APHA 2023

Jozkowski, K.N., Crawford, B.L., Hawbaker, A., Parker,E., Golzarri Arroyo, L., Turner, R.C., & Lo, W. (2023, November 12 - November 15). Abortion should be legal, but more difficult to obtain: Examining complexity in people’s attitudes toward abortion legality. American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

National polls and surveys consistently use the same questions to assess people’s abortion attitudes. For instance, for decades Pew has asked whether abortion should be legal in all/most cases or illegal in all/most cases whereas the General Social Survey has asked whether abortion should be legal considering six specific circumstances (e.g., rape, life endangerment). Alternatively, Gallup and Harris have asked whether abortion laws should be more or less strict and whether abortion should be easier or more difficult to obtain, respectively. Although data generated from these surveys individually provide important information regarding people’s attitudes toward abortion legality, if analyzed collectively, they may provide more insight. Using Latent Class Analysis, we examined responses to these commonly asked abortion attitude items collectively to uncover emerging response patterns. Three profiles of participants emerged: (1) 35.0%--abortion should be illegal and more restricted, (2) 35.1%--abortion should be legal and laws should reflect the status quo, and (3) 29.9%--abortion should be legal and more available. Although most participants believed abortion should be legal, most also wanted abortion to be restricted (i.e., status quo; more strict), demonstrating complexity in attitudes toward legal abortion. Such findings may explain why people were content with restrictive laws being passed at the state level, despite claiming to “support” legal abortion. Interpreting endorsement of legal abortion on a survey (e.g., respondents indicating “abortion should be legal”) as “support” for abortion may be inaccurate. More nuanced messaging strategies may be effective for those trying to mobilize people in abortion-related advocacy.

Büyüker, B., Hadfield, J., Bueno, X., Jozkowski, K.N., Crawford, B.L., Turner, R.C. & Lo, W. (2023, November 12 - November 15). Abortion Attitudes Among Latinx in the U.S: Findings from the General Social Survey.  American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Since the 1970s, research has shown that abortion attitudes have remained relatively stable in the U.S. and over time people tend to be more supportive of abortion in some circumstances (i.e., woman’s life endangerment, fetal anomaly, rape/incest) and less supportive in other circumstances (i.e., financial reasons, not being married, does not want any more children). While these trends are mostly true for different races/ethnic groups, the Latinx population tends to be slightly less supportive of abortion than the general population, often with religious beliefs and religious practice influencing people’s attitudes. Few studies, however, focus exclusively on Latinx attitudes toward abortion. In this study, we investigate predictors of abortion attitudes among U.S. Latinx, specifically focusing on education, religion, and political affiliation as common correlates of abortion attitudes. Given that the Latinx community varies in their levels of integration in US culture, we also examine the relationship between acculturation and Latinx abortion attitudes -using language, generational status, and country of origin as proxies. The data for the current study comes from the General Social Survey (GSS; 2006-2018) which uses a nationally representative probability sample of US adults (18 and older). We use a sub-sample of participants who identified as Hispanic or Latino (n = 1,701) and who responded to all related questions on abortion attitude items and the sociodemographic and acculturation variables of interest. Education, church attendance, religious fundamentalism, and generational status are consistent predictors of Latinx abortion attitudes across all circumstances. We will discuss implications of understanding Latinx abortion attitudes.

Learning Outcomes (34 words)
• Discuss how sociodemographic and acculturation variables are associated with abortion attitudes among Latinx population in the U.S.
• Assess how U.S. Latinx attitudes toward abortion might differ based on more endorsed and less endorsed circumstances.
• Describe unique features of U.S. Latinx attitudes toward abortion compared with non-Latinx U.S. adults.

Mena-Meléndez, L., Jozkowski, K.N., Crawford, B.L., Turner, R.C. & Lo, W.  (2023, November 12 - November 15),  Abortion attitudes in a post-Dobbs world: Do people in the U.S. support “forced pregnancies” and how does this vary by pregnancy and life context?  American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Abortion attitudes in the U.S. are commonly assessed through a legality framework—whether abortion should be legal in general or in specific circumstances. With the Supreme Court’s decision in Dobbs v. Jackson, which overturned Roe v. Wade and eliminated the constitutional protection for abortion up to fetal viability, states have or will continue to make abortion illegal. In these states, people who do not want to remain pregnant will have to continue their pregnancy, seek abortion elsewhere, or seek other illegal means for obtaining an abortion. Research assessing public opinion on this first outcome—being forced to maintain pregnancy—is scant. Using survey data collected in 2021 in both English and Spanish (N = 2,489), we assessed the extent that people believe a woman should have to continue a pregnancy when she does not want to remain pregnant (i.e., forced pregnancy). We also assess attitudes toward “forced pregnancies” across 17 different circumstances (e.g., fetal defect, low income, mental health, failed contraception). We weighted data using the 2019 ACS and the GSS and conducted descriptive, correlational, and regression analyses to examine predictors of general support for “forced pregnancies” and predictors across circumstances. Assessing public opinion on “forced pregnancy” is most important post-Dobbs, as public opinion may influence state-level abortion legislations and eventually have implication for abortion access. If the public is not supportive of “forcing” people to continue unwanted pregnancies, this may require policy interventions to provide support for pregnant people in states where abortion is or will be restricted.

Learning Outcomes (52 words)
• Describe the extent that people believe a pregnant person should have to continue a pregnancy when they do not want to remain pregnant
• Evaluate whether people’s opinions vary by the pregnancy and life circumstances of the pregnant person
• Identify predictors of general support for “forced pregnancies” and across pregnancy and life circumstances

Hawbaker,A.K., Paiz, J., Jozkowski, K.N., Turner, R.C., Crawford, B.L. & Lo, W.   (2023, November 12 - November 15).  Legal Means Safe: Americans’ Beliefs about the Medical Expertise and Health Consequences of Abortion Bans among US Adults.   American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Background: Legal abortion in the US results in limited long-term adverse health outcomes for patients. Although some overestimate abortion-related health risks, most Americans and medical providers perceive it as safe. US adults overwhelmingly endorse legal abortion when there are medical risks for the pregnant person and fetus. That Americans trust in the safety of abortions and doctors in diagnosing health risk raises questions about how trust in medicine affects abortion attitudes. We examined medical trust and opinions about abortion legality, asking: How does trust of medical professionals affect beliefs about abortion safety and legality among US adults?

Methods: We used 110 qualitative interviews with English-speaking US adults to examine complexities in abortion attitudes. Interviews were analyzed using Applied Thematic Analysis.

Results: US adults endorse legal abortion for health exceptions--86% support abortion when the pregnant person’s life is endangered. Most respondents (61%) also stated that a physician should be involved in abortion decisions and procedures. Many participants (30%) conceptualized abortion legality as ensuring medical safety and discussed risk for abortions occurring outside formal medical establishments as reasons to maintain legal abortion (28%).

Discussion & Conclusion: For most Americans, legality means medical safety. Public opinion favors maintaining legal abortion specifically due to the safety that formal medicine provides. Our findings suggest explicit trust in formal medicine in the US and demonstrate a widespread belief that making abortion illegal will remove it from the purview of medicine, thus making it dangerous. This has implications for lawmakers as abortion regulations become more restrictive.

Crawford, B.L., Jozkowski, K.N., Turner, R.C., & Lo, W. (2023).  (2023, November 12 - November 15). Abortion identity labels, abortion attitudes, and voting behaviors in the 2020 election.   American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Background: Abortion is multi-faceted social issue sitting at the intersection of politics and reproductive health. Abortion was a contentious issue during both the 2016 and 2020 election cycles, with presidential candidates in both races taking strong stances on the issue, however, the extent that people vote for candidates with abortion in mind is questionable. Abortion attitudes are often framed as dichotomous, with people described as being “pro-life” or “pro-choice,” despite evidence indicating most people hold complex or conflicting attitudes. Using more nuanced measures to assess people’s attitudes toward abortion in relation to voting behavior could provide insight regarding who might be engaged or disengaged regarding abortion.

Study Aim: The purpose of this study is to: (1) assess the relationship between abortion labels,, abortion attitudes, and both voting behaviors (i.e., whether people vote) and voting decisions (i.e., who people vote for) and (2) to specifically examine how more nuanced measures of abortion attitudes may better explain voting decisions in the 2020 presidential election.

Data and Methods: We use data collected from IPSOS’s Knowledge Panel (N=919) and a series of regression models to estimate the relationship between voting behavior, abortion identity labels, and contextual abortion attitudes.

Implications: With the overturning of Roe v. Wade, elections will continue to play a critical role for maintaining or improving abortion access. Understanding if and how abortion identity labels and abortion attitudes are related to voting behaviors and decisions is crucial to mobilizing people to engage in abortion-related activism.

Learning outcome:
(1) Evaluate the relationship between abortion identity labels, abortion attitudes, and voting behavior.
(2) Identify which aspects of abortion attitudes are more strongly related to voting behavior.

Büyüker, B., Bueno, X., Jozkowski, K.N., Crawford, B.L., Turner, R.C. & Lo, W.  (2023, November 12 - November 15). Exploring the Link between Abortion Attitudes and Personal Experience with Abortion, Miscarriage, and Infertility.  American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Reproductive experiences (i.e., miscarriage, abortion, infertility) may be related to people’s attitudes toward abortion. For instance, some people’s attitudes toward abortion are in part built on feelings of empathy and stigma, which may be related to their personal reproductive experiences. Additionally, according to qualitative findings, people cite these reproductive experiences as influencing their attitudes toward abortion. And, consistent with other work, the ways in which these experiences influence attitudes varies based on whether people consider whether abortion should be legal, or their personal moral perspective on abortion. Expanding on this initial work, we explored whether and how people’s reproductive experiences with (1) abortion, (2) miscarriage, and (3) infertility are associated with their attitudes toward abortion legality and morality. We fielded an online survey via Qualtrics’ national panel in 2021 (N = 3,046). Data were collected in English and Spanish, using a non-probability, quota-based sample to increase demographic diversity. Data were weighted using national benchmarks based on the American Community Survey and General Social Survey. Preliminary findings suggest that personal experience with miscarriage is significantly and negatively associated with both attitudes toward abortion legality and morality; this relationship is moderated by gender. Personal experience with abortion and infertility, however, are significantly positively associated with abortion legality, but not associated with attitudes toward abortion morality. Understanding how reproductive health experiences are associated with abortion attitudes will provide key information to health care providers regarding how to assess potential mental health risks associated to abortion stigma.

Learning Outcomes (24 words)
• Discuss how personal reproductive experiences are associated with abortion attitudes.
• Assess how attitudes toward abortion legality and morality might differ based on personal experiences.

Bueno, X., Asamoah, N.A., LaRoche, K.J., Dennis, B., Jozkowski, K.N., Crawford, B.L., Turner, R.C. & Lo, W.  (2023, November 12 - November 15). People’s Perception of Changes in their Abortion Attitudes over the Life Course: A Mixed Methods Approach.    American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

Researchers have not found a strong relationship between abortion attitudes and age, suggesting that attitudes toward abortion are static for some but malleable for others. Little is known about the prevalence, reasons, and directionality of attitude changes. This explanatory sequential mixed methods study investigates people’s perceptions on whether, how, why, and for whom abortion attitudes may have changed over their life course. We qualitatively investigated the reasons that triggered changes in attitudes and quantitatively explored the sociodemographic factors associated with the perceived direction of those changes. Data come from a 2020 online survey completed by 1,501 US adults. Qualitative data were collected from a subsample of 24 survey respondents. Our findings indicate that access to information and knowledge played an important role in changing abortion attitudes across support or opposition. For those who became more opposed to abortion over time, experiencing parenthood was an important trigger for change and family/religious upbringing were key to shaping attitudes. For those who became more supportive, empathy for women was an important trigger for change and disagreeing with or distancing oneself from family/religious upbringing were key to shaping their attitudes. If attitudinal change occurs, becoming more supportive of abortion over the life-course is more common than becoming more opposed, however there are some nuances across age and gender. As the legislative abortion landscape will continue to shift post-Dobbs, our findings provide important implications for understanding the nuances in people’s attitudes toward abortion which may have ramifications for state-level abortion laws, jeopardizing abortion care access.

Learning Outcomes (100 words)
• Discuss how people perceive changes on their abortion attitudes over time
• Discuss to what extent people become more opposed or supportive to abortion over time
• Describe which factors might drive changes toward greater support for or opposition to abortion legality.

Mena-Meléndez, L., Bueno, X., Jozkowski, K.N., Crawford, B.L., Turner, R.C. & Lo, W. (2023, November 12 - November 15). Exploring the Relationship between People’s Knowledge of Pregnancy and Abortion and their Attitudes toward Abortion Legality before and after the Dobbs Decision.   American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

In June 2022, the Supreme Court’s Dobbs vs. Jackson decision overturned Roe v. Wade and eliminated the constitutional protection for abortion up to fetal viability. Thus, state lawmakers are now able to restrict abortion earlier than under Roe, including throughout the pregnancy. Given lawmakers are elected to represent their constituents, it is important to understand how constituents’ knowledge and awareness of reproductive health and abortion laws may be related to their attitudes. Given the transcendence of the Dobbs decision, we ask: (1) are people knowledgeable and aware of pregnancy, abortion, and abortion laws?; (2) how is this knowledge and awareness associated with their attitudes toward legal abortion?; (3) are there differences before and after the Dobbs decision? We collected two waves of survey data, in both English and Spanish, via Ipsos’ KnowledgePanel®. Wave 1 (N=1,014) was collected in June 2022 (before the Dobbs decision) and Wave 2 (N=898) was collected in October-November 2022. We conducted difference-in-difference (DID) analysis comparing respondents’ responses before and after the Dobbs decision to assess the causal effect of the decision on people’s knowledge of pregnancy, abortion, and abortion law and their attitudes toward abortion legality. Assessing this relationship is most important post-Dobbs, as public opinion may influence state-level abortion legislations and eventually have implication for abortion care access. If people have limited or inaccurate knowledge and awareness of reproductive health issues, this may require public policy interventions to inform and raise awareness of accurate information and reduce abortion-related myths and misinformation.

Learning Outcomes (44 words)
• Assess whether people are knowledgeable and aware of reproductive health issues
• Evaluate whether knowledge and awareness of reproductive health issues is related to people’s attitudes and sentiment toward legal abortion
• Identify whether there are differences comparing before and after the Dobbs v. Jackson decision

Hadfield, J.I, Dennis, B., Haus, K., LaRoche, K.J., Jozkowski, K.N., Crawford, B.L., Turner, R.C., & Lo, W. (2023, November 12 - November 15). Emergent Thinking in Attitude Flexibility: Introspection in Qualitative Interviews on Abortion.   American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

The purpose of this study was to explore abortion attitudes centered around participants’ openness/closedness to alternative perspectives. We examined the following question: What influences flexibility in peoples’ abortion attitude?
We interviewed 24 participants in English and Spanish based on preferred language. We approached the study from a critical perspective and used reconstructive analysis to understand openness/closedness in abortion attitudes. As participants described points of fixedness/flexibility in their abortion attitudes, we came to understand the data through an emergent metaphor of “a doorway.” This metaphor allowed us to understand the ways interviewees positioned themselves regarding their own beliefs and which beliefs served to reinforce/relax their openness to alternate perspectives. The “doorway” metaphor was useful in locating complexity in one’s views on abortion, specifically, how the participants took up an open/closed orientation toward their own attitudes.
We found the following themed categories contextualized participants’ abortion attitude flexibility: religion, personal experience, perceived social norms, and moral correctness. These are commonly used themes in abortion attitudes research. Our findings show how the use of metaphor aids in contextualizing the complexity embedded in abortion attitudes and how these themes vary in meaning for many and are not homogenous. Within each theme there were various factors that contributed to either one’s opening or closing of the door to alternative abortion attitudes.
We introduce the critical reconstruction of commonly assessed factors influencing abortion attitudes. The idea that these themes are more complex than currently presented may contribute to understanding how people contextualize abortion research and health implications.
Learning Outcomes:
1. Describe different themes related to the openness and closedness of peoples’ abortion attitudes.
2. Assess the use of metaphor to reconstruct implied narratives related to abortion attitudes.
3. Discuss how qualitative analysis located in metaphor analysis can be used in public health research related to abortion and its social and health implications.

Lo, W., Turner, R.C., Crawford, B.L., & Jozkowski, K.N. (2023, November 12 - November 15). Would people attitude toward abortion be influenced by including gestational length and using different number of response options? A latent structure approach. American Public Health Association (APHA) Annual Meeting, Atlanta, GA.

People’s attitudes toward abortion have shown to fluctuate in the past few decades of survey results. When people are involved in this complex issue and already formed a solid attitude, they would use schema to guide them to make judgments quickly disregarding what extra information provided. However, if people lack a solid attitude toward abortion, they tend to actively interpret events based on the information they receive and the sequence in which the information is presented. In addition, various number of response options could play a critical role in reflecting the degree of changes when items included gestational age. Therefore, the purpose of this study is to investigate the potential design effect on abortion measurement using modified 6 GSS abortion items. First, we recruited 1,673 participants and randomly assigned them to one of five sets of response options with 2, 4, 5, 6, and 7 categories (from strongly agree to strongly disagree). Then, the same set of questions was provided again by adding the gestational length (i.e., in 4 months pregnant) at the end of each question. Since all participants responded to the original GSS items without the gestational length, they might mark responses differently after the extra statement was provided. We used the latent structural equation modeling to analyze the differences between two sets of items and comparing among 5 different response options. The full paper presents a discussion of the findings of these studies within the context of existing research and common practice.