People
Hans-Peter Kohler
Hans-Peter Kohler is a social and economic demographer whose current research focuses on health, demography, and social change in developing and developed countries. A key characteristic of his research is the attempt to integrate demographic, economic, sociological, and biological approaches in empirical and theoretical models of health and demographic behaviors.
In his prior work, he has investigated the role of social and sexual networks for HIV risk perceptions and HIV infection risks, the causal effects of education on health, the consequences of learning one’s HIV status on risky behaviors, the interrelations between marriage and sexual relations in developing countries, the role of social interaction processes for fertility and AIDS-related behaviors, processes of aging in low-income populations, the determinants and consequences of low fertility in developed countries, and global family change.
His research combines extensive knowledge about the life-course determinants of family change, health, fertility/mortality, social networks, and related economic behaviors in developing and developed countries with considerable experience in sophisticated econometric and demographic analyses, including analyses with controls for endowment and unobserved determinants of individuals’ behaviors, models of population and disease dynamics, randomized designs and integration of social science and biomedical research methods.
His research has been funded by the National Institutes of Health (NIH), the National Science Foundation (NSF), the Bill and Melinda Gates Foundation, and other foundations. He has been awarded the Clifford C. Clogg Award for Early Career Achievement by the Population Association of America for my interdisciplinary work on fertility and health, and have been honored with Otis Dudley Duncan Award for Outstanding Scholarship in Social Demography by the American Sociological Association. He has also been a Fellow at the Center for Advanced Studies at the Norwegian Academy of Science, served as the president of the Society of Biodemography and SocialBiology, and was engaged as lead-paper author in the Copenhagen Consensus Project to evaluate policies to prevent the sexual transmission of HIV (2011, with Behrman), reduce population growth(2012), and the post-2015 UN Development Goals in the area of Population and Demography.
He served as the Chair of Penn’s Ph.D. Program in Demography and the NICHD T32 Training Director for this program (successfully renewed in 2012). Kohler has extensive experience in the design and implementation of large-scale data collection in sub-Saharan contexts, and he has directed the Malawi Longitudinal Study of Families and Health (MLSFH) that documents more than two decades of demographic, socioeconomic and health conditions in one of the world’s poorest countries.
Selected Publications
(June 2023) “Longitudinal Associations Between Childhood Adversity and Adolescent Intimate Partner Violence in Malawi.” Journal of Interpersonal Violence 38, no. 11-12: 7335-7354. doi:10.1177/08862605221145720.
Adverse childhood experiences (ACEs)-including child maltreatment, witnessing violence, and household dysfunction-have been robustly associated with poor health in later life. There is also increasing evidence that those who experience childhood adversity are more likely subsequently to be victims or perpetrators of intimate partner violence (IPV). Most evidence, however, is cross-sectional and concentrated in high-income settings, and cannot be generalized to more diverse contexts. In contrast, this study assessed longitudinal relations between ACEs and IPV in a low-income country. We interviewed 1,878 adolescents in rural Malawi between 2017 and 2018 (aged 10-16) and again in 2021 (aged 13-20). Adolescents completed the Adverse Childhood Experience-International Questionnaire. Past-year physical, sexual, and emotional IPV victimization and perpetration were measured using the WHO’s Violence Against Women Instrument. We estimated multivariate regression models between cumulative adversity (0-13 adversities) at baseline and IPV at follow-up among respondents who reported any romantic or sexual partnerships. The cumulative ACEs score was associated with emotional IPV victimization for boys (OR = 1.12 per ACE) and sexual IPV victimization for girls (OR = 1.18). The ACEs score demonstrated a significant association with perpetration for girls only (OR = 1.33 for emotional IPV). By using longitudinal data, we more rigorously demonstrated the critical role of childhood adversity in shaping later IPV behavior. There are ongoing efforts toward primary prevention of childhood adversity. Given the burden that adolescents already carry (six ACEs on average in our sample), we also need secondary interventions that can help interrupt the pathway from adversity to IPV. This calls for increased collaboration between those working to address violence against children and violence against women.
(2023). “Longitudinal Associations Between Childhood Adversity and Adolescent Intimate Partner Violence in Malawi.” Journal of Interpersonal Violence 38, no. 11-12 (June 2023): 7335-7354. doi:10.1177/08862605221145720.
Adverse childhood experiences (ACEs)—including child maltreatment, witnessing violence, and household dysfunction—have been robustly associated with poor health in later life. There is also increasing evidence that those who experience childhood adversity are more likely subsequently to be victims or perpetrators of intimate partner violence (IPV). Most evidence, however, is cross-sectional and concentrated in high-income settings, and cannot be generalized to more diverse contexts. In contrast, this study assessed longitudinal relations between ACEs and IPV in a low-income country. We interviewed 1,878 adolescents in rural Malawi between 2017 and 2018 (aged 10–16) and again in 2021 (aged 13–20). Adolescents completed the Adverse Childhood Experience—International Questionnaire. Past-year physical, sexual, and emotional IPV victimization and perpetration were measured using the WHO’s Violence Against Women Instrument. We estimated multivariate regression models between cumulative adversity (0–13 adversities) at baseline and IPV at follow-up among respondents who reported any romantic or sexual partnerships. The cumulative ACEs score was associated with emotional IPV victimization for boys (OR = 1.12 per ACE) and sexual IPV victimization for girls (OR = 1.18). The ACEs score demonstrated a significant association with perpetration for girls only (OR = 1.33 for emotional IPV). By using longitudinal data, we more rigorously demonstrated the critical role of childhood adversity in shaping later IPV behavior. There are ongoing efforts toward primary prevention of childhood adversity. Given the burden that adolescents already carry (six ACEs on average in our sample), we also need secondary interventions that can help interrupt the pathway from adversity to IPV. This calls for increased collaboration between those working to address violence against children and violence against women.
(2021) Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa, Journal of Health Economics, Volume 75
PDRI affiliates Hans-Peter Kohler and Iliana Kohler recently co-authored a study, published in the Journal of Health Economics that investigates the effectiveness of health screenings to reduce the burden of non-communicable diseases in Malawi.
Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later.
These lasting effects are explained by a 20 percentage point increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts.
The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.