Brian Goesling

Accounting for the Recent Decline in Global Income Inequality1

Following nearly two centuries of growth, global income inequality declined in the last decades of the 20th century. To determine the causes of that historic decline, we focus on income inequality across nations and find that the major equalizing force is faster‐than‐world‐average income growth in China and South Asia, industrializing regions where 40% of the world’s people live. Apparently what matters most about economic globalization thus far is its role in the spread of industrialization throughout populous poor regions of the world. If so, then globalization most likely has reduced global income inequality. This decline is anticipated to continue over the next few decades, first, because of the continued industrialization of poor regions and, second, because most of the growth in the world’s working‐age population will occur in poor regions.

What Do We Know About the Link Between Marriage and Health

This special journal issue presents nine new studies on the relationship between marriage and health among African Americans. It discusses health disparities between African Americans and other racial and ethnic groups, offers an overview of African American marriage rates, and presents evidence for the marriage-health link in this population.

The Rising Significance of Education for Health

Research on inequality in America shows evidence of a growing social and economic divide between college graduates and people without college degrees. This article examines whether disparities in health between education groups have also recently increased. Pooled cross-sectional regression analyses of data from the National Health Interview Survey (NHIS) show that educational disparities in self-reported health status increased from 1982 to 2004 among older adults but held relatively steady or narrowed among younger adults. Sensitivity analyses show that the trends do not totally or primarily reflect change in the demographic composition of education groups. The trend of increasing disparities among older adults might reflect large and growing educational disparities in economic resources, health-promoting behaviors, or the use of health services and medical technology.

High-Stakes Systematic Reviews

Background: Systematic reviews help policy makers and practitioners make sense of research findings in a particular program, policy, or practice area by synthesizing evidence across multiple studies. However, the link between review findings and practical decision-making is rarely one-to-one. Policy makers and practitioners may use systematic review findings to help guide their decisions, but they may also rely on other information sources or personal judgment. Objectives: To describe a recent effort by the U.S. federal government to narrow the gap between review findings and practical decision-making. The Teen Pregnancy Prevention (TPP) Evidence Review was launched by the U.S. Department of Health and Human Services (HHS) in 2009 as a systematic review of the TPP literature. HHS has used the review findings to determine eligibility for federal funding for TPP programs, marking one of the first attempts to directly link systematic review findings with federal funding decisions. Conclusions: The high stakes attached to the review findings required special considerations in designing and conducting the review. To provide a sound basis for federal funding decisions, the review had to meet accepted methodological standards. However, the review team also had to account for practical constraints of the funding legislation and needs of the federal agencies responsible for administering the grant programs. The review team also had to develop a transparent process for both releasing the review findings and updating them over time. Prospective review authors and sponsors must recognize both the strengths and limitations of this approach before applying it in other areas.

A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers

BACKGROUND: Most interventions designed to reduce teen pregnancy rates have not focused on pregnant and/or parenting adolescents. Therefore, a large randomized controlled trial was conducted regarding a motivational interviewing program entitled Teen Options to Prevent Pregnancy in a low‐income sample of adolescent mothers. This program recommended monthly sessions between a participant and a registered nurse over 18 months. This program also featured facilitated birth control access through transportation assistance and a part‐time contraceptive clinic. OBJECTIVE: The impact of this program on rapid repeat pregnancies at 18 months after enrollment was evaluated. STUDY DESIGN: Five hundred ninety‐eight adolescent females were enrolled from 7 obstetrics‐gynecology clinics and 5 postpartum units of a large hospital system in a Midwestern city. Each participant was enrolled at least 28 weeks pregnant or less than 9 weeks postpartum. Each participant was randomized to either the Teen Options to Prevent Pregnancy intervention or a usual‐care control condition. Intervention participants averaged 4.5 hours of assistance. Participants were contacted by blinded research staff at 6 and 18 months to complete self‐report surveys. Differences in outcomes between the intervention and control groups were assessed using ordinary least‐squares regression. RESULTS: There was an 18.1% absolute reduction in self‐reported repeat pregnancy in the intervention group relative to the control group (20.5% vs 38.6%%; P < .001). There was a 13.7% absolute increase in self‐reported long‐acting reversible contraception use in the intervention group relative to the control group (40.2% vs 26.5%, P = .002). There was no evidence of harmful effects of the intervention on sexual risk behaviors, such as having sexual intercourse without a condom or greater number of partners. CONCLUSION: The Teen Options to Prevent Pregnancy program represents one of the few evidence‐based interventions to reduce rapid repeat teen pregnancy. This relatively brief intervention may be a viable alternative to more time‐intensive programs that adolescent mothers may be unable or unwilling to receive.

Impacts of an Enhanced Family Health and Sexuality Module of the HealthTeacher Middle School Curriculum: A Cluster Randomized Trial

OBJECTIVES To evaluate the impacts of an enhanced version of the Family Life and Sexuality Module of the HealthTeacher middle school curriculum. METHODS We conducted a cluster randomized trial of Chicago, Illinois, middle schools. We randomly assigned schools to a treatment group that received the intervention during the 2010-2011 school year or a control group that did not. The primary analysis sample included 595 students (7 schools) in the treatment group and 594 students (7 schools) in the control group. RESULTS Students in the treatment schools reported greater exposure to information on reproductive health topics such as sexually transmitted infections (STIs; 78% vs 60%; P < .01), abstinence (64% vs 37%; P < .01), and birth control (45% vs 29%; P < .01). They also reported higher average scores on an index of knowledge of contraceptive methods and STI transmission (0.5 vs 0.3; P = .02). We found no statistically significant differences in rates of sexual intercourse (12% vs 12%; P = .99), oral sex (12% vs 9%; P = .18), or other intermediate outcomes. CONCLUSIONS The program had modest effects when tested among Chicago middle school students.