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PubMed2006

Family stability during childhood and the risk to develop hypertensive diseases in pregnancy.

BACKGROUND: Parental care giving, divorce and death are associated with physical health as an adult. AIM: To investigate whether the structure of the nuclear family during childhood shows any correlation with the development of hypertensive diseases in pregnancy as an adult. STUDY DESIGN: Self-administered questionnaires were sent to 2600 women with hypertensive diseases in pregnancy and to 1484 controls. SUBJECTS: After confirmation of the diagnosis data from 842 patients and 623 control women were evaluated. OUTCOME MEASURES: Type, number and involvement of different caregivers, parental separation, parental death. RESULTS: In both groups parental separation and parental death were found equally often. In all age groups during childhood fathers were involved significantly less often in care giving when women with hypertensive disorders in pregnancy were compared to control women (1st-3rd year 23.4%/17%, <0.0001; 4th-10th year 25.7%/19.3%, <0.0001; 11th-18th year 30.1%/23.9%, <0.0001). The total number of caregivers involved was significantly higher in patients. CONCLUSIONS: The quality of parental care giving, i.e. the involvement of fathers and the total number of caregivers correlate with the risk to develop HDP. Further research is needed to specify underlying mechanisms and the relevant factors of the parent-child relationship.

Adult↗
PubMed2005

Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi.

This paper combines quantitative and qualitative data to investigate changes in perceived risk of contracting HIV/AIDS in rural Malawi. Using longitudinal survey data, we find that Malawians worried less about contracting HIV/AIDS in 2001 than in 1998. According to qualitative interviews and observational journal accounts, HIV/AIDS and strategies to prevent it are a frequent topic of conversation amongst married Malawians. Women report worrying most about their husbands as a possible source of infection, discussing with them the importance of avoiding infection, and, increasingly, using divorce to reduce their risk. Men report worrying most about their extramarital partners and adopting preventive strategies such as fewer partners and more careful partner selection. We show that the decline in perceived risk is significantly associated with declines in the behaviors that Malawians worry most about and perceptions of risk in individuals' social networks. We interpret these findings as evidence that Malawians are changing their behavior in ways that may reduce the spread of HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Adverse childhood experiences and risk of paternity in teen pregnancy.

OBJECTIVE: Few studies have investigated risk factors that predispose males to be involved in teen pregnancies. To provide new information on such factors, we examined the relationships of eight common adverse childhood experiences to a male's risk of impregnating a teenager. METHODS: We conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man's own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education. RESULTS: At least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P <.001) between the number of adverse childhood experiences and the risk of involvement in a teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64-100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences. CONCLUSION: Adverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four successive birth cohorts dating back to 1900-1929, suggesting that the effects of adverse childhood experiences transcend changing sexual mores and contraceptive methods. Efforts to prevent teen pregnancy will likely benefit from preventing adverse childhood experiences and their associated effects on male behaviors that might mediate the increased risk of teen pregnancy.

Adolescent↗
PubMed1988

The changing American family.

The increase in single-parent families, step-families, maternal employment, and young children in substitute care are among several important changes in the American family in recent decades. Although it is not clear that these changes necessarily lead to negative outcomes in children, it is apparent that a variety of potential risks and challenges confront many families today. Pediatricians can play a valuable role by helping families to adjust and cope with certain difficulties, such as divorce. However, in other areas such as child care, changes in public policies and programs are needed to better support families to optimally nurture their children.

Adolescent↗
PubMed2003

The epidemiology of cigarette smoking in Hong Kong Chinese women.

BACKGROUND: Smoking in women is a well-recognized public health problem. In many developed countries, cigarette smoking is now the single most important preventable cause of premature death in women. There are relatively few data on the epidemiology of cigarette smoking in Asian women, and this study examined the prevalence of and factors predisposing Chinese women to smoke cigarettes in Hong Kong. METHOD: A territory-wide random telephone survey of 26,716 households in Hong Kong was conducted. A total of 1064 current smokers and 291 ex-smokers were identified in these household, and in-depth interviews of 791 current smokers, 221 ex-smokers, and 1012 controls were conducted. RESULTS: The prevalence of cigarette smoking was 4.5% in women who were 25 years or younger, 2.6% in women aged 46-65 years, and 2.2% in women aged 65 years or older. Sixty-four percent of current smokers started when they were 19 years or younger. The main reasons for the initiation of cigarette smoking were the influence of friends, curiosity, feeling bored, or being idle. Current smokers and ex-smokers tended to have positive images of women who smoked. The following risk factors were found to be significant for cigarette smoking: less than university education, unemployment, being divorced, having a husband who smoked, and a low score on the perceived harms of cigarette smoking. CONCLUSION: Cigarette smoking is more prevalent in younger women in Hong Kong; and psychosocial issues should be addressed to prevent future epidemics.

Adolescent↗
PubMed2000

Revealing the existence of child abuse in the context of marital breakdown and custody and access disputes.

OBJECTIVE: Child abuse in the context of legal and de facto marital breakdown has received little attention internationally. Many believe it does not exist in this context and regard it as just a "gambit in the divorce wars." Recently, however, family courts in a number of countries have become concerned over the management of child abuse allegations in custody and access cases, known more commonly now as residence and contact cases. This article presents a unique research study, which investigated how the Family Court of Australia dealt with such cases. The study, covering all forms of child abuse, sought to discover who were the families bringing these problems to family courts, what precisely the abuse was and how the courts dealt with it. METHOD: The study reviewed court records of some 200 families where child abuse allegations had been made in custody and access disputes in jurisdictions in two states, observed court proceedings and interviewed court and related services' staff. RESULTS: The findings showed that these cases had become a core component of the court's workload without any public or professional awareness of this change, that the abuse was real, that it was severe and serious, and that the courts and child protection services did not provide appropriate services to the families. CONCLUSION: A new specialized intervention system was developed based on the research and it is now being trialed and evaluated. The new intervention system contains features derived from the research findings that may be suitable internationally for implementation.

Adult↗
PubMed2001

The family as the health producer--when spouses are Nash-bargainers.

The Grossman model is extended to a situation in which the family is regarded as the producer of individual health and spouses are Nash-bargainers. The model has implications for the interaction between family structure, income and the stocks of health capital and the bargaining strength of different family members. The main insight is that the possibility of divorce affects the distribution of health capital between family members. We analyse, inter alia, the impact on the distribution of health (particularly regarding child health) of changes in family policies related to the dissolution of the family.

Adult↗
PubMed2001

The impact of marital status on cancer survival.

Marital differentials in survival from 12 common types of cancer are assessed by estimating a mixed additive multiplicative hazard regression model on the basis of individual register and census data for the whole Norwegian population. These data cover the period 1960-91 and include more than 100,000 cancer deaths. The data and method make it possible to take into account the marital mortality differentialsin the absence of cancer. The excess all-cause mortality among cancer patients compared with similar persons without a cancer diagnosis is, on the whole, more than 15% higher for never-married men, never-married women and divorced men, than for the married of the same sex. Other previously married have an excess mortality elevated by about 7%. This protective effect of marriage is not due to stage, which is controlled for. The possible importance of treatment and host factors is discussed.

Aged↗
PubMed2004

[Psychosocial distress and stressful life antecedents associated with smoking. A survey of subjects consulting a preventive health center].

BACKGROUND: The relationship between smoking and various socio-demographic or socio-economic factors, as well as the interactions between depressive mood and smoking are already known. However, the respective contribution of psychological factors and stressful life antecedents during childhood and adolescence warrants further specification. METHODS: 2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health centre, supported by the National French Health insurance system, were invited to fill out a series of questionnaires: the GHQ-28 and the LOT, respectively measuring psychosocial distress and dispositional optimism, as well as a questionnaire on socio-demographic, socio-economic and biographical data. RESULTS: 78.1% complete records could be analysed: the "smokers" group (n = 870, 48.1%) declared a current tobacco consumption of at least one cigarette/day. This group was characterized by a predominance of male subjects, older age, modest educational level, low income level and responded to socio-economic criteria of precariousness more frequently (p < 0.001, except for age: p = 0.006). Smoking was also associated with higher levels of psychosocial distress, as assessed by GHQ-28, especially for the depressive mood and anxiety items of the questionnaire (p < 0.001), and with lower levels of dispositional optimism (p < 0.01). As regards biographical data, smokers were characterized by a way of life marked by financial problems, reduced social contacts, and a higher frequency, before the age of 18, of divorce or separation of the parents (p = 0.002), frequent parental quarrels (p < 0.001) or separation from the parents (p < 0.001). The presence of a depressive mood at GHQ-28 as well as frequent parental quarrels remained independent risk factors for smoking in multiple logistic regression (odds ratio respectively equal to 1.61 and 1.34), after adjustment on gender, educational level and the notion of socio-economic precariousness. CONCLUSION: These results highlight the complementary role of socio-economic, psychological factors and certain stressful life antecedents among the determinants of smoking and should be taken into account for tailoring smoking cessation programs.

Adolescent↗
PubMed1991

Effects of socioeconomic factors on secular trends in suicide in Japan, 1953-86.

The effects of socioeconomic factors on secular trends in suicide rates in Japan for the periods 1953-72 and 1973-86 were investigated using twelve socioeconomic indicators. Multiple regression analysis showed that the socioeconomic indicators affecting suicide rates were not identical in the two periods. The rates in both sexes in 1953-72 were closely related to unemployment rate and the labour force but between 1973 and 1986, divorce rate and the proportion in tertiary industry were most influential. The changes reflect the socioeconomic changes in industrial structure in Japan in transition from an industrial to a service economy.

Adolescent↗
PubMed1998

Stability of marital unions and fertility in Nigeria.

Using nationally representative data, it is shown that marital unions are relatively stable in Nigeria. Remarriage rates are high so little time is lost between unions. Consequently, the fertility of women who have experienced marital disruption is only slightly lower than for those in stable unions. Their slightly lower parity may be a function of a high incidence of reproductive impairment, which is a major reason for divorce and separation in Nigeria.

Adult↗
PubMed1988

Suicide, age and marital status.

A new data set concerning suicide in relation to marital status for Scotland, 1973-83, is presented. The effects of age-standardization on marital status rates and of marital status standardization on age-specific rates are both elucidated. The difficulties of drawing conclusions from marital status rates for suicide are outlined. Nevertheless, the data suggest that the importance of the widowed state has been underestimated and that it appears that the relative risk for suicide associated with divorce has probably been decreasing among Scottish men over the study period.

Adolescent↗
PubMed1998

Schizophrenic patients who were never treated--a study in an Indian urban community.

BACKGROUND: A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood. METHOD: A door-to-door survey was conducted on an Indian urban population of 100,000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information. RESULTS: Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and divorced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment. CONCLUSION: The larger extended/joint family, which was able to compensate and cope with the dysfunctional member, seemed to be the crucial factor related to non-treatment of the schizophrenic patient.

Adult↗
PubMed2000

Interparental conflict and adolescent depressed mood: the role of family functioning.

Family functioning was investigated as a mediator between interparental conflict and adolescent depressed mood among adolescents living in two-parent and divorced families. Data were collected three times, with one year intervals. At the initial interview, adolescents were, on the average, 15.5 years old. Two types of interparental conflict were assessed: interparental conflict involving arguments about the adolescent, and arguments focused on the parents' behaviors. The results confirmed that family functioning mediated the effects of parent issue/interparental conflict, but not adolescent issue/interparental conflict. This was most evident for girls than boys. Implications of the findings for research and practice are discussed.

Adolescent↗
PubMed2001

The effects of joint legal custody on mothers, fathers, and children controlling for factors that predispose a sole maternal versus joint legal award.

Findings from comparisons of joint and sole custody families that do not control for predivorce differences in demographic and family process variables (factors that may predispose families to choose or be awarded joint custody) are of limited generalizability, since obtained group differences may be attributable to predisposing (self-selection) factors, custody, or both. This study compared a random sample of 254 recently separated, not-yet-divorced families on 71 predivorce variables that might plausibly differentiate between families awarded joint legal versus sole maternal custody. Twenty such factors were identified and controlled for in subsequent comparisons of 52 sole maternal and 26 joint legal custody families 2 years postdivorce. Families with joint custody had more frequent father-child visitation, lower maternal satisfaction with custody arrangements, more rapid maternal repartnering, and fewer child adjustment problems (net of predivorce selection factors). Moreover, these effects did not appear to be moderated by level of predecree parental conflict. No association between custody and fathers' compliance with child support orders was obtained.

Adaptation, Psychological↗
PubMed2004

Adult sexual assault: prevalence, symptomatology, and sex differences in the general population.

The prevalence and impact of adult sexual assault (ASA) were examined in a stratified random sample of the general population. Among 941 participants, ASA was reported by 22% of women and 3.8% of men. Multivariate risk factors for ASA included a younger age, being female, having been divorced, sexual abuse in childhood, and physical assault in adulthood. Childhood sexual abuse was especially common among sexually assaulted men and women (61 and 59%, respectively). ASA victims were more symptomatic than their nonassaulted cohorts on all scales of the Trauma Symptom Inventory (TSI; J. Briere, 1995), despite an average of 14 years having passed since the assault. Assaulted men reported greater symptomatology than assaulted women, whereas nonassaulted men reported less symptomatology than nonassaulted women.

Adolescent↗
PubMed1993

Analyzing change in short-term longitudinal research using cohort-sequential designs.

This article illustrates a method for approximating longitudinal data analysis by combining information from different overlapping age groups to form a single developmental growth curve. Using this method, hypotheses about the form of growth, the extent of individual differences in growth, and factors that affect the rate and pattern of growth are investigated. The example used to illustrate this method examines the growth of externalizing behavior and of negativity in parent-child relationships during early adolescence using assessments from multiple methods and multiple informants. These 3 dimensions changed significantly during this period, with parental negativity increasing more rapidly after age 12. However, there were substantial individual differences in the pattern of change in these dimensions. Gender of child and type of family situation (nondivorced, divorced, and remarried) were investigated as possible factors affecting change.

Adolescent↗