Search

The benefits of physical activity are wide ranging and substantial. Yet the majority of US adults do not meet the recommended minimum guidelines of activity. Mothers, in particular, experience a decline in physical activity after having children. In the transition to having children, the facilitators and barriers to being active change. Though inactivity after having children poses a significant risk, there is insufficient research on the patterns, barriers and facilitators, and potential pathways for intervention. The first chapter of my dissertation explores patterns of physical activity and the association with having a child. The literature suggests that women experience a decline after birth but no studies examined more than 2 time points and thus we do not have sufficient insight into longtime patterns. We used a mixed model to estimate the percent change in physical activity with the event of birth, and for pre-specified times since birth. We found that there was a significant decrease in leisure time physical activity at birth and it persists through 5 years, however, by 10 years, women experience a rebound. The second chapter of my dissertation examines more closely the experience of pregnancy and postpartum and how that affects women’s’ abilities to stay active. We examined data from low-income Latina pregnant and postpartum women affected by gestational diabetes in San Francisco and Sonoma counties. Using a mixed methods design, we collected quantitative survey data and qualitative data from 3 focus groups. We used descriptive statistics to analyze the quantitative survey data, and grounded theory and the Capability, Opportunity, Motivation Behavior (COM-B) framework to code and identify themes from the focus groups. Our samples of pregnant and postpartum Latina women affected by GDM were predominately Spanish speaking, low-income, and born outside the US. In the transition from pregnancy to postpartum, women noted a shift from a focus on self-care in ord

The benefits of physical activity are wide ranging and substantial. Yet the majority of US adults do not meet the recommended minimum guidelines of activity. Mothers, in particular, experience a decline in physical activity after having children. In the transition to having children, the facilitators and barriers to being active change. Though inactivity after having children poses a significant risk, there is insufficient research on the patterns, barriers and facilitators, and potential pathways for intervention. The first chapter of my dissertation explores patterns of physical activity and the association with having a child. The literature suggests that women experience a decline after birth but no studies examined more than 2 time points and thus we do not have sufficient insight into longtime patterns. We used a mixed model to estimate the percent change in physical activity with the event of birth, and for pre-specified times since birth. We found that there was a significant decrease in leisure time physical activity at birth and it persists through 5 years, however, by 10 years, women experience a rebound. The second chapter of my dissertation examines more closely the experience of pregnancy and postpartum and how that affects women’s’ abilities to stay active. We examined data from low-income Latina pregnant and postpartum women affected by gestational diabetes in San Francisco and Sonoma counties. Using a mixed methods design, we collected quantitative survey data and qualitative data from 3 focus groups. We used descriptive statistics to analyze the quantitative survey data, and grounded theory and the Capability, Opportunity, Motivation Behavior (COM-B) framework to code and identify themes from the focus groups. Our samples of pregnant and postpartum Latina women affected by GDM were predominately Spanish speaking, low-income, and born outside the US. In the transition from pregnancy to postpartum, women noted a shift from a focus on self-care in ord

Background Infertility is a significant disability, yet there are no reliable estimates of its global prevalence. Studies on infertility prevalence define the condition inconsistently, rendering the comparison of studies or quantitative summaries of the literature difficult. This study analyzed key components of infertility to develop a definition that can be consistently applied to globally available household survey data. Methods We proposed a standard definition of infertility and used it to generate prevalence estimates using 53 Demographic and Health Surveys (DHS). The analysis was restricted to the subset of DHS that contained detailed fertility information collected through the reproductive health calendar. We performed sensitivity analyses for key components of the definition and used these to inform our recommendations for each element of the definition. Results Exposure type (couple status, contraceptive use, and intent), exposure time, and outcomes were key elements of the definition that we proposed. Our definition produced estimates that ranged from 0.6% to 3.4% for primary infertility and 8.7% to 32.6% for secondary infertility. Our sensitivity analyses showed that using an exposure measure of five years is less likely to misclassify fertile unions as infertile. Additionally, using a current, rather than continuous, measure of contraceptive use over five years resulted in a median relative error in secondary infertility of 20.7% (interquartile range of relative error [IQR]: 12.6%-26.9%), while not incorporating intent produced a corresponding error in secondary infertility of 58.2% (IQR: 44.3%-67.9%). Conclusions In order to estimate the global burden of infertility, prevalence estimates using a consistent definition need to be generated. Our analysis provided a recommended definition that could be applied to widely available global household data. We also summarized potential biases that should be considered when making estimates of infertili

Background Infertility is a significant disability, yet there are no reliable estimates of its global prevalence. Studies on infertility prevalence define the condition inconsistently, rendering the comparison of studies or quantitative summaries of the literature difficult. This study analyzed key components of infertility to develop a definition that can be consistently applied to globally available household survey data. Methods We proposed a standard definition of infertility and used it to generate prevalence estimates using 53 Demographic and Health Surveys (DHS). The analysis was restricted to the subset of DHS that contained detailed fertility information collected through the reproductive health calendar. We performed sensitivity analyses for key components of the definition and used these to inform our recommendations for each element of the definition. Results Exposure type (couple status, contraceptive use, and intent), exposure time, and outcomes were key elements of the definition that we proposed. Our definition produced estimates that ranged from 0.6% to 3.4% for primary infertility and 8.7% to 32.6% for secondary infertility. Our sensitivity analyses showed that using an exposure measure of five years is less likely to misclassify fertile unions as infertile. Additionally, using a current, rather than continuous, measure of contraceptive use over five years resulted in a median relative error in secondary infertility of 20.7% (interquartile range of relative error [IQR]: 12.6%-26.9%), while not incorporating intent produced a corresponding error in secondary infertility of 58.2% (IQR: 44.3%-67.9%). Conclusions In order to estimate the global burden of infertility, prevalence estimates using a consistent definition need to be generated. Our analysis provided a recommended definition that could be applied to widely available global household data. We also summarized potential biases that should be considered when making estimates of infertili