Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran.

BACKGROUND: Food security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran. METHODS: In this cross-sectional study, 583 older people, aged 60-80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied. RESULTS: The average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100-6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051-0.424). CONCLUSIONS: Overall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

Socioeconomic Status and Changes in Iranian Household Food Basket Using National Household Budget and Expenditure Survey Data, 1991-2017.

Background: Socioeconomic factors are major determinants of health and food consumption. The aim of the present study was assessing the changes in energy and different food groups consumption related to the socioeconomic status of Iranian households. Methods: In this repeated cross-sectional study, 717432 households data from the Households Income and Expenditure Survey (HIES) conducted yearly by the Statistical Centre of Iran (SCI) from 1991 to 2017 was used. The food consumption outcome was modeled as a function of household head age, household head age-squared, socioeconomic variables, household size, place of residence, and household's head sex. Principle Component Analysis (PCA) was used to extract a socioeconomic status variable based on the educational, occupational, and income status of households. A cross-classified random effects modeling (CCREM) specifications of Hierarchical Age-Period-Cohort (HAPC) models was used in the present study. Results: In the present study, by moving to the higher quartiles of SES had higher calorie intake increased. There was a positive relationship between "Vegetables", "Fruits", "Dairy", "Meat, Poultry, Fish, Eggs, Legumes, and Nuts" and "Fats, Oils, Sugars, and Sweets" with socioeconomic statues category. In the case of "Bread, Cereal, Rice, and Pasta", there was a reverse relationship, and lower SES quartile consumed a higher amount of this food group. Conclusion: Lower income, education, and occupational status in lower SES quartile groups lead to lower calorie consumption and higher consumption of "Bread, Cereal, Rice, and Pasta" food group, which had lower energy cost compared to the other food groups.

Who really counts in Iran's National Food Assistance Program? Lessons from multi-stakeholder processes in the wicked policy area of food security.

Multi-stakeholder processes - as a necessary part in the development of public policies - can provide diverse perspectives to inform and to improve food security policy-making. Iran's National Food Assistance Program (NFAP) is one of the major welfare programs in Iran that reduces food insecutiry to low-income households. This study aimed to identify and to categorize actual and potential stakeholders in NFAP using the stakeholder salience model. According to Mitchell's theory, stakeholders' attributes (power, legitimacy, and urgency) were assessed based on the nature of their interactions, roles, and level of engagement. Results revealed a number of significant but marginalized stakeholders, including Iranian Ministry of Health (office of community nutrition improvement), academia, center for food and nutrition research, target group, charities, and international organizations, who have not received any targeted organizational attention and priority to their claims. The unbalanced attention provided to some stakeholder groups characterized as "definitive" and "dominant" and ignoring some important ones will jeopardize long-term viability and undermine support for the program with inevitable declines in legitimacy. Understanding the change in the stakeholders' characteristics is the main variable to determine the allocation of organizational resources in response to different and rising stakeholders' demands and possibly the projects outcomes. This will facilitate and enhance the possibility of knowledge exchange and learning, and greater trust among stakeholders during the food and nutrition policy-making process.

Who really counts in Iran's National Food Assistance Program? Lessons from multi-stakeholder processes in the wicked policy area of food security / Quem importa realmente no Programa Nacional de Assistência Alimentar do Irã? Lições dos processos com múltiplos atores na área política complexa de segurança alimentar / ¿A quién se tiene en cuenta realmente en el Programa Nacional de Asistencia Alimentaria en Irán? Lecciones sobre procesos con participación múltiple en la complicada área de política de seguridad alimentaria

Abstract: Multi-stakeholder processes - as a necessary part in the development of public policies - can provide diverse perspectives to inform and to improve food security policy-making. Iran's National Food Assistance Program (NFAP) is one of the major welfare programs in Iran that reduces food insecutiry to low-income households. This study aimed to identify and to categorize actual and potential stakeholders in NFAP using the stakeholder salience model. According to Mitchell's theory, stakeholders' attributes (power, legitimacy, and urgency) were assessed based on the nature of their interactions, roles, and level of engagement. Results revealed a number of significant but marginalized stakeholders, including Iranian Ministry of Health (office of community nutrition improvement), academia, center for food and nutrition research, target group, charities, and international organizations, who have not received any targeted organizational attention and priority to their claims. The unbalanced attention provided to some stakeholder groups characterized as "definitive" and "dominant" and ignoring some important ones will jeopardize long-term viability and undermine support for the program with inevitable declines in legitimacy. Understanding the change in the stakeholders' characteristics is the main variable to determine the allocation of organizational resources in response to different and rising stakeholders' demands and possibly the projects outcomes. This will facilitate and enhance the possibility of knowledge exchange and learning, and greater trust among stakeholders during the food and nutrition policy-making process.

Resumo: Os processos com múltiplos atores (multi-stakeholder), como parte necessária do desenvolvimento de políticas públicas, podem ajudar a reunir perspectivas diversas para informar e melhorar as políticas de segurança alimentar. O Programa Nacional de Assistência Alimentar do Irã (NFAP) é um dos maiores programas de bem-estar social no Irã, e que fornece apoio a famílias de baixa renda para reduzir a insegurança alimentar. O estudo teve como objetivo identificar e categorizar os atores atuais e potenciais envolvidos no NFAP, usando o modelo de stakeholder salience). De acordo com a teoria de Mitchell, os atributos (poder, legitimidade e urgência) foram avaliados com base na natureza de suas interações, papeis e níveis de engajamento. Os resultados revelaram uma série de atores importantes, porém marginalizados, incluindo o Ministério da Saúde do Irã (Divisão de Melhoria Nutricional Comunitária), academia, centros de pesquisas em alimentação e nutrição, grupo-alvo, filantropias e organizações internacionais, que não receberam nenhuma atenção institucional dirigida ou prioritária quanto às suas demandas. O desequilíbrio da atenção prestada a alguns dos grupos interessados, caracterizados como "definitivos" e "dominantes", ignorando outros atores importantes, irá prejudicar a viabilidade no longo prazo e reduzir o apoio para o programa, com um declínio inevitável na legitimidade. A compreensão da mudança nas características dos atores é a principal variável na determinação da alocação dos recursos institucionais na resposta às diversas e crescentes demandas dos atores, e possivelmente dos resultados dos projetos. Tal compreensão facilitará e fortalecerá a troca de conhecimentos e lições, além de maior confiança mútua entre os atores durante o processo de políticas de alimentação e nutrição.

Resumen: Los procesos de participación múltiple, constituyen una parte necesaria en el desarrollo de políticas públicas, puesto que pueden ayudar a presentar diversas perspectivas, así como informar y mejorar la creación de políticas públicas en seguridad alimentaria. El Programa Nacional de Asistencia Alimentaria de Irán (NFAP) es uno de los principales programas de bienestar social en Irán, que proporciona ayuda a los hogares con bajos ingresos, a fin de reducir la inseguridad alimentaria. El objetivo del estudio fue identificar y categorizar a los actuales y potenciales participantes múltiples en el NFAP, utilizando un modelo de copartícipes relevantes. Los atributos de las partes interesadas (poder, legitimidad y urgencia), según la teoría de Mitchell, fueron evaluados basados en la naturaleza de sus interacciones, roles, y nivel de implicación. Los resultados revelaron un número de copartícipes importantes, pero marginalizados, incluyendo el Ministerio de Salud de Irán (Departamento de Mejora de la Nutrición en la Población), instituciones académicas, centros de investigación de alimentación y nutrición, así como grupos objetivo, organizaciones de beneficencia, y organizaciones internacionales, que no habían recibido ninguna atención específica institucional, ni ninguna prioridad en sus reclamaciones. La atención desequilibrada, otorgada a alguno de los grupos partícipes, caracterizada como "definitiva" y "dominante", e ignorando algunas otras importantes, pondrá en peligro a largo plazo la viabilidad y socavará el apoyo para el programa con su inevitable declive en términos de legitimidad. Entender el cambio en las características de los participantes es la variable principal para determinar la asignación de los recursos organizativos, en respuesta a las diferentes y crecientes demandas de los participantes, así como posiblemente a los resultados de los proyectos. Esto facilitará y acrecentará la posibilidad de intercambio de conocimiento y aprendizaje, así como una mayor confianza entre los partícipes durante los procesos de políticas alimentarias y nutricionales.

Assessing the Changes in Iranian Household Food Basket Using National Household Budget and Expenditure Survey Data, 1991-2017.

BACKGROUND: The aim of the present study was assessing the changes in Iranian household food basket. The Households Income and Expenditure Survey (HIES) data of 717,432 of Iranian households from 1991 to 2017 were used in this repeated cross-sectional study. METHODS: A cross-classified random-effects modeling (CCREM) specifications of hierarchical age-period-cohort (HAPC) in two models, one without controlling for the effects of key individual characteristics, namely socioeconomic status; household size; place; and household head sex, and another one with controlling for the effect of mentioned variables, was used in the present study. RESULTS: The present study showed that the equivalent to an adult male daily consumption of "total calorie" (P value = 0.0001) and "fats, oils, sugars, and sweets" (P value = 0.0002) had an increasing trend from 1991 to 2004 and a decreasing trend from 2005 to 2017 among Iranian households. The daily consumption of "bread, cereal, rice, and pasta" (P value = 0.0001) had a decreasing and "fruits" (P value = 0.0002) had a rising trend during periods. After an increasing trend for the "meat, poultry, fish, eggs, legumes, and nuts" (P value = 0.0002) and "vegetable" (P value=<0.0001) by 2004, there was a decreasing trend from 2004 to 2017, but the share of them in the total calorie consumption increased. The "dairy" (P value = 0.0002) consumption had a decreasing trend in recent years. CONCLUSIONS: Iranian household food basket, during these years, had significant changes that some of them (increase in the share of the vegetables and fruits in the total calorie intake) are positive and some of them are negative (decrease in the consumption of dairy).

Association between the socio-economic status of households and a more sustainable diet.

OBJECTIVE: A sustainable diet is an affordable diet with low environmental impact, high food security and sufficient healthiness. The present study aimed to assess the correlation between the socio-economic status of households and a sustainable diet. DESIGN: The food basket and socio-economic data of Iranian households were evaluated during 2016-2018. The households were classified based on the sustainability of their diet by determining the dietary carbon footprint, dietary water footprint, lower dietary costs of the household than the median and a higher dietary quality index than the median. Logistic regression was used with four models to calculate the OR of a more sustainable diet as the dependent variable regarding the different quartiles of socio-economic status (SES) as the independent variable. SETTING: Iran. PARTICIPANTS: Iranian households (n 102 303), nationally representative, were studied. RESULTS: Lower SES was associated with the higher OR of a sustainable diet (OR: 0·90; (95 % CI 0·87, 0·91)). Higher quartiles of SES compared with the lower SES group indicated the higher energy intake and consumption of more dairies, meat, poultry, fish, eggs, legumes, nuts and fruits, as well as the lower intake of bread, cereal, rice and pasta. CONCLUSION: In countries such as Iran, where nutrition transition occurs rapidly, better economic and social levels in the populations with a higher SES are associated with increased energy intake and higher consumption of animal-based foods, which decreases sustainable diets compared with the groups with a lower SES.

Designing a healthy, low-cost and environmentally sustainable food basket: an optimisation study.

OBJECTIVE: Sustainable diets are diets with low environmental impacts and high affordability which contribute to food and nutrition security. The present study aimed to develop a healthy, low-cost and environmental-friendly food basket for Iran based on current consumption. DESIGN: The Households Income and Expenditure Survey data were used. Linear Programming was utilised to obtain the optimal diets, separately, for each goal of the sustainable food basket: (1) Diet with maximum Nutrient Rich Food (NRF) index, (2) Diet with minimum cost, (3) Diet with the minimum water footprint and (4) Diet with the minimum carbon footprint. Goal Programming techniques were used to optimise the sustainable food basket by considering all goals simultaneously. SETTING: Iran. PARTICIPANTS: Households (n 100 500) in urban and rural areas of Iran, nationally representative. RESULTS: In the 'optimal model', compared with the usual consumption, the amount of the 'bread, cereal, rice, and pasta', 'meat, poultry, fish, eggs, legumes, and nuts' and 'fats, oils, sugars, and sweets' groups was decreased. Inside those food groups, cereals, poultry and vegetable oil subgroups were increased. Also, dairy, fruits and vegetable groups were increased. In this model, there was a 14 % reduction in the total water footprint, a 14 % decrease in the total carbon footprint, a 23 % decrease in the cost and a 7 % increase in NRF of diet compared with the usual consumption. CONCLUSIONS: Increasing the consumption of dairy, fruits and vegetables and reducing the consumption of bread, rice, pasta, meat, fish, eggs, legumes, nuts, hydrogenated fats and sugars are required to achieve a sustainable food basket.

Development and Validation of Food and Nutrition Literacy Assessment Tool for Iranian High-school Graduates and Youth.

BACKGROUND: Food and nutrition literacy (FNL) is an emerging concept that emphasizes not only on personal knowledge, but food and nutrition skills about. This study aimed to develop and validate a food and nutrition literacy assessment tool (FNLAT) for youth and high-school graduates in Iran. METHODS: The study protocol included the following steps: First, FNL components for Iranian high-school graduates and youth were identified through literature review and interviews with experts. Delphi method was used in order to achieve consensus about FNL components. Then, the questionnaire items were generated, and its content and face validity were assessed. Construct validity of the questionnaire was evaluated through applying principal component analysis (PCA) and confirmatory factor analyses (CFA) in the next step. Finally, reliability of the FNLAT was assessed by calculating Cronbach's Alpha and evaluating test-retest reliability. RESULTS: A 104-item questionnaire was developed. S-CVI was ≥90 which confirmed content validity of the questionnaire. PCA suggested that it was constructed of 6 factors, one in knowledge domain (food and nutrition knowledge) and five in skill domain (functional skills, interactive skills, advocacy, critical analysis of information, and food label reading skills). On the basis of CFA, the fit indices of the model had acceptable fit and confirmed construct validity of the FNLAT (X 2/df = 1.58, RMSEA = 0.041; P = 1.00, RMR = 0.034, GFI = 0.79). The values of Cronbach's Alpha and intraclass correlation coefficient (ICC) confirmed internal consistency and time stability of the FNLAT and its subscales. CONCLUSIONS: The developed FNLAT is a valid and reliable tool to assess FNL in Iranian late adolescents and youth.

WHO Ending Childhood Obesity and Iran-Ending Childhood Obesity Programs Based on Urban Health Equity Indicators: A Qualitative Content Analysis.

BACKGROUND: The childhood obesity epidemic is one of the most serious global health challenges, and many relevant policies have been designed and implemented. Regarding health equity policy-making, it is important to adopt proper interventional strategies, including childhood obesity policies. The purpose of this study is to assess compliance with the WHO Ending Childhood Obesity (ECHO), and the Iran-Ending Childhood Obesity (IRAN-ECHO) program draft in terms of Urban Health Equity Indicators (UHEIs) in Iran. METHODS: This is a descriptive study, using a directed quantitative content analysis approach to analyze the ECHO report and IRAN-ECHO program draft, based on Iranian UHEI. The UHEI consist of 52 indicators in 5 domains. The frequency of each code in the ECHO report and IRAN-ECHO draft was calculated and analyzed. RESULTS: In total, 148 and 84 phrases or words in ECHO and IRAN-ECHO were encoded with UHEI concepts. The results showed that the physical activity indicator was the most frequent among indicators in both ECHO (n = 48, 32.43%) and IRAN-ECHO (n = 41, 48.80%). Indicators 28 (prevalence of underweight in children under 5, n = 14, 9.45%) and 19 (use of primary care services, n = 21, 25%) were the next most frequent in ECHO and IRAN-ECHO, respectively. CONCLUSION: In this study, ECHO and IRAN-ECHO had high compliance with some UHEI, especially indicators placed in domain 3 (social and human development). It indicates that social and human development plays an important role in preventing and controlling childhood obesity.

Food and nutrition literacy (FNLIT) and its predictors in primary schoolchildren in Iran.

This study used a locally designed and validated questionnaire to describe the distribution of food and nutrition literacy (FNLIT) in a cross-sectional sample of 803 students aged 10-12 years from elementary schools in Tehran city, Iran. Logistic regression was used to assess the extent to which various independent covariates were associated with low FNLIT. The data were used to identify significant differences using a range of social and cultural variables relevant to the context of school students in Iran. The results of the study showed that although the total FNLIT level was good, this headline finding masked important differences in the sub-domains. More than half of the children (69%) had high levels of FNLIT in the cognitive domain, but in the skills domain, very few (3%) scored highly. The study also identified some associations between the total FNLIT and its subscales and sociodemographic variables including gender, parent's education and age, birth order. These results highlighted groups within the school population who were at higher risk of having lower FNLIT levels. They also indicate that girls feel more able to exert choice and control over food and nutrition decisions than boys are but may be less able to do so in practice. Overall, these results are a general reminder to schools of the different learning needs of children from different family backgrounds. The article highlights the need for continuous improvement in the health education curriculum of schools in Iran, particularly highlighting the importance of giving greater attention to the development of practical food and nutrition skills alongside more traditional food and nutrition knowledge. Additional studies (with long-term follow-up) are needed to more fully assess and understand the predictors of FNLIT.

Setting research priorities to achieve long-term health targets in Iran.

BACKGROUND: In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets. METHODS: Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran's long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity. FINDINGS: The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran's elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one. CONCLUSIONS: These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations' Sustainable Development Goals by 2030.

Process evaluation of a national, community-based, food supplementary programme for improving the nutritional status of children in Iran.

OBJECTIVE: To evaluate the process of implementation of a national nutritional programme for improving the nutritional status of children in Iran. DESIGN: A cross-sectional process evaluation was carried out using field observations, document reviews, semi-structured interviews and focus group discussions. SETTING: Data were collected across urban and rural areas of Qazvin and Semnan provinces of Iran, March-September 2014. SUBJECTS: Mothers (n 362) of children under programme coverage were chosen for the survey. Senior nutrition officers, the head of Hygiene, Remedy and Insurance Affairs at Imam Khomeini Relief Foundation and community health workers were selected purposively for interviews. Mothers with at least one child under 6 years of age covered by the programme were selected to participate in focus group discussions. RESULTS: Five steps of programme implementation were identified: supplementary food basket content, food basket distribution methods, selection of eligible children, distributed food consumption, and child growth monitoring and nutrition training sessions for mothers. The distributed food baskets did not have enough milk/dairy products, vegetables and fruits. Nearly 50 % of children consumed 75-100 % of the distributed milk and cake/biscuit, while staple foods were shared with other family members. When electronic cards were offered instead of food baskets, attendance for child growth monitoring and the food items participants chose with the cards tended to differ from what was originally designed. CONCLUSIONS: Focusing on food items that are mostly being used for child feeding (e.g. eggs or milk in food baskets) may be beneficial to assure the target child is receiving the distributed foods.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran.

OBJECTIVE: To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran. DESIGN: A cross-sectional study. SETTING: All four geographical zones of Urmia city. SUBJECTS: Participants (n 723; 427 women and 296 men), aged 20-64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds). RESULTS: Three major dietary patterns were extracted: 'Traditional High SES' (THS), 'Traditional Low SES' (TLS) and 'Transitional'. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The 'Transitional' pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level. CONCLUSIONS: Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups.

OBJECTIVE: To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran. DESIGN: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20-64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods. RESULTS: Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female (OR = 4.33, CI 95%: 2.35-7.97) and moderate-to-severe FI (OR = 2.00, CI 95%: 1.01-3.97) in Azeris and being female (OR = 5.39, CI 95%: 2.28-12.23) and higher total cost of household/capita (OR = 1.005, CI 95%: 1.002-1.009) in Kurds were related to higher odds of general obesity while low (OR = 0.41, CI 95%: 0.18-0.91) and moderate (OR = 0.13, CI 95%: 0.02-0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR = 0.64, CI 95%: 0.21-0.94), females (OR = 0.72, CI 95%: 0.34-0.86), home owners (OR = 0.56, CI 95%: 0.31-0.91) and females Kurds (OR = 0.60, CI 95%: 0.37-0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR = 1.06, CI 95%: 1.02-1.10) and total cost of household per capita (OR = 1.004, CI 95%: 1.000-1.008). CONCLUSION: These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.

Multidimensional life table estimation of the total fertility rate and its components.

Using discrete-time survival models of parity progression and illustrative data from the Philippines, this article develops a multivariate multidimensional life table of nuptiality and fertility, the dimensions of which are age, parity, and duration in parity. The measures calculated from this life table include total fertility rate (TFR), [corrected] total marital fertility rate (TMFR), parity progression ratios (PPR), age-specific fertility rates, mean and median ages at first marriage, mean and median closed birth intervals, and mean and median ages at childbearing by child's birth order and for all birth orders combined. These measures are referred to collectively as "TFR and its components." Because the multidimensional life table is multivariate, all measures derived from it are also multivariate in the sense that they can be tabulated by categories or selected values of one socioeconomic variable while controlling for other socioeconomic variables. The methodology is applied to birth history data, in the form of actual birth histories from a fertility survey or reconstructed birth histories derived from a census or household survey. The methodology yields period estimates as well as cohort estimates of the aforementioned measures.

Multidimensional life-table analysis of the effect of child mortality on total fertility in India, 1992-93, 1998-99, 2005-06.

This paper presents a new method for estimating the effect of child mortality on the total fertility rate (TFR). The method is based on discrete-time survival models of parity progression that allow construction of a multivariate multidimensional life table of fertility with four dimensions: woman's age, parity, duration in parity, and number of previous child deaths. Additional socio-economic variables are included in the set of predictor variables in the underlying survival models of parity progression. The life table yields a replacement rate, which measures the effect of one additional child death on the TFR. The method is illustrated by applying it to three Indian National Family Health Surveys. Major findings are that dead children are incompletely replaced, and that the replacement rate rises as the TFR falls, reflecting women's increasing ability to control their fertility.