Race and ethnicity responses can change over time and across contexts – a component of population change not usually considered in studies that use race and ethnicity as variables. To facilitate incorporation of this aspect of population change, we show patterns and directions of individual-level race and Hispanic response change throughout the U.S. and among all federally recognized race/ethnic groups. We use internal Census Bureau data from the 2000 and 2010 censuses in which responses have been linked at the individual level (N = 162 million). About 9.8 million people (6.1 percent) in our data have a different race and/or Hispanic origin response in 2010 than they did in 2000. Race response change was especially common among those reported as American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander, in a multiple-race response group, or Hispanic. People reported as non-Hispanic white, black, or Asian in 2000 usually had the same response in 2010 (3%, 6% and 9% of responses changed, respectively). Hispanic/non-Hispanic ethnicity responses were also usually consistent (13% and 1% changed). There were a variety of response change patterns, which we detail. In many race/Hispanic response groups, there is population churn in the form of large countervailing flows of response changes that are hidden in cross-sectional data. We find that response changes happen across ages, sexes, regions, and response modes, with interesting variation across race/ethnic categories. Researchers should think through and discuss the implications of race and Hispanic origin response change when designing analyses and interpreting results.

Race and ethnicity responses can change over time and across contexts -a component of population change not usually taken into account. To what extent do race and/or Hispanic origin responses change? Is change more common to/from some race/ethnic groups than others? Does the propensity to change responses vary by characteristics of the individual? To what extent do these changes affect researchers? We use internal Census Bureau data from the 2000 and 2010 censuses in which individuals' responses have been linked across years. Approximately 9.8 million people (about 6 percent) in our large, non-representative linked data have a different race and/or Hispanic origin response in 2010 than they did in 2000. Several groups experienced considerable fluidity in racial identification: American Indians and Alaska Natives, Native Hawaiians and Other Pacific Islanders, and multiple-race response groups, as well as Hispanics when reporting a race. In contrast, race and ethnic responses for single-race non-Hispanic whites, blacks, and Asians were relatively consistent over the decade, as were ethnicity responses by Hispanics. People who change their race and/or Hispanic origin response(s) are doing so in a wide variety of ways, as anticipated by previous research. For example, people's responses change from multiple races to a single race, from a single race to multiple races, from one single race to another, and some people add or drop a Hispanic response. The inflow of people to each race/Hispanic group is in many cases similar in size to the outflow from the same group, such that cross-sectional data would show a small net change. We find response changes across ages, sexes, regions, and response modes, with variation across groups. Researchers should consider the implications of changing race and Hispanic origin responses when conducting analyses and interpreting results.

Objective To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. Methods Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. Women were then interviewed by a blinded nurse practitioner who also measured blood pressure. Results The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% CI: 51.7%-60.6%) and specificity 57.6% (54.0%-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (79.5%-86.3%) and specificity 88.8% (86.3%- 90.9%). Using the checklist, 6.6% (5.2%-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely due to unrecognized hypertension. Seven percent (5.4%-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily due to misclassification of migraine headaches. In regression analysis, younger women, more educated women and Spanish-speakers were significantly more likely to correctly self-screen (p<0.05). Conclusion Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.

Background: Fear of side effects and previous negative experiences are common reasons for contraceptive non-use. Study Design: We collected information about perceptions of oral contraceptive (OC) safety from 1,271 women 18-49 years old in El Paso, Texas, and compared their responses to a medical evaluation by a nurse practitioner. We also asked participants about their interest in obtaining OCs over-the-counter (OTC). Results: Among 794 women potentially at risk of unintended pregnancy, 56.0% said that OCs were medically safe for them. Reasons given for OCs being unsafe related to fears of side effects and prior negative experiences rather than true contraindications. Older women and participants recruited at the less affluent recruitment site were significantly more likely to report that OCs were medically unsafe for them (p<0.05). Non-users who thought OCs were medically unsafe for them were as likely to be medically eligible for use as current hormonal users. Among non-users or non-hormonal users and potential OC candidates (n=601), 60.2% said they would be more likely to use OCs if they were available OTC. Conclusions: Women's perception of OC safety does not correlate well with medical eligibility for use. More education about the safety and health benefits of hormonal contraception is needed. OTC availability might contribute to more positive safety perceptions of OCs compared to a prescription environment.

Objective To measure the Medicaid undercount and analyze response error in the 2007‐2011 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). Data Sources/Study Setting Medicaid Statistical Information System (MSIS) 2006‐2010 enrollment data linked to the 2007‐2011 CPS ASEC person records. Study Design By linking individuals across datasets, we analyze false‐negative error and false‐positive error in reports of Medicaid enrollment. We use regression analysis to identify factors associated with response error in the 2011 CPS ASEC. Principal Findings We find that the Medicaid undercount in the CPS ASEC ranged between 22 and 31% from 2007 to 2011. In 2011, the false‐negative rate was 40%, and 27% of Medicaid reports in CPS ASEC were false positives. False‐negative error is associated with the duration of enrollment in Medicaid, enrollment in Medicare and private insurance, and Medicaid enrollment in the survey year. False‐positive error is associated with enrollment in Medicare and shared Medicaid coverage in the household. Conclusions Survey estimates of Medicaid enrollment and estimates of the uninsured population are affected by both false‐positive response error and false‐negative response error, and these response errors are non‐random.

Background Progestin-only oral contraceptive pills (POPs) have fewer contraindications to use compared to combined pills. However, the overall prevalence of contraindications to POPs among reproductive aged women has not been assessed. Study Design We collected information on contraindications to POPs in two studies: 1) the Self-Screening Study, a sample of 1,267 reproductive aged women in the general population in El Paso, Texas, and 2) the Prospective Study of Oral Contraceptive (OC) Users, a sample of current OC users who obtained their pills in El Paso clinics (n=532) or over the counter (OTC) in Mexican pharmacies (n=514). In the Self-Screening Study, we also compared women’s self-assessment of contraindications using a checklist to a clinician’s evaluation. Results Only 1.6% of women in the Self-Screening Study were identified as having at least one contraindication to POPs. The sensitivity of the checklist for identifying women with at least one contraindication was 75.0% (95% CI: 50.6–90.4%), and the specificity was 99.4% (95% CI: 98.8–99.7%). In total, 0.6% of women in the Prospective Study of OC Users reported having any contraindication to POPs. There were no significant differences between clinic and OTC users. Conclusion The prevalence of contraindications to POPs was very low in these samples. POPs may be the best choice for the first OTC oral contraceptive in the US.

Health and health care disparities associated with race or Hispanic origin are complex and continue to challenge researchers and policy makers. With the intention of improving the measurement and monitoring of these disparities, provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 require states to collect, report and analyze data on demographic characteristics of applicants and participants in Medicaid and other federally supported programs. By linking Medicaid records to 2010 Census, American Community Survey, and Census 2000, this new large-scale study examines and documents the extent to which pre-ACA Medicaid administrative records match self-reported race and Hispanic origin in Census data. Linked records allow comparisons between individuals with matching and nonmatching race and Hispanic origin data across several demographic, socioeconomic and neighborhood characteristics, such as age, gender, language proficiency, education and Census tract variables. Identification of the groups most likely to have non-matching and missing race and Hispanic origin data in Medicaid relative to Census data can inform strategies to improve the quality of demographic data collected from Medicaid populations.