A methodology for identifying married couples in medicare data: Mortality, morbidity, and health care use among the married elderly

Wedescribe a method for the development of cohorts of up to three quarters of the 14 million married couples aged 65 and over in the United States. The health care experiences, illness histories, and mortality of these identified couples can be assessed longitudinally using Medicare data. We summarize strengths and limitations of using data from Medicare administrative records for the study of marriage, health, and aging. We illustrate the method by demonstrating substantial differences in survival in a cohort of hospice patients as a function of not only the patient's own diagnosis and illness burden but also the patient's spouse's illness burden.     

HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

Perceived emotional support from family and friends in members of homosexual, married, and heterosexual cohabiting couples

The purpose of this study was to examine factors that influenced perceptions of emotional support from friends and family in members of gay, lesbian, married, and heterosexual cohabiting couples. Both the individual partner and the couple were used as units of analysis. Using the individual partner scores, perceived emotional support was related to Type of Couple (married perceived more emotional support from family than did gays and lesbians); Sex-Role Self-Concept (undifferentiated individuals perceived the least emotional support from both friends and family); and Source of Support (friends were perceived to provide more emotional support than family). Gays and lesbians, in particular, perceived more emotional support from friends than from family. Individuals reporting high degrees of emotional support from friends were less psychologically distressed than those reporting low degrees of emotional support from friends. Using the couple scores, the above Type of Couple and Source of Support effects were replicated. In addition, partner differences were obtained only in married couples in which wives perceived more emotional support than husbands. Results are discussed in terms of current research in the area of social support.     

Contraceptive use in South Africa under apartheid

In this paper, patterns of contraceptive use among black South African women in the late 1980s are examined. Multilevel logit models are used to evaluate the extent to which segregation of the African population into homelands gave rise to uneven patterns of contraceptive use; how this pattern was shaped by variations in family-planning acceptability; and the way in which the system of male labor migration and social and economic inequities across communities affected women's use of contraceptives. Results show that variation in contraceptive use across homeland areas diminished with the addition of community controls for development and migration. Controlling for unobserved heterogeneity indicated that localized conditions could offset the advantages or disadvantages of living in a former homeland.     

The end of rapid increase in the use of oral anovulants? Some problems in the interpretation of time series of oral use among married women

Several problems in the interpretation of time series of oral anovulant usage are discussed, among them the shifting marriage-duration distribution over time. Standardization fails to negate the conclusion that the rate of increase in the proportion of women using orals has slackened since January 1966. Separate analyses by duration-specific rates of use and by marriage cohorts show that the two factors sustaining the initial spectacular growth rate in the use of orals-the ever—higher initial use rates of new marriage cohorts and the rapid adoption of orals among earlier cohorts at later durations—have lost their sustaining force. Further analysis indicates that concern over the pill as a health hazard is a major deterrent to substantial increase in oral usage. A final distribution of women by risk status with respect to oral use, and current and prospective oral use, shows that under present circumstances the maximum oral use rate will be considerably less than unity.     

Sex-role attitudes and employment status as predictors of perceived life satisfaction among married women in Korea

The focus of this exploratory study is on reexamining the relationship between sex role attitudes and the employment status of married women in Korea, and exploring the nature and extent of women's sex role attitudes and employment status on their life satisfaction (marriage, family, work). Multicluster sampling was used to select 418 women from the city of Seoul. The Attitudes toward Women Scale (AWS) (Spence and Helmreich) was used to measure the concept of sex role attitudes. Life satisfaction was measured by 3 questions: ALLSAT, a general feeling; IGA for the general effect based on Osgood's semantic differential scales; and work status and voluntariness. Background characteristics are given. The results revealed that there was an independent relationship between sex role attitudes and employment status. Based on willingness to work groups (4), those who worked involuntarily had the most conservative sex role attitudes, and those involuntarily nonworking had the most liberal attitudes. When education background was controlled for, there were no significant differences between working and nonworking women and sex role attitudes. There was little relationship observed between sex role attitudes and overall satisfaction. When controlling for employment status, however, sex role attitudes and the relationship to work satisfaction was statistically significant among fulltime housewives, who had conservative attitudes. In fact, fulltime housewives reported greater satisfaction with their role as homemaker than those with liberal sex role attitudes. Women's attitudes and their actual roles has a greater influence on women's life satisfaction than sex role attitudes. Overall, working women are more satisfied with work and overall life than are nonworking women, when the mean satisfaction scored all 6 indicators are used in a 1 way analysis of variance. There were no significant differences in satisfaction with marriage or family life between working and nonworking women. When the intervening variable willingness to work is introduced, this plus employment status affects life satisfaction. The discrepancy between women's sex role attitudes and their work status produces the greatest dissatisfaction. The multiple regression of background variables affecting sex role attitudes shows that parent's encouragement for a woman to work has the strongest effect. Educational attainment has a positive effect on sex role attitudes, and among less well education has a negative effect and positive effect among those well educated, Husband's income is significantly higher than that for working women. Another model expressing reciprocal relations between marriage, family and work satisfaction was generated. Improvements are suggested for future research.     

The effects of high HIV prevalence on orphanhood and living arrangements of children in Malawi, Tanzania, and South Africa

Using longitudinal data from three demographic surveillance systems (DSS) and a retrospective cohort study, we estimate levels and trends in the prevalence and incidence of orphanhood in South Africa, Tanzania, and Malawi in the period 1988-2004. The prevalence of maternal, paternal, and double orphans rose in all three populations. In South Africa - where the HIV epidemic started later, has been very severe, and has not yet stabilized - the incidence of orphanhood among children is double that of the other populations. The living arrangements of children vary considerably between the populations, particularly in relation to fathers. Patterns of marriage, migration, and adult mortality influence the living and care arrangements of orphans and non-orphans. DSS data provide new insights into the impact of adult mortality on children, challenging several widely held assumptions. For example, we find no evidence that the prevalence of child-headed households is significant or has increased in the three study areas.     

Polygyny, Partnership Concurrency, and HIV Transmission in Sub-Saharan Africa

We study the relationship between polygyny and HIV infection using nationally representative survey data with linked serostatus information from 20 African countries. Our results indicate that junior wives in polygynous unions are more likely to be HIV positive than spouses of monogamous men, but also that HIV prevalence is lower in populations with more polygyny. With these results in mind, we investigate four explanations for the contrasting individual- and ecological-level associations. These relate to (1) the adverse selection of HIV-positive women into polygynous unions, (2) the sexual network structure characteristic of polygyny, (3) the relatively low coital frequency in conjugal dyads of polygynous marriages (coital dilution), and (4) the restricted access to sexual partners for younger men in populations where polygynous men presumably monopolize the women in their community (monopolizing polygynists). We find evidence for some of these mechanisms, and together they support the proposition that polygynous marriage systems impede the spread of HIV. We relate these results to the debate about partnership concurrency as a primary behavioral driver for the fast propagation of HIV in some parts of sub-Saharan Africa.     

Intimate partner violence and the spatial pattern of maternal healthcare services utilization among parous married women in northern Nigeria

Journal of Population Research - The low uptake of maternal healthcare services (MHS) in Nigeria is implicated in the country’s poor maternal health outcomes. In northern Nigeria where these...     

Contraceptive use at first intercourse among Jewish women in Israel, 1962–1988

Using data from the 1987–1988 Study of Fertility and Family Formation,this study examines the family planning practices of Jewish Israeli womenwho first had intercourse between 1962 and 1988. The overwhelming majorityof women reported using no contraception at first intercourse, and among those who did practice birth control approximately half relied on modern techniques. While the likelihood that Israeli women used contraception at first sex changed little between 1962 and 1988, there has been a marked shift towards the adoption of efficient methods of birth control. Moreover, factors which promote female empowerment, including education and military service, have been positively associated with contraceptive use at first intercourse. Among those women who practiced contraception at first intercourse, those from Africa and Asia have been especially likely to make use of inefficient methods such as withdrawal.     

Sexual activity and weekly contraceptive use among young adult women in Michigan

Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women’s partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.     

Spare time use and perceived well-being among black South African youth

Leisure opportunities for urban black South Africans are limited but there is little evidence which documents the experience of disadvantage or its significance for retarded advancement and depressed quality of life. An exploratory questionnaire study, conducted in 1989 in three metropolitan areas among black township youth (age 15–25 years, predominantly Zulu-and Xhosa-speakers) of both sexes, inquired into spare time habits and activities, participation rates, leisure aspirations, satisfactions, preferences, and barriers. Each subject also kept activity diaries for a specific weekday and a weekend day. Preliminary results from the time budget data are discussed with reference to subjects' overall life satisfaction and outlook on the future. Findings have policy implications for reducing inequalities in a socially divided society.The University of Natal rejects apartheid. It is an equal opportunities, affirmative action University.     

Child Mobility,Maternal Status,and Household Composition in Rural South Africa

This article examines the influence of maternal status, socioeconomic status of the household, and household composition on the mobility of children aged 0–14 in Mpumalanga Province, South Africa, from 1999 to 2008. Using data from the Agincourt Health and Demographic Surveillance System, we found that children whose mothers were temporary migrants, living elsewhere, or dead had higher odds of moving than children whose mothers were coresident. Older children and children living in richer households faced lower odds of mobility. For children whose mothers were coresident, there was no effect of maternal substitutes on child mobility. However, among children whose mothers were temporary migrants or living elsewhere, the presence of prime-aged and elderly females lowered the odds of mobility. For maternal orphans, the presence of elderly women in the household lowered their odds of mobility. The results underscore the importance of examining the conditions under which children move in order to strengthen service delivery targeted at safeguarding children’s well-being.     

Measurement issues involved in examining contraceptive use among young single women

The objective of this study was to determine how research findings on contraceptive use among young single women are affected by differing operational definitions of contraceptive use. Data were analyzed from a student sample and a clinic sample. In the analysis of the student sample were 244 high school and college women aged 16–22 who had experienced sexual intercourse. In the birth control clinic sample were 432 women aged 13–20. Six operational definitions of contraceptive use were analyzed. Correlation and multiple regression analyses were used to examine the relationship of predictor variables with the six definitions separately for each sample. The variance explained for each of the contraceptive measures ranged from 8 percent to 44 percent in the student sample and from 9 percent to 24 percent in the clinic sample.     

Children's residence patterns and educational attainment in rural South Africa, 1997

Using data collected by the Agincourt Health and Population Programme in a rural sub-district of South Africa's Northern Province, this paper describes the residential arrangements of a population in rural South Africa, and analyses the impact of these arrangements on children's educational attainment. Children with co-resident parents generally have higher levels of schooling than those who have one or no co-resident parents. However, having a father who is away from home as a migrant appears to benefit older children whereas, for girls aged 11 to 15, having a mother who is a migrant lowers educational attainment. Children who live in households headed by Mozambican refugees have lower levels of schooling than those who live in non-refugee households. Living in a household headed by a woman is not associated with lower levels of education and, for some age-sex groups, appears to be an advantage.     

Family Instability and Pathways to Adulthood in Cape Town,South Africa

Social, political, epidemiological, and economic forces have produced family instability during childhood for many young people transitioning to adulthood in South Africa. This study identifies pathways to adulthood for youth in Cape Town that capture the timing and sequencing of role transitions across the life domains of school, work, and family formation. It then uses these pathways to investigate the relationship between childhood family instability and the way young people's lives unfold during the transition to adulthood. Results indicate that changes in co‐residence with parents are associated with following less advantageous pathways into adulthood, independent of particular family structure or orphan status. Overall, the findings suggest that family instability influences not only single transitions for youth, but also combinations of transitions. They also indicate the value of a multi‐dimensional conceptualization of the transition to adulthood in empirical work.     

Factors associated with long-term benzodiazepine use among elderly women and men in Quebec

The goal of this study was to compare factors associated with long-term benzodiazepine use by elderly women and men (n = 1701) who participated in the Quebec Health Survey (QHS). Data from the 1998 QHS were linked with data from the administrative files of the Régie de l'assurance maladie du Québec. Results showed that elderly women were more at risk than men for long-term benzodiazepine use. Results of the multivariate logistic regression did not show a significant difference between women and men on any of the risk factors studied. Other factors such as elderly and physician attitudes deserve further study to explain differences in long-term benzodiazepine use between elderly women and men.     

Religiosity and quality of life in South Africa

Using nationally representative survey data, this paper explores the relationship between religiosity and quality of life. Three indicators of religiosity are used: (i) frequency of attendance at religious services or meetings, (ii) orthodoxy of beliefs in relation to Biblical teachings and (iii) religious denomination. Quality of life (QoL) is measured in terms of (i) household access to modern conveniences, (ii) self-assessed life satisfaction and (iii) level of satisfaction with government institutions. The data shows a significant but not very strong statistical relationship between religiosity and QoL. People who attend religious meetings most frequently and who hold the most orthodox religious views are thus more likely to have access to modern conveniences and to be satisfied with their lives. Satisfaction with government, however, tends to be highest amongst nominally religious people and lowest amongst both the most orthodox and the least religious.