Socorro Gultiano

Cohort Profile: The Cebu Longitudinal Health and Nutrition Survey

The Cebu Longitudinal Health and Nutrition Survey (CLHNS) was originally conceptualized as an interdisciplinary study of infant-feeding patterns, particularly the overall sequencing of feeding events (milks and complementary foods), the factors affecting feeding decisions and how feeding patterns affect the infant, mother and household. The idea was to study these topics within as natural a setting as possible and to analyse how infant-feeding decisions interacted with social, economic and environmental factors to affect health, nutritional, demographic and economic outcomes. The study was subsequently expanded to cover a wide range of maternal and child health and demographic issues that could be well studied using a prospective, community-based sample. The study was initially the product of collaboration among researchers at the Carolina Population Center at the University of North Carolina at Chapel Hill (led by B.M.P. with J.S.A. and D.K.G.), The Office of Population Studies Foundation at the University of San Carlos in Cebu, Philippines (led by the late Director Wilhelm Fleiger) and the Nutrition Center of the Philippines (led by Florentino Solon). L.S.A. took the lead for follow-up surveys beginning in 1990. Later, the study team was expanded to include researchers presently at the Northwestern University (C.W.K. and T.M.D.) and Johns Hopkins University (M.J.H.). The study was initiated with cooperation and approval from the Cebu Department of Health. The CLHNS website includes a full list of investigators and their affiliations. The CLHNS was one of the first large-scale, population-based surveys designed with a conceptual framework in mind. The guiding framework was adapted from Mosley and Chen’s health determinants model, which posits that underlying community-, householdand individual-level variables affect a set of proximate health behaviours which, in turn, influence health outcomes such as growth and infectious disease morbidity and mortality. The study was designed by a highly interdisciplinary group of economists, sociologists, nutritionists, demographers and physicians. The CLHNS has been funded by a large number of government and non-government organizations (listed in the Funding section).

Early Childhood Development Through an Integrated Program: Evidence from the Philippines

This brief summarizes the results of a gender impact evaluation study, entitled Early childhood development through an integrated program : evidence from the Philippines, conducted in 1999 in Philippines. The study observed the impact of early childhood development (ECD) to control a variety of observed characteristics measured at the municipality, barangay, household, and child level and unobserved fixed characteristics, with differential impacts by age of children and duration of exposure to the program on the child level. For children exposed to the program there is a statistically significant positive impact on outcomes related to child cognitive, social, motor skills, language development, and short term nutritional status. The program impacts tend to increase with duration. Younger children experienced greater impacts. Funding for the study derived from the National Institutes of Health or Fogarty International Center, National Institute of Child Health and Human Development (NICHD), Office of Behavioral and Social Science Research, the Global Development Network, the Department of Social Welfare and Development of the Government of the Philippines, the World Bank Research Support Budget, and NICHD postdoctoral training fellowship at the University of Michigan.

Family Background, Service Providers, and Early Childhood Development in the Philippines: Proxies and Interactions

We examine the importance of family background for early childhood development (ECD) using data collected in 2001 from 3,556 children ages 0–36 months in three regions of the Philippines. We focus on four main research questions: (1) Are associations of family background with ECD in part proxying for health and ECD‐related programs? (2) Are associations of family background with ECD biased due to omission of unobserved community characteristics that may be related to placement of health and ECD‐related services? (3) Are there important interactions between family background and health and ECD‐related programs in their effect on ECD? (4) Are there important interactions among the components of family background? Physical assets and human assets have a number of important positive associations with ECD. These include the positive relations between physical assets and the anthropometrics and hemoglobin levels of children, as well as lower occurrence of worms. Each parent’s schooling and height also have notable positive effects on these outcomes and the motor and language skills of children. The failure to account for community characteristics is related to often substantial bias in the estimated effect of family background on ECD. We do not find strong evidence that interactions are important.

Associations Between Witnessing Parental Domestic Violence and Experiencing Depressive Symptoms in Filipino Adolescents

OBJECTIVES We examined the association between 2 important public health problems in the developing world: parental domestic violence and depressive symptoms during adolescence. METHODS Data on depressive symptoms and witnessing of domestic violence were obtained during private face-to-face interviews conducted in 2002 with 2051 Filipino adolescents 17-19 years of age. RESULTS Symptoms of depression were common; 11% of young men and 19% of young women reported wishing that they were dead occasionally or most of the time, and nearly half of all respondents recalled parental domestic violence. Female adolescents had significantly higher scores than male adolescents on a 12-item index of depressive symptoms. Both male and female adolescents who had witnessed parental domestic violence reported more depressive symptoms. CONCLUSIONS Filipino adolescents who have witnessed parental domestic violence are significantly more likely to report depressive symptoms.

Before first sex: gender differences in emotional relationships and physical behaviors among adolescents in the Philippines.

CONTEXT Early age at first sex has been identified as a risk factor for unplanned pregnancy and HIV infection. However, the emotional relationships and physical behaviors that precede first intercourse, and how they differ by sex, also may provide important cues about how to prevent sexual risk behavior. METHODS The precoital activities of 2,051 adolescents aged 17-19 in Cebu, Philippines, are examined using 1998-2000 and 2002 data from the Cebu Longitudinal Health and Nutrition Survey. The timing and tempo of emotional relationships and physical behaviors for males and females are described. Cox proportional hazards models are used to identify the characteristics associated with age at first sex. RESULTS Males engage in precoital physical behaviors and first sex at younger ages than females. Although the standard order in which the two sexes engage in emotional relationships for the first time is the same, males progress through the sequence more quickly than females. After adolescents have progressed through the sequence of emotional relationships, there is a gap of a least a year before they begin to have sex. In the multivariate analysis, rapid progression through the sequence of emotional relationships was associated with initiating sex at a younger age for females (hazard ratio, 1.5), but not for males. CONCLUSION The period between first date and first sex experienced by both males and females provides an opportunity to ensure that adolescents have access to the information and services that will allow them to make informed choices about sexual behavior.

Effect of childbearing on Filipino women's work hours and earnings

Abstract. The effects of childbearing and work sector on womens hours and earnings in the 8 years following an index pregnancy were examined in a cohort of more than 2,000 women in the Cebu Longitudinal Health and Nutrition Survey. Change in cash earnings and hours worked were each modeled jointly with sector of labor force participation using an estimation strategy that deals with endogeneity of childbearing decisions and selectivity into sector of work. Two or more additional children born in the 8 year interval significantly reduced womens earnings, while having an additional child under 2 years of age in 1991 reduced hours worked.

20-Year Trends in Filipino Women's Weight Reflect Substantial Secular and Age Effects

Increasing obesity in low- and middle-income countries is well documented in cross-sectional studies. However, few longitudinal studies identify factors that influence individual weight gain patterns over time in relation to the major social and economic changes that now characterize these settings. This study uses data from adult Filipino women participating in the Cebu Longitudinal Health and Nutrition Survey from 1983 to 2005. A sample of 3005 women contributed 1-8 observations each. Longitudinal mixed effects models identified how age and secular weight trends related to underlying effects of urbanization and changing household socioeconomic status (SES) and to proximate individual effects of reproductive history, diet, and occupational physical activity. The 23-y secular trend in weight amounted to nearly 10 kg. Younger women gained more weight than older women (12.4 kg in those < 20 y old in 1983 vs. 4.9 kg in those > 35 y). Periods of more rapid weight gain corresponded to periods of rapid increase in SES and urbanization. Weight was positively related to energy intake, percentage of calories from protein, and more sedentary occupations, but negatively related to months pregnant and lactating and postmenopausal status. These effects all varied with age and over time. The trends contributed to a 6-fold increase in prevalence of overweight and an increasing number of women who have or are likely to develop obesity-related metabolic diseases. The trends are highly relevant for health policy and preventive health measures in the Philippines and other countries now facing the dual burden of over- and undernutrition.

The context of condom use among young adults in the Philippines: Implications for HIV prevention

We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which include societal and individual barriers to using condoms. The findings may provide insight for similar settings in which religion has a strong influence on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints and promote healthy sexuality in young adults is essential.

Implications of Changes in Family Structure and Composition for the Psychological Well-Being of Filipino Women in Middle and Later Years.

The health implications of multigenerational coresidence for older adults is a well-researched topic in the aging literature. Much less is known of its impact for women in midlife. We used data from the Cebu Longitudinal Health and Nutrition Study (2002, 2005, 2007, and 2012) to study the influence of transitions in multigenerational household composition on depressive symptoms for women in midlife transitioning into old age. Our initial analysis showed little effect when we use the conventional classification of nuclear versus extended family and transition in and out of extended family. When we described shifts in the family environment by compositional changes, that is, change in the presence and absence of particular family members, we found significant association between depressive symptoms and two types of role transitions: the loss of a spouse in the household and the entry and exit of grandchildren in the household.