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During the early phase of the COVID‐19 pandemic, legislative changes that expanded alcohol home delivery and options for "to‐go" alcohol sales were introduced across the United States to provide economic relief to establishments and retailers. Using data from the Alcohol Policy Information System, we examined whether these changes have persisted beyond the peak phase of the COVID‐19 emergency and explored the implications for public health. Illustration of state‐level policy data reveals that the liberalisation of alcohol delivery and "to‐go" alcohol sales has continued throughout a 2‐year period (2020 and 2021), with indications that many of these changes have or will become permanent after the pandemic. This raises concerns about inadequate regulation, particularly in preventing underage access to alcohol, and ensuing changes in drinking practices. In this commentary, we highlight the need for rigorous empirical evaluation of the public health impact of this changing policy landscape and underscore the potential risks associated with increased alcohol availability, including a corresponding increase in alcohol‐attributable mortality and other alcohol‐related harm, such as domestic violence. Policy makers should carefully consider public health consequences, whose costs may surpass short‐term economic interests in the long term. [ABSTRACT FROM AUTHOR]

Education involving active engagement in the arts, herein called arts education, is often believed to foster the development of desirable personality traits and skills in children and adolescents. Yet the impact of arts education on personality development has rarely been systematically investigated. In the current article, we reviewed the literature on personality change through arts education. We identified 36 suitable experimental and quasi-experimental studies. Evidence from these studies tentatively suggests that arts-education programs can foster personality traits such as extraversion and conscientiousness but not self-esteem. In addition, the effects of arts education appeared to be stronger in early and middle childhood than in preadolescence and early adolescence. However, the evidence for the effectiveness of arts education was very limited among the few included true experiments. Furthermore, the reviewed studies were heterogenous and subject to content-related, methodological, and statistical limitations. Thus, the current evidence base is inconclusive as to the effects of arts education on personality development. By identifying potential effects of arts education and limitations of past research, our review serves as a call for more research and guidepost for future studies on arts education and personality change. [ABSTRACT FROM AUTHOR]

Importance: The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse.Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.Design, Setting, and Participants: Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening.Exposures: World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics.Main Outcomes and Measures: Self-report of having ever had a screening test for cervical cancer.Results: Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened.Conclusions and Relevance: In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening. [ABSTRACT FROM AUTHOR]

• In the United States, the ability and probability of accessing health care varies by income. • People with low socioeconomic status seem to benefit more from brief advice. • Alcohol screening and brief intervention could help mitigate health inequalities. • The provision of alcohol screenings in primary healthcare needs to be improved. Alcohol-attributable mortality contributes to growing health inequalities. Addressing hazardous alcohol use and alcohol use disorders through alcohol screening and brief intervention is therefore a promising public health strategy to improve health equity. In this narrative mini-review, we discuss the extent to which socioeconomic differences exist in the alcohol screening and brief intervention cascade, highlighting the example of the United States. We have searched PubMed to identify and summarize relevant literature addressing socioeconomic inequalities in (a) accessing and affording healthcare, (b) receiving alcohol screenings, and/or (c) receiving brief interventions, focusing predominantly on literature from the Unites States. We found evidence for income-related inequalities in access to healthcare in the United States, partly due to inadequate health insurance coverage for individuals with low socioeconomic status. Alcohol screening coverage appears to be generally very low, as is the probability of receiving a brief intervention when indicated. However, research suggests that the latter is more likely to be provided to individuals with low socioeconomic status than those with high socioeconomic status. Individuals with low socioeconomic status also tend to benefit more from brief interventions, showing greater reductions in their alcohol use. Once access to and affordability of healthcare is ensured and high coverage of alcohol screening is achieved for all, alcohol screening and brief interventions have the potential to enhance health equity by reducing alcohol consumption and alcohol-related health harms. [ABSTRACT FROM AUTHOR]

Background: Moderate alcohol use may be associated with lower risk of type 2 diabetes mellitus (T2DM). Previous reviews have reached mixed conclusions. Purpose: To quantify the dose-response relationship between alcohol consumption and T2DM, accounting for differential effects by sex and BMI. Data Sources: Medline, Embase, Web of Science, and one secondary data source. Study Selection: Cohort studies on the relationship between alcohol use and T2DM. Data Extraction: Fifty-five studies, and one secondary data source, were included with a combined sample size of 1,363,355 men and 1,290,628 women, with 89,983 and 57,974 individuals, respectively, diagnosed with T2DM. Data Synthesis: Multivariate dose-response meta-analytic random-effect models were used. For women, a J-shaped relationship was found with a maximum risk reduction of 31% (relative risk [RR] 0.69, 95% CI 0.64–0.74) at an intake of 16 g of pure alcohol per day compared with lifetime abstainers. The protective association ceased above 49 g per day (RR 0.82, 95% CI 0.68–0.99). For men, no statistically significant relationship was identified. When results were stratified by BMI, the protective association was only found in overweight and obese women. Limitations: Our analysis relied on aggregate data. We included some articles that determined exposure and cases via self-report, and the studies did not account for temporal variations in alcohol use. Conclusions: The observed reduced risk seems to be specific to women in general and women with a BMI ≥25 kg/m2. Our findings allow for a more precise prediction of the sex-specific relationship between T2DM and alcohol use, as our results differ from those of previous studies. [ABSTRACT FROM AUTHOR]

Universal primary and secondary education is a key target of the Sustainable Development Goals. While substantial gains have been made at the primary school level, progress towards universal secondary education has slowed, particularly in sub-Saharan Africa. In this study, we aimed to determine perceived barriers of secondary schooling in rural Burkina Faso, where secondary school completion is among the lowest globally (<10%). We conducted a two-stage qualitative study using semi-structured interviews (N = 49). In the first stage, we sampled enrolled students (n = 10), out-of-school adolescents (n = 9), parents of enrolled students (n = 5), parents of out-of-school adolescents (n = 5) and teachers (n = 10) from a random sample of five secondary schools. In a second stage, we interviewed key informants knowledgeable of the school context using snowball sampling (n = 10). Systematic analysis of the pooled sample was based on a reading of interview transcripts and coding of the narratives in NVivo12 using the diathesis-stress model. Recurring themes were classified using a priori developed categories of hypothesized barriers to secondary schooling. Major reported barriers included school-related expenses and the lack of school infrastructure and resources. Insufficient and heterogeneous French language skills (the official language of instruction in Burkina Faso) were seen as a major barrier to secondary schooling. Forced marriages, adolescent pregnancies, and the low perceived economic benefits of investing in secondary schooling were reported as key barriers among young women. Our results guide future interventions and policy aimed at achieving universal secondary education and gender equity in the region. [ABSTRACT FROM AUTHOR]

Background: Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition's current socioeconomic gradients and how these are likely to change in the future as countries develop economically.Objectives: This cross-sectional study aimed to determine how hypertension prevalence in LMICs varies by individuals' education and household wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country's gross domestic product (GDP) per capita.Methods: We pooled nationally representative household survey data from 76 LMICs. We disaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses to adjust for age and sex.Results: We included 1,211,386 participants in the analysis. Pooling across all countries, hypertension prevalence tended to be similar between education groups and household wealth quintiles. The only world region with a clear positive association of hypertension with education or household wealth quintile was Southeast Asia. Countries with a lower GDP per capita had, on average, a more positive association of hypertension with education and household wealth quintile than countries with a higher GDP per capita, especially in rural areas and among men.Conclusions: Differences in hypertension prevalence between socioeconomic groups were generally small, with even the least educated and least wealthy groups having a substantial hypertension prevalence. Our cross-sectional interaction analyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically. [ABSTRACT FROM AUTHOR]

Background: Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure-lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries.Methods: We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure-lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline.Results: The proportion of adults in need of blood pressure-lowering medications was highest under the American College of Cardiology/American Heart Association, followed by the 140/90 mm Hg, National Institute for Health and Care Excellence, and World Health Organization guidelines (American College of Cardiology/American Heart Association: women, 27.7% [95% CI, 27.2-28.2], men, 35.0% [95% CI, 34.4-35.7]; 140/90 mm Hg: women, 26.1% [95% CI, 25.5-26.6], men, 31.2% [95% CI, 30.6-31.9]; National Institute for Health and Care Excellence: women, 11.8% [95% CI, 11.4-12.1], men, 15.7% [95% CI, 15.3-16.2]; World Health Organization: women, 9.2% [95% CI, 8.9-9.5], men, 11.0% [95% CI, 10.6-11.4]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood pressure-lowering medications were largest in the oldest (65-69 years) age group (American College of Cardiology/American Heart Association: women, 60.2% [95% CI, 58.8-61.6], men, 70.1% [95% CI, 68.8-71.3]; World Health Organization: women, 20.1% [95% CI, 18.8-21.3], men, 24.1.0% [95% CI, 22.3-25.9]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood pressure-lowering medicines, whereas the South and Central Americas had the lowest.Conclusions: There was substantial variation in the proportion of adults in need of blood pressure-lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country. [ABSTRACT FROM AUTHOR]

Background: The perceived returns on schooling are critical in schooling decision-making but are not well understood. This study examines the perceived returns on secondary schooling in Burkina Faso, where secondary school completion is among the lowest globally (<10%). Methods: We conducted a two-staged qualitative study using semi-structured interviews (N = 49). In the first stage, we sampled students, dropouts, parents and teachers from a random sample of five schools (n = 39). In the second stage, we interviewed key informants knowledgeable of the school context using snowball sampling (n = 10). Systematic analysis was based on a grounded theory approach with a reading of transcripts, followed by coding of the narratives in NVivo 12. Results: Respondents nearly universally perceived health benefits to schooling. In particular, key health benefits included improved sexual and reproductive health outcomes, hygiene knowledge and practices, as well as better interactions with the formal health system. Common economic returns on schooling included improved employment opportunities and the provision of support to family members, in addition to generally attaining success and recognition. Indirect and long-term health returns, however, were infrequently mentioned by respondents. Conclusions: While respondents reported nearly universally short-term health benefits to schooling, responses with regard to economic as well as indirect and long-term health benefits were more ambiguous. Future intervention studies on the perceived returns on formal education are needed to inform policy and reach education and health targets in the region. [ABSTRACT FROM AUTHOR]