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In addition, we controlled for four person-level variables age; educational attainment, defined as completing primary education or pursuing secondary or higher education, compared with no education; urban residence; and wealth, using household car ownership—information available only for women and three country-level time-varying variables gross domestic product per capita; contraception prevalence, defined as the prevalence of any modern contraceptive method; and HIV prevalence.

We conducted sensitivity analyses to examine the robustness of our findings to alternative assumptions. We repeated the main analyses using PEPFAR funding per capita US dollars per person rather than a binary country-level indicator for whether or not a country received abstinence and faithfulness funding. We also conducted country- and age-specific subanalyses, including an analysis for Uganda alone—given its reputation for successful abstinence programming. The Appendix contains additional details on our sample selection, descriptions of our model and variables, and additional analyses using alternative model specifications and outcomes including the use of condoms.

All analyses were conducted in Stata MP, version We fully recognize the importance of data sharing and transparency in research, and full analytical materials and data are available on request. Our study had several limitations. First, since it was an ecological analysis, we did not distinguish between people who were reached by abstinence and faithfulness programs and those who were not, since there is no way to measure the large-scale reach of these programs or the diffusion of their interventions. Our goal was to identify the effect of country-level support on population-level outcomes, and in that sense, cross-national comparisons represent the appropriate level of analysis.

Multiple studies have identified population-level effects of PEPFAR, including adult mortality and labor participation. Second, primary outcomes of numbers of sexual partners in the past twelve months and age at first sexual intercourse were self-reported. Third, we recognize the possibility that countries without PEPFAR funding may have received abstinence and faithfulness programming from other sources.

This would bias our results toward finding a reduction in HIV risk behaviors. Fifth, PEPFAR funding for antiretroviral therapy and other prevention that reduces personal perceptions of the dangers of HIV may have affected sexual behavior in ways contrary to the positive effects of abstinence and faithfulness programming.

That would have resulted in an overall null effect on HIV risk behavior. Finally, we acknowledge that although we controlled for many key differences between PEPFAR-funded countries and other countries by including individual-level covariates, country-level covariates, and the fixed-effects model, the two sets of countries may still have unique differences that we did not capture in the model. However, the large sample sizes reduce the potential for this bias to affect our results. Data [Internet]. Millennium Development Goals indicators [Internet].

NOTES Parameters for country-level comparisons were obtained from the sources listed as aggregated country-level means. Exhibit 4 Estimated differences, between sub-Saharan African countries receiving PEPFAR funding for abstinence and faithfulness and those not receiving that funding, in changes in high-risk sexual behavior over time. All respondents were under the age of thirty. The analysis adjusted for country-level covariates of gross domestic product per capita; HIV prevalence; contraception prevalence; and person-level covariates of age, education, urban residence, and wealth not shown.

Country and year fixed effects were used to account for time-invariant differences between countries and uniform time trends in all countries. CI is confidence interval. There was no significant effect of PEPFAR funding on the number of sexual partners or age at first intercourse for men or women, after we adjusted for individual- and country-level covariates. The results of all our analyses remained robust when we used abstinence and faithfulness funding per capita as the exposure variable instead of binary designation of residence in a PEPFAR-funded country, except for age at first sexual intercourse for men—where per capita funding was associated with an age at first sexual intercourse that was 0.

Our study failed to find evidence for a relationship between PEPFAR abstinence and faithfulness funding and reductions in high-risk sexual behaviors among residents of recipient countries. We detected no relative change over time in the number of sexual partners in the past twelve months, age at first intercourse, or proportion of teenage pregnancy between people living in countries with PEPFAR-funded abstinence and faithfulness programs and those living in countries without such funding.

Taken together, our results suggest that PEPFAR abstinence and faithfulness funding likely did not reduce these high-risk sexual behaviors. This finding is consistent with the results of previous studies that documented the ineffectiveness of abstinence and faithfulness programs in influencing sexual behavior, including number of sexual partners.


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Furthermore, our investigation found no significant relative change in age at first intercourse for people living in countries with PEPFAR-funded abstinence and faithfulness programs compared to those in countries without PEPFAR funding. The trend toward older age at first sexual intercourse was not significant and also was notably small—less than four months for men and women.

The inability of our study to detect a significant change in this age is aligned with findings in previous work of no effect or minimal impact of abstinence campaigns on sexual initiation in developed countries. Because PEPFAR-funded abstinence and faithfulness programs may not preferentially target many documented risk factors for teenage pregnancy such as poverty, low educational attainment, and lack of access to or use of contraception , the ability of this funding to influence pregnancy rates through behavior change alone may be limited.

Abstinence and faithfulness funding was not associated with a change in high-risk sexual behavior.

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However, advanced education beyond primary school was significantly associated with a decrease in high-risk behaviors among women, and the opposite was the case for men. Our findings are consistent with the findings in previous studies of no effect or only minimal change in high-risk sexual behavior and HIV incidence following abstinence programs in American populations.


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  • We hope that this study will further illustrate the importance of large-scale programmatic evaluation in global health. Finally, this study also contributes to the growing body of evidence that abstinence and faithfulness campaigns may not reduce high-risk sexual behaviors and supports the importance of investing in alternative evidence-based programs for HIV prevention in the developing world. To access the Appendix, click on the Appendix link in the box to the right of the article online. Published online 1 May Research Article Health Affairs Vol.

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    Additionally, a mg dose appears to offer no advantage to changes observed in the PLA and mg groups. Measurements are noted along the time line. Aro , A.

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    Tuomilehto , S. Uusitupa and K. Abstract The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum [ The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants.

    We also examined risk factors age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids for early retinal changes. Intervention lasted for median of four years in —, after which annual follow-up visits at study clinics were conducted. In the years — at least five years after stopping intervention , fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists A.

    In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index BMI , and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group OR 0.


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    Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group OR 1. Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy. OR, odds ratio. Data from the first five years of follow-up on metabolic variables. Abstract Nordic Nutrition Recommendations NNR recommend exclusive breastfeeding until 6 months, partial breastfeeding until 1 year or longer and irrespective of breastfeeding, avoiding solid foods before 4 months.

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    Nordic Nutrition Recommendations NNR recommend exclusive breastfeeding until 6 months, partial breastfeeding until 1 year or longer and irrespective of breastfeeding, avoiding solid foods before 4 months. Vitamin D is of special interest in the Nordic diet. At 12 months, IgE sensitized children had a lower intake of vitamin D median 25th, 75th percentiles : 3. These observations support the NNR in their recommendation against introducing complementary solid foods before the age of 4 months.

    Furthermore, they support encouraging vitamin D intake for young children at northern latitudes. Beauregard , Marlana Bates , Mary E. Cogswell , Jennifer M. Nelson and Heather C. Abstract Background: To describe the availability and nutrient composition of U. Materials and Methods: Data were from information presented on nutrition labels for ready-to-serve, pureed food products from 24 major U.

    Background: To describe the availability and nutrient composition of U. We described nutritional components e. Differences in 13 nutritional components between squeeze pouch versus other packaging types were generally small and varied by food category. Squeeze pouches in the fruits and vegetables, fruit-based, and vegetable-based categories were more likely to contain added sugars than other package types.

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    Conclusion: In , squeeze pouches were prevalent in the U.

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