Date post: | 10-Jul-2015 |
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CHALLENGES IN MEASURING LIFE
EVENTS AMONG ADOLESCENTS
IN MALAWI
Paul C. Hewett1,
Erica Soler-Hampejsek2,
Barbara S. Mensch2
Christine Kelly2,
Monica J. Grant3
1Population Council, Zambia; 2Population Council, New York; 3University of Wisconsin at Madison
Topics of Interest
Adolescent transitions- life events• Sexual initiation
• Leaving school
• Marriage
Measurement of…• Reporting of event (“ever”)
• Reporting of sequence of events (age & order)
Adolescent Transitions
Why is event reporting subject to error?
• Month/year/age of events not salient/fluid
• Misreporting or age not known
• Reporting of sensitive topics (sex) problematic
Why care? Researchers assert that…• Premarital sex, premarital pregnancy, early
marriage curtail schooling for girls
• School attendance reduces premarital sex
• Delayed marriage contributes to an increase in
premarital sex
Year Round
Full Sample
Follow-Up Rate
2007 1 Baseline
2008 2 91%
2009 3 90%
2010 4 88%
2011 5 88%
2013 6 83%
• Balaka and Machinga districts: southern
region (highest HIV prevalence, lowest
age at marriage)
Malawi Schooling and Adolescent Study
• 1764 in-school adolescents enrolled in
standards 4-8; 885 out-of-school
• Ages 14‒16 in January 2007
• 59 schools: probability of inclusion proportional to enrollment in 2006
MSAS Event Data
Rounds 1‒6
• ACASI: Sexual initiation & activity
• FTFI: School history
• FTFI: Marriage
Rounds 3‒6 • Life Event Cards: Sequence and age at sexual
initiation, first marriage, school leaving
MSAS: ACASI
• Audio: Respondents listen to questions and response categories: Chichewa and Chiyao;
• Text: Read questions on screen: Chichewa and Chiyao
ACASI
• Age at first sex?
0 = Never had sex
Sex defined explicitly
• Ever had sex with…
Boy/Girl friend
Hit and run
Relative
Teacher
Anyone else
Sexual Behavior Questions R1–R3
Sexual Behavior Questions R4–R6
• Updates from previous year
Reporting of Ever Had Sex
Reporting of sexual behavior at R1 (baseline)
Girls Boys
Had sex: Age of first sex 28% 48%
Had sex: Based on partners 26% 47%
Had sex: Based on either 37% 59%
Reported inconsistently 55% 41%
Inconsistent reporting between R1 and R2
Girls Boys
Had sex: Age of first sex 37% 31%
Had sex: Based on partners 37% 33%
Source: Soler-Hampejsek, Erica, Monica J. Grant, Barbara S. Mensch, Paul C. Hewett, Johanna Rankin.
2013. “The effect of school status and academic skills on the reporting of premarital sexual behavior:
Evidence from a Longitudinal Study in Rural Malawi.” Journal of Adolescent Health 53(2): 228-234.
Reporting of Ever Had Sex
Predicting inconsistent reporting
Within Round 1a
(RRs)
Across R1 & R2b
(ORs)
Girls Boys Girls Boys
In school 2.5** 1.4 3.2** 1.8*
School attainment 1.0 0.9 0.9 0.9
Literate, innumerate 0.4* 0.8 0.7 0.8
Literate and numerate 0.2** 0.8 1.2 1.3
* p <. 05, ** p < .01Note: Based on age at first sex reporting only
a Multinomial regression model: base: consistently reporting ever had sexb Logistic regression model: base: consistently reporting age at first sex
Round 3 Assessment
Drew an independent random sample• Same age (16-18)
• Same areas (catchment areas of schools)
• Same questionnaire
• FTFI for both sensitive and non-sensitive questions
Assess reporting of sensitive behaviors• Age at first sex
• Sex by partner type
• Alcohol use
• Petty theft
Compare• Responses from respondents interviewed R1-R3 (FTFI, ACASI)
• Responses from respondents interviewed only R3 (FTFI)
FTFI higher
Most Stigmatizing
Reporting of Ever Had Sex
By Interview Mode
Girls
FTFI ACASI
Had sex: Age of first sex 44% 38%
Sex with boy/girlfriend 35% 31%
Sex with hit and run 3% 4%
Sex with relative 0% 4%*
Sex with Teacher 0% 2%
Sex with anyone else 2% 5%
Alcohol use 1% 3%
Petty theft 3% 6%
* p <. 05, ** p < .01
Source: Kelly, Christine A., Erica Soler-Hampejsek, Barbara S. Mensch, and Paul C. Hewett. 2013. “Social
desirability bias in sexual behavior reporting: Evidence from an interview mode experiment in rural
Malawi.” International Perspectives on Sexual and Reproductive Health 39(1) March:14-21.
Boys
FTFI ACASI
70% 55%**
63% 40%**
21% 13%**
3% 9%*
0% 3%*
8% 12%
6% 4%
7% 5%
Over-reports?
Most Stigmatizing
No clear difference
MSAS: R3 ‒ R4 Life Event Cards
Left school
First marriage
First sex
Front Back
• Simple
• Visual
• Structured
Characteristics
• Enjoyable
• Quick
• Establishes age and sequence (order) without asking
about month of event
Measurements
• Sexual Initiation: “Age at first sex”
• First Marriage: “Age at first marriage”
• School leaving: Estimated from schooling
history
Month of event collected in FTFI / ACASI but unreliable
• 37% didn’t know month of sexual initiation
Comparing Interview Methods
Within round, across methods….
Source: Mensch, Barbara S. Erica Soler-Hampejsek, Christine A. Kelly, Paul C. Hewett, Monica J. Grant.
2014. “Challenges in measuring the sequencing of life events among adolescents in Malawi: A cautionary
note.” Demography. 51(1): 277-285
Round 3 Girls Boys
ACASI LE ACASI LE
Ever had sex 51% 63% 56% 54%
Age at sex consistent 37% 36%
Girls Boys
FTFI LE FTFI LE
Ever married 42% 45% 4% 4%
Age at marriage consistent 91% 88%
ACASI & LE
FTFI & LE
LE Card Sequencing: Girls R3 & R4
L = Left school
S = Sexual initiation
M = First Marriage
LSM
(216)
51%
Consistent
49%
Inconsistent
LMS 30%
SLM 16%
Other 4%
Round 3 Round 4
LMS
(149)
36%
Consistent
64%
Inconsistent
LSM 43%
SLM 20%
Other 1%
SML
(106)
18%
Consistent
82%
Inconsistent
LSM 53%
LMS 25%
Other 5%
Normative
Premarital
Sex
Cross-Sectional Comparison
L = Left school
S = Sexual initiation
M = First Marriage
LSM
(216)
Round 3 Round 4
LMS
(149)
SML
(106)
32%
46%
LSM
(228)
LSM
(145)
SML
(82)
Other
(16)
22%
48%
31%
18%
3%
Associations of Inconsistencies
Within round: ACASI verse LE
Different Age at 1st sex
ORsa
Girls
(524)
Boys
(494)
In school .62** .49**
School attainment .95 .87**
Numeracy 1.0 .93**
Can read simple sentence 1.0 .57*
Reading Comprehension .98 .88**
Late entry primary .98 .93
Repeated grades 1-3 .67* .53*
* p <. 05, ** p < .01a Logistic regression model: base: consistently reporting age of first sex
Associations of Inconsistencies
Across round, same method: LE Cards
* p <. 05, ** p < .01a Logistic regression model: base: consistently reporting age of first sex; age
controlled
Different Sequence: sex &
school leaving
ORsa
Girls
(524)
Boys
(494)
In school 1.3** .60**
School attainment 1.2** .87**
Numeracy 1.1** .96**
Can read simple sentence 2.0** .97
Reading Comprehension 1.1** .96**
Late entry primary .81 1.2
Repeated grades 1-3 .84 1.1
Summary
• Significant inconsistencies in reporting
• Within rounds using different methods
• Across rounds using the same methods
• Sexual behavior• Males appear to over report sexual activity in FTFI
• ACASI reveals higher reporting of most stigmatizing
behaviors
• ACASI potentially more difficult than expected for low
literate populations
• Reports of sexual behaviors influenced by schooling
status
• Sequence switching across rounds for (sex & school
leaving) and (sex and marriage), operates in both
directions
• Related to closer events in time, order less relevant
Recommendations
FTFI may be better for girls
• Ever had sex
• Sex with boyfriend
Carry over data from previous rounds
• Resolve inconsistencies
ACASI may be better for boys
• Ever had sex
• For stigmatizing Qs (… and girls)
Further analysis of inconsistent reporting warranted
• Motivations
• Related to academic and cognitive skills
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