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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