Biosocial models of demographic behavior: An introduction

A workshop on biosocial models of demographic behavior was organized to provide information to members of the Social Sciences and Population Study Section (SSP), the group entrusted by the National Institutes of Health (NIH) with the responsibility for conducting the first level of peer review of demographic applications submitted to NIH for possible funding. Some of the variables studies by demographers are biological, e.g., fertility, fecundity, morbidity, and mortality, so demographers are not unaware of biological variables. However, they tend to treat biological variables as something to be explained by social, economic, and psychological factors rather than to be integrated into an explanatory paradigm. This workshop contains papers that focus upon various stages of the life cycle and explore the importance of biosocial variables in explaining selected aspects of human behavior.This introduction presents an overview of the topics covered by the authors of the papers presented and the workshop, and is based upon opening remarks at the DRG Workshop on Biosocial Models of Demographic Behavior, Bethesda, MD, 12 October 1994.     

Racial Differences in Breast Cancer Screening Among Women from 65 to 74 Years of Age: Trends from 1987–1993 and Barriers to Screening

ABSTRACT

Breast cancer mortality is decreasing for elderly white women but increasing for elderly black women. National surveys were used to study racial differences in breast cancer screening and effects of Medicare funding for mammography and to examine explanatory factors. A total of 13,545 women, aged 65–74, from the Health Care Finance Administration's Master Beneficiary File participated. After Medicare funding for screening mammography, the percent reporting a mammogram increased for white women, but not for black women. Clinical breast examination and breast self-examination decreased. Physician's recommendation, geographic area, education level and health status were the variables significantly affecting mammography usage for both races. Physicians recommended mammography more often if women were white, married, educated beyond high school and had an annual income greater than $20,000. These results support the need to design and test strategies specifically for black women and interventions to emphasize physician recommendations for breast cancer screening.     

Gay male, lesbian and bisexual health-related research funded by the National Institutes of Health between 1974 and 1992

Health-related problems among lesbians, bisexuals, and gay men require research before solutions to them can be identified. This paper describes NIH sponsored research listing homosexuality as a primary or secondary issue between 1974 and 1992. Homosexual projects unrelated to HIV and excluding capitol funding averaged only $532,000 per year compared to about $20 million per year since 1982 for HIV projects. Considering the range of health threats to these communities and the amounts needed to deal with HIV alone, current funding is clearly inadequate. Community members, scientists, experts, and others need to take action if appropriate research is to be done and the health needs of these groups are to be addressed.     

Differences in egg wastage by superparasitism, contrastingVenturia (=Nemeritis) canescens searching singly versus searching in groups

Summary A statistical and graphic study is presented of the wastage of eggs byVenturia (=Nemeritis) canescens when searching singly and in groups of 10 among hosts at four different host densities in laboratory universes as described byHuffaker andMatsumoto (preceding paper of this journal). The host insect was the fluour mothAnagasta kühniella and the host densities used were 10, 30, 100 and 200 per universe. Intensity of egg wastage due to superparasitim varied significantly according to host density, and between the two parasite densities employed, 1 and 10, using bothF-tests and chi-square tests. Plots ofk-factor analysis on this egg wastage showed high negative correlations with host density, and the raw data for single parasites was well represented by a parabola while that for the grouped parasites departed from this relationship only at the lowest host density. These studies were conducted as a part of a general investigation into the processes operating in the population dynamics of arthropods under grants from the National Institutes of Health, U. S. Public Health Service (#A10-1611), and the National Science Foundation and Environmental Protection Agency (NSF DEB7504223) to the University of California. The findings, opinions and recommendations expressed herein are those of the authors and not necessarily those of the University of California, the National Institutes of Health, the National Science Foundation or the Environmental Protection Agency.     

Developing a Core Competency Model and Educational Framework for Primary Maternity Services: a national consensus approach

BackgroundAn appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals.ParticipantsKey stakeholders from professional organisations and providers of services related to maternity care and consumers of services.MethodsA national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation.FindingsA national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups’ education and practice.ConclusionsThe Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services.     

Family Instability and College Enrollment and Completion

This research uses data from waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health, N = 9,631) to consider whether and how family instability in early or later childhood affects college enrollment and completion of a Bachelor’s degree by age 24. Explanatory factors include maternal selection into unstable unions, household resources available in adolescence, and adolescents’ academic achievement, behavior, and attitudes in high school. The association of later family instability with college enrollment and completion is largely explained by household resources in adolescence. The association of early family instability with college enrollment is partially explained by each set of factors, and its association with college completion, given enrollment, is explained by pre-existing maternal characteristics. The results demonstrate that early family instability has enduring consequences for eventual status attainment and that the mechanisms that connect family instability to educational outcomes vary by the timing of family structure change.     

Nondrinker Mortality Risk in the United States

The literature has shown that people who do not drink alcohol are at greater risk for death than light to moderate drinkers, yet the reasons for this remain largely unexplained. We examine whether variation in people’s reasons for nondrinking explains the increased mortality. Our data come from the 1988–2006 National Health Interview Survey Linked Mortality File (N = 41,076 individuals age 21 and above, of whom 10,421 died over the follow-up period). The results indicate that nondrinkers include several different groups that have unique mortality risks. Among abstainers and light drinkers the risk of mortality is the same as light drinkers for a subgroup who report that they do not drink because of their family upbringing, and moral/religious reasons. In contrast, the risk of mortality is higher than light drinkers for former drinkers who cite health problems or who report problematic drinking behaviors. Our findings address a notable gap in the literature and may inform social policies to reduce or prevent alcohol abuse, increase health, and lengthen life.     

Genetic Bio-Ancestry and Social Construction of Racial Classification in Social Surveys in the Contemporary United States

Self-reported race is generally considered the basis for racial classification in social surveys, including the U.S. census. Drawing on recent advances in human molecular genetics and social science perspectives of socially constructed race, our study takes into account both genetic bio-ancestry and social context in understanding racial classification. This article accomplishes two objectives. First, our research establishes geographic genetic bio-ancestry as a component of racial classification. Second, it shows how social forces trump biology in racial classification and/or how social context interacts with bio-ancestry in shaping racial classification. The findings were replicated in two racially and ethnically diverse data sets: the College Roommate Study (N = 2,065) and the National Longitudinal Study of Adolescent Health (N = 2,281).     

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

The Methuselah Effect: The Pernicious Impact of Unreported Deaths on Old-Age Mortality Estimates

We examine inferences about old-age mortality that arise when researchers use survey data matched to death records. We show that even small rates of failure to match respondents can lead to substantial bias in the measurement of mortality rates at older ages. This type of measurement error is consequential for three strands in the demographic literature: (1) the deceleration in mortality rates at old ages; (2) the black-white mortality crossover; and (3) the relatively low rate of old-age mortality among Hispanics, often called the “Hispanic paradox.” Using the National Longitudinal Survey of Older Men matched to death records in both the U.S. Vital Statistics system and the Social Security Death Index, we demonstrate that even small rates of missing mortality matching plausibly lead to an appearance of mortality deceleration when none exists and can generate a spurious black-white mortality crossover. We confirm these findings using data from the National Health Interview Survey matched to the U.S. Vital Statistics system, a data set known as the “gold standard” (Cowper et al. 2002) for estimating age-specific mortality. Moreover, with these data, we show that the Hispanic paradox is also plausibly explained by a similar undercount.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

Religion,Contraceptive Method Mix,and Son Preference Among Bengali-Speaking Community of Indian Subcontinent

This paper examines the influence of religion on contraceptive method mix in the context of son preference among Bengali-speaking population of eastern India (i.e., West Bengal and Tripura) and Bangladesh. In spite of cultural similarity and parallel programmatic approach to family planning in these two distinct geopolitical spaces, differential use of contraception is evident. Using National Family Health Survey (2005–2006) and Bangladesh Demographic Health Survey (2007) and by employing sequential logit model, the paper finds evidence of latent son preference in adoption of modern contraception in Bengali-speaking Hindu and Muslim communities of eastern India. However, such practice is observed only among Hindus in Bangladesh. The paper further argues that although diffusion of the culture of son preference cuts across religious groups among Bengali-speaking community in eastern India, religious identity dominates over region in Bangladesh, encouraging minority Hindus to adopt a distinct pattern of contraceptive behavior with reference to sons. Such finding calls for further research in understanding the pros and cons of behavioral diffusion in majority–minority population mix in similar tradition and culture.     

第五届数字中国发展高层论坛暨信息主管峰会“数字健康论坛”在京举行

2008年12月7—8日，由北京大学数字中国研究院和中国人口与发展研究中心主办、中国标准化研究院人口与健康信息技术研究中心和中国仪器仪表学会医疗仪器分会电子健康专业委员会协办的“数字健康论坛”在北京大学举行。此次论坛是北京大学和国际数字地球学会联合主办的“第五届数字中国发展高层论坛暨信息主管峰会”的分论坛，主题为电子信息与空间技术在人口与健康领域的应用。     

Cigarette Smoking in Same-Sex and Different-Sex Unions: The Role of Socioeconomic and Psychological Factors

Cigarette smoking has long been a target of public health intervention because it substantially contributes to morbidity and mortality. Individuals in different-sex marriages have lower smoking risk (i.e., prevalence and frequency) than different-sex cohabiters. However, little is known about the smoking risk of individuals in same-sex cohabiting unions. We compare the smoking risk of individuals in different-sex marriages, same-sex cohabiting unions, and different-sex cohabiting unions using pooled cross-sectional data from the 1997–2010 National Health Interview Surveys (N = 168,514). We further examine the role of socioeconomic status (SES) and psychological distress in the relationship between union status and smoking. Estimates from multinomial logistic regression models reveal that same-sex and different-sex cohabiters experience similar smoking risk when compared to one another, and higher smoking risk when compared to the different-sex married. Results suggest that SES and psychological distress factors cannot fully explain smoking differences between the different-sex married and same-sex and different-sex cohabiting groups. Moreover, without same-sex cohabiter’s education advantage, same-sex cohabiters would experience even greater smoking risk relative to the different-sex married. Policy recommendations to reduce smoking disparities among same-sex and different-sex cohabiters are discussed.     

An age–period–cohort analysis of cancer incidence among the oldest old,Utah 1973–2002

We used age–period–cohort (APC) analyses to describe the simultaneous effects of age, period, and cohort on cancer incidence rates in an attempt to understand the population dynamics underlying their patterns among those aged 85+. Data from the Utah Cancer Registry (UCR), the US Census, the National Center for Health Statistics (NCHS), and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) programme were used to generate age-specific estimates of cancer incidence at ages 65–99 from 1973 to 2002 for Utah. Our results showed increasing cancer incidence rates up to the 85–89 age group followed by declines at ages 90–99 when not confounded by the separate influences of period and cohort effects. We found significant period and cohort effects, suggesting the role of environmental mechanisms in cancer incidence trends between the ages of 85 and 100.     

Determinants of morbidity and disability trends in the united states, 1958–77

Macrodynamic structural-equation models are presented that show how changes in annual levels of aggregate indexes of several morbidity and disability conditions for the United States over the years 1958 to 1977 affect each other and are affected by other aggregate demographic and socioeconomic changes. After reviewing the record of annual changes in these indexes based on data from the National Health Interview Survey, patterns of temporal covariation in the time series are discussed and some tentative structural-equation models are constructed to account for their behavior. Statistically, the analyses reveal considerable variation in levels of year-to-year variance explained for these indexes-from 35 percent explained for days of school loss to 97 percent for all acute conditions. Substantive findings imply that a decreasing proportion of preschool children in the population contributes to a decline in the incidence of infective and parasitic diseases, and an increasing proportion of the population at the older ages results in increases in the prevalence of chronic conditions, days of bed disability, and days of restricted activity. Further, increases in economic prosperity lead to an increase in the incidence of injuries and a decrease in the incidence of viral conditions, while higher levels of unemployment produce more injuries and restricted activity days. These inferences corroborate, for the most part, results of prior studies that have been restricted to crosssectional analyses. In addition, however, they provide a basis for making explicit quantitative projections of future levels of morbidity and disability in the American population on the basis of exogenous demographic and socioeconomic conditions.     

HEW devising teen pregnancy plan

In response to the national problem of teenage pregnancy, the Department of Health, Education, and Welfare has been developing a package of programs costing some $245 million to help teenagers avoid pregnancy and to help those who do become pregnant. In an August 4 decision memorandum to Health, Education, and Welfare Secretary Joseph Califano, an interagency task force underlined the 3 problems the initiatives must deal with: 1) adolescents are at high risk of pregnancy; 2) about 300,000 U.S. teenagers receive abortions annually; and 3) pregnancy and parenthood during adolescence pose serious health, economic, and social risks for both the young woman and her child. The decision memorandum recommended that state policies permitting adolescents to receive contraceptives without their parents consent be encouraged. Additionally, the memorandum outlined 9 spending options for the Secretary's consideration. However, in late November the decision memo gained notoriety when the press reported on its support for abortions for teenagers, and the controversial abortion issue obscured 3 other important issues involving Health, Education, and Welfare's teen pregnancy initiative: 1) the mix of funding and where it will come from, 2) the assignment of responsibility for implementation of the package, and 3) the amount of support for family planning services and sex education for teenagers.     

The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States

This study expands on previous findings of racial/ethnic and allostatic load (AL) associations with mortality by addressing whether differential AL levels by race/ethnicity may explain all-cause mortality differences. This study used data from the third National Health and Nutrition Survey public-use file, gathered between 1988 and 1994, with up to 18 years of mortality follow-up (n = 11,733). AL scores were calculated using a 10-biomarker algorithm based on clinically determined thresholds. Results of discrete-time hazard models suggest that AL is associated with increased mortality risks, independent of other factors, including race/ethnicity and SES. The results also suggest that the AL–mortality association is stronger for non-Hispanic blacks than for non-Hispanic whites, and that at low levels of AL observed mortality differences between non-Hispanic blacks and non-Hispanic whites are non-significant. These findings suggest that mortality differences between non-Hispanic blacks and non-Hispanic whites may be the result of how early life exposure causes premature aging and increased mortality risks. More attention to resource allocation and local environments is needed to understand why non-Hispanic blacks experience premature aging that leads to differential mortality risks compared to non-Hispanic whites.     

Peers and Fertility Preferences: An Empirical Investigation of the Role of Neighbours,Religion and Education

Individual fertility preference is influenced by observed social norms. The present paper investigates the effect of the observed fertility of peers on a woman’s fertility preference. We explore the role of two peer groups: neighbourhood peers and religious peers. Data from the National Family Health Surveys (1992–1993, 1998–1999 and 2005–2006) in India is employed for empirical estimations using a multinomial logit model. We find that both neighbourhood and religious peers have a significant impact on individual fertility preferences, but their relative importance changes with family size. An increase in peer fertility increases the probability of preferring more children. We further examine the roles of education and wealth as transmission channels between the fertility norms of peers to the fertility preferences of the women and find that education plays an important role in moderating peer influences. These findings can serve as vital inputs in formulating family planning and gender policies.     

Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.