Parental leave and child health

This study investigates whether rights to parental leave improve pediatric health. Aggregate data are used for 16 European countries over the 1969 through 1994 period. More generous paid leave is found to reduce deaths of infants and young children. The magnitudes of the estimated effects are substantial, especially where a causal effect of leave is most plausible. In particular, there is a much stronger negative relationship between leave durations and post-neonatal or child fatalities than for perinatal mortality, neonatal deaths, or low birth weight. The evidence further suggests that parental leave may be a cost-effective method of bettering child health.     

State Infant Mortality: An Ecologic Study to Determine Modifiable Risks and Adjusted Infant Mortality Rates

Objective To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Design/Methods Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR’s were standardized and states were compared with the United States adjusted rates. Results Models for IMR in individual states in 2001 (r ² = 0.66, P < 0.01) and 2002 (r ² = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Conclusions Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are potentially modifiable, significantly contributed to differences in state IMR. State risk adjusted IMR indicate that other factors impact infant mortality after adjustment by race/ethnicity and other risk factors.     

The impact of drinking on psychological well-being: Evidence from minimum drinking age laws in the United States

In this paper, we investigate the relationship between alcohol consumption and psychological well-being among young adults in the United States. We do so by exploiting the discontinuity in alcohol consumption at age 21 and using a regression discontinuity design. Using data from the National Longitudinal Survey of Youth (1997 Cohort), we document that young adults tend to increase their alcohol consumption and drink on average 1.5 days per month more once they are granted legal access to alcohol at age 21. However, we also show that in general, this discrete jump in alcohol consumption at age 21 has no statistically significant impact on several indicators of psychological well-being among young adults. This result suggests that although stricter alcohol control targeted toward young adults may result in meaningful reductions in alcohol consumption, the immediate spillover effects of such policies on psychological well-being are relatively limited.     

Women's health status and gender inequality in China

This paper examines the health status of women in China by reviewing levels and trends of female mortality at several phases of a woman's life cycle focusing on infancy, girlhood, childbearing and old age. The mortality rates of Chinese women and men are compared for the period 1950–1990 as are comparisons with women in selected countries. The cause-specific death rate, expressed as a percentage of all deaths, and the burden of disease, measured in terms of the disability-adjusted life years (DALYs), are used to reflect the changing patterns of female diseases and causes of deaths. Significant improvement in the health status of Chinese women since 1950 is widely acknowledged as a major achievement for a developing country with the largest population in the world, but the differentials in women's health by region and urban/rural areas are considerable. The Physical Quality of Life Index (PQLI) indicates that the overall level of physical well-being of Chinese women has increased in recent decades, but disparity in health between men and women still exists. The Gender-Related Development Index (GDI) further reveals that China has achieved significant progress in women's health during the past four decades, but far less has been achieved with respect to gender equality overall. The final sections of the paper focus on the discussion of some health problems faced by the female population during the process of economic reform since the 1980 s. In order to promote gender equality between women and men, concerns on women's health care needs are highlighted.     

Trends in infant and child mortality in Mozambique during and after a period of conflict

This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973-1997) by mother's place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988-1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother's place of residence.     

Supportive family contexts: promoting child well-being and resilience

Prevention and intervention programmes for children at risk aim to improve child well-being and resilience. They do so using both direct and indirect strategies, intervening with children but also considering broader contextual factors (such as family dynamics). Children's subjective well-being comprises five main components (physical health, mental health, self-regulation, social competence, and cognitive competence) and is predicted by person, relationship, and contextual factors. Children's resilience, or ability to beat the odds under adverse conditions, is predicted by similar protective factors. Family well-being (FWB) is one of the strongest and most consistent predictors of child well-being and resilience. Aspects of FWB (including adult health and well-being, family self-sufficiency, and family resiliency) have been shown to impact child well-being through positive parent–child interactions. However, risk factors (including poverty and living in geographic locales with limited resources or high levels of neighbourhood violence) can threaten both family and child well-being. Strategies are offered for promoting FWB as a means of supporting resilience and well-being in children at risk for violence, abuse, or neglect.     

Relative or absolute standards for child poverty: a state-level analysis of infant and child mortality

OBJECTIVES: The purpose of the present study was to compare the associations of state-referenced and federal poverty measures with states' infant and child mortality rates. METHODS: Compressed mortality and Current Population Survey data were used to examine relationships between mortality and (1) state-referenced poverty (percentage of children below half the state median income) and (2) percentage of children below the federal poverty line. RESULTS: State-referenced poverty was not associated with mortality among infants or children, whereas poverty as defined by national standards was strongly related to mortality. CONCLUSIONS: Infant and child mortality is more closely tied to families' capacity for meeting basic needs than to relative position within a state's economic hierarchy.     

中国儿童健康状况及服务利用地区差异分析

目的了解我国不同地区儿童健康状况及卫生服务利用的地区差异,为确定我国儿童保健工作重点及制定相应措施提供依据。方法以2008年中国卫生服务调查研究资料为基础,采用差异指数和地理分布图方法,分析儿童2周腹泻发病率、2周患病率、2周就诊率和住院率4项指标在不同地区的差异。结果儿童健康状况及卫生服务利用的4项统计指标均呈现农村高于城市。按照行政区域划分,儿童2周腹泻发病率较高的是西南(8.5%)和东北(8.0%),最低的是中南(5.1%);2周患病率和2周就诊率最高的都是中南(14.1%和20.9%),最低的均为西北(7.2%和6.9%);住院率最高的是中南(4.6%),最低的是华北(3.1%)。差异指数无论是在行政区域内部还是在全国范围基本都大于0.20,说明地区差异较为显著。结论我国儿童健康状况及卫生服务利用存在较大地区差异。     

Socioeconomic status,John Henryism and blood pressure among African-Americans in the Jackson Heart Study

John Henryism connotes a strong behavioral predisposition to engage in effortful, active coping with difficult social and economic stressors. This behavioral predisposition is measured by the 12 item John Henryism Scale for Active Coping (JHAC). The John Henry hypothesis predicts that the well-known inverse socioeconomic status (SES)-blood pressure association will be stronger among persons who score high rather than low on the JHAC. We tested this hypothesis in a large African American cohort using baseline data from the Jackson Heart Study. Unlike previous studies, we used multiple indicators of SES: income, education, occupation, childhood SES and cumulative SES. Because the hypothesis is most relevant for adults still in the labor force, we excluded retired participants, yielding a sample size of 3978. Gender-specific Poisson regression models for hypertension adjusting for age, John Henryism, SES, and a John Henryism-SES interaction term, were fit to examine associations. Separate models were fit for each SES indicator. We found some evidence that John Henryism modified the association between income and hypertension in men: low income was associated with higher prevalence of hypertension in men who scored high on John Henryism (prevalence ratio (PR) for low vs. high income tertile 1.12), but with lower hypertension prevalence among men who scored low on John Henryism (PR 0.85, one sided P value for multiplicative interaction <0.05). For women, the association of low income with higher hypertension prevalence was stronger at lower than higher levels of John Henryism (PR 1.27 and 1.06 at low and high levels of John Henryism respectively, P value<0.05). There was no evidence that John Henryism modified the associations of hypertension with other SES indicators in men or women. The modest support of the John Henryism Hypothesis in men only, adds to the literature on this subject, but underscores questions regarding the gender, spatial, socioeconomic and historical contexts in which the hypothesis is valid.     

Neighborhood Mapping and Evaluation: A Methodology for Participatory Community Health Initiatives

Objectives: This paper describes the use of neighborhood mapping as a key element in an ecological study of a community-based urban infant mortality prevention program. We propose the use of neighborhood mapping in evaluation research to more fully examine the local context of community health programs. Mapping can be used to study community change and to describe community assets and structural, epidemiological, and social features of neighborhoods that may influence program implementation and outcomes. Methods: Data on physical features were collected by community residents during street-by-street neighborhood walkthroughs. Other data sources included program records, Census, birth certificate, and state and city data. Analytic methods included geo-coding, exploratory factor analysis to create spatial density indicators of neighborhood features at the Census block group level, and analysis of associations between neighborhood features and outcomes. Results: Point and chloropleth maps provide a powerful illustration of neighborhood features (e.g., vacant buildings), client distribution and participation, health outcomes, and change over time. Factor analysis indicated two salient clusters of non-residential land use: (1) legitimate daily usage (liquor stores and other businesses) and (2) non-legitimate daily use (houses of worship and vacant buildings). A composite scale was created to indicate overall risk related to physical neighborhood features. Conclusions: Neighborhood mapping is a powerful tool that brings participants and residents into the research process. Moreover, it can improve understanding of the role of neighborhood ecology in program implementation and outcomes.     

Ecological analysis of the relationship between infant mortality and cardiovascular disease mortality at ages 45-69 in the Brazilian 1935 birth cohort

Background

International ecological studies have shown a positive association between infant mortality as a proxy for low birth weight and cardiovascular disease mortality in adult life.

Methods

Mortality rates due to Cardiovascular Diseases (CVDMR) standardised by age in adults between 45 and 69 years of age and by place of birth (pob) and residence (res) were related to Infant Mortality Rates (IMR) in the Brazilian 1935 birth cohort.

Results

Two relationship patterns were noted between IMR and CVDMR: for the Southeast, South and Centre-West group of regions (r_pob = 0.46; r_res = 0.29) and for the North and Northeast group of regions (r_pob = 0.21; r_res = 0.33). For the latter pattern, two states were identified (Rio Grande do Norte and Paraíba) as atypical areas, whose exclusion strengthened the association (r_pob = 0.73; r_res = 0.91).

Conclusions

The direction of the associations changed after the analysis by group of Brazilian regions (indirect control of socio-economic levels, coverage and quality of the information). There is a positive, although weak association between IMR and CVDMR. Attempts to control or minimise the interference of migratory movements, cohort effects and socio-economic levels represented methodological progress in ecological analyses of foetal programming in Brazil.     

Women's status and depressive symptoms: a multilevel analysis

The effects of state-level women's status and autonomy on individual-level women's depressive symptoms were examined. We conducted a multi-level analysis of the 1991 longitudinal follow up of the 1988 National Maternal Infant Health Survey (NMIHS), with 7789 women nested within the fifty American states. State-level women's status was assessed by four composite indices measuring women's political participation, economic autonomy, employment & earnings, and reproductive rights. The main outcome measure was symptoms of depression (Center for Epidemiologic Studies Depression Scale, CES-D). The participants were a nationally representative stratified random sample of women in the USA aged between 17 and 40 years old who gave birth to live babies in 1988, were successfully contacted again in 1991 and provided complete information on depressive symptoms. Women who were younger, non-white, not currently married, less educated or had lower household income tended to report higher levels of depressive symptoms. Compared with states ranking low on the employment & earnings index, women residing in states that were high on the same index scored 0.85 points lower on the CES-D (p<0.01). Women who lived in states that were high on the economic autonomy index scored 0.83 points lower in depressive symptoms (p<0.01), compared with women who lived in states low on the same index. Finally, women who resided in states with high reproductive rights scored 0.62 points lower on the CES-D (p<0.05) compared with women who lived in states with lower reproductive rights. Gender inequality appears to contribute to depressive symptoms in women.     

Parent use of food to soothe infant/toddler distress and child weight status. An exploratory study

The aim of the present study was to explore the parent feeding practice of using food to soothe infant/toddler distress and its relationship to child weight status. Seventy eight families with infants and toddlers (43 males) ranging in age from 3 to 34 months (M = 14 mos, SD = 9 mos) completed a survey which included questions on their use of food to soothe, questionnaires on parent feeding practices, parenting self-efficacy, child temperament and child's weight and length at the time of their last well-baby visit. Results revealed the use of food to soothe to be a valid construct. In addition, mothers who used food to soothe rated themselves lower in parenting self-efficacy and their children higher in temperamental negativity. Analyses examining weight status as the outcome variable revealed that mothers who reported the use of food to soothe had heavier children, however, this relationship was stronger for children rated as high in temperamental negativity.     

Reducing child mortality in Nigeria: a case study of immunization and systemic factors

The purpose of the study is to assess the outcome of the Expanded Program on Immunization (EPI) in Nigeria, as well as to examine systemic factors influencing its high under-five mortality rate (UFMR). The principal objective of the EPI program when it was implemented in 1978 was to reduce mortality, morbidity and disability associated with six vaccine preventable diseases namely tuberculosis, tetanus, diphtheria, measles, pertussis and poliomyelitis. The methodological approach to this study is quantitative, using secondary time series data from 1970 to 2003. The study tested three hypotheses using time series multiple regression analysis with autocorrelation adjustment as a statistical model. The results showed that the EPI program had little effect on UFMR in Nigeria. Only the literacy rate and domestic spending on healthcare had statistically significant effects on the UFMR. The military government was not a significant factor in reducing or increasing the UFMR. It appears that Nigeria needs a unified approach to healthcare delivery, rather than fragmented programs, to overcome cultural and political divisions in society.     

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries

Background: Over one-third of the world’s population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear.Objectives: To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality.Methods: We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models.Results: The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality.Conclusions: Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.     

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries

Background: Over one-third of the world’s population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear.

Objectives: To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality.

Methods: We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models.

Results: The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality.

Conclusions: Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.     

Professional Women's Well-Being: The Role of Discrimination and Occupational Characteristics

This study examined the association between perceived discrimination, workplace racial composition, and three outcomes—psychological distress, life dissatisfaction, and job dissatisfaction—among a sample of Black (n = 72) and White (n = 74) professional women. As a comparison, these relationships were analyzed to determine if they varied from those observed in more traditionally studied populations: Whites and non-professional Blacks, using data from a population of working women in the 1995 Detroit Area Study (N = 533). Perceived discrimination was associated with differences in psychological distress and job dissatisfaction but not with life dissatisfaction. The correlation between perceived discrimination and psychological distress was larger for White professional women than for Black professional women (White women odds ratio [OR]: 1.99; Black women OR: 0.80). A larger correlation between race and job dissatisfaction was observed for Black professional women than for Black non-professional women. The racial composition of the workplace was unrelated to any of the outcomes. Study results emphasized the importance of decreasing the frequency of discrimination for positive mental health and underscored the need for more systematic research on discrimination and health among Black women of higher socioeconomic status, a growing sub-population in the United States.