Public Health Commons^™

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Nevada Institute For Children's Research And Policy Legislative Bills-2007 Session, The Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

Legislative Bills-2007 Session for Nevada Institute for Children's Research and Policy.

Nevada Institute For Children's Research And Policy Public Health Bills- 2007 Session - Final, Nevada Institute For Children's Research And Policy Reports

Nevada Institute for Children's Research and Policy Reports

Nevada Institute for Children's Research and Policy Public Health Bills- 2007 Session - Final

Disclosure Of Maternal Hiv Status To Children: To Tell Or Not To Tell . . . That Is The Question, Tanya L. Tompkins

Faculty Publications

HIV-infected mothers face the challenging decision of whether to disclose their serostatus to their children. From the perspective of both mother and child, we explored the process of disclosure, providing descriptive information and examining the relationships among disclosure, demographic variables, and child adjustment. Participants were 23 mothers and one of their noninfected children (9 to 16 years of age). Sixty-one percent of mothers disclosed. Consistent with previous research, disclosure was not related to child functioning. However, children sworn to secrecy demonstrated lower social competence and more externalizing problems. Differential disclosure, which occurred in one-third of the families, was associated with …

Parentification And Maternal Hiv Infection: Beneficial Role Or Pathological Burden?, Tanya L. Tompkins

Faculty Publications

Parentification, along with parenting and child adjustment were examined in 23 9-through 16-year-old youth from families affected by maternal HIV infection and 20 same-age peers whose mothers were not infected. Children whose mothers were HIV-positive reported to more often engage in parental role behaviors, relative to children of HIV-negative mothers. This difference remained even after controlling for the effects of current drug use, number of adults per child in the household, and marital status. Findings revealed a beneficial relationship between parentification and both child adjustment and parenting, particularly among families affected by maternal HIV infection. When relationships were examined separately …

Examining Smoking And Cessation During Pregnancy Among An Appalachian Sample: A Preliminary View, Lesley Cottrell, Mark Gibson, Carole Harris, Alia Rai, Sabera Sobhan, Traci Berry, Bonita Stanton

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Several transitions that a woman experiences prenatally may influence her desire or ability to discontinue smoking. This study explores the role of smoking for young, Appalachian, nulliparous pregnant women and their plans for smoking during their pregnancies.

Results

The reports of women and their male partners were taken from baseline interviews conducted during the first trimester of pregnancy. Cigarette smoking appeared to be more than an isolated addictive activity; rather, smoking was interwoven in women's social and personal realms, often changing as their perceptions of self changed. Women and their partners who continued to smoke appeared to be …

Community-Based Approaches To Prevention Of Mother-To-Child Transmission Of Hiv: Findings From A Low-Income Community In Kenya, Susan Kaai, Carolyn Baek, Scott Geibel, Peter Omondi, Benson Ulo, Grace Muthumbi, Carol Nkatha, Naomi Rutenberg

HIV and AIDS

The Horizons program, in partnership with International Medical Corps and Steadman Research Services International, conducted an intervention study in Kibera, an urban slum in Nairobi, Kenya to determine what effect three different community-based activities had on utilization of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants and peer counselors as PMTCT promoters. Data from the study showed that there were positive trends during the study period in most of the PMTCT indicators, including knowledge of MTCT, …

Exploring The Barriers To Accessing Care And Treatment For Hiv-Infected Children In India: A Diagnostic Study, Avina Sarna, Jaleel Ahmad, Glory Alexander, Vaishali Sharma Mahendra, Ashok Rau, Arjun Singh, Naomi Rutenberg

HIV and AIDS

Each year 27 million births take place in India. A conservative estimate of HIV prevalence of 1 percent among antenatal women translates to about 80,000 HIV-infected children being born annually. The latest figures from the National AIDS Control Organisation show that there are about 5,600 documented HIV-positive children (0–14 years), but a very small number are receiving antiretroviral therapy. The Population Council and partners conducted a qualitative study in three high-prevalence states of India to explore the facilitators and barriers to accessing care for HIV-positive children and assessed the current level of adherence to ART among children receiving treatment. A …

The Status Of Childhood Lead Poisoning And Prevention In Nevada, Usa, Anne Rothweiler, Elena E. Cabb, Shawn Gerstenberger

Environmental & Global Health Faculty Research

One of the first steps in addressing the problem of childhood lead poisoning is to identify the possible sources of exposure in specific communities and target high-risk populations with appropriate interventions. Due to several factors, such as lack of funding and lack of blood lead reporting, little information exists regarding the occurrence of childhood lead poisoning and the prevalence of potential exposure sources in the state of Nevada. Following the recent establishment of a Nevada-based Lead Poisoning Program, we compiled the most current information available on Nevadans, and use this knowledge to suggest future research objectives and outreach activities for …

Continuum Of Care For Hiv-Positive Women Accessing Programs To Prevent Parent-To-Child Transmission: Findings From India, Vaishali Sharma Mahendra, Rupa Mudoi, Archana Oinam, Venkat Pakkela, Avina Sarna, Sucheta Panda, Ashok Rau, L. Birendrajit Singh, Naomi Rutenberg

HIV and AIDS

This study examined the efforts of PPTCT programs in different cities in India to offer women a continuum of care, and shows that the programs have both strengths and shortcomings. The government launched a national treatment program that offers antiretroviral therapy (ART) to HIV-positive women, children below 15 years of age, and men. However, since the start-up of the ART program there have been concerns about limited access to and utilization of these services by women and children. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, …

Situation Analysis Of The Sexual And Reproductive Health And Hiv Risks And Prevention Needs Of Older Orphaned And Vulnerable Children In Nyanza Province, Kenya, Milka Juma, Ian Askew, Alan Ferguson

Reproductive Health

The increasing number of children in Kenya who are orphaned or made vulnerable (OVC) from HIV/AIDS and other factors calls for a holistic understanding of their situation so that effective programs to address their needs can be designed. This is especially important for those areas hardest hit by the HIV/AIDS pandemic, such as Nyanza Province. Little is known about the vulnerabilities of older orphans to risky sexual behavior, and whether they are more vulnerable than nonorphans. The Department of Children’s Services has initiated a cash transfer program to households taking care of OVC. The main objective is to provide a …

Key Findings From An Evaluation Of The Mothers2mothers Program In Kwazulu-Natal, South Africa, Carolyn Baek, Vuyiswa Mathambo, Sibongile Mkhize, Irwin Friedman, Louis Apicella, Naomi Rutenberg

HIV and AIDS

The Horizons program of Population Council, in collaboration with Health Systems Trust, completed the first evaluation of mothers2mothers (m2m) as part of its introduction in KwaZulu-Natal Province, South Africa. It is the first external evaluation that provides quantitative evidence about the role of the well-known m2m program in complementing services to prevent mother-to-child transmission of HIV (PMTCT). m2m is a peer support program that aims to provide education and psychosocial support to HIV-positive pregnant women and new mothers, help women access existing health care, and follow up with mothers and babies to ensure they receive appropriate medical care after delivery. …

Kenya: Multisectoral Engagement Increases Support For Adolescent Reproductive Health, Frontiers In Reproductive Health

Reproductive Health

In 1999, FRONTIERS launched the Kenya Adolescent Reproductive Health Project (KARHP), testing a multisectoral approach to improving young people’s reproductive health knowledge and behavior at community, school, and health-facility levels in two pilot districts in the Western Province. The intervention involved three key government ministries—Education, Science and Technology, Health, and Gender, Sports, Culture, and Social Services—with input from community leaders, parents, and youth. Positive findings from the study convinced the three ministries and USAID to institutionalize and scale up selected elements from the pilot project. In 2003, FRONTIERS and PATH began providing technical assistance aimed at mainstreaming and expanding cost-effective …

The Experience Of Married Adolescent Girls In Northern Nigeria, Annabel Erulkar, Mairo Bello

Poverty, Gender, and Youth

Programs for young people in sub-Saharan Africa have been directed largely toward unmarried adolescents, neglecting the fact that a large proportion of adolescents—especially girls—are married in some settings. Early marriage is a common feature of girls’ adolescence in Northern Nigeria, yet few programs are in place to support this sizable and vulnerable group. To suggest directions for future programming, Adolescent Health and Information Projects (AHIP) and the Population Council examined the lives of married and unmarried girls in two geopolitical regions of Nigeria, North West and North East. The study, as described in this report, consisted of secondary analysis of …

Changing Transitions To Adulthood In Vietnam's Remote Northern Uplands: A Focus On Ethnic Minority Youth And Their Families [Vietnamese], Bussarawan Teerawichitchainan, Hac Van Vinh, Nguyen Thi Phuong Lan

Poverty, Gender, and Youth

Ethnic minorities, who tend to live in remote mountainous areas, account for 15 percent of Vietnam’s 84 million total population and, according to a recent estimate, 61 percent of them are poor. Evidence suggests that despite recent efforts by the Government of Vietnam to promote poverty reduction in remote areas, a majority of ethnic minorities have not yet experienced positive change, contrary to their Kinh (ethnic Vietnamese) neighbors who have enjoyed substantial improvement in living standards. To identify program interventions that promote healthy human development and, in turn, positively affect Vietnam’s economic growth, it is crucial to have a comprehensive …

The Role Of Schools In Promoting Sexual And Reproductive Health Among Adolescents In Developing Countries, Cynthia B. Lloyd

Poverty, Gender, and Youth

This Population Council working paper reviews the state of knowledge about relationships between schooling and adolescent reproductive health. With the spread of mass schooling and the growing share of adolescents who attend school, the opportunities for synergies between health and education policies and programs are growing. Data on cross-country variations in health conditions on the one hand, and variations in attendance and attainment patterns and school systems on the other hand, provide a framework for assessing alternative approaches to the promotion of adolescent sexual and reproductive health in different contexts. Disappointing findings from recent school-based reproductive health interventions in poor …

Girls' Adolescence In Burkina Faso: A Pivot Point For Social Change, Martha Brady, Lydia Saloucou, Erica Chong

Poverty, Gender, and Youth

As closer attention is paid to the lives of adolescents in sub-Saharan Africa, girls are found to be clearly disadvantaged, compared with their male counterparts. Burkinabé girls are frequently married at a young age, and more than one-third of married girls find themselves in polygamous unions as second or third wives, married to much older men. Understanding and recognizing girls’ realities is an important first step in planning appropriate and meaningful interventions for them. Girls who are unmarried, “promised,” engaged, or married face different constraints and merit different program approaches. This report by the Population Council aims to fill gaps …

Towards Messages That Matter: Understanding And Addressing Hiv And Srh Risks Among Married Young People In India, Armin Jamshedji-Neogi, Renu Kapoor, Jayashree Kumar, Ashwini Bhalerao Gandhi, Lakshmi Murthy, K.G. Santhya, Shireen J. Jejeebhoy, Saswata Ghosh, Vijaya Nidadavolu, Nicole Haberland, Komal Saxena, M.A. Jose

Poverty, Gender, and Youth

Although there is increasing interest in young people's sexual and reproductive health (SRH) situations and needs in India, married young people have received little attention as a vulnerable group with distinct needs because marriage is assumed to be safe and because married youth are assumed to face none of the stigma that their unmarried counterparts experience in accessing SRH services. However, emerging evidence shows that within this subpopulation, married young women and men constitute groups with distinct risks of HIV and other poor SRH outcomes. There remains a need to better understand their unique vulnerabilities and to design programs that …

Changing Transitions To Adulthood In Vietnam's Remote Northern Uplands: A Focus On Ethnic Minority Youth And Their Families, Bussarawan Teerawichitchainan, Hac Van Vinh, Nguyen Thi Phuong Lan

Poverty, Gender, and Youth

Ethnic minorities, who tend to live in remote mountainous areas, account for 15 percent of Vietnam’s 84 million total population and, according to a recent estimate, 61 percent of them are poor. Evidence suggests that despite recent efforts by the Government of Vietnam to promote poverty reduction in remote areas, a majority of ethnic minorities have not yet experienced positive change, contrary to their Kinh (ethnic Vietnamese) neighbors who have enjoyed substantial improvement in living standards. To identify program interventions that promote healthy human development and, in turn, positively affect Vietnam’s economic growth, it is crucial to have a comprehensive …

Premarital Sex And Schooling Transitions In Four Sub-Saharan African Countries, Ann E. Biddlecom, Richard Gregory, Cynthia B. Lloyd, Barbara Mensch

Poverty, Gender, and Youth

Using data from the 2004 National Survey of Adolescents conducted in Burkina Faso, Ghana, Malawi, and Uganda, this Population Council working paper investigates the timing of two key transitions in adolescence—school exit and premarital sex—among those who remain enrolled in school at the beginning of adolescence (age 12). Girls appear more vulnerable to dropout once they become sexually mature and once they engage in premarital sex. While girls were found to be less likely than boys, at any given age and controlling for other covariates, to have had premarital sex (except in Ghana), school enrollment and the timing of school …

Leave No Woman Behind, Ethiopia: Baseline Report, Annabel Erulkar, Tekle-Ab Mekbib, Helen Amdemikael, Garry Conille

Poverty, Gender, and Youth

“Leave No Woman Behind, Ethiopia” is an experimental project being implemented in rural areas of Ethiopia’s Amhara region. The project uses the mobilization of women into groups and adult literacy as an entry point for reproductive health education and referrals. Measurement of the program’s impact is being undertaken using a quasi-experimental research design including baseline and endline surveys in six Kebele Associations in rural Amhara. This report presents findings from the baseline survey conducted among more than 3,000 girls and women aged 10–45 in rural Amhara region. The results cover a broad range of topics including education, work, livelihoods, social …

Addressing The Sexual And Reproductive Health Needs Of Young People: Perspectives And Experiences Of Stakeholders From The Health And Non-Health Sectors, K.G. Santhya, Shireen J. Jejeebhoy, Saswata Ghosh, Nicole Haberland

Poverty, Gender, and Youth

In India, recent policies have underscored the right of adolescents and youth to sexual and reproductive health (SRH) counseling and services. Despite recent policies and programs, little information is available on the extent to which policy recommendations and program strategies have been implemented, and the extent to which services serve the disparate needs of married and unmarried young women and men. Also, there is limited evidence about the extent to which health-care providers at different levels of service delivery and stakeholders from other sectors are involved in providing SRH and HIV/AIDS-related information and services to young people, or their perceptions …

Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips

Poverty, Gender, and Youth

The recent introduction of user fees for Vietnam’s primary healthcare services has generated concern that economic policies may adversely affect health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This Population Council working paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under age 5 recorded by the 2001–02 Vietnam National Health Survey. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Results suggest that social equity …

South Africa: Improve Facility Management To Increase Nurse Retention, Frontiers In Reproductive Health

Reproductive Health

South Africa’s medical infrastructure is relatively well developed, but its maternal mortality rate remains high and numerous studies document poor maternal care. Shortages in nursing staff are a major factor in quality-of-care problems on maternity wards. A Population Council FRONTIERS study of antenatal care in rural clinics in Kwa-Zulu Natal showed that between one-third and one-half of providers interviewed had worked at their clinics for less than a year. In 2004, FRONTIERS followed up on the Kwa-Zulu Natal study to document factors affecting the tenure, motivations, and working conditions of maternal-health nursing staff in three South African provinces. The study …

South Africa: Youth Centers: A Costly Way To Provide Reproductive Health Services, Frontiers In Reproductive Health

Reproductive Health

Numerous reproductive health programs sponsor youth centers, which provide recreation and job-skills training as a means of attracting young people to seek reproductive health services or information. However, the productivity, cost, and cost-effectiveness of this approach are not clearly documented. In 2000, FRONTIERS conducted a cost analysis as part of a larger study on the effectiveness of three different youth center models in South Africa. The study focused on 8 of the 12 centers included in the larger study, chosen to be representative of each model. All the selected centers offered clinical services, seven also offered reproductive health information or …

Hiv/Aids Programming And Sexuality Of Young People Perinatally Infected With Hiv, Harriet Birungi

Reproductive Health

These conference proceedings draw on preliminary data from an ongoing project implemented by TASO Uganda and the Population Council that contributes to the promotion of sexual and reproductive health rights of young people aged 10–19 years perinatally infected with HIV. The key argument is that HIV/AIDS programming in Uganda and elsewhere in Africa will need to acknowledge that the population of young people perinatally infected with HIV is growing and to specifically target that population. HIV/AIDS programming will also address the sexual desires of young people perinatally infected with HIV by providing them with information and practical support to understand …

Avances En La Atención Postaborto En América Latina Y El Caribe: Investigando, Aplicando Y Expandiendo, Deborah L. Billings, Ricardo Vernon

Reproductive Health

This work by the Population Council and Ipas documents the intellectual, financial, and managerial effort that many organizations and institutions in Latin America and the Caribbean have made to achieve the objective of improving the quality and effectiveness of postabortion care services. This volume is a contribution to the preparation of directors, owners, and service providers, and to the creation and implementation of policies and programs based on scientific evidence, which will benefit women and the services themselves. Its five sections include an overview; results from country studies, and information about providers and program components; clinical care with various technologies, …

Increasing Use Of The Iud Through Community And Clinic Based Education Activities In Rural Honduras, Ivo Flores Flores, Elida Rosa Aguilar Fonseca, Rosa Merlen Flores, Ricardo Vernon, Jorge Solorzano, Suyapa Pavon, Marco Tulio Falck, Alba Lidia Sanchez

Reproductive Health

This document presents the results of an operations research project implemented by the Ministry of Health in Honduras with technical and administrative assistance from the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program, ASHONPLAFA, and EngenderHealth, and funding from USAID. The project tested a strategy to inform communities about the availability of the IUD in nearby health centers and about the method’s most salient attributes. The main conclusion is that communication of messages about a specific contraceptive method, while also communicating messages about other contraceptive methods, through printed materials (flyers, brochures, and posters) and interpersonal messages (individual talks and counseling) …

Strengthening Financial Sustainability Through Integration Of Voluntary Counseling And Testing Services With Other Reproductive Health Services, Rumeli Das, Kaushik Biswas, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

In West Bengal, India, the Child in Need Institute (CINI) operated an HIV/AIDS voluntary confidential counseling and testing center and a reproductive health clinic at separate locations. Concerns about lack of service coordination as well as cost and revenue considerations led CINI to integrate the two services. CINI conducted an operations research study to examine the impact of integration on utilization and revenues. The objective of the study was to examine whether integration of services would yield an increase in clients served and improve the financial position of the program. The study found that integrating services was associated with increased …

Provision Of Emergency Contraceptive Services Through Paraprofessionals In India, Shiv Kumar, Chander Shekhar, N.K. Gupta, Malabika Roy, M.E. Khan, Mary Philip Sebastian, Rukma Idnani, Ardash Bhargava, Vinita Salvi

Reproductive Health

In 2004, with funding for technical assistance provided by USAID, the Indian Council of Medical Research funded and collaborated with the Frontiers in Reproductive Health (FRONTIERS) program of the Population Council on a two-year study to assess the usefulness and effectiveness of using paraprofessionals in educating and providing emergency contraception (ECP) services to potential users. Based on the findings and advocacy efforts, the Indian Ministry of Health and Family Welfare introduced ECP as an over-the-counter medication beginning in September 2005. This made it possible for paraprofessionals in the National Family Planning Program to provide ECP services, making the method widely …