Project Summary/Abstract
The proposed research will provide a methodological framework for investigating the impact of policy (i.e., lag-
time, mechanism, and equity) on population health while contributing to the evaluation of the Affordable Care
Act (ACA) by assessing the impact of the ACA on one aspect of reproductive health, unintended pregnancy. The
first specific aim of the project is to assess the impact of the ACA on unintended pregnancy. Within this aim, I
will a) estimate the effect of the ACA on unintended pregnancy, and determine the lag period that precedes this
effect, and b) determine whether the effect of the ACA on unintended pregnancy is mediated by access and/or
affordability of contraceptives – and if so, which was more strongly impacted by the ACA. The second specific
aim of the project is to assess whether the impact of the ACA on unintended pregnancy was equitable by
comparing the effect of the ACA on unintended pregnancy between women of varying race/ethnicity and
socioeconomic status. Aims 1 and 2 will be achieved by using cross-sectional data from multiple years (i.e.,
2006-2019) of the National Survey of Family Growth, and an innovative analytic approach that combines
epidemiological, time-series, and econometric methods. This work is significant because it will provide a
methodological framework for future studies to investigate the health effects of policy while also informing current
debates regarding the expansion, reformation, or repeal of the ACA. The applicant, Colleen MacCallum, has an
MS in Biostatistics, is currently pursuing a PhD in Epidemiology at MSU, and is uniquely positioned for this
fellowship because of her previous work investigating the impact of the ACA contraception mandate on
unintended pregnancy, and her strong analytic background – on which she can build additional skills in
econometric methods and mediation analysis. This F31 award will provide the applicant with interdisciplinary
training in: 1) public policy, 2) econometric methods for policy evaluation, and 3) causal mediation analysis.
Training activities will include courses, workshops, and seminar series. The proposed fellowship will be
implemented in the Department of Epidemiology and Biostatistics at MSU, which is an ideal training environment
due to the department’s strengths in women’s health and its strong history of mentoring and interdisciplinary
collaboration. This fellowship will be mentored by: Dr. Claire Margerison (sponsor, expertise in policy impacts on
women’s health), Dr. Claudia Holzman (co-sponsor, expertise in women’s health and long track record of
successful mentoring), Dr. Robert Kaestner (collaborator, expertise in health policy and econometrics), Dr.
Zhehui Luo (collaborator, expertise in causal inference and econometrics), and Dr. Tim Bruckner (consultant,
expertise in time series modelling and health policy analysis). The proposed fellowship will equip the applicant
with substantive knowledge, analytic tools, and professional competencies necessary to achieve her long-term
goal of leading independent investigations to evaluate the impact of policy on population health and health equity.
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