January 2008 AJPH Highlights: Poverty and Human Development

Newswise — The articles below will be published online Nov.29, 2007, at 4 p.m. (EDT) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml, and will appear in the January 2008 print issue of the Journal. The January 2008 issue is participating in the Global Theme Issue on Poverty and Human Development, organized by the Council of Science Editors. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at http://www.ajph.org.

Immigrant children at higher risk of lead poisoningForeign-born children were five times more likely to have elevated blood lead levels than were U.S.-born children.

Researchers conducted a study among children in New York City to investigate associations of childhood lead poisoning with birth and residence in a foreign country. After controlling for housing characteristics and child behaviors such as eating non-food items, data suggested that foreign-born children were five times more likely than were U.S.-born children to have elevated blood lead levels. In addition, children living abroad within 6 months of their blood test had a 10-times increased risk for lead poisoning relative to U.S.-born children with no history of foreign residence.

"These results suggest a need for considering recent immigration as a risk factor for childhood lead poisoning and allocating resources to identify and remove lead exposure sources in the immigrant communities at greater risk," said the study's authors. "Equally important is educating immigrant families about methods of reducing children's exposure to lead paint hazards, given that paint may be an unfamiliar source for many immigrant families." [From: "Immigration and Risk of Childhood Lead Poisoning: Findings From a Case-Control Study of New York City Children." ]

Nearly 60 percent of women trafficked and sexually exploited suffered from posttraumatic stress Study is first to quantitatively document the health symptoms of trafficked women and adolescent girls in Europe.

Researchers interviewed 192 women and adolescent girls within 14 days of accessing post-trafficking services to investigate the health of women trafficked for sexual exploitation in Europe. Almost 60 percent of participants reported experiences of sexual or physical violence before being trafficked, and 12 percent had a forced or coerced sexual experience before the age of 15. Ninety-five percent of participants reported physical or sexual violence while in the trafficking situation. Symptoms associated with depression were most often reported, with 39 percent of participants acknowledging having suicidal thoughts within the past seven days.

"The severe symptom patterns identified suggest that diagnostic and treatment services should be made immediately available to survivors of trafficking," said the study's authors. "However, dissecting the constellation of women's symptoms and formulating treatment plans are not likely to be easy or short-term tasks." [From: "The Health of Trafficked Women: A Survey of Women Entering Post-trafficking Services in Europe." ]

Increased health care spending in developing countries not enough by itself to increase utilization of skilled birth attendantsAccess to education, however, contributes to birth attendant use, so the optimal scenario in a country combines higher health care expenditures and equitable access policies.

The study analyzed data from Demographic and Health Surveys of 45 developing countries to investigate the extent to which redistributive education policies modify the impact of higher health spending on the utilization of skilled birth attendants among the poorest compared with the least poor women. Data suggests that at any given level of health care spending, women's use of skilled birth attendants varied substantially, depending on the equity of distribution of education.

"This work supports the thesis that higher levels of health expenditure do not automatically mean substantially greater use of skilled birth attendants by poor women," said the study's authors. "Poor women's access to education, which is in the domain of government policy and reflects a redistributive policy environment, is an important influence on improving the equity of access." [From: "Equity of Skilled Birth Attendant Utilization in Developing Countries: Financing and Policy Determinants." ]

Early and late sexual debut associated with problems in sexual functioningEarly initiation of sexual intercourse is associated with increased number of sexual partners, increased sexual risk behaviors and problems in sexual functioning.

Researchers examined the adult consequences of early or late sexual debut by conducting a secondary analysis of data from the National Sexual Health Survey. Researchers also compared individuals whose first sexual intercourse occurred after marriage with those whose first experience occurred before marriage.

Data suggested that timing of first sexual intercourse was associated with several sexual risk factors in men and women. Men and women who had an early sexual debut reported more sexual partners, were more likely to have had sexual intercourse with at least one risky partner in the preceding year and preceding five years and were more likely to have had sexual intercourse under the influence of alcohol or drugs in the past year. When compared to those who debuted at a normative age, early starters were more likely to have a history of an STI, whereas late starting women were less likely than those who had started at a normative age to have such a history. Early initiation and late initiation were both associated with various problems in sexual functioning, especially in men. Differences observed between individuals whose first sexual intercourse occurred before marriage and those whose first intercourse occurred after marriage were similar to those observed between early and late starters.

"Although our findings support an association between early initiation and long-term STI risk, they also suggest a more complicated picture of sexual functioning. Contrary to the suggestions of proponents of abstinence-only education, we found that both early and late initiators are more likely to experience problems with sexual functioning than those who initiate sexual activity at a normative age," said the study's authors. "Such a finding in regard to late initiation lends credence to research showing that abstinence-only education may actually increase health risks and that strategies designed to promote relevant sexual health information, motivation and skills are likely to be more effective than abstinence-only messages in helping young people avoid short- as well as long-term health consequences." [From: "Long-term Health Consequences of Timing of Sexual Debut: Results from a National U.S. Study" by Sandfort, Orr, Hirsch & Santelli; ]

The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org.