April Greek

Concurrent Partnerships, Acute Infection and HIV Epidemic Dynamics Among Young Adults in Zimbabwe

This paper explores the roles of acute infection and concurrent partnerships in HIV transmission dynamics among young adults in Zimbabwe using realistic representations of the partnership network and all published estimates of stage-specific infectivity. We use dynamic exponential random graph models to estimate partnership network parameters from an empirical study of sexual behavior and drive a stochastic simulation of HIV transmission through this dynamic network. Our simulated networks match observed frequencies and durations of short- and long-term partnerships, with concurrency patterns specific to gender and partnership type. Our findings suggest that, at current behavior levels, the epidemic cannot be sustained in this population without both concurrency and acute infection; removing either brings transmission below the threshold for persistence. With both present, we estimate 20–25% of transmissions stem from acute-stage infections, 30–50% from chronic-stage, and 30–45% from AIDS-stage. The impact of acute infection is strongly moderated by concurrency. Reducing this impact by reducing concurrency could potentially end the current HIV epidemic in Zimbabwe.

A Longitudinal Study of the Effects of the Birth of a Sibling during the First 6 Years of Life.

We investigate links among the birth of a new infant, changes in the family environment, changes in the relationship between the mother and an older child, and changes in an older childs cognitive and socioemotional development. We hypothesize that the effects of sibling birth are mediated by the associated changes in the family environment and changes in the interaction patterns of the family members. Data from the National Longitudinal Survey of Youth are used on a cohort of nonminority children between 6 and 23 months old. The birth of a sibling results in significant changes in the family environment. At the same time, positive interactions with the older child diminish, especially if the birth interval is short, and the mother increasingly adopts controlling parenting styles. These changes result in lower levels of verbal development. About 2.5 years after the sibling birth, negative effects are detected on achievement and on socioemotional adjustment. Some positive effects of sibling birth also are noted on verbal ability and peer relations. Key Words: achievement, preschool children, sibling, socioemotional problems. JEANNE BROOKS-GUNN Columbia University* This study investigates the changes in the level of cognitive and socioemotional development after the birth of a sibling in a national cohort of infants and toddlers over a 4-year period. Previous studies relied on detailed data obtained from interviews and observations of small samples. These studies examined the prenatal and postnatal patterns of interaction among family members (Dunn & Kendrick, 1980; Dunn, Kendrick, & MacNamee, 1981; Dunn & Munn, 1985; Kendrick & Dunn, 1982; Stewart, 1990; Stewart, Mobley, Van Tuyl, & Salvador, 1987). They contribute to our understanding of the birth of a sibling as a process of adjustment in the family system that leads to some positive and some negative, outcomes for the older sibling. Generally, the quality and intensity of maternal interactions with the firstborn decrease after the birth of a sibling, and some specific behavioral and emotional problems-such as regression, anxiety, and aggression-in the older child are observed (Dunn & Kendrick, 1980; Stewart, 1990; Stewart et al., 1987). Sibling rivalry and the resulting behavior problems also have been studied (DelGiudice, 1986; Dunn & Munn, 1986; Jalongo & Renck, 1985; Pietropinto, 1985; Stewart et al., 1987). Most of these studies point to the importance of positive parenting styles in attenuating the sibling rivalry (Dunn & Munn, 1986; Gottlieb & Mendelson, 1990). They also show that the effects of sibling birth depend on age (Gibbs, Teti, & Bond, 1987; Stewart et al., 1987) and the sex of both siblings (Austin, Summers, & Leffler, 1987; Kendrick & Dunn, 1982). These studies of family processes after the birth of the second child are difficult to generalize for two reasons. First, the small samples of fewer than 100 families, often of middle-class origin and with two biological parents, may not be representative of the general population. Second, some of these study samples do not include families who did not experience the birth of a new baby. Hence, maturational changes cannot be distinguished from the changes attributed to the sibling birth (Stewart et al., 1987). Sociological studies that use large and diverse samples generally focus on the correlates of sibling group size, birth order, and birth spacing, rather than family changes after the birth of a sibling. These studies have three major shortcomings. First, sibling group size effects, holding constant the birth order, are equivalent to a study of aggregate outcomes of experiencing a number of births of siblings. This is a problem because the effects of the birth of a sibling cannot be distinguished from the effects of family size. Second, due to the limitations of cross-sectional data, neither the processes that account for sibling group size differentials, nor the factors that account for the differences in sibling group size effects (such as the age of the child at the time of sibling birth) can be fully studied. …

Young mothers' time spent at work and time spent caring for children

The association between the time a mother spends at work and in different child care activities is investigated, using data from the 1981 National Longitudinal Survey of Youth (NLSY). The mothers who worked on the index day spent almost one hour less time in physical care, one-half hour less time in interactive care, and over two hours less time in passive supervision of their children. The effects of a set of predictors on time use at work, time use in physical care, interactive care, and passive supervision of children were estimated using a covariance structure model. When the effects of these predictors are controlled, the number of hours at work predicts: (a) a small reduction in time spent in interactive care, and (b) larger reductions in time spent in physical care and passive supervision.

Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers.

OBJECTIVE Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥ 30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. METHOD Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. RESULTS 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screening tests (77%), patient concerns about missing cancer (62%), and liability (52%). CONCLUSION Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals.

Predicting 10-Year Alcohol Use Trajectories Among Men Age 50 Years and Older

OBJECTIVE To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories. DESIGN Longitudinal data were used to derive a semiparametric group-based model. PARTICIPANTS Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview. MEASUREMENTS Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease. RESULTS The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6% of cohort), increasing drinkers (5.5%), decreasing drinkers (7.6%), consistent at-risk drinkers (15.6%), and consistent moderate drinkers (30.7%). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95% confidence intervals (95% CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95% CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95% CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95% CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95% CI: 0.39-0.76). CONCLUSION Only 30.7% of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.

Anogenital warts knowledge and counseling practices of US clinicians: results from a national survey.

Objectives: To examine messages US clinicians use when counseling patients diagnosed with anogenital warts. Study Design: In mid-2004, we conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts. Results: After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (>95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (≥85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients’ psychosocial issues, and inadequate reimbursement. Conclusions: Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.

Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline.

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow‐up.

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval.

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998–2008. The best-fitting model based on the drinks per day data had four trajectories labeled as “Increasing Drinkers” (5.3% of sample), “Decreasing Drinkers” (5.9%), “Stable Drinkers” (24.2%), and “Non/Infrequent Drinkers” (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Testing conditions influence the race gap in cognition and achievement estimated by household survey data

Abstract The present study investigates the hypothesis that the race gap estimated using achievement test scores administered during household surveys may partly be accounted for by measurable testing conditions such as interviewer characteristics, interviewer–child interactions, and the testing environment in the home. Using the child assessments of the National Longitudinal Survey of Youth (NLSY) in 1992, the findings clearly indicate that the factors related to testing conditions in the home have significant effects on the test score gap between African American and White children of 6–9 years of age. The agreement between the race of the interviewer and the race of the child especially showed the positive effects on child test scores.

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: a pilot study in U.S. Federally Qualified Health Centers.

INTRODUCTION In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations. METHODS Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and providers belief about whether their screening and management procedures would change for women who were vaccinated. RESULTS 93% of providers recommended the HPV vaccine, most frequently for females aged 13-26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%). CONCLUSION Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9-12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.