Sequential screening for psychosocial and behavioural risk during pregnancy in a population of urban African Americans.

OBJECTIVE: Screening for psychosocial and behavioural risks, such as depression, intimate partner violence, and smoking, during pregnancy is considered to be state of the art in prenatal care. This prospective longitudinal analysis examines the added benefit of repeated screening, compared with a single screening, in identifying such risks during pregnancy. DESIGN: Data were collected as part of a randomised controlled trial to address intimate partner violence, depression, smoking, and environmental tobacco smoke exposure in African American women. SETTING: Prenatal care sites in the District of Columbia serving mainly women of minority background. POPULATION: A cohort of 1044 African American pregnant women in the District of Columbia. METHODS: Mothers were classified by their initial response (acknowledgement of risks), and these data were updated during pregnancy. Risks were considered new if they were not previously reported. Standard hypothesis tests and logistic regression were used to predict the acknowledgment of any new risk(s) during pregnancy. MAIN OUTCOME MEASURES: New risks: psychosocial variables to understand what factors might help identify the acknowledgement of additional risk(s). RESULTS: Repeated screening identified more mothers acknowledging risk over time. Reported smoking increased by 11%, environmental tobacco smoke exposure increased by 19%, intimate partner violence increased by 9%, and depression increased by 20%. The psychosocial variables collected at the baseline that were entered into the logistic regression model included relationship status, education, Medicaid, illicit drug use, and alcohol use during pregnancy. Among these, only education less than high school was associated with the acknowledgement of new risk in the bivariate analyses, and significantly predicted the identification of new risks (OR 1.39, 95% CI 1.01-1.90). CONCLUSIONS: It is difficult to predict early on who will acknowledge new risks over the course of pregnancy, and thus all women should be screened repeatedly to allow for the identification of risks and intervention during prenatal care.

Postponing sexual intercourse among urban junior high school students-a randomized controlled evaluation.

PURPOSE: To describe a randomized, controlled evaluation of a school-based intervention to delay sexual intercourse among urban junior high school students. METHODS: Six Washington, D.C., junior high schools were randomly assigned to the intervention or nonintervention control condition for an educational program. During the first school year, seventh graders (n = 582) from the six schools obtained written parental consent to participate. Three health professionals (one per intervention school) implemented the program, which consisted of reproductive health classes, the Postponing Sexual Involvement Curriculum, health risk screening, and "booster" educational activities during the following (eighth grade) school year. Cross-sectional surveys were administered at baseline, the end of the seventh grade, and the beginning and end of the eighth grade. Intervention and control group differences in virginity, attitudes toward delayed sex and childbearing, and sexual knowledge and behavior were assessed at all four time points. RESULTS: At baseline, 44% of the seventh grade males and 81% of the seventh grade females reported being virgins. At the end of the seventh grade (first follow-up), after controlling for baseline study group differences, intervention-group females were more likely to report virginity, self-efficacy to refuse sex with a boyfriend, and the intention to avoid sexual involvement during the following 6 months. At the end of the eighth grade, significantly more intervention- than control-group females reported virginity, birth control use at last intercourse (for nonvirgins), and knowledge of adolescent reproductive health and confidentiality rights. No changes in virginity, self-efficacy to refuse sex, or sexual intent for the next 6 months were observed among male participants at any time during the study. However, on all three follow-up surveys, intervention-group males scored significantly higher than their control-group counterparts in knowledge of birth control method efficacy. No change in attitudes toward abstinence was observed for either gender at any follow-up point. CONCLUSIONS: Gender differences in baseline sexual activity rates and in various study outcomes suggest a possible need for separate, gender-specific intervention activities that can adequately address the social and cognitive needs of both sexes.

Sociodemographic correlates of virginity in seventh-grade black and Latino students.

PURPOSE: To examine rates of virginity in seventh-grade black and Latino students and assess the extent to which various sociodemographic factors are correlated with virginity. METHODS: A total of 523 seventh-grade students from five junior high schools and one middle school in the District of Columbia completed an anonymous self-administered questionnaire. Students responded to questions about age at first intercourse, demographics, grades, educational expectations, and risk behaviors. Multivariate analysis was used to determine the independent strength of the association of these variables with virginity. RESULTS: Eighty-one percent of girls and 44% of boys reported never having had sexual intercourse, i.e., being virgins. Black and Latino students were equally as likely to report being virgins. Younger age and absence of other risk behaviors, including smoking and alcohol use, were associated with virginity for males and females. For boys, reporting high academic achievement and living with both parents was significantly correlated with virginity and appeared to be protective. CONCLUSIONS: Although prevalent particularly in seventh-grade black and Latino boys, sexual activity was clearly associated with other risk behaviors in both boys and girls. Sociodemographic correlates of virginity were gender-specific. School-based efforts to delay the onset of initiation of sexual activity in high-risk populations should be targeted at boys 12 years and younger with interventions which are gender-specific. This study underscores a need to examine correlates of virginity to generate practical approaches to prevention of early sexual activity.

Childbearing and Bongaarts indices for Coale-Trussell's model fertility schedules.

PIP: It is often important to measure the determinants which have direct impact upon the fertility and childbearing process, especially when information on such mechanisms is nonexistent or defective. Methodologies have therefore been developed to that end over the last two decades. Each development, however, addressed only one or some aspects of the complete process of fertility and childbearing in a society. A comprehensive picture is often desired. This paper provides a broader knowledge of the mechanisms which underlie the reproductive patterns in human populations by combining and linking various recent methodologies and models. The following methodology is proposed: age-specific fertility rates are first obtained from Coale-Trussell model fertility schedules, then used in the childbearing model to compute childbearing indices. Fertility-inhibiting indices finally are estimated as functions of the childbearing indices, using El-Khorazaty's multivariate regression model.^ieng

Indirect mortality estimates for children under five in six Arab countries.

"Data from various censuses and surveys covering the last two decades for six Arab countries (Bahrain, Egypt, Jordan, Kuwait, the Syrian Arab Republic, and the United Arab Emirates) are analysed using the Brass-Trussell methodology and the Coale-Demeny West model life tables. Overlapping levels and trends with respect to various infant and childhood mortality measurements since the mid-1950s are determined. The measurements show that these countries are not homogeneous with respect to mortality, as they reflect disparities in both health programmes, standards of living and quality of life."

Estimation of fertility-inhibiting indices using vital registration data.

PIP: The Bongaarts model quantifies intermediate variables that have a direct impact on fertility and it is related to the classical analytic framework of intermediate fertility variables (IFVs) introduced by Davis and Blake. The model requires data on age-specific proportions of women currently married, age-specific fertility rates (ASFRs), estimates of postpartum infecundability, and proportion of women currently using effective contraceptive methods. Horne, El-Khorazaty, and Suchindran (1990) developed a childbearing model estimating projected ages at 1st and last birth (AFB, ALB) and the reproductive life span (RLS), making use of only ASFRs available from either vital statistics or sample surveys. The correspondence between Bongaarts-type indices of marriage, contraception, and infecundability and the childbearing indices is discussed. Data on both fertility-inhibiting and childbearing indices were available for 225 subpopulations. Application 1: Characterization of the fertility-inhibiting indices by the childbearing indices. Contraceptive practice is the major fertility-inhibiting factor among women who stop childbearing before age 35 years, but for those women who stop reproducing in their late thirties, long duration of breastfeeding is. Application 2: Decomposition of fertility decline by the childbearing indices. For societies with a low TFR of only 2 births, contraceptive use plays the major role in achieving this low fertility level, regardless of age at 1st birth, and age at last birth not exceeding 35 years. Application 3: Annual fertility-inhibiting indices using ASFRs. In Kuwait the TFR declined from 4.7 births in the early 1960s to well below 2 births in the late 1970s and 1980s owing to direct government support to family planning programs. The correspondence model, using only macro-level vital statistics data, can predict indirectly fertility-inhibiting indices on an annual basis for countries lacking the micro-level data necessary for estimating those indices directly.^ieng

Statistical modeling of selected aspects of the childbearing process with application to World Fertility Survey countries.

"A mathematical model for estimation of certain aspects of the childbearing process, which requires only data on age-specific fertility rates, is developed. Synthetic maternal childbearing indices, namely, mean ages at first and last birth, length of reproductive life span, inter-birth spacing, and proportion of childless women, in addition to the well-known mean age at childbearing, for the WFS [World Fertility Surveys conducted in developing] countries are obtained using the proposed model. The indices are free from age truncation effects, and, under certain assumptions, provide information about a cohort's completed fertility before the women stop reproducing. The effects of women's residence and education on fertility are also examined." (SUMMARY IN FRE)

A century of demographic and socio-economic dynamics in Egypt.

"The purpose of the present paper is to help elucidate the mechanisms and reasons behind demographic changes in Egypt during the century from 1882 to 1981 using the Box-Jenkins time series technique...." Projections of demographic and socioeconomic trends up to the year 2000 are also made.

Childbearing indices in the Arab world.

PIP: Patterns and tempo of entry into marriage and motherhood, birth spacing, and exit from the childbearing process play significant roles in the realization of societal level fertility. Childbearing models using quantum measures of period fertility, namely, age-specific fertility rates, to develop projected temporal indices of the childbearing process have been extended to 16 Arab countries representing over 90% of the population of the Arab world. Comparisons of 2 Arabian Gulf countries revealed diverse levels and patterns reflecting the populations' backgrounds, levels of societal development, and the stage of demographic transition. Results for Arab countries and national populations indicated younger projected ages at 1st birth, older projected ages at last birth, longer projected reproductive spans, and shorter projected birth spacing than expatriate populations. It is suggested that reproductive span is the best predictor of fertility, as well as of mortality and socioeconomic factors, at the societal level. Countries in which childbearing is initiated at earlier ages also show termination of childbearing at later ages and thus tend to have relatively higher fertility and mortality levels, poorer health conditions, and unfavorable social environments.^ieng

Lessons of "what-if" thirty years ago in population policy.

PIP: Egypt's rapid rate of population growth (3.0%/year) must be seriously addressed by policy makers either by making a major effort to promote family planning or by developing and implementing plans for providing services and employment for a population of massive size in the near future. If the current population growth rate continues into the future, population size will increase from its current level of 46 million to 137 million in the year 2020 and to 333 million by 2050. Egypt currently has the 26th highest growth rate in the world and 9th highest population density in the world. Those who argue that population growth is economically beneficial claim that a large labor force is needed to increase production. They ignore the fact that Egypt cannot provide sufficient jobs nor adequate training for its current working age population. Other proponents argue that a large home market is necessary to obtain the economic benefits of scale economies in production; however, these benefits can just as easily be derived through increasing international trade. It is also argued that Egypt's excess labor force can be absorbed by the current high demand for workers in other Arab countries and that the remittances of these workers can contribute toward the economic development of Egypt. Reliance on foreign employment is not a practical longterm solution. If the external demand for workers declines, Egypt will be confronted with an even more serious unemployment problem. If the government had heeded the advice of those who advocated the adoption of growth reduction polcies in 1953, many of Egypt's current development problems could have been minimized. If the average growth rate had been reduced to 1.5% over the past 30 years: 1) existing food stocks would be sufficient to eliminate the current pattern of substandard diets among a large segment of the population; 2) the need to rely on imported grain would now be minimal or completely unnecessary; 3) the number of persons/physician would be 900 rather than 1200, and the number of persons/hospital bed would be 370 rather than 500; 4) the infant mortality rate would be lower than its present 132 level, and life expectancy would be greater than its current 55 year level; and 5) current educational facilities could accommodate a 85% primary school enrollment rate instead of the current 65% enrollment rate. Egypt had a population policy and a family planning program; however, the contraceptive prevalence rate remains low. What is lacking is a total commitment strategy. At the present time, population programs have a moderate priority, and population policies are pursued half-heartedly. Population planning must be integrated into all aspects of development planning, and all relevant government agencies must assume responsibility for promoting the country's population policies. A total commitment strategy will ensure that in the future Egypt has a healthy, educated, and productive population rather than a massive population with a high level of unmet needs.^ieng

Prevalence, continuation and availability of contraceptive methods: a summary of the results of the Egypt Contraceptive Prevalence Survey.

PIP: The Egypt Contraceptive Prevalence Survey, conducted in 1980, was designed to 1) collect data on current levels of contraceptive knowledge, use, and continuation in rural Egypt; 2) provide data on rural fertility levels and family size ideals; 3) investigate perceived availability of and accessibility to family planning services among the rural population; and 4) provide baseline data for evaluation of the Population and Development Project. The survey was based on interviews with 5313 ever-married women. 67% of respondents had married before the age of 18 years, although a trend over time toward delayed age at marriage, particularly among those with greater education, was noted. The mean number of children ever born was 4.6 in Lower Egypt and 4.7 in Upper Egypt. Women in Upper Egypt had lost an average of 1.5 children compared with 1.1 in Lower Egypt. 53% of respondents indicated an interest in limiting their family size (42% in Upper Egypt and 63% in Lower Egypt). The proportion desiring no more children was positively associated with age and number of surviving children, but not with socioeconomic status. 97% of respondents were aware of at least 1 family planning method, largely the pill, and 79% approved of contraceptive use. 83% of women in Lower Egypt and 57% of those in Upper Egypt could identify a source for family planning services. 35% of respondents (46% in Lower Egypt and 22% in Upper Egypt) had ever used a family planning method; the pill and IUD accounted for the majority of contraceptive use. 17% (25% in Lower Egypt and 8% in Upper Egypt) of currently married respondents were current users of family planning, and 15% were using a modern method. Contraceptive use was greatest among women with husbands in nonagricultural occupations and those with higher educational status and number of surviving children. Over half of contraceptive users rely on government-sponsored family planning programs for their supplies, and services are perceived as easily accessible.^ieng

The results of the Egyptian Contraceptive Prevalence Survey in rural Egypt, 1980.

PIP: A field sample survey was conducted in rural Egypt at the end of 1980 to collect current information about levels of contraceptive knowledge; to provide data on fertility levels, desired family size, and the affecting factors; to detect the rural inhabitants' knowledge of the availability and accessibility of family planning services; and to offer the base data needed for evaluation of the Population and Development Project (PDP) in some of the villages in which the PDP functioned. The sampling plan was based on the selection of a self-weighted sample representing all currently or ever married women between the ages of 15-60 living in rural Egypt. A total of 5049 households from the selected households were actually contacted, and 5313 eligible women were successfully interviewed. About 83% of the sample married before age 18. The mean preferred age of marriage was 17.4 years among the respondents, slightly higher than the mean age (16.6) at which these women actually married. Women in Lower Egypt preferred to delay marriage longer than women in Upper Egypt. The average number of live births among ever married women between the ages of 15-45 years in all of rural Egypt was 7.4; the average number of live births among ever married women in the entire sample was 4.6. The average number of surviving children was 3.3. Women in rural areas showed a tendency towards limiting family size. About 45% of the women desired more sons than daughters. 91% of the sample had knowledge of at least 1 contraceptive method. Oral contraception (OC) was the most familiar method in rural Egypt, followed by the IUD. About 79% of all ever married women approved of contraceptive use. 71% of all ever married women in rural Egypt were able to mention at least 1 source of modern contraceptive methods. About 35% were currently or had ever used contraception. 24% of the respondents used OC. Women who used prolonged breastfeeding to stop childbearing amounted to 11%. In Lower Egypt the percentage of current users was 25% in contrast to 8% in Upper Egypt. Percentage of users was 3% for women in the age cohort 15-19 years, 27.4% for those 35-39, and 9.9% for those 45-49 years. Controlling for other differentials, current use in rural Egypt was directly related to number of surviving children. Increased educational status of both respondent and husband had a direct positive effect on contraceptive usage. More than half of the current contraceptive users in rural Egypt depended on governmental sources, 35% on pharmacies, and 12% on doctors, private clinics, and other nongovernmental sources.^ieng