A presentation by Paul Hewett as part of the Comparability of Measurement Instruments Across Ages and Contexts panel discussion at the International Symposium on Cohort and Longitudinal Studies in Developing Contexts, UNICEF Office of Research - Innocenti, Florence, Italy 13-15 October 2014

1. 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

2. 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)

3. 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

4. Malawi Schooling and Adolescent Study
• Balaka and Machinga districts: southern
region (highest HIV prevalence, lowest
age at marriage)
• 59 schools: probability of inclusion
proportional to enrollment in 2006
• Ages 14‒16 in January 2007
• 1764 in-school adolescents enrolled in
standards 4-8; 885 out-of-school
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%

5. 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

6. MSAS: ACASI
• Audio: Respondents listen to
questions and response categories:
Chichewa and Chiyao;
• Text: Read questions on screen:
Chichewa and Chiyao

7. ACASI
Sexual Behavior Questions R1–R3
• 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 R4–R6
• Updates from previous year

8. 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.

9. 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
Note: Based on age at first sex reporting only
* p <. 05, ** p < .01
a Multinomial regression model: base: consistently reporting ever had sex
b Logistic regression model: base: consistently reporting age at first sex

10. 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
Compare
• Responses from respondents interviewed R1-R3 (FTFI, ACASI)
• Responses from respondents interviewed only R3 (FTFI)
Assess reporting of sensitive behaviors
• Age at first sex
• Sex by partner type
• Alcohol use
• Petty theft

11. Reporting of Ever Had Sex
Boys
FTFI ACASI
70% 55%**
FTFI higher
63% 40%**
21% 13%**
3% Most Stigmatizing
9%*
0% 3%*
8% 12%
6% 4%
7% 5%
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
Over-reports?
Most Stigmatizing
No clear difference
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.

12. MSAS: R3 ‒ R4 Life Event Cards
Left school
First marriage
First sex
Front Back
Characteristics
• Simple
• Visual
• Structured
• Quick
• Enjoyable
• Establishes age and sequence (order) without asking
about month of event

13. 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

14. Comparing Interview Methods
Within round, across methods….
ACASI & LE
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
FTFI & LE
Ever married 42% 45% 4% 4%
Age at marriage consistent 91% 88%
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

15. 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
Premarital
Sex
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

16. Cross-Sectional Comparison
L = Left school
S = Sexual initiation
M = First Marriage
Round 3 Round 4
LSM
(216)
46%
LMS
(149)
32%
SML
(106)
LSM
(228)
LSM
(145)
SML
(82)
Other
(16)
22%
48%
31%
18%
3%

17. 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 < .01
a Logistic regression model: base: consistently reporting age of first sex

18. Associations of Inconsistencies
Across round, same method: LE Cards
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
* p <. 05, ** p < .01
a Logistic regression model: base: consistently reporting age of first sex; age
controlled

19. 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

20. Recommendations
ACASI may be better for boys
• Ever had sex
• For stigmatizing Qs (… and girls)
FTFI may be better for girls
• Ever had sex
• Sex with boyfriend
Carry over data from previous rounds
• Resolve inconsistencies
Further analysis of inconsistent reporting warranted
• Motivations
• Related to academic and cognitive skills

21. Ideas. Evidence. Impact.
The Population Council conducts research
and delivers solutions that improve lives
around the world. Big ideas supported by
evidence: It’s our model for global change.