Gender-based violence against adolescent and young adult women in low- and middle-income countries.

PURPOSE: Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, policies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent and young adult women using Demographic and Health Surveys across low- and middle-income countries. METHODS: National prevalence estimates were generated among adolescents (15-19 years) and young adults (20-24 years) for lifetime and the past-year physical and sexual IPV among ever-married/cohabitating women (30 nations) and forced sexual debut among sexually experienced women (17 nations). Meta-analyses provided regional estimates and cross-national comparisons, and compared the past-year IPV prevalence among adolescent and young adult women to adult women. RESULTS: An estimated 28% of adolescent and 29% of young adult women reported lifetime physical or sexual IPV, most prevalent in the East and Southern Africa region. Regional and cross-national variation emerged in patterns of violence by age; overall, young adult women demonstrated higher risk for the past-year IPV relative to adult women (meta-analysis odds ratio, 1.20; 95% confidence interval, 1.10-1.37) and adolescents had a comparable risk (meta-analysis odds ratio, 1.07; 95% confidence interval, .91-1.23). Forced sexual debut was estimated at 12% overall, highest in the East and Southern Africa region. CONCLUSIONS: GBV is pervasive among adolescent and young adult women in low- and middle-income countries. The unique risk to youth varies across nations, suggesting an age-place interaction. Future research is needed to clarify contextual determinants of GBV. Findings provide direction for integrating youth within GBV prevention efforts.

A conceptual framework for early adolescence: a platform for research.

Early adolescence (ages 10-14 years) is among the most neglected stages of development, yet there are few stages during the life course where changes are as dramatic. The present conceptual framework proposes four central goals to be achieved by early adolescence: engagement with learning, emotional and physical safety, positive sense of self/self-efficacy, acquisition of life/decision-making skills. The framework proposes an ecological model where the macro level factors (economic forces, historical events, national priorities, laws/policies/norms and values, national events, and political realities) all set the contexts that influence community, family, school and peer factors that all in turn influence the adolescent. Existing indicators for points of development are noted as are future areas of research priority.

Union status and sexual risk behavior among men in their 30s.

CONTEXT: Understanding the relationship between union status and men's sexual risk behavior in their 30s is important to ensure appropriate reproductive health services for men in middle adulthood. METHODS: Data from 1,083 men aged 34-41 who participated in the 2008-2010 wave of the National Survey of Adolescent Males were used to examine differentials in sexual risk behaviors by union status, past risk behavior and selected characteristics. Bivariate tabulations were done to assess relationships between current risk behavior and background variables, multinomial regression analysis was conducted to identify associations between union status and past risk behavior, and logistic regression analysis was used to assess associations between current behavior and both union status and past behavior. RESULTS: Eight percent of men in their 30s had had three or more sexual partners in the last 12 months, 10% had had at least one risky partner and 8% had had concurrent partners. Men living outside co-residential unions reported higher levels of these behaviors (24%, 29% and 24%, respectively) than did married men (1-2%) or cohabiting men (7-12%). In multivariate analyses that controlled for past risk behavior, married men were less likely than cohabiting men to have had at least one risky partner or concurrent partners in the last year (odds ratio, 0.2 for each), while men who were not in a co-residential union had an increased likelihood of reporting each risk behavior (2.2-5.3). CONCLUSIONS: Men in their 30s, especially those who are not married, engage in risky sexual behaviors. Further studies are needed to assess what contributes to behavioral differences by union status and what types of services might help men in this age-group reduce their risk.

Fathers' beliefs about parenting and fathers' clubs to promote child health in rural Haiti.

Health care providers are challenged to use culturally appropriate, low-technology approaches to improve child health in resource-poor countries. Village fathers' clubs is one approach used in rural Haiti since 1994. Fathers meet regularly for health education and community-building activities. Our aim was to investigate parenting practices and beliefs among Haitian fathers of young children and to explore their views on fathers' clubs. We conducted semistructured interviews with 18 fathers. Themes identified were fathers' involvement in routine care of their children, the close partnerships of fathers and mothers in child care, fathers' responsibilities to their communities, and fathers' clubs as an important supportive institution for the Haitian fathers and their families. Rural Haitian fathers reported taking a very active role in the lives of their families and children. Increased involvement of fathers should be explored as a strategy to improve child health and survival in other parts of Haiti and throughout the world.

Men's Work Efforts and the Transition to Fatherhood.

In this paper we tested three hypotheses: (a) the transition to fatherhood is associated with an increase in work effort; (b) the positive association (if any) between the transition to fatherhood and work effort is greater for fathers who are married at the time of the transition; and (c) the association (if any) is greater for men who make the transition at younger ages. The data are from the National Longitudinal Survey of Youth 1979 Cohort. The transition to fatherhood was associated with an increase in work effort among young unmarried men, but not for married men. Among married men who were on-time fathers, work effort decreased. Among childless men, the marriage transition was associated with increased work effort.

The impact of fathers' clubs on child health in rural Haiti.

In recognition of the important role that fathers play in the lives of young children in Haiti, a public health organization instituted fathers' clubs in 1994 as a strategy to improve the health outcomes of children. Fathers' clubs focus on child and family health education. To evaluate the effectiveness of fathers' clubs, we examined the health of children born in Haitian villages with and without active fathers' clubs and compared results for the two groups. The presence of a fathers' club in a child's birth village had a positive effect on vaccination status, growth monitoring, and vitamin A supplementation after we controlled for socioeconomic status, time, and the quality of the village health agent. Child weights and mortality were not affected by the fathers' clubs.

The effect of maternal socio-economic status throughout the lifespan on infant birthweight.

The objective of this study was to investigate whether maternal socio-economic status during childhood and at the time of pregnancy each have unique associations with infant birthweight when biological determinants of birthweight are controlled. The data are from a three-generation study which contains information on the mothers and grandmothers of 987 singleton infants, collected over a period of 25 years. We used simple and multivariable regression to assess the association between indicators of a woman's socio-economic status and her offspring's birthweight. Women who grew up in poor households had smaller babies than those who did not, and a unit increase in the income/needs ratio (analogous to the poverty index), in non-poor households only, was associated with a 185 g [95% CI 70, 200] increase in infant birthweight. Maternal age at the index infant's birth had a positive association with birthweight that diminished as women reached their mid-twenties. Among mothers with low education, high grandmaternal education was associated with a 181 g [95% CI 71, 292] increase in infant birthweight, while high grandmaternal education had no effect among infants whose mothers were relatively well-educated. This interaction between grandmaternal and maternal education is consistent with claims that cumulative stress is an important mechanism connecting maternal socio-economic status and infant health.

Effects of out-of-school care on sex initiation among young adolescents in low-income central city neighborhoods.

OBJECTIVE: To examine the association between patterns of out-of-school care over time and the initiation of sex among young adolescents living in low-income urban families. DESIGN: A prospective cohort study (using a 16-month follow-up) examining the predictive value of changes in out-of-school-care arrangements on early sex initiation. SETTING AND PARTICIPANTS: By using a multistage stratified area probability sampling strategy, we selected 494 subjects aged 11 to 13 years living in low-income central city neighborhoods who did not report having had sexual intercourse by time 1. MAIN OUTCOME MEASURE: Adolescent report of having had sexual intercourse by time 2. RESULTS: Bivariate results suggested that being at home with an adult during out-of-school hours was related to less sex initiation than self-care, care at another person's home, and attendance at an organized/supervised activity. Adjusting for demographic attributes, parental monitoring, parental curfews, and family routines, remaining in out-of-home care or self-care was associated with a 2.5 times (95% confidence interval, 1.3-5.1 times) increase in the likelihood of initiating sexual intercourse when compared with being at home with an adult at both assessment times. CONCLUSION: Policies and programs that enable young adolescents to spend their out-of-school hours at home with an adult may help reduce the risk of early sex initiation among youth in low-income urban areas.

Early adult characteristics and mortality among inner-city African American women.

OBJECTIVES: This study examined predictors of longevity in a cohort of inner-city African American women. METHODS: Data were derived from a cohort study of inner-city African American mothers whose median age in 1966 was 31 years. Analyses involved single-decrement life tables and pooled logistic regression. RESULTS: Giving birth for the first time before age 25 and having at least a high school education predicted longevity in this sample. Effects of later age at first delivery in terms of mortality risk were stronger after 55 years and, especially, after 70 years. CONCLUSIONS: The findings offer support for Geronimus's weathering hypothesis. Predictors of longevity among African Americans may be distinct from predictors for the population as a whole.