Women's interest in vaginal microbicides.
CONTEXT: Each year, an estimated 15 million new cases of sexually transmitted diseases (STDs), including HIV, occur in the United States. Women are not only at a disadvantage because of their biological and social susceptibility, but also because of the methods that are available for prevention. METHODS: A nationally representative sample of 1,000 women aged 18-44 in the continental United States who had had sex with a man in the last 12 months were interviewed by telephone. Analyses identified levels and predictors of women's worry about STDs and interest in vaginal microbicides, as well as their preferences regarding method characteristics. Numbers of potential U.S. microbicide users were estimated. RESULTS: An estimated 21.3 million U.S. women have some potential current interest in using a microbicidal product. Depending upon product specifications and cost, as many as 6.0 million women who are worried about getting an STD would be very interested in current use of a microbicide. These women are most likely to be unmarried and not cohabiting, of low income and less education, and black or Hispanic. They also are more likely to have visited a doctor for STD symptoms or to have reduced their sexual activity because of STDs, to have a partner who had had other partners in the past year, to have no steady partner or to have ever used condoms for STD prevention. CONCLUSIONS: A significant minority of women in the United States are worried about STDs and think they would use vaginal microbicides. The development, testing and marketing of such products should be expedited. (+info)
Predicting longitudinal growth curves of height and weight using ecological factors for children with and without early growth deficiency.
Growth curve models were used to examine the effect of genetic and ecological factors on changes in height and weight of 225 children from low income, urban families who were assessed up to eight times in the first 6 y of life. Children with early growth deficiency [failure to thrive (FTT)] (n = 127) and a community sample of children without growth deficiency (n = 98) were examined to evaluate how genetic, child and family characteristics influenced growth. Children of taller and heavier parents, who were recruited at younger ages and did not have a history of growth deficiency, had accelerated growth from recruitment through age 6 y. In addition, increases in height were associated with better health, less difficult temperament, nurturant mothers and female gender; increases in weight were associated with better health. Children with a history of growth deficiency demonstrated slower rates of growth than children in the community group without a history of growth deficiency. In the community group, changes in children's height and weight were related to maternal perceptions of health and temperament and maternal nurturance during feeding, whereas in the FTT group, maternal perceptions and behavior were not in synchrony with children's growth. These findings suggest that, in addition to genetic factors, growth is dependent on a nurturant and sensitive caregiving system. Interventions to promote growth should consider child and family characteristics, including maternal perceptions of children's health and temperament and maternal mealtime behavior. (+info)
The relationship of family size and spacing to the growth of preschool Mayan children in Guatemala.
The height of preschool Mayan children is analyzed with respect to family size and the spacing of their siblings, controlling for parental heights and weights. Data on 643 cases were abstracted from the records of two previous longitudinal studies on the health of children under age five years living in the highlands of Guatemala. Height at age three years is estimated from the linear regression equations fitted for each child to measurements of height repeated at three-month intervals from ages one to four years. Family size is expressed in terms of birth rank, live siblings, and the number of dependent and independent family members. Family spacing is measured as birth intervals, i.e., the number of months between the birth of the index child and his previous and subsequent siblings. Most previous studies have reported that height decreases as family size increases. This study shows that Mayan children from both small and large families are taller than those from middle-sized families. Evidence is presented to support the hypothesis that children in large families are relatively tall because their early-born siblings contribute to the family fortunes. Birth intervals are positively correlated with height. The findings are discussed in terms of their implications for family planning. (+info)
Active infection with Helicobacter pylori in healthy couples.
The mode of spread of Helicobacter pylori infection is subject to ongoing debate. Recent studies among patients with gastrointestinal disorders suggest a potential role of conjugal transmission. In this study, the clustering of H. pylori infection was assessed among 110 employees of a health insurance company and their partners. Active infection with H. pylori was measured by the 13C-urea breath test. Information on potential confounders was collected by a standardized questionnaire. Overall, 16 employees (14.5%) and 24 partners (21.8%) were infected. While only 7% (6/86) of employees with an uninfected partner were infected, this applied to 42% (10/24) of employees with an infected partner. A very strong relation between partners' infection status persisted after control for age and other potential confounders (adjusted odds ratio, 7.0; 95% confidence interval, 1.8-26.7). Furthermore, the risk of infection increased with the number of years lived with an infected partner. These results support the hypothesis of a major role of spouse-to-spouse transmission of H. pylori infection. (+info)
Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome.
OBJECTIVE: To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome. DESIGN: Retrospective audit in the south west of England of 801 children with diabetes mellitus. MAIN OUTCOME MEASURES: Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates. RESULTS: There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status. CONCLUSIONS: Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome. (+info)
Nutrient intake of food bank users is related to frequency of food bank use, household size, smoking, education and country of birth.
The number of individuals and families accessing food assistance programs has continued to grow throughout the 1990s. Despite the increased health risk among low-income people, few studies have addressed nutrient intake throughout the month or at the end of the month when food and financial resources are thought to be compromised, and no study has described dietary status of a random sample of food bank users. Nutrient intakes of adult female and male food bank users in metropolitan Montreal, Quebec, Canada, were monitored week-by-week over a month by dietitian-administered 24-h recall interviews. A total of 428 participants from a stratified random sample of 57 urban area food banks completed all four interviews. Mean energy intake, as an indicator of diet quantity, was similar to other adult populations (10.2 +/- 4.8 and 7.9 +/- 3.6 MJ for men and women, respectively, age 18-49 y) and not related to sociodemographic variables except the expected biological variation of age and sex. Macronutrient intake was stable throughout the month. Overall median intakes of calcium, vitamin A, and zinc were below recommended levels for all age and sex groups. Intakes of several micronutrients were related to frequency of food bank use, household size, smoking, education, and country of birth. High nutrient intake variability characterized these adult food bank users. (+info)
Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.
CONTEXT: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. METHODS: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. RESULTS: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. CONCLUSIONS: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States. (+info)
Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth.
CONTEXT: Half of all pregnancies in the United States are unintended. Of these, half occur to women who were practicing contraception in the month they conceived, and others occur when couples stop use because they find their method difficult or inconvenient to use. METHODS: Data from the 1995 National Survey of Family Growth were used to compute life-table probabilities of contraceptive failure for reversible methods of contraception, discontinuation of use for a method-related reason and resumption of contraceptive use. RESULTS: Within one year of starting to use a reversible method of contraception, 9% of women experience a contraceptive failure--7% of those using the pill, 9% of those relying on the male condom and 19% of those practicing withdrawal. During a lifetime of use of reversible methods, the typical woman will experience 1.8 contraceptive failures. Overall, 31% of women discontinue use of a reversible contraceptive for a method-related reason within six months of starting use, and 44% do so within 12 months; however, 68% resume use of a method within one month and 76% do so within three months. Multivariate analyses show that the risk of contraceptive failure is elevated among low-income women and Hispanic women. Low-income women are also less likely than other women to resume contraceptive use after discontinuation. CONCLUSIONS: The risks of pregnancy during typical use of reversible methods of contraception are considerably higher than risks of failure during clinical trials, reflecting imperfect use of these methods rather than lack of inherent efficacy. High rates of method-related discontinuation probably reflect dissatisfaction with available methods. (+info)