Kohler, Hans-Peter
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Publication Copenhagen Consensus 2012: Challenge Paper on "Population Growth"(2012-06-04) Kohler, Hans-PeterWhile the majority of the population is now estimated to live in regions with below replacement fertility, high fertility, poor reproductive health outcomes and relatively rapid population growth remain an important concern in several low income countries. International and national spending devoted to family planning, however, has declined significantly in recent years. Recent research has brought about a revision in the understanding of the interactions between population growth and economic development, as well as the effects of family planning programs in terms of reduced fertility, improved reproductive health outcomes and other life-cycle and intergenerational consequences. This paper discusses recent evidence about the benefits of family planning programs and the interactions between population growth and developments, and it attempts to estimate benefit-cost ratios for increased spending on family planning.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 The Marital Process and HIV/AIDS in Rural Malawi(2007-05-03) Clark, Shelley; Poulin, Michelle; Kohler, Hans-PeterThis article has since been published, please cite this published version: Clark, Shelly, Michelle Poulin, and Hans-Peter Kohler. 2009 "Marital Aspirations, Sexual Behaviors, and HIV/AIDS in Rural Malawi." Journal of Marriage and Family 71(2):396 - 416. Available online at: http://www3.interscience.wiley.com/journal/122328396/abstract Using both qualitative and quantitative data from young men and women in rural Malawi, this paper takes an in-depth look at how youths in an AIDS-afflicted sub-Saharan country – Malawi – attempt to achieve the dual goals of avoiding HIV/AIDS and finding a suitable spouse. For youths in Malawi facing AIDS epidemics, we show that the process leading to marriage, with its concurrent rapid changes in sexual partnerships and sexual behaviors, is integrally related to HIV/AIDS risks. In addition, concerns about HIV/AIDS appear to be influencing adolescents’ marital aspirations with respect to the timing of marriage as well as the selection of spousal partners. Many youths are clearly failing to find safe pathways into marriage, indicating a strong need for far greater research and policy attention on the dynamic relationship between HIV risks and the marital process.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 Up, Down and Reciprocal: The Dynamics of Intergenerational Transfers, Family Structure and Health in a Low-Income Context(2017-06-07) Payne, Collin F.; Pesando, Luca Maria; Kohler, Hans-PeterIn the absence of well-functioning public transfer systems and safety nets, the family acts as the key provider of income and support through the intergenerational redistribution of resources. In this paper we use micro-level longitudinal data and a mix of methodologies to document the lifecycle patterns of financial transfers in a rural, sub-Saharan African population. Underneath a well-established age-pattern of intergenerational transfers in which transfer patterns change according to broad stages of the economic life cycle, our analyses document significant heterogeneity and fluidity: Intergenerational transfers are variable and reverse their direction, with individuals moving between the provider and recipient states repeatedly across their life course and within each major stage of the life-cycle. Contrary to common perceptions about family transfers ameliorating short-term shocks, transfers in our analyses are driven primarily by demographic factors such as changes in health, household size, and household composition, rather than short-term events. Overall our analyses suggest that the role of transfers in this rural sub-Saharan context is significantly more complex than suggested by theories and evidence on aggregate transfer patterns, and at the micro-level, intergenerational transfers encapsulate multiple functions ranging from direct exchange to old-age support in the absence of a public pension system.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 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC)(2020-01-28) Kohler, Iliana V.; Bandawe, Chiwoza; Ciancio, Alberto; Kämpfen, Fabrice; Payne, Collin F.; Mwera, James; Mkandawire, James; Kohler, Hans-PeterCohort purpose: The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global aging studies by providing a rare opportunity to study the processes of individual and population aging, the public health and social challenges associated with aging and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context. Design and Measures: The MLSFH-MAC is a population-based cohort study of mature adults aged 45 years and older living in rural communities in three districts in Malawi (Mchinji, Balaka and Rumphi). Initial enrollment at baseline is 1,266 individuals in 2012. MLSFH-MAC follow-ups were in 2013, 2017, and 2018. Survey instruments cover aging-related topics such as cognitive and mental health, NCDs and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, BMI, a broad range of individual- and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, health care facilities and health care providers in the MLSFH-MAC study areas. Unique features: MLSFH-MAC is a data resource that covers 20 years of the life course of cohort members and provides a wealth of information unprecedented for aging studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa. Among these are the longitudinal population-based data on depression and anxiety using clinically-validated instruments. MLSFH-MAC is also vanguard in measuring longitudinal changes in cognitive health among older individuals in SSA. Complemented by contextual and qualitative information, the extensive MLSFH-MAC data facilitate a life-course perspective on aging that reflects the dynamic and distinct settings in which people reach older ages in SSA LICs. Across many domains, MLSFH-MAC also allows for comparative research with global aging studies through harmonized measures and instruments. Collaboration and data access: Public-use version of the 2012 (baseline) MLSFH-MAC data can be requested at http://www.malawi.pop.upenn.edu. Sharing of additional MLSFH-MAC data is currently possible as part of collaborative research projects (if not overlapping with ongoing research projects, and subject to a Data Use Agreement).Publication The Social and the Sexual: Networks in Contemporary Demographic Research(2013-01-18) Kohler, Hans-Peter; Helleringer, Stéphane; Behrman, Jere R.; Watkins, Susan C.The analysis of networks has become an important theme in contemporary demographic research in both developed and developing countries, including investigations of the determinants of fertility behaviors, the interaction between social network and social structures and population policies, the role of intergenerational networks in aging societies, and the relevance for sexual networks for the spread of HIV AIDS. This paper reviews the current research on networks across several domains in demographic research, and it discusses some of the specific challenges of network-based approaches with respect to data collection, analytic approaches and methodologies, interpretation of results, and micro-to-macro aggregation by drawing on research conducted as part of the Kenyan Diffusion and Ideational Change Project (KDICP), the Malawi Longitudinal Study of Families and Health (MLSFH) and the Likoma Network Study (LNS).Publication Perception of HIV risk and the quantity and quality of children: The case of rural Malawi(2010-11-29) Castro, Ruben; Behrman, Jere R; Kohler, Hans-PeterThe empirical literature on HIV and the quality (Q) and quantity (N) of children generally reports negative associations for Q and unclear associations for N. We focus our analysis on the effects of HIV, as a predictor of mother and child mortality, on investments in child Q and N. We develop a Q-N model within which higher mothers’ mortality predicts lower N while higher child mortality predicts lower Q. Those effects together make reasonable the expectation of negative influences of higher HIV likelihood on child Q and N. Based on longitudinal micro data on mothers and their children in rural Malawi we find that variation in mothers’ reported HIV risk reduces both child quality, as reflected in children’s schooling and health, and child quantity, when the perceived risk is already moderate or high. The effects are sizable, and, in the case of Q (schooling and health) are found in children and teenagers, as well as boys and girls, while in the case of N are found for young and mature women.Publication Cohort Profile: The Malawi Longitudinal Study of Families and Health (MLSFH)(2013-07-31) KOHLER, HANS-PETER; Watkins, Susan C.; Behrman, Jere R; Kohler, Iliana V.; Anglewicz, Philip; Fleming, Peter; Thornton, Rebecca L.; Mkandawire, James; Kalilani-Phiri, Linda; Honde, Hastings; Hawara, Augustine; Chilima, Ben; Bandawe, Chiwoza; Mwapasa, Victor; MLSFH Study Team,The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-standing publicly-available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries. With data collection rounds in 1998, 2001, 2004, 2006, 2008, 2010 and 2012 for up to 4,000 individuals, the MLSFH permits researchers to investigate the multiple influences that contribute to HIV risks in sexual partnerships, the variety of ways that people manage risk within and outside of marriage, the possible effects of HIV prevention policies and programs, and the mechanisms through which poor rural individuals, families, households, and communities cope with the impacts of high morbidity and mortality that are often---but not always---related to HIV/AIDS. The MLSFH been used to document (i) the influence of social networks on HIV-related behaviors and perceptions, (ii) the HIV prevention strategies employed by individuals in rural high-HIV prevalence contexts, (iii) the relationship between life-course transitions and HIV infection risks, (iv) the acceptability of HIV testing and counseling (HTC) and the consequences of HTC on subsequent behaviors, and (v) the health and well-being across the life-course of individuals facing multiple challenges resulting from high disease burdens and widespread poverty.