International Public Health Commons^™

Dietary Carbohydrates And Breast Cancer Risk: A Prospective Study Of The Roles Of Overall Glycemic Index And Glycemic Load, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

We examined breast cancer risk in association with overall glycemic index (GI), glycemic load (GL), and dietary carbohydrate and sugar intake in a prospective cohort of 49,613 Canadian women enrolled in the National Breast Screening Study who completed a self‐administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow‐up ending between 1998 and 2000. During a mean follow‐up of 16.6 years, we observed 1,461 incident breast cancer cases. GI, GL, total carbohydrate and total sugar intake were not associated with breast cancer risk in the total …

Dietary Carbohydrates And Breast Cancer Risk: A Prospective Study Of The Roles Of Overall Glycemic Index And Glycemic Load, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

We examined breast cancer risk in association with an overall glycemic index (GI), glycemic load (GL), and dietary carbohydrate and sugar intake in a prospective cohort of 49,613 Canadian women enrolled in the National Breast Screening Study who completed a self-administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000. During a mean follow-up of 16.6 years, we observed 1,461 incident breast cancer cases. GI, GL, total carbohydrate, and total sugar intake were not associated with breast cancer risk in the …

A Theater-Based Approach To Primary Prevention Of Sexual Behavior For Early Adolescents, Jessica B. Janega, David M. Murray, Sherri P. Varnell, Jonathan L. Blitstein, Amanda Birnbaum, Leslie A. Lytle

Department of Public Health Scholarship and Creative Works

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (σΔ) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers using these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods are …

Assessing Intervention Effects In A School-Based Nutrition Intervention Trial: Which Analytic Model Is Most Powerful?, Jessica B. Janega, David M. Murray, Sherri P. Varnell, Jonathan L. Blitstein, Amanda Birnbaum, Leslie A. Lytle

Department of Public Health Scholarship and Creative Works

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (σΔ) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers to use these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods …

A Schematic For Focusing On Youth In Investigations Of Community Design And Physical Activity, Kevin J. Krizek, Amanda Birnbaum, David M. Levinson

Department of Public Health Scholarship and Creative Works

This paper provides a first step in addressing special considerations for youth in a relatively new area of physical activity research. After reviewing the urgent need for novel approaches to increasing physical activity, the growing interest in the effects of community design are discussed. Although most discussion on this topic has focused on adults, there are important differences between youth and adults that warrant a special focus on youth and need to be accounted for. This article presents a schematic that accounts for how and where youth spend their time, decomposing the day into time spent in travel and time …

Casting Health Messages In Terms Of Responsibility For Dietary Change: Increasing Fruit And Vegetable Consumption, Pamela Williams-Piehota, Ashley R. Cox, Stephanie A. Navarro Silvera, Linda Z. Mowad, Sharon Garcia, Nicole A. Katulak, Peter Salovey

Department of Public Health Scholarship and Creative Works

Objective

To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake.

Design/Setting

Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later.

Participants

528 callers to a cancer information hotline who were not meeting the “5 A Day” dietary recommendation.

Interventions

A brief telephone-delivered message and 3 mailings of pamphlets and promotional items encouraging fruit and vegetable intake that emphasized either personal or social …

School-Based Approaches To Affect Adolescents’ Diets: Results From The Teens Study, Leslie A. Lytle, David M. Murray, Cheryl L. Perry, Mary Story, Amanda Birnbaum, Martha Y. Kubik, Sherri Varnell

Department of Public Health Scholarship and Creative Works

This article reports on the outcomes of the Teens Eating for Energy and Nutrition at School (TEENS) study, a 2-year intervention study conducted in 16 middle schools with a goal of increasing students’ intakes of fruits, vegetables, and lower-fat foods. Despite positive interim results for students randomized to intervention schools, the positive effects of the intervention were not seen for the primary outcomes at the end of the 2nd year. Positive effects were seen only for a food choice score (suggesting that the students usually choose lower versus higher fat foods) and not for measures of food intake. Future studies …

Assessing The Most Powerful Analysis Method For School-Based Intervention Studies, Jessica B. Janega, David M. Murray, Sherri P. Varnell, Jonathan L. Blitstein, Amanda Birnbaum, Leslie A. Lytle

Department of Public Health Scholarship and Creative Works

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and a single posttest, the most common design used in GRTs. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs with alcohol, tobacco, and other drug measures as the outcomes of interest. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect of both adjustments for fixed and time-varying covariates, as well as correlations over time. These estimates will allow other researchers using these variables to plan their studies by …

An Assessment Of Hiv/Aids Risk In Higher Education Students In Yerevan, Armenia, Talin Babikian, Mary Catherin Freier, Gary L. Hopkins, Ralph Diclemente, Duane C. Mcbride, Matt Riggs

Faculty Publications

Armenia's current sociopolitical and economic instability and the alarming HIV incidence rates in neighboring countries amplify its risk for a national epidemic. The goals of this study were to assess HIV/AIDS knowledge and risk behaviors among higher education students in Yerevan. Knowledge of HIV transmission through sexual intercourse was markedly higher than that on intravenous transmission and prevailing myths; however, HIV/AIDS knowledge was not related to risk behaviors. Tobacco and alcohol prevalence was relatively high. Students reported risky sexual behaviors, including inconsistent condom use, casual sex, and multiple partners. In addition to descriptive statistics delineating gender differences across the target …

Encuestas De Voluntad De Pago Para Fijar Precios De Productos Y Servicios De Salud Reproductiva: Manual De Usuarios, Karen G. Fleischman Foreit, James R. Foreit

Reproductive Health

Social programs need to balance volume (coverage) and income (sustainability). The law of supply and demand states that we can not obtain coverage and support at the same time, because when prices rise, demand decreases. This manual presents willingness-to-pay (WTP) surveys that allow program managers to simulate changes in demand related to price, without actually changing prices. The Population Council with The Futures Group International developed these surveys that can be used for existing and new products and services, collect responses from clients with no formal education with sensitivity to their individual characteristics, and provide conservative estimates that accurately predict …

Medicalization Of Female Genital Cutting Among The Abagusii In Nyanza Province, Kenya, Carolyne Njue, Ian Askew

Reproductive Health

This study sought to understand the role that health providers play in the medicalization of female genital cutting (FGC) among the Abagusii community in western Kenya, among whom the practice continues to be almost universal. Interviews with service providers and their clients revealed an overwhelming belief that FGC fulfills a traditional cultural obligation among the Abagusii, and that it limits a woman’s sexual desire and confers respect on girls. New approaches are needed within this community to present FGC as violating human rights and national laws, as well as threatening girls’ and women’s health. The study recommends measures such as …

Effects Of Igss' Job Aids-Assisted Balanced Counseling Algorithms On Quality Of Care And Client Outcomes, Federico R. Leon, Carlos Brambila, Marisela De La Cruz, John H. Bratt, Gustavo Gutierrez, Veronica Davila, Carlo Boniato, Alex Rios

Reproductive Health

This study identified a need to improve the quality of care at the main maternity hospital of the Social Security Institute (IGSS) in Guatemala. Problems included very short counseling sessions, counseling not focused on clients’ needs, redundancy in the role of physicians and social workers as providers, skewed method mix, and low client return rate for method resupply. The intervention, using Balanced Counseling Algorithms, changed the counseling behavior of physicians and social workers and enhanced the quality of family planning care. The report includes recommendations for continuing these improvements: monitoring provider implementation of the job aids–assisted Balanced Counseling Algorithms, monitoring …

Improving Health Care Providers' Knowledge, Attitudes, And Practices In Reproductive Health In Rural Romania, Elaine Claire Himelfarb

Reproductive Health

To support new health reform initiatives undertaken by the Romanian Ministry of Health and Family, and in support of the USAID Romania strategy for improving women’s reproductive health, Project Concern International/Romania (PCI/R) was awarded a two-year grant to implement a reproductive healthcare project, Healthy Parents-Healthy Children (HP-HC). This project trained family physicians and nurses in rural dispensaries in techniques to improve pre- and postnatal care, including training on modern contraception, cervical and breast cancer screening, treating menopause and its symptoms, and the encouragement of healthy lifestyles. The goal of this OR project was to test the efficacy of interventions to …

Strengthening Sti Treatment And Hiv/Aids Prevention Services In Carletonville, South Africa, Lewis Ndhlovu, Catherine Searle, Johannes Van Dam

HIV and AIDS

Although knowledge about HIV/AIDS is widespread in South Africa, adult HIV prevalence is high, indicating high levels of risky sexual behavior. Understanding the gap between knowledge and behavior requires an examination of the social context in which the epidemic occurs. The Horizons Program conducted an intervention study in the Carletonville area to study the social determinants of the HIV epidemic and to assess the impact of a targeted program of HIV and STI prevention and service delivery. In 1998, the Mothusimpilo (“Working together for health”) Intervention Project (MIP) was launched to reduce community prevalence of HIV and other STIs and …

Equitable Access To Hiv Counseling And Testing For Youth In Developing Countries: A Review Of Current Practice, Ann P. Mccauley

HIV and AIDS

While many people get HIV-related counseling and testing, only those who receive pre- and post-test counseling, and test voluntarily, are participating in voluntary counseling and testing (VCT). The high rates of HIV infection among youth make it crucial to find programs to prevent infection. Because there is evidence that many adults benefit from VCT, there is increasing interest in extending these services to young people. VCT counseling helps adolescents evaluate their own behavior and its consequences. A negative test result offers the opportunity to recognize vulnerabilities and develop risk-reduction plans to adopt safe behaviors. Young people who test HIV-positive can …

Willingness To Pay Surveys For Setting Prices For Reproductive Health Products And Services: A User's Manual, Karen G. Fleischman Foreit, James R. Foreit

Reproductive Health

Social programs need to balance volume (coverage) and revenue (sustainability). The law of demand says that we cannot get both coverage and sustainability at the same time—as prices go up, demand will come down. Client loss with increasing prices is inevitable, except in those cases where starting prices are so low or demand is so high that demand is insensitive to price changes. Willingness to pay surveys allow program managers to simulate price-related changes in demand without actually changing prices, giving them a way to make pricing decisions based on empirical information. In making pricing decisions, managers of social programs …

Integration Of Reproductive Health Services For Men In Health And Family Welfare Centers In Bangladesh, Ubaidur Rob, Sharif M.I. Hossain, M.E. Khan, Ahmed Al-Sabir, Mohammed Ahsanul Alam

Reproductive Health

Since the mid-1970s, the Bangladesh national family planning program primarily focused on motivating women to use modern contraceptive methods and encouraging them to seek services from clinics. In addition, female field workers were recruited to deliver contraceptive methods at homes. The program design facilitated women’s access to information and medical care through clinics and home visits. In the process, however, the medical needs of males were marginalized. Men generally seek services from pharmacies, private practitioners, and district hospitals, and often ignore preventive steps and postpone seeking medical care for chronic health conditions. In cases of acute illness, they often resort …

Promoting Young People's Sexual And Reproductive Health: Stigma, Discrimination And Human Rights, Kate Wood, Peter Aggleton

Reproductive Health

Sponsored jointly by the DFID-supported Safe Passages to Adulthood program, John Snow International, YouthNet/Family Health International, and the Population Council, the international knowledge synthesis meeting on Promoting Young People’s Sexual and Reproductive Health: Stigma, Discrimination and Human Rights took place in Brighton, England, June 5–7, 2003. Participants from a wide variety of countries were invited to describe their experiences of working to challenge stigma and discrimination and promote human rights as they relate to young people’s sexual and reproductive health. The meeting brought together program leaders from a variety of countries to discuss stigma, discrimination, and human rights in relation …

Formal And Informal Abortion Services In Rajasthan, India: Results Of A Situation Analysis, Sandhya Barge, Hillary J. Bracken, Batya Elul, Nayan Kumar, Wajahat U. Khan, Shalini Verma, Carol Camlin

Reproductive Health

As part of a Population Council program of research on unwanted pregnancy and induced abortion in Rajasthan, the Population Council and the Centre for Operations Research and Training conducted a situation analysis of abortion services in both the formal and informal sectors in six districts. This report offers insights into the availability and organization of abortion services in the sampled areas in Rajasthan. The report also documents a vast array of informal providers who offer services for delayed menstruation or unwanted pregnancy. Informal providers appear particularly accessible to women because they are far more prevalent in rural areas than formal …

Determining An Effective And Replicable Communication-Based Mechanisms For Improving Young Couples' Access To And Use Of Reproductive Health Information And Services In Nepal—An Operations Research Study, Center For Research On Environment Health And Population Activities (Crehpa)

Reproductive Health

This operations research study sought to determine an effective communication-based model for increasing the involvement of community-based groups in improving access to and use of reproductive health services and information by young married couples. The study employed a quasi-experimental design with two experimental and two nonequivalent control groups in the Udaypur district of Nepal. As stated in this report, this OR study clearly demonstrates the effectiveness of communication-based models such as the formation and reactivation of Youth Communication Action Groups and Mother’s groups, basic and refresher training, group interaction and mobilization, and social events in creating an enabling environment for …

Understanding Induced Abortion: Findings From A Programme Of Research In Rajasthan, India, Population Council

Reproductive Health

In India, abortion has been legal for over 30 years, following the enactment of the Medical Termination of Pregnancy (MTP) Act in 1971. While the MTP Act permits abortion for a broad range of social and medical reasons, it also includes provisions regarding delivery of services that have proved to constrain access to safe and legal abortion for the great majority of women in India. Due in part to these constraints, up to 90 percent of the six million induced abortions estimated to occur annually in India are illegal—provided in uncertified settings and/or by uncertified providers. Many are unsafe and …

Improving Adolescent Reproductive Health In Bangladesh, Ismat Bhuiya, Ubaidur Rob, Asiful Haider Chowdhury, Laila Rahman, Nazmul Haque, Susan E. Adamchak, Rick Homan, M.E. Khan

Reproductive Health

An operations research project was launched in northwestern Bangladesh with the objective of preventing adverse outcomes and promoting healthy lifestyles among adolescents by providing reproductive health education and services. The Population Council, in collaboration with the Urban Family Health Partnership and its three nongovernmental service delivery partners, worked in three urban areas of the country. On the basis of its findings, the study first recommends implementation of a combination of reproductive health interventions at the school, community, and health-facility levels, accompanied by community sensitization, to effectively respond to adolescent reproductive health needs. Second, information providers such as teachers and facilitators …

Scaling Up A Successful Counseling Model In Guatemala, Guatemalan Association Of Female Physicians (Agmm)

Reproductive Health

This project aimed to improve clients’ ability to make an informed choice of contraceptive methods by scaling up the use of the balanced counseling strategy in public service delivery institutions in Guatemala. To reach this end, the project provided technical assistance to Calidad en Salud (Quality in Health), the leading reproductive health project in Guatemala, to train service providers in public institutions about the counseling methodology. The project successfully introduced the balanced counseling strategy in Guatemala and, as a result, has improved the informed choice of contraceptives in the country.

Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Dale Huntington, Mary Philip Sebastian, Barbara Mensch, Wesley H. Clark, Aditya Narain Singh, Sohini Roychowdhury, M.E. Khan, Nirmala Selvam, Bella C. Patel, Sandhya Barge, Y.P. Gupta, Lovleen Johri, Gita Biswas, Manohar Shenoy

Reproductive Health

The Population Council’s Frontiers in Reproductive Health (FRONTIERS) program and Policy Research Division, in collaboration with CARE India, conducted an operations research study in Allahabad, Uttar Pradesh to examine the feasibility and impact of adding livelihood counseling and training, savings formation activities, and follow-up support to an ongoing reproductive health program for adolescents. The short-term objective of the study was to foster development of alternative socialization processes for adolescent girls that encourage positive sexual and reproductive health behaviors. The study also aimed to produce a replicable model for CARE and other agencies to use in adding livelihood activities to adolescent …

Developing A Supervision Instrument For Postabortion Care In Guatemala, Bolivia And Mexico, Carlos Brambila

Reproductive Health

The main objective of this project was to develop and test a supervision instrument and corresponding guidelines to collect information about postabortion care (PAC) services and to provide constructive feedback to service providers and program managers. The instrument and guidelines were designed to be used by technical supervisors to monitor performance and engage providers in continuous quality improvement of PAC services. As part of the project activities, existing postabortion care supervision practices were reviewed and analyzed, and, during a one-week workshop in December 2002, an international technical committee produced a first version of the instrument and guidelines. These materials were …

Involving Men In Maternity Care: South Africa, Busi Kunene, Mags Beksinska, Simphiwe Zondi, Nobuhle Mthembu, Saiqa Mullick, Emma Ottolenghi, Immo Kleinschmidt, Susan E. Adamchak, Barbara Janowitz, Carmen Cuthbertson

Reproductive Health

The Reproductive Health Research Unit University of the Witwatersrand, South Africa, in partnership with the FRONTIERS Program of the Population Council, and the KwaZulu-Natal Department of Health conducted a three-year operations research study titled “Men in Maternity” in the Ethekwini district. The intervention was clinic-based and included two broad strategies: improving antenatal care services by strengthening the existing antenatal package and service monitoring and supervision; and introducing couple counseling by providing training to health providers, inviting partners of antenatal women to attend counseling twice during pregnancy and once post delivery, and providing information to couples with a new antenatal booklet. …

Evaluation Of Community Education Interventions In Sexual And Reproductive Health Services In Urban-Marginal Areas Of La Paz, Bolivia, Maria Dolores Castro Mantilla, Mariel Loayza Antezana

Reproductive Health

The purpose of this study was to strengthen community strategies to improve quality-of-care services first implemented as part of a Bolivian Ministry of Health and Prevention and World Health Organization (WHO) project in 1997–98. To reach groups that do not regularly attend health facilities and improve community demand for services, the Centro de Información y Desarrollo de la Mujer (Center for Information and Development of Women) implemented a community education intervention focusing on sexual and reproductive health and rights targeting adolescents, men, and women with older or no children. Results showed that the interventions improved access to and utilization of …

Community Involvement In Reproductive Health: Findings From Research In Karnataka, India, Foundation For Research In Health Systems

Reproductive Health

In 1996, the government of India decided to provide a package of reproductive and child health services through the existing family welfare program, adopting a community needs assessment approach (CNAA). To implement this approach, the government abolished its practice of setting contraceptive targets centrally and introduced a decentralized planning strategy whereby health workers assessed the reproductive health needs of women in their respective areas and prepared local plans to meet those needs. They also involved community leaders to promote community participation in the reproductive and child health program. Since 1998, several evaluation studies have assessed the impact of CNAA on …

A World Apart: The Disadvantage And Social Isolation Of Married Adolescent Girls, Nicole Haberland, Erica Chong, Hillary J. Bracken

Poverty, Gender, and Youth

This brief is based on a paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents, held in Geneva, Switzerland, December 9–12, 2003. The consultation brought together experts from the United Nations, donors, and nongovernmental agencies to consider the evidence regarding married adolescent girls’ reproductive health, vulnerability to HIV infection, social and economic disadvantage, and rights. The relationships to major policy initiatives—including safe motherhood, HIV, adolescent sexual and reproductive health, and reproductive rights—were explored, and emerging findings from the still relatively rare programs that are directed at this population were discussed. Despite the program attention and funding that have …

Socioeconomic Disadvantage And Unsafe Sexual Behaviors Among Young Women And Men In South Africa, Kelly Hallman

Poverty, Gender, and Youth

This study investigates how relative socioeconomic status influences the sexual behaviors of young women and men aged 14–24 years in KwaZulu-Natal Province, South Africa—an environment characterized by high HIV prevalence and high rates of poverty and inequality. Relative economic disadvantage is found to significantly increase the likelihood of a variety of unsafe sexual behaviors and experiences. Poorer young people, especially females, also have significantly lower access to media sources for family planning information. Without sufficient attention in the design and placement of HIV prevention programs to the economic and social conditions in which individuals live, the potential effectiveness of the …