How access to contraception affects fertility and contraceptive use in Tunisia

To a great extent, fertility decline in Tunisia can be explained by the rise in the age at which women marry, probably because they are better educated and because social legislation has given them more rights. A second major factor in fertility decline was the increased use of contraception. The main focus of this paper is what determines the practice of contraception. The general increase in the use of contraception was the result of a strong family planning program as well as increases in education over time. The family planning program in Tunisia is considered one of the best in the world. There has been a substantial program to improve the access of the rural, poor, and least educated population groups to family planning. Although in the last 10 years contraceptive use increased the most among the least educated women, these groups are still served less well than the more privileged. The results of this paper show the central role of mortality decline and access to contraception. Health facilities, especially clinics, and good water are important in reducing mortality, which in turn increases the motivation to restrict fertility and the likelihood that people will act on that motivation. The structural model used is designed to distinguish such community variables as access to family planning from the channels through which they operate.Health Monitoring&Evaluation,Adolescent Health,Reproductive Health,Early Child and Children's Health,Statistical&Mathematical Sciences

Reaching urban female adolescents at key points of sexual and reproductive health transitions: evidence from a longitudinal study from Kenya

Urban areas include large numbers of adolescents (ages 15-19) and young adults (ages 20-24) who may have unmet sexual and reproductive health (SRH) needs. Worldwide, adolescents contribute 11% of births, many of which are in low and middle-income countries. This study uses recently collected longitudinal data from urban Kenyan women to examine the association between targeted intervention activities and adolescents‘ SRH transitions. The focus was on a female adolescent (15-19) sample and their transition to first sex and first pregnancy/birth. Multinomial logistic regression methods were used to examine whether exposure to program activities was associated with delays in transitions. Overall, a high percentage of adolescents were exposed to television activities with family planning messages. About a third were exposed to community events, program posters, or the Shujaaz comic book that included themes related to relationships and positive health outcomes using recognizable characters. Multivariate analyses found that exposure to the Shujaaz comic book was associated with remaining sexually inexperienced and never pregnant at end line. Future programs for urban adolescents should implement interventions that test novel media strategies, like the Shujaaz comic book, that may be more interesting for young people. Innovative strategies are needed to reach female adolescents in urban settings.Keywords: Urban; Kenya; Sexual Initiation; Pregnancy; Adolescent

Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood

Abstract Background Built environment research is dominated by cross-sectional designs, which are particularly vulnerable to residential self-selection bias resulting from health-related attitudes, neighborhood preferences, or other unmeasured characteristics related to both neighborhood choice and health-related outcomes. Methods We used cohort data from the National Longitudinal Study of Adolescent Health (United States; Wave I, 1994-95; Wave III, 2001-02; n = 12,701) and a time-varying geographic information system. Longitudinal relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures (landcover diversity, pay and public physical activity facilities per 10,000 population, street connectivity, median household income, and crime rate) from adolescence to young adulthood were estimated using random effects models (biased by unmeasured confounders) and fixed effects models (within-person estimator, which adjusts for unmeasured confounders that are stable over time). Results Random effects models yielded null associations except for negative crime-MVPA associations [coefficient (95% CI): -0.056 (-0.083, -0.029) in males, -0.061 (-0.090, -0.033) in females]. After controlling for measured and time invariant unmeasured characteristics using within-person estimators, MVPA was higher with greater physical activity pay facilities in males [coefficient (95% CI): 0.024 (0.006, 0.042)], and lower with higher crime rates in males [coefficient (95% CI): -0.107 (-0.140, -0.075)] and females [coefficient (95% CI): -0.046 (-0.083, -0.009)]. Other associations were null or in the counter-intuitive direction. Conclusions Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self-selection can bias associations toward the null, as opposed to its typical characterization as a positive confounder. Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias. The authors discuss complexities of adjusting for residential self-selection and residential relocation, particularly during the adolescent to young adult transition

Estimation of a Dynamic Model of Weight

The ongoing debate about the economic causes of obesity has focused on the changing relative prices of diet and exercise. This paper uses a model that explicitly includes time and spatially varying community-level urbanicity and price measures as instruments to obtain statistically correct measures for the endogenous effects of diet, physical activity, drinking, and smoking on weight. We apply a dynamic panel system GMM estimation model to longitudinal (1991–2006) data from China to model weight and find that among adult men in China, about 6.1% of weight gain was due to declines in physical activity and 2.9-3.8% was due to dietary changes over this period. In the long run, physical activity can account for around 6.9% of weight gain, while diet can account for 3.2-4.2% of weight gain.

Examination of youth sexual and reproductive health transitions in Nigeria and Kenya using longitudinal data

Abstract Background The adolescent (ages 15–19) and young adult (ages 20–24) years are a crucial time as many sexual and reproductive health (SRH) transitions take place in these years. The study of youth SRH transitions in sub-Saharan Africa is limited due to a paucity of longitudinal data needed to examine the timing and circumstances of these transitions. Methods This paper uses recently collected longitudinal data from select urban areas in Kenya and Nigeria that include a large youth sample at baseline (2010/2011) and endline (2014). We control for unobserved heterogeneity in our modelling approach to correct for selectivity issues that are often ignored in similar types of analyses. Results We demonstrate that the transition patterns (i.e., sexual initiation, first marriage, and first pregnancy/birth) differ within and across the urban areas and countries studied. Urban Kenyan youth have more premarital sex and pregnancy than youth from the Nigerian cities. Further analyses demonstrate that more educated and wealthier youth transition later than their less educated and poorer counterparts. Conclusions The findings from this study can be used to inform programs seeking to serve young people based on their varying reproductive health needs in different contexts over the adolescent and young adult years

Modelling Screwpile Installation Using the MPM

Screwpiles are, as the name suggests, piled foundations which are screwed into the ground. They provide restraint to both upwards and downward loading directions and are commonly used for light structures subject to overturning or wind loading, such as sign gantries at the sides of motorways. An EPSRC-funded project led by University of Dundee has recently started, with Durham and Southampton as partners, in which the use of screwpiles (individual or in groups) for offshore foundations is under investigation. At Durham, a numerical modelling framework based on the material point method (MPM) is being developed for the installation phase of a screwpile. The aim is to use the model to provide an accurate representation of the in situ ground conditions once the pile is installed, as during installation the ground is disturbed and any model that “wishes in place” a screwpile may not provide representative long-term performance predictions. Following modelling of installation, the soil state will be transferred to a standard finite element package for the subsequent modelling of in-service performance (the MPM being considered unnecessary and computationally expensive for this phase of the life of a screwpile). In this preliminary work, we present the development of features of this numerical tool to simulate the screwpile installation. These features include a moving mesh concept (both translation and rotation) and interface elements. The effectiveness of the algorithm is illustrated through simple examples

Choice of a family planning outlet in urban areas: The role of distance and quality of services in Kenya and Uganda

Introduction Quality of care and physical access to health facilities affect facility choice for family planning (FP). These factors may disproportionately impact young contraceptive users. Understanding which components of service quality drive facility choice among contraceptive users of all ages can inform strategies to strengthen FP programming for all potential users of FP. Methods This study uses data from Population Services International's Consumer's Market for Family Planning (CM4FP) project, to examine drivers of facility choice among female FP users. The data collected from female contraceptive users, the outlet where they obtained their contraceptive method, and the complete set of alternative outlets in select urban areas of Kenya and Uganda were used. We use a mixed logit model, with inverse probability weights to correct for selection into categories of nonuse and missing facility data. We consider results separately for youth (18–24) and women aged 25–49 in both countries. Results We find that in both countries and across age groups, users were willing to travel further to public outlets and to outlets offering more methods. Other outlet attributes, including signage, pharmacy, stockouts, and provider training, were important to women in certain age groups or country. Discussion These results shed light on what components of service quality drive outlet choice among young and older users and can inform strategies to strengthen FP programming for all potential users of FP in urban settings