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In the present study, we examined cultural variation in couples' emotions during disagreement. We coded the emotions of 58 Belgian and 80 Japanese couples using the Specific Affect Coding System. We observed more anger and domineering, but less fear/tension and other-validation in Belgian than in Japanese couples. Moreover, in Japanese couples, culturally typical emotions were associated with higher conflict resolution and relationship satisfaction. The findings suggest meaningful cultural differences in couples' observed emotions during disagreement, as they can be understood from the prevailing relationship ideals in each culture. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contemporary trends in low fertility can in part be explained by increasing incentives to invest in offspring's embodied capital over offspring quantity in environments where education is a salient source of social mobility. However, studies on this subject have often neglected to empirically examine heterogeneity, missing out on the opportunity to investigate how this relationship is impacted when individuals are excluded from meaningful participation in economic spheres. Using General Social Survey data from the United States, I examine changes in the relationship between number of siblings and college attendance for White and Black respondents throughout the 1900s. Results show that in the early 1900s, White individuals from larger families had a lower chance of completing four years of college education than those from smaller families, whereas the likelihood for Black individuals was more uniform across family sizes. These racial differences mostly converged in the later part of the century. These results may help explain variations in the timing of demographic transitions within different racial groups in the United States and suggest that the benefits of decreasing family size on educational outcomes may be conditional on the specific economic opportunities afforded to a family., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: Couple-based HIV interventions that increase uptake of two or more effective biomedical HIV prevention methods may be a promising HIV prevention strategy for young Black and Latino heterosexual couples. We conducted in-depth, semi-structured individual interviews with 23 Black and Latino adolescent and young adult heterosexual couples that explored their attitudes toward using combination HIV prevention methods (CHPMs). A qualitative hybrid thematic analysis approach was used to identify key themes. Themes included: (a) attitudes that encouraged uptake-CHPMs increased assurance of safety against HIV/sexually transmitted infections and (b) attitudes that impeded uptake-CHPMs are too much to do and are not appropriate for serious relationships. Although Black and Latino adolescents and young adults may recognize the combined protective benefits of using multiple HIV prevention methods, personal and relational considerations play an instrumental role in uptake of CHPMs., (Copyright © 2024 Association of Nurses in AIDS Care.)

From AD 567-568, at the onset of the Avar period, populations from the Eurasian Steppe settled in the Carpathian Basin for approximately 250 years 1 . Extensive sampling for archaeogenomics (424 individuals) and isotopes, combined with archaeological, anthropological and historical contextualization of four Avar-period cemeteries, allowed for a detailed description of the genomic structure of these communities and their kinship and social practices. We present a set of large pedigrees, reconstructed using ancient DNA, spanning nine generations and comprising around 300 individuals. We uncover a strict patrilineal kinship system, in which patrilocality and female exogamy were the norm and multiple reproductive partnering and levirate unions were common. The absence of consanguinity indicates that this society maintained a detailed memory of ancestry over generations. These kinship practices correspond with previous evidence from historical sources and anthropological research on Eurasian Steppe societies 2 . Network analyses of identity-by-descent DNA connections suggest that social cohesion between communities was maintained via female exogamy. Finally, despite the absence of major ancestry shifts, the level of resolution of our analyses allowed us to detect genetic discontinuity caused by the replacement of a community at one of the sites. This was paralleled with changes in the archaeological record and was probably a result of local political realignment., (© 2024. The Author(s).)

Objective: This study aimed to estimate the association of household food insecurity with gestational diabetes mellitus (GDM) risk by race and ethnic group., Study Design: The study was a secondary analysis from the National Health and Nutrition Examination Survey from 2007 to 2018. A survey-weighted logistic regression model was constructed with self-reported GDM as the response. The primary independent variable was a four-level food security indicator, defined as the inability to obtain food in a socially acceptable way due to the lack of financial resources and controlled for several established risk factors. Analyses were stratified by race (White and Black) and ethnicity (Hispanic) to provide insight into how gestational diabetes risk differs by subpopulation., Results: Results indicated that family history of diabetes is a risk factor across all races (adjusted odds ratio [aOR]: 4.22-16.26), while household food insecurity is a significant risk factor for only Hispanic women living with a partner (aOR: 8.50 for very low food security)., Conclusion: In the United States, Hispanic women's GDM risk may be uniquely impacted by food insecurity., Key Points: · This study provides a national estimate of the GDM risk from food insecurity by race and ethnicity.. · The results in this study suggest a statistically significant relationship between household food insecurity and an increasing risk of developing GDM for Hispanic individuals.. · White women who live alone (without spouse or partner) were also at elevated risk of GDM.. · Age at delivery, poverty ratio, and family history of diabetes are also risk factors for the disease.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: US-born Latinos have a higher incidence of hepatocellular carcinoma (HCC) than foreign-born Latinos. Acculturation to unhealthy lifestyle behaviors and an immigrant self-selection effect may play a role. In this study, the authors examined the influence of generational status on HCC risk among Mexican American adults., Methods: The analytic cohort included 31,377 self-reported Mexican Americans from the Multiethnic Cohort Study (MEC). Generational status was categorized as: first-generation (Mexico-born; n = 13,382), second-generation (US-born with one or two parents born in Mexico; n = 13,081), or third-generation (US-born with both parents born in the United States; n = 4914). Multivariable Cox proportional hazards regression was performed to examine the association between generational status and HCC incidence., Results: In total, 213 incident HCC cases were identified during an average follow-up of 19.5 years. After adjusting for lifestyle and neighborhood-level risk factors, second-generation and third-generation Mexican Americans had a 37% (hazard ratio [HR], 1.37; 95% confidence interval [CI], 0.98-1.92) and 66% (HR, 1.66; 95% CI, 1.11-2.49) increased risk of HCC, respectively, compared with first-generation Mexican Americans (p for trend = 0.012). The increased risk associated with generational status was mainly observed in males (second-generation vs. first-generation: HR, 1.60 [95% CI, 1.05-2.44]; third-generation vs. first-generation: HR, 2.08 [95% CI, 1.29-3.37])., Conclusions: Increasing generational status of Mexican Americans is associated with a higher risk of HCC. Further studies are needed to identify factors that contribute to this increased risk., (© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Across many cultural contexts, the majority of women conduct the majority of their household labor. This gendered distribution of labor is often unequal, and thus represents one of the most frequently experienced forms of daily inequality because it occurs within one's own home. Young children are often passive observers of their family's distribution of labor, and yet little is known about the developmental onset of their perceptions of it. By the preschool age, children also show strong normative feelings about both equal resource distribution and gender stereotypes. To investigate the developmental onset of children's recognition of the (in)equality of household labor, we interviewed 3 to 10-y-old children in two distinct cultural contexts (US and China) and surveyed their caregivers about who does more household labor across a variety of tasks. Even at the youngest ages and in both cultural contexts, children's reports largely matched their parents', with both populations reporting that mothers do the majority of household labor. Both children and parents judged this to be generally fair, suggesting that children are observant of the gendered distribution of labor within their households, and show normalization of inequality from a young age. Our results point to preschool age as a critical developmental time period during which it is important to have parent-child discussions about structural constraints surrounding gender norms and household labor.

Purpose: The purpose of this study was to explore the couple communication process for gynecologic cancer (GC) patients and their spouses. Particular attention was given to examining the relationship between couple communication quality and family resilience for GC dyads., Methods: In this cross-sectional study, 354 dyads were recruited from a gynecology ward of a public hospital in China. The patients and their spouses completed the Couples' Communication Quality Scale and the Family Hardiness Index. This study used the actor-partner interdependence model (APIM) to examine the effect of couple communication quality on family resilience in distinguishable GC dyads., Results: Both GC patients and their spouses reported a moderate level of couple communication quality and family resilience, but spouses reported better couple communication and family resilience than patients. With the exception of perceived response, for which only a patient actor effect was observed, the factors of couple communication quality had significant actor effects on family resilience for both patients and spouses. Additionally, four significant partner effects were found: spouse self-disclosure, stress coping, and productive action positively predicted patients' family resilience, while patient normalcy crafting positively predicted spouses' family resilience., Conclusion: This study not only highlights the need for couple-based communication strategies for developing family resilience but also identifies differences in the experiences of patients and their partners, which provides a direction for future intervention research. Through the development of interventions at a dyadic level, spouses can be encouraged to actively engage in communication, which may promote mutual family resilience in a larger sense., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Māori (Indigenous) households with little variations in non-Māori households. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial., (© 2022. The Author(s).)

Background: Food insecurity refers to uncertain access to food on a consistent basis and the stress experienced by families who worry about having sufficient resources to provide balanced meals in their households. Food insecurity has a disproportionate influence on people of color. A robust body of evidence links food insecurity to poor health outcomes., Objective: To document experiences of food insecurity among linguistically and ethnically diverse residents of the East Harlem neighborhood of New York City by exploring the ways in which food availability and cost intersect with household budgets, personal preferences, and shopping strategies., Design: In-depth qualitative interviews were conducted with adult residents of New York City's East Harlem neighborhood to provide insights about the links between food insecurity, well-being, and quality of life., Participants/setting: Thirty-seven adult residents of East Harlem were recruited through purposive sampling. Eligibility requirements included living in an East Harlem zip code (10029 or 10035); being aged 18 years or older; being the main food shopper and food decision-maker in the household; and speaking English, Spanish, or Mandarin Chinese. The study was conducted from February to May 2018., Statistical Analyses Performed: Interviews were analyzed using a grounded theory approach. Codes were organized into broad thematic topics and cross-case analyses were conducted., Results: Participants discussed overall perceptions of food insecurity and seven themes related to the challenges of and strategies for coping with food insecurity: intermittent vs chronic food insecurity, shopping and budgeting strategies, pantries as a vital community resource, social support systems, food insecurity and health, frustration with an unjust system, and pride in "making it work.", Conclusions: To manage food insecurity, many study participants carefully managed food spending, dedicated substantial time to visiting stores and accessing food pantries, and relied on a public benefits cycle that left many without sufficient financial resources at the end of each month., (Copyright © 2022 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Anaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women's decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries., Methods: We used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women's decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs)., Results: Approximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5-54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16-1.83), secondary education (AOR = 1.45, 95% CI; 1.05-2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19-3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation., Conclusions: Adherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women's decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation., (© 2021. The Author(s).)

Background: We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women., Methods: A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies., Results: The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies., Conclusions: Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings., (© 2021. The Author(s).)

Objectives: To understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada., Methods: Using data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent's race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities., Results: The weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30-3.85) to 1.88 (95% CI: 1.70-2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance., Conclusion: Being racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels., (© 2021. The Canadian Public Health Association.)

Objectives: Poor housing conditions and household crowding have been identified as important health concerns for Indigenous populations in many countries but have not been explored in relation to adverse birth outcomes in these populations. We investigated housing conditions and adverse birth outcomes in a nationally representative sample of Indigenous people in Canada., Methods: Data were from a cohort of births between May 2004 and May 2006 created by linking birth and infant death registration data with the 2006 Canadian census. Log-binomial regression was used to examine associations between housing variables (persons per room and needed household repairs) and three adverse birth outcomes: preterm birth (PTB), small-for-gestational-age (SGA) birth, and infant mortality. Separate regression models were run for First Nations, Métis and Inuit mothers, with adjustment for parity and parental socio-economic variables., Results: Need for major household repairs was associated with a slightly increased risk of PTB among First Nations and Métis mothers (adjusted RRs 1.12 and 1.13, respectively; 95% CI 0.94-1.34 and 0.89-1.44, respectively) and a moderately increased risk of infant death in all three groups (aRR = 1.69, 95% CI 1.00-2.85). Household crowding was also associated with a slightly elevated risk of PTB in all three groups (aRR = 1.10, 95% CI 0.95-1.29) and with an increased risk of infant mortality among First Nations (aRR = 1.57, 95% CI 0.97-2.53)., Conclusion: This study highlights the need to improve understanding of links between housing conditions and perinatal health outcomes in Indigenous populations, including examining cause-specific infant mortality in relation to housing characteristics., (© 2021. The Canadian Public Health Association.)

Background: Male support for partners' antenatal care (ANC) has the potential to improve women's care-seeking and maternal health outcomes. This study describes factors that are associated with men's involvement in household tasks and explores the relationship between men's help with tasks and women's ANC-seeking, diet and workload during pregnancy as well as other health behaviors., Methods: This study was conducted in five Lake Zone regions of Tanzania. Cross-sectional surveys were carried out among approximately 10,000 households that had children under the age of 2 years. Surveys were administered to mothers of children less than 2 years and where available, their male partners. Data were collected between December 2015 and May 2020, in conjunction with a large-scale campaign aimed at reducing childhood stunting by changing the behavior of mothers, caregivers, and decision makers. Data analysis included bivariate analysis and logistic regression modeling., Results: Men's engagement in household activities was significantly associated with living in an urban setting, being younger, having at least some formal schooling, early verbal interactions with their children, and male involvement in healthcare decisions. Additionally, mothers of male partners that were engaged in household activities were significantly older and more likely to have at least some secondary school education. Relative to households where men only infrequently helped out with chores or not at all, women from households where men frequently helped were significantly more likely to have taken iron tablets during pregnancy, report having eaten more than usual, lessening their household workload during their most recent pregnancy, and more likely to have played with their child in the week prior to the survey., Conclusion: Male's participation in household tasks is associated with a general improvement in mother's ANC behaviors. Implicit in these findings is that general primary education for both men and women has health benefits that transcend socioeconomic class and that future interventions aimed to engage males in household tasks may target older males with less education living in rural areas., (© 2021. The Author(s).)

Objective: Our objective was to estimate the relative risk of IBD among first-generation and second-generation immigrants in Denmark compared with native Danes., Design: Using national registries, we established a cohort of Danish residents between 1977 and 2018. Cohort members with known country of birth were followed for Crohn's disease (CD) and ulcerative colitis (UC) diagnoses. Incidence rate ratios (IRRs) served as measures of relative risk and were calculated by log-linear Poisson regression, using rates among native Danes as reference, stratified by IBD risk in parental country of birth, and among first-generation immigrants by age at immigration and duration of stay in Denmark., Results: Among 8.7 million Danes, 4156 first-generation and 898 second-generation immigrants were diagnosed with CD or UC. Overall, comparing first-generation immigrants with native Danes, the IRR was 0.80 (95% CI 0.76 to 0.84) for CD and 0.74 (95% CI 0.71 to 0.77) for UC. The IRR of IBD increased with ≥20 years stay in Denmark. The IRR of CD increased with immigration at ≥40 years of age. Comparing second-generation immigrants with native Danes, the IRR of IBD was 0.97 (95% CI 0.91 to 1.04). There was significant interaction with sex, with higher IRR of IBD in male than in female immigrants., Conclusion: Relative to native Danish men and women, IBD risk among first-generation immigrants was lower, reflected the risk in their parental country of birth and increased with ≥20 years stay in Denmark. For second-generation immigrants, relative risk of IBD was lower only among women. These complex patterns suggest the role of environmental IBD risk factors., Competing Interests: Competing interests: MA receives intramural research support from the Dickler Family Fund. SS, a doctoral student at the Newbreed doctoral programme, receives funding from the European Union’s Horizon 2020 research and innovation programme under Marie Skłodowska-Curie Grant Agreement No 754285. J-FC reports receiving research grants from AbbVie, Janssen Pharmaceuticals and Takeda; receiving payment for lectures from AbbVie, Amgen, Allergan, Ferring Pharmaceuticals, Shire and Takeda; receiving consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Celgene Corporation, Celltrion, Eli Lilly, Enterome, Ferring Pharmaceuticals, Geneva, Genentech, Janssen Pharmaceuticals, Landos, Ipsen, Imedex, Medimmune, Merck, Novartis, O Mass, Otsuka, Pfizer, Shire, Takeda, Tigenix and Viela Bio; and hold stock options in Intestinal Biotech Development and Genfit., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Elderly living alone in South Korea report higher rates of psychological distress compared to the population at large. Using a person-centered approach, the aim of the present study was to identify the latent profiles of South Korean elderly living alone based on self-esteem, life satisfaction, and depression., Method: Latent profile analysis (LPA) was conducted based on data of 1545 older age individuals living alone. In addition, we examined significant factors that differentiate the observed profiles using multinomial logistic regression analysis., Results: We identified five profiles: "extremely depressed (n = 44, 2.9%)," "severely depressed (n = 169, 10.9%)," "mildly depressed (n = 529, 34.2%)," "low life satisfaction (n = 128, 8.3%)," and "positive adaptation (n = 675, 43.7%)." In addition, results of multinomial logistic regression analysis indicated that males (OR: 1.69; 95% CI: 1.02-2.81), and elderly with lower income (OR: 0.86; 95% CI: 0.81-0.91), lower level of physical health (OR: 0.43; 95% CI: 0.33-0.57), and lower social relationship satisfaction (OR: 0.25; 95% CI: 0.18-0.35) were more likely to fall in the "low life satisfaction" rather than the "positive adaptation" profile. In addition, being female (OR: 0.48; 95% CI: 0.30-0.79), of older age (OR: 1.04; 95% CI: 1.01-.1.07), and higher income (OR: 1.14; 95% CI: 1.08-1.20) were related to classification in the "mildly depressed" rather than the "low life satisfaction" profile. The "severely depressed" group was differentiated by older age (OR: 1.05; 95% CI: 1.01-1.08), lower level of physical health (OR: 0.49; 95% CI: 0.34-0.71), and lower satisfaction with social relationship (OR: 0.54; 95% CI: 0.38-0.76)., Conclusion: The results highlight the need for welfare policies that secure income and physical health in elderly living alone to enhance their quality of life. Furthermore, interventions that aim to maintain social networks are tantamount in order to prevent isolation in the elderly living alone.

Objective: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household., Design: Causal mediation analysis., Setting: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020)., Participants: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568)., Main Outcome Measures: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health., Results: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups., Conclusion: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.

Background: There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities., Methods: In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities., Results: The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m 2 per person up to 67.7 m 2 per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities., Conclusion: The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.

Introduction: Bedouin women in Israel confront a challenging circumstance between their traditional patriarchal society and transition to modernity. In terms of reproductive health, they face grave disparities as women, pregnant women and mothers. In this article we aim to understand the challenges of Bedouin women who work as mediators in the promotion of Bedouin women's perinatal health. We explore their challenges with the dual and often conflictual role as health peer-instructors-mediators in mother-and-child clinics, and also as members of a Bedouin community, embodying a status as women, mothers, and family caretakers. Drawn upon a feminist interpretative framework, the article describes their challenges in matters of perinatal health. Our research question is: how do women who traditionally suffer from blatant gender inequality utilize health-promotion work to navigate and empower themselves and other Bedouin women., Methods: Based on an interpretive feminist framework, we performed narrative analysis on eleven in-depth interviews with health mediators who worked in a project in the Negev area of Israel. The article qualitatively analyses the ways in which Bedouin women mediators narrate their challenging situations., Results: This article shows how difficult health mediators' task may be for women with restricted education who struggle for autonomy and better social and maternal status. Through their praxis, women mediators develop a critical perspective without risking their commitments as women who are committed to their work as well as their society, communities, and families. These health mediators navigate their ways between the demands of their employer (the Israeli national mother and child health services) and their patriarchal Bedouin society. While avoiding open conflictual confrontations with both hegemonic powers, they also develop self-confidence and a critical and active approach., Conclusions: The article shows the ways by which the mediator's activity involved in perinatal health-promotion may utilize modern perinatal medical knowledge to increase women's awareness and autonomy over their pregnant bodies and their role as caregivers. We hope our results will be applicable for other women as well, especially for women who belong to other traditional and patriarchal societies.

Objective: To characterise the self-isolating household units (bubbles) during the COVID-19 Alert Level 4 lockdown in New Zealand., Design, Setting and Participants: In this cross-sectional study, an online survey was distributed to a convenience sample via Facebook advertising and the Medical Research Institute of New Zealand's social media platforms and mailing list. Respondents were able to share a link to the survey via their own social media platforms and by email. Results were collected over 6 days during Alert Level 4 from respondents living in New Zealand, aged 16 years and over., Main Outcomes Measures: The primary outcome was the mean size of a self-isolating household unit or bubble. Secondary outcomes included the mean number of households in each bubble, the proportion of bubbles containing essential workers and/or vulnerable people, and the mean number of times the home was left each week., Results: 14 876 surveys were included in the analysis. The mean (SD) bubble size was 3.58 (4.63) people, with mean (SD) number of households 1.26 (0.77). The proportion of bubbles containing one or more essential workers, or one or more vulnerable persons was 45.3% and 42.1%, respectively. The mean number of times individual bubble members left their home in the previous week was 12.9 (12.4). Bubbles that contained at least one vulnerable individual had fewer outings over the previous week compared with bubbles that did not contain a vulnerable person. The bubble sizes were similar by respondent ethnicity., Conclusion: In this New Zealand convenience sample, bubble sizes were small, mostly limited to one household, and a high proportion contained essential workers and/or vulnerable people. Understanding these characteristics from a country which achieved a low COVID-19 infection rate may help inform public health interventions during this and future pandemics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although nearly 43 % of Egyptian children aged less than 14 years had ever experienced severe physical violent punishment at home, no previous studies identified the predictors of the practice in Egypt., Objective: This research aims at identifying the determinants of the use of any severe violent physical practice to discipline children., Participants and Setting: The latest national Egyptian Demographic and Health Survey is the main source of data. The caregivers of 13024 children were interviewed., Methods: A binary logistic regression model is developed to identify the determinants of the use of severe physical disciplinary practices., Results: Results show that children whose parents believe that physical punishment is necessary to discipline children are more likely to experience severe violence (OR = 3.3). Children in the preprimary stage have a high odds ratio of experiencing a severe violent punishment compared to those in preparatory and secondary stages (OR = 3.5). Children whose mothers have experienced domestic physical violence are more likely to be subject to severe physical violence (OR = 1.6 for husband violence, and 1.4 for parents/siblings violence). Children living in Urban Lower Egypt are approximately twice likely as children living in urban governorates to be subject to severe physical violence. Children living in the poorest households are the most likely to experience severe physical violence., Conclusion: Severe violent disciplinary practice inside the home is common in Egypt. The findings urge for activating Egyptian Child Law and implementing continuous training programs for parents on positive parenting., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Adolescents may be known to take risks, but they may also conform to societal norms if they are given proper guidance, implying that there is a need for proper monitoring. This qualitative study explores the influence of family dynamics on adolescents sexual risk behaviour within a migration affected community. Method: Using thematic analysis, we processed data collected from 13 adolescents and 10 parents. Results: The themes generated from our data include the following, "Household poverty", "Family conflicts", "Lack of discipline", "Parent-child closeness", "Generational gap between adolescents and their parents" and "Lack of sex education". Our study found that financial constrain was a major problem in this community, the impact of this was worse felt among adolescents who lived by themselves. In addition, some parents were delinquent, distant or detached from their adolescents. We also found evidence to suggest that couple conflict was a common occurrence, and this had negative influence on adolescent well-being and there sexual behaviour. Conclusion: In view of the deepening crisis of early sexual engagement among adolescents and the accompanying risk of unplanned pregnancy and sexually transmitted infections, it is imperative to foster adolescent friendly households where the parents/caregivers are empowered to support their adolescents.

While studies in high-income countries have shown that failure to achieve fertility desires is significantly associated with unfavourable personal circumstances, there is barely any empirical evidence on the factors that influence the pattern of unrealized fertility in sub-Saharan Africa. Using data from the 2018 Nigeria Demographic and Health Survey, this paper investigates the roles of ethnicity and the sex composition of living children on unrealized fertility in Nigeria. The results show that the odds of having unrealized fertility were higher among Hausa-Fulani women compared with women of other ethnic groups in Nigeria. Also, having daughters only (no sons) was associated with higher odds of unrealized fertility, after controlling for other important covariates. The findings suggest that cultural norms and pronatalism significantly influence the fertility desires of women in Nigeria, even at the end of their reproductive lifespan.

Family formation in the United States has changed dramatically: marriage has become less common, nonmarital cohabitation has become more common, and racial and economic inequalities in these experiences have increased. We provide insights into recent U.S. trends by presenting cohort estimates for people born between 1970 and 1997, who began forming unions between 1985 and 2015. Using Panel Study of Income Dynamics data, we find that typical ages at marriage and union formation increased faster across these recent cohorts than across cohorts born between 1940 and 1969. As fewer people married at young ages, more cohabited, but the substitution was incomplete. We project steep declines in the probability of ever marrying, declines that are larger among Black people than White people. We provide novel information on the intergenerational nature of family inequalities by measuring parental income, wealth, education, and occupational prestige. Marriage declines are particularly steep among people from low-income backgrounds. Black people are overrepresented in this low-income group because of discrimination and opportunity denial. However, marriage declines are larger among Black people than White people across parental incomes. Further, most racial differences in marriage occur among people from similar socioeconomic backgrounds. Family inequalities increasingly reflect both economic inequalities and broader racial inequalities generated by racist structures; in turn, family inequalities may prolong these other inequalities across generations.

Interracial couples cohabit at higher rates than same-race couples, which is attributed to lower barriers to interracial cohabitation relative to intermarriage. This begs the question of whether the significance of cohabitation differs between interracial and same-race couples. Using data from the 2006-2017 National Survey of Family Growth, we assessed the meaning of interracial cohabitation by comparing the pregnancy risk, pregnancy intentions, and union transitions following a pregnancy among women in interracial and same-race cohabitations. The pregnancy and union transition behaviors of women in White-Black cohabitations resembled those of Black women in same-race cohabitations, suggesting that White-Black cohabitation serves as a substitute to marriage and reflecting barriers to the formation of White-Black intermarriages. The behaviors of women in White-Hispanic cohabitations fell between those of their same-race counterparts or resembled those of White women in same-race cohabitations. These findings suggest that White-Hispanic cohabitations take on a meaning between trial marriage and substitute to marriage and support views that Hispanics with White partners are a more assimilated group than Hispanics in same-race unions. Results for pregnancy intentions deviated from these patterns. Women in White-Black cohabitations were less likely than Black women in same-race cohabitations to have an unintended pregnancy, suggesting that White-Black cohabitations are considered marriage-like unions involving children. Women in White-Hispanic cohabitations were more likely than White and Hispanic women in same-race cohabitations to have an unintended pregnancy, reflecting possible concerns about social discrimination. These findings indicate heterogeneity in the significance of interracial cohabitation and continuing obstacles to interracial unions.

Background: Purchases of foods containing nonnutritive sweetener (NNS) alone or in combination with caloric sweeteners (CS) has increased in recent years in the United States. At the same time clinical evidence is emerging of different cardiometabolic effects of each NNS type., Objective: To examine the prevalence and volume purchased of commonly consumed types of NNS in packaged food and beverage products comparing 2002 and 2018 using data from nationally representative samples of US households., Participants/setting: Nielsen Homescan Consumer Panels (The Nielsen Company); 2002 and 2018., Main Outcome Measures: Prevalence and volume of foods and beverages purchased containing CS, NNS, both CS and NNS, or neither CS nor NNS, as well as prevalence and volume of products containing specific NNS types., Statistical Analyses Performed: Differences examined using Student t test, P value of <.05 considered significant., Results: Volume of products purchased containing CS decreased comparing 2002 and 2018 (436.6 ± 1.6 to 362.4 ± 1.3 g/d; P < .05), yet increased for products containing both CS and NNS (10.8-36.2 g/d; P < .05). Regarding specific types of NNS, changes were noted in the prevalence of households purchasing products containing saccharin (1.3%-1.1%; P < .05), aspartame (60.0%-49.4%; P < .05), rebaudioside A (0.1%-25.9%) and sucralose (38.7%-71.0%). Non-Hispanic whites purchased twice the volume of products containing NNS compared to Hispanics and non-Hispanic blacks in both years. Beverages were predominantly responsible for larger volume per capita purchases of products containing only NNS as well as both CS and NNS., Conclusions: A decline in purchases of products containing CS occurred in tandem with an increase in purchases of products containing both CS and NNS, along with a large shift in the specific types of NNS being purchased by US households. New NNS types enter the market regularly, and it is important to monitor changes in the amount of NNS and products containing NNS that consumers purchase., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the maternal characteristics associated with consent to a randomized trial of labor induction in pregnancy., Methods: This is a secondary analysis of low-risk nulliparous women randomized to induction of labor at 39 weeks or expectant management. During the trial, the Data and Safety Monitoring Committee requested additional fields on the screening log, which already included race and ethnicity: maternal age, type of insurance, and the reason for declining consent if declined., Results: From August 2016 (start of additional data collection) to August 2017, 1,965 (28%) of the 7,112 eligible women consented to the trial. Consent was more likely for Black women (41%, adjusted odds ratio [aOR] 1.47, 95% CI 1.24-1.74), and less likely for Asian women (15%, aOR 0.64, 95% CI 0.48-0.84), compared with White women (24%). Women without private insurance were more likely to consent (38%, aOR 1.55, 95% CI 1.34-1.79), compared with those with private insurance (22%). Younger women were also more likely to consent. Among eligible women who declined participation and provided a reason (68%), preference to be expectantly managed (85%) was most common, a response more common in Asian women (aOR 1.75, 95% CI 1.31-2.33) and less common in women without private insurance (aOR 0.60, 95% CI 0.51-0.70). Not wanting to participate in research was more common in Asian women (aOR 2.41, 95% CI 1.44-4.03). Declining consent because family or friends objected was more common in Asian women (aOR 2.51, 95% CI 1.27-4.95) and women without private insurance (aOR 1.68, 95% CI 1.10-2.59)., Conclusion: Frequency of consent and reasons for declining consent were associated with age, type of insurance, and race and ethnicity. These findings should be considered when developing recruitment strategies that promote diverse participant representation., Clinical Trial Registration: ClinialTrials.gov, NCT01990612.

In China, the adjustment of the family planning policy was expected to increase the number of births and trigger a change in the demographic and obstetrical background of pregnant women. The policy itself, and corresponding background variations of the pregnant mothers, might have various influences on certain birth-related characteristics. Moreover, the adaption of the medical system to the policy needs to be demonstrated. To address these issues, over 50,000 individual records from January 2012 to December 2018 were collected from a large tertiary care centre of southwest China as a representative. The monthly numbers of deliveries and births showed stabilized patterns after remarkable upward trends. Policy-sensitive women, among whom older age and multiparity were typical features, contributed considerably to the remarkable additional births. Indeed, multivariable logistic regression analysis identified the child policy and these two background characteristics as factors influencing CS (caesarean section) rate and certain pregnancy complications or adverse outcomes. After the implementation of the two-child policy, a care provider was faced with fewer but more difficult cases. Briefly speaking, more individual-based studies on family planning policy and more efforts to improve obstetrical service are needed to better guide clinical practice in the new era.

We used data from the Medical Expenditure Panel Survey to explore potential explanations for racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19 illness. However, Whites were older, on average, than Blacks. Thus, when all factors were considered, Whites tended to be at higher overall risk compared with Blacks, with Asians and Hispanics having much lower overall levels of risk compared with either Whites or Blacks. We explored additional explanations for COVID-19 disparities-namely, differences in job characteristics and how they interact with household composition. Blacks at high risk for severe illness were 1.6 times as likely as Whites to live in households containing health-sector workers. Among Hispanic adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home, versus 56.5 percent among Black adults and only 46.6 percent among White adults.

Background: Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews., Methods: Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach., Results: Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources., Conclusion: This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers., Competing Interests: The authors have declared that no competing interests exist.

As populations age and longevity rises, the structure of the extended family is changing. Parents of young children are increasingly turning to the children's grandparents to provide childcare and help them reconcile work and family. This study is the first to investigate whether would-be grandparents' propensity to care for their grandchildren influences the adult children's transition to parenthood. Because grandparental childcare provision is not observable at the time of the transition to the first birth, I built a measure based on the characteristics of both actual grandparents and adult children to act as a proxy for the childcare that prospective grandparents are expected to provide in the future. Using data from the first two waves of the Survey of Health, Aging, and Retirement in Europe, I examine changes in the likelihood of having a first birth by different levels of expected future childcare provision. Given that the role grandparents play varies depending on the national context, I estimate distinct models for different groups of countries. Furthermore, I analyze different intensities of grandparental childcare: regular, occasional, and any other type of positive childcare. The comparison across 11 countries reveals that grandparental propensity to provide occasional childcare has a positive effect on the transition to parenthood in all country clusters and that grandparental propensity to provide regular childcare has a positive and significant association with having a first child in both pro-natalist (Belgium and France) and pro-traditional countries (Austria, Germany, Greece, Italy, Spain, and Switzerland).

This research aimed to explore the family planning perspectives and experiences of Afghan women and men living in Melbourne. A total of 57 Afghan women and men participated in six focus groups and 20 semi-structured interviews. The majority of participants indicated a preference for two or three children and were open to using modern contraception. However, many women described experiencing negative side effects when using hormone-based contraception and expressed difficulty negotiating condom use with their husbands as an alternative. Some women described how these difficulties resulted in inconsistent contraceptive practices and, at times, unintended pregnancy. Participants recognised that health professionals have an important role in addressing their family planning needs. This study highlights the ways in which Afghan women and men are changing in relation to their family planning beliefs and practices, and the opportunities, challenges and transcultural tensions they experience as they navigate these issues in Australia.

Qualitative study explores the adjustment process of young Bedouin women in Israel who were minors and legally underage when they married. Child brides have always existed in Bedouin society, which sees marriage as a social and religious framework that protects the girl. This study's participants, 30 young women who were 13-17 when they married, shed light on the long and continuing process of adjustment, the sharp transitions in their lives, and their cognitive assimilation of married life. Their stories allow a glimpse of how a generation of young women within a traditional, strongly patriarchal society is starting to challenge accepted traditional practices. The case of Bedouin society may be relevant to other traditional societies, to indigenous peoples, and in general to the issue of child marriage that is so widespread globally. Child brides, a worldwide phenomenon, have always existed in Bedouin society, which sees marriage as a social and religious framework that protects the girl and her family from dishonor. Such marriages continue despite legal prohibition. This qualitative study in the phenomenological tradition explores the adjustment process of young Bedouin women in Israel who were legally underage when they married. The participants, 30 young women who married at ages 13-17, were recruited from the case loads of social workers in southern Israel. Data were obtained through in-depth semistructured interviews. The data shed light on the women's long and continuing process of adjustment, the sharp transitions in their lives, and their cognitive assimilation of married life and motherhood. Optimism that everything will work out and individual and family resilience are important factors, but the adjustment process is different for each of two groups of the participants: In one group, the girl met her prospective husband before marriage, was engaged for at least 6 months, and was prepared by her family for marriage and intimate relations. In the second group, the girl did not know the prospective husband, was engaged very briefly (up to 1 month), was not prepared for marriage, and was not asked for her opinion or consent. For the second group, the adjustment process was longer and more difficult. The stories of both groups reveal how a generation of young women within a traditional, strongly patriarchal society is starting to challenge traditional practices, including the husband's dependence on his family and the mother-in-law's interference, although ultimately they conform to their society's norms. Social services need to be aware of the processes these young women are undergoing and to build suitable intervention programs for them, their spouses, and their families. Also needed is a program that will explain to girls and their families the implications of marriage at a young age. The case of Bedouin society may be relevant to other traditional societies, to indigenous peoples, and to the global issue of child marriage. This article contributes to global knowledge by presenting the world of these young women, members of a society that is undergoing powerful changes that have weakened the traditional establishment but that still clings to such values as honor and male supremacy., (© 2020 Wiley Periodicals LLC.)

Introduction: cervical cancer is a leading cause of death among Nigerian women. Women often require spousal support before attending cervical cancer screening services. This study assessed married men´s knowledge and attitude towards male involvement in cervical cancer screening of their wives., Methods: a cross-sectional study using a mixed methods approach was conducted among 245 married men in Izzi, Local Government Area of Ebonyi State, South-East Nigeria. Quantitative data collected using structured, interviewer-administered questionnaires and qualitative data from focus group discussions were triangulated. Data analysis was done using IBM SPSS version 20. Qualitative findings were analysed using thematic analysis., Results: the mean knowledge of cervical cancer was 2.06±0.55. Only 2.9% of the respondents had adequate knowledge of risk factors for cervical cancer. Up to 89.8% were willing to approve screening for their spouses. Majority (76.3%) considered screening important in cervical cancer prevention, while 91.4% were willing to pay for the screening test. Most of them exhibited patriarchal tendencies and insisted that their wives must obtain their consent before screening as depicted by the statement "It is what I tell her that she will do". Previous spousal screening was a predictor of good knowledge (OR = 10.94, 95% CI = 2.44-48.93; P=0.002)., Conclusion: married men in this study had poor knowledge of cervical cancer. However, they were willing to support cervical cancer screening conditional on their pre-information and consent. Awareness creation activities on cervical cancer screening should incorporate active engagement of husbands in order to promote screening uptake by their wives., Competing Interests: The authors declare no competing interests., (Copyright: Ijeoma Nkem Okedo-Alex et al.)

Background: Cultural beliefs, practices and experiences significantly influence pregnancy preparation. Limited in-depth information exists regarding how women from migrant and refugee backgrounds (migrant women) prepare for pregnancy. This study explored pregnancy planning, preconception lifestyles, awareness, experiences and healthcare needs of migrant women in Australia., Methods: Semi-structured interviews and focus groups were conducted with 25 women recruited through a diverse community in Melbourne, Australia (November 2017-February 2018). Discussions explored pregnancy planning, preconception health awareness, experiences and information needs. Qualitative data was analysed iteratively, through content and thematic analysis., Findings: Four themes were identified: pregnancy planning experiences and perspectives, preconception health awareness and behaviours, social and cultural influences on pregnancy planning, and health information needs. Women had limited understanding of the concept or importance of preconception health, limited access to preconception health information and most women with children had experienced at least one unplanned pregnancy. Cultural mores constrained community discussion of preconception health in the context of sexual and reproductive health. Social factors emerged as predominant preconception concerns. Women reported wanting more information on preconception health through multiple, broad-reaching avenues, paired with timely, sensitive healthcare engagement., Conclusion: Information for women addressing preconception health and pregnancy planning is limited. Our study demonstrates additional cultural and social nuances that need to be understood when working with migrant women. Discomfort raising reproductive and preconception health discussions with healthcare providers was a reported concern. Integration of culturally-sensitive preconception care within routine client assessments warrants exploration. Emphasis of the importance of preconception care for all women is needed., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objectives: The presence of kin is often, but not always, associated with higher fertility in historical populations. However, the effect of other household members on fertility is less frequently studied. While not genetically related, life-cycle servants lived and worked alongside household members and may have provided assistance to reproducing families. Female servants in particular may have helped mothers with small children through direct help with childcare activities or by replacing the economic effort of mothers whose work was not compatible with childcare. This study examines the presence of servants in the households of married women of reproductive age to assess whether households with young children are more likely to also have servants., Materials and Methods: This study uses individual-level census data from North Orkney, Scotland (1851-1911) to investigate the relationship between the presence of servants in households and a measure of recent net marital fertility, the number of women's own-children under age 5, using logistic regression models., Results: Households with young children were more likely to have a female, but not male, servant in the household after controlling for the effects of other possible helpers, including older children, mothers, and mothers-in-law., Discussion: These findings are consistent with prior research that indicates the importance of female labor to smallholder agricultural households and suggests that female servants may have provided support to reproducing families. Life-cycle servants should be considered one component of biocultural reproduction in historical Northwest Europe. The use of hired help is not restricted to contemporary or elite groups., (© 2020 Wiley Periodicals, Inc.)

Matam is one of the poorest and most food-insecure regions of Senegal. In the past years, repeated environmental shocks such as drought have limited the access to food and it is unclear whether food insecurity is more a function of food availability (FA) and accessibility at the community level (CL) or more related to FA at the household level (HL). T o better understand the FA and food security (FS) situation in this region, in 2018, a cross-sectional study was conducted in 103 households living in four villages. Through focus group discussions and direct observations, data on food available at HL and CL were collected as well as on food affordability and household FS. Overall, between 49 and 64 different foods, mostly from plant source, were identified. Around 75% of households had 0 to 3 foods and 7%, 7 to 10; 64% of all households were severely food insecure. FA at HL and its socioeconomic status were positively associated with household FS whereas FA at the CL was negatively associated. Although food assistance may be required to respond to shocks in the area, investments could be made to improve households` socioeconomic level to enhance their access to food.

Food insecurity has been associated with decreased household food supplies, which could affect children's fruit and vegetables intakes and increases their risk of being overweight or obese. The aim of this study was to determine if food insecurity was associated with lower fruit and vegetables consumption and overweight and obesity in children from Mexican fishing communities. A cross-sectional study was 4conducted with 100 elementary-school children aged 6-12 years. A survey that evaluated socioeconomic conditions, food insecurity, and fruits and vegetables consumption was applied. Weight and height were measured. The association between key variables and food insecurity was assessed using linear regression. Sixty-four percent of households experienced food insecurity. Food-insecure children reported lower consumption of fruits and fruits plus vegetables than did their peers with food security (P trend = 0.040 and 0.038, respectively). Food insecurity was also associated with lower chance to meet the recommendation of fruit and vegetable consumption (P trend in logit < 0.001), but was negatively associated with the prevalence of overweight and obesity (P trend in logit < 0.001). Food-insecure children had lower fruits and vegetables consumption but were no more likely to be overweight or obese than their food-secure counterparts.

The current study analyzed how identity, couple, and intergroup dynamics are related to life satisfaction among 210 intercultural partners living in Italy. Three levels of analysis were considered: a micro level, taking into account the identity aspect of each partner in terms of self- or hetero-ethnic identification; a meso level, examining the passion, commitment, and intimacy of the couple sphere of the partners; a macro level investigating the discrimination that partners can perceive by the community as an effect of the relationship between dominant and minority groups. The results show that for both partners, foreign and Italian, the variables that have a predictive value on life satisfaction bring into play the couple and the intergroup dynamics, leaving out the identitary one. Specifically, increased perceived discrimination as a member of a mixed couple leads to decreased life satisfaction by partners. In turn, we can see that a strong intimacy between partners enhances their life satisfaction. These results introduce a reflection on the role of the differences about the ethnic identity, considered erroneously the main cause of dissatisfaction in the mixed couple. The implications of the study are described and suggestions for future research discussed., (© 2019 Family Process Institute.)

In this cross-sectional study of 60 American Indian mother-child dyads from Southeastern North Carolina, we examined whether childhood asthma control was related to household-level factors, such as environmental tobacco smoke and family management behaviors. We also examined the relationships among family management behaviors and maternal depressive symptoms. We used logistic regression to assess the relationships among childhood asthma control, the presence of environmental tobacco smoke, and family management behaviors, specifically condition management ability (CMA) and condition management effort (CME). We used linear regression to evaluate the relationships between both CMA and CME and maternal depressive symptoms. Better asthma control in children was associated with the absence of environmental tobacco smoke in the home and the maternal perception of asthma as a manageable condition. Mothers perceived an increase in effort to manage their child's asthma as their depressive symptoms increased. These findings emphasize the importance of environmental triggers, perceptions of condition management, and maternal mental health in controlling asthma in American Indian children. Interventions to reduce environmental triggers, treat maternal depressive symptoms, and support mothers in their ability to manage childhood asthma may yield better asthma control and help to reduce existing racial disparities in this population., (© 2020 Wiley Periodicals, Inc.)

This paper examines the factors associated with the cultural phenomenon of bacha posh in Afghanistan (in which girls are dressed and raised as boys), which occurs against a background of rigid gender norms and the male-centric nature of Afghan families. Survey data were collected from 1463 women in two provinces of Afghanistan, Kabul and Nangarhar. The primary outcome is a nominal variable, derived from the question, 'Do you have any girl in your family who has been raised for any time as a boy?' Independent variables comprise women's socio-demographic characteristics, family composition, economic characteristics, patriarchal gender attitudes and perceptions of community patriarchal attitudes. Factors associated with bacha posh include women having fewer sons and more daughters, working in the past three months and having less patriarchal gender attitudes. That bacha posh is often driven by a large number of daughters in the family with a corresponding low number of sons suggests that bacha posh is a response to very contextual features of Afghan life, including the preference for sons. Bacha posh in the family is linked to less patriarchal gender norms and can be a way for girls and women to acquire education, mobility and engagement in income-generating activities.

Background: Evidence is limited on the risk of maternal smoking before and during pregnancy across generations of Hispanic immigrants., Purpose: The aim of this study was to determine whether immigration generational status predicts maternal smoking behaviors before and during pregnancy among Hispanic women., Methods: Data on pregnancies in National Longitudinal Survey of Youth 1979 were used. Current study sample consists of Hispanic women (15-24 years) reporting pregnancy between 1979 and 2014 (n = 616). Data on birthplaces of the respondent and their parents were used to determine generation status. Maternal smoking behaviors before and during pregnancy were self-reported. Data were analyzed using weighted covariate-adjusted logistic regression models., Results: There were 24% first-generation, 20% second-generation, and 56% third or higher generation Hispanic women in the sample. Majority of participants were married (72%), with a high school degree or more (69%), and of Mexican origin (56%). After controlling for covariates, first generation Hispanic women had lower likelihood of smoking prior to (OR = 0.40, p = 0.009) and during pregnancy (OR = 0.35, p = 0.007) compared to third or higher generation women. The second-generation women had lower likelihood of smoking during pregnancy (OR = 0.46, p = 0.038) compared to third or higher generation women., Conclusions: First generation Hispanic women are at lower risk of smoking both prior to and during pregnancy. Identification of cultural factors discouraging smoking during pregnancy among first/second generation Hispanic women and incorporating in smoking prevention interventions targeting Hispanic women could benefits the later generations of Hispanic immigrants., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This paper explores reproductive decision-making among young women in South Africa's informal settlements and considers whether and how agency and social norm theory inform their decisions. Understanding whether, when and how young women make decisions about conception and motherhood is critical for supporting women to avoid unplanned, early motherhood. Qualitative data were collected from 15 young women in informal settlements in eThekwini, South Africa at three time points over 18 months, using in-depth interviews, participant observation and photovoice, and were analysed inductively. When the young women were teenagers and into their early twenties, and had not yet had a child, most paid little attention to whether or not they conceived. This shifted as they grew older and/or after having a first child, at which point many of the women began to express, and sometimes act upon, a greater desire to control whether and when they conceived and delay further pregnancies. At different times in their lives, both social norms and reproductive agency, specifically 'distributed agency' played significant roles in influencing their reproductive decision-making. Social norms held the most influence when they were teenagers and experiencing normative pressures to have a baby while young. As they grew older and/or had a first child they began to assert some agentic control around their reproduction. We therefore recommend that in order to improve the effectiveness of services and interventions supporting young women to delay unplanned pregnancies, programmers, researchers and policy makers must develop a better understanding of the role of social norms and agency at different stages of women's lives., Competing Interests: The authors have declared that no competing interests exist.

Gender inequality has been associated with HIV infection among women. Less is known about the relationship between gender inequality and HIV care continuum outcomes. This study assessed whether household decision-making power (DMP), one component of gender inequality, was associated with linkage to HIV care, antiretroviral therapy (ART) initiation, or retention in care among women living with HIV in Mozambique. The sample included 600 women ≥18 years of age newly diagnosed with HIV in Mozambique. Data were collected between April 2013 and June 2016. DMP was assessed with three questions about participation in decisions regarding: major household decisions, routine household decisions, and visits to family. Women who did not contribute to decision making in any domain were categorized as having low DMP. HIV care information was obtained from electronic medical records. Multivariable log-Poisson regression analyses were conducted to assess the relationship between DMP and HIV care continuum outcomes. Almost half (49%) of participants reported medium DMP, followed by high (39%) and low DMP (12%). In multivariable regression analyses, when compared with respondents with medium DMP, those with low DMP had a lower likelihood of retention in care 12 months after diagnosis [adjusted risk ratio (aRR) 0.69 (95% CI 0.49-0.98)]. There was no significant relationship between low DMP and linkage to HIV care or ART initiation. High DMP was not significantly associated with HIV outcomes assessed. Women who report low DMP may face barriers to long-term engagement in HIV care. Interventions to improve retention in care among women should consider the role of household decision making and gender inequality.

Sex ratio at birth remains highly skewed in many Asian countries because of son preference. The ratio in South Korea, however, declined beginning in 1990 and reached the natural range in 2007. We study changes in child gender effects on fertility and parental investment during this period of decreasing sex ratio at birth. We find that gender discrimination on the extensive margin (fertility), such as sex-selective abortions and son-biased stopping rules, have nearly disappeared among recent cohorts. On the intensive margin (parental inputs), boys receive higher expenditures on private academic education, have mothers with fewer hours of labor supply, and spend less time on household chores relative to girls. These gender gaps have also narrowed substantially, however, over the past two decades. We consider alternative explanations, but altogether, evidence suggests the weakening of son preference in South Korea.