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Curtis S.,University of North Carolina at Chapel Hill | Sambisa W.,Carolina Population Center
International Perspectives on Sexual and Reproductive Health | Year: 2011

CONTEXT: Contraceptive discontinuation is a common event that may be associated with low motivation to avoid pregnancy. If this is the case, a substantial proportion of pregnancies that follow discontinuation will be reported as intended. METHODS: Demographic and Health Survey data from six countries (Bangladesh, the Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe) over the period 1999-2003 were used to explore the proportions of pregnancies women reported as intended or unintended following various contraceptive behaviors. Multivariate logistic regression analysis was used to examine the characteristics of women who reported births as intended when they followed contraceptive failure or discontinuation for reasons other than a desire for pregnancy. RESULTS: The proportion of births reported as intended following contraceptive failure ranged from 16% in Bangladesh to 54% in Kazakhstan, and the proportion reported as intended following discontinuation for reasons other than a desire for pregnancy ranged from 37% in Kenya to 51% in Kazakhstan. In at least half the countries, associations were found between selected women's characteristics and their reports that births following either contraceptive failure or discontinuation were intended: Factors that were positively associated were women's age and the time elapsed between contraceptive discontinuation and the index conception; factors that were negatively -associated were increasing number of living children and reporting method failure as opposed to method discontinuation. CONCLUSION: These findings suggest that underlying variation in the motivation to avoid pregnancy is an important factor in contraceptive discontinuation.

Siddiqi A.,Carolina Population Center
Journal of Epidemiology and Community Health | Year: 2010

Background: Cross-national comparisons allow the examination of the malleability of associations between race and health. Racial inequities in chronic conditions, indicators of health status and behavioural risk factors between two similar advanced capitalist countries were compared. It was hypothesised that racial inequities will be mitigated in Canada compared with the USA. Methods: Population-based, cross-sectional data from the 2002-3 Joint Canada-USA Survey of Health (JCUSH) with 4953 adult respondents from the USA and 3455 from Canada. Models adjusted for age, sex, foreign birth, marital status, health insurance, education, income and home ownership. Results: Compared with the USA, racial inequities in health were attenuated in Canada. In the USA, racial inequities in chronic diseases and fair or poor self-rated health were largely driven by inequities found among the native born. Strikingly, in Canada, however, there were few significant racial inequities and those occurred exclusively among the foreign born. Within strata of race and foreign birth, Canadians fared better, with both white people and non-white people reporting better health than their American counterparts. Foreign-born Canadians and Americans were more similar to each other in terms of health than native-born Canadians and Americans. Only among the native born did American white people and American non-white people have higher adjusted odds of hypertension, diabetes and obesity than Canadian white people and Canadian non-white people respectively. Self-rated health was worse for non-white Americans than non-white Canadians regardless of foreign birth. Conclusion: The influence of race on health is context dependent. There is no necessary link between race and a variety of health indicators.

News Article | November 8, 2016

Providing pregnant and postpartum women in sub-Saharan Africa with multiple HIV self-tests can make it more likely their male partners will be tested for HIV compared to a standard approach of distributing invitation cards for clinic-based testing, according to a randomized trial published in PLOS Medicine by Harsha Thirumurthy of the University of North Carolina at Chapel Hill, USA, and colleagues. Low use of testing services in sub-Saharan Africa, particularly by men, is one of the key barriers to meeting targets that UNAIDS has set for HIV prevention. Moreover, efforts to encourage pregnant women and postpartum women to refer their partners for testing and to test as a couple, in order to help prevent mother-to-child transmission of HIV, have had limited success. Between June and October 2015, Thirumurthy and colleagues enrolled in their study 600 women seeking pregnancy and postpartum care at three facilities in Kisumu County, Kenya. All women enrolled were 18-39 years old, had a partner that was not known to be HIV-positive, and agreed to participate. Half the women were given two oral fluid-based HIV self-test kits to take home, instructions on use, and were encouraged to give a test to their male partner or to test with their partner if they felt comfortable. The other 300 women were given invitation cards to give their partner for HIV testing at a clinic. Over the following three months, women were followed up to determine if their partner had self-tested or visited a clinic to test for HIV. In the group that received HIV self-tests, 90.8 percent of partners were reported to have tested within 3 months of enrollment in the study. In the comparison group, 51.7 percent of partners were reported to have visited a clinic for HIV testing. Based on these results, self-tests led to 39.1% more partner testing than the control (95% confidence interval 32.4% to 45.8%, P "The promising results from this study suggest that secondary distribution of self-tests warrants further consideration as countries develop HIV self-testing policies and seek new ways to promote partner and couples testing," the authors say. The study was funded by the International Initiative for Impact Evaluation (TW2-02-02). HT acknowledges support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD061605). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist. Masters SH, Agot K, Obonyo B, Napierala Mavedzenge S, Maman S, Thirumurthy H (2016) Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial. PLoS Med 13(11): e1002166. doi:10.1371/journal.pmed.1002166 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

Buckley J.P.,University of North Carolina at Chapel Hill | Palmieri R.T.,University of North Carolina at Chapel Hill | Matuszewski J.M.,University of North Carolina at Chapel Hill | Herring A.H.,University of North Carolina at Chapel Hill | And 5 more authors.
Journal of Exposure Science and Environmental Epidemiology | Year: 2012

Human phthalate exposure is ubiquitous, but little is known regarding predictors of urinary phthalate levels. To explore this, 50 pregnant women aged 18-38 years completed two questionnaires on potential phthalate exposures and provided a first morning void. Urine samples were analyzed for 12 phthalate metabolites. Associations with questionnaire items were evaluated via Wilcoxon tests and t-tests, and r-squared values were calculated in multiple linear regression models. Few measured factors were statistically significantly associated with phthalate levels. Individuals who used nail polish had higher levels of mono-butyl phthalate (P = 0.048) than non-users. Mono-benzyl phthalate levels were higher among women who used eye makeup (P = 0.034) or used makeup on a regular basis (P = 0.004). Women who used cologne or perfume had higher levels of di-(2-ethylhexyl) phthalate metabolites. Household products, home flooring or paneling, and other personal care products were also associated with urinary phthalates. The proportion of variance in metabolite concentrations explained by questionnaire items ranged between 0.31 for mono-ethyl phthalate and 0.42 for mono-n-methyl phthalate. Although personal care product use may be an important predictor of urinary phthalate levels, most of the variability in phthalate exposure was not captured by our relatively comprehensive set of questionnaire items. © 2012 Nature America, Inc. All rights reserved.

Saville B.R.,Vanderbilt University | Herring A.H.,University of North Carolina at Chapel Hill | Herring A.H.,Carolina Population Center | Koch G.G.,University of North Carolina at Chapel Hill
Statistics in Medicine | Year: 2010

We consider regulatory clinical trials that require a prespecified method for the comparison of two treatments for chronic diseases (e.g. Chronic Obstructive Pulmonary Disease) in which patients suffer deterioration in a longitudinal process until death occurs. We define a composite endpoint structure that encompasses both the longitudinal data for deterioration and the time-to-event data for death, and use multivariate time-to-event methods to assess treatment differences on both data structures simultaneously, without a need for parametric assumptions or modeling. Our method is straightforward to implement, and simulations show that the method has robust power in situations in which incomplete data could lead to lower than expected power for either the longitudinal or survival data. We illustrate the method on data from a study of chronic lung disease. Copyright © 2009 John Wiley & Sons, Ltd.

Lenhart P.M.,University of North Carolina at Chapel Hill | Nguyen T.,Harvard University | Wise A.,University of North Carolina at Chapel Hill | Caron K.M.,University of North Carolina at Chapel Hill | And 3 more authors.
American Journal of Perinatology | Year: 2014

Objective Reduced maternal plasma levels of the peptide vasodilator adrenomedullin have been associated with adverse pregnancy outcomes. We measured the extent to which genetic polymorphisms in the adrenomedullin signaling pathway are associated with birth weight, glycemic regulation, and preeclampsia risk. Study Design We genotyped 1,353 women in the Pregnancy, Infection, and Nutrition Postpartum Study for 37 ancestry-informative markers and for single-nucleotide polymorphisms in adrenomedullin (ADM), complement factor H variant (CFH), and calcitonin receptor-like receptor (CALCRL). We used linear and logistic regression to model the association between genotype and birth weight, glucose loading test (GLT) results, preeclampsia, and gestational diabetes (GDM). All models were adjusted for pregravid body mass index, maternal age, and probability of Yoruban ancestry. p values of < 0.05 were considered statistically significant. Results Among Caucasian women, ADM rs57153895, a proxy for rs11042725, was associated with reduced birth weight z-score. Among African-American women, ADM rs57153895 was associated with increased birth weight z-score. Two CALCRL variants were associated with GDM risk. CFH rs1061170 was associated with higher GLT results and increased preeclampsia risk. Conclusion Consistent with studies of plasma adrenomedullin and adverse pregnancy outcomes, we found associations between variants in the adrenomedullin signaling pathway and birth weight, glycemic regulation, and preeclampsia. Copyright © 2014 by Thieme Medical Publishers, Inc.

Mehta U.J.,University of North Carolina at Chapel Hill | Siega-Riz A.M.,Carolina Population Center | Herring A.H.,Carolina Population Center | Adair L.S.,Carolina Population Center | Bentley M.E.,University of North Carolina at Chapel Hill
Journal of the Academy of Nutrition and Dietetics | Year: 2012

Objective: To determine whether women who entered pregnancy overweight or obese were less likely to follow American Academy of Pediatrics guidelines for introducing complementary foods to infants after 4 months of age. In addition, we explored whether psychological factors accounted for any of the effect of pregravid body mass index on age of complementary food introduction. Design: A prospective cohort study from 2001 to 2005 that recruited pregnant women between 15 to 20 gestational weeks with follow-up through 12 months postpartum from University of North Carolina hospitals (n=550). Statistical analysis: Multinomial models were used to estimate relative risk ratios. The outcome was age of complementary food introduction, categorized as younger than 4 months of age, 4 to 6 months, and 6 months or later (referent). Maternal body mass index was categorized as underweight (<18.5), normal weight (18.5 to 24.9), and overweight/obese (≥25). A series of regression analyses tested mediation by psychological factors measured during pregnancy (depressive symptoms, stress, and anxiety). Results: More than a third of the study population (35.7% of 550) entered pregnancy overweight/obese. The majority of participants (75.3%) introduced foods to their infants between 4 and 6 months of age. Compared with normal-weight women, those who were overweight/obese before pregnancy were more likely (relative risk ratios=2.22 [95% CI 1.23 to 4.01]) to introduce complementary foods before the infant was 4 months old, adjusting for race, education, and poverty status. Depressive symptoms, stress, and anxiety did not account for any of the effect of pregravid overweight/obesity on early food introduction. Conclusions: The results suggest that overweight and obese women are more likely to introduce complementary foods early and that psychological factors during pregnancy do not influence this relationship. Future studies need to explore why overweight/obese women are less likely to meet the American Academy of Pediatrics recommendations for the introduction of complementary food. © 2012 Academy of Nutrition and Dietetics.

Halpern C.T.,University of North Carolina at Chapel Hill | Halpern C.T.,Carolina Population Center | Whitsel E.A.,UNC CH | Wagner B.,UNC CH | And 3 more authors.
Psychoneuroendocrinology | Year: 2012

Objectives: Longitudinal examinations of associations between daily stress, diurnal cortisol concentrations, and physiological parameters in population-based studies are needed. This study evaluates issues related to consent, collection, and protocol adherence for a low-burden saliva collection protocol. Methods: In the 2007 pretest (n=193) for Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) a three-sample, one-day, unsupervised saliva collection protocol was pilot tested. Embedded experiments allowed for examination of adherence and effects of monetary incentives. Results: Although most (97%) study participants consented to collection, only about 80% actually mailed back samples. Use of a time-stamping TrackCap allowed comparison of self-reported and stamp-recorded collection times. Of returned samples, self-report of collection time was missing for about a quarter, and only about one in three respondents (of those for whom adherence was calculable) fully adhered to the collection protocol, indicating significant potential for bias. Consent, return, and protocol adherence were unrelated to key sociodemographic characteristics, and did not improve with higher monetary incentives or knowledge of being monitored. Conclusions: Despite the relatively low-burden collection protocol and use of multiple strategies thought to improve collection and protocol adherence, response and adherence were poor, leading to a decision to drop cortisol measurement from the Wave IV Add Health protocol. Large field studies should carefully evaluate the feasibility of collection and protocol adherence for unsupervised collection protocols before implementing costly, and potentially unusable, biological measurements. © 2011 Elsevier Ltd.

Thompson A.L.,Carolina Population Center | Adair L.S.,Carolina Population Center | Bentley M.E.,Carolina Population Center | Bentley M.E.,University of North Carolina at Chapel Hill
Pediatrics | Year: 2013

OBJECTIVE: This study examines the development of television (TV) behaviors across the first 18 months of life and identifies maternal and infant predictors of infant TV exposure. METHODS: We used longitudinal TV exposure, maternal sociodemographic, and infant temperament data from 217 African-American mother-infant pairs participating in the Infant Care and Risk of Obesity Study. Longitudinal logistic models and ordered regression models with clustering for repeated measures across subjects adjusted for infant gender and visit were used to assess maternal and infant predictors of TV exposure and to test whether infants with both maternal and infant risk factors had higher odds of more detrimental TV exposure. RESULTS: Infants as young as 3 months old were exposed to an average of 2.6 hours of TV and/or videos daily, and nearly 40% of infants were exposed to .3 hours of TV daily by 12 months of age. Maternal TV viewing and maternal obesity and infant activity, fussiness, and crying were associated with greater infant TV exposure, whereas maternal education and infant activity were associated with having the TV on during most meals. Infants perceived as being more active or fussier had higher TV exposure, particularly if their mothers also had risk factors for higher TV exposure. Copyright © 2013 by the American Academy of Pediatrics.

Popkin B.M.,Carolina Population Center | Popkin B.M.,The Interdisciplinary Center
Health Affairs | Year: 2010

Nationally representative surveys of food intake in U.S. children show large increases in snacking between the 1989-91 to 1994-98 and 1994-98 to 2003-06 periods. Childhood snacking trends are moving toward three snacks per day, and more than 27 percent of children's daily calories are coming from snacks. The largest increases have been in salty snacks and candy. Desserts and sweetened beverages remain the major sources of calories from snacks. © 2010 Project HOPE-The People-to-People Health Foundation, Inc.

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