Do we say what we mean?
Stan Becker
Professor, JHSPH
In science including public health, we need
precise terminology in order to:
a) communicate precisely/avoid confusion
b) understand phenomena correctly
c) allow replication of studies
Outline
Process
Fifteen examples of problematic usage
Pair and share about which ones are ‘right on’
and which ones “miss the mark completely”
and which are ……
Substance (next slide)
Methods
Logic, dictionary, literature searches
using the bibliographic search
engine, SCOPUS (articles only) using
terms in title, abstract or keywords
Simple matter
1. Data is
OR
Data are?
Problem with using singular only
PICK ONE
This data is wrong.
This datum is wrong.
PICK ONE
The data is complete.
The data are complete.
• If we use only singular, then we cannot
distinguish a single data point from the
whole data file!
Scopus search of usage over time
Usage
Time period of publication
Before 1990
1990-2013
Data are/Data is
Both uses (Number) 105,400
329,882
Percent
100.0
100.0
“data is”
20.7
32.5
“data are”
79.3
67.5
Another easy one
• We “CONTROL FOR” x, y, and z in the
analysis
OR
• We “ADJUST FOR” x, y, and z in the
analysis
• In experiments one can CONTROL for effects x,
y and/or z by random or block random
allocation to levels x1, x2, y1, y2, etc.
• In observational studies we CANNOT
CONTROL for covariates but merely ADJUST
(as best we can)
• When we control for effects, we have balance
on the effect variable of interest; this is almost
never the case for adjustments.
Scopus search of usage over time
Usage
Time period of publication
Before 1990
1990-2013
Control for/Adjust for
Both uses (Number) 95,827
2611
Percent
100.0
100.0
“Adjust for”
66.3
56.3
“Control for”
33.7
43.7
Note: articles which had “experiment” or some variation are excluded
3. What is under-5 mortality?
5D0/5P0
= 5M0 is under-5 mortality
5q0
is a probability of dying before age 5
(from a life table)
Note very different numbers. For
Colombia (data from Siegel and Swanson,
2004)
5M0 = .006 but 5q0 = .032
4. What is education?
• In general, by education we usually mean level
of schooling. We should say schooling when
we mean that.
• Note there are some self-educated people!
• En francais “durée d’études” ou “durée de
formation” ou “scolarisation?”
5. When do we use
SEX
and when do we use
GENDER?
UGH!
Source: Aziz, Gemmell and Laws, 2013. The Distribution of Income….
BUT we know that:
Sex is biology
and
Gender is socially constructed
Scopus search of usage (all years)
Population by:
age and gender
or gender and age
age and sex
or sex and age
No. of articles
in Scopus
16
64
• To many, gender and sex are interchangeable
but they are not
• To say gender when we mean sex does a
disservice to transgender persons
• So let us say sex when we mean sex and
gender when we mean gender please!
6. Did President Clinton have ‘sex’
with Monica Lewinsky?
http://www.youtube.com/watch?v=KiIP_KDQmXs
Fellatio in ancient times. Is it sex?
• The problem is that sex means both
biology (gametes/sex organs) as just
noted but also it means coitus and
other sexual behaviors. But sexual
behavior generally vs. coitus
specifically is ambiguous.
• So let us say coitus or heterosexual
intercourse (vaginal-penile
intercourse is even more precise)
when we mean that and fellatio, anal
sex or cunnilingus when we mean
those.
The CDC Behavioral Risk Survey does this.
7. What is family planning?
Planning a family
or
Contraception?
Problems with using “family
planning” if we mean contraception
1. Unmarried sexually active teens need
contraception but are usually NOT planning a
family!
2. Planning a family can include abortion and
even infanticide in places like China.
Others have been thinking along the
same lines very recently
The Lancet Global Health
Family planning versus
contraception: what’s in a name?
Maria I Rodrígueza, , Lale Saya, Marleen Temmermana
Volume 2, Issue 3, March 2014, Pages e131–e132
But switching is a problem too
• Because “Family planning” has a long history
• But let us switch and try to use contraception
when/where we can when we mean
contraception!
8. What is birth control?
• Birth control for some means the
contraceptive pill.
• For others, it means any contraception.
• But controlling births (i.e. birth
control) includes both
contraception and abortion!
• So again, can we say contraception when
we mean contraception, oral
contraception when we mean the
contraceptive pill……
9. Who uses condoms?
“women using condoms”
“women use condoms” and
“women used condoms”.
In SCOPUS, 41 articles had one of
these usages in the abstract or
title but only 1 was about the
female condom
Female condom
Not very
popular
• So let us be clear that men (or couples
if you wish, but not women) use
condoms!
10. What is a modern method
of contraception?
DHS list (till recently anyway)
Female sterilization
Male sterilization
Pill
IUD
Injections
Implants
Male condom; female condom
Diaphragm
Jelly/foam
But is a condom a modern method?
• “In ancient Egypt a linen sheath was used as
protection….. “
Source:
http://condomerie.com/geschiedenis_condoom?___store=francais&___fr
om_store=spaans
A modern method is one with high effectiveness
BUT IS IT
Theoretical effectiveness?
OR
Use-effectiveness?
Are any fertility awareness methods
modern methods?
Fertility Awareness Methods: Theoretical effectiveness
Method
Pregnancies per 100 women over 1
year
Calendar-based methods
Standard Days Method
4.8
2-days method
3.5
Calendar Rhythm Method
5 (13)
Symptoms-based methods
Vaginal secretions
3.2
Sympto-thermal
0.4
Source: Hatcher, R. et al. Contraceptive Technology 2011
st
Guess what?
Standard Days Method is now classified as a
modern method!
But not other Fertility Awareness Methods
(which have even lower failure rates according
to the table assembled by Hatcher et al. )
*Note also that Lactational Amenorrhea Method has
also been added as modern
Fertility Awareness Methods
Standard Days Method
Source: early-pregnancy-tests.com/ovulation.html
Published research showing effectiveness
of Standard Days Method
What can we do?
Maybe we should drop the dichotomy and
embrace the continuum less effective to more
effective! This is what Hatcher et al. have done
on the inside cover of their 2011 edition of
Contraceptive Technology
11. What is included in
reproductive health?
Reproductive health components (SB)
•
•
•
•
•
•
•
•
•
Sexual behavior
Infertility
Contraception
Contraceptive sterilization
Sexually transmitted diseases including HIV
Antenatal care
Delivery care
Breastfeeding
Abortion
Scopus search of usage by year of publication
Terms in the article
“family planning and
reproductive health”
“family planning and other
reproductive health”
Year of
publication
Before 1995+
1994*
19
221
1
13
“HIV and reproductive health”
0
15
“HIV and other reproductive
0
1
HMM!
IUSSP General Conference 1997
• Reproductive Health Scientific committee
open meeting.
• I asked: What components are included in
reproductive health since I have heard
different things from different colleagues?
(e.g. is violence against women reproductive
health?)
Answer from committee
• “ We don’t want to give one list since different
funding agencies have different lists.”
• (slightly paraphrased perhaps with passage of
time)
So there is no agreed-upon list it seems!
But this is poor science.
12. Is HIV an STI?
Scopus search:
Phrase
“HIV and STIs”
“HIV and other STIs
No. of articles
151
18
But over 90% of HIV transmission in the world is
via sexual contact!
HMM!
So HIV is OF COURSE an STI
13. Unmet need for contraception
• Why is it for women only?
• Can men have unmet need?
• Can couples have unmet need?
Couples' Unmet Need for Family Planning in
Three West African Countries
Erin Pearson and Stan Becker
Studies in Family Planning Volume 45, Issue 3,
pages 339–359, September 2014
14. Men’s reproductive rights
See next slide for details
Men’s Reproductive Rights?
Does the man need to pay 18 years of child
support:
A. if the condom breaks, she gets pregnant and
she does not believe in abortion?
B. in the case of entrapment (She says she is on
the pill but is not and gets pregnant)?
Answer: In BOTH these cases courts
have ruled YES, he MUST pay
Reproductive rights
In 2006, the American National Center for Men backed a
lawsuit known as Dubay v. Wells. The case concerned
whether men should have the opportunity to decline all
paternity rights and responsibilities in the event of an
unplanned pregnancy. Supporters said that this would
allow the woman time to make an informed decision and
give men the same reproductive rights as women.[157] The
case and the appeal were dismissed, the U.S. Court of
Appeals (Sixth Circuit) stating that neither parent has the
right to sever their financial responsibilities for a child, and
that "Dubay's claim that a man's right to disclaim
fatherhood would be analogous to a woman's right to
abortion rests upon a false analogy."[158][159]
Source: Wikipedia
Then is it:
Men’s reproductive rights
OR
“Watch out where you put your
penis?” (Source: Christina Fleming in “Couples and
Reproductive Health” class, 2014)
Maybe this message is important for adolescent
boys to hear!
15. What is a(the) demographic
dividend?
“The demographic dividend is the accelerated
economic growth that may result from a
decline in a country's mortality and fertility
and the subsequent change in the age
structure of the population.”
Source: Gribble and Bremer, Population Reference Bureau
• …the demographic dividend refers only to
changes in age-dependency ratios…, whose
evolution over the course of demographic
transition presumably results in a
demographic window that first opens and
then closes in a predictable way as the old-age
dependency ratio starts to increase…”
Cuaresma, Lutz & Sanderson, 2014.
But “dividend” means something positive.
“ a sum or quantity, usually of money, to be
divided among stockholders…”
Webster’s dictionary
In demography we have the dependency ratio:
Pop < 15 + Pop 65+
Pop 15-64
A decline in the dependency ratio may or may
not represent a dividend depending on
availability of work for those in the working
ages!
In fact, if little paid work is available then a high
proportion in the young working ages is
associated with a higher frequency of civil
disorder (next slide)
Demographic dividend or demographic liability?
(n = 145 countries)
Source: Cincotta, Engelman and Anastasion, 2003
Note: Young adults = age 15 to 29 years.
Also demographic dividend
could have other meanings.
In fact, MORE births could be a “demographic
dividend” for Russia, Japan and some Eastern
European countries which have declining and
rapidly aging populations.
Similarly immigration could be a “demographic
dividend” for such countries with more deaths
than births.
But “demographic dividend” as used by many, is
key for getting World Bank folks and finance
ministers and others in Africa and other
countries to increase funding for
contraceptive programs. So should we keep
that language even though it is somewhat
misleading ???
16. What is demography?
What is applied demography?
What is mathematical demography?
Personal story
What is demography?
“The study of the size, territorial distribution, and
composition of population, changes therein, and
the components of such changes.” (Hauser and
Duncan, 1959)
There are two subareas:
1. Demographic analysis: study of relationships
between demographic variables (age, sex, births,
deaths, migration)
2. Population studies: Study of relationships
between demographic variables and social,
economic , environmental and other variables.
We can distinguish three levels of
demographic analysis
1. Applied demography (cookbook formulas)
2. Formal demography/Demographic methods
(derivations of formula are given)
3. Mathematical demography (mathematical
generalizations in continuous time are given
and so on)
“What Is Applied Demography?
Applied Demography is the subfield of
demography that focuses on practical
applications of demographic methods and
materials for decision-making purposes.”
• Source: Population Association of America website
• http://www.populationassociation.org/about/committees/cad-resources/
Example: Decomposition analysis
Level 1: “Applied demography”:
Here is the formula you can use
Two-Factor Decomposition
r. - R. = rate effect + composition effect
 1   ni N i 
1
 ni N i 
r. - R. = ∑    +  (ri − Ri ) + ∑   (ri + Ri )  − 
 2   n. N . 
2
 n. N . 
Formal demography/demographic
methods
Study of relationships between demographic
variables: Age, sex, births, deaths, and
migration
Level 2: Demographic Methods:
Go through the derivation
Algebra for Two-Factor Decomposition
ni
N
− ∑ Ri i
n. i
N.
i
1
ni
Ni
= ∑ ( ri + ri + Ri − Ri ) − ∑ ( Ri + Ri + ri − ri )
2 i
n. i
N.
1
n
n
n
n
N
N
N
N
= ∑ ri i + ri i + Ri i − Ri i − Ri i − Ri i − ri i + ri i
2 i n.
n.
n.
n.
Ni
N.
N.
N.
r. − R. = ∑ ri
=
1
ni
ni
Ni
Ni 1
ni
ni
Ni
Ni
r
R
R
r
r
R
R
r
+
−
−
+
−
−
+
∑i
∑i
i
i
i
i
i
i
2 i n.
n.
N
N . 2 i n.
n.
N.
N.
 ni N i 

 +
 ri + Ri  ni N i 
.
.
n
N
(ri − Ri )
= ∑
 −
 + ∑
2  n. N .  i 
2

i 



78
Mathematical demography
Mathematical demography …accommodates the
formalization, through mathematical
representation, of relations of population
status and changes”
Source: Canudas-Romo et al. Encyclopedia of Life Support Systems. (n.d.)
Level 3: Mathematical demography:
Here is a continuous time generalization
Source: Canudas-Romo, V.
Thank you.
Now it is your turn.
Pair and share
For which of these 15 items do you disagree
with my arguments/logic the most?
For which of these 15 items do you agree with
my arguments/logic the most?
PLEASE TAKE 4-5 MIN. TO DISCUSS THESE WITH
YOUR NEIGHBOR
Comments first from long-time faculty pair:
Amy Tsui and Henry Mosley
Items
1. Data is/are
9. Who uses condoms?
2. Control/Adjust
10.modern contraception =?
3. Under-5 mortality
11.Reproductive health = ?
4. Education/schooling
12.HIV is an STI?
5. Sex/gender
13.Unmet need = ?
6. Sex = ?
14.Men’s reprod. Health = ?
7. Family planning = ?
15.Demographic dividend =?
8. Birth control = ?
16.Applied demography = ?