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  1. Article: Perceptions of Protection under Nondiscrimination Law.

    Underhill, Kristen

    American journal of law & medicine

    2020  Volume 46, Issue 1, Page(s) 21–54

    Abstract: Nondiscrimination rules-statutes, regulations, and soft law protections-are critical for reducing health and health care disparities. Although scholarship has interrogated how nondiscrimination rules affect behavior by discriminators, comparatively ... ...

    Abstract Nondiscrimination rules-statutes, regulations, and soft law protections-are critical for reducing health and health care disparities. Although scholarship has interrogated how nondiscrimination rules affect behavior by discriminators, comparatively little has considered how protections can affect choices made by members of protected groups. A number of states and some interpretations of federal law protect people from discrimination on the basis of sexual orientation. This Article seeks to identify relationships between actual state law, perceived state law, and experiences of discrimination and medical mistrust. This Article reports the results of a national cross-sectional survey of over 3,000 men using Grindr to meet male partners. Participants scored comparable to chance in knowledge about state nondiscrimination protections, with "optimistic errors" (erroneous beliefs that one was protected) significantly more common than pessimistic errors. Perceptions of protection were significantly correlated with lower medical mistrust and greater uptake of care, as well as lower perceived barriers to disclosure and care-seeking. Actual state law protections, however, were significant predictors of having had discussions with providers that depended on disclosure of sexual behavior or orientation. Building on these results, this Article considers pathways by which nondiscrimination law may exert welcome mat (and "unwelcome mat") effects.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Disclosure ; Health Knowledge, Attitudes, Practice ; Healthcare Disparities/legislation & jurisprudence ; Humans ; Male ; Patient Acceptance of Health Care/psychology ; Public Nondiscrimination Policies ; Sexual and Gender Minorities/psychology ; Trust ; United States
    Language English
    Publishing date 2020-05-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 753043-2
    ISSN 0098-8588
    ISSN 0098-8588
    DOI 10.1177/0098858820919551
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Raising the Stakes for Nondiscrimination Protections in the ACA.

    Underhill, Kristen

    The Hastings Center report

    2018  Volume 48, Issue 1, Page(s) 8–9

    Abstract: In the struggle over the durability of the Affordable Care Act, defenders of the ACA stand guard at many fronts. A major contribution of the ACA to nondiscrimination law, however, appears increasingly vulnerable. The ACA established significant new ... ...

    Abstract In the struggle over the durability of the Affordable Care Act, defenders of the ACA stand guard at many fronts. A major contribution of the ACA to nondiscrimination law, however, appears increasingly vulnerable. The ACA established significant new nondiscrimination protections for patients under section 1557 and its implementing regulations. Several of these regulations-including protections on the basis of gender identity and pregnancy termination-are now under reconsideration at the Department of Health and Human Services, after a nationwide injunction lasting almost a year. Nondiscrimination laws matter, of course, because they promote equal access to health care. But focusing on discriminatory behavior alone is a narrow view of the purpose and potential of nondiscrimination rules-and underestimates the stakes of softening section 1557. To evaluate these protections, we must consider not only their impacts on discriminatory behavior but also their behavioral and attitudinal impacts on patients and communities. This is because supportive or stigmatizing rules can exert an expressive effect: laws communicate information about prevailing social norms, they give some norms greater authority by virtue of the state's support, and they can shape community values. Through these expressive impacts, nondiscrimination laws may affect not only discriminatory behavior in health activities but also the attitudes, beliefs, and decisions of people who are legally protected.
    MeSH term(s) Humans ; Patient Protection and Affordable Care Act/legislation & jurisprudence ; Sexual and Gender Minorities ; Social Discrimination/legislation & jurisprudence ; United States
    Language English
    Publishing date 2018-02-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 194940-8
    ISSN 1552-146X ; 0093-0334
    ISSN (online) 1552-146X
    ISSN 0093-0334
    DOI 10.1002/hast.805
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  3. Article ; Online: Consent Laws for Minors Regarding Sexually Transmitted Infection and HIV Services-Reply.

    Underhill, Kristen / Nelson, Kimberly M

    JAMA

    2022  Volume 328, Issue 23, Page(s) 2364

    MeSH term(s) Humans ; HIV Infections/prevention & control ; HIV Infections/therapy ; Informed Consent/legislation & jurisprudence ; Minors/legislation & jurisprudence ; Parental Consent/legislation & jurisprudence ; Sexually Transmitted Diseases/prevention & control ; Sexually Transmitted Diseases/therapy
    Language English
    Publishing date 2022-12-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.19040
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  4. Article: Infected by Bias: Behavioral Science and the Legal Response to COVID-19.

    Teichman, Doron / Underhill, Kristen

    American journal of law & medicine

    2021  Volume 47, Issue 2-3, Page(s) 205–248

    Abstract: This Article presents the first comprehensive analysis of the contribution of behavioral science to the legal response to the COVID-19 pandemic. At the descriptive level, the Article shows how different psychological phenomena such as loss aversion and ... ...

    Abstract This Article presents the first comprehensive analysis of the contribution of behavioral science to the legal response to the COVID-19 pandemic. At the descriptive level, the Article shows how different psychological phenomena such as loss aversion and cultural cognition influenced the way policymakers and the public perceived the pandemic, and how such phenomena affected the design of laws and regulations responding to COVID-19. At the normative level, the Article compares nudges (i.e., choice-preserving, behaviorally informed tools that encourage people to behave as desired) and mandates (i.e., obligations backed by sanctions that dictate to people how they must behave). The Article argues that mandates rather than nudges should serve in most cases as the primary legal tool used to regulate behavior during a pandemic. Nonetheless, this Article highlights ways in which nudges can complement mandates.
    MeSH term(s) Behavioral Sciences ; Bias ; COVID-19/prevention & control ; Communicable Disease Control/methods ; Humans ; Motivation ; Policy Making ; SARS-CoV-2 ; Social Cognition ; Social Control Policies/legislation & jurisprudence ; Social Norms
    Language English
    Publishing date 2021-08-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 753043-2
    ISSN 0098-8588
    ISSN 0098-8588
    DOI 10.1017/amj.2021.16
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  5. Article ; Online: Disparities in Mistreatment During Childbirth.

    Liu, Chen / Underhill, Kristen / Aubey, Janice J / Samari, Goleen / Allen, Heidi L / Daw, Jamie R

    JAMA network open

    2024  Volume 7, Issue 4, Page(s) e244873

    Abstract: Importance: Lack of respectful maternity care may be a key factor associated with disparities in maternal health. However, mistreatment during childbirth has not been widely documented in the US.: Objectives: To estimate the prevalence of ... ...

    Abstract Importance: Lack of respectful maternity care may be a key factor associated with disparities in maternal health. However, mistreatment during childbirth has not been widely documented in the US.
    Objectives: To estimate the prevalence of mistreatment by health care professionals during childbirth among a representative multistate sample and to identify patient characteristics associated with mistreatment experiences.
    Design, setting, and participants: This cross-sectional study used representative survey data collected from respondents to the 2020 Pregnancy Risk and Monitoring System in 6 states and New York City who had a live birth in 2020 and participated in the Postpartum Assessment of Health Survey at 12 to 14 months' post partum. Data were collected from January 1, 2021, to March 31, 2022.
    Exposures: Demographic, social, clinical, and birth characteristics that have been associated with patients' health care experiences.
    Main outcomes and measures: Any mistreatment during childbirth, as measured by the Mistreatment by Care Providers in Childbirth scale, a validated measure of self-reported experiences of 8 types of mistreatment. Survey-weighted rates of any mistreatment and each mistreatment indicator were estimated, and survey-weighted logistic regression models estimated odds ratios (ORs) and 95% CIs.
    Results: The sample included 4458 postpartum individuals representative of 552 045 people who had live births in 2020 in 7 jurisdictions. The mean (SD) age was 29.9 (5.7) years, 2556 (54.4%) identified as White, and 2836 (58.8%) were commercially insured. More than 1 in 8 individuals (13.4% [95% CI, 11.8%-15.1%]) reported experiencing mistreatment during childbirth. The most common type of mistreatment was being "ignored, refused request for help, or failed to respond in a timely manner" (7.6%; 95% CI, 6.5%-8.9%). Factors associated with experiencing mistreatment included being lesbian, gay, bisexual, transgender, queer identifying (unadjusted OR [UOR], 2.3; 95% CI, 1.4-3.8), Medicaid insured (UOR, 1.4; 95% CI, 1.1-1.8), unmarried (UOR, 0.8; 95% CI, 0.6-1.0), or obese before pregnancy (UOR, 1.3; 95% CI, 1.0-1.7); having an unplanned cesarean birth (UOR, 1.6; 95% CI, 1.2-2.2), a history of substance use disorder (UOR, 2.6; 95% CI, 1.3-5.1), experienced intimate partner or family violence (UOR, 2.3; 95% CI, 1.3-4.2), mood disorder (UOR, 1.5; 95% CI, 1.1-2.2), or giving birth during the COVID-19 public health emergency (UOR, 1.5; 95% CI, 1.1-2.0). Associations of mistreatment with race and ethnicity, age, educational level, rural or urban geography, immigration status, and household income were ambiguous.
    Conclusions and relevance: This cross-sectional study of individuals who had a live birth in 2020 in 6 states and New York City found that mistreatment during childbirth was common. There is a need for patient-centered, multifaceted interventions to address structural health system factors associated with negative childbirth experiences.
    MeSH term(s) Pregnancy ; United States/epidemiology ; Humans ; Female ; Adult ; Cross-Sectional Studies ; Maternal Health Services ; Delivery, Obstetric ; Cesarean Section ; Sexual and Gender Minorities
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2024.4873
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  6. Article ; Online: The Health And Social Needs Of Medicaid Beneficiaries In The Postpartum Year: Evidence From A Multistate Survey.

    Daw, Jamie R / Underhill, Kristen / Liu, Chen / Allen, Heidi L

    Health affairs (Project Hope)

    2023  Volume 42, Issue 11, Page(s) 1575–1585

    Abstract: As of September 2023, thirty-seven states and Washington, D.C., had adopted the option in the American Rescue Plan Act of 2021 to extend pregnancy Medicaid eligibility to one year postpartum. To inform state initiatives to support this newly covered ... ...

    Abstract As of September 2023, thirty-seven states and Washington, D.C., had adopted the option in the American Rescue Plan Act of 2021 to extend pregnancy Medicaid eligibility to one year postpartum. To inform state initiatives to support this newly covered population, we conducted a representative survey of postpartum people in six states and New York City from January 2021 to March 2022. Compared with respondents who had commercial insurance at the time of childbirth, Medicaid respondents were less likely to have a usual source of care and reported less use of primary, specialty, and dental care in the postpartum year. Depression symptoms and social concerns such as food insecurity, intimate partner violence, and financial strain were significantly higher in the Medicaid population. Rates of anxiety symptoms, delaying or not getting needed care, and unsatisfactory child care were similar in both populations. Our findings suggest that postpartum Medicaid extensions should be coupled with state initiatives to address beneficiaries' health and social needs. National investments in data collection on postpartum people will be critical to support evidence-based policy making to improve maternal health and well-being.
    MeSH term(s) Pregnancy ; Female ; United States ; Humans ; Medicaid ; Postpartum Period ; Surveys and Questionnaires ; Eligibility Determination ; Washington
    Language English
    Publishing date 2023-11-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.2023.00541
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  7. Article ; Online: Minor Consent Laws for Sexually Transmitted Infection and HIV Services.

    Nelson, Kimberly M / Skinner, Alexandra / Underhill, Kristen

    JAMA

    2022  Volume 328, Issue 7, Page(s) 674–676

    MeSH term(s) Delivery of Health Care/legislation & jurisprudence ; HIV Infections ; Humans ; Informed Consent/legislation & jurisprudence ; Informed Consent By Minors/legislation & jurisprudence ; Minors/legislation & jurisprudence ; Sexually Transmitted Diseases
    Language English
    Publishing date 2022-08-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.10777
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  8. Article ; Online: Malpractice Liability and Quality of Care: Clear Answer, Remaining Questions.

    Sage, William M / Underhill, Kristen

    JAMA

    2020  Volume 323, Issue 4, Page(s) 315–317

    MeSH term(s) Liability, Legal ; Malpractice ; Quality of Health Care
    Language English
    Publishing date 2020-01-27
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2019.22530
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  9. Article ; Online: Intimacy, condom use, and pre-exposure prophylaxis (PReP) acceptability among men who have sex with men (MSM) in primary partnerships: a comment on Gamarel and Golub.

    Underhill, Kristen

    Annals of behavioral medicine : a publication of the Society of Behavioral Medicine

    2014  Volume 49, Issue 2, Page(s) 151–153

    MeSH term(s) Anti-HIV Agents/therapeutic use ; HIV Infections/prevention & control ; Humans ; Intention ; Male ; Motivation ; Pre-Exposure Prophylaxis ; Sexual Behavior
    Chemical Substances Anti-HIV Agents
    Language English
    Publishing date 2014-09-22
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 632630-4
    ISSN 1532-4796 ; 0883-6612
    ISSN (online) 1532-4796
    ISSN 0883-6612
    DOI 10.1007/s12160-014-9651-6
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  10. Article ; Online: Legal and ethical values in the resolution of research-related disputes: how can IRBS respond to participant complaints?

    Underhill, Kristen

    Journal of empirical research on human research ethics : JERHRE

    2014  Volume 9, Issue 1, Page(s) 71–82

    Abstract: Under US federal regulations, participants providing informed consent must receive information regarding whom to contact in case of a research-related injury or complaint. Although informed consent processes routinely direct participants to contact ... ...

    Abstract Under US federal regulations, participants providing informed consent must receive information regarding whom to contact in case of a research-related injury or complaint. Although informed consent processes routinely direct participants to contact institutional review boards (IRBs) with questions or concerns, there has been little empirical study of the ways in which IRBs act to resolve participants' research-related complaints. This article explores available literature on participant complaints, considers the responsibilities of IRBs in dispute resolution, and outlines a research agenda. As a case study, this review considers disputes arising from HIV/AIDS research, focusing on novel issues arising from biomedical HIV prevention trials.
    MeSH term(s) Biomedical Research/ethics ; Biomedical Research/legislation & jurisprudence ; Dissent and Disputes ; Ethics Committees, Research ; Ethics, Research ; HIV Infections/prevention & control ; Humans ; Informed Consent/legislation & jurisprudence ; Social Responsibility ; Surveys and Questionnaires ; United States
    Language English
    Publishing date 2014-02-26
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2263068-5
    ISSN 1556-2654 ; 1556-2646
    ISSN (online) 1556-2654
    ISSN 1556-2646
    DOI 10.1525/jer.2014.9.1.71
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