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ItemTHE ACCURACY OF MOTHERS' REPORTS OF CHILD VACCINATION: EVIDENCE FROM RURAL EGYPT(2006-08-01T19:58:42Z) Langsten, Ray; Hill, KennethEstimates of immunization coverage in developing countries are typically made on a "card plus history" basis, combining information obtained from vaccination cards with information from mothers' reports, for children for whom such cards are not available. A recent multi-round survey in rural lower Egypt was able to test the accuracy of mothers' reports for a subset of children whose cards were not seen at round 1 of the survey but were seen a year later at round 3. Comparisons of the unsubstantiated reports at round 1 with information recorded from cards seen at round 3 indicate that mothers' reports are of very high quality; mothers' reports at round 1 were confirmed by card data at round 3 for between 83 and 98 percent, depending on vaccine, of children aged 12-23 and 24-35 months at round 3. The number of incorrect "Not Vaccinated" answers is higher than the number of incorrect "Vaccinated" responses, suggesting that, at least in this setting, "card plus history" based estimates slightly underestimate true coverage levels. Most of the inconsistencies between round 1 and round 3 data apparently arose from interviewer or data processing error rather than from misreporting by mothers. ItemAlleviating Disability and Unmet Need: Differential dimensions addressed by assistive technology and personal care(Hopkins Population Center, 2004-01) Agree, Emily M.; Freedman, Vicki A.Purpose. To examine differences in reports of residual disability and unmet need by type of care arrangement (assistive technology and/or personal care) amongst disabled adults. Method. This study compares three specific dimensions of residual difficulty (pain, fatigue, and time intensity) and unmet need for hands-on care across combinations of assistive technology and personal care. Analyses are conducted on samples of between 3,493 to 7,051 persons with limitations in bathing, transferring, walking, and getting outside from the U.S. 1994-95 National Health Interview Survey Phase 2 Disability Supplements. Results. Even accounting for differences in underlying disability, equipment use confers no additional benefit in the three dimensions of residual difficulty analysed here. Equipment users equally or more often report that tasks are tiring or time consuming, or painful even when they use assistance. Though this would appear to indicate unmet needs for care, fewer equipment users report a desire for hands on personal care. Conclusions. We find that disability alleviation by technology is no better on specific dimensions of difficulty, but technology users report less unmet need for personal care. Designing appropriate and cost-effective home care for disabled adults depends upon an understanding of the ways in which technology users may differ from others and the circumstances in which technology can be most effective. ItemAlternative Fertility Measures: Their Sensitivity and Relationship to Fertility Rates(Hopkins Population Center, 1977-04) Becker, Stan ItemThe Association Between Grandparental Co-Residence and Adolescent Childbearing(Hopkins Population Center, 1993) Astone, Nan MarieThere is some evidence to suggest that, in the US, young women are predisposed to have children early and outside of marriage and to marry early when growing up in a non-intact family, plagued by poverty and economic dependence. The number of children growing up in non-intact families has increased, and many grow up in families with multiple characteristics, which place them in a high risk context. In this examination of the influence of family structure on children's outcome, residence with extended kin, specifically grandparents, is examined for its impact on early childbearing. Data were obtained on a nationally representative sample of 4786 females who were sophomores in 1980 from the HIgh School and Beyond study. Dependent variables were evidence of childbearing before the age of 20 and childbearing out of wedlock before the age of 20. Independent variables were race and living arrangements that included both natural parents, one natural parent and one stepparent, one natural parent and no stepparent, and neither parent. In each of these situations, a dummy variable was coded for the presence of a grandparent in the household in both 1980 and 1982. Control variables were region, size of place of residence, number of siblings, and socioeconomic status score. Interaction effects between control and independent variables was found for growing up in a single parent family and being African-American. The results of logistic regression techniques showed that grandparent co-residence effects did not vary by race or family type. African-American teenagers were found to be more likely to have a teenage birth and more likely to have the birth outside of marriage. African-American teenagers from a single parent family were also more likely to have a teenage birth and to have the birth outside of marriage; this effect was not seen in Whites. The results are considered quite preliminary due to the marginal significance levels of coefficients and the lack of attention to selectivity bias. Grandparents co-residence was significantly negatively associated with a birth before the age of 20 at the .10 level of significance. The pattern was similar for outside marriage births but was not significant. There is a need for better specification of measures; for instance, there may be important differences between growing up with a divorced versus a never married mother. ItemA bargaining theory of sexual behavior in women's adolescence(Hopkins Population Center, 1992) Nathanson, Constance A.; Schoen, Robert ItemBlack Activist Mothering: A Historical Intersection of Race, Gender, and Class(Hopkins Population Center, 1997) Bell McDonald, KatrinaThe prevalence of poor health among young disadvantaged Black mothers and their children has prompted a revival of maternal activism among Black middle-class urban women. A study of the California-based "Birthing Project," founded in 1988, reveals that such activism is best understood as a modern-day version of Black activist mothering practiced by African-American clubwomen from the time of slavery to the early 1940s. This article demonstrates the legacy of "normative empathy" as a significant motivator for middle-class maternal activism and as a basis for a middle-class critique of Black mothering among the disadvantaged. ItemChild Mortality Estimation by Time Since First Birth(Hopkins Population Center, 1999) Hill, Kenneth; Figueroa, Maria-ElenaThe Brass method for estimating child mortality from proportions dead of children ever born classified by age or duration of marriage of mother has revolutionized our knowledge of child mortality levels and trends in developing countries. However, the age-based version of the method suffers from selection biases for young women whose data provides the most recent estimates, and the duration of marriage-based method is only applicable where most births occur within stable marriages. This paper develops and illustrates a methodology based on time since first birth using a model of fertility by time since first birth and model life tables. This methodology avoids the selection bias of the age-based method, and is applicable to all populations regardless of marriage customs, but does require an extra question, on date of or age at first birth, on the census or survey instrument. An application to data from Haiti shows the method to give estimates similar to those from a subsequent birth history. The method is likely to be of most value in large survey operations such as censuses in populations with moderate to high levels of pre- or extra-marital fertility. ItemChildhood Mortality in Kenya: An examination of trends and determinants in the late 1980s to mid 1990s(Hopkins Population Center, 2001-01) Hill, Kenneth; Bicego, George; Mahy, MaryAfter Independence in the early 1960s, child mortality in Kenya fell rapidly. Until around 1980, the under 5 mortality rate (U5MR), the probability of dying by age 5, fell at an annual rate of about 4 percent per annum. This rate of decline slowed in the early 1980s, to about 2 per cent per annum. Recent data from the 1998 Kenya Demographic and Health Survey showed that, far from declining, the U5MR increased by as much as 25 percent from the late 1980s to the mid 1990s. This adverse trend coincided with a number of other adverse trends: stagnation in growth of per capita income, declining levels of immunization, falling school enrolment, and the emergence of an HIV/AIDS epidemic. On a more positive note, fertility fell by about 30 percent from the mid 1980s to the mid 1990s. Controversy surrounds the factors responsible for the increase in child mortality in the 1990s, and the objective of this paper is to clarify the situation. Data from the 1993 and 1998 DHSs have been merged into a single data set, and multivariate analysis used to examine the factors associated with mortality risks in childhood. Dummy variables were used to represent different three-year time periods, from 1984-86 to 1996-98. Socioeconomic controls, including mother¹s education, an indicator of household wealth, urban/rural residence, and indicators of health service utilization, plus controls for reproductive dynamics such as age of mother at the birth, birth order, sex and preceding birth interval, were developed. In addition, an indicator of the HIV epidemic, the prevalence of HIV in the district of birth at the time of each child¹s birth, was developed. With no controls, the models confirmed an increase in mortality of about 25 percent. Including socioeconomic and biodemographic controls tended to strengthen the upward trend in mortality; in other words, had there been no changes in these factors, child mortality would have been expected to decline. Introducing controls for health variables immunization, pregnancy and delivery care, prevalence of childhood diseases and maternal and child malnutrition also did not alter the underlying trends substantially. Thus rising child mortality could not be explained by socioeconomic, biodemographic or health status factors. Including the prevalence of HIV in the models, however, changed the underlying trends fundamentally, from sharp increase to monotonic decline. Although models of this sort cannot demonstrate causation, only association, the HIV epidemic appears to be the most probable cause of the recent increases in child mortality in Kenya. Of the health variables, the only one found to be significantly protective was immunization coverage. ItemChildhood Precursors of Adult Morbidity and Mortality In Developing Countries : Implications for Health Programs(Hopkins Population Center, 1992-06-05) Mosley, W. Henry; Gray, RonThis paper will examine only one aspect of this health transition in developing countries. It will look at the emerging health problems among the adults and the aged and assess to what degree these chronic diseases and disabilities might be a consequence of infectious diseases and other adverse conditions which were experienced decades earlier in infancy and childhood. A recognition of these relationships can enhance our understanding of the cost-effectiveness and cost benefits of programs to promote child health. Child health interventions are not only cost-effective in saving lives and preventing disabilities in the short run but, more importantly, in the long run can result in major cost savings to health systems and accelerate national development by improving the health and productivity of these children when they become adults. ItemDemography and Policy : an Asian Experience(Hopkins Population Center, 1991) Sirageldin, IsmailThe purpose of this paper is to investigate the factors influencing the use of demographic knowledge in the formulation, implementation and evaluation of public policies. The focus of the discussion is to conceptualize the dynamic and interactive nature of the supply and demand for demographic knowledge, or more generally, analyze the structure of the market for such knowledge. ItemDemography and the Biomedical Sciences: The Integration of Demographic and Epidemiologic Approaches to Studies of Health in Developing Countries(Hopkins Population Center, 1985-06) Gray, Ronald H. ItemDisagreement in Spousal Reports of Current Contraceptive Use in Sub-Saharan Africa(Hopkins Population Center, 1998-12) Becker, Stan; Hossain, Mian Bazle; Thomson, ElizabethContraceptive prevalence is a key variable estimated from Demographic and Health Surveys. But the prevalence estimated from reports of husbands differs widely from that estimated for wives. In this research, using data from six Demographic and Health Surveys of sub-Saharan Africa, reports from spouses in monogamous couples with no other reported sex partners in the recent period are examined. Agreement ranged from 47% to 82%, but among couples in which one or both reported use, the 'both' category represented less than half in all nations except Zimbabwe. Husbands generally had higher reports of condoms, periodic abstinence and pills but fewer reports of the IUD, injections and female sterilization. Either discussion of family planning with the spouse and/or higher socioeconomic status was associated with agreement in most of the surveys. Ambiguities in the survey question regarding current use need to be reduced, perhaps with an added probe question for non-permanent methods. ItemDoes the Law of Diminishing Returns Apply to Infant Motality Decline?(Hopkins Population Center, 2001-06-22) Bishai, David; Poon, AndrewObjective: This paper examines time series data on infant mortality from 21 countries to demonstrate an appropriate test of the hypothesis that percentage reductions in infant mortality are larger when infant mortality is lower. Prior research expounding this hypothesis has dubbed it "the Matthew effect". Method: Time series for infant mortality can be modeled as X t = m + q1 X t-1 +e t where e t is identically and independently distributed. If q1=1 it is easily demonstrated that the time series has an asymptotic distribution with infinite variance. The correct test to apply in this situation is the Dickey-Fuller test which we use to test the statistical significance of q1 in a regression analysis of Dlog IMR t = m + q1 log IMR t-1 +e t. Evidence that q1 is significant and negative would support the claim that there is a Matthew Effect in infant mortality. This paper uses time series data on IMR from 21 nations for 1870-1988. Several additional lagged values of Dlog IMR were appended using an Akaike Indicator Criterion to select the preferred specification. Transformations of IMR other than simple logarithms were explored. Results: With the preferred specification, the Dickey-Fuller test rejected the presence of any Matthew Effect in all but three countries. The rejection of a Matthew Effect was robust to alternative specifications of the lag structure of IMR and to various transformations of IMR other than logarithmic. Conclusion: Based on 20th century data there is scarce evidence that percentage reductions in infant mortality are generally smaller in higher mortality countries. Large percentage reductions in infant mortality are possible for countries at any stage in economic development and are likely to be reflective of durable advances in human knowledge, social institutions, and physical capital. ItemEconomic, physical, and political characteristics of neighborhood of residence and the risk of low birth weight.(Hopkins Population Center, 1996) O'Campo, Patricia; Aronson, Robert E.; Johnson, Tracy L.Low birth weight remains an important public health problem in the U.S. Most research on low birth weight focuses on individual-level determinants of low birth weight such as health behaviors or use of prenatal care. We sought to determine how characteristics of residential neighborhood influenced low birth weight. We first present a theoretically based framework that describes the mechanisms by which neighborhoods can lead to adverse health outcomes. Our research question centered on whether neighborhood economic, physical and political characteristics directly and indirectly influenced the risk of low birth weight and whether neighborhood factors moderated the relation between individual-level risk factors and low birth weight. We used methods of multi-level statistical modelling to investigate our research question. Direct neighborhood level determinants of low birth weight included high crime (OR=2.49), low wealth (OR=5.50) and low level of political organization (2.54). Interactions and confounding between individual- and neighborhood-level characteristics were observed. When multi-level models accounted for neighborhood levels of wealth, the two-fold gap between African-American and White births was no longer significant. Methods of multi- level modelling facilitated testing of a model emphasizing environmental and social factors in determining poor health outcome. The application of such models also resulted in a better explanatory model for low birth weight. High rates of low birth weight births remain an important public health problem in the U.S., especially among impoverished communities. Most research on low birth weight, however, focuses on individual-level determinants of low birth weight such as maternal education, health behaviors including smoking during pregnancy, and quantity and quality of clinical care (1). Increasingly, public health researchers are recognizing that models of disease etiology that focus exclusively on individual characteristics (e.g., demographic, biologic or personality factors) are insufficient for explaining the complex set of factors that contribute to poor health (2, 3). For example, health behaviors and health outcomes of individuals are influenced by workplace and residential environments (2, 4-14). Studies on the influence of neighborhood residence on health outcomes often analyze individual- and community-level characteristics separately (15, 16). This has, in part, been due to (1) a lack of available data on the contexts of study subjects, (2) lack of easily accessible statistical methods and software for the analyses of complex multi-level data (17- 20), and (3) lack of appropriate theory that explicitly acknowledges the mechanisms by which contexts are related to health outcomes (17, 19, 22-24). We undertook the current study to contribute to theoretical development of neighborhood effects on health. In particular, we sought to build a conceptual framework describing the mechanisms by which residential characteristics influence health outcomes and low birth weight. We also were interested in answering two research questions concerning the relation between residential neighborhood risk of low birth weight. (1) Do neighborhood economic, physical and political characteristics directly and indirectly influence the risk of low birth weight? (2) Do neighborhood economic, physical and political characteristics moderate the relation between individual-level risk factors and low birth weight (LBW)? ItemThe Effectiveness of Natural Family Planning Methods for Birth Spacing: A comprehensive review(Hopkins Population Center, 1999-07) Kambic, Robert T.Calendar rhythm is in the same range of effectiveness as modern NFP. When calendar rhythm studies are standardized, the projected rhythm pregnancy rates, 15.0 and 18.5 are within the range of modern NFP methods. Unplanned pregnancy rates for the modern NFP methods range between 10 and 20 pregnancies per 100 women per year. Multivariate analysis comparing sympto-thermal and ovulation method unplanned pregnancy rates shows an ST life table rate of 10.2+2.5 and an OM rate of 16.0+3.3. NFP is as effective as barrier methods of birth spacing and can be used very effectively to avoid pregnancy (less than 5 pregnancies per 100 women per year) if the rules are followed. ItemEffects of Divorce on Mental Health Through the Life Course(Hopkins Population Center, 1997-02) Cherlin, Andrew J; Chase-Lansdale, P. Lindsay; McRae, ChristineThe long-term effects of divorce on individuals after the transition to adulthood are examined using information from a British birth cohort that has been followed from birth to age 33. Growth-curve models and fixed-effects models are estimated. The results suggest that part of the seeming effect of parental divorce on adults is a result of factors that were present before the parents’ marriages dissolved. But in addition, the results also suggest that there is an effect of the divorce and its aftermath on adult mental health. Moreover, a parental divorce during childhood or adolescence appears to continue to have a negative effect when a person is in his or her twenties and early thirties.