Sexual Behavior Among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship.

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

Fracture risk assessment in older adults using a combination of selected quantitative computed tomography bone measures: a subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study.

Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry-like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status.

Healthcare coverage and use among undocumented Central American immigrant women in Houston, Texas.

We investigated the prevalence and correlates of having current healthcare coverage and of having a usual formal source of care among undocumented Central American immigrant women. Participants were recruited using respondent driven sampling. Thirty-five percent of participants had healthcare coverage and 43% had a usual formal source of care. Healthcare coverage was primarily through the local indigent healthcare program and most of those with a usual formal source of care received care at a public healthcare clinic. Having healthcare coverage and having a usual formal source of care were both associated with older age; having a usual formal source of care was also marginally associated with increased time of residence in the US and increased income security. The primary barriers to healthcare use were not having money or insurance, not knowing where to go, and not having transportation. Healthcare interventions may benefit from targeting young and newly arrived immigrants and addressing the structural and belief barriers that impede undocumented immigrant women's use of healthcare services.

HIV testing behaviors among undocumented Central American immigrant women in Houston, Texas.

This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sampling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural characteristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population.

The impact of pregnancy intention on breastfeeding duration in Bolivia and Paraguay.

Research has demonstrated that prolonged duration of breastfeeding promotes child survival. This study examines the impact of unintended--mistimed or unwanted--pregnancy on breastfeeding duration. We use data from the 1990 Paraguay and 1994 Bolivia Demographic and Health Surveys and restrict our analysis to last-born, surviving children younger than 36 months from singleton births. To assess the association, unintended and intended pregnancies are compared by calculating incidence rates and adjusted hazard ratios (aHR) using survival analysis. Most children (approximately 95 percent) were breastfed initially, but the median duration of breastfeeding in Bolivia was five months longer than that in Paraguay (19 versus 14 months). A greater proportion of pregnancies were described as intended in Paraguay than in Bolivia (74 percent versus 45 percent). In adjusted analyses, unwanted and mistimed pregnancies were associated with slightly longer duration of breastfeeding (aHR = 0.9) than were intended pregnancies, but the association was not statistically significant. In this study, therefore, pregnancy intention was not an important factor in duration of breastfeeding in Bolivia or Paraguay.

Método simplificado para evaluar la lactancia materna y la amenorrea / A simplified methodology for the community-based assessment of breast-feeding and amenorrhea in Mexico

En este trabajo se presenta un método simplificado para efecturar una evaluación epidemiológica basada en la comunidad, compatible con las metas de la investigación en el marco de la atención primaria de salud. Para este fin se utilizó el "análisis de las tablas de vida del estado actual" de los datos correspondientes a 1 131 mujeres asistidas por trabajadores de salud de la comunidad en el estado de México, con objeto de determinar las distribuciones de la duración de la lactancia materna, la amenorrea y el uso de anticonceptivos después del parto. En los métodos de campo empleados se incorporaron procedimientos de control de la calidad. Un mes después del parto, 78 por ciento de los lactantes eran aún amamantados; a los cinco meses, el porcentaje se redujo a 50 por ciento y, a los 12 meses, a 25 por ciento. El porcentaje de amenorrea un mes después del parto fue de 85 por ciento, de 50 por ciento a los tres meses y de 25 por ciento a los cinco meses. El uso de anticonceptivos se inició tempranamente: 42 por ciento de las usuarias comenzaron a emplearlos durante el primer mes posterior al parto (AU)

Método simplificado para evaluar la lactancia materna y la amenorrea / A simplified methodology for the community-based assessment of breast-feeding and amenorrhea in Mexico

En este trabajo se presenta un método simplificado para efecturar una evaluación epidemiológica basada en la comunidad, compatible con las metas de la investigación en el marco de la atención primaria de salud. Para este fin se utilizó el "análisis de las tablas de vida del estado actual" de los datos correspondientes a 1 131 mujeres asistidas por trabajadores de salud de la comunidad en el estado de México, con objeto de determinar las distribuciones de la duración de la lactancia materna, la amenorrea y el uso de anticonceptivos después del parto. En los métodos de campo empleados se incorporaron procedimientos de control de la calidad. Un mes después del parto, 78 por ciento de los lactantes eran aún amamantados; a los cinco meses, el porcentaje se redujo a 50 por ciento y, a los 12 meses, a 25 por ciento. El porcentaje de amenorrea un mes después del parto fue de 85 por ciento, de 50 por ciento a los tres meses y de 25 por ciento a los cinco meses. El uso de anticonceptivos se inició tempranamente: 42 por ciento de las usuarias comenzaron a emplearlos durante el primer mes posterior al parto (AU)

Disponible en inglés en el Bull WHO 68(2), 1990