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Aims/hypothesis We aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI. Methods A Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010–2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008–2015). Results Lifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI. Conclusions/interpretation Lifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country.

To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition.We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis.Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993-1994 expenditure survey (12.4%) and the 2011-2012 expenditure survey (18.2%) and 2.24-fold between the 1995-1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76-3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31-2.89), with a female head (aOR: 1.32; 95% CI: 1.19-1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20-1.35).The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.Étudier les tendances en matière de paiement direct des frais de santé et de dépenses de santé catastrophiques en Inde selon la répartition par âge des ménages.Nous avons utilisé les données de quatre enquêtes nationales sur les dépenses des consommateurs et de trois enquêtes sur le recours aux soins, menées entre 1993 et 2014. Les ménages ont été divisés en cinq groupes suivant leur répartition par âge. Nous avons défini les dépenses de santé catastrophiques comme les paiements directs égaux ou supérieurs à 10% des dépenses des ménages. Les facteurs associés à des dépenses catastrophiques ont été déterminés par analyse multivariable.Globalement, la proportion de dépenses de santé catastrophiques a été multipliée par 1,47 entre l'enquête sur les dépenses de 1993–1994 (12,4%) et celle de 2011–2012 (18,2%), et par 2,24 entre l'enquête sur le recours aux soins de 1995–1996 (11,1%) et celle de même type de 2014 (24,9%). Cette proportion a davantage augmenté dans le quintile le plus pauvre que dans le plus riche, puisqu’elle a été multipliée respectivement par 3,00 et par 1,74, selon les enquêtes sur le recours aux soins. Les dépenses catastrophiques étaient plus courantes dans les foyers composés uniquement de personnes de 60 ans ou plus: le rapport des cotes ajusté (RCa) était de 3,26 (intervalle de confiance de 95%, IC: 2,76–3,84) par rapport aux foyers sans personnes âgées ou avec des enfants de moins de 5 ans. Le risque était également plus élevé pour les foyers composés de personnes âgées et d'enfants (RCa: 2,58; IC 95%: 2,31–2,89), pour ceux qui avaient une femme comme chef de famille (RCa: 1,32; IC 95%: 1,19–1,47) et pour ceux vivant en zone rurale (RCa: 1,27; IC 95%: 1,20-1,35).En Inde, la proportion de ménages faisant face à des dépenses de santé catastrophiques a augmenté au cours des deux dernières décennies. Ces dépenses étaient plus élevées pour les ménages qui comprenaient des personnes âgées. Il est nécessaire de mettre en place des mécanismes de protection financière pour les groupes de population qui courent un risque d'être confrontés à des dépenses de santé catastrophiques.Investigar las tendencias en los pagos directos en los servicios sanitarios y el gasto sanitario catastrófico en la India según la composición por edad en el hogar.Se obtuvieron datos de cuatro encuestas nacionales sobre los gastos de los consumidores y tres encuestas de uso de los servicios sanitarios realizadas entre 1993 y 2014. Los hogares se dividieron en cinco grupos según la composición por edad. Se definió el gasto sanitario catastrófico como los pagos directos que igualan o superan el 10% del gasto doméstico. Los factores asociados con el gasto catastrófico se identificaron mediante un análisis multivariable.En general, la proporción del gasto sanitario catastrófico aumentó 1,47 veces entre la encuesta de gastos de 1993-1994 (12,4%) y la encuesta de gastos de 2011-2012 (18,2%) y 2,24 veces entre la encuesta de uso de 1995-1996 (11,1%) y la encuesta de uso de 2014 (24.9%). La proporción aumentó más en el sector más pobre que el más rico: 3,00 veces frente a 1,74 veces, respectivamente, en todas las encuestas de uso. El gasto catastrófico fue más común en los hogares en los que solo había personas de 60 años o más: el coeficiente de posibilidades ajustado, (CPa) fue de 3,26 (intervalo de confidencia (IC) del 95%: 2,76–3,84) en comparación con los hogares sin personas mayores o niños menores de 5 años. El riesgo también aumentó en los hogares con personas mayores y niños (CPa: 2,58; IC del 95%: 2,31–2,89), con una mujer como cabeza de familia (CPa: 1,32; IC del 95%: 1,19-1,47), y en una zona rural (CPa: 1,27; IC del 95%: 1,20–1,35).La proporción de hogares con un gasto sanitario catastrófico en la India aumentó en las últimas dos décadas. Tal gasto fue mayor en los hogares con personas mayores. Los mecanismos de protección financiera son necesarios en los grupos de población en riesgo de gasto sanitario catastrófico.التحقيق في الاتجاهات السائدة في تكاليف الرعاية الصحية التي يتحملها المريض والنفقات الصحية الجائرة بالهند من خلال التركيبة العمرية لأفراد الأسر.لقد حصلنا على بيانات من أربعة مسوح وطنية تتعلق بنفقات المستهلكين وثلاثة مسوح تتعلق بمعدل الاستخدام تم إجراؤها في الفترة من عام 1993 إلى عام 2014. وقد تم تقسيم أفراد الأسر إلى خمس مجموعات بحسب التركيبة العمرية لهم. وقمنا بتحديد النفقات الصحية الجائرة بأنها تكاليف يتحملها المريض بنفسه تساوي أو تتجاوز 10‏% من نفقات الأسرة. وتم تحديد العوامل المرتبطة بالنفقات الجائرة من خلال تحليل متعدد المتغيرات.يمكن القول بشكلٍ عام أن نسبة النفقات الصحية الجائرة زادت أضعاف ذلك بمعدل 1.47 في مسح النفقات الذي أجري في الفترة ما بين عام 1993 إلى عام 1994 (بنسبة 12.4‏%) ومسح النفقات الذي أجري في الفترة ما بين عام 2011 إلى عام 2012 (بنسبة 18.2‏%) وأضعاف ذلك بمعدل 2.24 في المسح المتعلق بمعدل الاستخدام الذي أجري في الفترة ما بين عام 1995 إلى عام 1996 (بنسبة 11.1‏%) والمسح المتعلق بمعدل الاستخدام الذي أجري في عام 2014 (بنسبة 24.9‏%). وزادت النسبة أكثر في الفئات الخمسية السكانية الأفقر عن الفئات الخمسية السكانية الأغنى: حيث زادت بمقدار 3 أضعاف بالمقارنة مع الزيادة بواقع 1.74، مرة على الترتيب، وذلك عبر المسوح المتعلقة بمعدل الاستخدام. وكان تكبد النفقات الصحية الجائرة هو الأكثر شيوعًا بين الأسر التي لا تضم سوى أفراد تبدأ أعمارهم من 60 عامًا فما فوق: وكانت نسبة الاحتمالات المعُدلة (aOR) 3.26 (بنسبة أرجحية مقدارها 95‏%، بفاصل ثقة يبلغ: 2.76–3.84) مقارنة بالأسر التي لا تشتمل على كبار السن أو الأطفال الذين تقل أعمارهم عن 5 أعوام. كما زادت الخطورة بين الأسر التي تشتمل على كبار السن والأطفال على حدٍ سواء (نسبة الاحتمالات المعُدلة: 2.58؛ ‏بنسبة أرجحية مقدارها 95‏%: 2.31–2.89)، مع تقدم نسبة الإناث (نسبة الاحتمالات المعُدلة: 1.32؛ ‏بنسبة أرجحية مقدارها 95‏%: 1.19–1.47) ومع التواجد بموقع ريفي (نسبة الاحتمالات المعُدلة: 1.27؛ ‏بنسبة أرجحية مقدارها 95‏%: 1.20–1.35).لقد زادت نسبة الأسر التي تتكبد نفقات صحية جائرة في الهند خلال العقدين الماضيين. وكانت هذه النفقات هي الأعلى بين الأسر التي تشتمل على كبار السن. وينبغي إيجاد آليات مالية لحماية الفئات السكانية المعرضة لخطر تكبد النفقات الصحية الجائرة.旨在按年龄结构调查印度家庭的自费医疗保健支出和灾难性卫生支出的趋势。.我们从 1993 年至 2014 年期间进行的四次全国消费者支出调查和三次卫生保健利用率调查中获得了数据。按年龄结构将所有家庭分为五组。我们将灾难性卫生支出定义为自费支出相当于家庭支出的 10% 或超过 10%。通过多变量分析确定了与灾难性支出相关的因素。.总体而言，1993-1994 年 (12.4%) 和 2011-2012 年支出调查 (18.2%) 之间增加了 1.47 倍，1995–1996 年 (11.1%) 和 2014 年利用率调查 (24.9%) 之间增加了 2.24 倍。最贫穷人群比最富有的五分之一人口的比例增加了：在利用率调查中，这两个数据分别为 3.00 倍和 1.74 倍。与无老年人或年龄小于 5 岁的儿童家庭相比，年龄在 60 岁或以上的家庭中，灾难性支出是最常见的：调整后的优势率 (aOR) 为 3.26 (95% 置信区间，CI:2.76–3.84)。同时拥有老年人和儿童的家庭风险也在增加 (aOR: 2.58; 95% CI: 2.31–2.89)，女性为主 (aOR: 1.32; 95% CI: 1.19–1.47) 和农村人口 (aOR: 1.27; 95% CI: 1.20–1.35)。.过去二十年里，印度家庭的灾难性卫生支出的比例有所增加。老年人家庭的支出是最高的。需要为面临灾难性卫生支出风险的人群提供财务保障机制.Изучить тенденции в расходах собственных средств пациентов на медицинское обслуживание и катастрофически высоких расходах на здравоохранение с учетом возрастного состава семей в Индии.Были получены данные из четырех национальных опросов об уровне потребительских расходов и трех опросов относительно использования услуг здравоохранения, проведенных в период между 1993 и 2014 годами. Все семьи были разделены на пять групп с учетом возрастного состава. Катастрофически высокие расходы на здравоохранение определялись как расходы собственных средств пациентов, равные или превышающие 10% от расходов семьи. Факторы, связанные с катастрофически высокими расходами, были определены с помощью многофакторного анализа.В целом доля катастрофически высоких расходов на здравоохранение увеличилась в 1,47 раза при сравнении результатов изучения потребительских расходов в 1993–1994 годах (12,4%) и 2011–2012 годах (18,2%), а также в 2,24 раза при сравнении исследований использования услуг здравоохранения в 1995–1996 годах (11,1%) и 2014 году (24,9%). Более высокий рост этой доли расходов был отмечен в самом бедном квинтиле по сравнению с самым богатым: в 3,00 раза по сравнению с 1,74 раза соответственно во всех обследованиях использования услуг здравоохранения. Катастрофически высокие расходы были наиболее распространены среди семей, в которых проживали только люди в возрасте 60 лет и старше: скорректированное отношение шансов (сОШ) составило 3,26 (95%-й доверительный интервал, ДИ: 2,76–3,84) по сравнению с семьями без пожилых людей или детей моложе 5 лет. Риск был также выше среди семейств как с пожилыми людьми, так и с детьми (сОШ: 2,58; 95%-й ДИ: 2,31–2,89), с женщиной во главе семьи (сОШ: 1,32; 95%-й ДИ: 1,19–1,47) и в сельской местности (сОШ: 1,27; 95%-й ДИ: 1,20–1,35).В Индии за последние два десятилетия увеличилась доля семей, несущих катастрофически высокие расходы на здравоохранение. Такие расходы были наиболее высокими среди семей с пожилыми людьми. Для групп населения, подверженных риску катастрофически высоких расходов на здравоохранение, требуется создание механизмов финансовой защиты.

Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995–96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995–96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (−0.320; −0.391, −0.249) than the younger (−0.176; −0.211, −0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995–96 for the older (−0.189; −0.234, −0.145 vs − 0.065; −0.129, −0.001) and the younger (−0.145; −0.175, −0.115 vs − 0.056; −0.086, −0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.

A common view within academia and Indian society is that older Indians are cared for by their families less than in the past. Children are a key source of support in later life and alternatives are limited, therefore declining fertility appears to corroborate this. However, the situation may be more complex. Having many children may be physiologically burdensome for women, sons and daughters have distinct care roles, social trends could affect support provision, and spouses also provide support. We assessed whether the changing structure of families has negatively affected health of the older population using three cross-sectional and nationally representative surveys of India's 60-plus population (1995–96, 2004 and 2014). We described changes in self-rated health and family structure (number of children, sons, and daughters, and marital status) and, using ordinal regression modelling, determined the association between family structure and self-rated health, stratified by survey year and gender. Our results indicate that family structure changes that occurred between 1995-96 and 2014 were largely associated with better health. Though family sizes declined, there were no health gains from having more than two children. In fact, having many children (particularly daughters) was associated with worse health for both men and women. There was some evidence that being sonless or childless was associated with worse health, but it remained rare to not have a son or child. Being currently married was associated with better health and became more common over the inter-survey period. Although our results suggest that demographic trends have not adversely affected health of the older population thus far, we propose that the largest changes in family structure are yet to come. The support available in coming years (and potential health impact) will rely on flexibility of the current system., Highlights • Past family structure changes do not indicate support declines or worsening health. • Large families are associated with poor health and family sizes are declining. • It remains rare to not have a child or son. • Marriage is associated with better health, and widowhood is declining. • Future family structure changes will be more considerable.

Background In India, the prevalence of overweight and obesity has increased rapidly in recent decades. Given the association between overweight and obesity with many non-communicable diseases, forecasts of the future prevalence of overweight and obesity can help inform policy in a country where around one sixth of the world's population resides. Methods We used a system of multi-state life tables to forecast overweight and obesity prevalence among Indians aged 20-69 years by age, sex and urban/rural residence to 2040. We estimated the incidence and initial prevalence of overweight using nationally representative data from the National Family Health Surveys 3 and 4, and the Study on global AGEing and adult health, waves 0 and 1. We forecasted future mortality, using the Lee-Carter model fitted life tables reported by the Sample Registration System, and adjusted the mortality rates for Body Mass Index using relative risks from the literature. Results The prevalence of overweight will more than double among Indian adults aged 20-69 years between 2010 and 2040, while the prevalence of obesity will triple. Specifically, the prevalence of overweight and obesity will reach 30.5% (27.4%-34.4%) and 9.5% (5.4%-13.3%) among men, and 27.4% (24.5%-30.6%) and 13.9% (10.1%-16.9%) among women, respectively, by 2040. The largest increases in the prevalence of overweight and obesity between 2010 and 2040 is expected to be in older ages, and we found a larger relative increase in overweight and obesity in rural areas compared to urban areas. The largest relative increase in overweight and obesity prevalence was forecast to occur at older age groups. Conclusion The overall prevalence of overweight and obesity is expected to increase considerably in India by 2040, with substantial increases particularly among rural residents and older Indians. Detailed predictions of excess weight are crucial in estimating future non-communicable disease burdens and their economic impact.

Background India’s economic development and urbanisation in recent decades has varied considerably between states. Attempts to assess how overweight (including obesity) varies by socioeconomic position at the national level may mask considerable sub-national heterogeneity. We examined the socioeconomic patterning of overweight among adults in India’s most and least economically developed states between 1998 and 2016. Methods We used state representative data from the National Family Health Surveys from 1998 to 99, 2005–06 and 2015–16. We estimated the prevalence of overweight by socioeconomic position in men (15–54 years) and women (15–49 years) from India’s most and least economically developed states using multilevel logistic regressions. Results We observed an increasing trend of overweight prevalence among low socioeconomic position women. Amongst high socioeconomic position women, overweight prevalence either increased to a smaller extent, remained the same or even declined between 1998 and 2016. This was particularly the case in urban areas of the most developed states, where in the main analysis, the prevalence of overweight increased from 19 to 33% among women from the lowest socioeconomic group between 1998 and 2016 compared to no change among women from the highest socioeconomic group. Between 2005 and 2016, the prevalence of overweight increased to similar extents among high and low socioeconomic status men, irrespective of residence. Conclusions The converging prevalence of overweight by socioeconomic position in India’s most developed states, particularly amongst urban women, implies that this subpopulation may be the first to exhibit a negative association between socioeconomic position and overweight in India. Programs aiming to reduce the increasing overweight trends may wish to focus on poorer women in India’s most developed states, amongst whom the increasing trend in prevalence has been considerable. Electronic supplementary material The online version of this article (10.1186/s12889-019-7155-9) contains supplementary material, which is available to authorized users.

Objectives We aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016. Design Repeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP. Setting 26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively. Participants 628 795 ever-married women aged 15–49 years and 93 618 men aged 15–54 years. Primary outcome measure Overweight/obesity defined by body mass index >24.99 kg/m2. Results Between 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%–32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%. Conclusions We identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a ‘diseases of affluence’.

ObjectivesWe report hospitalisation trends for different age groups across the states of India and for various disease groups, compare the hospitalisation trends among the older (aged 60 years or more) and the younger (aged under 60 years) population and quantify the factors that contribute to the change in hospitalisation rates of the older population over two decades.DesignSerial cross-sectional study.SettingNationally representative sample, India.Data sourcesThree consecutive National Sample Surveys (NSS) on healthcare utilisation in 1995–1996, 2004 and 2014.ParticipantsSix hundred and thirty-three thousand four hundred and five individuals in NSS 1995–1996, 385 055 in NSS 2004 and 335 499 in NSS 2014.MethodsDescriptive statistics, multivariable analyses and a regression decomposition technique were used to attain the study objectives.ResultThe annual hospitalisation rate per 1000 increased from 16.6 to 37.0 in India from 1995–1996 to 2014. The hospitalisation rate was about half in the less developed than the more developed states in 2014 (26.1 vs 48.6 per 1000). Poor people used more public than private hospitals; this differential was higher in the more developed (40.7% vs 22.9%) than the less developed (54.3% vs 40.1%) states in 2014. When compared with the younger population, the older population had a 3.6 times higher hospitalisation rate (109.9 vs 30.7) and a greater proportion of hospitalisation for non-communicable diseases (80.5% vs 56.7%) in 2014. Among the older population, hospitalisation rates were comparatively lower for females, poor and rural residents. Propensity change contributed to 86.5% of the increase in hospitalisation among the older population and compositional change contributed 9.3%.ConclusionThe older population in India has a much higher hospitalisation rate and has continuing greater socioeconomic differentials in hospitalisation rates. Specific policy focus on the requirements of the older population for hospital care in India is needed in light of the anticipated increase in their proportion in the population.

There is concern that current UK policy and intervention aimed at supporting fathers remains primarily informed by dominant White middle-class values and experiences, and therefore fails to respond adequately to the needs of Britain's diverse fathers. This paper contributes to understanding of ethnic diversity in fathering contexts, practices and experiences, by reporting findings from a qualitative study of British Asian fathers, involving in-depth interviews with fifty-nine fathers and thirty-three mothers from Bangladeshi Muslim, Pakistani Muslim, Gujarati Hindu and Punjabi Sikh background, and over eight additional respondents engaged through Key Informant interviews, ethnographic interviews and group discussions. The paper highlights four areas that require greater recognition by policy-makers and practitioners to appropriately meet the needs of fathers from diverse ethnic and socio-economic backgrounds. These are: recognising that fathers and mothers do not necessarily constitute an autonomous unit; appreciating diversity in fathers’ understandings of desirable child outcomes; addressing additional obstacles to achieving similar outcomes for children; and understanding that the boundaries and content of fathering are not universally recognised. Policies that are less normative and more responsive to diversity are essential to ensure that all fathers can be effectively supported.

The mean age at marriage of Iranian women increased by three years between the mid-1980s and 2000 during a period of great socio-economic change, particularly affecting the 1971–1975 and 1976–1980 birth cohorts. This paper analyses the marriage timing and life course experience of these cohorts of women and highlights the contribution that ethnicity and changes in the socio-economic context made to the sharp marriage delay experienced by the 1976–1980 birth cohort. A discrete time hazard model is applied to the 2000 Iran Demographic and Health Survey data, which are linked to a range of time-varying district-level contextual variables created from the 1986 and 1996 Iranian censuses. The findings suggest that the marriage postponement experienced by the younger birth cohort is related to improvements in women's education and can partly be explained by the increased opportunity costs of marriage, which resulted from limited access to education after marriage. The findings also suggest that differences in marriage timing between areas predominated by certain ethnic groups became less evident for the younger birth cohort.

The timing of first sexual intercourse is often defined in terms of chronological age, with particular focus on "early" first sex. Arguments can be made for a more nuanced concept of readiness and appropriateness of timing of first intercourse. Using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), conducted in 2010-2012, this study examined whether a context-based measure of first intercourse-termed sexual competence-was associated with subsequent sexual health in a population-based sample of 17-to 24-year-olds residing in Britain (n = 2,784). Participants were classified as "sexually competent" at first intercourse if they reported the following four criteria: contraceptive protection, autonomy of decision (not due to external influences), that both partners were "equally willing," and that it happened at the "right time." A lack of sexual competence at first intercourse was independently associated with testing positive for human papillomavirus (HPV) at interview; low sexual function in the past year; and among women only, reported sexually transmitted infection (STI) diagnosis ever; unplanned pregnancy in the past year; and having ever experienced nonvolitional sex. These findings provide empirical support for defining the nature of first intercourse with reference to contextual aspects of the experience, as opposed to a sole focus on chronological age at occurrence.

This study examines the social context of men’s health and health behaviors in rural KwaZulu-Natal, South Africa, particularly in relationship to fathering and fatherhood. Individual interviews and focus groups were conducted with 51 Zulu-speaking men. Three themes related to men’s health emerged from the analysis of transcripts: (a) the interweaving of health status and health behaviors in descriptions of “good” and “bad” fathers, (b) the dominance of positive accounts of health and health status in men’s own accounts, and (c) fathers’ narratives of transformations and positive reinforcement in health behaviors. The study reveals the pervasiveness of an ideal of healthy fathers, one in which the health of men has practical and symbolic importance not only for men themselves but also for others in the family and community. The study also suggests that men hold in esteem fathers who manage to be involved with their biological children who are not coresident or who are playing a fathering role for nonbiological children (social fathers). In South Africa, men’s health interventions have predominantly focused on issues related to HIV and sexual health. The new insights obtained from the perspective of men indicate that there is likely to be a positive response to health interventions that incorporate acknowledgment of, and support for, men’s aspirations and lived experiences of social and biological fatherhood. Furthermore, the findings indicate the value of data on men’s involvement in families for men’s health research in sub-Saharan Africa.

Fathers who live apart from their children have been investigated mainly through the lens of separation, divorce, and repartnering. With the growing prison population in many western countries, fathering from prison is emerging as a further significant context in which to understand the contemporary experience of fathers in families. This paper contributes to the developing research evidence about the meanings and experiences of fathering while in prison by presenting new data from a pilot study of 43 men serving sentences in English prisons. Using an ecological framework, the authors propose that the prison context overwhelms “responsible” or “active” fathering for prisoners and that mothers are central figures in the facilitation of father-child visitation contact.

Higher proportions of births outside marriage and more family breakdown indicate that children experience increased diversity of family circumstances at birth and during childhood. While England/Wales and Norway have many similar features, there are distinct differences in social and welfare policies. This article compares children’s experiences in the two countries in relation to these policies. Emphasis is put particularly on the impact of consensual unions. Children are the statistical unit and data from surveys and national statistics are compared. In both countries there is considerable risk of family dissolution in the case of children born into consensual unions, but the more so in England/Wales than in Norway. Even though the rate of extramarital births is much higher in Norway than in England/Wales, the corresponding rate of family change is lower. The article suggests that behind parental break-up lies an old pattern of social stratification masked as family change.

We evaluate men;s retrospective fertility histories from the British Household Panel Survey and the U.S. Panel Study of Income Dynamics (PSID). Further, we analyze the PSID men’s panel-updated fertility histories for their possible superiority over retrospective collection. One third to one half of men’s nonmarital births and births within previous marriages are missed in estimates from retrospective histories. Differential survey underrepresentation of previously married men compared with previously married women accounts for a substantial proportion of the deficits in previous-marriage fertility. More recent retrospective histories and panel-updated fertility histories improve reporting completeness, primarily by reducing the proportion of marital births from unions that are no longer intact at the survey date.

Using data from the British Household Panel Survey and the National Survey of Families and Households in the United States, we present a sociodemographic profile of fathers and compare the determinants of absent fatherhood in each country. Although fatherhood has a younger profile in the United States, especially for blacks, predictors of fathers’ residency with their children are remarkably similar in the two countries. In both countries, the strongest predictor of a father’s absence is the parents’ relationship to each other at the time of the child’s birth. Policy implications of this finding are discussed.

This paper is concerned with the social patterning of ill-health amongst women in Britain. It uses the various health measures available in the Health and Lifestyle Survey (self-assessed health, disease/disability, illness, psycho-social well-being and fitness) to explore whether there are particular aspects of health systematically associated with social advantage and disadvantage, as measured by current or last occupation, employment status, household composition and household income. Among women aged 18-59, after controlling for age, number of psychological symptoms experienced in the past month showed the greatest social variation. Number of physical illness symptoms in the last month showed the least. Lone mothers with dependent children were found to have particularly poor psycho-social health, although this was confined to those in full-time employment. The presence of a long-standing disease/disability proved useful as a control for the influence of health selection in to and out of both employment and motherhood.