This study aimed to assess the prevalence of and risk factors associated with alcohol abuse among women and men in Moshi in northern Tanzania. Alcohol abuse was measured by a CAGE score of 2–4, versus 0–1 for no alcohol abuse (Ewing, 1984). Crude and adjusted logistic regression models determined odds ratios (OR) and 95% confidence intervals (95% CI) of alcohol abuse by characteristics of, respectively, women with partners (n=1200), women without partners (n=614) and men (n=788) (women’s partners). Prevalence of alcohol abuse was 7·0% (95% CI: 5·6–8·4) among women with partners, 9·3% (95% CI: 7·0–11·6) among women without partners, and more than double among men at 22·8% (95% CI: 19·9–25·8). In general, Christians had higher alcohol abuse than Muslims or other religions, as did Chagga men compared with men of other ethnic groups. Other socio-demographic characteristics, such as education or income, were not significant. Sexual behaviours were significant predictors of alcohol abuse. For example, women without partners who reported more than two partners in the last year had higher alcohol abuse compared with women reporting no partners (OR=8·75; 95% CI: 2·37–32·31), as did men reporting it is ‘OK to hit a partner’ for any reason (OR=1·79; 95% CI: 1·16–2·77) compared with men who did not. HIV-1 infection was not significantly associated with alcohol abuse by women or men. The Christian Church in Moshi should consider raising awareness about the harmful effects of high alcohol use among its adherents. Comprehensive programmes focusing on reducing number of partners and alcohol use, particularly by men, are needed in this community.

There is certainly a growing need to justify the significance of studying health-seeking behaviours for designing advocacy campaigns, lobbying for a policy shift and convincing donors to invest in priority areas. Moreover, policymakers need to be encouraged to design evidence-based policies that take into account information relating to health-promoting, -seeking and -utilization behaviour and the factors determining these behaviours. This paper primarily covers the ‘methodology’ used in the study of health-seeking behaviours and determinants of health services utilization in a predominantly rural district of Pakistan. The paper substantiates that this methodology is comprehensive and reliable, and there is potential for replicating this in similar settings. The approach of Kroeger in his research on the study of health-seeking behaviours, particularly in developing countries, provides the most holistic framework for examining, analysing and interpreting factors and determinants of health-seeking behaviours and health services utilization in developing countries. This study endeavoured to validate Kroeger’s framework in a Pakistani setting, exploring all the factors listed through mixed method research, and qualitative supplemented by representative quantitative enquiry. This approach has also helped in understanding the inter-relationship of various factors and drivers of health-seeking behaviours from all angles.

The socioeconomic milieu has benefits and drawbacks for determining level of nutrition. The Indian population provides an excellent example of nutrition-driven adaptation. The present paper deals with the relationship between BMI (body mass index) and traditional occupation and process of adaptation among adult males of Central India. Anthropometric data collected by the Anthropological Survey of India on stature, sitting height and weight of 6663 adult males belonging to 22 castes were used for computation of BMI and Cormic index. The caste groups earning their living as labourers are found to be shortest (157·4±6·5 cm), and the caste group practising priesthood are tallest (168·6±6·6 cm). The prevalence of chronic energy deficiency is found to be highest (72%) among castes earning their living as daily wage labourers. The ANOVA on Cormic index and BMI suggests that people within the same occupational group are more homogeneous than those from different occupational groups. The t test also supports the homogeneity of the same occupational group.

During the past year, data have been published on the offspring sex ratios of people diagnosed with toxoplasmosis, hepatitis B, and pre- and post-menopausal breast cancer. It is shown here how these offspring sex ratios constitute further support for the hypothesis that mammalian (including human) parental hormone concentrations around the time of conception partially control the sexes of the resulting infants. If this interpretation were correct, then hormonal treatments might be considered for some or all of these conditions. It is intended that anyone who has read the present note and my two previous papers (James, 1996, 2004) should be aware of all the data relating to the hypothesis.

Several studies have found relationships between early life factors (birth weight, length of gestation, height, weight, duration of breast-feeding, maternal age, social class, periods of infection, presence of adverse life events, and quality of housing conditions in childhood) and age at menarche but none has considered all of these factors in the same study. The follow-up study of the Newcastle Thousand Families birth cohort, established in 1947, provided age at menarche data collected retrospectively at age 50 from 276 women who returned self-completion questionnaires in 1997. Three main independent associations were observed: girls who experienced a shorter gestation, girls whose mothers were younger when they were born, and girls who were heavier at age 9 had earlier menarche. Birth weight, standardized for gestational age, was found to have different relationships with age at menarche depending upon how heavy or light a girl was at age 9. The results of this study support the hypotheses that conditions in fetal and early life are associated with the timing of menarche and that greater childhood growth is associated with earlier menarche. It is suggested that future work should focus on illuminating the mechanisms underlying these statistical relationships.

Using data from the first wave of the Netherlands Kinship Panel Study (NKPS) for 2867 women and 2195 men aged 40 to 79, this study examines to what extent educational, employment and marital pathways shape the likelihood of remaining childless, and whether these pathways are gendered. The findings indicate that women and men have distinctive pathways into childlessness. Educational attainment increases the likelihood of remaining childless among women only. A stable career increases the likelihood of remaining childless among women, but it increases the likelihood of entering fatherhood. Years without a partner is positively associated with childlessness among both women and men. Not having had a partnership and having had multiple partnerships are strong determinants of childlessness, especially among men.

This study examines the short- and long-term effects of war-induced and war-unrelated migration on fertility outcomes using data from two peri-urban municipalities of Greater Luanda in Angola. In the short term, results from multi-level discrete-time logistic regression models indicate that net of other factors, war-unrelated migration is associated with a lower probability of birth than war-induced migration in a given year. Similar results are obtained when the effects of migration are lagged by a year. At the same time, the effects of war-triggered migration do not differ significantly from those of not migrating in a given year but are statistically significant when the effects of migration are lagged by a year. In the long term, the effects of migration experience on cumulative fertility are negligible and not statistically significant net of demographic and socioeconomic variables. Interpretations of the results are offered in the context of Angola and their broader implications are reflected on.

Although the IUD is an extremely effective and low-cost contraceptive method, its use has declined sharply in Kenya in the past 20 years. A study tested the effectiveness of an outreach intervention to family planning providers and community-based distribution (CBD) agents in promoting use of the IUD in western Kenya. Forty-five public health clinics were randomized to receive the intervention for providers only, for CBD agents only, for both providers and CBD agents, or no detailing at all. The intervention is based on pharmaceutical companies’ ‘detailing’ models and included education/motivation visits to providers and CBD programmes, as well as provision of educational and promotional materials. District health supervisors were given updates on contraceptives, including the IUD, and were trained in communication and message development prior to making their detailing visits. Detailing only modestly increased the provision of IUDs, and only when both providers and CBD agents were targeted. The two detailing visits do not appear sufficient to sustain the effect of the intervention or to address poor provider attitudes and lack of technical skills. The cost per 3·5 years of pregnancy protection was US$49·57 for the detailing intervention including the cost of the IUD, compared with US$15·19 for the commodity costs of the current standard of care – provision of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA). The effectiveness of provider-based activities is amplified when concurrent demand creation activities are carried out. However, the cost of the detailing in comparison to the small number of IUDs inserted indicates that this intervention is not cost-effective.

In modern societies, there are regular social gradients in most health parameters, and also in the structure of morbidity and mortality. However, the significance of inter-generation social mobility for general health status still remains equivocal. This study was therefore performed in order to compare the effect of social mobility on coronary heart disease (CHD) risk between middle-aged Polish men and women. A total of 342 men and 458 women, aged 40 and 50 and inhabitants of Wrocław, were examined. Risk of CHD was estimated using the Framingham Risk Score (FRS), calculated for each individual. Social mobility was defined as an inter-generation change in social status expressed as educational level between the examined individual and his/her father. Using two-variable regression models, it was demonstrated that FRS in men was determined by both their father’s education level (β=0·33, p<0·0001) and inter-generation change in educational status (β=0·18, p=0·008). In contrast, FRS in women was related only to their father’s education level (β=0·35, p<0·0001), but not to inter-generation social mobility (β=0·35, p=0·25). In particular, an incremental change in educational level among those men whose father had finished primary school at the very most or among those whose father had finished basic trade school was accompanied by a significant decrease in FRS (F=4·12, p=0·009 and F=3·25, p=0·04, respectively). It is concluded that inter-generation social mobility modifies CHD risk (as estimated using FRS) in middle-aged Polish men, but not in women. The precise mechanisms responsible for the observed sex difference in this phenomenon need to be established in further studies.

An isonymic analysis has been carried out using a sample of 1529 reconstituted families residing during 1870–1964 in Aranjuez, an urban area situated south of Madrid, Spain. The random, non-random and total-components inbreeding coefficients from isonymy were obtained and the various combinations of surnames compared in order to infer the patri- or matrilocal pattern of residence. Throughout the period studied the random component of inbreeding (Fr) has not changed, in contrast to the non-random component (Fn), thus suggesting the latter could be responsible for the reduction of total inbreeding. Using several methodological approaches (biplot analysis, α, ν and percentage of immigrants) the predominance of the immigration of grooms was interpreted in terms of Aranjuez as a matrilocal pattern of residence. From this study it can also be concluded that surnames provided by reconstituted families are good estimators of inbreeding and migration.

This study used data from a community-based survey to examine women’s experiences of abortion in Nigeria. Fourteen per cent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two per cent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women’s socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman’s life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.

Globally, unplanned pregnancies and sexually transmitted infections (STIs) persist as significant threats to women’s reproductive health. Barriers to the use of modern contraceptives by women might inhibit uptake of novel woman-controlled methods for preventing STIs/HIV. Use of modern contraceptives and perceptions and attitudes towards contraceptive use were investigated among women in Antananarivo, Madagascar, using qualitative research. The hypothetical acceptability of the diaphragm – a woman-controlled barrier contraceptive device that also holds promise of protecting against STIs/HIV – was assessed. Women consecutively seeking care for vaginal discharge at a public health clinic were recruited for participation in a semi-structured interview (SSI) or focus group discussion (FGD). Audiotaped SSIs and FGDs were transcribed, translated and coded for predetermined and emerging themes. Of 46 participating women, 70% reported occasional use of male condoms, mostly for preventing pregnancy during their fertile days. Although women could name effective contraceptive methods, only 14% reported using hormonal contraception. Three barriers to use of modern contraceptives emerged: gaps in knowledge about the range of available contraceptive methods; misinformation and negative perceptions about some methods; and concern about social opposition to contraceptive use, mainly from male partners. These results demonstrate the need for programmes in both family planning and STI prevention to improve women’s knowledge of modern contraceptives and methods to prevent STI and to dispel misinformation and negative perceptions of methods. In addition, involvement of men will probably be a critical component of increased uptake of woman-controlled pregnancy and STI/HIV prevention methods and improved health.

Recent research has highlighted the risk of HIV infection for married teenage women compared with their unmarried counterparts (Clark, 2004). This study assesses whether a relationship exists, for women who have completed their adolescence (age 20–29 years), between HIV status with age at first marriage and the length of time between first sex and first marriage. Multivariate analysis utilizing the nationally representative 2004 Cameroon Demographic and Health Survey shows that late-marrying women and those with a longer period of pre-marital sex have the highest risk of HIV. Although women in urban areas overall marry later than their rural counterparts, the positive relationship between age at marriage and HIV risk is stronger in rural areas. The higher wealth status and greater number of lifetime sexual partners of late-marrying women contribute to their higher HIV risk. Given that the age at first marriage and the gap between first marriage and first sex have increased in recent years, focusing preventive efforts on late-marrying women will be of much importance in reducing HIV prevalence among females.

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children’s survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999–2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban–rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural–urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant–native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural–urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor–non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant’s children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban–rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.

In this paper, longitudinal data from northern Ghana is used to assess the effects of encouragement to use family planning that men receive from their personal network partners on the adoption of modern contraception by their wives. The study tests a conceptual model that, in addition to the effect of men’s network encouragement, incorporates the effect of encouragement to use family planning that women receive from their respective network partners and the effect of spousal communication on reproductive matters and approval of family planning. Results show that encouragement received by men from their social networks significantly increases the likelihood of subsequent contraceptive use by their wives but this effect operates primarily by galvanizing spousal communication on reproductive matters. The effect of encouragement received by women from their respective network partners is largely independent from the effect of male network encouragement but it influences contraceptive adoption both directly and through spousal communication.

The study of marriage seasonality of populations with different socioeconomic backgrounds may contribute to the better understanding their reproductive behaviours. This study analyses the monthly distribution of marriages in the 19th century in four agricultural villages and four pastoral villages on the island of Sardinia (Italy). The data were derived from 7340 marriage acts (3571 for the four agricultural villages and 3769 for the four pastoral villages). The aim is to ascertain whether the Sardinian agricultural and pastoral communities followed the matrimonial models reported for contemporary Italy and Europe and whether there was a change in the monthly distribution of marriages between the two halves of the 19th century. The results suggest that the marriage seasonality of the Sardinian farmers and shepherds was very similar to the patterns shown in the 19th century by Italian and European agricultural and pastoral communities. The Sardinian farmers preferred to marry in autumn–winter, while the Sardinian shepherds had a very high concentration of marriages in summer–autumn. Both communities avoided marriages in the Advent and Easter periods and in the month of May (dedicated to the Virgin Mary), and the farmers also in August (also dedicated to the Virgin Mary). Despite a certain seasonal stability, there was a significant change in the monthly distribution of marriages between the two halves of the 19th century in both the agricultural and pastoral communities, probably due to a series of laws that transformed the centuries-old socioeconomic system of Sardinia in the second half of the century.

The ‘helpers at the nest’ hypothesis suggests that individuals who are not currently reproducing often help kin by caretaking and thereby increase their inclusive fitness. Using a large scale historical dataset (Integrated Public Use Microdata Series sample of 1910; n=13,935), the hypothesis is tested that childless couples are more likely to fulfil such a role by taking care of a niece or nephew, but not a parent, than couples with children. Childless couples were significantly more likely to take care of a niece or nephew than couples with children. In contrast, couples with children and childless couples did not differ in caretaking of parents. Childless couples were also more likely to have more and younger nieces/nephews in their home than couples with children.

The use of height data to measure living standards is now a well-established method in economic history. Moreover, a number of core findings in the literature are widely agreed upon. There are still some populations, places and times, however, for which anthropometric evidence remains thin. One example is 19th century African-Americans in US border-states. This paper introduces a new data set from the Missouri state prison to track the heights of comparable black and white men born between 1820 and 1904. Modern blacks and whites come to comparable terminal statures when brought to maturity under optimal conditions; however, whites were persistently taller than blacks in the Missouri prison sample by two centimetres. Throughout the 19th century, black and white adult statures remained approximately constant, while black youth stature increased during the antebellum period.

This study explores rural, suburban and urban differences in coronary heart disease (CHD) using the 2005 Behavior Risk Factor Surveillance Survey conducted in the United States. Although areal context is not often considered in morbidity studies, this study evaluates the importance of place of residence given that areas offer differential access to health infrastructures and different contextual factors that could affect health. Also examined is the role of geographic heterogeneity on the recent racial divergence in CHD in the United States. Results indicate that area of residence is associated with CHD diagnosis, net of health and demographic variables. The area-stratified analysis documents that rural residents are most impacted by exercise and smoking, while being male or above age 50 are most detrimental for suburban residents. In addition, the racial divergence in CHD is driven by differences in rural locales. These findings indicate a disparate impact of geography on CHD and highlight the need for health research to take into account areal context.

South Korea reported a total fertility rate (TFR) of 1·08 in 2005. This is the lowest level of all nations in the Organisation for Economic Co-operation and Development (OECD). Recently, the decline in the fertility rate has been a dominant phenomenon in Korea’s major cities. This study investigated the relationship between social environmental factors and fertility intentions for married women in Seoul, the capital of Korea, using a sample of 2211 married women who responded to the Seoul Citizens Health and Social Indicators Survey, 2005. Here, the effects of selected social environmental characteristics on fertility intentions are explored using multivariate logistic regression models. The relationships among a woman’s age, number of living children, job type, housing type, and social group participation were strong indicators of the intention to have additional children. Younger women living with fewer children generally have a higher intention to have additional children. Among women’s job types, blue-collar workers have a lower preference for additional children than white-collar workers and housewives. Married women participating in social groups have a lower preference for additional children than non-participants. Women’s participation in social activities appears to have various benefits, both individually and socially. However, whereas women’s participation in economic activities has been linked to questions of fertility in previous studies, the relationship between fertility and social activities has been downplayed. Women’s participation in social activities has increased over the past several decades, and the trend continues to grow. Therefore, women’s participation in social activities must be accepted as the status quo, and compatibility between women’s participation in social activities and childrearing needs to be increased. Consequently, a strong foundation for a fertility-friendly environment is needed, focusing on blue-collar workers and participation in social activities by married women.