Isaac W. Eberstein

Relationship dynamics ethnicity and condom use among low-income women.

CONTEXT Womens protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use. METHODS Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms. RESULTS Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently. CONCLUSIONS HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Infant mortality by cause of death: main and interaction effects.

We examine infant mortality among the 1980–1982 live birth cohorts in the state of Florida, specific to five categories of underlying cause of death: infections, perinatal conditions, delivery complications, congenital malformations, and sudden infant death syndrome. The gross and net effects of eight categorical and continuous independent variables, along with 11 first-order interactions, are examined with microlevel data through the use of multinomial logit regression. Findings suggest the complexity of variable effects by cause of death and indicate the simultaneous importance of biological and social factors. It is important that the pattern of interactions suggests an overall dependence of infant life chances on social circumstances. It also suggests that these effects are attenuated for some variables and causes of death at lower birth weights, probably due to advances in health care organization, access, and technology.

Demographic research on infant mortality

I present an overview of the current status and recent trends in social-demographic research on infant mortality in the United States. Following from a fundamental interest in social differentials, recent research has come to emphasize the diverse linkages between social inequality and mortality. Research increasingly uses multilevel perspectives, combining background as well as proximate variables. Coupled with the availability of new individual-level data sets linking information from diverse sources, researchers are able to give increasing attention to the study of cause of death from interdisciplinary perspectives. The analysis of racial/ethnic infant mortality differentials is an example of these trends.

The association between substance use condom use and sexual risk among low-income women.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

Factors associated with use of the female condom.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

CONTEXT Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of womens background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS Both womens individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and womens control over economic decision-making ensure greater protection against HIV infection.

Racial differences in infant mortality by cause of death: The impact of birth weight and maternal age

This research examines racial disparities in infant mortality, overall and separately according to cause of death. Using linked birth and death records for the 1975 cohort of live births in Florida, racial differences are initially described and then explained statistically as a product of the distribution of births by birth weight and maternal age. The impact of birth weight is more pronounced than is the effect of maternal age. The analysis suggests the potential utility of examining infant mortality separately by cause of death. Based on the findings, we argue for systematic research focused on factors affecting birth weight.

Age at first birth, parity, and post-reproductive mortality among white and black women in the US, 1982-2002.

We investigate the relationship between the timing of first birth, parity, and womens risk of post-reproductive mortality over twenty-one years (1982-2002), among representative samples of black and white women in the United States. Data are taken from the National Longitudinal Survey of Mature Women. We find early childbearing to be associated with higher mortality among whites, while later childbearing is associated with higher mortality among blacks. The effect of age at first birth on white womens mortality is explained by background and mediating social, economic, and health related factors, but this effect remains robust for black women. In addition, childless white women have a higher risk of post-reproductive mortality than those with 2-3 children. High parity (6+ children) has a significant protective effect for blacks, though the effect is reduced with age. A similar protective effect of high parity becomes apparent among whites only after controlling for background and mediating characteristics. Findings are interpreted in light of the weathering hypothesis and from a life course framework that views womens fertility as adaptive to particular social and historical contexts.

Ethnic Differences in Sexual Decisions and Sexual Behavior

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Causes of death and mortality crossovers by race.

Abstract The phenomenon of “mortality crossovers,” the intersection of age curves of mortality at older ages, has been observed in comparisons of various populations for some time. Some researchers have argued that crossovers are an artifact of deficient reporting of age that is greater for some populations than others. Other researchers attribute crossovers to selective processes by age that vary by group. We use mortality data from the National Center for Health Statistics for the U.S. at ages 55 and over, supplemented by comparable data from matched records of the National Health Interview Survey and National Death Index, to reexamine causes of death linked to mortality crossovers for Whites and Blacks in the U.S. Findings portray a more elaborate set of influences of causes of death than has been discovered heretofore; however, the major finding is that the mortality crossover for Whites and Blacks in the U. S. is real and, although observed for several causes of death, operates principally through varying trajectories of heart disease mortality.