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Seltzer J.A.,University of California at Los Angeles | Friedman E.M.,Harvard Center for Population and Development Studies
Journals of Gerontology - Series B Psychological Sciences and Social Sciences | Year: 2014

Objectives. Coresidence is one way that middle-aged offspring assist vulnerable, aging parents. This study investigated which characteristics of widowed mothers and adult children predict coresidence. When coresidence occurred, the analysis explored how individual children's characteristics were associated with their coresidence with the mother. Method. Survey data from adults 53-54 years old in 1993 (N = 2,324) and a random sibling reported about their living situation, other siblings, and their mother, median age 80. Results. Logistic regressions revealed that mothers in poor health, who were older, and who had a daughter were more likely to live with a child. Among coresiding families, results from discrete choice conditional logit models showed that widowed mothers were more likely to live with an unmarried son than an unmarried daughter. Married children were less likely to coreside than unmarried children, but married daughters were more likely than married sons to coreside. Past receipt of financial help from parents was not associated with coresidence. Coresidence was more likely for those with a close relationship with the mother. Discussion. The discussion considers coresidence as an intergenerational transfer and its importance for the contemporary aging society. Data are needed on characteristics of all offspring to test theories about parent-child relationships. © The Author 2013.

El Arifeen S.,International Center for Diarrhoeal Disease Research | Hill K.,Harvard Center for Population and Development Studies | Ahsan K.Z.,University of North Carolina at Chapel Hill | Jamil K.,USAID | And 2 more authors.
The Lancet | Year: 2014

Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regressionFindings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253391) in 19982001 to 194 deaths per 100 000 livebirths (149238) in 200710, an annual rate of decrease of 56%. This decrease rate is slightly higher than that required (55%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal deathInterpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This fi nding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in BangladeshFunding United States Agency for International Development, UK Department for International Development, Bill and Melinda Gates Foundation. © 2014 Elsevier Ltd.

Vollmer S.,University of Gottingen | Vollmer S.,Harvard Center for Population and Development Studies | Harttgen K.,ETH Zurich | Subramanyam M.A.,Indian Institute of Technology Gandhinagar | And 3 more authors.
The Lancet Global Health | Year: 2014

Background: Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries. Methods: We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0-35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. Findings: Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for wasting. Overall, 35·6% (95% CI 35·4-35·9) of young children were stunted (ranging from 8·7% [7·6-9·7] in Jordan to 51·1% [49·1-53·1] in Niger), 22·7% (22·5-22·9) were underweight (ranging from 1·8% [1·3-2·3] in Jordan to 41·7% [41·1-42·3] in India), and 12·8% (12·6-12·9) were wasted (ranging from 1·2% [0·6-1·8] in Peru to 28·8% [27·5-30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989-0·995) for stunting, 0·986 (0·982-0·990) for underweight, and 0·984 (0·981-0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993-1·000) for stunting, 0·989 (0·985-0·992) for underweight, and 0·983 (0·979-0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990-1·004) for stunting, 0·999 (0·991-1·008) for underweight, and 0·991 (0·978-1·004) for wasting. Interpretation: A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries. © 2014 Vollmer et al.

Ertel K.A.,Harvard University | Berkman L.F.,Harvard Center for Population and Development Studies | Buxton O.M.,Brigham and Womens Hospital
Sleep | Year: 2011

Study Objectives: To advance our understanding of the interplay of socioeconomic factors, occupational exposures, and race/ethnicity as they relate to sleep duration. We hypothesize that non.Hispanic African/Caribbean immigrant employees in long-term health care have shorter sleep duration than non-Hispanic white employees, and that low education, low income, and occupational exposures including night work and job strain account for some of the African/Caribbean immigrant-white difference in sleep duration. Design: Cross-sectional Setting: Four extended care facilities in Massachusetts, United States Participants: 340 employees in extended care facilities Measurements and Results: Sleep duration was assessed with wrist actigraphy for a mean of 6.3 days. In multivariable regression modeling controlling for gender and age, African/Caribbean immigrants slept 64.4 fewer minutes (95% CI: -81.0, -47.9) per night than white participants; additional control for education and income reduced the racial gap to 50.9 minutes (-69.2, -32.5); additional control for the occupational factors of hours worked per week and working the night shift reduced the racial gap to 37.7 minutes (-57.8, -17.6). Conclusions: This study provides support for the hypothesis that socioeconomic and occupational characteristics explain some of the African/Caribbean immigrant-white difference in sleep duration in the United States, especially among health care workers.

Hawkins S.S.,Harvard Center for Population and Development Studies | Berkman L.,Harvard Center for Population and Development Studies
Preventive Medicine | Year: 2011

Objective: To examine selected social determinants of a home smoking policy among US households with children and whether these associations vary by the presence of a smoker and children's ages. Methods: In the 2006/2007 US Tobacco Use Supplement to the Current Population Survey there were 30,874 parents with 0-17-year-olds. Results: 83.9% of parents reported that no one was allowed to smoke inside the home. However, a no smoking policy varied by the presence of a smoker (93.6% of non-smoking households; 55.8% of smoking households) and children's ages (87.1% of parents with any 0-5-year-olds; 82.1% with 6-17-year-olds only; 79.2% with 14-17-year-olds only). In smoking and non-smoking households, parents of 6-17-year-olds were 25%-46% less likely to have a no smoking policy than parents of younger children. Among smoking households, Hispanic and Asian parents were over twice as likely to not allow smoking inside the home as white parents, while Black parents were half as likely. Parents from more disadvantaged circumstances were less likely to have a no smoking policy. Conclusions: Parents of 6-17-year-olds are less likely to have a no smoking policy than parents of younger children. Parents with children of all ages should enact a smoking policy that promotes a smoke-free home. © 2011 Elsevier Inc.

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