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This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of “supportive” social contacts and “risky” social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.

This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of “supportive” social contacts and “risky” social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.

Objective: Social integration is a foundational feature of society that influences individual-level outcomes. However, as our social worlds increase in complexity, integration becomes difficult to precisely measure. Contributing to research on social integration, this dissertation: (1) develops more precise ways to measure social integration, (2) identifies who is socially integrated, and (3) explores which social ties have the most influence on social integration. Study 1: The first study aims to measure social integration more precisely by establishing a network structure and set of measures that utilize personal and associational ties with ego network data. Defined as personal affiliation networks (PAN), this study identifies 15 measures capturing unique aspects of PANs, bridging personal and associational ties. Study 2: Pairing the methodological framework from Study 1 with the 2006 National Voluntary Association Study (NVAS), Study 2: (1) describes the distribution of, and the relationship between the PAN measures and (2) identifies ego-level characteristics associated with social integration in PANs. This study identifies that established differences in integration across demographic groups do not always hold when using more nuanced integration measures. Rather, I find that associational ties can supplement personal ties, washing out many group differences; concluding that tie characteristics of alters may be more influential for individual integration than ego characteristics alone. Study 3: Study 3 further explores the role that alters have on social integration, identifying: (1) who bridges the personal and associational spaces of individuals and (2) who has the most influence on individual social integration. This study shows that spouses and stronger ties have the highest influence on social integration. High integrating alters also share more social contexts with egos, specifically those that bridge personal and associational spaces have more influence o

Background: Ecological momentary assessment (EMA) is an increasingly popular and feasible form of data collection, but it can be intensive and intrusive. Especially for at-risk, vulnerable populations like people who use drugs (PWUD), poor experiences with EMA may exacerbate existing chronic struggles while decreasing response rates. However, little research queries participants’ experiences with EMA studies. Objectives: We explore participants’ positive and negative experiences with EMA, identifying what they liked about the study, the problems they experienced, and suggested solutions to these problems. Methods: Results come from semi-structured interviews from 26 PWUD (6 women; 20 men) in Nebraska who participated in a two-week EMA pilot study on drug use with a study-provided smartphone. Participant responses were recorded by interviewers into open-text fields in Qualtrics. Data were analyzed with an iterative open coding procedure. Results: We found that many participants enjoyed the study and seamlessly incorporated the phone into their daily lives. There were a number of negative study aspects identified, however, as many participants experienced functional issues (e.g., running out of high-speed data, trouble keeping the phone charged, not able to answer questions within the two-hour timeframe) that detracted from their experience, especially if they were homeless. Conclusion: Our findings provide methodological considerations for studies with EMA components among at-risk, vulnerable populations, like PWUD. These suggestions are targeted toward the continued ethical collection of high-quality data in clinical and non-clinical settings.

Background: Ecological momentary assessment (EMA) is a set of research methods that capture events, feelings, and behaviors as they unfold in their real-world setting. Capturing data in the moment reduces important sources of measurement error but also generates challenges for noncompliance (ie, missing data). To date, EMA research has only examined the overall rates of noncompliance. Objective: In this study, we identify four types of noncompliance among people who use drugs and aim to examine the factors associated with the most common types. Methods: Data were obtained from a recent pilot study of 28 Nebraskan people who use drugs who answered EMA questions for 2 weeks. We examined questions that were not answered because they were skipped, they expired, the phone was switched off, or the phone died after receiving them. Results: We found that the phone being switched off and questions expiring comprised 93.34% (1739/1863 missing question-instances) of our missing data. Generalized structural equation model results show that participant-level factors, including age (relative risk ratio [RRR]=0.93; P=.005), gender (RRR=0.08; P=.006), homelessness (RRR=3.80; P=.04), personal device ownership (RRR=0.14; P=.008), and network size (RRR=0.57; P=.001), are important for predicting off missingness, whereas only question-level factors, including time of day (ie, morning compared with afternoon, RRR=0.55; P<.001) and day of week (ie, Tuesday-Saturday compared with Sunday, RRR=0.70, P=.02; RRR=0.64, P=.005; RRR=0.58, P=.001; RRR=0.55, P<.001; and RRR=0.66, P=.008, respectively) are important for predicting expired missingness. The week of study is important for both (ie, week 2 compared with week 1, RRR=1.21, P=.03, for off missingness and RRR=1.98, P<.001, for expired missingness). Conclusions: We suggest a three-pronged strategy to preempt missing EMA data with high-risk populations: first, provide additional resources for participants likely to experience phone charging

Background: Ecological momentary assessment (EMA) is an increasingly popular and feasible form of data collection, but it can be intensive and intrusive. Especially for at-risk, vulnerable populations like people who use drugs (PWUD), poor experiences with EMA may exacerbate existing chronic struggles while decreasing response rates. However, little research queries participants’ experiences with EMA studies. Objectives: We explore participants’ positive and negative experiences with EMA, identifying what they liked about the study, the problems they experienced, and suggested solutions to these problems. Methods: Results come from semi-structured interviews from 26 PWUD (6 women; 20 men) in Nebraska who participated in a two-week EMA pilot study on drug use with a study-provided smartphone. Participant responses were recorded by interviewers into open-text fields in Qualtrics. Data were analyzed with an iterative open coding procedure. Results: We found that many participants enjoyed the study and seamlessly incorporated the phone into their daily lives. There were a number of negative study aspects identified, however, as many participants experienced functional issues (e.g., running out of high-speed data, trouble keeping the phone charged, not able to answer questions within the two-hour timeframe) that detracted from their experience, especially if they were homeless. Conclusion: Our findings provide methodological considerations for studies with EMA components among at-risk, vulnerable populations, like PWUD. These suggestions are targeted toward the continued ethical collection of high-quality data in clinical and non-clinical settings.

Background: Ecological momentary assessment (EMA) is a set of research methods that capture events, feelings, and behaviors as they unfold in their real-world setting. Capturing data in the moment reduces important sources of measurement error but also generates challenges for noncompliance (ie, missing data). To date, EMA research has only examined the overall rates of noncompliance. Objective: In this study, we identify four types of noncompliance among people who use drugs and aim to examine the factors associated with the most common types. Methods: Data were obtained from a recent pilot study of 28 Nebraskan people who use drugs who answered EMA questions for 2 weeks. We examined questions that were not answered because they were skipped, they expired, the phone was switched off, or the phone died after receiving them. Results: We found that the phone being switched off and questions expiring comprised 93.34% (1739/1863 missing question-instances) of our missing data. Generalized structural equation model results show that participant-level factors, including age (relative risk ratio [RRR]=0.93; P=.005), gender (RRR=0.08; P=.006), homelessness (RRR=3.80; P=.04), personal device ownership (RRR=0.14; P=.008), and network size (RRR=0.57; P=.001), are important for predicting off missingness, whereas only question-level factors, including time of day (ie, morning compared with afternoon, RRR=0.55; P<.001) and day of week (ie, Tuesday-Saturday compared with Sunday, RRR=0.70, P=.02; RRR=0.64, P=.005; RRR=0.58, P=.001; RRR=0.55, P<.001; and RRR=0.66, P=.008, respectively) are important for predicting expired missingness. The week of study is important for both (ie, week 2 compared with week 1, RRR=1.21, P=.03, for off missingness and RRR=1.98, P<.001, for expired missingness). Conclusions: We suggest a three-pronged strategy to preempt missing EMA data with high-risk populations: first, provide additional resources for participants likely to experience phone charging

Competing hypotheses exist with regard to how men’s and women’s pregnancy desires and intentions are associated with births among contemporary heterosexual couples. There are compelling cultural and structural reasons to support either the hypothesis that men’s desires and intentions (patriarchal) or that women’s desires and intentions (matriarchal) will have more influence, or that both partner’s desires and intentions will be associated with births (mutual influence). In addition, patterns of change are likely to differ for couples that have children at wave 1 compared to those who do not. Path analyses of the of heterosexual couples (n = 615) who completed both waves of the National Survey of Fertility Barriers support the matriarchal hypothesis, because among couples without children, only women’s desires were associated with subsequent births. Among couples with children, men’s characteristics and desires are indirectly, and women’s are directly, associated with subsequent births, indicating support for the mutual influence hypothesis.

The authors use 2014–2018 data from the American Community Survey to answer two questions: To what extent is military service associated with higher rates of earning a bachelor’s degree in a science, technology, engineering, and mathematics (STEM) field (vs. a non-STEM field)? To what extent is this relationship gendered? The findings suggest that military service is associated with higher odds of completing a STEM degree and that this association is particularly strong for female veterans. Comparison across multiple STEM definitions suggests that military service does not simply channel women into traditionally female-dominated STEM fields. Instead, the findings show the biggest boost for women earning degrees in traditionally male-dominated STEM fields. The authors situate these findings in light of extant empirical and theoretical research on gender gaps in STEM and discuss implications for policy and research.

The authors use 2014–2018 data from the American Community Survey to answer two questions: To what extent is military service associated with higher rates of earning a bachelor’s degree in a science, technology, engineering, and mathematics (STEM) field (vs. a non-STEM field)? To what extent is this relationship gendered? The findings suggest that military service is associated with higher odds of completing a STEM degree and that this association is particularly strong for female veterans. Comparison across multiple STEM definitions suggests that military service does not simply channel women into traditionally female-dominated STEM fields. Instead, the findings show the biggest boost for women earning degrees in traditionally male-dominated STEM fields. The authors situate these findings in light of extant empirical and theoretical research on gender gaps in STEM and discuss implications for policy and research.

The authors use 2014–2018 data from the American Community Survey to answer two questions: To what extent is military service associated with higher rates of earning a bachelor’s degree in a science, technology, engineering, and mathematics (STEM) field (vs. a non-STEM field)? To what extent is this relationship gendered? The findings suggest that military service is associated with higher odds of completing a STEM degree and that this association is particularly strong for female veterans. Comparison across multiple STEM definitions suggests that military service does not simply channel women into traditionally female-dominated STEM fields. Instead, the findings show the biggest boost for women earning degrees in traditionally male-dominated STEM fields. The authors situate these findings in light of extant empirical and theoretical research on gender gaps in STEM and discuss implications for policy and research.

The authors use 2014–2018 data from the American Community Survey to answer two questions: To what extent is military service associated with higher rates of earning a bachelor’s degree in a science, technology, engineering, and mathematics (STEM) field (vs. a non-STEM field)? To what extent is this relationship gendered? The findings suggest that military service is associated with higher odds of completing a STEM degree and that this association is particularly strong for female veterans. Comparison across multiple STEM definitions suggests that military service does not simply channel women into traditionally female-dominated STEM fields. Instead, the findings show the biggest boost for women earning degrees in traditionally male-dominated STEM fields. The authors situate these findings in light of extant empirical and theoretical research on gender gaps in STEM and discuss implications for policy and research.

Competing hypotheses exist with regard to how men’s and women’s pregnancy desires and intentions are associated with births among contemporary heterosexual couples. There are compelling cultural and structural reasons to support either the hypothesis that men’s desires and intentions (patriarchal) or that women’s desires and intentions (matriarchal) will have more influence, or that both partner’s desires and intentions will be associated with births (mutual influence). In addition, patterns of change are likely to differ for couples that have children at wave 1 compared to those who do not. Path analyses of the of heterosexual couples (n = 615) who completed both waves of the National Survey of Fertility Barriers support the matriarchal hypothesis, because among couples without children, only women’s desires were associated with subsequent births. Among couples with children, men’s characteristics and desires are indirectly, and women’s are directly, associated with subsequent births, indicating support for the mutual influence hypothesis.

BACKGROUND Demographers typically ask about societal, not personal, fertility ideals. Societal ideals are probably more stable than personal ideals. Assessing whether personal fertility ideals are as stable as societal ideals could inform models of population fertility change and models of well-being associated with fertility outcomes. METHODS We use the two-wave National Survey of Fertility Barriers (NSFB) to model stability and change in fertility ideals among 879 women in heterosexual couples that persisted for both waves. RESULTS Personal fertility ideals are stable for most (69%) women, but roughly one-third adjust their ideal number between waves. Of the women who changed their personal fertility ideal, approximately half increase and half decrease their personal fertility ideal over time. Multinomial logistic regression indicates that women with a higher fertility ideal at Wave 1 had higher odds of increasing and lower odds of decreasing their fertility ideal by Wave 2. Higher education was associated with lower likelihood of increasing fertility ideals. In addition, full-time employment at the initial interview was associated with higher likelihood of decreasing fertility ideals. CONCLUSIONS Individual characteristics, attitudes, life course, and social cues are associated with changes in personal fertility ideals. More characteristics were associated with decreases than increases in personal fertility ideals. CONTRIBUTIONS By demonstrating that many women change personal fertility ideals over three years, the current study advances understanding of variations in fertility experiences. Importantly, these findings can also inform policies and interventions designed to support child and maternal health.

BACKGROUND Demographers typically ask about societal, not personal, fertility ideals. Societal ideals are probably more stable than personal ideals. Assessing whether personal fertility ideals are as stable as societal ideals could inform models of population fertility change and models of well-being associated with fertility outcomes. METHODS We use the two-wave National Survey of Fertility Barriers (NSFB) to model stability and change in fertility ideals among 879 women in heterosexual couples that persisted for both waves. RESULTS Personal fertility ideals are stable for most (69%) women, but roughly one-third adjust their ideal number between waves. Of the women who changed their personal fertility ideal, approximately half increase and half decrease their personal fertility ideal over time. Multinomial logistic regression indicates that women with a higher fertility ideal at Wave 1 had higher odds of increasing and lower odds of decreasing their fertility ideal by Wave 2. Higher education was associated with lower likelihood of increasing fertility ideals. In addition, full-time employment at the initial interview was associated with higher likelihood of decreasing fertility ideals. CONCLUSIONS Individual characteristics, attitudes, life course, and social cues are associated with changes in personal fertility ideals. More characteristics were associated with decreases than increases in personal fertility ideals. CONTRIBUTIONS By demonstrating that many women change personal fertility ideals over three years, the current study advances understanding of variations in fertility experiences. Importantly, these findings can also inform policies and interventions designed to support child and maternal health.