This study is part of a larger survey on women’s menstrual health, symptoms suggestive of endometriosis, and stigma. The online survey was conducted in April 2019 among a nationally-drawn sample of undergraduate women.
The sample was selected with the assistance of Qualtrics, a research firm specializing in online surveys and recruitment. Potential respondents likely to meet the inclusion criteria received an email introducing the study and its procedures. Interested participants read the written consent form online and provided informed consent before completing the 20-minute, online survey. The study received Institutional Review Board approval from George Mason University (# 1159779-6).
Participants met eligibility criteria if they were aged 18–24, reported a female sex at birth, and enrolled as a student in undergraduate education. A total of 515 respondents completed the survey. For this analysis, 471 respondents were included. Those who have never had a period (n = 4) or who hadn’t had a period in the past-year (n = 27) were excluded from analysis.
Period poverty was assessed by asking two questions, first: “In the past 12 months have you struggled to afford menstrual products (such as sanitary pads or tampons)?” Those who answered “yes” (vs. “no”) were asked a follow-up question, “Do you struggle to afford menstrual products every month?”. Responses were used to construct a three-level categorical variable: participants who reported experiencing period poverty every month; participants who reported experiencing period poverty in the past year, but not on a monthly basis; and those who reported never experiencing period poverty.
Respondents who reported any past-year period poverty or period poverty every month were also asked, “have you done any of the following because you did not have enough money to purchase menstrual products?” and could select any of the following options: Used other products (e.g., toilet paper, fabric) as menstrual products, Borrowed menstrual products (e.g., from friends, coworkers, strangers), Left a menstrual product in too long, Had to go without menstrual products, I have always had enough money to purchase menstrual products, Other. These measures were developed based on previous menstrual health research [5]. An additional file provides these questionnaire items (see Additional file 1).
The Patient Health Questionnaire (PHQ-9), a 9-item scale that has been well-validated and widely used with a variety of populations including young people, was used to assess depression [11]. Respondents were asked, “Over the past 2 weeks, how often have you been bothered by the following problems?” Nine “problems” were listed (for example, “poor appetite or overeating”) and responses included “not at all,” “several days,” “more than half the days,” “nearly every day.” Respondents received a total score ranging from 0 to 27. A dichotomous variable was constructed: those who had none or mild depression (scores 0–9), and those who had moderate to severe depression (scores 10–27).
Previous health research among college students informed our demographic variables [12]. Respondents were asked their age (numeric responses), relationship status (not in a relationship, in a relationship but not cohabitating, in a relationship and cohabitating), self-reported health status (excellent, very good, good, fair, poor, don’t know), where they live (on- or off-campus), and enrollment status (full- or part-time). They were also asked their race (White; Black; Hispanic or Latino/a; Asian or Pacific Islander; American Indian, Native Alaskan, Native Hawaiian; Biracial or Multiracial; Other), though this variable was collapsed to 4 categories (White, Black, Hispanic or Latino/a, Other). Country of origin (259 response options) was constructed as a dichotomous variable, differentiating between individuals born in the United States and individuals born elsewhere. Sexual orientation (asexual, bisexual, gay, lesbian, pansexual, queer, questioning, same gender loving, straight/heterosexual, other) was collapsed to a 2-category variable (heterosexual/straight, other). Finally, two variables, mother’s education and father’s education (response options: less than high school completed, high school diploma or equivalent, some college, vocational or trade school, bachelor’s degree, master’s degree, professional degree, doctorate, don’t know, not applicable), were combined to create a “first generation” college student variable. Respondents who did not have a parent with a college degree were considered “first generation”; respondents with at least one parent with a college degree or higher were not considered “first generation” [13].
Frequencies and means (where appropriate) were examined for all variables. Bivariate analysis using Pearson’s χ2, t-tests, and one-way analysis of variance assessed the relationship between demographic variables and period poverty, and demographic variables and depression. Logistic regressions assessed the relationship between period poverty and depression, controlling for sociodemographic variables. To preserve power, some covariates were dichotomized for regression analyses. Significance levels were set at 0.05. All analysis was conducted in Stata v14.1.
