Risks among youths who have multiple sisters who were adolescent parents. (73/2475)

CONTEXT: Past research has revealed that having a sister who gave birth as a teenager is associated with increases in young people's likelihood of engaging in risky sexual behavior. To date, however, no study has determined if having several sisters who were adolescent mothers further raises youths' chances of engaging in risky activities. METHODS: Data were collected from 1,510 predominantly Hispanic and black 11-17-year-olds in a California program for youths who have at least one pregnant or parenting sister. Correlational analyses, analyses of variance and regression analyses were conducted to assess the effects of having multiple teenage parenting sisters on a variety of outcomes that are known risk factors for teenage pregnancy RESULTS: Twenty-four percent of participants had two or more sisters who had given birth as teenagers. The likelihood of having multiple adolescent parenting sisters was greatest in large families, but was unrelated to youths' other background characteristics. In analyses controlling for background factors, females with many parenting sisters had increased levels of behavioral problems (school problems, drug or alcohol use, and delinquent behavior) and an elevated likelihood of being sexually experienced. Having lived with two or more parenting sisters (as opposed to having lived with only one) was related to more permissive sexual and childbearing attitudes among young women and to earlier first intercourse among young men. Males with a sister who gave birth at a young age had elevated levels of delinquent behavior and promiscuous sexual behavior. CONCLUSIONS: As the number of teenage parenting sisters rises, youths'--particularly females'--risk of pregnancy involvement increases beyond the level associated with having only one teenage parenting sister. Screening for the number, living situation and age at first birth of parenting sisters is likely to be useful for programs seeking to identify youths at high risk of an early pregnancy.  (+info)

Children of divorce. (74/2475)

BACKGROUND: The rapidly changing nature and demographics of divorce in United States within the past 30 years has spawned an epidemic that affects more than one half of the families in the United States. METHODS: I performed a MEDLINE-assisted review of the medical literature searching with the key words "divorce" and "children." In addition, a Web search was conducted using Webferret with the same key words. RESULTS AND CONCLUSIONS: The past view of divorce as a short-term family crisis must mature into a longitudinal view of the effects of divorce. Divorce affects children according to their coping mechanisms in their own stages of development. Many problems and concerns previously attributed to divorce have their roots in the period of family interaction before the divorce and in the ongoing conflicts in many families after the divorce itself. Because family physicians are objective observers with whom the family comes into regular contact, they must be able to assist families through the transitions of divorce and to intervene on behalf of the children to help them through this stressful life event with the fewest detrimental effects possible. Counseling, group therapy, and divorce mediation have been assessed as effective tools for intervention.  (+info)

Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. (75/2475)

OBJECTIVE: This study was undertaken to assess the ability of a water container with a cover and a spout to prevent household contamination of water in a Malawian refugee camp. METHODS: A randomized trial was conducted in a refugee population that had experienced repeated outbreaks of cholera and diarrhoea and where contamination of water in the home was found to be a significant cause of cholera. Four hundred Mozambican refugee households were systematically identified and followed over a 4-month period, one fourth of the households were randomly assigned to exclusively use the improved container for water collection. FINDINGS: Water flowing from the source wells had little or no microbial contamination although the water collectors quickly contaminated their water, primarily through contact with their hands. Analysis of water samples demonstrated that there was a 69% reduction in the geometric mean of faecal coliform levels in household water and 31% less diarrhoeal disease (P = 0.06) in children under 5 years of age among the group using the improved bucket. Regression models examining diarrhoea among under 5-year-olds confirmed the protective effect of the bucket and found that visible faeces in the family latrine and the presence of animals were significantly associated with an increased diarrhoeal incidence in children. CONCLUSION: Household contamination of drinking-water significantly contributed to diarrhoea in this population. Proper chlorination is a less expensive and more effective means of water quality protection in comparison with the improved bucket, but was unpopular and rarely utilized by the camp inhabitants.  (+info)

Environmental pesticide exposure in Honduras following hurricane Mitch. (76/2475)

OBJECTIVE: To investigate whether environmental contamination occurred in the wake of hurricane Mitch (30-31 October 1998), we conducted a population-based cross-sectional household survey in the barrio of Istoca, Department of Choluteca, Honduras. The goals were to evaluate chemical contamination of potable water and the extent of human exposure to chemicals as a result of extensive flooding. METHODS: The survey consisted of an environmental exposure assessment, which included assaying water and soil samples for contaminants, and taking blood and urine samples from 45 adolescents aged 15-18 years. We also made a subjective questionnaire assessment of 155 households. FINDINGS: There was significant contamination of the soil in Istoca, but no water contamination in the aftermath of hurricane Mitch. The soil levels of chlopyrifos and parathion were 30- and 1000-times higher, respectively, than the Environmental Data Quality Level. However, the most striking finding was the detection of elevated levels of chlorinated and organophosphate pesticides in adolescents. Toxicological analyses of serum specimens showed that 51% of the samples had elevated levels of 1,1-dichloro-2,2-bis-(p-chlorophenyl) ethylene (p,p-DDE) (range, 1.16-96.9 ng/ml) (US reference mean = 3.5 ng/ml) in adults). Dieldrin levels > 0.2 ng/ml were also present in 23% of the serum specimens (serum levels of this analyte in US adolescents are < 0.2 ng/ml). Of 43 urine samples analysed for organophosphate metabolites, 18.6% contained diethyl phosphate (DEP) at levels which were greater that the reference mean of 6.45 micrograms/g creatinine. We also detected elevated levels of p-nitrophenol (p-NP) and of 3,5,6-trichloro-2-pyridinol (3,5,6-TCPY) in 91% and 42% of the samples, respectively. CONCLUSIONS: The elevated levels of chlorinated pesticides were surprising, since although these substances were banned in Honduras 15 years ago it appears that they are still being used in the country. Moreover, elevated levels of organophosphates were detected in the study adolescents even three weeks after the hurricane. Since these chemicals are usually cleared from the body quickly, our data suggest that the adolescents face an ongoing threat from pesticide exposure.  (+info)

Changing roles of grass-root level health workers in Kerala, India. (77/2475)

OBJECTIVE: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA: DESIGN: Cross-sectional, community-based survey. PARTICIPANTS: We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members. RESULTS: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields. CONCLUSIONS: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWS:  (+info)

Gene-environment interaction and affected sib pair linkage analysis. (78/2475)

OBJECTIVES: Gene-environment (GxE) interaction influences risk for many complex disease traits. However, genome screens using affected sib pair linkage techniques are typically conducted without regard for GxE interaction. We propose a simple extension of the commonly used mean test and evaluate its power for several forms of GxE interaction. METHODS: We compute expected IBD sharing by sibling exposure profile, that is by whether two sibs are exposed (EE), unexposed (UU), or are discordant for exposure (EU). We describe a simple extension of the mean test, the "mean-interaction" test that utilizes heterogeneity in IBD sharing across EE, EU, and UU sib pairs in a test for linkage. RESULTS: The mean-interaction test provides greater power than the mean test for detecting linkage in the presence of moderate or strong GxE interaction, typically when the interaction relative risk (R(ge)) exceeds 3 or is less than 1/3. In the presence of strong interaction (R(ge) = 10), the required number of affected sib pairs to achieve 80% power for detecting linkage is approximately 30% higher when the environmental factor is ignored in the mean test, than when it is utilized in the mean-interaction test. CONCLUSION: Linkage methods that incorporate environmental data and allow for interaction can lead to increased power for localizing a disease gene involved in a GxE interaction.  (+info)

Evolution and inequality. (79/2475)

Some scientists remain wary of evolutionary theory because of its supposed genetic determinism and insensitivity to the inequalities often associated with gender, race and class. Our aim is to show that such fears are outdated and to foster a role for evolutionary theory in public health. We use complex adaptive systems theory and the concept of a tradeoff between current and future reproduction to argue that when the future is objectively risky and uncertain the optimal reproductive strategy will often be to reproduce at a young age and/or high rate. Because reproducing early and/or often can lead to ill health and shortened lives, and because inequality is a major source of environmental risk and uncertainty, we argue that any attempt to use evolutionary theory to understand human reproduction, health or wellbeing must include considerations of inequality and social capital.  (+info)

Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm Female Coronary Risk Study. (80/2475)

BACKGROUND: Measures of low socioeconomic position have been associated with increased risk for coronary heart disease (CHD) among women. A more complete understanding of this association is gained when socioeconomic position is conceptualized from a life course perspective where socioeconomic position is measured both in early and later life. We examined various life course socioeconomic indicators in relation to CHD risk among women. METHODS: The Stockholm Female Coronary Risk Study is a population-based case-control study, in which 292 women with CHD aged < or =65 years and 292 age-matched controls were investigated using a wide range of socioeconomic, behavioural, psychosocial and physiological risk factors. Socioeconomic disadvantage in early life (large family size in childhood, being born last, low education), and in later life (housewife or blue-collar occupation at labour force entry, blue-collar occupation at examination, economic hardships prior to examination) was assessed. RESULTS: Exposure to early (OR = 2.65, 95% CI : 1.12-6.54) or later (OR = 5.38, 95% CI : 2.01-11.43) life socioeconomic disadvantage was associated with increased CHD risk as compared to not being exposed. After simultaneous adjustment for marital status and traditional CHD risk factors, early and later socioeconomic disadvantage, exposure to three instances of socioeconomic disadvantage in early life was associated with an increased CHD risk of 2.48 (95% CI : 0.90-6.83) as compared to not being exposed to any disadvantage. The corresponding adjusted risk associated with exposure to later life disadvantage was 3.22 (95% CI : 1.02-10.53). Further analyses did not show statistical evidence of interaction effects between early and later life exposures (P = 0.12), although being exposed to both resulted in a 4.2-fold (95% CI : 1.4-12.1) increased CHD risk. Exposure to cumulative socioeconomic disadvantage (combining both early and later life), across all stages in the life course showed strong, graded associations with CHD risk after adjusting for traditional CHD risk factors. Stratification of cumulative disadvantage by body height showed that exposure to more than three periods of cumulative socioeconomic disadvantage had a 1.7- (95% CI : 0.9-3.2) and 1.9- (95% CI : 1.0-7.7) fold increased CHD risk for taller and shorter women, respectively. The combination of both short stature and more than two periods of cumulative socioeconomic disadvantage resulted in a 4.4-fold (95% CI : 1.7-9.3) increased CHD risk. CONCLUSIONS: Both early and later exposure to socioeconomic disadvantage were associated with increased CHD risk in women. Later life exposure seems to be more harmful for women's cardiovascular health than early life exposure to socioeconomic disadvantage. However, being exposed to socioeconomic disadvantage in both early and later life magnified the risk for CHD in women. Cumulative exposure to socioeconomic disadvantage resulted in greater likelihood of CHD risk, even among women who were above median height. In terms of better understanding health inequalities among women, measures of socioeconomic disadvantage over the life course are both conceptually and empirically superior to using socioeconomic indicators from one point in time.  (+info)