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Family formation patterns among US young adults are shifting, reflecting an accelerating retreat from marriage coupled with significant increases in cohabitation and nonmarital childbearing. Drawing on a selection of published longitudinal studies, this article reviews key contributions to the literature on these trends in union and family formation that have stemmed from research conducted using the National Longitudinal Study of Adolescent to Adult Health, or Add Health. Add Health is integral to deciphering the adolescent precursors to young adult union formation and childbearing, allowing researchers to gauge the roles of multiple social contexts such as family, schools, peers, and adolescent romance, with attention to variation across racial-ethnic groups and by socioeconomic status. In turn, researchers use Add Health to assess how young adult family formation behaviors are related to numerous indicators of health and well-being, ranging from mental and physical health to relationship quality and stability, interpersonal violence, and crime. With its sibling and couples samples, genetic data, and detailed partnership histories for both different- and same-sex relationships, Add Health is an invaluable data source for tracking the familial experiences (formation and dissolution) of a large cohort from adolescence into middle age.

Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family. Resumo O Brasil é caracterizado por fortes desigualdades sociais e diferenças no acesso a alimentos de qualidade e em quantidade suficiente, o que representa uma violação do direito humano à alimentação adequada. O objetivo foi avaliar os gastos com alimentação de acordo com o perfil social do responsável pelo domicílio. Dados da Pesquisa de Orçamentos Familiares Brasileiros de corte transversal (2017/2018) foram usados com uma amostra nacionalmente representativa de participantes da pesquisa domiciliar (n=52.917). A regressão de Poisson foi utilizada para estimar razões de prevalência (RP) para avaliar a associação de diferentes perfis sociais com a aquisição de alimentos. O perfil caracterizado pela mulher auto classificada como branca, com maior escolaridade, cujas características estiveram positiva e significativamente associadas a maior aquisição de frutas (RP=1,22; IC95% 1,09-1,36), verduras e legumes (PR=1,24; IC95% 1,09-1,41) e queijo (RP=1,32; IC95% 1,09-1,59). Mulheres negras com baixa escolaridade apresentaram associação negativa com o consumo de refrigerantes (RP=0,53; IC95% 0,45-0,62) e alimentos preparados (RP=0,52; IC95% 0,37-0,74). Os resultados revelam grandes desigualdades na aquisição de alimentos entre os perfis sociais dos chefes de família.

Background. Community-based health insurance (CBHI) scheme is an emerging strategy to achieve universal health coverage and protect communities in developing countries from catastrophic financial expenditure at the service delivery point. However, high membership discontinuation from the CBHI scheme remained the challenge to progress toward universal financial protection in resource-constrained countries. Therefore, this study assessed the community-based health insurance membership renewal rate and associated factors in the Gedeo zone, Southern Ethiopia. Methods. We conducted a community-based cross-sectional study among households in the Yirga Chafe district, Gedeo zone, Southern Ethiopia, from September 10 to 30, 2021. We used a multistage simple random sampling to recruit 537 respondents. We entered data into Epi-Info 7 and exported it to SPSS version 25 for analysis. We used a logistic regression model to determine factors associated with the CBHI scheme membership renewal. Variables with a P value of 3years ( AOR = 3.12 ; 95% CI: 1.40–6.97), having illnesses in the last three months ( AOR = 2.97 ; 95% CI: 1.47–5.99), the CBHI premium affordability ( AOR = 12.64 ; 95% CI: 3.25–49.38), good knowledge of the CBHI scheme ( AOR = 21.11 ; 95% CI: 10.63–41.93), perceived quality of health service ( AOR = 4.21 ; 95% CI: 1.52–11.68), and favorable attitude towards the CBHI scheme ( AOR = 3.89 , 95% CI: 1.67–9.04) were significantly associated with the CBHI program membership renewal rate. Conclusion. In our study, we found the magnitude of CBHI members who discontinued their CBHI scheme membership was high. Besides, we found that the affordability of the CBHI premium, respondents’ attitude, and knowledge of the CBHI program were predictor factors for dropout from the CBHI membership. Therefore, the government should consider the economic status of communities during setting the CBHI program contribution. Moreover, awareness creation through health education should be provided to improve participants’ knowledge and perception of the CBHI program.

BACKGROUND Pediatric household contacts (HHCs) of patients with multidrug-resistant TB (MDR-TB) are at high risk of infection and active disease. Evidence of caregiver willingness to give MDR-TB preventive therapy (TPT) to children is limited.METHODS This was a cross-sectional study of HHCs of patients with MDR-TB to assess caregiver willingness to give TPT to children aged RESULTS Of 743 adult and adolescent HHCs, 299 reported caring for children aged CONCLUSIONS A high percentage of caregivers living with MDR- or rifampicin-resistant TB patients were willing to give children a hypothetical MDR TPT. These results provide important evidence for the potential uptake of effective MDR TPT when implemented.

Global efforts to eliminate tuberculosis (TB) must address the unique barriers that children (ages 0 through 9 years) and adolescents/young adults (AYA; ages 10 through 24 years) face in adhering to treatment for TB infection and disease. We conducted a narrative review to summarize current knowledge on the social determinants of treatment adherence among these age groups to guide efforts and policy to address their unique needs. Our findings revealed that research on TB treatment adherence among children and AYA is still in its nascent stage. The current literature revealed structural/community-, health system-, household-, and individual-level factors that influence treatment adherence and varied with developmental stage. There is a need to develop multilevel interventions to address the unique challenges that children and AYA face in adhering to TB treatment.

Shocks to health have been shown to reduce labor supply for the individual affected. Less is known about household self-insurance through a partner's response. Previous studies have presented inconclusive empirical evidence on the existence of a health-related Added Worker Effect, and results limited to labor and income responses. We use UK longitudinal data to investigate within households both the labor supply and informal care responses of an individual to the event of an acute health shock to their partner. Relying on the unanticipated timing of shocks, we combine Coarsened Exact Matching and Entropy Balancing algorithms with parametric analysis and exploit lagged outcomes to remove bias from observed confounders and time-invariant unobservables. We find no evidence of a health-related Added Worker Effect but a significant and sizable Informal Carer Effect. This holds irrespective of spousal labor market position or household financial status and ability to purchase formal care provision, suggesting that partners' substitute informal care provision for time devoted to leisure activities.

The premise that a woman's social status has intergenerational effects on her children's health has featured prominently in population science research and in development policy. This study focuses on an important case in which social hierarchy has such an effect. In joint patrilocal households in rural India, women married to the younger brother are assigned lower social rank than women married to the older brother in the same household. Almost 8% of rural Indian children under 5 years old—more than 6 million children—live in such households. We show that children of lower-ranking mothers are less likely to survive and have worse health outcomes, reflected in higher neonatal mortality and shorter height, compared with children of higher-ranking mothers in the same household. That the variation in mothers' social status that we study is not subject to reporting bias is an advantage relative to studies using self-reported measures. We present evidence that one mechanism for this effect is maternal nutrition: although they are not shorter, lower-ranking mothers weigh less than higher-ranking mothers. These results suggest that programs that merely make transfers to households without attention to intrahousehold distribution may not improve child outcomes.

To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey.Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed.A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors.The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches.The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants.

COVID-19 disparities exposed health inequity across socioeconomic status, with community members of color experiencing higher rates of COVID-19 infections, hospitalizations, and death. Racial/ethnic differences were especially disparate in Benton and Washington counties in northwest Arkansas, a region in the United States that experienced high COVID-19 infection rates. To address these disparities and support families with COVID-19, the University of Arkansas for Medical Sciences and Community Clinic (a federally qualified health center) worked with the Arkansas Department of Health and community partners to develop systematic Care Navigation and Enhanced Case Management. During an initial screening process, contact tracers offered Care Navigation and Enhanced Case Management services to individuals who tested positive for COVID-19 within Washington and Benton counties. Bilingual community health navigators, social workers, and nurses began providing enhanced case management to households that accepted services. Between September 9, 2020 and June 19, 2021, 3,502 households representing ∼13,000 individuals were offered services, and 1,511 (43.1%) households requested/accepted services. Based on our experience, we provide four recommendations for practice: (a) provide contact tracing in community members' preferred language, (b) incorporate assessments into the contact tracing process to ensure community members have necessary resources for quarantine, (c) implement comprehensive care navigation and case management services for those who need additional support, and (d) integrate bilingual health navigators who are part of the target community into the process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective To assess if water from improved sources are microbiologically safe in Niassa province, Mozambique, by examining the presence of total coliforms in different types of water sources. Methods We conducted a cross-sectional household survey in two rural districts of Niassa province during the dry season, from 21 August to 4 October 2019. We observed water sources and conducted microbiological water quality tests and structured household interviews. Findings We included 1313 households, of which 812 (61.8%) used water from an improved source. There was no significant difference in presence of total coliforms between water sampled at improved and unimproved water sources, 62.7% (509 samples) and 65.7% (329 samples), respectively (P-value = 0.267). Households using improved water sources spent significantly longer time collecting water (59.1 minutes; standard deviation, SD: 55.2) than households using unimproved sources (49.8 minutes; SD: 58.0; P-value < 0.001). A smaller proportion of households using improved sources had access to water sources available 24 hours per day than that of households using unimproved sources, 71.7% (582 households) versus 94.2% (472 households; P-value < 0.001). Of the 240 households treating water collected from improved sources, 204 (85.4%) had total coliforms in their water, while treated water from 77 of 107 (72.0%) households collecting water from an unimproved source were contaminated. Conclusion Current access to an improved water source does not ensure microbiological safety of water and thereby using access as the proxy indicator for safe drinking and cooking water is questionable. Poor quality of water calls for the need for integration of water quality assessment into regular monitoring programmes., Bulletin of the World Health Organization, 100(9), pp. 534-543; 2022

Intergenerational relationships are one of the most frequently studied topics in the social sciences. Within the area of family, researchers find intergenerational similarity in family behaviors such as marriage, divorce, and fertility. Yet less research has examined the intergenerational aspects of a key proximate determinant of fertility: sexual frequency. We use the National Survey of Families and Households to examine the relationship between sexual frequency of parents and the sexual frequency of children when adults. We link parental sexual frequency in 1987/1988, when children were ages 5-18, to the sexual frequency of the children in 2001-2003 when these grown children were ages 18-34. We find a modest, yet significant association, between parental and adult children sexual frequency. A mechanism behind this association appears to be the higher likelihood of being in a union among children of parents with high sexual frequency.

Eating last is a gendered cultural norm in which the youngest daughters-in-law are expected to eat last after serving others in the household, including men and in-laws. Using women's eating last as an indicator of women's status, we studied the association between eating last and women's mental health. Using four rounds of prospective cohort data of 18-25-year-old newly married women (n = 200) cohabiting with mothers-in-law between 2018 and 2020 in the Nawalparasi district of Nepal, we examined the association between women eating last and depressive symptom severity (measured using 15-item Hopkins Symptom Checklist for Depression; HSCL-D). Twenty-fivepercent of women reported eating last always. The prevalence of probable depression using the established cutoff was 5.5%, consistent with the prevalence of depression in the general population. Using a hierarchical mixed-effects linear regression model, we found that women who always ate last had an expected depressive symptom severity (0-3 on HSCL-D) 0.24 points (95% confidence interval [CI]: 0.13-0.36) greater compared to women who did not eat last when adjusted for demographic variables, household food insecurity, and secular trends. Sensitivity analysis using logistic regression also suggested that women who eat last have greater odds of having probable depression (adjusted odds ratio [AOR] = 4.05; 95% CI: 1.32-12.44). We explored if the association between eating last and depressive symptom severity was moderated by household food insecurity and did not observe evidence of moderation, underscoring the significance of eating last as a woman's status indicator. Our study findings highlight that newly young married women in Nepal are a vulnerable group.

This article analyzes factors influencing the adoption of kitchen gardens and food and nutrition security implications of kitchen gardens on farming households. For this, the Per Capita Kilocalorie Intake (PKCI) and Food Consumption Score (FCS) were applied as food and nutrition security indicators. This paper is based on cross-sectional data that include a sample of 825 households from two districts in Tanzania. Endogenous Switching Regression is employed to determine factors influencing the adoption of a kitchen garden and its impact on food and nutrition security of the involved farming households. The results of the analysis indicate that the adoption of a kitchen garden increased with the family size (adult equivalent), credit use, access to information, districts (location), and the usage of other water sources for agriculture in addition to rainfed. It decreased with total land size and TLU. While the adoption of a kitchen garden significantly increased adopters' FCS by 1.45 or 2.96% and non-adopters' FCS by 1.26 or 2.69%. In contrast, the adoption of a kitchen garden significantly reduced non-adopters' PKCI by 101.18 or 3.92% but it does not have significant impact for adopters. Therefore, policymakers and development organizations should further promote and scale-up the kitchen garden intervention in order to use it as a tool to enhance the household's food and nutrition security.

The link between university graduation and liberal values is well-established and often taken as evidence that higher education participation causes attitudinal change. Identification of education’s causal influence in shaping individual preferences is notoriously difficult as it necessitates isolating education’s effect from self-selection mechanisms. This study exploits the household structure of the Harmonized British Household Panel Study and Understanding Society data to tighten the bounds of causal inference in this area and ultimately, to provide a more robust estimate of the independent effect of university graduation on political attitudes. Results demonstrate that leveraging sibling fixed-effects to control for family-invariant pre-adult experiences reduces the size of higher education’s effect on cultural attitudes by at least 70%, compared to conventional methods. Significantly, within-sibship models show that obtaining higher education qualifications only has a small direct causal effect on British individuals’ adult attitudes, and that this effect is not always liberalizing. This has important implications for our understanding of the relationship between higher education and political values. Contrary to popular assumptions about education’s liberalizing role, this study demonstrates that the education-political values linkage is largely spurious. It materializes predominately because those experiencing pre-adult environments conducive to the formation of particular values disproportionately enroll at universities.

Multiple studies examine how couples organize their economic resources, but most focus on wages, with little attention to assets. This paper helps to fill this research gap in Québec (Canada) by asking what proportion of married and cohabiting different-sex couples of working age jointly own their primary residence, instead of remaining in more independent arrangements regarding this asset-either through individual ownership of the home by the man or the woman or by not owning one at all. Also, drawing on transaction cost and institutional approaches to economic organization, we explore variation on several relationship characteristics. Individual ownership is uncommon, especially by the woman, but it is more prevalent among couples with little time together and who do not have children. Individual ownership is also more common among income-unequal couples than equal ones, because, we argue, it allows primary earners to cover housing costs without transferring wealth. Those results advance knowledge on both within-household wealth inequality and conjugal redistributive practices.De nombreuses études examinent la façon dont les couples organisent leurs ressources économiques, mais la plupart d'entre elles se concentrent sur les salaires, et accordent peu d'attention aux actifs. Cet article comble cette lacune dans le contexte du Québec (Canada), en abordant la question suivante : dans quelle proportion les couples mariés et en union de fait de sexes différents et en âge de travailler sont-ils conjointement propriétaires de leur résidence principale? Et dans quelle proportion optent-ils plutôt pour un arrangement offrant davantage d'indépendance, par exemple la propriété individuelle de la maison par l'un des partenaires ou encore la location de la résidence plutôt que sa propriété? De plus, en nous appuyant sur les théories transactionnelles et institutionnelles de l'organisation économique conjugale, nous explorons la variation des arrangements en fonction de plusieurs caractéristiques des couples. La propriété individuelle par l'un des conjoints est peu commune, surtout par la femme, mais elle est plus répandue chez les couples en début de relation et chez ceux qui n'ont pas d'enfants. La propriété individuelle est également plus commune chez les couples à revenus inégaux, car cet arrangement permet à la personne gagnant leplus haut revenu de couvrir les coûts d'habitation sans transférer de richesse à l'autre partenaire. Ces résultats font progresser les connaissances sur les inégalités de richesse au sein des ménages et sur les pratiques de redistribution conjugale.

Out-of-pocket (OOP) payments and catastrophic health expenditure (CHE) have a strong age gradient. Though studies have examined the socio-demographic and geographic inequality in OOP payments and CHE in India, the role of old-age dependency in financial catastrophe remains unclear. Disaggregated estimates of CHE by the level of old-age dependency of households may help identify the most vulnerable sub-group and provide evidence for specific policies for the financial protection and health care of the elderly. The present study aims to estimate the incidence and intensity of CHE by the old-age dependency of households among middle-aged adults and the elderly in India.A total of 42,949 households from the Longitudinal Aging Study in India (LASI), 2017-18, covering households with at least one-member aged 45+ years, were included in the analysis. Households were classified into three mutually exclusive groups: no old-age dependency, low old-age dependency, and high old-age dependency. The incidence and intensity of CHE were estimated using the capacity-to-pay (CTP) approach. Concentration indices and concentration curves examine the extent of socioeconomic inequality in CHE. Binary logistic regression helps to understand the potential predictors of CHE across each type of old-age-dependent household.We estimated the overall incidence of CHE at 24.6% (95% CI: 23.3-25.8) among middle-aged adults and the elderly in India. The incidence was 33.2% (95% CI: 31.4-35.1) among households with high old-age dependency, 23.1% (95% CI: 20.8-25.5) among those with low old-age dependency, and 20.4% (95% CI: 19.0-21.7) among no old-age dependency households. CHE intensity was highest among households with low old-age dependency compared to those no old-age dependents. Catastrophic health expenditure was higher among the poorer households in each type of old-age dependency. Among all households, the odds of incurring CHE were higher among households with high old-age dependency (AOR: 1.52; 95% CI: 1.36-1.69) than those with no old-age dependency. Lower-income households, households with pensions as the main source of income, households belonging to scheduled castes, and households residing in rural areas had higher odds of incurring CHE. The co-variates of CHE varied significantly across the type of old-age dependency households. A household's enrolment into a health insurance scheme did not necessarily lower its CHE.Households with high old-age dependency had a higher probability of incurring CHE in India. Providing preventive and curative geriatric care in primary health centres (PHC) is recommended.

To describe the frequency of food and beverages purchased made by Mexican households at different types of grocery retailers.A national cross-sectional survey.Mexico.A representative sample of Mexican households (n = 70,311).Household food and beverages purchases.The association between amounts of food and beverages supply bought in different food retailers (as outcome) and households' sociodemographic characteristics (as covariates) was assessed using logistic and linear regression models.Mexican households acquired their food and beverages primarily from abarrotes stores, followed by supermarkets and mercados and tianguis. Abarrotes stores and supermarkets were sources of unprocessed and processed foods. Specialized stores, mercados, and tianguis were primary sources of unprocessed foods. Households with low socioeconomic status and those in the central or southern regions acquired more foods from abarrotes stores, mercados and tianguis, and specialized stores. Households with high socioeconomic status and living in the northern region acquired more foods from supermarkets and convenience stores.Abarrotes stores are the primary source of food and beverages for Mexican households; however, some interventions are needed to increase their supply of unprocessed foods. Public health interventions aiming at increasing access to unprocessed foods could be done through traditional retailers.

It is essential to solve the problem of information asymmetry in bank housing credit management, thus reducing bank operating costs and credit risk. Therefore, the present work constructs a bank housing credit blockchain alliance system based on the technical characteristics of blockchain to strengthen bank housing credit risk control. First, according to blockchain’s elements and system architecture, the application of blockchain to bank housing credit business is analyzed. On this basis, the bank housing credit risk control strategy is proposed. Finally, the mathematical model is used to investigate residents’ household consumption to explore the impact of housing credit on the household consumption plan of residents. The results show that when the educational level of the head of household is illiterate or semi-illiterate, the coefficients of participation credit (PC), nonparticipation credit (NPC), and total samples (TSs) of total household consumption are −0.064, 0.067, and 0.174, respectively; when the educational level of the head of household is primary school or junior middle school, the coefficients of PC, NPC, and TS of total household consumption are -0.026, 0.017, and 0.105, respectively; when the educational level of the head of household is high school or above, the coefficients of PC, NPC, and TS of total household consumption are 0.084, 0.073, and 0.064, respectively. The results indicate that the education level of the head of household plays a crucial role in the family consumption plan. Those with a high educational level will compromise on the best consumption decision after constantly weighing the consumption motivation and consumption thinking after obtaining the credit funds. The content reported here is vitally significant in guiding households to clarify the proportion of credit fund distribution and understand their consumption tendency.

Introduction Parents/guardians can effectively reduce tobacco smoking and secondhand smoke exposure among youth by adopting and enforcing rules against indoor tobacco smoking (ie, home smoke-free policies). We investigate home smoke-free policies from childhood to adolescence in the United States and across rural, suburban, and urban households. Aims and Methods We analyzed 2019–2020 National Survey of Children’s Health data from n = 5,955 parents of youth aged 0–17, living at home with a tobacco smoker in the United States (U.S). Geographical categories were: rural, suburban, and urban. Home smoke-free policy reflected prohibiting tobacco smoking inside the home. Weighted logistic regressions examined the (1) association between youth age and home smoke-free policies, (2) interaction between geographic category and youth age, and (3) differing associations between youth age and home smoke-free policies by geography. Models controlled for youth race, ethnicity, sex, parental education, household annual income, and home structure. Results Approximately 13.2% of U.S. households with a smoker did not have a home smoke-free policy. Stratified analyses found one-year increase in youth age was associated with lower odds of having a home smoke-free policy in rural (aOR:0.91; 95%CI: 0.87–0.95) and urban (aOR: 0.96; 95%CI: 0.92–1.00; p = .039), but not suburban (aOR:1.00; 95%CI: 0.95–1.05) households, controlling for covariates. Conclusion Odds of having a smoke-free home in the U.S. declined significantly in rural (9% per year) and urban (4%) but not suburban (0%) households. We quantify declines in home smoke-free policies as children age and identify geographic disparities for this environmental determinant of health. Implications Health promotion efforts targeting secondhand smoke prevention is needed, particularly for parents of older youth. Furthermore, there is a clear geographic bias in secondhand smoke exposure among all youth particularly older youth. Tailored interventions are needed to address geographic disparities in secondhand smoke exposure among rural and urban youth.

Mexico ranks among the OECD countries with the highest prevalence of teenage pregnancies, exhibiting a fertility rate of 70.6 births for every 1000 adolescents. Mexican adolescents with a history of pregnancy are twice as likely to lag behind in their studies as those who have not been pregnant. Research on adolescent maternity and its explanatory mechanisms is required as a basis for implementing policies and programs that effectively curb teenage pregnancy-related behaviors, prevent educational gaps, and reduce the intergenerational transmission of poverty. Based on quasi-experimental methodology and a non-recursive structural equation model with instrumental variables, this paper analyzed the intergenerational transmission of teenage pregnancy from mothers to daughters, as well as the relationship between teenage pregnancy and educational attainment. Using data from the 2009 National Survey of Demographic Dynamics in Mexico, our estimated model indicated a unidirectional relationship from teenage pregnancy to educational attainment. An association was observed between teenage pregnancy and an increased probability of a moderate or severe educational gap (≥ 1 year) by 21% ± 5 and a severe educational gap (≥ 2 years) by 33% ± 8. Adolescents whose mothers reported teenage pregnancy at 15 years of age were approximately 84% more likely to experience teenage pregnancy themselves than other adolescents. Relevant explanatory mechanisms included low socioeconomic status and a low level of education in the household. Mexico needs to formulate, implement, and expand comprehensive and early prevention strategies as well as teenage pregnancy care throughout its most vulnerable regions. Efforts should be made at the individual, family, and community levels; incorporate alliances with teenage networks; actively engage parents, teachers, and health care providers; and reinforce educational initiatives on sexual and reproductive health for adolescents. It would be convenient for the Government to implement public policies that emphasize the results obtained. There is no better instrument than to show the evidence of the gradual deterioration of human capital in Mexico associated with adolescent pregnancy.

This paper examines the socio-economic implications of scaling back China's Sloping Land Conversion Programme (SLCP), one of the world's largest payments for ecosystem services programmes. Using the consolidation phase of SLCP as a natural experiment, a staggered difference-in-differences design is applied to a panel of rural villages (and households) located in poor and ecologically fragile areas. SLCP consolidation, consisting of a 50% subsidy reduction and suspension of a job training programme, leads to larger income declines in treated villages driven by a reduction in the likelihood that SLCP households transition from farm to non-farm work. These harmful socio-economic effects disappear, however, in villages with stronger land rights and more job training prior to consolidation. When these favourable site-specific characteristics exist, SLCP households remain equally engaged in off-farm work even after subsidy payments and training resources are scaled back. Moreover, on aggregate, village income losses are no longer detectable. The findings provide partial support in favour of the behavioural permanence thesis, highlighting the important role of prevailing local characteristics in mitigating harmful development effects otherwise brought about by programme roll-back.

This study examines how motherhood earnings penalties in combination with the cost of partner absence affect single mothers' economic well-being. Using longitudinal data from the Panel Study of Income Dynamics for 1990–2015 and fixed-effects models with individual-specific slopes reveals that when needs are controlled for, the transition to parenthood is as strongly linked to reduced family income as partner absence is. I consider different routes to single motherhood and predict that income penalties will differ for women entering single motherhood at a first child's birth and for women who were married at first childbirth but later separated. I show that previously married mothers face larger income penalties than those who were single at first childbirth because they see larger declines in their earnings following childbirth. The results illustrate how marriage and parenthood, alongside partner absence, shape the economic prospects of single-mother families. These findings highlight the importance of reducing gender inequalities in the labor market to improve single mothers' economic well-being.

Redistributive health policies aim to orchestrate welfare distribution in response to the needs of the underprivileged sections of society. Turkey has undertaken a massive pharmaceutical price reform since 2009 to show a more appealing, positive side to its citizens. This investigation examines the welfare implications of pharmaceutical price reductions on Turkish households.Data from the Turkish Statistical Institute, pertaining to the national household budget survey for 2003, 2009, 2015, and 2019, were collected and analyzed. Difference-in-difference estimators combined with propensity score matching were applied to repeated cross-sectional microdata to evaluate the impact of strict pharmaceutical price policy on households' out-of-pocket (OOP) pharmaceutical expenditures.The Kakwani index and the Lorenz and concentration curves revealed a coherently regressive pattern and highlighted that vulnerable groups shoulder the burden of pharmaceutical expenditures (KWThe effective use of fiscal capacity, the continual monitoring of the household poverty effect of pharmaceutical price reductions, and the groundwork for a developmental pharmaceutical sector industrial policy agenda are imperative to disseminating the benefits of universal health coverage and constructing rationally conceived inclusive policies.

This study examined the relationship of family social capital (FSC) and pediatric primary health care services (PHCU) among young children aged 0-5 years in the United States. FSC involves the interrelated contexts of child health and family characteristics. Understanding how this impacts PHCU may reveal important considerations for supporting access and use of essential health care services.Using data from the 2016-19 National Survey of Children's Health (weighted N = 21,496,634), we conducted descriptive statistics and logistic regression to ascertain the relationship between FSC and PHCU.Statistically significant contributions included FSC (odds ratio [OR] = 1.2; confidence interval [CI] = 1.08-1.40), high school (OR = 0.49; CI = 2.65-5.39), and some college (OR = 0.72; CI = 0.62-0.85) DISCUSSION: Findings support that FSC and parent academic achievement impact PHCU. Interventions that foster family connection and parent adult health literacy may enhance PHCU.

More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children's health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018-2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need-income assistance, health insurance, housing, and food assistance-at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

The Chinese government implemented a national household energy transition program that replaced residential coal heating stoves with electricity-powered heat pumps for space heating in northern China. As part of a baseline assessment of the program, this study investigated variability in personal air pollution exposures within villages and between villages and evaluated exposure patterns by sociodemographic factors. We randomly recruited 446 participants in 50 villages in four districts in rural Beijing and measured 24 h personal exposures to fine particulate matter (PM

Decades of research have documented the apparent health benefits of marriage, but the dynamics of how health may change across the transition to marriage are not fully understood. In two studies, we compared being unmarried or married on several indices of mental and physical health. In Study 1, we used a national sample of 1,078 individuals in different-sex relationships who completed surveys by mail. Compared with those who were cohabiting or dating, married individuals generally reported better mental and physical health than those in less committed relationships, and most differences remained when controlling for putative selection factors. Study 2 used longitudinal data from the participants in the Study 1 sample who later married (N = 168) to study changes within individuals over the transition to marriage on the same indicators. Six waves of mailed surveys spanning 20 months were employed. Findings of Study 2 indicated that although some indicators of mental and physical health were improving up until the point of marriage, these indicators then stabilized or began to decline, with women experiencing these declines more than men. Findings are more consistent with selection effects (i.e., better-adjusted individuals are more likely to get married) than social causation effects (i.e., marriage causes improvements in mental and physical health) and suggest that if marriage does have a causal effect on well-being in the short term, it may actually manifest in the lead-up to the wedding. Implications of these findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. Methods In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. Results Sumadhur significantly impacted (p Conclusions Entrenched social norms surrounding fertility and family planning contrasted with participants’ personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

OBJECTIVES: To examine whether neighborhood and household disorder matter for cognitive functioning among middle-aged and older adults and whether the disorder-cognition link is moderated by social network resources. METHOD: Data are drawn from National Social Life, Health, and Aging Project Wave 2 (N=3,198). Both neighborhood and household were considered as key residential contexts that shape one’s social life and health. Exposure to neighborhood and household disorder was measured using interviewer assessments of signs of disorder and decay, including the presence of disrepair, trash, noise, and unpleasant smells such as air pollution, in the buildings and streets in which the respondent lives. Cognitive function was measured using the survey-adapted Montreal Cognitive Assessment (MoCA-SA). Network size, network range, and frequency of interaction among network members were assessed as moderators. RESULTS: Neighborhood and household disorder were independently associated with cognitive function. However, disorder in the household appeared to have more direct associations with cognitive function than did the neighborhood when both were present. The association between household disorder and cognitive function was mitigated by network size, such that poor housing conditions were associated with lower cognitive function only for those with small social networks. CONCLUSION: The current study suggests a larger network may play a role in minimizing the negative influence of household disorder on cognitive function for middle-aged and older adults. Social policy and intervention aimed at promoting network ties may help reduce further disparities in cognitive function, especially for those vulnerable groups living in a poor-quality household.

Latin America has experienced a rise in noncommunicable diseases (NCDs) which is having repercussions on the structuring of healthcare delivery and social protection for vulnerable populations. We examined catastrophic (CHE) and excessive (EHE, impoverishing and/or catastrophic) health care expenditures in Mexican households with and without elderly members (≥65 years), by gender of head of the households, during 2000-2020. We analyzed pooled cross-sectional data for 380,509 households from eleven rounds of the National Household Income and Expenditure Survey. Male- and female-headed households (MHHs and FHHs) were matched using propensity scores to control for gender bias in systematic differences regarding care-seeking (demand for healthcare) preferences. Adjusted probabilities of positive health expenditures, CHE and EHE were estimated using probit and two-stage probit models, respectively. Quintiles of EHE by state among FHHs with elderly members were also mapped. CHE and EHE were greater among FHHs than among MHHs (4.7% vs 3.9% and 5.5% vs 4.6%), and greater in FHHs with elderly members (5.8% vs 4.9% and 6.9% vs 5.8%). EHE in FHHs with elderly members varied geographically from 3.9% to 9.1%, being greater in less developed eastern, north-central and southeastern states. Compared with MHHs, FHHs face greater risks of CHE and EHE. This vulnerability is exacerbated in FHHs with elderly members, because of gender intersectional vulnerability. The present context, marked by a growing burden of NCDs and inequities amplified by COVID-19, makes key interlinkages across multiple Sustainable Development Goals (SDGs) apparent, and calls for urgent measures that strengthen social protection in health.

Objectives. To characterize statewide seroprevalence and point prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Rhode Island. Methods. We conducted a cross-sectional survey of randomly selected households across Rhode Island in May 2020. Antibody-based and polymerase chain reaction (PCR)–based tests for SARS-CoV-2 were offered. Hispanics/Latinos and African Americans/Blacks were oversampled to ensure adequate representation. Seroprevalence estimations accounted for test sensitivity and specificity and were compared according to age, race/ethnicity, gender, housing environment, and transportation mode. Results. Overall, 1043 individuals from 554 households were tested (1032 antibody tests, 988 PCR tests). The estimated seroprevalence of SARS-CoV-2 antibodies was 2.1% (95% credible interval [CI] = 0.6, 4.1). Seroprevalence was 7.5% (95% CI = 1.3, 17.5) among Hispanics/Latinos, 3.8% (95% CI = 0.0, 15.0) among African Americans/Blacks, and 0.8% (95% CI = 0.0, 2.4) among non-Hispanic Whites. Overall PCR-based prevalence was 1.5% (95% CI = 0.5, 3.1). Conclusions. Rhode Island had low seroprevalence relative to other settings, but seroprevalence was substantially higher among African Americans/Blacks and Hispanics/Latinos. Rhode Island sits along the highly populated northeast corridor, making our findings broadly relevant to this region of the country. Continued monitoring via population-based sampling is needed to quantify these impacts going forward.

When households struggle to pay their energy bills and avoid being disconnected from the grid, they may accrue debt, forgo expenses on food, and use space heaters or ovens to warm their homes. These coping strategies can introduce significant physical and financial risks. In this study, we analyze an original survey with a representative sample of low-income households during the first year of the COVID-19 pandemic, from June 2020 to May 2021. We evaluate the prevalence of a wide range of coping strategies and empirically estimate the determinants of these strategies. We find that more than half of all low-income households engage in at least one coping strategy, and many use multiple strategies. Households with vulnerable members, including young children or those who rely on electronic medical devices, and households that live in deficient housing conditions, are more likely to use a range of coping strategies, and many at once. Our findings have direct implications for public policy improvements, including modifications to the US Weatherization Assistance Program, the Low-Income Home Energy Assistance Program, and state utility disconnection protections.

PURPOSE: The objectives of the current study were to (1) assess associations between household structure (i.e., living with spouse compared to living alone, with children, or with a spouse and children), presence of children, and mental distress in April 2020 and change in mental distress (between April and August 2020); and (2) determine whether these associations are moderated by income or sex. PARTICIPANTS: A total of 2,214 adults aged 25–55 from the April and August 2020 waves of the Understanding America study were included in the analytic sample. STUDY METHOD: Multivariable, survey-weighted linear regression models were used to examine associations between explanatory variables (i.e., household structure and number of children) and outcome variables (mental distress in April and change in mental distress), measured via the Patient Health Questionnaire (PHQ)-4. RESULTS: In adjusted models, each additional child under the age of 12 was associated with lower mental distress in April 2020 (β = −.30, p = .002). Having children aged 13 to 18 and household structure were not significantly associated with mental distress. In interaction models, living with children only was associated with decreased mental distress among individuals reporting low income (interaction β = −1.28, p = .016) but not high income. Similarly, living with children only was associated with decreased mental distress in females (interaction β = −1.09, p = .025) but not males. CONCLUSION: This study supports prior literature that demonstrates the positive association of child rearing with psychological well-being and suggests that these benefits may be present even under stay-at-home orders in the early stages of the U.S. COVID-19 pandemic.

The pollutants discharged untreated into water bodies become a challenge in Ethiopia. This study aims to assess sanitation and hygiene status and the associated problems. A total of 500 households were selected using a systematic random sampling technique. Questionnaires, interviews, and site observation were employed. The absence of public and communal latrines had been seen as the constraint. The present study confirmed that waste disposal management has serious problems. In conclusion, these findings revealed that part of the households are living in communities with the town-owned poor sanitary facilities and that further studies are encouraged on waste disposal management.

We assessed the impacts of Tanzania’s adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14–19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0–30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April–June 2017), midline (May–July 2018), and endline (June–August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = −0.36, 95% confidence interval: –0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings.

OBJECTIVES The purpose of this study is to describe an advocacy effort to implement a food insecurity (FI) screening during hospital admission and describe characteristics of hospitalized patients with household FI. METHODS This is a descriptive study after the implementation of FI screening at a quaternary-care children’s hospital in the Southeastern United States between August 2020 and April 2021. The Hunger Vital Sign, a 2-question screening tool for FI, was added to the intake questionnaire performed on inpatient admissions. A positive screen triggered a social work consult to connect patients with resources. Chart review and statistical analyses were performed on patients with household FI. RESULTS There were 7751 hospital admissions during the study period, of which 4777 (61.6%) had an FI screen completed. Among those with a completed screen, 233 patients (4.9%) were positive for household FI. Patients with household FI were more likely to be Black (P CONCLUSIONS This initiative highlights hospitalization as an opportunity to screen for FI using a multidisciplinary approach. Our findings underscore the importance of identifying FI with the goal of reducing FI and mitigating the adverse effects of FI on child health outcomes.

Couples relationship education is grounded in teaching couples' skills and strategies to form and sustain healthy relationships. The purpose of this investigation was to examine the impact of a relationship education intervention on emotion regulation, individual distress, dyadic coping, and relationship adjustment utilizing a randomized control trial for economically vulnerable couples. The analysis sample included 1418 couples (2836 individuals) who were randomly assigned to receive the 12-h Within Our Reach curriculum immediately, or to a wait-list control group. We estimated multilevel growth curve models over time among outcomes between treatment and wait-list control conditions. Treatment group couples demonstrated statistically significant improvements over the 6-month study period on emotional regulation and dyadic coping when compared to their wait-list group counterparts. Although models showed improvements in individual distress and relationship adjustments, these improvements did not amount to statistically significant group differences. Implications and limitations are also noted.夫妻关系教育的基础是教授夫妻形成和维持健康关系的技能和策略。本研究的调查目的是利用一项针对经济弱势夫妇的随机控制试验，研究关系教育干预对情绪调节、个人痛苦、双方应对和关系调整的影响。分析样本包括1,418对夫妇（2,836人），他们被随机分配到立即接受12小时的 "力所能及 " 项目课程，或进入等待名单的对照组。我们预估了一段时间内的多层次增长曲线模型，主要基于治疗和等待控制条件之间的结果情况的。在6个月的研究期间，治疗组的夫妇与等待名单组的夫妇相比，在情绪调节和双方处理关系方面有明显的改善。尽管模型显示在个人痛苦和关系调整方面有所改善，但这些改善并不等同于统计学上显著的群体差异。本文还指出了本研究的启示和局限性。.

Background: Stunting is one of the main contributing factors in the under-five mortality rate worldwide. In Laos, the prevalence of stunting remains high, particularly in mountainous rural areas. To prevent stunting, insight into positive deviant behaviors can help understand how people can cope or adapt in resource-poor settings. Objective: This study aims to analyze the practices and underlying factors that explain discrepancies in nutritional outcomes in children under the age of 5 in remote mountainous areas in Laos. Methods: This mixed-methods study included all children under the age of 5 living in 6 selected villages. Anthropometric measurements were taken, and a Z-score for stunting was calculated to select the positive and negative deviant children. To identify the causes of discrepancies in childhood stunting, household questionnaires, focus group discussions, observations, and individual interviews with family members and health workers were conducted. Results: Fifty-five percent of children were stunted. Inappropriate care and feeding practices were observed such as providing unbalanced diets and not attending health facilities. Positive deviant mothers were less likely to follow inappropriate practices, experienced less food insecurity, and had higher motivation and autonomy, which resulted in prioritizing their children’s health. An active role of fathers seemed to benefit positive practices within households. Conclusions: The combination of many different practices in which positive deviant families are doing slightly better was associated with in less stunting of children. Those practices are related to the household resources, such as access to food and social support; and the mother’s motivation, autonomy, and perspectives on child health.

To investigate lifetime reproductive outcomes and the relationship of ideal family size (IFS) achievement with metabolic, psychiatric and reproductive history in women with and without polycystic ovary syndrome (PCOS).Cross-sectional.A total of 9034 women with (n = 778) and without self-reported PCOS (n = 8256) born between 1973 and 1978 in the Australian Longitudinal Study on Women's Health.Self-reported IFS achievement and total number of live births.Women with and without PCOS aspired for similar IFS. Compared with women without PCOS, significantly less women with PCOS achieved their IFS (53.08% vs. 60.47%, p 0.001). Higher proportion of women with PCOS did not achieve a live birth (37.15% vs. 31.64%, p = 0.002) and their median total number of live births was also lower (1 vs. 2, p 0.001) than women without PCOS. After controlling for sociodemographic factors, negative associations were observed between IFS achievement and PCOS status, various metabolic, psychiatric and reproductive history. However, only hypertension (adjusted odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.67-1.00), obesity (adjusted OR: 0.79, 95% CI: 0.69-0.90), history of in vitro fertilisation use (IVF) (adjusted OR: 0.49, 95% CI: 0.38-0.63) and maternal age at first childbirth (adjusted OR: 0.92, 95% CI: 0.91-0.93) remained inversely associated with achievement of IFS in further multivariable regression models.Metabolic conditions and reproductive history of maternal age at first childbirth and history of IVF use, but not psychological conditions, were associated with reduced odds of achieving IFS. Early family planning/initiation and optimisation of metabolic health may help to improve reproductive outcomes.

Background Household contacts who provide care to an Ebola virus disease (EVD) case have a 3-fold higher risk of EVD compared with contacts who do not provide care. Methods We enrolled persons with confirmed EVD from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index cases and contacts were interviewed, and contacts were followed for 21 days to identify secondary cases. Epidemiological data were analysed to describe household care and to identify risk factors for developing EVD. Results Of 838 contacts in 147 households, 156 (17%) self-reported providing care to the index case; 56 households had no care provider, 52 a single care provider and 39 multiple care providers. The median care provider age was 29 years, 68% were female and 32% were the index case’s spouse. Care providers were more likely to report physical contact, contact with body fluids or sharing clothing, bed linens or utensils with an index case, compared with non-care providers (P Conclusions Limiting the number of care providers in a household could reduce the risk of EVD transmission to both care providers and non-care providers. Strategies to protect care providers from EVD exposure are needed.

COVID-19 has highlighted the importance of household infrastructure in containing the spread of SARS-CoV-2, with Global South urban settlements particularly vulnerable. Targeted interventions have used area or dwelling type as proxies for infrastructural vulnerability, potentially missing vulnerable households. We use infrastructural determinants of COVID-19 (crowding, water source, toilet facilities, and indoor pollution) to create an Infrastructural Vulnerability Index using cross-sectional household data (2018-2019) from Mamelodi, a low-income urban settlement in South Africa. Households were stratified into vulnerability groups by index results; sociodemographic variables were assessed as predictors of index scores; and inequality analysis and decomposition were conducted. Thirty-three percent of households fell in the lowest risk group, 32% in the second, 21% in the third, and 14% in the highest. Dwelling type and geographical ward were associated with changes in index scores, with a shack (adjusted β (aβ) = 3.45, CI = 3.39-3.51) associated with highest increase compared to a house. Wards in more developed areas were not consistently associated with lower index scores in the final regression model. The infrastructural vulnerability of the top 10% of households was greater than the bottom 40%, and inequality was predominantly within (80%) rather than between (20%) wards, and more between (60%) than within (40%) dwelling types. Our results show a minority of households account for the majority of infrastructural vulnerability, with its distribution only partially explained by area and dwelling type. Efforts to contain COVID-19 can be improved by using local-level data, and a vulnerability index, to target infrastructural support to households in greatest need.

Maternal parity, which is usually measured as the number of children born to a mother, has a substantial impact on the social and environmental factors around children and their development. This paper estimates the Early Childhood Development Index (ECDI) of 3- and 4-year-old children in Bangladesh and examines the relationship between maternal parity and early childhood development.The study analysed nationally representative data from the Bangladesh Multiple Indicator Cluster Survey 2019. The dataset had 9453 children aged from 36 to 59 months. The ECDI was computed following the UNICEF's approach involving psychometric computation of four domains of development: physical, literacy-numeracy, learning and social-emotional. Since the dataset has a hierarchical structure, we used multilevel logistic regression.A quarter (25%) of the children were not on track in their early childhood development. Seventy-one percent were not developmentally on track in the literacy-numeracy domain, 27% were not in the social-emotional and smaller percentages were not in learning (9%) and physical (1%) domains. There was a significant negative association between maternal parity and ECDI (adjusted odds ratio [AOR] 0.95; 95% CI: 0.91-0.99). Attendance at early childhood education programmes was significantly associated with early childhood development (AOR 1.73; 95% CI: 1.47-2.03). Also, female children, those who were not stunted, located in rural areas, received parental stimulation activities, lived in relatively wealthy households or had mothers who had received secondary or further education were more likely than others to be on track of early childhood development.Early childhood development is negatively correlated with maternal parity. The literacy-numeracy domain constitutes the major developmental delay. Programmes for parental awareness should be widely expanded.

Background The number of people providing informal caregiving, including dual care, which is the combination of child and nursing care, is increasing. Due to the burden of multiple responsibility, dual care could negatively affect the health of informal caregivers. Previous research has not studied the effects of combining different types of informal caregiving. Therefore, we examined, among Japanese women, 1) the association between types of informal caregiving and self-rated health (SRH), and 2) difference in this association according to caregivers' socio-economic conditions. Methods We analyzed the nationally representative 2013 Comprehensive Survey of Living Conditions data of 104,171 women aged 20-59. The odds ratios (ORs) for poor SRH by type of informal caregiving (no care, childcare, nursing care, and dual care) were estimated by logistic regression. We also conducted sub-group analyses by socio-economic conditions (equivalent monthly household expenditure and educational attainment). Results Compared to the no care group, the adjusted ORs (95% confidence interval [CI]) for poor SRH of the childcare, nursing-care, and dual care groups were 0.92 (95% CI, 0.88-0.97), 1.33 (95% CI, 1.21-1.47), and 1.42 (95% CI, 1.23-1.64), respectively. There was no extra risk arisen from combining childcare and nursing care. The sub-group analyses indicated that neither household expenditure nor educational attainment affected the association between caregiving type and poor SRH. Conclusion Our study found that informal nursing care and dual care impose a health burden on female caregivers, regardless of their socio-economic conditions. This highlights the importance of addressing the effects of informal caregiving on the health of women.

This study identifies the driving forces that contribute to the probabilities of incidence of out-of-pocket (OOP) expenditures by households in Turkey. Factors affecting the probability of OOP expenditures on medical products/devices/supplies (MP), outpatient services (OTS), and inpatient services (ITS) are examined using the Household Budget Survey data gathered by the Turkish Statistical Institute in 2018. The study applies the multivariate probit model. The incidence of OOP spending varied with 48.9% of the households reporting OOP expenditure on MP, 22.4% on OTS, and 25.4% on ITS. The largest probability changes were associated with household disposable annual income, household type and size, age category, and having private health insurance. Gender and marital status also influenced expenditures in some categories. Lifestyle choices had small and mixed effects, with smoking and alcohol consumption lowering the probability of OOP spending. From a policy standpoint, households with the lowest incomes, large households, and those where the household head was 'others' (retiree, student, housewife, not actively working, etc.) or had a condition preventing employment seemed to report OOP expenditures less frequently and may have chosen not to receive healthcare services, leading to the need for more healthcare services later.

Purpose. To compare the differences in rural household livelihood capital before and after the development of rural tourism to derive factors that affect rural household livelihood capital. Methodology. This study establishes a household livelihood capital index system to determine the total livelihood capital owned by rural households. Findings. After the development of rural tourism, regardless of farmers participating in rural tourism or not participating in rural tourism, their livelihood capital has increased, but the growth rate of livelihood capital of farmers participating in rural tourism is significantly higher than that of non-participating farmers, especially social capital and financial capital. Originality. This study is based on the sustainable livelihood analysis framework developed by DFID, analyzes the characteristics of farmers’ livelihood capital and livelihood activities, and discusses the differences of farmers’ livelihood capital before and after rural tourism development.

The measurement of health expenditure–related impoverishment as a proxy of financial risk protection is regularly used as an indicator of progress towards universal health coverage. However, the use of this indicator is greatly sensitive to analysts’ choices and data sources, making comparisons across time and countries challenging. We report the results of a sensitivity analysis of critical methodological choices in estimating health-related financial impoverishment in Cambodia from 2009 to 2017. We include the following in our analysis: the construction and data sources for consumption aggregates and out-of-pocket health estimates; the use of international and national absolute and relative poverty thresholds (defined by the share of household food consumption); time and regional price adjustment methods and index sources. Marginal changes substantially affected estimates at the national and regional levels among households. In most cases, the choice of poverty thresholds and temporal and regional deflators had a significant effect. An increase of 0.01 USD in the average daily per capita poverty line resulted in relative increases in impoverished incidences of 2.90–2.62% for 2009 and 3.06–2.95% for 2014. From 2013 onwards, estimates for impoverishment in rural areas based on median food consumption were often significantly higher than estimates using official poverty lines. The high sensitivity of the impoverishment indicator cautions against its use in assessing health-related financial hardship and protection, especially with low and absolute poverty lines. In the context of low- and middle-income countries, assessing financial hardship in relative terms by using measures such as catastrophic health expenditure, complemented with research on coping strategies and their socio-economic effects on households, may be more conducive to policymaking goals and progress towards achieving universal health coverage.

Livelihood diversification has become an integral focus of policies and investments aiming to reduce poverty, vulnerability, and pressure on fishery resources in coastal communities around the globe. In this regard, coastal fisheries in the Pacific Islands have long been a sector where livelihood diversification has featured prominently. Yet, despite the widespread promotion and international investment in this strategy, the ability of externally funded livelihood diversification projects to facilitate improved resource management and rural development outcomes often remains inconsistent. We argue these inconsistencies can be attributed to a conceptual ambiguity stemming from a lack of attention and awareness to the complexity of livelihood diversification. There is still much to learn about the process of livelihood diversification, both in its theoretical conceptualizations and its practical applications. Herein, we utilize a common diversity framework to clarify some of this ambiguity by distinguishing three diversification pathways. These pathways are illustrated using an ideal–typical Pacific Island coastal household and supported by examples provided in the literature that detail livelihood diversification projects in the Pacific. Through this perspective, we seek a more nuanced understanding of what is meant within the policy and practice goal of livelihood diversification. Thereby enabling more targeted and deliberate planning for development investments that facilitates outcomes in support of sustainable livelihoods.

Currently, around 36% of the rural Ethiopian population is accessing drinking water from unimproved sources and it is unevenly distributed through time and geographic regions. Therefore, this study aimed to analyze the spatiotemporal patterns of unimproved drinking water sources and identify hotspot areas in rural Ethiopia. Ethiopian Socioeconomic Survey (ESS) data obtained from the Central Statistical Agency were used. It was conducted in four waves from 2011 to 2019. A two-stage probability sampling design was applied. The sample of enumeration areas and households were taken as the first and second stages of sampling, respectively. A total of 3912, 3775, 3698, and 3115 sample households with complete information on drinking water sources were taken in each wave of ESS data, respectively. Weighted proportions, autocorrelation (Moran’s “I”) statistic, and hotspot analyses were applied to estimate the prevalence, test the presence of clustering, and identify vulnerable areas with unimproved drinking water sources. The STATA version 14, Excel, and ArcGIS 10.6 were used to manage and analyze data. The proportions of households with unimproved drinking water sources were 0.497, 0.385, 0.298, and 0.363 in consecutive waves of ESS data. The results also revealed the existence of geographical and temporal variations of access to drinking water from unimproved sources, and the most recent vulnerable (hotspot) areas in the borders of the West and East Gojjam zones in the western Amhara region, Zone one in southern Afar region, and Liben, Afder, Shebelle, Korahe, and Nobob zones in Somali region were identified. In conclusion, this study reveals significant geographic inequalities in the use of improved drinking water sources. This may be necessary for policies and coverage targeting the most vulnerable regions. The presented map and analytical approaches can provide a mechanism to monitor future reductions in inequality within countries by reflecting resource allocation priorities.