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. Author manuscript; available in PMC: 2024 Mar 14.
Published in final edited form as: Psychol Addict Behav. 2023 Sep 7;38(2):197–204. doi: 10.1037/adb0000957

Watching the Fall of Roe v. Wade: Media Exposure Relates to U.S. Women’s Alcohol Use Intentions

Stacy M Post 1, Mary C Jobe 1, Arianne N Malekzadeh 1, Katarina E AuBuchon 1, Rebecca K Hoffman 1, Michelle L Stock 1, Lisa Bowleg 1
PMCID: PMC10918026  NIHMSID: NIHMS1956620  PMID: 37676169

Abstract

Objective:

The Supreme Court of the United States’ decision in Dobbs v. Jackson Women’s Health Organization in June 2022 overturned Roe v. Wade and ended federal protection of abortion rights. Given the drastic policy changes as a result of the ruling and high exposure to media related to abortion, women opposed to the decision may have experienced distress, which could trigger maladaptive coping strategies, such as alcohol use. The present research examined how consuming abortion-related media in the weeks following the Dobbs decision impacted alcohol use intentions among women of reproductive age residing in the 13 “trigger law” states that immediately restricted abortion access.

Method:

A sample of 196 women (Mage = 30.52, SD = 6.9) residing in trigger law states answered questions about abortion-related media consumption, views toward the Dobbs ruling, negative affect, and alcohol use intentions.

Results:

Consuming more abortion-related media predicted higher alcohol use intentions for women who opposed the ruling, but not those who were in favor of abortion restrictions.

Conclusions:

This timely study provides evidence of how the Dobbs ruling is associated with health ramifications beyond reproduction, yielding insights about how high media exposure to large-scale, distressing events may put those most affected—women of reproductive age in states that enacted new policies restricting abortion access—at risk for alcohol use. Findings highlight an imperative direction for future research as abortion restrictions continue to be spotlighted in U.S. media and state legislatures.

Keywords: abortion attitudes, women, alcohol, media consumption, coping strategies

The Supreme Court of the United States’ (SCOTUS) decision in Dobbs v. Jackson Women’s Health Organization in June 2022 eliminated the constitutional right to abortion, relegating this critical legal authority to state legislatures. Immediately or shortly after the ruling, 13 “trigger law” states—Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming—implemented abortion bans or gestational limits for the procedure (Jiménez, 2022). This capsizing of nearly 50 years of federal protection for abortion access is a representation of structural sexism, the multilevel systematic gender inequality in power and resources that underlies U.S. institutions (Homan, 2019). Sexism is an insidious stressor that can adversely impact health behaviors and outcomes (Homan, 2019; Meyer, 2003), including increased alcohol use (Roberts, 2012; Zucker & Landry, 2007). Similarly, consuming high levels of distressing media can have negative health implications (Alexander et al., 2023; Amram et al., 2021; Ford et al., 2023; Silver et al., 2013). Although it is critical to inform the public of legislative changes, the extensive media coverage of abortion-related issues immediately following the Dobbs ruling may be particularly harmful for women who opposed (vs. supported) the ruling as they may be most distressed by this infringement on reproductive rights. Thus, the present research tested a conceptual model (Figure 1) that media consumption can predict alcohol use cognitions (i.e., intentions), mediated by negative affect, among women who opposed the ruling residing in the trigger law states—a population that was immediately impacted following the Dobbs decision.

Figure 1.

Figure 1

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Moderated Mediation Conceptual Model: Abortion-Related Media Consumption on Alcohol Use Intentions Through Negative Affect, Dependent on Ruling Opposition

The motivational model of alcohol use (Cooper et al., 1995) suggests that, for women who opposed the Dobbs ruling, high levels of media consumption related to distressing events may impact alcohol use. The model posits that people drink alcohol to cope with negative emotions and experiences (Cooper et al., 1995; Merrill & Thomas, 2013; Metzger et al., 2017; Park et al., 2004). In these conditions, they are more likely to consume alcohol at greater quantities and frequencies and experience more alcohol-related problems (Skrzynski & Creswell, 2020; Veilleux et al., 2014). Additionally, extended alcohol use imposes negative effects on health (e.g., heart disease, cancer) and increases the risk for developing alcohol use disorder (Mayo Clinic, 2022). Women are especially vulnerable to experiencing alcohol’s effects as compared to men (e.g., faster alcohol absorption; National Institute of Alcohol Abuse and Alcoholism, 1999), and while cisgender men tend to have higher rates of alcohol consumption and alcohol use disorder diagnoses, the gender gaps have narrowed (White, 2020).

Past research illustrates that consuming more media about distressing, large-scale events, such as the 9/11 terror attacks (Silver et al., 2013), Boston Marathon bombings (Holman et al., 2014), and police brutality (Alexander et al., 2023; First et al., 2020), were associated with negative mental and physical health effects. Research examining the negative effects of media consumption primarily focuses on those groups most affected by the events, presumably because the exposure effects would be most salient for them. For example, exposure to media coverage of the #MeToo Movement related to greater negative emotions for sexual assault survivors (Strauss Swanson & Szymanski, 2020), and exposure to police brutality coverage predicted more posttraumatic stress disorder symptoms among Black people (Alexander et al., 2023; Eichstaedt et al., 2021). Indeed, prior to the Dobbs decision, mental health experts warned that the overturn would be distressing for women of childbearing age, especially those who support abortion rights (Garcia & Amato, 2022; Mikhail, 2022; O’Connor, 2022).

In sum, past research demonstrates that media exposure to the Dobbs ruling should be most distressing for women of reproductive age who oppose (vs. support) it and, according to the motivational model of alcohol use, the negative affect experienced from high levels of media consumption may mediate the effect on intentions to use alcohol as a coping strategy.

The Present Study

The present cross-sectional data were collected in the immediate aftermath of the June 2022 Dobbs decision with women residing in the 13 trigger law states. Alcohol use intentions, a proximal predictor of alcohol use (Ajzen, 1991; Bhochhibhoya & Branscum, 2018; Cooke et al., 2016; Gerrard et al., 2008; Hamilton et al., 2022), allowed for a close assessment of women’s planned alcohol use following the Dobbs decision. We hypothesized that higher abortion-related media consumption would predict higher alcohol use intentions, but only among women who opposed (vs. who were in favor of) the Dobbs decision. We also hypothesized that negative affect would mediate the relationship between abortion-related media consumption and alcohol use intentions, but only for women who opposed the ruling.

Method

Participants and Procedure

Participants (N = 211) were recruited online via Prolific Academic to complete a Qualtrics survey as a part of a larger study examining women’s reactions to the Dobbs ruling. An a priori power analysis showed that to detect a medium effect size (f = 0.25) with a power of .80, an N of 179 was needed. Eligible participants were U.S. citizens, self-identified as capable of getting pregnant (individuals with health conditions affecting pregnancy were not included), aged 18–44 years, resided in a trigger law state, and were aware of the overturn of Roe v. Wade. People who may not identify as women (such as nonbinary people and transmen) who were capable of getting pregnant were included. Data were collected from July 13 to August 8, 2022 immediately following the Dobbs ruling. Recruitment was stratified to ensure we had approximately half self-reported prochoice (56.0%) and prolife (44.0%) participants (demographics in Table 1). Compensation started at $2.63 for all participants (the amount recommended by Prolific Academic for the survey length). Because recruitment was slower than anticipated, payment was increased incrementally to speed recruitment and capped at $9.00.

Table 1.

Demographics

Total N = 196
Demographic characteristic N %
Gender identity
 Cisgender 187 95.4
 Trans/nonbinary 9 4.6
Sexual identity
 Straight or heterosexual 144 73.5
 Gay or homosexual 24 12.2
 Bisexual 6 3.1
 Other 22 11.2
Racial group
 Asian 3 1.5
  Asian/White 1 0.5
 Black/African American 16 8.1
  Black/mixed racial group 7 3.6
 Hispanic/Latina/o/x 15 7.7
  Hispanic/Latina/o/x/mixed 5 2.6
 White 147 75
 Native American/Indigenous 1 0.5
  Native American/mixed 1 0.5
Household income
 <$19 k 25 12.8
 $20 k–$39 k 44 22.4
 $40 k–$59 k 27 13.8
 $60 k–$79 k 34 17.3
 $80 k–$99 k 31 15.8
 $100–$139 k 21 10.7
 >$140 k 9 4.6
 No personal income 5 2.6
Education
 Some high school 3 1.5
 High school diploma or equivalent 21 10.7
 Some college 49 25
 Associate’s degree 22 11.2
 Bachelor’s degree 72 36.7
 Some graduate school 8 4.1
 Master’s degree 18 9.2
 Professional degree 2 1.0
 Doctoral degree 1 0.5
M SD
 Past 6-month alcohol use (average drinks/week) 4.73 5.71
 Daily minutes of media consumption (postruling) 72.80 95.64
 Daily minutes of abortion-related media consumption (postruling) 29.80 52.22
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Measures

Demographics

Participants reported their age, “racial”/ethnic group (select all that apply), gender identity (recoded as cisgender woman vs. any other gender identity), highest degree of education earned, and household income after taxes in the past 12 months. Participants also reported the total number of drinks they consumed, on average, each day of a typical week in the past 6 months (Collins et al., 1985).

Abortion-Related Media Consumption

Participants provided an open-ended response to a single question asking the amount of time each day (in hours and minutes; converted to minutes), on average, they spent consuming news since June 24, 2022 (adapted from Jones et al., 2016). Then, participants reported what percentage of the news they consumed since June 24, 2022 was about abortion, selecting a response that ranged from 0% to 100% in increments of 10 (converted to a decimal). The product of these two responses indicated the number of minutes of abortion-related media that participants consumed.

Dobbs Ruling

To screen participants’ awareness of the ruling, participants answered “true,” “false,” and “don’t know” to “The U.S. Supreme Court recently overturned Roe vs. Wade (the federal constitutional protection of abortion rights in America).” Participants who selected “true” were invited to participate. Opposition to the Dobbs ruling was measured with a single item (Brenan, 2022): “Were/Are you in favor of the Supreme Court overturning its 1973 Roe v. Wade decision concerning abortion?” Response options ranged from 1 (strongly not in favor of overturning Roe v. Wade) to 5 (strongly in favor of overturning Roe v. Wade) and were reverse-coded, with higher scores indicating higher opposition to the ruling.

Negative Affect

A modified version of the Positive and Negative Affect Schedule (Watson et al., 1988) measured negative affect. Participants indicated the extent to which they experienced 10 negative emotions since June 24, 2022 on a scale from 1 (not at all) to 5 (extremely). A mean of the items (e.g., distressed, scared) was calculated (α = .90).

Alcohol Use Intentions

Participants were asked if they intended to drink alcohol in the next week (five items; adapted from Stock et al., 2017). The first question asked, “Would you be willing to drink alcohol in the next week?” The next four questions differed in social setting (i.e., drinking with friends vs. alone) and drinking intensity (i.e., to get buzzed vs. drunk), and all were scaled from 1 (definitely not) to 7 (definitely yes). The format was: “How willing would you be to get buzzed (drunk) from alcohol when drinking with friends (drinking by yourself) in the next week?” A computed mean of all five questions served as an indicator of overall intentions (α = .83).

Transparency and Openness

The present study was preregistered on Open Science Framework (OSF), and data used for the current analyses are available online at https://osf.io/9q2bf. Details about study measures and adaptations can be found in OSF. Study procedures were approved by the George Washington University Institutional Review Board.

Data Analytic Plan

Participants were included in analyses if they correctly answered six of seven attention checks embedded in the questionnaire and answered the media consumption questions (n = 203). Seven participants were excluded for reporting 20 or more hours of media consumption per day, resulting in a final sample of 196 participants. A nonparametric Mann–Whitney U test illustrated that participants excluded from analyses were not significantly different in drinking intentions (U = 730.50, p = .39). All analyses were conducted in SPSS (Version 28) and primary predictor variables were z score standardized. Heteroscedasticity assumptions were tested using White’s (1980) test, and normality of residuals was examined using the Kolmogorov–Smirnov test (Mishra et al., 2019); these assumptions were warranted. Influential outliers were identified using Cook’s distance, using a critical F value consistent with F(p, n − p) α = .50, where p is the number of parameters (Cook, 1977; Glen, 2016). No influential outliers were identified. Hayes PROCESS macro (5,000 samples) tested our hypotheses. Using Model 1, we tested the interaction between abortion-related media and ruling opposition on alcohol use intentions. Using Model 7, we tested moderated mediation to examine whether negative affect mediated the effect of abortion-related media on alcohol use intentions, dependent on ruling opposition. Education, income, and age were entered as covariates. Significant interactions were examined at 1 SD above and below the mean of Dobbs ruling opposition.

Results

Descriptive statistics and bivariate correlations for measures of interest can be found in Table 2. Negative affect was significantly and positively correlated with abortion-related media consumption (p = .006), Dobbs ruling opposition (p = .019), and alcohol use intentions (p = .029). Alcohol use intentions were also significantly and positively correlated with abortion-related media (p = .036) and Dobbs ruling opposition (p = .007).

Table 2.

Correlations

Variable 1 2 3 4 5 6 7 8
1. Abortion-related media —
2. Dobbs ruling opposition .06 —
3. Negative affect .195** .168* —
4. Alcohol intentions .15* .192** .156* —
5. Age −.115 −.143* −.122 −.031 —
6. Income −.004 −.019 −.17* .099 .035 —
7. Education .127 .053 .059 .217** .115 .32** —
8. Past 6 months drinks/week .178 .199* .032 .466** .145 .110 .181 —
M (SD) 29.8 (52.2) 3.69 (1.61) 2.35 (.81) 1.96 (1.21) 30.52 (6.9) $40,000–$59,999a 4.61 (5.61)
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a

Median income range.

*

p < .05.

**

p < .01.

PROCESS Model 1 indicated that Dobbs ruling opposition significantly predicted alcohol use intentions, though abortion media consumption was not a significant predictor (Table 3). This was qualified by a hypothesized significant interaction between Dobbs ruling opposition and abortion-related media consumption on alcohol use intentions (Figure 2). The relationship between abortion-related media consumption and alcohol use intentions was significant for participants with high levels of opposition to the Dobbs ruling (b = .29, 95% CI [.08, .50], p = .008), but not for low levels of opposition (b = −.02, 95% CI [−.23, .20], p = .888).

Table 3.

Model Results for Predictors of Alcohol Use Intentions

[95% CI]
Predictor Estimate SE t LL UL p
Constant 1.317 .297 4.429 .731 1.904 <.001
Abortion-related media .147 .084 1.749 −.019 .314 .082
Dobbs ruling opposition .203 .085 2.384 .035 .372 .018
Media × Dobbs Ruling Opposition interaction .171 .076 2.238 .02 .321 .026
Age −.004 .012 −.339 −.028 .02 .735
Income .022 .046 .483 −.069 .114 .63
Education .143 .058 2.486 .03 .256 .014
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Note. Dobbs ruling opposition was continuous such that increasing numbers indicated higher opposition. SE = standard error; CI = confidence interval; LL = lower level; UL = upper level.

Figure 2.

Figure 2

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Interaction of Dobbs Ruling Opposition (at ±1 SD) and Abortion-Related Media on Alcohol Use Intentions

Testing our moderated mediation hypothesis (Tables 4 and 5), Model 7 revealed that abortion-related media consumption was a significant positive predictor of negative affect, but Dobbs ruling opposition was a nonsignificant predictor of negative affect. However, neither negative affect nor ruling opposition was significant predictors of alcohol use intentions. Furthermore, results revealed that the effect of abortion-related media on alcohol use intentions was not mediated by negative affect for women low or high in ruling opposition, and the index of moderated mediation was also not significant.

Table 4.

Moderated Mediation Model: The Effects of Abortion-Related Media Consumption on Alcohol Use Intentions Through Negative Affect, Dependent on Ruling Opposition

Negative affect Alcohol use intentions
[95% CI] [95% CI]
Predictor Estimate SE LL UL P Estimate SE LL UL P
Constant 2.56 .202 2.162 2.958 <.001 .816 .411 .006 1.627 .049
Abortion-related media .133 .057 .02 .245 .022 .119 .087 −.052 .291 .172
Dobbs ruling opposition .112 .058 −.002 .226 .055 — — — — —
Negative affect — — — — — .20 .108 −.014 .413 .067
Age −.011 .008 −.027 .006 .205 −.005 .013 −.029 .02 .709
Abortion-Related Media × Dobbs Ruling Opposition .007 .052 −.095 .109 .891 — — — — —
Income −.085 .031 −.147 −.023 .007 .042 .048 −.053 .136 .383
Education .055 .039 −.022 .132 .158 .14 .059 .024 .256 .018
R2 = .105
F = 3.696; p = .0017		 R2 = .082
F = 3.393; p = .0058
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Note. SE = standard error; CI = confidence interval; LL = lower level; UL = upper level; Dobbs ruling opposition was continuous such that increasing numbers indicated higher opposition; conditional indirect effects are at ±1 SD above/below mean ruling opposition.

Table 5.

Conditional Indirect Effects of Abortion-Related Media on Alcohol Use Intentions Through Negative Affect

[95% CI]
Ruling opposition Estimate Boot SE Boot LL Boot UL
Low ruling opposition .025 .027 −.028 .08
High ruling opposition .028 .031 −.007 .11
Index of moderated mediation .001 .017 −.019 .046
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Note. SE = standard error; CI = confidence interval; LL = lower level; UL = upper level; Boot = Bootstrap; Dobbs ruling opposition was continuous such that increasing numbers indicated higher opposition; conditional indirect effects are at ±1 SD above/below mean ruling opposition.

Discussion

The present study examined how abortion-related media consumption in the immediate aftermath of the Dobbs decision related to alcohol use intentions among participants of reproductive age who live in the 13 trigger law states—a unique population most directly impacted by the ruling due to immediate abortion restrictions. Results demonstrated that consuming more abortion-related media after the Dobbs decision predicted higher alcohol use intentions, but only for participants who opposed the ruling. Significant bivariate relationships emerged between negative affect, abortion-related media consumption, Dobbs ruling opposition, and alcohol use intentions. However, negative affect did not explain the relationship between abortion-related media consumption and alcohol use intentions. Our study’s findings align with previous literature demonstrating that exposure to distressing news media negatively affects cognitions, which could subsequently impact health outcomes (Alexander et al., 2023; He et al., 2021; Holman et al., 2014; Silver et al., 2013). This study also expands previous literature by showing that consuming media about political events is associated with intentions to drink alcohol for those who are most affected by the event. Finally, although negative affect did not explain the effect of abortion-related media consumption on alcohol use intentions, these findings support theoretical and empirical evidence that people often consume alcohol after negative or distressing experiences (Blevins et al., 2016; Cooper et al., 1995; Veilleux et al., 2014).

While abortion was immediately restricted in the 13 trigger law states, policymakers in other states are proposing legislation to fully ban or limit abortions (e.g., Olivo, 2022) and to criminalize medical professionals who assist with abortions (Vestal, 2022). It is critical for media outlets to inform the public about these changes in state laws and criminal cases related to abortion. Yet, our research indicates that high exposure to such coverage could yield adverse health behaviors, such as increased alcohol use, for some women. Our findings further underscore the ways structural sexism, as a stressor, influences health (Homan, 2019). Psychologists and public health practitioners could therefore focus alcohol reduction interventions at pivotal moments for people who consume high levels of distressing media. Alcohol reduction interventions for people most affected by large-scale political events could provide resources on adaptive coping strategies. For example, targeting people most affected by political events to form implementation intentions to reduce or avoid alcohol use when feeling distressed after media exposure (Gollwitzer, 1999). Implementation intentions are self-regulatory techniques that pair a negative temptation with a predetermined response and are effective at reducing alcohol use (Cooke et al., 2023). In the context of our study, implementing alcohol reduction interventions could allow prochoice women to stay abreast of legislative changes and abortion rights movements via the media without an increased risk of alcohol’s negative health effects. Prochoice women who consume high levels of distressing media may consider setting daily time limits to mitigate potential negative effects of such coverage while still staying informed.

Although exposure to political events can correspond with negative emotions, it can also motivate political action (Ford et al., 2023). Thus, one explanation for why negative affect did not mediate the effect of media consumption on alcohol intentions may be that, for some individuals who support abortion rights, negative affect motivated political engagement rather than alcohol use as a coping mechanism. If this is the case, calls for political advocacy related to abortion legislation should be framed in a manner that enhances individuals’ perceived control (a strategy that has been shown to increase political action; Smith, 2022), decreases distress (Frazier et al., 2004), and reduces the negative impact of stressors (Bollini et al., 2004; Dijkstra & Homan, 2016). To increase perceived control, for example, advocacy organizations could highlight in their messaging instances where states recently restored or protected abortion rights (e.g., Michigan; Nash & Guarnieri, 2023). Sustained political engagement is critical for the restoration of reproductive freedoms and may buffer negative effects of distressing media consumption.

Limitations and Future Directions

This study is a timely examination of how ending the federal right to abortion affected alcohol use intentions, but it is not without limitations. Given the cross-sectional design of this study, we cannot draw causal conclusions regarding the Dobbs ruling, media consumption, negative affect, and alcohol use intentions. However, our design was pertinent given limited time and resources to collect data after the ruling. We attempted to reduce temporality issues by asking participants specifically about abortion-related media consumption and negative affect in the weeks after the ruling, asking about intentions to drink alcohol in the future, and counterbalancing questions to omit order effects. Future research should prioritize longitudinal designs, such as multiwave studies and ecological momentary assessments, to test the temporal ordering of large-scale distressing events, media consumption (with specific attention to types of media source), and alcohol use. Longitudinal designs are also best suited to test mediators such as negative affect and stress, which may further explain these relationships.

Our sample was primarily White, thus limiting the generalizability of the findings to women of color, a group most affected by abortion restrictions (Artiga et al., 2022; Bloomfield, 2020) due to the intersection of structural racism and sexism. Our participants were also mostly of mid-high socioeconomic status (SES), and thus the findings may not be as applicable to women of lower SES of any racial/ethnic group, given that they are more likely to experience alcohol-related harms compared to high SES individuals (Bloomfield, 2020). Although we did not capture participants’ disability status, women with disabilities face additional socio-structural barriers that limit access to quality reproductive health care (Matin et al., 2021) and result in poorer health outcomes (Wisdom et al., 2010). Further, the majority of our sample identified as heterosexual; however, women of all sexual identities may seek abortion-related care. Future research should prioritize recruiting more diverse samples of women to ensure research is focused on those most at-risk for adverse health outcomes, and adopt an intersectional lens to examine how abortion restrictions yield individual outcomes that are seeded in structural sexism, racism, classism, ableism, and heterosexism.

Finally, our correlations with past alcohol use are consistent with previous research showing that women who identify as liberal (who would have opposed the ruling) tend to consume more alcohol on average compared to women who identify as conservative (Yakovlev & Guessford, 2013). However, the effect of opposition to the ruling predicting alcohol use intentions was qualified by the interaction with media consumption and thus, media consumption was a key factor in predicting intentions to drink. Future studies should examine past alcohol use as a way to examine the unique variance of media exposure above and beyond past alcohol use.

Conclusion

The Dobbs v. Jackson Women’s Health Organization SCOTUS decision is a conspicuous example of structural sexism’s impact on women’s health. This study provided initial evidence that this event impacted alcohol use intentions among women residing in the 13 trigger law states immediately after the ruling. It is critical for health researchers to examine the rippling negative health consequences of heavy media consumption of events that limit individual freedoms and for public health officials to implement timely alcohol reduction interventions after state-level policymakers pass additional abortion restrictions into law. Yet, the swift public backlash to the Dobbs decision and the galvanization of researchers to address its health ramifications demonstrate how such events can motivate action and indicate that, with regard to reproductive rights in the United States, not all hope is lost.

Public Health Significance Statement.

This study illustrated that consuming more abortion-related media immediately after the Supreme Court overturned Roe v. Wade predicted higher alcohol use intentions for women who opposed the ruling, but not for those who supported it. Alcohol reduction interventions should focus on individuals who consume high levels of media and have distress in response to political events.

Acknowledgments

Stacy M. Post, Mary C. Jobe, Arianne N. Malekzadeh, and Rebecca K. Hoffman received a research grant from the DC Psychological Association that partially supported this project.

The authors would like to thank the George Washington University undergraduate research assistants Meg Lyons, Mikaila Loughlin, and Katrina King for their help with background research. The authors have no known conflicts of interest to disclose.

Preregistration, data, and code for this study are available on the Open Science Framework at https://osf.io/9q2bf.

Stacy M. Post played a lead role in methodology, project administration, and visualization and an equal role in conceptualization, data curation, formal analysis, funding acquisition, investigation, writing–original draft, and writing–review and editing. Mary C. Jobe played an equal role in conceptualization, data curation, funding acquisition, investigation, methodology, writing–original draft, and writing–review and editing. Arianne N. Malekzadeh played a lead role in funding acquisition and an equal role in conceptualization, methodology, writing–original draft, and writing–review and editing. Katarina E. AuBuchon played a supporting role in visualization and an equal role in conceptualization, data curation, formal analysis, funding acquisition, writing–original draft, and writing–review and editing. Rebecca K. Hoffman played a supporting role in data curation and an equal role in conceptualization, funding acquisition, methodology, writing–original draft, and writing–review and editing. Michelle L. Stock played a supporting role in supervision and an equal role in writing–review and editing. Lisa Bowleg played a lead role in supervision and an equal role in writing–review and editing.

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