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Perkins, Jessica M.

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Perkins

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Jessica M.

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Perkins, Jessica M.
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    Short-term and long-term associations between household wealth and physical growth: a cross-comparative analysis of children from four low- and middle-income countries
    (Co-Action Publishing, 2015) Krishna, Aditi; Oh, Juhwan; Lee, Jong-koo; Lee, Hwa-Young; Perkins, Jessica M.; Heo, Jongho; Ro, Young Sun; Subramanian, S.V.
    Background: Stunting, a form of anthropometric failure, disproportionately affects children in developing countries with a higher burden on children living in poverty. How early life deprivation affects physical growth over various life stages is less well-known. Objective: We investigate the short- and long-run associations between household wealth in early life with physical growth in childhood in four low- and middle-income countries to understand the persistent implications of early life conditions of poverty and resource constraints on physical growth. Design: Longitudinal study of eight cohorts of children in four countries – Ethiopia, India, Peru, and Vietnam (n=10,016) – ages 6 months to 15 years, using data from the Young Lives project, 2002–2009. Physical growth outcomes are standardized height-for-age z-scores (HAZ) and stunting. The key exposure is household wealth measured at baseline using a wealth index, an asset-based indicator. Covariates include child's age and sex, caregiver's educational status, household size, and place of residence. Results: Baseline wealth index is significantly associated with higher physical growth rates as suggested by higher HAZ and lower odds of stunting. We found these associations in all four countries, for younger and older cohorts and for children who experienced changes in living standards. For the older cohort, despite the timing of the first survey at age 7–8 years, which is beyond the critical period of 1,000 days, there are lasting influences of early poverty, even for those who experienced changes in wealth. Conclusions: Household wealth in early life matters for physical growth with conditions of poverty and deprivation influencing growth faltering even beyond the 1,000 days window. The influences of early childhood poverty, so prevalent among children in low- and middle-income countries, must be addressed by policies and programs targeting early life but also focusing on older children experiencing growth faltering.
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    Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India
    (BioMed Central, 2016) Perkins, Jessica M.; Lee, Hwa-young; James, K. S.; Oh, Juhwan; Krishna, Aditi; Heo, Jongho; Lee, Jong-koo; Subramanian, S. V.
    Background: Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender. Methods: Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural–urban location for men and women, separately. We then assess these associations when widowhood accounts for duration. Results: Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0–4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5–9 years were not, compared to married women. Conclusions: Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3682-9) contains supplementary material, which is available to authorized users.
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    Measuring personal beliefs and perceived norms about intimate partner violence: Population-based survey experiment in rural Uganda
    (Public Library of Science, 2017) Tsai, Alexander; Kakuhikire, Bernard; Perkins, Jessica M.; Vořechovská, Dagmar; McDonough, Amy Q.; Ogburn, Elizabeth L.; Downey, Jordan M.; Bangsberg, David R.
    Background: Demographic and Health Surveys (DHS) conducted throughout sub-Saharan Africa indicate there is widespread acceptance of intimate partner violence, contributing to an adverse health risk environment for women. While qualitative studies suggest important limitations in the accuracy of the DHS methods used to elicit attitudes toward intimate partner violence, to date there has been little experimental evidence from sub-Saharan Africa that can be brought to bear on this issue. Methods and findings We embedded a randomized survey experiment in a population-based survey of 1,334 adult men and women living in Nyakabare Parish, Mbarara, Uganda. The primary outcomes were participants’ personal beliefs about the acceptability of intimate partner violence and perceived norms about intimate partner violence in the community. To elicit participants’ personal beliefs and perceived norms, we asked about the acceptability of intimate partner violence in five different vignettes. Study participants were randomly assigned to one of three survey instruments, each of which contained varying levels of detail about the extent to which the wife depicted in the vignette intentionally or unintentionally violated gendered standards of behavior. For the questions about personal beliefs, the mean (standard deviation) number of items where intimate partner violence was endorsed as acceptable was 1.26 (1.58) among participants assigned to the DHS-style survey variant (which contained little contextual detail about the wife’s intentions), 2.74 (1.81) among participants assigned to the survey variant depicting the wife as intentionally violating gendered standards of behavior, and 0.77 (1.19) among participants assigned to the survey variant depicting the wife as unintentionally violating these standards. In a partial proportional odds regression model adjusting for sex and village of residence, with participants assigned to the DHS-style survey variant as the referent group, participants assigned the survey variant that depicted the wife as intentionally violating gendered standards of behavior were more likely to condone intimate partner violence in a greater number of vignettes (adjusted odds ratios [AORs] ranged from 3.87 to 5.74, with all p < 0.001), while participants assigned the survey variant that depicted the wife as unintentionally violating these standards were less likely to condone intimate partner violence (AORs ranged from 0.29 to 0.70, with p-values ranging from <0.001 to 0.07). The analysis of perceived norms displayed similar patterns, but the effects were slightly smaller in magnitude: participants assigned to the “intentional” survey variant were more likely to perceive intimate partner violence as normative (AORs ranged from 2.05 to 3.51, with all p < 0.001), while participants assigned to the “unintentional” survey variant were less likely to perceive intimate partner violence as normative (AORs ranged from 0.49 to 0.65, with p-values ranging from <0.001 to 0.14). The primary limitations of this study are that our assessments of personal beliefs and perceived norms could have been measured with error and that our findings may not generalize beyond rural Uganda. Conclusions: Contextual information about the circumstances under which women in hypothetical vignettes were perceived to violate gendered standards of behavior had a significant influence on the extent to which study participants endorsed the acceptability of intimate partner violence. Researchers aiming to assess personal beliefs or perceived norms about intimate partner violence should attempt to eliminate, as much as possible, ambiguities in vignettes and questions administered to study participants. Trial registration ClinicalTrials.gov NCT02202824.
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    Conducting Social Network and Social Norm Research in Low-Resource Settings: Food Insecurity, Depression, and HIV Testing in Rural Uganda
    (2015-05-18) Perkins, Jessica M.; Marsden, Peter V.; Christakis, Nicholas A.; O'Malley, James; Swartz, B. K.; Subramanian, Sankaran V.
    This dissertation examines the role of social networks and social norms in health outcomes and behaviors among low-and middle-income countries (LMICs), with a particular focus on Uganda. Paper 1 presents a systematic review of sociocentric network studies conducted in LMICs on health-related outcomes and other development topics. I first discuss the sociocentric network study designs employed in 36 selected papers, and provide a catalog of 105 name generator questions used to measure social ties. Second, I show that network composition, individual network centrality, and network structure are associated with health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, I highlight opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. Papers 2 and 3 exploit a population-based dataset on eight villages from rural Southwest Uganda, arising from a pilot study which myself and colleagues designed to collect sociocentric network data. There were a total of 1,669 adults interviewed representing a response rate of 96%. Paper 2 assesses the relationship between food insecurity and depression symptom severity in the general adult population, and the potential confounding or moderating roles of social network position, structure, and composition in that relationship. I find that severe and moderate food insecurity was associated with greater depression symptom severity among both men and women, and that none of the social network characteristics were directly associated with the outcome. Moreover, there were no interactions between food insecurity and network characteristics among women. For severely food insecure men, however, personal network centrality was positively associated with symptoms and personal network poverty composition was negatively associated with symptoms. Findings reveal that nutrition interventions aimed at improving food security in rural areas may have significant beneficial effects in terms of mental health outcomes for the whole population. I discuss the possible role of shame in affecting depression among severely food insecure men with wealthier networks and in more central network locations. Paper 3 examines the extent to which individuals underestimate the prevalence of HIV testing in their village and misperceive the norm, and also assesses the relationship between perception of the HIV testing norm in one’s village with personally never having been tested. I find that although a majority of people had been tested in each of the villages, a majority of people underestimated the actual prevalence and thought that testing was not normative. Men who perceived testing as not normative were much more likely to never have been tested, and both men and women who felt they didn’t know anything about the norm were also more likely to never have been tested. Results suggest that interventions promoting true HIV testing norms may help increase uptake of testing.
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    Patterns and Distribution of HIV among Adult Men and Women in India
    (Public Library of Science (PLoS), 2009) Perkins, Jessica M.; Khan, Kashif T.; Subramanian, Sankaran
    BACKGROUND: While the estimated prevalence of HIV in India experienced a downward revision in 2007, the patterning and distribution of HIV in the population remains unclear. We examined the individual and state-level socioeconomic patterning of individual HIV status among adult men and women in India as well as the patterning of other individual demographic and behavioral determinants of HIV status. METHODOLOGY/PRINCIPAL FINDINGS: We conducted logistic regression models accounting for the survey design using nationally representative, cross-sectional data on 100,030 women and men from the 2005-2006 India National Family Health survey which, for the first time, provided objective assessments of HIV seroprevalence. Although there was a weak relationship between household wealth and risk of being HIV-positive, there was a clear negative relationship between individual education attainment and risk of being HIV-positive among both men and women. A 1000 Rupee change in the per capita net state domestic product was associated with a 4% and 5% increase in the risk for positive HIV status among men and women, respectively. State-level income inequality was associated with increased risk of HIV for men. Marital status and selected sexual behavior indicators were significant predictors of HIV status among women whereas the age effect was the most dominant predictor of HIV infection among men. CONCLUSIONS/SIGNIFICANCE: Although the prevalence of HIV in India is low, the lack of strong wealth patterning in the risk of HIV suggests a more generalized distribution of HIV risk than some of India's high-risk group HIV prevention policies have assumed. The positive association between state economic development and individual risk for HIV is intriguing and requires further scrutiny.