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Biomedical subjects

D P Hogan

Publications and source records attributed to D P Hogan.

At least 19 recordsLinked to original sources
PubMed2001

War, famine and excess child mortality in Africa: the role of parental education.

BACKGROUND: Civilian-targeted warfare and famine constitute two of the greatest public health challenges of our time. Both have devastated many countries in Africa. Social services, and in particular, health services, have been destroyed. Dictatorial and military governments have used the withholding of food as a political weapon to exacerbate human suffering. Under such circumstances, war and famine are expected to have catastrophic impacts on child survival. This study examines the role of parental education in reducing excess child mortality in Africa by considering Tigrai-Ethiopia, which was severely affected by famine and civil war during 1973--1991. METHODS: This study uses data from the 1994 Housing and Population Census of Ethiopia and on communities' vulnerability to food crises. Child mortality levels and trends by various subgroups are estimated using indirect methods of mortality estimation techniques. A Poisson regression model is used to examine the relationship between number of children dead and parental education. RESULTS: Although child mortality is excessively high (about 200 deaths per 1000 births), our results show enormous variations in child mortality by parental education. Child mortality is highest among children born to illiterate mothers and illiterate fathers. Our results also show that the role of parental education in reducing child mortality is great during famine periods. In the communities devastated by war, however, its impact was significant only when the father has above primary education. CONCLUSIONS Our findings suggest that both mother's and father's education are significantly and negatively associated with child mortality, although this effect diminishes over time if the crisis is severe and prolonged. The policy implications of our study include, obviously, reducing armed conflict, addressing food security in a timely manner, and expansion of educational opportunities.

Child↗
PubMed2000

Functional limitations and key indicators of well-being in children with disability.

OBJECTIVES: To compare measures of well-being in children with and without different types and severity of limitations. DESIGN: Nationally representative data for American children aged 5 to 17 years were drawn from the 1994 and 1995 National Health Interview Surveys on Disability (NHIS-D) (N = 41,300) and the Year 2000 Health Supplement to the 1994 NHIS-D (N = 9530). Family resources, safety, health status, and health access were measures of environment. The presence and severity of limitations were measured in the domains of mobility, self-care, communication, and learning. RESULTS: Children with functional limitations were more likely to live in families with limited resources and have greater exposure to secondhand smoke, less access to health care, and lower health status. Children with a limitation were not less likely to have a regular source of medical care, but they more often were delayed or prevented from getting necessary health care due to cost or insurance. CONCLUSIONS: Standard measures of child well-being were appropriate for children with functional limitations and showed their unfavorable situations. Children with functional limitations more often have unfavorable family resources, less healthy home environments, poorer health status, and less health service access than other children, making them more susceptible to developmental difficulties beyond those difficulties associated with the challenges of their specific functional limitations.

Activities of Daily Living↗
PubMed2000

Family factors and social support in the developmental outcomes of very low-birth weight children.

This study used data that were representative of the normative population of all infants born in 1988 and were followed during the first 3 years of life. Large developmental delays and limitations in function were common among children weighing less than 1500 g at birth. Among very low-birth weight infants, minority status and living in a household headed by a single mother further worsen the disadvantages associated with a very low birth weight. Nor could the disadvantages associated with very low birth weight be accounted for by controls for other risk factors or buffering statuses and behaviors. Among all children (including those of very low birth weight) poverty, reliance on Medicaid and other government sources for health insurance, a history of risky behaviors, and inadequate prenatal care are the major risk factors for developmental delays, limitations in function, and impairment at birth. State program benefit levels have no obvious effects on child outcomes, taking into account participation in individual programs. An important finding in light of TANF is that maternal work, the use of child care, and the form and cost of child care did not influence developmental delay, limitation in function, or impairment, the outcomes that we were able to measure during the first 3 years of life. TANF eligibility requirements, however, may increase difficulty in obtaining prenatal and other medical services for mothers and children in need--factors shown here to be related strongly to increased risk of low birth weight and developmental delays, limitations, and impairments. Race and ethnicity, poverty status, and family structure are fundamental factors in early child development and function. Minority status, poverty, and single-parent households greatly increase the likelihood that a mother will engage in risky behaviors (smoking, alcohol use, illegal drug use) during pregnancy and receive inadequate prenatal care. Risky behaviors and inadequate prenatal care are the major risk factors for a baby of very low birth weight. When perinatologists first encounter a new patient who is of very low birth weight they often see an infant who is minority, in poverty, and in a single-parent household. Although such children did more poorly in development and function by age 3, the major effects of these variables were through the selectivity of such children into very low birth weight; the direct impact of these factors on development is somewhat muted. This research suggests there are a number of policies that can reduce development delays and functional limitations among children in the United States. Programs that are targeted to a mother and child (such as WIC, AFDC, health insurance coverage, and possibly the more recent TANF programs) significantly reduced the risk an infant will be of very low birth weight. Access and use of adequate prenatal care are essential. Programs designed to combat maternal behaviors that place the fetus at risk (smoking, alcohol, and illegal drug use) can be very successful in reducing the likelihood an infant will be of very low birth weight. An additional payoff from such programs comes after the birth, because even taking into account birth weight, these variables negatively impact on early childhood development and function. Single-parent family structure, race and ethnic minority status, and poverty status also are known to impact on kindergarten readiness, so that we expect a delayed impact of these variables on the child. The strength of this article is the use of normative population data to assess the role of birth weight in child outcome. We examined prenatal risk factors for a baby of very low birth weight, traced the manner by which these selective risks are reflected in the composition of very low-birth weight babies, demonstrated how a very low birth weight was fundamental to delays in development, and identified risk factors and potential buffers in this process. (ABSTRACT TRUNCATED)

Birth Weight↗
PubMed2000

Sexual and fertility behaviors of American females aged 15-19 years: 1985, 1990, and 1995.

OBJECTIVES: This study characterized changes in sexual and reproductive behaviors from 1985 through 1995 among American females aged 15 to 19 years and related these changes to family factors. METHODS: Nationally representative sample survey data from the 1995 National Survey of Family Growth were analyzed with Weibull hazards models of age at first intercourse and first pregnancy and with logistic regression models of contraceptive use at first intercourse and pregnancy outcome. RESULTS: Improvements in the family socioeconomic situations of young women have lessened the risk of teen motherhood, while changes in family structure have increased the risk. Young women whose parents have more than a high school education, who live with both parents, and who attend church delay the timing of first sexual intercourse and are more likely to use a contraceptive. CONCLUSIONS: The trend of increases in teenage motherhood has ended owing to a halt in increases in the proportion of sexually active young women and substantial improvement in contraception, with the greatest improvements among those from advantageous family situations.

Adolescent↗
PubMed1999

Household organization, women's autonomy, and contraceptive behavior in southern Ethiopia.

The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region.

Adolescent↗
PubMed1997

Improved disability population estimates of functional limitation among American children aged 5-17.

OBJECTIVES: This paper (a) creates and validates measures for population survey data to assess functional limitation in mobility, self-care, communication, and learning ability for school-age American children; (b) calculates rates of functional limitation using these measures, and provides population estimates of the number of children with limitations; and (c) examines these limitations as a function of socioeconomic factors. METHOD: The study is based on data for children aged 5-17 collected in the 1994 National Health Interview Survey on Disability. Ordinal values are assigned to survey items in the four functional areas and analyzed to produce scales of high reliability. These measures are used to identify within a 95% confidence interval the number of children with these limitations. Ordered logistic regression models measure the effects of functional limitations on disability and societal limitation. Socioeconomic differences are measured with an ordered logistic regression model that predicts severity and comorbidity. RESULTS: Limitations in learning ability (10.6%) and communication (5.5%) are the most common, with mobility (1.3%) and self-care (0.9%) occurring less often. Six percent of children have one serious functional limitation and 2.0% have two or more serious functional limitations. This corresponds to 4.0 million school-age American children with serious functional limitations. Functional limitation is strongly linked to socioeconomic disadvantage and to residence in single-mother households. CONCLUSIONS: Future population research should use multiple-item scales for four distinct areas of functional limitation, and a summary that takes into account both severity and comorbidity. The improved estimates of the number of school-age children with functional limitation in this paper may help contribute to a more informed scientific and policy discussion of functional limitation and disability among American school-age children. Future research on the disability process among children must consider the role of socioeconomic disadvantage and family structure.

Activities of Daily Living↗
PubMed1996

Living arrangements of minority elders.

We used 1990 census data to examine differences in the current living arrangements of minority elderly. We found that differences among the minority populations in age, sex, and marital status account for only a small part of the observed differences in living arrangements. However, while minority groups as a whole differ substantially from the White population, national ethnic patterns within groups appear to be relatively small. Hispanic ethnic groups vary little once differences in marriage patterns are taken into account, although differences are greater within the Asian population.

Age Factors↗
PubMed1985

Migration patterns during Italian urbanization, 1865-1921.

This study examines patterns of male migration in central Italy during its transformation from an agrarian to an urban-industrial society. The Italian population registers provide data on the extent and type of emigration among more than 3,500 men (ages 10 and over) who immigrated to the commune of Casalecchio di Reno, bordering the city of Bologna, from 1865 to 1915. Demographic and social differentials in overall rates of emigration and their relation to places of origin and destination are measured. The implications of these results for an understanding of population mobility are discussed.

Female↗
PubMed1982

The impact of class, education, and health care on infant mortality in a developing society: the case of rural Thailand.

Demographic and social factors affecting infant mortality in rural northern Thailand are examined using log-linear modified multiple regression models and data drawn from a representative sample of married couples in Chiang Mai and Chiang Rai provinces. Demographic factors do not account for the effects of variations in parental ability or willingness to provide adequate infant care. The final model estimated incorporated both these social dimensions of child care. Parental ability, measured by father's social class, mother's health information, and local community development levels, continued to have significant independent effects upon infant survival. Parental willingness, measured by parent's beliefs about intergenerational wealth transfers, no longer had a significant effect net of other social variables, but infant survival was still affected by whether both parents wanted a birth.

Adolescent↗
PubMed1981

Antecedents to contraceptive innovation: evidence from rural Northern Thailand.

A number of different causal mechanisms have been proposed to explain the onset of fertility declines in populations with previously uncontrolled fertility, but they have never been adequately tested. The present study identifies and tests five antecedents to family limitation practices in a sample of 755 currently married couples resident in rural Northern Thailand. The log-linear multiple regression models estimated indicate that couples in more developed districts, more modern couples, couples in which wives have more equal roles, couples believing that intergenerational wealth transfers favor children rather than their parents, and more wealthy couples, were all significantly more likely to be early adopters of contraception. Local development levels appeared to have the greatest net effects on the timing of adoption of fertility control. In addition, couples in areas where contraceptive services were more readily available were also significantly more likely to be contraceptive innovators, net of these five variables.

Adolescent↗
PubMed1981

Community availability of contraceptives and family limitation.

This study examines the impact of contraceptive service availability on contraceptive use in Korea, Mexico, and Bangladesh. Using World Fertility Survey Data on once-married females and their communities of residence, the multivariate analysis finds that the community level of contraceptive availability directly affects the likelihood of current use, net of the effects of community development, education, parity, and marital duration. The results are supportive of the recent policy emphasis on maximizing the geographic availability of contraceptive services.

Adult↗
PubMed1978

A components method for measuring the impact of a family planning program on birth rates.

One of the major goals of family planning programs worldwide has been to reduce the level of fertility in hopes of slowing the rate of natural increase and promoting social and economic development. Such programs have now been in existence for sufficient lengths of time to have had an impact on fertility levels. In general countries with organized family planning programs, marked declines in fertility levels have been observed. The extent to which such declines may be credited to organized programs has not been rigorously measured because an appropriate research methodology has been lacking. This paper describes one method of directly linking declines in fertility levels to the contraceptive protection experienced by a population. The contribution of organized family planning programs is estimated by decomposing the amount of total contraceptive protection into within-program and outside-program sources.

Age Factors↗
PubMed1978

The effects of demographic factors, family background, and early job achievement on age at marriage.

National data for ever-married men age 20 to 65 in March 1973 are utilized to estimate least squares and log-linear structural equation models of age at marriage. We demonstrate that most characteristics of family background (including both the family structure and its socioeconomic standing) are irrelevant in their effect on age at marriage. Intercohort trends are not explicable with reference to the changing socioeconomic, ethnic, or nativity compositions of the cohorts. Regional differences in age at marriage have persisted over the years in only slightly diminished form and cannot be explained by reference to the nativity, ethnic, or socioeconomic compositions of the regions. Early job status relates only weakly to age at marriage. Only those activities that are time-consuming or otherwise disruptive of the smooth operation of normal life-cycle processes during the transition from adolescence to adulthood (such as college attendance and service in the military) seriously affect the age at which a man marries.

Achievement↗
PubMed1978

Fertility and family planning in rural northern Thailand.

From the mid-1960s to the mid-1970s, when fertility was declining in Thailand as a whole, especially rapid declines occurred in Northern Thailand, but they did not occur uniformly in all the region's provinces. The Northern Thailand Fertility Study, initiated in 1975 to study the reported fertility changes, gathered data in two provinces: Chiang Mai, where fertility decline has been quite rapid, and Chiang Rai, which experienced relatively little decline until 1974. This preliminary report discusses fertility levels and trends in the two provinces, fertility experience and expectations of respondents, attitudes toward and knowledge of family planning, and contraceptive practice. The results suggest that most of the difference in fertility decline is related to the different level of family planning program activity in the two provinces.

Abortion, Spontaneous↗
PubMedDate not supplied

Family networks in prenatal and postnatal health.

This paper examines the effects of kin access on prenatal health practices, birth outcome, and postnatal health practice for infants born to black and white mothers ages 21 to 28 in the U.S. during 1984-86. The data used for this research were compiled from three sources: (1) The National Longitudinal Survey of Youth; (2) The Children of the National Longitudinal Survey of Youth; (3) special kin access data files, which were created specifically for this study. Logistic regression procedures are used to assess the effects of kin proximity, maternal grandmother proximity, and presence of the child's father on health practices (N = 1,030) and birth outcome (N = 1,385), controlling for the mother's educational attainment, work experience, poverty, presence of the child's father, and birth order of the child. We find no evidence supporting the notion that kin access positively affects the prenatal and postnatal health practices of young mothers. The results suggest that young mothers who reside with their mothers or other adult kin, and those who are in close proximity to them, are no more likely to seek prenatal care during the first trimester, or to avoid smoking or drinking during pregnancy. Mothers who live with a sexual partner or husband are, however, somewhat more likely to seek prenatal care and to avoid alcohol use during pregnancy. Closer kin access is associated with a lower probability of breastfeeding. These results suggest that it will not be adequate to rely on kin networks or kin assistance to improve the prospect of healthy birth outcomes.

Female↗