A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens

BACKGROUND

Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective.

AIM

To document the breadth and nature of harms and impact of men's drinking on women.

METHODS

A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases.

RESULTS

Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies.

CONCLUSION

Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.

Mapping of technological strategies for reducing social isolation in homebound older adults: A scoping review

BACKGROUND

Homebound older adults (HOAs) are particularly vulnerable to social isolation and loneliness, which engender a poorer physical and mental health, and greater cognitive decline. The purpose of this review is to map the literature to identify potential technological strategies that reduce social isolation in HOAs, and to understand facilitators and barriers for adoption and implementation.

METHODS

Six databases including PubMed (MEDLINE), Google Scholar, Cochrane Database, EBSCOHost, National Library ProQuest, Web of Science, and the Journal of Medical Internet Research were searched for relevant articles. Peer-reviewed literature published in English from Jan 2014 to Feb 2024 that employed technological strategies applicable to HOAs and assessed social isolation or connectedness as an outcome measure were included.

RESULTS

107 studies were reviewed and classified into different technological categories based on their functions and features. A social technology framework encompassing delivery, hardware, software, content, training, and support was conceptualized with core characteristics identified from the reviewed technological strategies. Cost and complexity of technology, and resource commitment were identified as barriers while user-friendliness, content curation and a supportive ecosystem may facilitate the adoption of a technological strategy to address social isolation in HOAs.

CONCLUSION

There is a need for early and concerted effort to identify HOAs, provide technology training, and empower them to tap on the digital world to complement and/or supplement social interactions. Development of cost-effective and rapid-to-implement technology is vital for HOAs who are at highest risk to social isolation.

Seeking Help From Primary Health-Care Providers in High-Income Countries: A Scoping Review of the Experiences of Migrant and Refugee Survivors of Domestic Violence

Migrant and refugee women experiencing domestic violence (DV) may face compounding factors that impact their ability and experiences of seeking help. Health-care providers are in a unique position to identify and assist victims of DV, however, they often lack the confidence and training to do this well. Little is known of the health-care experiences of migrant and refugee women experiencing abuse when they access primary health care (PHC). Using scoping review methodology, we undertook a systematic search of seven databases (Medline, Scopus, ProQuest, CINAHL, Informit Complete, and Google Scholar). We sought peer-reviewed and grey literature, published in English between January 1980 and August 2021 that identified women (18+) who had experienced DV, from low- or middle-income countries (LMICs), seeking help or health care in a primary care setting of a high-income country (HIC). Nine articles met the inclusion criteria. Findings identify sociocultural and sociopolitical barriers for migrant and refugee women seeking help for DV, which are contextualized within the ecological model. Migration-related factors and fear were major barriers for migrant and refugee women, while kindness, empathy and trust in health-care providers, and children's well-being were the strongest motivators for help-seeking and disclosure. This review provides insight into an under-researched and marginalized group of victim-survivors and highlights the need for increased awareness, guidance, and continuing education for health-care providers and health-care systems to provide best practice DV care for migrant and refugee women.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

The relationship between fathers' heavy episodic drinking and fathering involvement in five Asia-Pacific countries: An individual participant data meta-analysis

BACKGROUND

This study aims to increase understanding of the relationship between heavy episodic drinking (HED) and fathers' involvement in parenting in five countries. The potential moderating effect of fathers' experiences of childhood trauma is also studied, controlling for the possible confounding of the effect of HED by father's attitudes toward gender equality, father's age and father's education.

METHOD

United Nations Multi-Country Study on Men and Violence (UNMCS) survey data from 4562 fathers aged 18-49 years from Cambodia, China, Indonesia and Papua New Guinea (PNG) and Sri Lanka were used to assess the relationship between fathering involvement (e.g., helping children with their homework) and self-reported HED of 6+ drinks in one occasion vs. non-HED and abstaining. Moderating effects of a 13-item fathers' childhood trauma (FCT) scale were tested and analyses were adjusted for gender-inequitable attitudes using the Gender-Equitable Men scale score. Bivariate and adjusted individual participant meta-analyses were used to determine effect estimates for each site and across all sites.

RESULTS

Fathers' HED was associated with less positive parental involvement after adjusting for gender-equitable attitudes, FCT, age and education. No overall interaction between HED and FCT was identified. Gender equitable attitudes were associated with fathering involvement in some countries but not overall (p = 0.07).

CONCLUSIONS

Heavy episodic drinking was associated with reduced positive fathering involvement. These findings suggest that interventions to increase fathers' involvement in parenting should include targeting reductions in fathers' HED. Structural barriers to fathers' involvement should be considered alongside HED in future studies of fathers' engagement with their children.

Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers

AIM

The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers.

DESIGN

Scoping review using Arksey and O'Malley's five-stage framework.

METHODS

Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation.

RESULTS

Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

Does drinking modify the relationship between men's gender-inequitable attitudes and their perpetration of intimate partner violence? A meta-analysis of surveys of men from seven countries in the Asia Pacific region

BACKGROUND AND AIMS

Although men's alcohol misuse and less gender-equitable attitudes have been identified as risks for perpetration of intimate partner violence (IPV), less is known about how men's gender-equitable attitudes and drinking act together to increase risk of IPV. This study aimed to assess the independent relationships of lower gender-equitable attitudes and drinking to perpetration of IPV and their interaction among men in seven countries.

DESIGN

Secondary analysis of the United Nations Multi-Country Study on Men and Violence (UNMCS) and Nabilan Study databases consisting of (1) unadjusted and adjusted logistic regression to measure the association of perpetration of IPV with gender-equitable men (GEM) scale score and regular heavy episodic drinking (RHED) and (2) meta-analyses of prevalence and effect estimates adjusted for country-level sites and countries.

SETTING AND PARTICIPANTS

A total of 9148 ever-partnered 18-49-year-old men surveyed in 2011-15 from 18 sites in Bangladesh, Cambodia, China, Indonesia, Papua New Guinea, Sri Lanka and Timor Leste.

MEASUREMENTS

The outcome variable is reported perpetration of physical or sexual IPV in the previous year.

INDEPENDENT VARIABLES

GEM scale scores; RHED, defined as six or more drinks in one session at least monthly (compared with other drinkers and abstainers).

FINDINGS

Pooled past-year prevalence of perpetration of IPV was 13% [95% confidence interval (CI) = 9-16%]. GEM scores and RHED were independently associated with perpetration of IPV overall and in most sites. Pooled odds ratios (ORs) for perpetration of IPV with less equitable GEM scores were 1.07 (95% CI = 1.04, 1.09) and with RHED were 3.42 (95% CI = 2.43, 4.81). A significant interaction between GEM score and RHED (P = 0.001) indicated that RHED increased the relationship of less gender-equitable attitudes and perpetration of IPV.

CONCLUSION

Both gender-inequitable attitudes and drinking appear to be associated with perpetration of intimate partner violence by men, with regular heavy episodic drinking increasing the likelihood of intimate partner violence among men with less equitable gender attitudes.

Relationship trajectories of women experiencing alcohol-related intimate partner violence: A grounded-theory analysis of women's voices

RATIONALE

The association between male partner alcohol use and increased risk and severity of their perpetration of intimate partner violence (IPV) is well-established in quantitative research. However, few studies have explored the nature and trajectory of relationships involving partner drinking and abuse, and how women find pathways to safety.

OBJECTIVE AND METHOD

We conducted in-depth interviews with a community sample of 18 Australian women (aged 20-50 years) who reported feeling afraid when their male partner drank alcohol. Using a constructivist grounded theory approach, we identified key processes underpinning women's experience of alcohol-related IPV and mapped these over four relationship phases.

RESULTS

Partner alcohol use played a key role in how women interpreted and dealt with IPV victimisation. In early relationships, women spoke of not seeing or dismissing early warning signs of problem drinking and aggression in settings that normalized men's heavy drinking. Later, women identified patterns of inter-connected drinking and aggression, leading to questioning their reality, trying to 'fix' their partner's drinking to stop the abuse, and in the absence of change, learning to manage daily life around the drinking and abuse. In the third phase, giving up hope that the partner would stop drinking, women ended the relationship. Finally, after leaving the abuser, women attempted to reset normal around drinking behaviour but continued to experience trauma associated with others' drinking in social settings.

DISCUSSION AND CONCLUSION

For women who have experienced partners' alcohol use intertwined with violence in their relationship, changing their partners' drinking plays a central role in their journey to safety, possibly obscuring recognition of abuse and complicating their ability to leave. Greater understanding of the stages of the alcohol-IPV relationship can help health providers support women as they navigate these complex relationships, and provide appropriate support depending on the needs of women in their relationship trajectory.

Children's experience of physical harms and exposure to family violence from others' drinking in nine societies

AIM

To study caregiver reports of children's experience of physical harm and exposure to family violence due to others' drinking in nine societies, assess the relationship of harm with household drinking pattern and evaluate whether gender and education of caregiver affect these relationships.

METHOD

Using data on adult caregivers from the GENAHTO (Gender and Alcohol's Harm to Others) project, child alcohol-related injuries and exposure of children to alcohol-related violence (CAIV) rates are estimated by country and pooled using meta-analysis and stratified by gender of the caregiver. Households with and without heavy or harmful drinker(s) (HHD) are compared assessing the interaction of caregiver gender on the relationship between reporting HHD and CAIV, adjusting for caregiver education and age. Additionally, the relationship between caregiver education and CAIV is analysed with meta-regression.

RESULTS

The prevalence of CAIV varied across societies, with an overall pooled mean of 4% reported by caregivers. HHD was a consistent correlate of CAIV in all countries. Men and women in the sample reported similar levels of CAIV overall, but the relationship between HHD and CAIV was greater for women than for men, especially if the HHD was the most harmful drinker. Education was not significantly associated with CAIV.

CONCLUSION

One in 25 caregivers with children report physical or family violence harms to children because of others' drinking. The adjusted odds of harm are significantly greater (more than four-fold) in households with a heavy or harmful drinker, with men most likely to be defined as this drinker in the household.

Harm from Known Others' Drinking by Relationship Proximity to the Harmful Drinker and Gender: A Meta-Analysis Across 10 Countries

BACKGROUND

Drinking is a common activity with friends or at home but is associated with harms within both close and extended relationships. This study investigates associations between having a close proximity relationship with a harmful drinker and likelihood of experiencing harms from known others' drinking for men and women in 10 countries.

METHODS

Data about alcohol's harms to others from national/regional surveys from 10 countries were used. Gender-stratified random-effects meta-analysis compared the likelihood of experiencing each, and at least 1, of 7 types of alcohol-related harm in the last 12 months, between those who identified someone in close proximity to them (a partner, family member, or household member) and those who identified someone from an extended relationship as the most harmful drinker (MHD) in their life in the last 12 months.

RESULTS

Women were most likely to report a close male MHD, while men were most likely to report an extended male MHD. Relatedly, women with a close MHD were more likely than women with an extended MHD to report each type of harm, and 1 or more harms, from others' drinking. For men, having a close MHD was associated with increased odds of reporting some but not all types of harm from others' drinking and was not associated with increased odds of experiencing 1 or more harms.

CONCLUSIONS

The experience of harm attributable to the drinking of others differs by gender. For preventing harm to women, the primary focus should be on heavy or harmful drinkers in close proximity relationships; for preventing harm to men, a broader approach is needed. This and further work investigating the dynamics among gender, victim-perpetrator relationships, alcohol, and harm to others will help to develop interventions to reduce alcohol-related harm to others which are specific to the contexts within which harms occur.

The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review

Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

Alcohol interventions, alcohol policy and intimate partner violence: a systematic review

BACKGROUND

Intimate partner violence (IPV) is a significant global public health issue. The consistent evidence that alcohol use by one or both partners contributes to the risk and severity of IPV suggests that interventions that reduce alcohol consumption may also reduce IPV. This study sought to review the evidence for effects on IPV of alcohol interventions at the population, community, relationship and individual levels using the World Health Organization ecological framework for violence.

METHODS

Eleven databases including Medline, PsycINFO, CINAHL and EMBASE were searched for English-language studies and grey literature published 1 January 1992 - 1 March 2013 investigating whether alcohol interventions/policies were associated with IPV reduction within adult (≥ 18) intimate relationships. Eleven studies meeting design criteria for attributing effects to the intervention and ten studies showing mediation of alcohol consumption were included in the review. The heterogeneity of study designs precluded quantitative meta analysis; therefore, a critical narrative approach was used.

RESULTS

Population-level pricing and taxation studies found weak or no evidence for alcohol price changes influencing IPV. Studies of community-level policies or interventions (e.g., hours of sale, alcohol outlet density) showed weak evidence of an association with IPV. Couples-based and individual alcohol treatment studies found a relationship between reductions in alcohol consumption and reductions in IPV but their designs precluded attributing changes to treatment. Randomized controlled trials of combined alcohol and violence treatment programs found some positive effects of brief alcohol intervention as an adjunct to batterer treatment for hazardous drinking IPV perpetrators, and of brief interventions with non-dependent younger populations, but effects were often not sustained.

CONCLUSIONS

Despite evidence associating problematic alcohol use with IPV, the potential for alcohol interventions to reduce IPV has not been adequately tested, possibly because studies have not focused on those most at risk of alcohol-related IPV. Research using rigorous designs should target young adult populations among whom IPV and drinking is highly prevalent. Combining alcohol and IPV intervention/policy approaches at the population, community, relationship and individual-level may provide the best opportunity for effective intervention.

Green leaf volatiles as antiaggregants for the mountain pine beetle,Dendroctonus ponderosae Hopkins (Coleoptera: Scolytidae)

We tested the hypothesis that green leaf volatiles act as antiaggregants for the mountain pine beetle (MPB),Dendroctonus ponderosac Hopkins. In coupled gas chromatographic-electroantennographic detection (GC-EAD) analysis MPB antennae responded to 30 ng doses of all six-carbon green leaf alcohols tested [1-hexanol, (E)-2-hexen-1-ol, (Z)-2-hexen-1-ol, (E)-3-hexen-1-ol, and (Z)-3-hexen-1-ol], but not to the aldehydes, hexanal or (E)-2-hexenal, or to alcohol or aldehyde homologues with more or fewer than six carbon atoms. In field trapping experiments a blend of green leaf alcohols [1-hexanol, (Z)-2-hexen-1-ol, (E)-3-hexen-1-ol and (Z)-3-hexen-1-ol] effectively disrupted the response to attractive semiochemicals; a blend of the aldehydes hexanal and (E)-2-hexenal was inactive. The two best disruptants. (E)-2-hexen-1-ol and (Z)-3-hexen-1-ol, reduced catches of both sexes to levels not significantly different from catches in unbaited control traps. They also reduced the attack on trees baited with attractive MBP pheromones to a level not significantly different from that on unbaited control trees. Neither of the clerid predators captured,Enoclerus sphegeus (F.) norThanasimus undatulus (Say), was repelled by green leaf volatiles. Our results suggest that green leaf alcohols are promising disruptants which may be used to supplement the antiaggregation pheromone, verbenone, in protecting single high-value trees as well as carefully selected stands with low-level populations of MPBs.

EYA4 is inactivated biallelically at a high frequency in sporadic lung cancer and is associated with familial lung cancer risk

In an effort to identify novel biallelically inactivated tumor suppressor genes (TSG) in sporadic invasive and pre-invasive non-small cell lung cancer (NSCLC) genomes, we applied a comprehensive integrated multi-‘omics approach to investigate patient matched, paired NSCLC tumor and non-malignant parenchymal tissues. By surveying lung tumor genomes for genes concomitantly inactivated within individual tumors by multiple mechanisms, and by the frequency of disruption in tumors across multiple cohorts, we have identified a putative lung cancer TSG, Eyes Absent 4 (EYA4). EYA4 is frequently and concomitantly deleted, hypermethylated and underexpressed in multiple independent lung tumor data sets, in both major NSCLC subtypes, and in the earliest stages of lung cancer. We find not only that decreased EYA4 expression is associated with poor survival in sporadic lung cancers, but EYA4 SNPs are associated with increased familial cancer risk, consistent with EYA4’s proximity to the previously reported lung cancer susceptibility locus on 6q. Functionally, we find that EYA4 displays TSG-like properties with a role in modulating apoptosis and DNA repair. Cross examination of EYA4 expression across multiple tumor types suggests a cell type-specific tumorigenic role for EYA4, consistent with a tumor suppressor function in cancers of epithelial origin. This work shows a clear role for EYA4 as a putative TSG in NSCLC.

Low back pain in people with a stoma: patients' views

PURPOSE

Low back pain (LBP) is a major health problem in western society. Stoma surgery, which involves creating a permanent opening in the abdominal wall, may interfere with the function of the abdominal muscles. Therefore people with a stoma may be at greater risk of developing LBP. A literature review revealed no research exploring a possible link between stoma formation and LBP, nor any study involving patients' perceptions. Therefore, the aims of this study were to determine (1) whether people with a stoma have LBP, (2) whether people with LBP and a stoma perceive that the conditions are linked, and (3) what issues regarding LBP should be included in a large survey of persons with a stoma.

METHODS

Members of the Ileostomy Association of Northern Ireland volunteered to participate in a focus group study. Events from this group were recorded, transcribed, and validated. Thematic analysis was performed.

RESULTS

Three themes were identified: (1) the presence of LBP, (2) a perceived link between LBP and a stoma, and (3) relevant issues for LBP. Ten of the 11 participants had experienced at least one episode of LBP, however 5 (50%) emphasized that they did not have a back problem. Six participants had no LBP prior to their surgery, but have experienced episodes of LBP since. The majority thought that the stoma and their LBP experience were linked. Suggested reasons for this link were changes in muscle strength, posture, and activities. Others included having an epidural or a pouching system that did not optimally suit their needs.

CONCLUSIONS

The results suggest that LBP is a problem for some people with an abdominal stoma and support the need for further study in this population. Two possible areas of future study are an investigation of what the term low back pain means to this population, and further study of the mechanisms that may link stoma surgery to an increased risk of LBP.

The need for inpatient palliative care facilities for noncancer patients in the Thames Valley

Inpatient facilities in palliative care units are generally considered to be mainly for cancer patients. We present and discuss the results of a survey that attempted to estimate the number of noncancer patients requiring inpatient palliative care. Questionnaires sent to all general practices in the Thames Valley area asked about the diagnosis and the number of bed-days that would have been required for each noncancer patient in the practice dying in the last year or still in their care. The replies suggest that about 11 noncancer patients per practice per year were in need of respite or continuing care. For the Thames Valley area this would amount to at least 66,000 bed-days per year for noncancer patients, compared with the current provision, mainly for cancer patients, of about 40,000 bed-days per year. The diagnoses involved and the reasons why our figures may overestimate need, are discussed. There can be no doubt that, if the need is to be met, current facilities will be inadequate and additional beds and services will be required.

The relation of mothers' controlling vocalizations to children's intrinsic motivation

Twenty-six mother-child dyads played together in a laboratory setting. Play sessions were surreptitiously videotaped (with mothers' permission), and each maternal vocalization was transcribed and coded, first into 1 of 24 categories and then ipso facto into one of three supercategories--namely, controlling, autonomy supportive, and neutral. The degree of mothers' controllingness was calculated as the percentage of vocalizations coded as controlling. This index was correlated with the intrinsic motivation of their 6- or 7-year-old children, as assessed primarily by the free-choice behavioral measure and secondarily by a child self-report measure of interest and liking for the task. Both correlations were significantly negative, thereby suggesting that the robust laboratory findings of a negative relation between controlling contexts and individuals' intrinsic motivation are directly generalizable to the domain of parenting. Results are discussed in terms of the processes that undermine intrinsic motivation and the means through which parental controllingness is communicated.

Pure tone audiograms from hearing-impaired children. II. Predicting speech-hearing from the audiogram

Pure tone audiograms and speech audiograms using sentence lists were obtained from 150 8-16-year-old children with pure tone hearing losses ranging from mild to severe. Most of the hearing impairments were cochlear in origin. Three 'speech-hearing' measures were selected from the speech audiograms, and it was shown that the correlation coefficients between two of these and the pure tone hearing thresholds were roughly in agreement with figures from previous studies of adults = 0.882 for Speech Reception Threshold and 0.533 for Discrimination Score. In addition, a correlation of 0.329 was found between the slope of the speech audiogram and pure tone thresholds. The strength of different summaries of the pure tone audiogram for predicting the various speech-hearing measures were compared. It was found that although the traditional summaries did quite well, their relative strengths varied according to the speech-hearing measure under consideration. The best summary predictors for all the speech-hearing measures were, either alone or in combination, two indices which have been proposed recently by the present authors, and which measure both the degree of pure tone hearing loss and the slope of the pure tone audiogram. However, the gains in predictive strength achieved with these indices were small.

Pure tone audiograms from hearing-impaired children. I. A statistical approach to summarizing audiogram information

Principal component analyses of the better-ear pure-tone audiograms from 201 hearing-impaired children are reported. The analyses show that two components, one measuring degree of hearing loss, the other the slope of the audiogram, account for 86% of the total variability. Two indices are proposed which correspond to the two components, but which have numerically simple coefficients and which, unlike the raw components, are perfectly "clean" measures of the two variables. Since these indices, 11 and 12, still account for 84% of the total audiogram variability, it is suggested that they may provide a quantitative basis for summarizing pure tone audiograms for general use.