Unwanted sexual activity among United States women early in the COVID-19 pandemic.

BACKGROUND: Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. OBJECTIVE: This study aimed to describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among US women early in the COVID-19 pandemic. STUDY DESIGN: The National US Women's Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3200 English-speaking women (88% cooperation rate) aged 18 to 90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely, racial and ethnic subgroups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying "how the coronavirus pandemic is affecting your sex life" were assessed using conventional content analysis. Logistic regression analyses-adjusting for sociodemographic characteristics, self-reported health, and prepandemic health-related socioeconomic risk factors, including food insecurity, housing instability, utilities and transportation difficulties, and interpersonal violence-were used to model the odds of unwanted sex by a pandemic-related change in health-related socioeconomic risk factors. RESULTS: The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about the transmission of the virus because of sex, and having sex to meet the partner's needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4-10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7-4.3). CONCLUSION: More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.

Unwanted Sexual Activity among U.S. Women early in the COVID-19 Pandemic

Background Female sexual activity and, accordingly, birth rates, tend to decline in times of stress, such as a pandemic. Additionally, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. Objective To describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among U.S. women early in the COVID-19 pandemic. Study Design The National U.S. Women’s Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3,200 English-speaking women (88% cooperation rate) ages 18-90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely racial and ethnic sub-groups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying “how the coronavirus pandemic is affecting your sex life” were assessed using conventional content analysis. Logistic regression analyses - adjusting for sociodemographic characteristics, self-reported health and pre-pandemic health-related socioeconomic risk factors (HRSRs), including food insecurity, housing instability, utilities and transportation difficulties and interpersonal violence - were used to model the odds of unwanted sex by pandemic-related change in HRSRs. Results The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months pre-pandemic (52%), although 7% became active and 7% became inactive. Eleven percent of sexually active women were having unwanted sex in the early pandemic. Rates of anxiety, depression, traumatic stress symptoms and each of the five HRSRs assessed were about 2 times higher among women having unwanted sex compared to others (p-values <0.001). Women having unwanted sex were also 5 times more likely than others to report increased frequency of sex since the pandemic (65% vs 13%, p<0.001) and 6 times more likely to be using emergency contraception (18% vs 3%, p<0.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about transmission of the virus due to sex, and having sex to meet the partner's needs. Among sexually active women, odds of unwanted sex (adjusting for demographic, reproductive and health factors) were higher among women with one (aOR 2.0, 95% CI 1.1, 3.8) and two or more pre-pandemic HRSRs (aOR 6.0, 95% CI 3.4, 10.6). Among sexually active women with any pre-pandemic HRSRs, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (aOR 2.7, 95% CI 1.7, 4.3). Conclusions More than one in ten sexually active U.S. women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems due to the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.

COVID-19-Related Food Insecurity Among Households with Dietary Restrictions: A National Survey.

BACKGROUND: Food insecurity dramatically increased because of the COVID-19 pandemic; however, little is known about pandemic-related food insecurity in households with dietary restrictions. OBJECTIVE: To examine pre-pandemic rates of and pandemic-related change in food insecurity among households with and without dietary restrictions. METHODS: A cross-sectional, panel-based survey of 3200 U.S. women was conducted in April 2020. Pre-pandemic food insecurity and early pandemic-related change in food insecurity were assessed using the adapted Hunger Vital Sign. Weighted, multivariate logistic regression was used to model the odds of pre-pandemic food insecurity and the odds of incident or worsening pandemic-related food insecurity among households with and without dietary restrictions. In models predicting pandemic-related outcomes, interaction effects between race/ethnicity and dietary restrictions were examined. RESULTS: Before the COVID-19 pandemic, households with self-reported food allergy (adjusted odds ratio [aOR]: 1.5, 95% confidence interval [CI]: 1.2-1.9), celiac disease (aOR: 2.3, 95% CI: 1.4-3.5), or both (aOR: 2.1, 95% CI: 1.2-3.6) were significantly more likely to be food insecure than households without restrictions. Households with dietary restrictions were also significantly more likely to experience incident or worsening food insecurity during the early pandemic (food allergy: aOR: 1.6, 95% CI: 1.3-2.1) (celiac disease: aOR: 2.3, 95% CI: 1.5-3.5) (both: aOR: 2.0, 95% CI: 1.2-3.4). Race/ethnicity was not a significant moderator of the relationship between dietary restrictions and pandemic-related food insecurity. CONCLUSION: Households with dietary restrictions were more likely to experience both pre-pandemic and pandemic-related incident or worsening food insecurity than households without restrictions. Clinical care for patients with dietary restrictions requires attention to food insecurity.

Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago.

PURPOSE: To describe coronavirus disease 2019 (COVID-19) mortality in Chicago during the spring of 2020 and identify at the census-tract level neighborhood characteristics that were associated with higher COVID-19 mortality rates. METHODS: Using Poisson regression and regularized linear regression (elastic net), we evaluated the association between neighborhood characteristics and COVID-19 mortality rates in Chicago through July 22 (2514 deaths across 795 populated census tracts). RESULTS: Black residents (31% of the population) accounted for 42% of COVID-19 deaths. Deaths among Hispanic/Latino residents occurred at a younger age (63 years, compared with 71 for white residents). Regarding residential setting, 52% of deaths among white residents occurred inside nursing homes, compared with 35% of deaths among black residents and 17% among Hispanic/Latino residents. Higher COVID-19 mortality was seen in neighborhoods with heightened barriers to social distancing and low health insurance coverage. Neighborhoods with a higher percentage of white and Asian residents had lower COVID-19 mortality. The associations differed by race, suggesting that neighborhood context may be most tightly linked to COVID-19 mortality among white residents. CONCLUSIONS: We describe communities that may benefit from supportive services and identify traits of communities that may benefit from targeted campaigns for prevention and testing to prevent future deaths from COVID-19.