Roadmap: Feb.

4 and 11
• The overall sequence of events
– Contraception de-links sex and marriage
– Demographic transition and the sequence of
changes in population composition
• Decline in proportions of infants/children
• Rise then decline in proportions of adolescents/youth
• Slow rise in proportions of elderly
• Rapid and permanent rise in proportions of elderly
 Roadmap-2
• Adolescence research in 1980s-1990s
• The resilience framework
• Elderly research from 2000 onward
• Young Adult Reproductive Health Surveys in
Asia
• New forms of living: living away from family or
even alone
•
DT/youth
bulge/greying
 Figure 1: The Demographic Youth Transition: Korea
(South)
50.0
45.0 1962 - Onset of
40.0 Fertility Decline

Crude birth/date rate

35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Crude birth rate

Crude death rate

10.0 30.0

8.0 1980 - Peak 25.0

1975 - Peak
Youth Share
Youth growth rate (%)
6.0 Youth Growth

Youth share (%)

20.0
4.0
Rate
15.0
2.0
10.0
0.0
Share
5.0
-2.0 Growth rate
-4.0 0.0

1990 - Peak
Number of Youth
10000
9000
8000
Number of Youth

7000
6000
5000
4000
3000
2000
1000
0
1950 1960 1970 1980 1990 2000 2010 2020
Year
 Table 1. Important Dates in the Demography of Youth
Transition: Countries of Asia

Onset Peak Peak youth Peak number

Country of fertility growth rate share of total of youth
decline among youth population population

Japan 1925 1964 1950 1967

Singapore 1959 1969 1978 1980
Hong Kong 1960 1970 1950 1980
Korea 1962 1974 1980 1981
Sri Lanka 1962 1975 1980 2002
Philippines 1963 1974 1977 2021
Brunei 1965 1970 1980 2012
Taiwan 1965 1960 1980 1980
Malaysia 1966 1970 1980 2015
Thailand 1968 1973 1986 1992
China 1969 1984 1987 1989
Indonesia 1970 1974 1992 2005
India 1973 1977 1984 2014
Myanmar 1976 1985 1994 2001
Bangladesh 1981 1995 2002 2004
Nepal 1988 2001 2007 2032
Pakistan 1990 2005 2010 2033

NOTE: Onset dates for sustained fertility decline as suggested by Bongaarts and Watkins (1996), whose criterion was a 10 percent decline
in the Total Fertility Rates given in United Nation (1994). Their estimates have been supplemented by estimates for Japan, Taiwan, Brunei
and Pakistan. Japan’s date was taken as 1925, following Kobayashi and Tsoubouchi (1979). Taiwan’s was taken as 1965 based on data
presented in Chang, Freedman and Sun (1981). Brunei’s was taken as 1965 based on data in United Nations (1994). Pakistan’s was taken
as 1990 based on Total Fertility Rates used in the World Bank projections (Bos et al 1994).
 Figure 8: The Asian Historical Trend toward Late Marriage:
Percents Single at Ages 15-19, Females

100

Bangladesh
90
India
Maldives
80 Nepal
Pakistan
Sri Lanka
70
Brunei
Burma
60 Cambodia
Indonesia
Percent

Malaysia
50
Myanmar
Philippines
40 Singapore
Thailand
Vietnam
30
Hong Kong
Japan
20 Korea
Macau
China
10
Taiwan

0
1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Review of YARH
literature
 Some Key Terms
1. Resilience
2. The setting – the settings approach
3. Risk factors and protective factors
 Main factors for discussion
1. Macro-level environment
2. Community
3. Family
4. Peers
5. Schools
6. The Individual
An Ecological Model of Resilience

Macro-level Environment
Political Realities
Youth Laws/Policies
Macro level Economics
Historical Events
 An Ecological Model of Resilience
Macro-level Environment

Community Environment
Risk
• arrests by age, type
• poverty
• single parent
• female head of household
• age of migration
• exposure to violent media/
youth-oriented
advertising
• access to tobacco, alcohol,
drugs, firearms
Protection
•average educational
attainment
• health care access and
utilization
• employment rates of adults
• informal support systems
• religious institutions
• access to role models
• pro-social media
 An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family
Risk Protection
• low parental education • connectedness
• family mental illness • parental presence
• maternal stress • parental values
• large family size - towards school
• overcrowding - toward risk taking
• poverty • two parents
• access to weapons • fewer siblings
• engaging in health • family cohesion
compromising behaviors • authoritative
• authoritarian parenting style parenting style
• family violence
An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family

Peers
Risk Protection
• prejudice from • being treated fairly
peers by peers
• perception of • having low-risk
threat friends
• social isolation • peers with pro-
• participation in social norms
deviant culture
 An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family

School Peers
Risk Protection
• retention • connectedness
• large schools • academic
• absenteeism performance
• harsh • classroom
discipline management
• integrated social
networks
 An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family

School Peers

Individual
Ris
• biological
k vulnerability
• intellectual impairment
• dyssynchronous maturation
• aggressive temperament
• impulsivity
• affective disorder
• aggressive behavior
• stress reactivity
Protection
• spirituality/religiosity
• social skills
• average intelligence
• late maturation
• positive self-image
• positive self-efficacy
• perceived importance
of parents
 An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family

School Peers

Individual

Health Risk Behaviors Sexual/

Substance Use Diet & Exercise Injury & Violence Reproductive
- tobacco - inactivity - weapon carrying - non contraception
- alcohol - disordered eating - interpersonal - condom avoidance
- marijuana - eating disorders violence - early sexual debut
- other - over-consumption - seat belt use - multiple sexual
- helmet use partners
- motorcycle use
- drinking & driving
- sexual assault
 An Ecological Model of Resilience
Macro-level Environment

Community Environment

Family

School Peers

Individual
Health Risk Behaviors

Health Outcomes
Physical Emotional Social
• Appropriate pubertal • Perception of self as • Positive school
development happy performance
• Age-appropriate cholesterol/LDL • No clinical evidence • Contributing to
• Perception of self as healthy of depression community
• Physically fit • No history of suicide • Positive family
• Injury free attempts relationships
• Not overweight • No mental or emotional • Prosocial values
• No STDs/HIV/ health disorders • Relationships with
unwanted pregnancies healthy peers
Knowing and Using
Household Surveys
 Some Features Common in
Household Sample Survey Designs
• Multi-stage, clustered and often stratified sampling designs
• Well-designed questionnaires using best practices
– e.g. a complete roster of household members
• Often (increasingly) take the form of repeated surveys
– attention to comparability across survey rounds
• Use of a Master Sample maintained centrally
• Often imbedded in an international system of surveys
which are methodologically consistent (therefore
comparable)
• Often (increasingly) featuring linkages with other kinds of
data at other levels (household, community, spatial etc.)
 Elements of the Modern Survey
System
• Very good national survey infrastructures
• National methods converging on global best practices
• Frequent surveys and regular censuses -- repeated
surveys common; panel surveys less common
• International survey systems common (UN and other
auspices)
• Frequently linkages with other kinds of data
 Examples of How to Take Advantage
in Your Own Work
• Use micro-files to select study areas (e.g. to select a
control district for an RCT)
• Use the national mastersample as your frame for
drawing a subsample of households
• Track long term change in key variables of interest by
combining a repeated series of surveys or censuses
 Surveys, Longitudinal/Panel and
Repeated
• Longitudinal/Panel
– Indonesian Family Life Survey
– Kanchanaburi Project
– Cebu Longitudinal Health and Nutrition Survey
• Repeat Surveys
– Many national survey series
– Most international survey series
– All census series
•SEAn youth
sexuality surveys
(AYARR)
 AYARR
The Asian Young Adult Reproductive
Risk Project
The AYARR Participating Countries and Surveys
Young Adult Coverage of the DHS Survey System
by World Region
Including
Region Total Single Males

Latin America 27 27 7

Europe/Eurasia 8 6 3

Sub-Saharan Africa 56 55 43

Near East (W. Asia)/

12 2 5
North Africa

Asia 17 4 4
Reproduction of Alan Guttmacher Institute, Into A New World (1998), Appendix Table 3
 Core Features of a YARH Survey
• Large-scale coverage, often national scale
• Representative sample of households
• Screens for an age-defined eligible cohort
• Represents the entire cohort (no systematic
exclusions)
• Coverage of many/most young adult topics
 Risk Behaviors in the AYARR Surveys
(X indicates that one or multiple questions on the topic are asked)

Country Hong Kong Indonesia Nepal Philippines Taiwan Thailand

TOPIC Date 1996 1998 2000 1994 1994 1990 1994
Risk behaviors
Smoking X X X X X X
Drinking X X X X X
Drug use X X X X
Medical injection X
Blood transfusion X
Pre-marital sex X
 Topic: Sexuality
(X indicates that one or multiple questions on the topic are asked
Region EAST ASIA SOUTHEAST ASIA
Country Hong Kong Taiwan Indonesia Philippines Thailand
Survey ASS ASS ASS HK-FLE TYPS RRS YAFS-II YAFS-II FAYS Partner
TOPIC Date 1996 1991 1986 1981 1994 1998 1994 1982 1994 1990
Sexuality
Knowledge
of reproductive system1 X X X X X X X X X
Sources of X X X X X X X X
Attitudes (includes on virginity) X X X X X X X X X
Experience X X X X X X X X X
2
Premarital X X X X X X X X X X
Commercial sex
Attitudes X X
Pay/buy X X X
Receive for pay/sell X X
Homosexuality
Attitudes X X X X X
Behaviors X X X X X
Extra-marital X X X X
Masturbation X X X X

Notes:
1 May include misconceptions or myths
 Topic: Proximate Contexts and Institutions
(X indicates that one or multiple questions on the topic are asked
Country Hong Kong Taiwan Indonesia Philippines Thailand
TOPIC Date 1981 1986 1991 1996 1994 1998 1982 1994 1990 1994
Proximate Contexts and
Institutions
Media exposure X X X X X X X X
Population/sex education X X X X X X
Family
Characteristics X X X X X X X X X
Relationships X X X X X X X X X
Friends X X X X X X X
Dating and courtship X X X X X X X
Marriage
Attitudes X X X X X X X X X
Behaviors X X X X X X
Dormitory/boarding experience X X X
 Event Information in the AYARR Surveys
Country
Event: Age at… Hong Kong Philippines Thailand Indonesia Nepal

puberty M F M F M F F
left school M F M F M F M F
first crush M F
first admired M F M F
first boy/girlfriend M F M F M F
first date M F M F
first kissed M F
first cohabitation M F M F
first marriage M F M F M F M F M F
 Event Information in the AYARR Surveys (continued)
Country
Event: Age at… Hong Kong Philippines Thailand Indonesia Nepal

first pre-marital sex M F M F M F M F M F

first sex M F M F M F M F M F
first sex with CSW M M M
first pregnancy F F F F
first birth F F F
left home M F M F M F M F
first work M F M F M F
first smoked M F M F M F M F
first drank M F M F M F M F
first used drugs M F M F M F
Table 3. Reproductive Health Indicators for Asian Youth
1 Hong Indo- Phil- Bangla-
Indicator China Kong Taiwan nesia ippines Thailand desh India3 Nepal Pakistan Sri Lanka
Sexual Activity and Marriage Among Adolescents
% of persons 15-19 Male 1 u u 2 4 4 7 6 4 1
who are married or
Females 32 3 36 20 8 19 48 38 24 72
cohabiting
All 5 2 3 27 8 13 73 51 32 14
% of women 20-24
who began their If had fewer than 7 years of
8 8 0 41 50 18 82 66 38 u
marriage or union schooling1
before age 18 If had 7 or more years of
2 1 3 24 8 3 40 21 7 u
schooling1
All u 40 39 79 58 63 u u u u

% of women 20-24 Before 18 u 16 8 1 10 3 u u u u

sexually active by Before marriage
age 20 18-19 u 7 13 2 13 5 u u u u
Before 18 u 6 5 51 13 18 u u u u
Within marriage
18-19 u 10 12 25 23 36 u u u u

NOTES:
U = Unavailable
1 = See AGI (1998), notes to Appendix Tables 1-4
2 = From AGI (1998)
3 = National Family Health Survey, 1992-93
Sources: Extracted from Alan Guttmacher Institute (1998) [AGI (1998)], appendix tables 1-6, and supplemented by the AYARR surveys.
Unless otherwise indicated, source is an independent YARH survey for Hong Kong, Indonesia, Nepal, Philippines, Taiwan,
or Thailand (see text for details) and AGI (1998) for other countries.
 Piggy-Back on the DHS?
• Advantages
– Economies re survey infrastructure, sampling,
etc.
• Issues to Resolve
– Sampling
• Need adequate sample size by age, sex, marital
status
• Must screen adequate numbers of households
• (more)
 More issues
– Content
• Adequate coverage of issues would drive out some
DHS content
 Whom to Interview
• Household screening: screen 10,000 to yield
7,000 youth)
• Interview all persons ages 15-29, about 10,000
• Interview sub-sample of “young teens” on
limited range of topics
• Interview spouses of youth sample
• (more)
 A Modified
YARH Survey Design--Basics
• Multistage sampling to yield adequate
number of localities (for linkage with
community-level information)
• Consortium approach to assure full data-
linkage possibilities and full use of the data
 Components of Data Collection:
Household
• Parents
• Siblings
• spouses
Components of Data Collection: Extra-
household
• Household survey
• Non-household special sample(s)
• Linkage to schools
– Institutional information
– Personal information
• Local labor market and job base information
• Medical system information (RH,FP, youth services
Living alone
 The Concept – Living Alone (LA)

• Living alone – in conventionally defined household:

• individuals in one-person households

• “Living alone” in group quarters, i.e. institutions

(monasteries, military barracks, prison, welfare
lodging, etc.)
• Living in other dwelling units classified as
“households” of some sort:
• Living with other persons but no one from core kin group
• living with other persons but no one who is any sort of relative
• Living in households with every member unrelated to anyone in
that household
 Age-Sex Profile of LA (Total): Overall Picture

• Asian patterns of LA are low comparing to

European national patterns, but for particular age
group and for each sex; but they are high enough
to be interesting
• Typical age-sex patterns exist as well as distinct
national departures from those common patterns
• Difference between LA in conventional household
and GQ
Common Pattern – Proportion (Total) LA, by Age &
Sex: Bangladesh
Age Profiles of LA in Group Quarters,
by Age & Sex, Bangladesh 1991-2011
 LA among those in other households
but no Core Family Members

• General patterns show:

(1) Very low level among youth -- but not zero, and
higher for males than for females
(2) High level in older ages among females
The case of Bangladesh
Proportion Living with Others, But No Core Family,
by Age, Sex, and Residence, Countries of Asia
Living Alone VS Living with Others but No Core
Family

• For India and Thailand levels of living alone

exceed level of living with others but away
from core family
• For Bangladesh, Indonesia, Malaysia, Vietnam
living with non-core others is much more
common than living alone
Living Alone VS Living with Others but No Core
Family – India 2001