Kohler, Hans-Peter
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Publication Resilience, Accelerated Aging and Persistently Poor Health: Diverse Trajectories of Health among the Global Poor(2022-08-01) Kohler, Iliana V; Hoang, Cung Truong; Amin, Vikesh; Behrman, Jere R; Kohler, Hans-PeterObjectives: This study is among the first to document lifecourse trajectories of physical and mental health across adult and older ages (20-70 years) for a poor sub-Saharan African population having faced frequent and sustained adversities. Methods: The 2006-19 waves of the Malawi Longitudinal Study of Families and Health (MLSFH) were analyzed using group-based trajectory models (GBTM) to identify trajectories of heath (SF12 mental/physical health and BMI) across the lifecourse. Predictors of trajectory membership were estimated using fractional multinomial logits. Results: Analyses identified three distinct trajectories: (1) good initial mental/physical health that persisted throughout the lifecourse ("resilient aging"); (2) good initial mental and physical health that deteriorated with age ("accelerated aging"); or (3) poor initial mental and physical health with possibly further declines over the lifecourse ("aging with persistently poor health"). Predictors of trajectory group membership included gender, childhood poverty, and schooling. Discussion: Despite lifecourses being characterized by poverty and frequent adversities in this poor population, our analyses identified a sizable group (30%) of resilient individuals who experienced successful aging with good initial health that persisted across the lifecourse and into old age. Accelerated aging was the most common trajectory for SF12 physical and mental health in this poor population, while for BMI, persistently poor health was most common. Men were more likely to enjoy resilient aging than women in terms of physical/mental health, contrary to previous findings from high-income contexts. Other predictors of trajectory membership sometimes confirmed, and sometimes contradicted, hypotheses derived from high-income country studies.Publication Schooling has Smaller or Insignificant Effects on Adult Health in the US than Suggested by Cross-Sectional Associations: New Estimates Using Relatively Large Samples of Identical Twins(2013-12-09) Behrman, Jere R.; Amin, Vikesh; Kohler, Hans-PeterAdult health outcomes and health behaviors generally are strongly associated with schooling attainment. But such associations do not necessarily imply that schooling has causal effects on health outcomes and behaviors of the magnitudes of the associations. Schooling may be proxying for unobserved factors that are related to genetics and family background. Recently several studies have used within-identical (monozygotic, MZ) twins methods to control for those unobserved factors that are shared completely by identical twins. Estimates based on relatively small samples for the US, as well as some larger samples for other countries, suggest that causal impacts of schooling on health outcomes and behaviors are insignificant or much smaller than suggested by cross-sectional associations. This study contributes new estimates of cross-sectional associations and within-MZ causal effects of twins using three relatively large US samples: Mid-Atlantic Twin Registry, Minnesota Twin Registry and NAS-NRC Twin Registry of WWII Military Veterans. The estimates suggest that schooling is significantly associated with numerous health outcomes and behaviors in the US. However if within-MZ twins estimators are used to control for unobserved factors, there is no causal relationship between schooling and better health behaviors. There is some evidence that more schooling causally affects self-reported health and overweight status, net of unobservable cofounders, though not to the extent that cross-sectional associations suggest. Finally, spousal schooling is associated with better health outcomes and behaviors, but there is no evidence of any causal effect.Publication Social Science Methods for Twins Data: Integrating Causality, Endowments and Heritability(2010-01-01) Kohler, Hans-Peter; Behrman, Jere R; Schnittker, JasonTwins have been extensively used in both economic and behavioral genetics to investigate the role of genetic endowments on a broad range of social, demographic and economic outcomes. However, the focus in these two literatures has been distinct: the economic literature has been primarily concerned with the need to control for unobserved endowments—including as an im¬portant subset, genetic endowments—in analyses that attempt to establish the impact of one vari¬able, often schooling, on a variety of economic, demographic and health outcomes. Behavioral genetic analyses have mostly been concerned with decomposing the variation in the outcomes of interest into genetic, shared environmental and non-shared environmental components, with recent multivariate analyses investigating the contributions of genes and the environment to the correlation and causation between variables. Despite the fact that twins studies and the recogni¬tion of the role of endowments are central to both of these literatures, they have mostly evolved independently. In this paper we develop formally the relationship between the economic and behavioral genetic approaches to the analyses of twins, and we develop an integrative approach that combines the identification of causal effects, which dominates the economic literature, with the decomposition of variances and covariances into genetic and environmental factors that is the primary goal of behavioral genetic approaches. We apply this new integrative approach to an illustrative investigation of the impact of schooling on several demographic outcomes such as fertility and nuptiality and health.Publication High Development and Fertility: Fertility at Older Reproductive Ages and Gender Equality Explain the Positive Link(2011-10-03) Myrskylä, Mikko; Kohler, Hans-Peter; Billari, FrancescoA fundamental switch in the fertility—development relationship has occurred so that among highly developed countries, further socioeconomic development may reverse the declining fertility trend. Here we shed light on the mechanisms underlying this reversal by analyzing the links between development and age and cohort patterns of fertility, as well as the role of gender equality. Using data from 1975 to 2008 for over 100 countries, we show that the reversal exists both in a period and a cohort perspective and is mainly driven by increasing older reproductive-age fertility. We also show that the positive impact of development on fertility in high-development countries is conditional on gender equality: countries ranking high in development as measured by health, income, and education but low in gender equality continue to experience declining fertility. Our findings suggest that gender equality is crucial for countries wishing to reap the fertility dividend of high development.Publication Family Change and Variation Through the Lens of Family Configurations in Low- and Middle-Income Countries(2021-09-27) Castro Torres, Andrés Felipe; Pesando, Luca Maria; Kohler, Hans-Peter; Furstenberg, Frank F.Using 254 Demographic and Health Surveys from 75 low- and middle-income countries, this study shows how the joint examination of family characteristics across rural and urban areas provides new insights for understanding global family change. We operationalize this approach by building family configurations: a set of interrelated features that describe different patterns of family formation and structure. These features include partnership (marriage/unions) regimes and their stability, gender relations, household composition, and reproduction. Factorial and clustering techniques allow us to summarize these family features into three factorial axes and six discrete family configurations. We provide an in-depth description of these configurations, their spatial distribution, and their changes over time. Global family change is uneven because it emerges from complex interplays between the relative steadiness of longstanding arrangements for forming families and organizing gender relations, and the rapidly changing dynamics observed in the realms of fertility, contraception, and timing of family formation.Publication Mortality Risk Information, Survival Expectations and Sexual Behaviors(2020-01-29) Ciancio, Alberto; Delavande, Adeline; Kohler, Hans-Peter; Kohler, Iliana V.Individuals in low-income settings are often overly pessimistic about their own survival, suggesting that better knowledge about survival risks might encourage investments in health. This paper provides evidence from a randomized experiment that provided mature adults aged 45+ in Malawi with information about mortality risks. Treated individuals are less likely to engage in risky sexual practices one year after the intervention, and they increase other forward-looking behaviors such as investments in agriculture. Expectations of HIV+ people living longer, which makes the pool of potential partners riskier, are a primary driver of reduced sexual risk taking in response to the intervention.Publication Health Screening for Emerging and Non-Communicable Disease Burdens Among the Global Poor(2021-01-26) Ciancio, Alberto; Kämpfen, Fabrice; Kohler, Hans-Peter; Kohler, Iliana V.Among adults in rural Malawi, population health screening for high blood pressure (BP) led to a 22-percentage point drop in the likelihood of being hypertensive four years later. Individuals with elevated BP received a referral letter upon initial screening; at follow-up, they had lower BP and higher self-reported mental health than individuals with similar BP who were just below the threshold for referral. Population health screenings can reduce the burden of non-communicable diseases in low-income countries.Publication The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, Condom Use with Spouses(2013-03-20) Fedor, Theresa M.; Kohler, Hans-Peter; Behrman, Jere R.This paper assesses how knowledge of HIV status gained through HIV testing and counseling (HTC) by married individuals affects divorce, the number of sexual partners and the use of condoms within marriage. Instrumental variable probit and linear models are estimated, using a randomized experiment administered as part of the Malawi Longitudinal Study of Families and Health. The results indicate that knowledge of HIV status (1) does not affect chances of divorce for either HIV-negative or HIV-positive respondents; (2) reduces the number of sexual partners among HIV-positive respondents, and (3) increases condom use with spouses for both HIV-negative and HIV-positive respondents. These results imply that individuals actively respond to learning HIV status through HTC, invoking protective behavior against future risk of HIV/AIDS for themselves and their actual and potential sexual partners.Publication Curtailing COVID-19 on a Dollar-a-Day in Malawi: Implications for the Ongoing Pandemic(2021-03-15) Kohler, Iliana V.; Kämpfen, Fabrice; Ciancio, Alberto; Mwera, James; Kohler, Hans-Peter; Mwapasa, VictorUtilizing population-based data from the COVID-19 phone survey (N=2,262$) of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd--August 17th, 2020, we investigate behavioral, economic and social responses COVID-19 and focus on the crucial role that community leadership and trust in institutions play towards shaping these responses. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leaders to mobilize communities to adapt and adhere to COVID-19 prevention strategies. Village heads (VHs) played pivotal role in shaping individual's knowledge about the pandemic and the adaption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals' behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to COVID-19 will remain the primary prevention strategy for a foreseeable future.Publication Global Family Change: Persistent Diversity with Development(2018-02-07) Pesando, Luca Maria; Castro, Andrés F.; Andriano, Liliana; Furstenberg, Frank; Behrman, Julia A.; Kohler, Hans-Peter; Billari, Francesco; Monden, ChristiaanThis paper provides a broad empirical overview of the relationship between family change and socio-economic development drawing on 30+ years of Demographic and Health Survey data from 3.5 million respondents across 84 low- and middle-income countries (LMICs). We conduct two sets of analyses. First, we document global and regional-level associations between the Human Development Index (HDI) and novel indicators reflecting multidimensional family change. Second, we use methods from the growth convergence literature to examine whether – and in which domains – there is evidence of cross-country convergence in family indicators over levels of development. We show that families in LMICs have transformed in multiple ways, changing differently across domains, world regions, and genders. Fertility, intra-couple decision-making, and women’s life-course timing indicators are strongly associated with HDI, yet cross-country convergence is limited to the latter domain. Marriage, cohabitation, household structure, and men’s life-course timing indicators are more weakly associated with HDI, and span a broad spectrum of convergence dynamics ranging from divergence to modest convergence. We describe this scenario as “persistent diversity with development,” and shed light on the underlying regional heterogeneity – driven primarily by sub-Saharan Africa.