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Although induced abortion is common, measurement issues have long made this area of research challenging. The current analysis applies an indirect method known as the list experiment to try to improve survey-based measurement of induced abortion. We added a double list experiment to a population-based survey of reproductive age women in Rajasthan, India and compared resulting abortion estimates to those we obtained via direct questioning in the same sample. We then evaluated list experiment assumptions. The final sample completing the survey consisted of 6,035 women. Overall, 1.8 percent of the women reported a past abortion via the list experiment questions, whereas 3.5 percent reported an abortion via the direct questions, and this difference was statistically significant. As such, the list experiment failed to produce more valid estimates of this sensitive behavior on a population-based survey of reproductive age women in Rajasthan, India. One explanation for the poor list experiment performance is our finding that key assumptions of the methodology were violated. Women may have mentally enumerated the treatment list items differently from the way they enumerated control list items. Further research is required to determine whether researchers can learn enough about how the list experiment performs in different contexts to effectively and consistently leverage its potential benefits to improve measurement of induced abortion. [ABSTRACT FROM AUTHOR]

Background/Objectives: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. Design: Single‐arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model. Setting: Baltimore, MD Participants: Individuals aged 65 and older with reported difficulty with at least one activity of daily living. Intervention: CAPABLE is a 5‐month program to reduce the health effects of impaired physical function in low‐income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self‐identified functional goals. Measurements: Monthly average Medicaid expenditure and likelihood of high‐ or low‐cost use of eight healthcare service categories. Results: Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1–31 months). The largest differential reduction in expenditures were for inpatient care and long‐term services and supports. Conclusion: CAPABLE is associated with lower likelihood of inpatient and long‐term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use. Clinical trial registration: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495 [ABSTRACT FROM AUTHOR]

We estimate the relationship between unmet need for contraception and coital frequency using data from the most recent Standard Demographic and Health Surveys conducted from 2005 to 2015. Individual-level analyses include 55 countries (n=245,732 women). The dependent variable is women's report of any sex in the last four weeks; the independent variable is current unmet need. Bivariate ecological results using country averages indicate that prevalence of unmet need is significantly negatively correlated with the proportion reporting recent sexual activity. Multivariate regression of individual-level data show that the overall odds ratio of having had sex in the last four weeks is 3.23 and 2.97 for women with met contraceptive need for spacing and limiting fertility, respectively, compared with women with unmet contraceptive need. These results suggest that current estimates of unmet need exaggerate the risk of unintended pregnancy because coital frequency is not uniform with respect to unmet need. Findings also suggest that, despite being categorized as having unmet need, many women may still be taking measures to control their fertility through regulating the tempo of marital coitus, thus reducing their risk of unintended pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009.Data Sources: This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho.Study Design: Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis.Principal Findings: Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending.Conclusion: Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States. [ABSTRACT FROM AUTHOR]

Using cross-country data on gross domestic product and national expenditure on vaccines, we estimate and compare the income elasticity of vaccine expenditure and general curative healthcare expenditure. This study provides the first evidence on the national income elasticity of vaccination spending. Both fixed and random effects models are applied to data from 84 countries from 2010 to 2011. The income elasticities for healthcare expenditure and vaccine expenditure are 0.844 and 0.336, respectively. Despite vaccines' high cost-effectiveness, the national propensity to spend income on vaccines as income increases lags behind general health care. The low income elasticity of vaccine spending means that relying on economic growth alone will provide an unacceptably slow trajectory to achieving high vaccine coverage levels. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Certain nutrients can stimulate appetite making them fattening in a way that is not fully conveyed by the calorie content on the label. For rational eaters, this information gap could be corrected by more labeling. As an alternative, this paper proposes a set of positive and negative taxes on the fattening and slimming nutrients in food rather than on the food itself. There are conditions under which this tax plus subsidy system could increase welfare by stopping unwanted weight gain while leaving the final retail price of food unchanged. A nutrient tax system could improve welfare if fattening nutrients, net of their effect on weight, are inferior goods and the fiscal cost of administering the tax is sufficiently low. More data on the price elasticity of demand for nutrients as well as data on how specific nutrients affect satiety and how total calorie intake would be necessary before one could be sure a nutrient tax would work in practice. [ABSTRACT FROM AUTHOR]

Current medical models frequently overlook functional limitations and the home environment even though they partially determine healthcare usage and quality of life. The Centers for Medicare and Medicaid Services ( CMS) Innovation Center funds projects that have potential to affect the 'triple aim,' a framework for decreasing costs while improving health and quality of life. This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders ( CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults. CAPABLE is a patient-directed, team-based intervention comprising an occupational therapist, a registered nurse, and a handyman to decrease hospitalization and nursing home usage of community-dwelling older adults with functional limitations who are dually eligible for Medicare and Medicaid. Activity of daily living limitations improved in 79% of the first 100 people who completed the intervention. Preliminary findings of this novel intervention may have implications for other older adults with functional limitations. [ABSTRACT FROM AUTHOR]

Although the rate of contraceptive use in France is high, more than one-third of pregnancies are unintended. We built a dynamic microsimulation model that applies data from the French COCON study on method switching, discontinuation, and failure rates to a hypothetical population of 20,000 women, followed for five years. We use the model to estimate the adjustment factor needed to make the survey data fit the demographic profile of France by adjusting for underreporting of contraceptive nonuse and abortion. We then test three behavior-change scenarios that could reduce unintended pregnancies: decreasing method failure, increasing time using effective methods, and increasing switching from less effective to more effective methods. Our model suggests that decreasing method failure is the most effective means of reducing unintended pregnancies, but we found that all of the scenarios reduced unintended pregnancies by at least 25 percent. Dynamic microsimulations may have great potential in reproductive health research and prove useful for policymakers. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost-effectiveness of community-based distribution of misoprostol for prevention with misoprostol for treatment of postpartum hemorrhage (PPH).Methods: A Monte Carlo simulation depicted mortality and anemia-related morbidity attributable to PPH among 3 scenarios of 10,000 women delivering at home in rural India: (1) standard management; (2) standard management plus 800microg of sublingual misoprostol for PPH treatment; and (3) standard management plus 600microg of prophylactic oral misoprostol. The model included costs of drugs, birth attendant training, and transport for women who did not respond to misoprostol.Results: Misoprostol lowered mortality by 70% and 81% in scenarios 2 and 3, respectively. Scenarios 2 and 3 raise costs by 6% and 35%, respectively. Incremental cost per disability-adjusted life year (DALY) saved is estimated at $6 and $170, respectively.Conclusion: Both interventions were more effective at decreasing mortality and anemia than standard management. The most efficient scale-up plan would focus initially on increasing coverage with the treatment strategy ($6 per DALY). [ABSTRACT FROM AUTHOR]

Objective: To determine the cost-effectiveness of prenatal iron supplementation and misoprostol use as interventions to prevent maternal mortality in home births in rural India.Methods: A cost-effectiveness analysis depicted three hypothetical cohorts of 10,000 pregnant women delivering at home in rural India: one with no intervention, one receiving standard prenatal iron supplements, and 1 receiving 600 microg of misoprostol in the third stage of labor.Results: Misoprostol used to prevent postpartum hemorrhage resulted in a 38% (95% CI, 5%-73%) decrease in maternal deaths, while prenatal iron supplementation resulted in a 5% (95% CI, 0%-47%) decrease. Misoprostol cost a median US $1401 (IQR US $1008-$1848) prenatal iron supplementation cost a median US $2241 (IQR No Lives Saved-$3882) per life saved compared with the standard care outcome.Conclusion: Misoprostol is a cost-effective maternal mortality intervention for home births. Iron supplementation may be worthwhile to improve women's health, but it is uncertain whether it can prevent mortality after hemorrhage. [ABSTRACT FROM AUTHOR]

Considerable change in the romantic and sexual behaviors of Asian young people may be occurring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). A survey was conducted of 17,016 males and females aged 15-24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15-19 and 20-24. Significant differences are found in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nearly 300,000 paternity tests are performed in the United States annually to include or exclude a male as the biological father of a child. Little is known about how well the test outcomes could be predicted simply on the basis of the subjects’ social background. Our objective is to document the demographic composition of test subjects and to determine how well ethnic background and age predict paternity inclusion. STUDY DESIGN AND METHODS: A national database of 9999 paternity test results was formed weighted to represent the population of paternity establishment cases for the United States. Multiple regression determined the odds ratio of a paternity inclusion based on demographic variables such as race and age. RESULTS: The test results indicated paternity inclusions in 72 percent of cases, overall. The percent included varied little across racial and/or ethnic categories with a low of 67 percent in African Americans and a high of 82 percent among Native Americans, but these differences were not significant in multivariate analysis. The likelihood of inclusion showed a modest but significant correlation with increased maternal age. Mothers of European origin who nominated non-Europeans as fathers were less likely to identify the correct man as father. CONCLUSION: For any subject receiving a genetic test in a child support office, predicting a 72 percent probability that the test will show paternity inclusion offers as good an estimate of the test outcome as a subgroup estimate based on a subject's age, race, and child characteristics. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia. Methods Pre- and post-intervention comparison in a cluster randomized trial of primary care facilities. Seven health posts and 33 subhealth posts in Nepal were stratified by type and randomized into intervention and control groups. Health workers from the intervention facilities received 5 days training on the adapted PAL guidelines and their use. To collect prescription details, we used carbon-copy prescription pads in both groups. To measure the impact of PAL guidelines we used the World Health Organization's rational use of drug indicators and drug cost indicators, in a multivariate regression analysis. Results The PAL guidelines led to fewer prescriptions of multiple drugs and to more prescriptions of generic and essential drugs. The guidelines also lowered average prescription cost and wastage by disease except for chronic obstructive pulmonary disease although not to a statistically significant degree. Similarly, the prescription of antibiotics and adherence to guidelines improved, albeit not statistically significant. Conclusion There is evidence that the implementation of PAL guidelines promotes rational use of drugs for some respiratory diseases. The expected health effects of PAL guidelines should be compared with their implementation costs before continuing training on lung health, and strategies put in place to sustain the effects. [ABSTRACT FROM AUTHOR]

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established, little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention--measles vaccination--on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children--from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity. [ABSTRACT FROM AUTHOR]