Browsing by Subject "Family Characteristics"
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Item Open Access Alcohol dependence and use of treatment services among women in the community.(The American journal of psychiatry, 2004-10) Wu, Li-Tzy; Ringwalt, Chris LOBJECTIVE:This study examined the extent and characteristics of alcohol dependence and the perceived need for and use of alcohol treatment services among women compared with men in a nonclinical sample of adults 18-64 years of age. METHOD:Data were drawn from the 1999 National Household Survey on Drug Abuse. The authors calculated rates and correlates of alcohol dependence and treatment among adult alcohol users in this sample. RESULTS:About 3% of the women in the survey met criteria for DSM-IV alcohol dependence in the previous year. About 13% of these women received alcohol treatment services in the same period. Only 8% of the women who did not receive treatment perceived a need for treatment. Younger women-those who were 18-25 years of age-were more likely to be dependent on alcohol but less likely to perceive a need for treatment or to use treatment services. Among alcohol-dependent women who received no treatment, those with a family income of 75,000 US dollars or more, those who had two or more children living with them, and those who were not dependent on psychotherapeutic medications were less likely to perceive a need for help. CONCLUSIONS:There were no significant differences between men and women in use of treatment services, location of services received, and perceived need for treatment. However, correlates of treatment service use varied somewhat by gender. These findings suggest that the goal of efforts to reduce barriers to alcohol treatment services should be to change people's attitudes toward alcohol abuse and seeking professional help.Item Open Access Burning a hole in the budget: tobacco spending and its crowd-out of other goods.(Appl Health Econ Health Policy, 2004) Busch, Susan H; Jofre-Bonet, Mireia; Falba, Tracy A; Sindelar, Jody LSmoking is an expensive habit. Smoking households spend, on average, more than $US1000 annually on cigarettes. When a family member quits, in addition to the former smoker's improved long-term health, families benefit because savings from reduced cigarette expenditures can be allocated to other goods. For households in which some members continue to smoke, smoking expenditures crowd-out other purchases, which may affect other household members, as well as the smoker. We empirically analyse how expenditures on tobacco crowd-out consumption of other goods, estimating the patterns of substitution and complementarity between tobacco products and other categories of household expenditure. We use the Consumer Expenditure Survey data for the years 1995-2001, which we complement with regional price data and state cigarette prices. We estimate a consumer demand system that includes several main expenditure categories (cigarettes, food, alcohol, housing, apparel, transportation, medical care) and controls for socioeconomic variables and other sources of observable heterogeneity. Descriptive data indicate that, comparing smokers to nonsmokers, smokers spend less on housing. Results from the demand system indicate that as the price of cigarettes rises, households increase the quantity of food purchased, and, in some samples, reduce the quantity of apparel and housing purchased.Item Open Access Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health.(PLoS One, 2012) Thielman, Nathan; Ostermann, Jan; Whetten, Kathryn; Whetten, Rachel; O'Donnell, Karen; Positive Outcomes for Orphans Research TeamBACKGROUND: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries. METHODOLOGY: Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic regression models describe associations between the characteristics of children, caregivers, and households and child health outcomes: fair or poor child health; fever, cough, or diarrhea within the past two weeks; illness in the past 6 months; and fair or poor health on at least two assessments. PRINCIPAL FINDINGS: Across the six study areas, 23% of OAC were reported to be in fair or poor health; 19%, 18%, and 2% had fever, cough, or diarrhea, respectively, within the past two weeks; 55% had illnesses within the past 6 months; and 23% were in fair or poor health on at least two assessments. Female gender, suspected HIV infection, experiences of potentially traumatic events, including the loss of both parents, urban residence, eating fewer than 3 meals per day, and low caregiver involvement were associated with poorer child health outcomes. Particularly strong associations were observed between child health measures and the health of their primary caregivers. CONCLUSIONS: Poor caregiver health is a strong signal for poor health of OAC. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.Item Open Access Influenza vaccination of household contacts of newborns: a hospital-based strategy to increase vaccination rates.(Infect Control Hosp Epidemiol, 2010-10) Walter, Emmanuel B; Allred, Norma J; Swamy, Geeta K; Hellkamp, Anne S; Dolor, Rowena JWe implemented a hospital-based influenza vaccination program for household contacts of newborns. Among mothers not vaccinated prenatally, 44.7% were vaccinated through the program, as were 25.7% of fathers. A hospital-based program provided opportunities for vaccination of household contacts of newborns, thereby facilitating better adherence to national vaccination guidelines.Item Open Access Magic moment? Maternal marriage for children born out of wedlock.(Demography, 2014-08) Gibson-Davis, ChristinaTo test the existence of the "magic moment" for parental marriage immediately post-birth and to inform policies that preferentially encourage biological over step parent marriage, this study estimates the incidence and stability of maternal marriage for children born out of wedlock. Data came from the National Survey of Family Growth on 5,255 children born non maritally. By age 15, 29 % of children born non maritally experienced a biological-father marriage, and 36 % experienced a stepfather marriage. Stepfather marriages occurred much later in a child's life-one-half occurred after the child turned age 7-and had one-third higher odds of dissolution. Children born to black mothers had qualitatively different maternal marriage experiences than children born to white or Hispanic mothers, with less biological-parent marriage and higher incidences of divorce. Findings support the existence of the magic moment and demonstrate that biological marriages were more enduring than stepfather marriages. Yet relatively few children born out of wedlock experienced stable, biological-parent marriages as envisioned by marriage promotion programs.Item Open Access Social dynamics of short term variability in key measures of household and community wellbeing in Bangladesh.(Scientific data, 2019-07-17) Tamal, Md Ehsanul Haque; Bell, Andrew R; Killilea, Mary E; Ward, Patrick SHigh-frequency social data collection may facilitate improved recall, more inclusive reporting, and improved capture of intra-period variability. Although there are examples of small studies collecting particular variables at high frequency in the social science literature, to date there have been no significant efforts to collect a wide range of variables with high frequency. We have implemented the first such effort with a smartphone-based data collection approach, systematically varying the frequency of survey task and recall period, allowing the analysis of the relative merit of high-frequency data collection for different key variables in household surveys. This study of 480 farmers from northwestern Bangladesh over approximately one year of continuous data on key measures of household and community wellbeing could be particularly useful for the design and evaluation of development interventions and policies. While the data discussed here provide a snapshot of what is possible, we also highlight their strength for providing opportunities for interdisciplinary research in the household agricultural production, practices, seasonal hunger, etc., in a low-income agrarian society.Item Open Access Sociocultural and socioeconomic influences on type 2 diabetes risk in overweight/obese African-American and Latino-American children and adolescents.(J Obes, 2013) Hasson, Rebecca E; Adam, Tanja C; Pearson, Jay; Davis, Jaimie N; Spruijt-Metz, Donna; Goran, Michael IPURPOSE: It is unclear whether sociocultural and socioeconomic factors are directly linked to type 2 diabetes risk in overweight/obese ethnic minority children and adolescents. This study examines the relationships between sociocultural orientation, household social position, and type 2 diabetes risk in overweight/obese African-American (n = 43) and Latino-American (n = 113) children and adolescents. METHODS: Sociocultural orientation was assessed using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) questionnaire. Household social position was calculated using the Hollingshead Two-Factor Index of Social Position. Insulin sensitivity (SI), acute insulin response (AIRG) and disposition index (DI) were derived from a frequently sampled intravenous glucose tolerance test (FSIGT). The relationships between AHIMSA subscales (i.e., integration, assimilation, separation, and marginalization), household social position and FSIGT parameters were assessed using multiple linear regression. RESULTS: For African-Americans, integration (integrating their family's culture with those of mainstream white-American culture) was positively associated with AIRG (β = 0.27 ± 0.09, r = 0.48, P < 0.01) and DI (β = 0.28 ± 0.09, r = 0.55, P < 0.01). For Latino-Americans, household social position was inversely associated with AIRG (β = -0.010 ± 0.004, r = -0.19, P = 0.02) and DI (β = -20.44 ± 7.50, r = -0.27, P < 0.01). CONCLUSIONS: Sociocultural orientation and household social position play distinct and opposing roles in shaping type 2 diabetes risk in African-American and Latino-American children and adolescents.Item Open Access Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.(PLoS One, 2011) O'Meara, Wendy Prudhomme; Smith, Nathan; Ekal, Emmanuel; Cole, Donald; Ndege, SamsonInsecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.Item Open Access Spousal concordance in health behavior change.(Health Serv Res, 2008-02) Falba, TA; Sindelar, JLOBJECTIVE: This study examines the degree to which a married individual's health habits and use of preventive medical care are influenced by his or her spouse's behaviors. STUDY DESIGN: Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a function of changes in his or her spouse's health habits. Specifically, we analyze changes in smoking, drinking, exercising, cholesterol screening, and obtaining a flu shot. DATA SOURCE: This study uses data from the Health and Retirement Study (HRS), a nationally representative sample of individuals born between 1931 and 1941 and their spouses. Beginning in 1992, 12,652 persons (age-eligible individuals as well as their spouses) from 7,702 households were surveyed about many aspects of their life, including health behaviors, use of preventive services, and disease diagnosis. SAMPLE: The analytic sample includes 6,072 individuals who are married at the time of the initial HRS survey and who remain married and in the sample at the time of the 1996 and 2000 waves. PRINCIPAL FINDINGS: We consistently find that when one spouse improves his or her behavior, the other spouse is likely to do so as well. This is found across all the behaviors analyzed, and persists despite controlling for many other factors. CONCLUSIONS: Simultaneous changes occur in a number of health behaviors. This conclusion has prescriptive implications for developing interventions, treatments, and policies to improve health habits and for evaluating the impact of such measures.Item Open Access Substance use, dependence, and service utilization among the US uninsured nonelderly population.(American journal of public health, 2003-12) Wu, Li-Tzy; Kouzis, Anthony C; Schlenger, William EOBJECTIVES:We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS:We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS:An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS:Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.Item Open Access Test-to-Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2.(The Journal of school health, 2023-05) Scott, Zeni; Uthappa, Diya M; Mann, Tara K; Kim, Hwasoon; Brookhart, MA; Edwards, Laura; Rak, Zsolt; Benjamin, Daniel K; Zimmerman, Kanecia O; ABC Science CollaborativeBackground
Test-to-stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K-12) school settings following household SARS-CoV-2 exposure.Methods
Three hundred twenty-two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post-exposure. Analysis-eligible participants completed the 15-day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within-school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants.Results
Seventy-three of 265 analysis-eligible participants tested positive for SARS-CoV-2 (secondary attack rate of 28% [95% CI: 16-63%]). Among 77 within-school close contacts, 2 were positive (TAR = 3% [95% CI: 1-5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved.Implications for school health policy, practice, and equity
TTS facilitates continued in-person learning and can greatly reduce the number of missed school days.Conclusions
Within universally masked K-12 schools, TTS is a safe alternative to school exclusion following household SARS-CoV-2 exposure.Item Open Access The relationship between employment and substance use among students aged 12 to 17.(The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2003-01) Wu, Li Tzy; Schlenger, William E; Galvin, Deborah MPURPOSE:To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS:Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS:About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS:The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.Item Open Access The trials and tribulations of enrolling couples in a randomized, controlled trial: a self-management program for hyperlipidemia as a model.(Patient education and counseling, 2011-07) Voils, Corrine I; Yancy, William S; Weinberger, Morris; Bolton, Jamiyla; Coffman, Cynthia J; Jeffreys, Amy; Oddone, Eugene Z; Bosworth, Hayden BObjective
Capitalizing on spousal support may enhance the effectiveness of interventions for chronic disease management. However, couples-based interventions present logistical challenges. We describe our experience and lessons learned while recruiting couples into the Couples Partnering for Lipid-Enhancing Strategies (CouPLES) trial.Methods
This trial seeks to reduce serum low-density lipoprotein cholesterol levels using a couples-based intervention designed to help patients engage in self-management behaviors. We proposed enrolling 250 couples over 13 months.Results
Due to practical challenges that we encountered, recruitment and enrollment lasted 21 months. Those challenges included: travel to study site; effectively marketing the study; participant burden; and establishing eligibility criteria. By modifying our protocol to address these challenges, the recruitment rate increased from 12 to 33%.Conclusion
In the absence of trials identifying the most effective recruitment strategies, investigators may need to experiment, amending their protocol intermittently until target enrollment numbers are reached. The lessons we present may help researchers conducting couples-based interventions develop more effective protocols.Practice implications
To achieve target enrollment numbers, researchers conducting couples-based interventions should consider minimizing travel to the study site; carefully crafting recruitment materials; budgeting more for participant incentives and staff effort; and limiting exclusion criteria. These practices may also enhance retention.Item Open Access Use of substance abuse treatment services by persons with mental health and substance use problems.(Psychiatric services (Washington, D.C.), 2003-03) Wu, Li-Tzy; Ringwalt, Christopher L; Williams, Charles EOBJECTIVES: This study provided population estimates of mental syndromes and substance use problems and examined whether the co-occurrence of mental health and substance use problems was associated with the use of substance abuse treatment services. METHODS: Study data were drawn from the 1997 National Household Survey on Drug Abuse. RESULTS: Of the total sample of 16,661 adults, 2 percent reported using services for alcohol or drug use problems in the previous year. Among the 3,474 (17 percent) who reported at least one alcohol or drug use problem, 6 percent used substance abuse services. Only 4 percent of persons who reported substance use problems alone received any substance abuse treatment service in the previous year. Only 3 percent of persons who reported alcohol use problems alone received such services. Among persons with one or more substance use problems, the prevalence of service use was 11 percent among persons who reported one co-occurring mental syndrome and 18 percent among those who reported two or more mental syndromes. Multiple logistic regression analyses identified a number of subgroups who might have needed substance abuse services but did not receive them, including women, Asians and Pacific Islanders, college graduates, persons employed full-time, persons who abused alcohol only, and persons with substance use problems who reported no coexisting mental syndromes. CONCLUSIONS: The rate of help seeking among persons with alcohol use problems is low, which is a public health concern.