudes have been affected by these changes. This presentation examines if the pandemic has changed participants' attitudes toward abortion and why their support for abortion has increased, decreased, or remained the same.

Method: We administered a web-based survey to US-based English and Spanish-speaking adults (n= 1583) to assess their abortion beliefs. Participants answered open and close-ended questions about abortion, including whether the pandemic has changed their views about abortion and why. We conducted a multinomial logistic regression to examine the influence of demographic correlates on participants' responses and a content analysis of open-ended responses to determine why attitudes may or may not have changed.

Results: Most participants (91.7%) indicated that COVID-19 did not affect their abortion views. Pro-choice participants were more likely to say COVID-19 increased their support for abortion, while pro-life participants were more likely to say their support has decreased. For participants, whose views did not change, many did not see a relationship between COVID-19 and abortion. Participants who became more supportive (5%) cited concerns for the fetus and mothers' well-being, financial issues, and the importance of access to healthcare. Participants' who became less supportive (3.3%) emphasized how the pandemic highlighted the sanctity of life.

Conclusion: While COVID-19 has increased and decreased some participants' support toward abortion, most participant's views have not changed, suggesting that the pandemic did not have a substantial influence on most participants' abortion attitudes.

Learning Objectives:
Understand participants' abortion attitudes due to COVID-19.
Understand what characteristics are associated with participants' change in attitudes toward abortion during COVID-19.

Valdez, D., Crawford, B.L., Lo, W., Turner, R.C., Jozkowski, K.N. (2021, October 24 - October 27). Abortion in a public health context: A decade-wide scoping review of abortion research. American Public Health Association (APHA) Annual Meeting, Virtual.

Background: Abortion is a critical public health topic. Since Roe v. Wade, abortion science has greatly evolved to encompass the complexity of abortion as a medical, sociological, and psychological issue. Yet, scoping reviews of abortion-related research to identify themes over time is lacking.
Purpose: This study is a scoping review of abortion articles published in Public Health, Health Education, and Health Promotion journals over a ten-year period (2010-2020).

Methods: We leveraged institutional library servers to archive publication histories of 10 leading Public Health, Health Education, and Health Promotion journals. We reviewed each journal and isolated articles about 'abortion'. Three researchers qualitatively reviewed abortion-related articles and classified each into one of several themes. We used Cohen's Kappa (k) to assess inter-rater reliability.

Results: Across 10 years of abortion research in Public Health journals we identified (n=59) articles, which were classified into one of seven themes: (1) Reproductive Justice (n=9), (2) Abortion & Healthcare (n=7), (3) Unplanned Pregnancies (n=2), (4) Medication Abortion (n=3), (5) International Abortion (n=15), (6) Commentaries (n=8), and (7) Abortion Consequences (n=15).

Discussion & Conclusion: Our findings highlight the complexity of Public Health abortion research over the last decade. Most public health abortion research dichotomously emphasizes reproductive justice (positive abortion stances), and abortion consequences (often framed as negative health outcomes). These findings underscore the divisive nature of abortion as a critical public health issue, which is most often discussed within the realm of Public Opinion. However, research about abortion may be equally divisive and contentious.