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PubMed1977

Socioeconomic factors affecting the utilization of surgical operations.

Between 1963 and 1970 public programs were introduced to reduce inequalities in access to medical care. We examined differentials in surgical utilization among socioeconomic groups in 1970 as well as changes between 1963 and 1970. Multivariate analysis of National Health Interview Survey data indicated that large increases in surgical utilization occurred among disadvantaged groups: the aged, lower educated and nonwhites in urban areas. Some differential by race and residence remains, but is strongly related to income. Income had a large positive effect on surgical utilization, but this effect was less strong in 1970 than in 1963. Education had a negative effect on surgical utilization. Eleven surgical procedures were selected and scaled on indexes of "complexity," "urgency" and "necessity." These indexes do not vary among demographic groups that have significant differences in surgical utilization. However, lower-income groups utilized to a lesser extent procedures rated lowest on the necessity scale.

Adolescent↗
PubMedDate not supplied

Human sex ratio as it relates to caloric availability.

The relationship between human sex ratios at birth and caloric availability per capita was examined across different countries. Significant positive correlations were obtained between the amount of food a country had available and the percentage of male births. Furthermore, increases or decreases in a country's caloric availability were related to corresponding changes in that country's sex ratio. These results provide evidence of adaptive sex ratio biasing in humans. The physiological mechanism by which this effect operates is probably higher mortality rates for male embryos and fetuses as a result of nutritional deficiencies and associated stressors.

Abortion, Spontaneous↗
PubMed1990

Who is breast-feeding? Implications of associated social and biomedical variables for research on the consequences of method of infant feeding.

The objective of this paper is to identify social and biomedical variables that influence the selection of methods of infant feeding in the United States and to provide guidelines for the choice of control variables in the design and interpretation of studies that examine the influence of breast-feeding on infant and child health. Data were drawn from a national household survey, the Child Health Supplement of the 1981 Health Interview Survey conducted by the National Center for Health Statistics. Relationships between demographic, socioeconomic, and health variables were studied for the total sample of children under age 5 y as well as for black and white women separately. The data provide evidence for the importance of both social and health variables as selection factors for breast-feeding in the United States.

Adult↗
PubMed1977

An epidemiologic study of homicides in Allegheny County, Pennsylvania.

Extensive demographic data concerning homicide victims and perpetrators in Allegheny County, 1966-1974, were obtained retrospectively from the records of the County Coroner's Office and Police Department. Analysis revealed that the demographic characteristics describing perpetrators and victims were essentially identical. Rates of homicide peaked in the young adult years of life. The race ratio (B/W) among victims was 18.7 for males and 6.7 for females, while sex ratio (M/F) was 5.4 for blacks and 1.9 for whites. An inverse relationship between the rate of homicide and socioeconomic status was present among both black and white races. The majority of victims were killed by a spouse, relative, or friend (66%), usually in familiar locations, i.e., residence or place of work (60%), and usually during an alteration (68%). Shooting was the method used to perpetrate 61% of the killings, most of which were by means of a handgun. An increasing trend of homicide was noted, particularly for the type perpetrated by shooting.

Adolescent↗
PubMed1991

Breast cancer risk and oral contraceptive use: results from a large case-control study.

The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.

Adult↗
PubMed1992

Two methods for assessing the risk-factor composition of the HIV-1 epidemic in heterosexual women: southeast England, 1988-1991.

OBJECTIVE: The prevalence of HIV-1 in the heterosexual population in southeast England between 1988 and 1991 was examined using two methods. DESIGN AND METHODS: First, district neonatal seroprevalence was compared on a geographical basis to social and demographic variables reflecting risk-factor prevalence. Second, over the same period eight children who developed AIDS within the first 12 months of life were born. RESULTS: The differences in seroprevalence between districts could be explained by the proportion of livebirths to women born in parts of Africa. An estimated 92% of neonatal seropositives could be associated with this demographic variable. The proportions of livebirths to women born in other countries, the prevalence of notified injecting drug use, and area measures of social deprivation, were only poorly related to HIV seroprevalence, and had no additional explanatory value. Seven of the eight (87.5%) children who developed AIDS in the first year were born to black women from Africa. CONCLUSIONS: Both methods suggest that a high proportion of heterosexually transmitted HIV in southeast England has been imported.

Adult↗
PubMed1990

A Children's Health Belief Model.

The classic Health Belief Model (HBM) was adapted to explain children's expected medicine use for five common health problems. To evaluate this Children's Health Belief Model (CHBM), 270 urban preadolescents, stratified by socioeconomic status, grade level, and sex, and their primary caretakers (93% mothers) were individually interviewed. Analyses were performed in two steps. First, regression analysis evaluated the influence of the child's primary caretaker on the child's expected medicine use. Individual differences in children's motivations, perceived benefits and threats, and expectations to take medicines were partially explained by caretakers' perceptions of these children. Second, path analysis evaluated hypothesized causal relationships in the CHBM, accounting for 63% of the adjusted variance in children's expected medicine use. Two readiness factors, perceived severity of illness and perceived benefit of taking medicines, had the highest path coefficients, with illness concern and perceived vulnerability to illness accounting for a smaller, but significant, portion of the variance. Cognitive/Affective variables, notably children's health locus of control, contributed to indirect paths between demographic and readiness factors. The CHBM appears to be a promising model for studying the development of children's health beliefs and expectations.

Adolescent↗
PubMed1990

Factors influencing the relationship between a newborn assessment of gestational maturity and the gestational age interval.

This study examines the correlation and agreement between the calculated 'gestational interval' from the date of last menstrual period (LMP) and the Ballard newborn assessment of gestational maturity. It then investigates selected maternal socio-demographic, prenatal, intrapartum and infant factors which may account for differences between these two gestational age determination methods. Single live-born deliveries (n = 10,794) were selected from a 1982-1986 medical university perinatal information data system for analysis. The Ballard assessment overestimates the LMP at earlier gestational ages and underestimates in the post-term range. The discrepancy between LMP and Ballard varies across the range of gestational age values and the extent of variation differs by several maternal and infant risk factors. These findings suggest considerable bias may result from the indiscriminate case mixing of LMP and Ballard values for use in gestational age research or in standardising developmental tests. We highlight the deficiencies in using correlation coefficients or mean differences to assess agreement between these measures.

Delivery, Obstetric↗
PubMed1991

Dynamics of spread of HIV-I infection in a rural district of Uganda.

OBJECTIVE: To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN: Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING: Rural population of Rakai district, south west Uganda. SUBJECTS: 1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES: HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS: The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS: Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.

Adolescent↗
PubMed1979

Statistical analysis of an urban population of 236 patients with head and neck pain. Part I. Patient profile.

A large group of patients (236) was examined for myofascial pain dysfunction syndrome. The parameters used for diagnosis of the syndrome were pain and tenderness in the head and neck muscles and temporomandibular joint, joint sounds, and limited function. It was found that the demographic profile of our patient population did not vary greatly from those reported previously in other studies. However, we did examine more details of the patients' backgrounds than any other single study. The relationships of age, sex, occupation, marital status, emotional stress, and head trauma were discussed.

Adolescent↗
PubMed1975

Levels and patterns of infant and child mortality in Ghana.

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968-1069 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960's. The urban rate is lower than the rural rate, 98, as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0-4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1-4 years.

Age Factors↗
PubMed1975

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal↗
PubMed1975

Do statements about desired family size predict fertility? The case of Taiwan, 1967-1970.

The predictive accuracy of respondents' statements about their future fertility is examined, using interview data from a longitudinal study conducted in Taiwan. Two measures of preference are found to be highly intercorrelated; and regardless of which one is used, Taiwanese women are shown to predict their subsequent fertility at least as well as U.S. women. The preference measures are also predictive of rates of contraceptive use and abortion. While demographic and social characteristics are correlated with fertility in expected directions, statements about wanting more children prove to be highly predictive of subsequent fertility for both modern and less advanced segments of the population.

Abortion, Induced↗
PubMed1992

Parents and AIDS education.

The objective of this research was to study parents' attitudes toward AIDS education in schools. Questionnaires were mailed to employees in an industrial plant and a hospital in a city of 150,000 in Ontario, Canada. Two hundred and sixteen questionnaires from parents with children in schools were analyzed. Two thirds of the parents agreed that AIDS education should discourage premarital sex; whereas, 88% believed that AIDS education should teach about condoms. Pearson correlations and multiple regression were used to analyze hypotheses that tested attitudes toward AIDS education in the schools. Two predictor variables--attitude toward premarital intercourse and fear of casual contact of AIDS--were significantly correlated with all three measures of attitudes toward AIDS education in the schools. Church attendance and knowledge of AIDS were related to both attitudes toward discouraging premarital sex and teaching about condoms. Three multiple regression models were constructed to predict attitudes toward AIDS education in the schools. The final models accounted for between 11% and 33% of the variance.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Environmental indicators: a tool for evaluating community-based health-promotion programs.

We propose using a class of community-level measures--environmental indicators--as part of the evaluation of community-based health-promotion programs. Community-level measures of health-related behavior can be divided into three conceptual categories. The first two categories comprise statistical aggregates (e.g., means, sums, percentages) of measurements made on individuals, distinguished by whether individual-level covariates are also available. Individual-disaggregated measures include covariates, such as a comprehensive survey of health-risk behavior, including demographic information; individual-aggregated measures, such as sales data, do not. Our main focus is on the third category, environmental indicators, derived from observations of the community environment. Environmental indicators measures aspects of the physical, legal, social, and economic environment in a community that reflect, and likely influence, the attitudes and behavior of individual community members. They also measure an important intermediate step in community-based health-promotion interventions, namely environmental factors that programs target to modify individual attitudes and behavior. We present examples of environmental indicators for tobacco use and diet.

Attitude to Health↗
PubMed1991

Sociodemographic correlates of breast feeding in Ghana.

This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to investigate breast feeding in Ghana and the factors that affect it. Using life table procedures, we found evidence that, when other factors are held constant, older cohorts, women with no schooling, those who work in the agricultural sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis, rural residents, residents of the Volta, Brong-Ahafo, northern, and upper regions, and low-parity women show longer durations of breast feeding. It is recommended that, along with other fertility reduction measures, prolonged breast feeding among all Ghanaian mothers should be encouraged to help reduce conception and to ensure healthy children.

Body Image↗