Carolyn Halpern

University of North Carolina at Chapel Hill | UNC · Department of Maternal and Child Health

Background Women with disabilities face a number of barriers when accessing reproductive health services, including maternal healthcare. These include physical inaccessibility, high costs, transportation that is not accessible, negative attitudes from family and healthcare providers, and a societal belief people with disabilities shouldn’t be paren...

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy. However, few studies have examined individual patterns of contraceptive use over time. These trajectories are important to understand given the high rate of un...

Background Women with disabilities face a number of barriers when accessing reproductive health services, including maternal healthcare. These include physical inaccessibility, costs, transportation, negative attitudes from family and healthcare providers, and a societal belief people with disabilities shouldn’t be parents. While qualitative studie...

Importance: Studies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships. Objective: To evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple dom...

Violence victimization has been associated with low-grade inflammation. Lesbian, Gay, and Bisexual (LGB) individuals are at greater risk for victimization in childhood and young adulthood compared to heterosexuals. Moreover, the intersection of LGB identity with gender, race/ethnicity, and educational attainment may be differentially associated wit...

The National Longitudinal Study of Adolescent to Adult Health (Add Health) represents a data treasure for developmental psychologists working in both adolescent and life-span development. Add Health is a nationally representative sample of more than 20,000 adolescents in grades 7–12 in 1994–1995, who were followed for 25 years into early midlife ov...

Racial disparities in birth outcomes are seemingly intractable. Using person-centered methods and drawing from the life course and Weathering Hypothesis literatures, we used data from the National Longitudinal Study of Adolescent to Adult Health to group non-Hispanic White and non-Hispanic Black women ages 24–34 into latent classes based on pre-pre...

Objective The objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. Methods: The study uses secondary analysis of the Rajasthan dataset of the 2010-2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 wo...

Little is known about how minor sex exchange (MSE) may impact violence victimization during adulthood. This study investigates potential associations between MSE and forms of interpersonal violence victimization in young adulthood, while controlling for additional forms of violence experienced in childhood and adolescence. Data from The National Lo...

Background Longitudinal studies on resilience among children who have experienced maltreatment indicate that resilience is multi-dimensional. However, most research consolidates diverse developmental domains comprising resilience into a single score, which does not allow for detection of potentially heterogeneous associations between risk factors a...

Over the last two decades, in‐person interviewing costs continued to increase while the data quality advantages traditionally identified with this data collection mode have faded. Consequently, some longitudinal surveys have begun transitioning from in‐person to web data collection despite risks to data quality and longitudinal comparability. This...

This work investigates the associations between experiences of domestic minor sex trafficking and adolescent interpersonal violence victimizations, including intimate partner violence (IPV) and community violence. Abuse and violence in childhood are commonly proposed as risk factors for domestic minor sex trafficking. However, less is known about h...

Funding reductions combined with increasing data-collection costs required that Wave V of the USA’s National Longitudinal Study of Adolescent to Adult Health (Add Health) abandon its traditional approach of in-person interviewing and adopt a more cost-effective method. This approach used the mail/web mode in Phase 1 of data collection and in-person...

Self-rated health (SRH) is one of the most important social science measures of health. Yet its measurement properties remain poorly understood. Most studies ignore the measurement error in SRH despite the bias resulting from even random measurement error. Our goal is to estimate the measurement reliability of SRH in contemporaneous, retrospective,...

Purpose This study aimed to examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation. Methods Data were from 13,458 respondents to Waves I and IV of the National Longitudinal...

Background: Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge. Objective: Our objective was to describe the develop...

CONTEXT Intimate partner violence (IPV) among sexual minority young adults has been understudied, and victimization and perpetration estimates are needed. METHODS Data on 13,653 women and men aged 24–32 who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between sexual orien...

Objectives To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB).Methods We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospectiv...

While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental health, particularly across early life and among a diverse set of population subgroups. This study investigates how intra- and inter-individual trends in depressive symptoms unfold...

This study used population‐representative data to examine associations of risk and protective factor patterns among Alaska Native/American Indian (AN/AI; N = 592) and non‐Native (N = 1,018) children with maternal and child outcomes at age 3 years. Among AN/AI children, a high risk/moderate protection class was associated with child developmental ri...

Objectives Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child. Methods Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012–2014 Alas...

Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Nat...

Introduction: Although previous research has suggested a positive association between child maltreatment and BMI over the life course, it is unclear when this develops. Methods: The authors used time-varying effect models and data from a nationally representative, longitudinal, cohort study (Add Health), to test how childhood physical, sexual, a...

Maintaining high response rates over time is critical for the integrity of longitudinal studies. A best practice for encouraging survey participation in cross-sectional studies is to send sample members a pre-incentive with the survey invitation. However, in longitudinal studies this may change sample members’ future expectations of incentives. Ins...

Background Contact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups. Objective We aimed to identify longitudinal trajectory classes of CPS con...

Background: Prior studies have suggested maltreatment is a strong predictor of later weight outcomes, such that maltreatment experiences in childhood increase the likelihood of being overweight or obese in adulthood. Estimates of this relationship may be biased due to: 1) inadequate selection of covariates; 2) improper operationalization of child...

Objective: To provide national estimates of donor insemination (DI) use in the United States and a description of the population of users. Design: Population estimates were generated from nationally representative data through weighted proportions and count estimates. Setting: Not applicable. Patient(s): Participants were U.S. women of child...

Background: Sexual partners are the primary source of incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Identifying partner types at greatest risk of HIV transmission could guide the design of tailored HIV prevention interventions. Methods: We conducted a secondary analysis of data from AGYW (aged 13-23...

Background: A single measure that distills complex body mass index (BMI) trajectories into one value could facilitate otherwise complicated analyses. This study creates and assesses the validity of such a measure: average excess BMI. Methods: We use data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (n = 17,669...

Objectives: To test whether indicators of despair are rising among US adults as they age toward midlife and whether this rise is concentrated among low-educated Whites and in rural areas. Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of US adolescents in 1994. Our samp...

An unhealthy body mass index (BMI) trajectory can exacerbate the burdens associated with child maltreatment. However, we have yet to explain why the relationship between maltreatment and BMI trajectories exists and what allows individuals to attain healthy BMI trajectories despite adversity. Guided by the Transactional Model of Stress and Coping, w...

Purpose: The study tested if sexual orientation is associated with metabolic syndrome (MetS) in young adulthood (ages 24-32), and if economic strain impacts associations. Methods: Gender-stratified logistic regressions were fit among 11,575 young adults (1644 sexual minority [SM]) in Wave IV of The National Longitudinal Study of Adolescent to Ad...

Objective: To compare the Centers for Disease Control and Prevention's (CDC) contraceptive effectiveness poster with a more patient-centered poster on factors affecting the likelihood of using effective contraceptives. Methods: The posters were tested in a randomized controlled trial. Women were eligible if they were aged 18-44 years, could spea...

Background Evidence suggests that gender equality positively influences family planning. However, the evidence from urban Africa is sparse. This study aimed to examine the association between changes in gender norms and modern contraceptive use over time among women in urban Nigeria. Methods Data were collected in 2010/2011 from 16,118 women aged...

Background: Timing of first sex has important implications for later sexual health, but little research has considered this in populations with physical disabilities. Objective: The purpose of this paper was to examine timing of sexual experiences among populations with physical disabilities in the United States from adolescence to early adulthood...

The goal of this paper was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Waves 1 (adolescence), 3 (emerging adulthood), and 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). First,...

Background Socioeconomic status (SES) is a fundamental contributor to health; however, limited research has examined sexual orientation differences in SES. Methods 2008–2009 data from 14 051 participants (ages 24–32 years) in the US-based, representative, National Longitudinal Study of Adolescent to Adult Health were analysed using multivariable r...

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health....

Objectives: To refine the Centers for Disease Control and Prevention (CDC)'s contraceptive education poster using patient-centered design. Study design: We conducted cognitive interviews with 26 women aged 18-44 living in North Carolina who spoke and read English and had ever had sex. We interviewed women about both a CDC and a patient-centered...

This study examines the relationship between childhood maltreatment experiences and body mass index (BMI) over time. Using data from the National Longitudinal Study of Adolescent to Adult Health, we use latent profile analysis to create child maltreatment experience classes and latent growth modeling to understand how classes relate to BMI trajecto...

Objective: School attendance prevents HIV and herpes simplex virus-2 (HSV-2) in adolescent girls and young women, but the mechanisms to explain this relationship remain unclear. Our study assesses the extent to which characteristics of sex partners, partner age, and number mediate the relationship between attendance and risk of infection in adoles...

Background: There are 20 million new sexually transmitted infections (STIs) in the United States each year, and half of these are among young people aged 15 to 24. Methods. A logit model on a subset of National Longitudinal Study of Adolescent and Adult Health respondents (n = 12,129) tests whether perceived survival expectations assessed in adoles...

Purpose: The goal of this paper is to examine gender-typed behavior longitudinally and consider its relationship with sexual orientation in adulthood. Method: Data were from 10,624 respondents to the National Longitudinal Study of Adolescent to Adult Health. After stratifying by biological sex, we examined differences in gender-typed behavior amon...

Purpose: The goal of this paper is to examine, in a nationally representative sample, intimate partner violence perpetration and victimization among sexual minorities, and how this relationship varies between males and females. Method: Data were a subset of 13,945 respondents from the National Longitudinal Study of Adolescent to Adult Health. Init...

The present study tests the assumption that peers wield sufficient influence to induce sexual homophily (i.e., similarities in sexual experiences). Because girls face greater stigma for their sexual experiences than do boys, sexual homophily may be greater in girls' friendship networks than in boys'. Stochastic actor‐based models were used to analy...

Although a large amount of research has focused on changes in adolescent sexual behavior over the last half century, relatively little is known about what characterizes optimal sexual development through the life course. Populations with disabilities have been particularly understudied for various reasons, including historical restrictions on their...

Purpose: Using a clustered randomized controlled trial design, we evaluated whether support to keep Kenyan orphaned adolescents in school reduces the risk of HIV infection. Methods: Participants included 835 orphaned boys and girls in grades 7 and 8 (mean age at the baseline = 15 years) in western Kenya. Primary schools (N = 26) were randomized...

Purpose: Few studies have sought to understand the typical sexual development of populations with physical disabilities in the United States, and those that do are often based on convenience samples or cross-sectional data. The purpose of this paper is to examine relationships between physical disability and experiences of vaginal, oral, and anal...

Self-rated health (SRH) is a robust measure of general health status and an indicator of where and when to target disease prevention efforts-especially in adolescent populations when clinical endpoints are rare. This study's purpose was to model SRH trajectories from ages 13 to 31 and identify whether and when differences between demographic groups...

Background: Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection. S...

Purpose: Relative to on-time or late-maturing peers, girls who begin puberty early typically begin romantic and sexual experiences earlier; however, advanced pubertal status does not necessarily coincide with commensurate interpersonal skills necessary for healthy romantic relationships. Research is limited on the long-term implications of early p...

Male perpetration of intimate partner violence (IPV) against women in sub-Saharan Africa is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, though research on this topic in the region is limited. We assessed the degree to which peer network gender norms are associated with Tanz...

Orphaned adolescents are a large and vulnerable population in sub-Saharan Africa, at higher risk for HIV than non-orphans. Yet prevention of new infection is critical for adolescents since they are less likely than adults to enter and remain in treatment and are the only age group with rising AIDS death rates. We report process evaluation for a ran...

Objective: To estimate the association between school attendance, school dropout, and risk of incident HIV and HSV-2 infection among young women. Design: We used longitudinal data from a randomized controlled trial in rural Mpumalanga province, South Africa, to assess the association between school days attended, school dropout and incident HIV...

The influence of masculinity and femininity on behaviors and outcomes has been extensively studied in social science research using various measurement strategies. In the present paper, we describe and evaluate a measurement technique that uses existing survey items to capture the extent to which an individual behaves similarly to their same-gender...

Purpose: The goal of this paper was to examine, in a nationally representative sample, relationships between various sexual initiation pathways, subsequent sexual partnerships, and reproductive health outcomes from adolescence through early adulthood. Method: Data were a subset of 5,667 respondents from the National Longitudinal Study of Adolescent...

Child mortality is one of the most pressing global health and policy issues in the developing world. The leading drivers of death-pneumonia, diarrhea and malaria-are preventable and treatable. However, these illnesses are exacerbated by a lack of accessible nutrition, water, basic and preventive health services, and sanitary living conditions-all f...

We evaluated 2 assays to detect antibodies to herpes simplex virus type 2 in dried blood spots prepared from blood specimens submitted to a reference laboratory in Kenya. Dried blood spots did not perform well with the Kalon herpes simplex virus type 2 assay. Focus HerpeSelect 2 was 98.8% sensitive and 98.9% specific with dried blood spots.

Context: The typical understanding of sexual debut as first vaginal intercourse is often irrelevant to sexual minority youth. Better understanding of sexual initiation patterns among these youth is necessary to inform efforts to safeguard their sexual and reproductive health. Methods: Early sexual experiences were examined among 1,628 female and...

South Africa has high youth unemployment. This article examines the predictors of youth employment in rural Agincourt, Mpumalanga Province. A survey of 187 out-of-school 18 to 24 year olds found that only 12% of women and 38% of men were currently employed. Men with skills/training were significantly more likely to report employment, mostly physica...

Introduction There is limited research on rapid repeat pregnancies (RRP) among adolescents, especially using nationally representative samples. We examine distal factors—school, family, peers, and public/private religious ties—and their associations with RRP among adolescent mothers. Methods Guided by social development theory, we conducted multiva...

Methods: Logistic regression and linear models tested associations between triallelic (L'S', based on rs25531) 5HTTLPR genotypes and hypertension severity and mean systolic and diastolic blood pressure (SBP and DBP) collected during the Wave IV survey of the National Longitudinal Study of Adolescent to Adult Health (Add Health, N=11,815) in 2008-0...

Few studies have investigated the sexual development of populations with low cognitive abilities in the United States. This article examines the relationship between cognitive ability and various sexual experiences from adolescence (ages 12 to 18) to early adulthood (ages 28 to 34). Data were from 13,845 respondents interviewed at Waves I and IV of...

Our previous studies documented large racial disparities in sexually transmitted infections (STI) between Black and White young adults. In this chapter, we apply a longitudinal person-centered analysis of sex and drug use behavior to examine whether infection among young adults varies by the trajectory of such behaviors over time. Findings suggest...

Purpose: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship, and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms...

Purpose The purpose of this study was to explore the association between sexual orientation and teen pregnancy (before age 20 years) in a U.S. nationally representative cohort of young adult females aged 24–32 years. Methods A total of 5,972 participants in Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health were includ...

Modeling and computation for multivariate longitudinal surveys have proven challenging, particularly when data are not all continuous and Gaussian but contain discrete measurements. In many social science surveys, study participants are selected via complex survey designs such as stratified random sampling, leading to discrepancies between the samp...

Past evidence has documented that attitudes toward marriage and cohabitation are related to sexual behavior in adolescence and young adulthood. This study extends prior research by longitudinally testing these associations across racial/ethnic groups and investigating whether culturally relevant variations within racial/ethnic minority groups, such...

Purpose: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships...

To date, few studies have been conducted on the sexual development of adolescents and young adults with intellectual disabilities in the United States. Furthermore, the majority of this research has relied on cross-sectional or convenience samples, which has generated conflicting findings. Past research has shown that adolescents with intellectual...