Anne R. Pebley

Prenatal and delivery care and childhood immunization in guatemala: Do family and community matter?*

In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or “modern ”) health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.

Grandparents Caring for Grandchildren What Do We Know

Approximately 5% to 6% of grandchildren and 10% of grandparents live in grandparent-grandchild households at any point in time. The proportion of children living with grandparents appears to have remained relatively stable over time. In this article, the authors critically review previous research on the determinants of grandparent care for grandchildren. This research suggests that grandparent care generally is precipitated by need or problems experienced by parents. However, the determinants of custodial care (in which grandparents become sole caretakers) and of coresidence (three-generation households) are quite different. Custodial care generally occurs when parents are no longer able or willing to take care of their children. Coresidence more commonly is associated with the middle generations problems with living independently or with transition among roles.

Birth spacing and child mortality in bangladesh and the Philippines

This analysis uses data from Bangladesh and the Philippines to demonstrate that children who are born within 15 months of a preceding birth are 60 to 80% more likely than other children to die in the first two years of life, once the confounding effects of prematurity are removed. The risks associated with short conception intervals are confined to children who are also high birth order; they persist in the presence of controls for prior familial child mortality, breast-feeding, mother’s age, and socioeconomic status. In Bangladesh but not in the Philippines, these effects are confined to the neonatal period.

Socioeconomic Gradients in Health for White and Mexican-Origin Populations

OBJECTIVES We assessed whether the few findings to date suggesting weak relationships between education and health-related variables among Hispanics are indicative of a more widespread pattern. METHODS We used logistic regression models to examine education differentials (i.e., education gradients) in health behaviors and outcomes among White and Mexican-origin adults, adolescents, and infants. We gathered information from 3 data sets: the Los Angeles Family and Neighborhood Survey, the Fragile Families and Child Wellbeing Study, and the National Health Interview Survey. RESULTS In contrast with patterns for Whites, education was weakly associated or not associated with numerous health-related variables among the US Mexican-origin population. Among adults, Mexican immigrants were especially likely to have weaker education gradients than Whites. CONCLUSIONS The weak relationships between education and health observed among individuals of Mexican origin may have been the result of several complex mechanisms: social gradients in health in Mexico that differ from those in the United States, selective immigration according to health and socioeconomic status, and particular patterns of integration of Mexican immigrants into US society.

Reproductive patterns and child mortality in guatemala

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child.

Child mortality in the developing world.

This article reexamines an important and controversial issue relating to the effect of current economic conditions and public health programs on trends in child mortality in the developing world. Several observers in the 1980s have suggested that there has been a major slowdown in the pace of mortality decline because living standards are not improving very rapidly and more recently because of structural-adjustment policies designed to cope with deteriorating economic conditions. The authors find little basis for the conclusion that mortality decline has slowed in general. On the other hand the effects of declining rates of economic growth and of structural-adjustment policies on mortality if they occur take more time to become apparent. In addition there is little evidence to support the notion that public health interventions merely change the causes or delay the occurrence of child deaths rather than actually prevent them. (authors)

Premarital sexuality in urban Nigeria.

This study examines changes and differentials in premarital sexual activity in Nigerian cities. The incidence of sexual activity before marriage provides an indication of the extent of erosion in traditional practices and in family control of young womens behavior in urban areas. Pregnancy and childbirth outside of marriage and traditional family support systems have also become a matter of increasing concern in many African cities, especially in the public health community. The results suggest that premarital sexual behavior has become more common over time, as Nigerian society has undergone marked social change, and that premarital sexual behavior appears to be more common among women who come from nontraditional backgrounds. Relatively few premaritally sexually active women attempted to avoid pregnancy by using a contraceptive method, although premarital contraceptive use is more common in younger cohorts, and among more educated women. Much of the contraceptive use that occurs, however, is use of efficient methods.

Voluntary childlessness: A review of the evidence and implications

This paper reviews evidence on the incidence, correlates, and implications of voluntary childlessness in the United States. Overall, the evidence points toward the increasing prevalence of this phenomenon, with some analysts projecting that as much as 30 percent of recent cohorts of American women will remain permanently childless. These high rates are shown to be similar in magnitude to rates of childlessness projected for recent cohorts of women in several European countries with fertility patterns comparable to those of the United States. Explanations for the increasing prevalence of childlessness are also considered. The second half of this paper examines existing evidence on the correlates of voluntary childlessness. In this connection, special attention is paid to education, area of residence, labor force status, income, and geographic mobility. This section also explores the implications of increasing childlessness and selected ways to redistribute the cost of children.

Family and neighborhood sources of socioeconomic inequality in children’s achievement

We examined family and neighborhood sources of socioeconomic inequality in children’s reading and mathematics achievement using data from the 2000–2001 Los Angeles Family and Neighborhood Survey. To describe inequality in achievement scores, we used Gini coefficients and concentration indices and multilevel regression models. We found no inequality in children’s achievement by family income when other variables in the model were held constant. Mother’s reading scores and average neighborhood levels of income accounted for the largest proportion of inequality in children’s achievement. Neighborhood economic status appears to be strongly associated with children’s skills acquisition.

The Relationship Between Neighborhood Characteristics and Self-Rated Health for Adults With Chronic Conditions

OBJECTIVES We sought to determine whether the association between neighborhood characteristics and health differs for people with and without a chronic condition. METHODS We analyzed data from 2536 adults from the Los Angeles Family and Neighborhood Survey and evaluated the relationship between the presence of a chronic condition at the individual level, neighborhood socioeconomic status (SES), and self-rated health. We constructed multilevel models to evaluate the relationship between the neighborhood SES index and self-rated health for people with and without chronic conditions, after adjustment for other individual characteristics. RESULTS Having a chronic condition was associated with substantially poorer self-rated health among participants in a deprived area than among those in a more advantaged area. CONCLUSIONS Residence in a disadvantaged neighborhood may be associated with barriers to the management of a chronic condition. Further work is needed to identify the specific characteristics of disadvantaged areas associated with poorer self-rated health for adults with chronic conditions.