Child Marriage in the United States: How Common Is the Practice, And Which Children Are at Greatest Risk?

CONTEXT: Marriage before the age of 18, commonly referred to as child marriage, is legal under varying conditions across the United States. The prevalence of child marriage among recent cohorts is unknown. METHODS: American Community Survey data for 2010-2014 were used to estimate the average national and state-level proportions of children who had ever been married. Prevalence was calculated by gender, race and ethnicity, and birthplace, and the living arrangements of currently married children were examined. RESULTS: Approximately 6.2 of every 1,000 children surveyed had ever been married. Prevalence varied from more than 10 per 1,000 in West Virginia, Hawaii and North Dakota to less than four per 1,000 in Maine, Rhode Island and Wyoming. It was higher among girls than among boys (6.8 vs. 5.7 per 1,000), and was lower among white non-Hispanic children (5.0 per 1,000) than among almost every other racial or ethnic group studied; it was especially high among children of American Indian or Chinese descent (10.3 and 14.2, respectively). Immigrant children were more likely than U.S.-born children to have been married; prevalence among children from Mexico, Central America and the Middle East was 2-4 times that of children born in the United States. Only 20% of married children were living with their spouses; the majority of the rest were living with their parents. CONCLUSIONS: Child marriage occurs throughout the country. Research on the social forces that perpetuate child marriage is needed to inform efforts to prevent it.

Public transportation and tuberculosis transmission in a high incidence setting.

BACKGROUND: Tuberculosis (TB) transmission may occur with exposure to an infectious contact often in the setting of household environments, but extra-domiciliary transmission also may happen. We evaluated if using buses and/or minibuses as public transportation was associated with acquiring TB in a high incidence urban district in Lima, Peru. METHODS: Newly diagnosed TB cases with no history of previous treatment and community controls were recruited from August to December 2008 for a case-control study. Crude and adjusted odd ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression to study the association between bus/minibus use and TB risk. RESULTS: One hundred forty TB cases and 80 controls were included. The overall use of buses/minibuses was 44.9%; 53.3% (72/135) among cases and 30.4% (24/79) among controls [OR: 3.50, (95% CI: 1.60-7.64)]. In the TB group, 25.7% (36/140) of subjects reported having had a recent household TB contact, and 13% (18/139) reported having had a workplace TB contact; corresponding figures for controls were 3.8% (3/80) and 4.1% (3/73), respectively[OR: 8.88 (95% CI: 2.64-29.92), and OR: 3.89 (95% CI: 1.10-13.70)]. In multivariate analyses, age, household income, household contact and using buses/minibuses to commute to work were independently associated with TB [OR for bus/minibus use: 11.8 (95% CI: 1.45-96.07)]. CONCLUSIONS: Bus/minibus use to commute to work is associated with TB risk in this high-incidence, urban population in Lima, Peru. Measures should be implemented to prevent TB transmission through this exposure.

Developing a tuberculosis transmission model that accounts for changes in population health.

BACKGROUND: Simulation models are useful in policy planning for tuberculosis (TB) control. To accurately assess interventions, important modifiers of the epidemic should be accounted for in evaluative models. Improvements in population health were associated with the declining TB epidemic in the pre-antibiotic era and may be relevant today. The objective of this study was to develop and validate a TB transmission model that accounted for changes in population health. METHODS: We developed a deterministic TB transmission model, using reported data from the pre-antibiotic era in England. Change in adjusted life expectancy, used as a proxy for general health, was used to determine the rate of change of key epidemiological parameters. Predicted outcomes included risk of TB infection and TB mortality. The model was validated in the setting of the Netherlands and then applied to modern Peru. RESULTS: The model, developed in the setting of England, predicted TB trends in the Netherlands very accurately. The R(2) value for correlation between observed and predicted data was 0.97 and 0.95 for TB infection and mortality, respectively. In Peru, the predicted decline in incidence prior to the expansion of "Directly Observed Treatment Short Course" (The DOTS strategy) was 3.7% per year (observed = 3.9% per year). After DOTS expansion, the predicted decline was very similar to the observed decline of 5.8% per year. CONCLUSIONS: We successfully developed and validated a TB model, which uses a proxy for population health to estimate changes in key epidemiology parameters. Population health contributed significantly to improvement in TB outcomes observed in Peru. Changing population health should be incorporated into evaluative models for global TB control.

Children home alone unsupervised: modeling parental decisions and associated factors in Botswana, Mexico, and Vietnam.

OBJECTIVE: This paper examines different child care arrangements utilized by working families in countries undergoing major socio-economic transitions, with a focus on modeling parental decisions to leave children home alone. METHOD: The study interviewed 537 working caregivers attending government health clinics in Botswana, Mexico, and Vietnam. Analyses involve descriptive statistics, content analysis, and ethnographic decision modeling. RESULTS: In one-half of the families in Botswana, over one-third of the families in Mexico, and one-fifth of the families in Vietnam, children are left home alone on a regular or occasional basis. Moreover, 52% of families leaving children home alone relied on other children to help with child care. Parental unavailability and poor working conditions, limited support networks, inability to afford child care, neighborhood safety, and children's age are critical factors in parents' decisions to leave children home alone. Children also may remain home alone or without quality supervision when informal child care providers fail to provide care. Seldom their preferred choice, parents identified risks (e.g., increasing unintentional injuries, loneliness, and poor behavioral and developmental consequences) and benefits (e.g., strengthening child independence and sibling relations) of this arrangement. CONCLUSIONS: Poverty, social integration, local norms, and child development frame parents' decisions of care. Insufficient societal support to working families frequently resulted in unsafe child care arrangements and limited parental involvement in child education and health care. Current, comprehensive data on this phenomenon are needed to inform social services and policies in countries undergoing major socio-economic transitions. PRACTICE IMPLICATIONS: Existing attention to children home alone has mostly focused on the associated risks, injuries, and poor outcomes; consequently, this child care arrangement is often assessed as parental neglect. However, understanding why children are left home alone or under the supervision of another child is crucial to the development of suitable interventions. Findings from this study of parental decision-making in Botswana, Mexico, and Vietnam highlight the need to understand the etiology of each case to assess whether parents are seeking the best option among untenable choices, or if it is, indeed, a case of parental, caregiver, or societal neglect.