Joint testing for the cumulative effect of multiple single nucleotide polymorphisms grouped on the basis of prior biological knowledge has become a popular and powerful strategy for the analysis of large scale genetic association studies. The kernel machine (KM) testing framework is a useful approach that has been proposed for testing associations between multiple genetic variants and many different types of complex traits by comparing pairwise similarity in phenotype between subjects to pairwise similarity in genotype, with similarity in genotype defined via a kernel function. An advantage of the KM framework is its flexibility: choosing different kernel functions allows for different assumptions concerning the underlying model and can allow for improved power. In practice, it is difficult to know which kernel to use a priori since this depends on the unknown underlying trait architecture and selecting the kernel which gives the lowest p-value can lead to inflated type I error. Therefore, we propose practical strategies for KM testing when multiple candidate kernels are present based on constructing composite kernels and based on efficient perturbation procedures. We demonstrate through simulations and real data applications that the procedures protect the type I error rate and can lead to substantially improved power over poor choices of kernels and only modest differences in power versus using the best candidate kernel.

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Intimate partner violence (IPV), including physical, sexual, emotional, and economic violence, has profound immediate and long-term effects on individuals and communities worldwide. To date, few studies have focused on couples' reporting of IPV. The aim of this article is to present the results of a survey of couples' reporting of IPV and the individual, interpersonal, and social correlates of IPV in northern Tanzania. Four hundred fifty couples from Karatu District, Tanzania, completed a questionnaire measuring attitudes on gender norms and relations, men's experience of childhood trauma, and men's perpetration and women's experience of IPV. We found high levels of acceptance and experience of IPV: 72% of men justified a husband's perpetration of IPV, and 54% of men and 76% of women said that a woman should tolerate violence to keep her family together. The majority of women had ever experienced IPV (77.8%), and 73.6% and 69% had experienced IPV in the past 12 and 3 months, respectively. Men were significantly less likely to report that they had committed IPV: 63.6% ever, 48.9% in the past 12 months, and 46.2% in the past 3 months. Multivariate logistic regression found that younger men, men who reported gender inequitable attitudes, childhood trauma, multiple sexual partners, and alcohol use were significantly more likely to report IPV perpetration in the past 3 months. Younger women, and women with low levels of education and reported food shortages were significantly more likely to report IPV in the past 3 months. These results indicate that social and individual acceptance and justification of IPV are common. Experience of violence persists over time in many relationships. This study demonstrates the need for interventions that address individual-, interpersonal-, and community-level determinants of IPV, including attitudes regarding gender equity, exposure to violence as children and intergenerational violence, lack of education, and poverty.

ImportanceSome states have implemented policies that consider substance use during pregnancy as child abuse and require mandated reporting of substance use during pregnancy. Implications of these policies for health care receipt among pregnant people who engage in substance use are unknown.ObjectiveTo examine the association of state child abuse policies and mandated reporting policies with prenatal and postpartum care among women who engaged in substance use during pregnancy.Design, Setting, and ParticipantsIn this cross-sectional study, data from the 2016-2019 Pregnancy Risk Assessment Monitoring System survey were analyzed. The study population included 4155 women from 23 states who reported substance use during pregnancy. Data were analyzed between August and November 2021.ExposuresDelivery in a state with a child abuse policy only (n = 6), a mandated reporting policy only (n = 4), both policies (n = 7), or neither policy (n = 5). One state switched from a mandated reporting policy only to having both policies.Main Outcomes and MeasuresMonth of gestation at prenatal care initiation (ie, months 1-10, with a higher number of months indicating later initiation), receipt of adequate prenatal care, and receipt of a postpartum health care visit 4 to 6 weeks after delivery. Sample characteristics were calculated using unweighted frequencies and weighted percentages and means. Associations of state policies with the outcomes were examined using generalized linear regression with generalized estimating equations, adjusting for potential confounders and accounting for the complex sampling design of the Pregnancy Risk Assessment Monitoring System survey.ResultsThe study sample included 4155 women who reported substance use during pregnancy; 33.9% of these women delivered in states with a child abuse policy only, 16.4% in states with a mandated reporting policy only, 32.9% in states with both policies, and 16.8% in states with neither policy. Overall, 14.7% of women were Black, 69.0% were White, and 64.6% were aged 18 to 29 years at delivery. Women who delivered in states with a child abuse policy only, mandated reporting policy only, or both policies initiated prenatal care at a later month of gestation (β = 0.44 [95% CI, 0.10-0.78], 0.32 [95% CI, 0.04-0.59], and 0.40 [95% CI, 0.09-0.72], respectively) and had a lower likelihood of adequate prenatal care (risk ratio, 0.85 [95% CI, 0.79-0.91], 0.94 [95% CI, 0.87-1.01], and 0.95 [95% CI, 0.89-1.03], respectively) and a postpartum health care visit (risk ratio, 0.89 [95% CI, 0.82-0.96], 0.89 [95% CI, 0.80-0.98], and 0.92 [95% CI, 0.83-1.02], respectively) compared with women who delivered in states with neither policy.Conclusions and RelevanceThe results indicate that state child abuse policies and mandated reporting policies are associated with reduced receipt of prenatal and postpartum care among women who engage in substance use during pregnancy.