James Lepkowski

• PhD
• Professor (Full) at University of Michigan

Introduction: India's childhood vaccination coverage has increased amid the implementation of national health policies intended to improve immunization levels. However, there is a dearth of contemporary studies comparing state-level childhood vaccination rates across India's highly diverse states and territories. This study assesses SES-based ineq...

Web‐mail surveys conducted using address‐based samples exploit the advantages of web surveys with respect to cost, timeliness, measurement flexibility, reduced respondent burden, interactive question–answer processes, and the advantages of address‐based samples with respect to coverage of a household population. The studies described here investiga...

Objective: This article presents data on the burden of periodontal diseases in Turkish adults aged 35 years or older. Methods: Within each region of Turkey, a rural and an urban area or city were selected in 2009-10 using a probability proportional to size method. In the selected towns, local officials who were familiar with their communities as...

HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence a...

The effects of incentives on response rates, web completion rates, and demographic and socioeconomic characteristics were investigated in a randomized experiment for a general population economic attitude survey. The experiment was conducted in two groups: (1) fresh cases from address-based sampling (ABS) postal addresses and (2) recontact cases th...

Background: India has the highest number of deaths among children younger than 5 years of age globally; the majority are from vaccine preventable diseases. Untimely vaccination unnecessarily prolongs susceptibility to disease and contributes to the burden of childhood morbidity and mortality yet there is scarce literature on vaccination delays. Th...

India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. This study utilized District Level Household and Facility Survey Data, 2008 (DLHS-...

Many dual frame estimators have been proposed in the statistics literature. Some of these estimators are theoretically optimal but hard to apply in practice, whereas others are applicable but have larger variances than the first group. In this paper, a Joint Calibration Estimator (JCE) is proposed that is simple to apply in practice and meets many...

Many dual frame estimators have been proposed in the statistics literature. Some of these estimators are theoretically optimal but hard to apply in practice, whereas others are applicable but have larger variances than the first group. In this paper, a Joint Calibration Estimator (JCE) is proposed that is simple to apply in practice and meets many...

Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of cult...

Background: India contributes to more than 20 percent of the child deaths in the world. Poor vaccination coverage has been identified as a leading cause of high child mortality rates in India, in spite of a free vaccination program for children. The aim of this study is to characterize the risk factors for under-vaccinations and non-vaccinations am...

Despite major improvements over the past several decades, many patients undergoing hematopoietic stem cell transplants (HSCT) continue to suffer from significant treatment-related morbidity and mortality. Clinical research studies (trials) have been integral to advancing the standard-of-care in HSCT. However, one of the biggest challenges with clin...

The increasing cost and decreasing coverage of Random Digit Dialing (RDD) landline telephone surveys motivated The Surveys of Consumer Attitudes (SCA) at the University of Michigan to conduct monthly experimental mail survey studies using address-based sampling (ABS). The primary objectives of the experimental studies were to evaluate the feasibili...

Expanded partnership with the medical community is a promising and necessary strategy for reducing disparities in dental caries among young children. Objective: To develop a self-administered, simple-to-score caries risk tool to identify toddlers at risk of developing caries through medical settings. Methods: A psychometrically defensible, 52-item...

Surveys on families and family growth clearly show the increasing demands, and uncertainties, of survey research. Using a new design for 2006–2010 data collection, National Survey of Family Growth (NSFG) produced approximately 22,500 interviews 60-70 min in length and using the same computer-assisted data collection modes for approximately the same...

Objective-The National Survey of Family Growth (NSFG) collects data on pregnancy, childbearing, men's and women's health, and parenting from a national sample of men and women aged 15-44 in the United States. The 2006-2010 NSFG design was a significant departure from the previous periodic design, used in 1973-2002. This report shows fieldwork resul...

Age- and sex-specific estimates of serum dioxin concentrations are important for comparisons among populations. However, such comparisons are problematic because populations have different age and sex structures and values are typically reported only in broad age ranges that are not comparable across studies. There are few studies that report conge...

Objective The National Survey of Family Growth (NSFG) collects data on pregnancy, childbearing, men's and women's health, and parenting from a national sample of men and women aged 15-44 in the United States. The 2006-2010 NSFG design was a significant departure from the previous periodic design, used in 1973-2002. This report shows fieldwork resul...

In many surveys there is a great deal of uncertainty about assumptions regarding key design parameters. This leads to uncertainty about the cost and error structures of the surveys. Responsive survey designs use indicators of potential survey error to determine when design changes should be made on an ongoing basis during data collection. These cha...

As part of the University of Michigan Dioxin Exposure Study, soil, household dust, and serum samples were collected from more than 750 households in five populations around the city of Midland and in Jackson and Calhoun Counties, Michigan, USA. Polytopic vector analysis, a type of receptor model, was applied to better understand the potential sourc...

Nechuta S, Mudd LM, Elliott MR, Lepkowski JM, Paneth N, the Michigan Alliance for the National Children's Study. Attitudes of pregnant women towards collection of biological specimens during pregnancy and at birth. Paediatric and Perinatal Epidemiology 2012; 26: 272–275. Epidemiological investigations of maternal and child health may involve the co...

Dioxins are a family of chemical compounds that has received considerable attention, both historically and currently. This article reviews scientific field studies that examine the relationship between living on soil contaminated with dioxins and the level of dioxins in people's serum, with an emphasis on the University of Michigan Dioxin Exposure...

This pragmatic randomized trial evaluated the effectiveness of a tailored educational intervention on oral health behaviors and new untreated carious lesions in low-income African-American children in Detroit, Michigan. Participating families were recruited in a longitudinal study of the determinants of dental caries in 1021 randomly selected child...

Nonresponse follow-up studies are often conducted to understand whether respondents and nonrespondents differ on survey variables of interest in sample surveys. Methods used to recruit respondents often differ between nonresponse follow-up studies and main studies. One method is persuasion letters sent from study staff to nonrespondents that are ta...

The University of Michigan Dioxin Exposure Study was undertaken to address concerns that the industrial discharge of dioxin-like compounds in the Midland, Michigan, USA area had resulted in the contamination of soil and vegetation in the Tittabawassee River floodplain and downwind of the incinerator in the City of Midland. The study included the an...

Polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls that have toxic equivalency factors (TEFs) were measured in serum of 946 subjects in five Michigan counties. The study was motivated by concerns about human exposure to dioxin-contaminated sediments in the Tittabawassee River (TR). Most of th...

The goal of the present study was to quantify the population-based background serum concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) by using data from the reference population of the 2005 University of Michigan Dioxin Exposure Study (UMDES) and the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Multiple imputation...

The National Survey of Family Growth (NSFG) collects data on pregnancy, childbearing, men's and women's health, and parenting from a national sample of women and men 15-44 years of age in the United States. This report describes the sample design for the NSFG's new continuous design and the effects of that design on weighting and variance estimatio...

Data with some values below a limit of detection (LOD) can be analyzed using methods of survival analysis for left-censored data. The reverse Kaplan-Meier (KM) estimator provides an effective method for estimating the distribution function and thus population percentiles for such data. Although developed in the 1970s and strongly advocated since th...

Objectives: To evaluate the efficacy of a tailored, educational intervention utilizing brief motivational interviewing (MI) on reducing the incidence of dental caries in low-income African-American children. Methods: The data were collected as part of the Detroit Dental Health Project (DDHP), a seven-year study regarding oral health disparities amo...

As part of the University of Michigan Dioxin Exposure Study, soil samples were collected from 766 residential properties near the Tittabawassee River between Midland and Saginaw; near the Dow Chemical Facility in Midland; and, for comparison, in the other areas of Midland and Saginaw Counties and in Jackson and Calhoun Counties, all located in the...

We assessed attitudes of a multi‐ethnic sample of pregnant women in regard to participation in five data collection procedures planned for use in the National Children's Study. A cross‐sectional survey was conducted in nine prenatal clinics in Kent County, Michigan between April and October 2006. Women were approached in clinic waiting rooms at the...

This report describes how the continuous National Survey of Family Growth (NSFG) (begun in 2006) was designed, planned, and implemented. The NSFG is a continuous national survey of men and women 15-44 years of age designed to provide national estimates of factors affecting pregnancy and birth rates; men's and women's health; and parenting. The surv...

In 2005, the World Health Organization (WHO) - International Programme on Chemical Safety reevaluated the toxic equivalency factors (TEFs) for dioxin-like compounds and made changes that affect the calculation of the total toxic equivalent (TEQ). The impact of these changes on the TEQs for human blood and abiotic matrices such as soil and household...

The University of Michigan Dioxin Exposure Study was undertaken to address concerns that the discharge of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzo furans (PCDFs) from the Dow Chemical Company in the Midland, Michigan, area had resulted in contamination of soils in the Tittabawassee River floodplain and the city of Midla...

We conducted a population-based human exposure study in response to concerns among the population of Midland and Saginaw counties, Michigan, that discharges by the Dow Chemical Company of dioxin-like compounds into the nearby river and air had led to an increase in residents' body burdens of polychlorinated dibenzofurans (PCDDs), polychlorinated di...

The University of Michigan Dioxin Exposure Study (UMDES) was undertaken in response to concerns that the discharge of dioxin-like compounds from the Dow Chemical Company facilities in Midland, Michigan, resulted in contamination of soils in the Tittabawassee River floodplain and areas of the city of Midland, leading to an increase in residents' bod...

As part of the University of Michigan Dioxin Exposure Study, the 29 congeners of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls that have World Health Organization consensus toxic equivalency factors were measured in house dust from 764 homes using a population-based sampling design over...

A representative sample of 365 low-income African-American preschool children aged 3-5 years was studied to determine the association between sugar-sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002-2003 and again after 2 years. Dietary information was...

Most contamination of residential property soil with dioxin-like compounds occurs as a result of proximity to industrial activity that produces such compounds and, outside the industrially impacted zone, the soil concentrations are at background levels. However, as part of the University of Michigan Dioxin Exposure Study, residential properties in...

The University of Michigan dioxin exposure study was undertaken to address concerns that the industrial discharge of dioxin-like compounds in the Midland, MI area had resulted in contamination of soils in the Tittabawassee River floodplain and downwind of the incinerator. The study was designed in a rigorously statistical manner comprising soil mea...

Deposition of pollutants around point sources of contamination, such as incinerators, can display complex spatial patterns depending on prevailing weather conditions, the local topography, and the characteristics of the source. Deterministic dispersion models often fail to capture the complexity observed in the field, resulting in uncertain predict...

A key component in any investigation of cause-effect relationships between point source pollution, such as an incinerator, and human health is the availability of measurements and/or accurate models of exposure at the same scale or geography as the health data. Geostatistics allows one to simulate the spatial distribution of pollutant concentration...

While national surveys have found that African-Americans have a higher prevalence and severity of dental caries than white-Americans, there are only a few descriptive studies of the prevalence and severity of dental caries in low-income urban African-Americans. This study assessed the prevalence, severity and determinants of dental caries, using th...

For the general population, the dominant source of exposure to dioxin-like compounds is food. As part of the University of Michigan Dioxin Exposure Study (UMDES), we measured selected polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like polychlorinated biphenyls (PCBs) in serum of 946 subjects who were a...

Objectives The cooperation of healthcare personnel is essential for implementing clinical research, yet little is known about the willingness of staff to facilitate research. This study assessed attitudes of prenatal clinic and delivery room (DR) staff toward facilitation of research, with a particular focus on the National Children’s Study (NCS)....

Hierarchical model such as Fay-Herriot (FH) model is often used in small area estimation. The method might perform well overall but is vulnerable to outliers. We propose a robust extension of the FH model by assuming the area random effects follow a t distribution with an unknown degrees-of-freedom parameter. The inferences are constructed using a...

This study examines whether reasonable standard errors for multivariate models can be calculated using the public use file of the Current Population Survey's Annual Social and Economic Supplement (CPS ASEC). We restrict our analysis to the 2003 CPS ASEC and model three dependent variables at the individual level. income, poverty, and health insuran...

The objective of the authors' analysis was to investigate the determinants of dental care visits among young, low-income African-American children. Trained researchers interviewed a representative sample of low-income black families (caregivers and children aged 0 through 5 years) in Detroit to assess their dental visit history, dental insurance st...

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significan...

Cycle 6 of the National Survey of Family Growth (NSFG) was conducted by the National Center for Health Statistics in 2002 and early 2003. This report describes how the sample was designed, shows response rates for various subgroups of men and women, describes how the sample weights were computed to make national estimates possible, shows how missin...

The Healthy Environments Partnership (HEP) is a community-based participatory research effort investigating variations in cardiovascular disease risk, and the contributions of social and physical environments to those variations, among non-Hispanic black, non-Hispanic white, and Hispanic residents in three areas of Detroit, Michigan. Initiated in O...

This report describes how Cycle 6 of the National Survey of Family Growth (NSFG) was designed, planned, and implemented. The NSFG is a national survey of women and men 15-44 years of age designed to provide national estimates of factors affecting pregnancy and birth rates; men's and women's health; and parenting. Cycle 6, conducted in 2002, was the...

Hierarchical model such as Fay-Herriot (FH) model is often used to develop small area estimates. It might perform well overall but is vulnerable to outliers. We propose a robust extension of the FH model by assuming the area random effects follow a t distribution with an unknown degree of freedom. The inference is done in a Bayesian framework. Mont...

Many states rely on telephone surveys to produce estimates of uninsurance. To the extent that people in households without telephones differ from those living in households with telephones, estimates will be biased due to lack of coverage of those in households without telephones. We find the disparity in estimates of uninsurance in the Current Pop...

Measurement of individuals' valuation of dental treatments is important in the evaluation of new technologies. In this paper the value of dentin regeneration, a new treatment for teeth with reversible pulpitis, is measured based on what individuals say they would be willing to pay to receive the treatment. A total of 611 randomly selected dentate a...

Adolescents are a high risk group for HIV infection and the characteristics of their partners may affect their susceptibility to infection. The goal of this study was to examine the effects of partner characteristics on sexually transmitted disease (STD) infection in a national sample of adolescents. Data from 8,024 sexually active adolescents who...

This population-based study measured utilities (preferences measured under conditions of uncertainty) of dentin regeneration (DR), a potential new therapy, root canal therapy (RCT), and extraction (EXT). A representative sample of dentate adults (aged 18-69 years) was randomly selected from the Detroit area. A computer program was used to administe...

Many states rely on telephone surveys to produce estimates of uninsurance. To the extent that people in households without telephones differ from those living in households with telephones, estimates will be biased due to lack of coverage of those in households without telephones. We find the disparity in estimates of uninsurance in the Current Pop...

The aim of this paper is to examine the association of individual demographic variables and area characteristics with the characteristics of sexual partners of American adolescents. Data for the study were drawn from the National Longitudinal Study of Adolescent Health. The data indicate that the community characteristics of ethnic or racial compos...

In this paper, we conducted an empirical study to investigate the design and weighting effects on descriptive and analytic statistics. The design and weighting effects were calculated for estimates produced from the 1998 small firm survey data. We considered the design and weighting effects on coefficients estimates of regression model using the de...

American adolescents have a high incidence of sexually transmitted infections. Patterns of sexual partner choice influence the transmission of infections in this population. To examine patterns of sexual mixing, bridging, and concurrency in American adolescents and the association of these characteristics with condom use. This project used the AddH...

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3,617 adults representative of the US non-instit...

While a number of studies have examined the association between individuals' characteristics and their contraceptive use, few studies have examined the influence of partners' characteristics on individuals' contraceptive use. Using nationally representative data from the National Longitudinal Study of Adolescent Health, multiple logistic analyses w...

The goals of this study were to estimate prospective mortality risks of city residence, specify how these risks vary by population subgroup, and explore possible explanations. Data were derived from a probability sample of 3617 adults in the coterminous United States and analyzed via cross-tabular and Cox proportional hazards methods. After adjustm...

This article describes and evaluates a procedure for imputing missing values for a relatively complex data structure when the data are missing at random. The imputations are obtained by fitting a sequence of regression models and drawing values from the corresponding predictive distributions. The types of regression models used are linear, logistic...

A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinkin...

The authors studied weighting adjustments for the National Comorbidity Survey (1990–1992), a large-scale national epidemiologic investigation of the prevalence, risk factors, and consequences of psychiatric morbidity and comorbidity in the United States. Weighting adjustments for differential selection within households, new construction, unit nonr...

Background and Objectives Description of the Health Field Study Analysis Conclusions Acknowledgments

The degree to which the relationship between race and depression in US black and white women is modified by socioeconomic and marital status was investigated. Data on 534 black and 836 white women, 25 to 64 years old, obtained from the 1986 Americans' Changing Lives national survey were utilized. Depression was measured by the Centers for Epidemiol...

The way health varies with age is importantly stratified by socioeconomic status (SES)--specifically, education and income. Prior theory and cross-sectional data suggest that among higher SES persons the onset of health problems is usually postponed until rather late in life, while health declines are prevalent in lower SES groups by middle age. Th...

Abstract Two stage random ,digit dialing procedures ,as developed ,by Mitofsky ,and elaborated by Waksberg ,are widely used in telephone ,sampling ,of the ,U.S. household population. Current alternative approaches have, relative to this procedure, coverage and cost deficiencies. These deficiencies are addressed through,telephone ,sample ,designs ,w...

The use of a commercial file of listed residential telephone numbers can improve the efficiency of samples drawn for telephone surveys. The extent of this improvement depends, however, upon characteristics of the file that are usually not available to the user. This paper addresses the problem by examining the characteristics of commercial files bo...

The research evidence indicates that health maintenance organizations (HMOs) participating in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) At-Risk Program tend to experience favorable selection. Although favorable selection might result from patient decisions, a common conjecture is that it can be induced by HMOs through their marke...

The cost and effectiveness of eight approaches to reducing barriers to cataract surgery were evaluated in a rural area of South India during 1987-1989. The approaches were based on four intervention alternatives--aphakic motivator (AM), basic eye health worker (BW), screening van (SV), and mass media (MM). Each intervention was offered at two level...

The issue of selection bias was investigated using data from 22 HMOs who are enrolling Medicare beneficiaries under Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) at-risk contracts. The study differs from previously published analyses of this issue in that it deals with the current Medicare risk program (TEFRA) rather than with earlier De...

A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. Cataract screening and follow-up surgery were offered to more than 19,000 residents age 40 years and older in a probability sample of 90 villages in south India. Eight months after in...

Difficult-to-sample populations are defined as rare populations or populations that are difficult to locate, enumerate or interview. This definition includes subgroups of the United States population that are at increased risk of adverse health effects associated with malnutrition. Examples include persons who are rare (pregnant women), difficult t...

This article studies the excess levels of disability experienced by persons with arthritis, compared to persons without the disease. The data set is the Supplement on Aging (1984 National Health Interview Survey); it has information for a national probability sample of community-dwelling persons ages 55 + (N = 16,148). (1) Arthritis people have mor...

Cardiovascular conditions have a major economic as well as health impact on adults in the United States. In the National Medical Care Utilization and Expenditure Survey, conducted during 1980, health service data were obtained from a national sample of 17,123 civilian noninstitutionalized individuals. These data have been analyzed to define the imp...