Childhood deprivation, health and development: associations with adult health in the 1958 and 1970 British prospective birth cohort studies.

OBJECTIVE: To examine the associations between childhood socioeconomic and family circumstances, health and behavioural and cognitive development, and health and mental well-being outcomes in adulthood; exploring whether associations are different for cohorts born in 1958 and 1970, or for men and women. DESIGN: Pooled analysis of two prospective, population-based, British birth cohort studies. PARTICIPANTS: 11 327 men and women born in 1958 and 11 177 men and women born in 1970 who responded in the adult follow-up investigations at ages 33 and 30 respectively. MAIN OUTCOME MEASURES: Self-rated general health, Rutter malaise scale indicating mental well-being, and presence of a long-standing illness limiting daily activities; assessed at ages 33 and 30 for the 1958 and 1970 birth cohorts respectively. RESULTS: A diversity of family background (socioeconomic deprivation, housing tenure, family disruption and parental interest), health and development (cognition and behaviour) measures each provided powerful independent indications for general health and mental well-being. Indications for limiting long-standing illness in adulthood were focused most strongly upon health difficulties in childhood. Few interactions between either birth cohort or gender and childhood measures were observed, and excepting these interactions consistency in associations between the childhood measures and the outcomes by gender and cohort was observable. CONCLUSIONS: This study emphasises the importance of cognitive and behavioural development in childhood, as well as deprivation, family background and childhood health in indicating future adult health and mental well-being, emphasising time-persistent effects and important indications for men and women.

Mortality.

The author surveys the contributions of the U.N. Population Division to the study of mortality and elaborates the three that he considers to be the most significant. "They are synthesizing the findings of national and regional research on mortality issues; developing and disseminating methods for improving estimates of levels and trends in mortality and standards of analysis; and bringing together researchers working from different perspectives to discuss mortality issues of global importance and disseminating the results of those meetings to potential users." Publications, reports, model life tables, and other tools created by the Population Division are identified.

Fertility patterns and child survival: a comparative analysis.

PIP: The data from the Demographic and Health Surveys (DHS) for 18 countries spanning the 1970s and the 1980s were utilized for straightforward tabular analysis. Results were also contrasted with those from World Fertility Surveys (WFS) covering the 1960s and part of the 1970s. Further analysis in 10 categories of family formation was carried out. Life-tables were calculated covering the mortality experience over 15 complete years plus the year of the DHS survey concerning the survival chances of about 193,000 children and some 23,000 deaths. The overall chances of survival to age 5 for children born to women aged 20-34 was used as the reference category. The average excess mortality risks for children born to mothers aged under 18 was 51% across all 18 DHS countries, and a 14% average excess was associated with the mother being an older teenager. For teenage mothers under 18 only 4 countries fell outside the range of 125-167 excess risk. The average relative risk of child death, compared with an interval of 24-47 months, was about double for very short intervals of 1-17 months, where prematurity was a possible factor of the excess risk. There was around a 30% excess risk for intervals of 18-23 months. Early fertility (especially under age 18) and short birth intervals were strongly associated with the chances of child survival 10 years on using DHS data as they were shown in earlier WFS studies. Poor timing of birth impacted child survival substantially in many countries but has been improving over time, probably because of increased use of family planning, as in Colombia and Morocco. On the other hand, child mortality in Senegal might have improved by 50% over the 8-year observation period, if child-spacing had not deteriorated during that period. It is possible that mortality gains in several sub-Saharan African countries are slowed down by worsening family-formation patterns.^ieng

Fertility in England and Wales: a fifty-year perspective.

This paper provides a detailed account of fertility levels and trends in England and Wales since 1938, with a briefer coverage of a much longer time-span. The paper is concerned both with the measurement of fertility and with understanding the observed fertility behaviour. We lament and correct the failure of demographers to apply measurement tools available since the 1950s to the analysis of fertility in England and Wales, with a particular emphasis on adjustment of period measures and period parity progression ratios and show how some of the grosser errors of analysis and interpretation might have been avoided by earlier use of these approaches. We also relate these estimates to more recent ones. Once a clearer account of trends has been established, the paper goes on to reinterpret and explain the baby boom and baby bust. The conclusion looks at future prospects for fertility.

Women's education, child welfare and child survival: a review of the evidence.

This paper reviews recent evidence concerning the relative importance of women's education for child health, especially child survival in the Third World. Important regional patterns are uncovered, and particular attention is paid to discussion of the weaker associations observed in sub-Saharan Africa.

Demographic event history analysis: a selective review.

This is a selective review of the literature concerning demographic event history analysis. "We have attempted to emphasize work that we consider to be particularly important or innovative, to note some of the difficulties that may arise with the use of event history analysis, and to point to several substantive areas where research is still poorly developed."

Childhood poverty, early motherhood and adult social exclusion.

Childhood poverty and early parenthood are both high on the current political agenda. The key new issue that this research addresses is the relative importance of childhood poverty and of early motherhood as correlates of outcomes later in life. How far are the 'effects' of early motherhood on later outcomes due to childhood precursors, especially experience of childhood poverty? Subsidiary questions relate to the magnitude of these associations, the particular levels of childhood poverty that prove most critical, and whether, as often assumed, only teenage mothers are subsequently disadvantaged, or are those who have their first birth in their early twenties similarly disadvantaged? The source of data for this study is the National Child Development Study. We examine outcomes at age 33 for several domains of adult social exclusion: welfare, socio-economic, physical health, emotional well-being and demographic behaviour. We control for a wide range of childhood factors: poverty; social class of origin and of father; mother's and father's school leaving age; family structure; housing tenure; mother's and father's interest in education; personality attributes; performance on educational tests; and contact with the police by age 16. There are clear associations for the adult outcomes with age at first birth, even after controlling for childhood poverty and the other childhood background factors. Moreover, we demonstrate that the widest gulf in adult outcomes occurs for those who enter motherhood early (before age 23), though further reinforced by teenage motherhood for most adult outcomes. We also show that any experience of childhood poverty is clearly associated with adverse outcomes in adulthood, with reinforcement for higher levels of childhood poverty for a few outcomes.

Age, period, and cohort effects in demography: a review.

PIP: This paper considers only the vital events of demographic measurement, the factors influencing the rate at which those events occur and then investigates the consequences of patterns of these events. It reviews the state of the art of age, period and cohort analysis for demographic dependent variables. Major examples of such analyses are given in both mortality and fertility studies. In the area of mortality the conventional approach to such analysis apears to be well suited to a wide range of applications yielding useful results. The reasons for this suitability are: early childhood experience is important in many major disease and death processes, so that cohorts are legitimately viewed as acquiring early on a certain fixed susceptibility; data sometimes stretch back far enough that stationary standards of age patterns can be developed empirically, and applied to later experience; and, logarithmic or logistic transformations linearize comparisons of age schedules or mortality so that standard statistical procedures are suitable. Applications of age, period, and cohort analysis are not always routine; external constraints are required, in the form of theoretically based and mathematically expressed age patterns of mortality, in order to distinguish effectively between period and cohort effects. A set of models of age patterns of mortality that are based on cohort as well as period experience could be constructed with useful applications. With fertility analysis the conventional approach is much less suitable. Once goal directed behavior is introduced, empirical examinations must be based on theories or assumptions about how such goals are formulated and pursued. Conventional analysis might suffice only if one is prepared to accept the assumption that all pertinent goals and strategies are formulated before the initiation of childbearing and remain unaffected by subsequent events. This assumption is untenable for modern developed populations and the forms of analysis appropriate to age period cohort investigations of fertility will have to develop along with theories of reproductive behavior.^ieng

Fertility exposure analysis: A new method for assessing the contribution of proximate determinants to fertility differentials.

Summary Several recent papers have dealt with the problem of assessing the impact of the proximate determinants on fertility. All these approaches rely on combining a series of separately estimated aggregate level indicators. This paper proposes an approach which uses individual-level data and thus permits regression analyses as well as analyses for sub-groups. In the course of development it became clear that there are several deficiencies and inconsistencies in the measurement and formation of indices proposed elsewhere, which are overcome. We illustrate our approach with data from the Dominican Republic. The approach used involves attributing exposure to one or more of several states, including pregnancy, lactational and non-lactational components of post-partum amenorrhoea, absence of sexual relations and contraception. Key elements are efficacies of contraception and components of post-partum infecundity and the treatment of overlaps through an explicit hierarchy. We treat both unconditional (or additive) and conditional analyses. Intriguing findings on the age-specific pattern of fertility control emerge. Major advantages of regression analysis, such as simultaneous treatment of several variables and estimation of sampling variation are stressed.

Advances in the P/F ratio method for the analysis of birth histories.

Abstract One of the most frequently used indirect techniques for deriving estimates of recent fertility from simple questions in censuses and surveys is the 'P/F ratio' method. Availability of detailed birth-history data, as in the World Fertility Survey, and applications of the P/F procedure as a diagnostic tool in the evaluation of the quality of data have led to simplifications and extensions of the original method. This analysis illustrates that when complete maternity histories are available, the P/F procedure can be simplified and made more powerful by (1) calculation of P/F values from cohort-period fertility rates and (2) use of two further indexing variables, namely duration since first marriage and duration since first birth, in addition to age. More generally, the paper indicates that a set of P/F values is only one of a battery of measures which aid in the analysis of trends and errors in data from maternity histories. Illustrative examples are given from various analyses of world Fertility Survey data. Howard Goldberg has been independently pursuing an investigation of the P/F procedure by marriage duration at the Office of Population Research (Princeton University), and we have profited from recent discussions with him. We would also like to acknowledge useful comments and criticisms on earlier drafts from James Trussell and Kenneth Hill.

The case for samples of anonymized records from the 1991 census.

"The census of population represents a rich source of social data. Other countries have released samples of anonymized records from their censuses to the research community for secondary analysis. So far this has not been done in Britain. The areas of research which might be expected to benefit from such microdata are outlined, and support is drawn from considering experience overseas. However, it is essential to protect the confidentiality of the data. The paper therefore considers the risks, both real and perceived, of identification of individuals from census microdata. The conclusion of the paper is that the potential benefits from census microdata are large and that the risks in terms of disclosure are very small. The authors therefore argue that the Office of Population Censuses and Surveys and the General Register Office of Scotland should release samples of anonymized records from the 1991 census for secondary analysis."

Every death counts: measurement of maternal mortality via a census.

Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates. We evaluated use of the national population census as a means of measuring maternal mortality by assessing data from five countries (Benin, Islamic Republic of Iran, Lao People's Democratic Republic, Madagascar, and Zimbabwe) which identified maternal deaths in their censuses. Standard demographic methods were used to evaluate the completeness of reporting of adult female deaths and births in the year prior to the census. The results from these exercises were used to adjust the data. In four countries, the numbers of adult female deaths needed to be increased and three countries required upward adjustment of the numbers of recent births. The number of maternal deaths was increased by the same factor as that used for adult female deaths on the assumption that the proportion of adult female deaths due to maternal causes was correct. Age patterns of the various maternal mortality indicators were plausible and consistent with external sources of data for other populations. Our data suggest that under favourable conditions a national census is a feasible and promising approach for the measurement of maternal mortality. Moreover, use of the census circumvents several of the weaknesses of methods currently in use. However, it should also be noted that careful evaluation of the data and adjustment, if necessary, are essential. The public health community is urged to encourage governments to learn from the experience of these five countries and to place maternal mortality estimation in the hands of statistical agencies.