The impact of class,education, and health care on infant mortality in a developing society: The case of rural Thailand

Demographic and social factors affecting infant mortality in rural northern Thailand are examined using log-linear modifiedmultiple regression models and data drawn from a representative sample of married couples in Chiang Mai and Chiang Rai provinces. Demographic factors do not account for the effects of variations in parental ability or willingness to provide adequate infant care. The final model estimated incorporated both these social dimensions of child care. Parental ability, measured by father’s social class, mother’s health information, and local community development levels, continued to have significant independent effects upon infant survival. Parental willingness, measured by parent’s beliefs about intergenerational wealth transfers, no longer had a significant effect net of other social variables, but infant survival was still affected by whether both parents wanted a birth.     

Impact of health and fitness-related behavior on quality of life

While the relationships between (a) health behavior and health status and (b) health status and perceived quality of life (QOL) have received some attention, the association between health behaviors and QOL has not been determined. The primary objective of this study was to assess the effects of health behaviors on QOL that are independent of the effects of health status. A sample of approximately 5 000 randomly selected U.S. Navy personnel was split into halves and analyses performed on each to establish the replicability of the findings. At step one of a multiple regression procedure, health status variables were forced into the equation; next, health behavior variables were entered. As expected, the block of health status variables was significantly related to QOL: self-assessed health and fitness status and lower reporting of physical symptoms accounted for 16% and 18% of the variance in QOL for the two subsamples. After controlling for health status, two behavioral measures made unique contributions to the prediction of QOL: behaviors related to avoiding unnecessary risks as a driver or pedestrain and avoiding or minimizing accidents. Wellness maintenance behaviors also were associated with QOL in one subsample. After controlling for health status, health behavior measures contributed an additional 11% and 6% of the explained variance in QOL for the two subsamples. Results indicate that health behaviors influence QOL independently of health status.     

Perceptions of quality of life in an industrializing country: The case of the Republic of Korea

Research on perceived quality of life to date has been confined to industrialized countries mostly in the West. As a result, very little has been known about the quality of life perceived and desired by the people living in industrializing countries. This study has sought to fill this void by analyzing data collected from a national sample survey conducted recently in Korea. The analysis has produced a number of results which do not accord with those from research undertaken in industrialized countries.     

The effects of maternal smoking on infant health

Maternal smoking has serious consequences for the developing fetus and infant, including a higher probability that the infant will be born prematurely and at low birth weight, will require admission to neonatal intensive care, and die during infancy. Data from Alabama birth certificates for births occurring between 1988 and 1991 were analyzed using log linear methods to calculate relative risks of adverse pregnancy outcomes and infant death. Smoking by mothers during pregnancy is associated with an elevated risk of infant death, low birth weight, and prematurity, controlling for mother's educational attainment, age, marital status, race, and trimester prenatal care was initiated. Smoking was also associated with a higher rate of admission to neonatal intensive care and to deaths from SIDS and respiratory causes. Reducing maternal smoking can contribute to a reduction of premature and low weight births and infant deaths. Because of the difficulty of stopping smoking, efforts need to be directed at preventing younger women from beginning to smoke.An earlier version of this paper was presented at the Southern Demographic Association annual meeting in New Orleans in October 1993.     

Gerontological research on the quality of life: The Guelph satellite method

This paper describes an interdisciplinary research strategy designed to address gaps in research on the quality of life of older people. We propose that such gaps be addressed through small intensive studies, and that the limitations of such studies be addressed by combining them in phases with a panel approach in the form of “satellite” studies. The emphasis is on the intensive studies as an integral rather than a subsidiary part of the strategy, and on the panel as a vehicle for the satellite studies. As an illustration of the strategy, we describe a project in which the satellite studies focus on intensive examination of specific topics such as family relationships and the panel method employs interviews and questionnaires to collect baseline information and quality of life ratings. We then focus on methodological issues, such as participant selection and the sequencing of phases, and briefly compare the present strategy to other longitudinal approaches. The paper concludes with a discussion of some of the methodological and substantive advantages of the strategy.     

The impact of women's status on infant mortality rate: A cross-national analysis

A number of prior studies have attempted to account for cross-national differences in infant mortality rate using a variety of economic, demographic, and health related variables. These studies have given relatively little attention to the impact of predictors measuring the status of women. The present study, based on a sample of 96 less developed countries circa 1990, tests a series of hypotheses derived from gender stratification theory and industrialism theory. Evidence is presented of an inverse relationship between the status of women and infant mortality rate. The present study shows that it makes a difference whether we use relative or absolute measures of women's status and it shows that in addition to women's educational status, other dimensions of women's status particularly economic status and autonomy are also important predictors of infant mortality rate.     

The impact of breast feeding patterns on the biometric analysis of infant mortality

A major assumption of the biometric analysis of infant mortality as developed by Bourgeois-Pichat is that the age structure of infant deaths after the first month of life is virtually constant across time and cultures. Reanalysis of results from studies which compare the mortality of infants according to the type of feeding indicated that the relationship between mortality and age within the first year of life followed different patterns for breast fed and artificially fed infants. Historical data for populations with different breast feeding customs reveal similar differences in the age pattern of infant mortality. In populations where breast feeding was uncommon or of very short duration, infant mortality rises particularly steeply during the early months of the first year of life. The age structure of infant mortality in less developed countries where breast feeding is decreasing rapidly may be similarly affected. When substantial deviations from the linear relationship are evident, particular caution is required in applying the biometric technique, since in such situations the estimated endogenous mortality is very much affected by the particular set of data points within the first year of life which are chosen for the basis of the estimates.     

The quality of life in the Caribbean: A political interpretation

A study of 23 Caribbean polities attempted to relate two types of measures of economic and political development to measures of the quality of life. On the one hand are two closely related concepts, the level of economic development and the political status of the polity (colony, internal self-government, or autonomy). On the other hand are two measures of the type of government and economic structure: plantation agriculture and repressive government. Measures of the quality of life included per capita income, health measures, educational measures, communication and transportation per capita. Plantation structure and political repression were found to be related to most of the measures of the quality of life, but measures of economic development and political status to practically none.     

Working off the farm: Impacts on quality of life

The purpose of this paper is to determine the effects of off-farm employment on perceptions of quality of life. Data collected on 311 Western Ontario male and female farmers revealed that although most indicated satisfaction with their lives, some differences are apparent. Women employed off the farm report more areas of lower satisfaction than their male counterparts and men and women working solely on the farm. Low levels of satisfaction with time issues, leisure and exercise were most evident for employed women. Men employed off the farm report the most effects from time issues, satisfaction with the farm business, income and the environment. People working off the farm feel their farms are less successful and are more concerned with their environment. Whereas the farm family's pluriactivity enables many to hold on to herished aspects of the farming lifestyle for a while, its burdens are perceived to fall neaviest on female farmers especially if they have young children. The magnitude of their concerns about the quality of their environment and not being able to farm successfully suggests that many of these farmers would improve their quality of life by peeding up the transition out of farming before all their farm's equity is lost.     

The quality of life in Australia

This paper outlines a long term project on the quality of life in Australia and presents some initial survey data. The long term project is intended (1) to find which domains of life most affect the perceived well-being of Australians and the values/satisfactions people wish to achieve in these domains (2) to propose policy programs designed to enhance satisfaction with particular domains and (3) to assess the political feasibility of proposed programs. Policy programs intended to enhance satisfaction are termed positive welfare programs to distinguish them from conventional compensatory welfare programs. The survey data analysed here (national sample, N=679) deal with the satisfactions and dissatisfactions of Australians, the correlates of perceived well-being and the links between domains and values. Perceived well-being is measured by Andrews and Withey's Life-as-a-whole index and Bradburn's Affect Balance scale. Satisfactions are measured on a 9 point modified version of Andrews and Withey's delighted-terrible scale. Readers familiar with American, British and Canadian findings will find the results reported here broadly similar. However, the linkage between people's sociological characteristics and their satisfaction levels appears to be exceptionally weak in Australia, which tends to confirm the view that Australia is a comparatively unstratified society.     

The impact of infant and child death on subsequent fertility in Ethiopia

This paper uses hazard regression models to assess the impact of experienced infant and child mortality on the risk of subsequent conceptions in Ethiopia. The purpose of this paper is to test for the presence of a fertility response to an infant or child death, net of the effects of truncated breastfeeding on fecundity. Using retrospective birth history data from a national survey in Ethiopia, we find a significantly higher risk of a conception in the months following the death of an index child, even after controlling for postpartum amenorrhoea and breastfeeding status. The fertility response is strongest after the death of the fourth or fifth child, which is when most women in Ethiopia are at or near their desired family size. However, we find no evidence of a fertility response to the death of a nonindex child. We attribute the higher risk of a conception following an index child’s death to the intentional efforts of couples to reduce the waiting time to a next birth and thereby replace the deceased child. However, absent evidence of replacement fertility in response to the death of older nonindex children, we interpret the response to the death of an index child as an emotional response to child loss rather than a conscious strategy to meet a fertility target.

The quality of urban life and the perception of livability: A case study of neighbourhoods in Benin City,Nigeria

Third World cities face many persistent planning problems. The problems persist partly because planning has not been sufficiently responsive to local peculiarities. This lack of responsiveness is in turn because of the gross scale at which problems are conceived and attacked. One of the persistent problems in all Nigerian cities is their poor environmental quality. This study, therefore, seeks to investigate the environmental problems of Benin City, capital of Bendel State of Nigeria. Six environmental dimensions are measured and analysed. A composite conceptual index of quality of life is derived from the six dimensions, and compared with an index of perceived quality for each area. The study adopts the neighbourhood as the unit in collecting and analysing data, and in proposing solutions. It is recommended that planning administration in Benin City must be decentralized, if it is to be more responsive to intra-city environmental eccentricities, and improve the quality of life.     

Using quality of life information to set priorities in health policy

Health care has as primary objectives extending life expectancy and improving quality of life in years prior to death. This paper offers a General Health Policy Model as a method for quantifying these outcomes. The model adjusts life expectancy for diminished quality of life, which is measured using a standardized instrument known as the Quality of Well-being (QWB) scale. The Well-year or Quality Adjusted Life Year (QALY) results from these analyses and serves as a single quantitative expression of health benefit. QALY units integrate side effects and benefits of treatment by combining into a single number, mortality, morbidity, and duration of each health state. Examples show the application of the model relevant to a variety of medical and public health problems, including diabetes, arthritis, AIDS, neonatal circumcision, and tobacco tax. It is suggested that the General Health Policy Model has advantages for guiding both individual and public health decisions.     

The quality of student life: Toward a coherent conceptualization

Under various guises, the concept of the quality of student life (QSL) has received much attention in the higher education literature. Unfortunately, its various uses have in common that they all lack conceptual coherence. In an effort to remedy this situation, and render QSL useful for researchers, administrators and student services personnel, this paper does three things. First, a conceptual framework is used as a means of organizing a wide-ranging review of relevant literatures across several disciplines. Integration of the inferences derived yields a new formal definition of QSL. Next, building on a critique of four theoretical models of QSL, a new ecological formulation is advanced which stresses the need to consider various on- and off-campus contexts if efforts to assess student satisfaction and happiness are to be meaningful. Third, a number of salient methodological issues are examined in light of this formulation. To the extent that these approaches collectively yield a more coherent conceptualization of QSL, it is concluded that the idea of QSL deserves much greater prominence than it now enjoys.     

Forging ahead: Linking health and behavior to improve quality of life in older people

This chapter will focus on conceptual and methodological issues related to health promotion/disability prevention for older people. The first section will begin with a discussion of why older people, as compared to younger persons, are not traditionally seen as targets of health promotion efforts. In recent years several national working groups have been established to examine how older people's health and functioning can be improved. Their objectives and recommendations for older Americans will be reviewed. The second section will address the conceptual framework underlying health and behavior research supported by the National Institute on Aging. The movement from correlational studies to studies of basic mechanisms linking health and behaviour will be discussed, with particular attention to interactions with aging processes. Examples of health and behavior research representing these processes will be presented as well as methodological issues in the measurement of health and functional outcomes for older people. Measurement of quality of life in the cognitively impaired is seen as especially difficult. The third section will review several common themes emanating from these research studies. These include attention to a life course perspective, variability in aging processes, alternative research approaches, and intervention strategies for both initiating and maintaining recommended behavioral changes. A fourth section will review current areas of investigation at the National Institute of Aging. Successful intervention strategies in both community and institutional settings will to presented. These include: (1) a comprehensive behavioral and environmental falls prevention program which has been shown to reduce falls in the community; (2) a health education program to increase older women's use of cancer-related health practices; and (3) behavioral strategies for reducing incontinence in nursing homes. A new NIA initiative on special care units for persons with dementia will also be discussed. The fifth and final section will deal with issues involved in the translation of research into policy and practice. Approaches for increasing the relevance of research to policymakers will be discussed.     

The wealth of nations revisited: Income and quality of life

Does economic prosperity enhance the quality of human life? Across 101 nations, 32 indices were analyzed that reflect a representative sample of universal human values (e.g., happiness, social order, and social justice). Wealth correlated significantly with 26 of the 32 indices, indicating a higher QOL in wealthier nations. Only suicide and CO₂ emissions were worse in wealthier societies. Basic physical needs were met early in economic development, whereas advanced scientific work occurred only when basic physical needs were fulfilled for almost all people in the society. Limitations of the conclusions are discussed.     

Improving the quality of life: Prescriptions for change

The main points made in the previous papers are summarized and integrated and the strategies that the authors have recommended for producing an improved QOL are discussed. QOL is also systematically reviewed in relation to matters of definition, assessment, applications, and directions for future research and practice.