Olga Maslovskaya

Disentangling the complex association between female genital cutting and HIV among Kenyan women

Female genital cutting (FGC) is a widespread cultural practice in Africa and the Middle East, with a number of potential adverse health consequences for women. It was hypothesized by Kun (1997) that FGC increases the risk of HIV transmission through a number of different mechanisms. Using the 2003 data from the Kenyan Demographic and Health Survey (KDHS), this study investigates the potential association between FGC and HIV. The 2003 KDHS provides a unique opportunity to link the HIV test results with a large number of demographic, social, economic and behavioural characteristics of women, including womens FGC status. It is hypothesized that FGC increases the risk of HIV infection if HIV/AIDS is present in the community. A multilevel binary logistic regression technique is used to model the HIV status of women, controlling for selected individual characteristics of women and interaction effects. The results demonstrate evidence of a statistically significant association between FGC and HIV, after controlling for the hierarchical structure of the data, potential confounding factors and interaction effects. The results show that women who had had FGC and a younger or the same-age first-union partner have higher odds of being HIV positive than women with a younger or same-age first-union partner but without FGC; whereas women who had had FGC and an older first-union partner have lower odds of being HIV positive than women with an older first-union partner but without FGC. The findings suggest the behavioural pathway of association between FGC and HIV as well as an underlying complex interplay of bio-behavioural and social variables being important in disentangling the association between FGC and HIV.

Using prior wave information and paradata: Can they help to predict response outcomes and call sequence length in a longitudinal study?

Abstract In recent years the use of paradata for nonresponse investigations has risen significantly. One key question is how useful paradata, including call record data and interviewer observations, from the current and previous waves of a longitudinal study, as well as previous wave survey information, are in predicting response outcomes in a longitudinal context. This article aims to address this question. Final response outcomes and sequence length (the number of calls/visits to a household) are modelled both separately and jointly for a longitudinal study. Being able to predict length of call sequence and response can help to improve both adaptive and responsive survey designs and to increase efficiency and effectiveness of call scheduling. The article also identifies the impact of different methodological specifications of the models, for example different specifications of the response outcomes. Latent class analysis is used as one of the approaches to summarise call outcomes in sequences. To assess and compare the models in their ability to predict, indicators derived from classification tables, ROC (Receiver Operating Characteristic) curves, discrimination and prediction are proposed in addition to the standard approach of using the pseudo R2 value, which is not a sufficient indicator on its own. The study uses data from Understanding Society, a large-scale longitudinal survey in the UK. The findings indicate that basic models (including geographic, design and survey data from the previous wave), although commonly used in predicting and adjusting for nonresponse, do not predict the response outcome well. Conditioning on previous wave paradata, including call record data, interviewer observation data and indicators of change, improve the fit of the models slightly. A significant improvement can be observed when conditioning on the most recent call outcome, which may indicate that the nonresponse process predominantly depends on the most current circumstances of a sample unit.

The determinants of transitions into sheltered accommodation in later life in England and Wales

Background Population ageing is a global challenge and understanding the dynamics of living arrangements in later life and their implications for the design of appropriate housing and long-term care is a critical policy issue. Existing research has focused on the study of transitions into residential care in the UK. This paper investigates transitions into sheltered accommodation among older people in England and Wales between 1993 and 2008. Methods The study uses longitudinal data constructed from pooled observations across waves 2–18 of the British Household Panel Survey (BHPS) data, focusing on individuals aged 65 and over who lived in private housing at baseline and who were observed for two consecutive time points. A discrete-time logistic regression model was used to examine the association of transitioning into sheltered accommodation with a range of demographic, health and socioeconomic predictors. Results Demographic (age, region), socioeconomic factors (housing tenure, having a washing machine) and contact with health professionals (number of visits to the general practitioner, start in use of health visitor) were significant determinants of an older persons move into sheltered accommodation. Conclusions Transitions into sheltered accommodation are associated with a range of demographic and socioeconomic characteristics as well as service use but not with health. Such results indicate that this type of housing option may be accessible by individuals with relatively good health, but may be limited to those who are referred by gatekeepers. Policymakers could consider making such housing option available to everyone, as well as providing incentives for building lifecourse-sensitive housing in the future.

HIV awareness in China among women of reproductive age (1997–2005): a decomposition analysis

Summary HIV prevalence in China is less than one per cent, but the absolute number of people living with HIV/AIDS is large and growing. Given the limited scope of any potential cure for HIV, prevention plays a crucial role in controlling the epidemic. This paper examines the evolution of HIV awareness among women in China between 1997 and 2005. A regression decomposition analysis technique was used to disentangle the two main components driving a change in HIV awareness. The results show that HIV awareness has increased over time in China. The gaps between groups are narrowing over time and lower HIV awareness groups are catching up with the higher awareness groups. In 2005 education remained one of the main factors associated with HIV awareness, the other main factors being ethnicity, exposure to TV and newspapers. The increases in HIV awareness observed between 1997 and 2001 are similar between groups of women with different demographic characteristics, whereas between 2003 and 2005 increases are more pronounced among specific groups of women such as women from rural areas, women from Western parts of the country, women who belong to ethnic minorities and those with no education or with only primary education. The results suggest that the main driver of the observed change in HIV awareness over time in China is change in the environment such as in political commitment, interventions and campaigns rather than change in population structure.

A comparison of simple score and latent class approaches: application to HIV knowledge data in Chinese and multi-country contexts

Abstract Knowledge about different health-related attitudes, beliefs, and risks is of significant interest to scholars in different Social Science disciplines. Usually knowledge is collected in a form of multiple variables and then constructed as a composite indicator. The question any researcher working with knowledge-related variables faces is: what is the best way to measure and summarise different dimensions of health-related knowledge? The main goal of this paper is to evaluate and compare simple score and latent class approaches to measuring and summarising health-related knowledge using population data on HIV knowledge collected in five selected countries (China, India, Kenya, Malawi, and Ukraine). The advantages and shortcomings of both approaches (simple score and latent class approaches) to measuring and summarising health-related knowledge are evaluated and discussed.

Investigating call record data using sequence analysis to inform adaptive survey designs

ABSTRACT Researchers have become increasingly interested in better understanding the survey data collection process in interviewer-administered surveys. However, tools for analysing paradata capturing information about field processes, also called call record data, are still not yet fully explored. This paper introduces sequence analysis as a simple tool for investigating such data with the aim of better understanding and improving survey processes. A novel approach is to use sequence analysis within interviewers, which allows the identification of unusual interviewer calling behaviours, and may provide guidance on interviewer performance. Combining the technique with clustering, optimal matching and multidimensional scaling, the method offers a way of visualising, displaying and summarising complex call record data. The method is introduced to inform survey management and survey monitoring. The method is hence informative for adaptive survey designs and will help to identify unusual behaviour and outliers and to improve survey processes. Sequence analysis is applied to call record data from the UK Understanding Society survey. The findings inform further modelling of call record data to increase efficiency in call scheduling.

What determines an older person’s move into sheltered accommodation and residential care?

Studies addressing multiple morbid conditions in elderlypopulations usually focus on disease and physiological indicatorsrelevant for the medical care system. Few studies include bothmedical and fu ...The UK’s population is ageing, and understanding the dynamics of living arrangements in later life and the implications for the provision and funding of appropriate housing and long-term care is critical given the current economic climate which can have an adverse impact on state support for older people. This paper investigates the dynamics of living arrangements amongst people aged 65 years old and over between 1991 and 2008, focussing on the two key housing and care pathways in later life: moving into sheltered accommodation and moving into residential care. The empirical research examines the rates of moving into sheltered accommodation and institutional care and investigates the determinants and probabilities of these transitions in the UK. The paper employs all 18 waves of the British Household Panel Survey data (1991-2008) and uses a discrete-time logistic regression model in order to model the probability of entering sheltered accommodation and residential care. After reading this poster, participants will be able to associate specific factors with each of the two transitions in later life. For example age, health and marital status are significant determinants of a move into residential care, while the move into sheltered accommodation is also associated with housing tenure and education. After reading this poster, participants will be able to discuss the prevalence of each the two kinds of transition at different stages of the latter part of the life course, and to understand the crucial implications for the design of social care provision for older people in the future.This pilot project aimed to try something different - rekindle positive memories of swimming in people with dementia who enjoyed swimming throughout their lives, and involve them in active swimming again using a swimming club intervention. Club members were recruited from two residential aged care facilities in Queensland, Australia (n=25 recruited, n=18 commenced, n=11 (median age=88.4, IQR=12.3; 1 male) completed the intervention). The 12 week program consisted of two, 45 minute sessions per week held at a municipal pool, using a trained instructor and assistants. Measures, taken at baseline, Week 6, Week 9 and post intervention included psychosocial and physical assessments such as the Revised Memory and Behavior Problems Checklist, Psychological Well-Being in Cognitively Impaired Persons, Seniors Physical Performance Battery and bioelectric impedance analysis. Stakeholder focus groups determined the barriers and facilitators for the club. Three outcomes have been achieved: 1) the development of a dementia specific, evidence-based, aquatic exercise program. This valuable resource will ensure that the benefits will be maximized with tailored exercises for strength, agility, flexibility, balance, relaxation and stress reduction, 2) improved quality of life for members, with statistically significant improvements in psychological wellbeing (χ2 =8.66, p<0.05), BPSD expression (χ2=16.91, p=0.001) and staff distress (χ2=16.86, p=0.001) and 3) an informative website with instructional video clips and a manual to assist others in implementing and maintaining a Watermemories Swimming Club. This pilot project has provided strong evidence that aquatic exercise can produce positive physical, psychosocial and behavioral outcomes for people with dementia.