Affluent Respondents Research Articles

Awareness of skin cancer screening coverage in U.S. healthcare plans: Is there a need to better educate the public?

ObjectivesTo understand whether financial barriers or the lack of accessibility to dermatology services was a significant motivation for the public to seek free skin cancer screening. MethodsAn anonymous and voluntary survey was administered to participants of The Sun Bus free skin cancer screening program in 2023 at U.S. outdoor events in Colorado, Texas, Arizona, New Mexico, Iowa, Wyoming, Missouri, and Montana. 491 respondents answered questions on motivation, healthcare coverage, and demographics. Survey data was analyzed using Qualtrics’ crosstab IQ and statistical tests software. ResultsSkin screening found suspicious lesions in 45 % of 1300 participants with 18 % of respondents sharing a previous history of skin cancer. Concern for a lesion or Curiosity were the two top reasons for 60 % of respondents to seek free skin screening and remained the top reasons after data was stratified by gender, age, or income. Only 15 % of respondent were motivated by the cost of dermatology services or a long wait to see a dermatologist. A total of 38 % of people surveyed reported comprehensive plans covering skin screening while 46 % were unaware of the inclusion of screening in their healthcare plan. Notably, this unawareness increased up to 52 % among younger and less affluent respondents. Additionally, females were less likely than males to be aware of skin screening options in their healthcare plans. ConclusionsThis work highlights the significance of promoting public awareness of dermatology services covered by health insurance and the need for continued efforts in skin cancer education and screening programs.

Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

PurposeGuided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. MethodsSecondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. ResultsPoorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65–74 years, younger respondents were less likely to rate their care favourably (16–34 years old ORadj. = 0.55 (0.36–0.84). Compared to White British, Asian (ORadj. = 0.51 (0.39–0.66)) and Black African women (ORadj. = 0.53 (0.33–0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (ORadj. = 0.79 (0.64–0.97)). ConclusionThere is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.

5 Translating developmental neurotoxicity for the public: A large, international, randomized-control trial investigating children's environmental health literacy

Objective:Exposure to toxic chemicals during early brain development increases the risk of neurodevelopmental problems in children. Parents' and prospective parents' understanding of the impact of toxic chemicals on brain development and the efficacy of translation tools for children's environmental health literacy are poorly understood. We developed and validated a questionnaire, PRevention of Toxic chemicals in the Environment for Children Tool (PRoTECT) to assess knowledge of toxic chemicals and neurodevelopment, intentions to reduce exposures to toxic chemicals, and preferences for actions by government and industry to prevent neurodevelopmental disorders. Using PRoTECT, we surveyed people of child-bearing age across five countries (Canada, United States (US), United Kingdom (UK), India, and Australia) to identify general patterns of responses on this questionnaire by demographic characteristics, including country, age, gender, parental status, pregnancy status, and education. We also employed a randomized control design to examine the efficacy of a knowledge translation video to instill knowledge and prompt behavioral changes to reduce exposures to toxic chemicals immediately following its presentation and after a six-week follow-up period.Participants and Methods:We recruited 15,594 participants, ages 18 to 45, via CloudResearch's Prime Panels between October-December 2021. After completing the PRoTECT survey, participants were randomly assigned to watch the video Little Things Matter: Impact of Toxic Chemicals on Brain Development (i.e., the experimental group) or to serve as the control group. Next, both groups answered a series of questions to assess their knowledge of toxic chemicals, their intentions to reduce exposures to toxic chemicals, and barriers to changing their behaviours. After six-weeks, we recontacted a subset (N=4,842) of participants to repeat PRoTECT and answer the same series of behavioural questions assessing whether they modified any of their behaviours to reduce exposure and why or why not.Results:Most participants (i.e., 75-85%) agreed that toxic chemicals can impact brain development and endorsed preferences (∼85%) for allocating more resources to prevent neurodevelopmental disorders, especially people with higher education, parents and pregnant women, and people who lived in India. Despite this, a large proportion of participants (∼50%) trusted industry and believed that government effectively regulated toxic chemicals. After the six-week follow-up, experimental participants showed greater changes in scores on PRoTECT (i.e., between 5-15% change), indicating greater knowledge about harms posed by toxic chemicals, more intentions to reduce exposure, and stronger preferences for prevention as compared to the control group. Differences were larger among people from the US, those who were more highly educated, and people in their thirties. However, the differences between groups in making behavioural changes to reduce exposures were attenuated at the six-week follow up as compared to baseline. Significant barriers to reduce exposure to toxic chemicals were reported by both groups and included cost, inconvenience, and not knowing how to determine whether a product is non-toxic or where to purchase non-toxic products.Conclusions:We observed greater knowledge and concerns about toxic chemicals among more affluent respondents, pregnant women and parents, and people living in India across both groups. While the video enhanced participants' knowledge about toxic chemicals and intentions to reduce exposure, they indicated that barriers hindered them from making behavioral changes.

ОСНОВНІ ДЕТЕРМІНАНТИ ВИБОРІВ В КОНГРЕС США 2022 РОКУ

Relations with the USA since Ukraine gained independence have been one of the priorities of the state's foreign policy due to a number of geopolitical, economic, security and other factors. Since the beginning of Russian aggression in 2014, the United States has turned into one of the main strategic partners of Ukraine, and with the beginning of a large-scale war in 2022, the United States plays a key role in its foreign policy strategy, given the unprecedented economic and military aid. The war issue in Ukraine, given the significant US support.is the center of political discussions in this state, especially during election campaigns, since no political force can ignore it and not include in the election platform. Therefore, it is vital for Ukraine to cooperate with both leading parties of the USA, to ensure constant support and allocation of aid regardless of the configuration of political forces in the Congress. These circumstances determine the relevance of the study of the main factors affecting the elections to the Congress and the role of the Russia-Ukraine war in the pre-election processes. Thus, the purpose of this article is to establish the main determinants of the US Congress elections in 2022. It is determined that the US electoral system has unique features and institutions such as the Electoral College, the primaries, caucuses, etc. The course of elections is significantly determined by the specifics of the electoral system and electoral culture. It is pointed out that Republican identity and more traditional moral views are most common among older, white, religious, affluent, and married respondents, mostly men. On the other hand, Democratic and progressive political views are more common among minorities, younger respondents who are not married, secular or less religious, low-income people, and women. Among the trends in the development of US electoral processes, such phenomena as "negative commitment" and "expansion of the conflict" stand out. The first one forces people to refuse to communicate with each other due to different political views, and the second is characterized by party absorption of issues and strong party identification. And at the same time, in the last three elections held in the USA, a record voter turnout was observed. In addition to these traditional determinants of the American electoral process, the following factors determining the course of the midterm elections to the US Congress in 2022 can also be identified: the pool of the most discussed topics (the right to abortion, high taxes, inflation, social security, the war in Ukraine), big interest in the elections, stratification of society according to party identifications, preservation of an ideological view of politics, trust in electoral institutes. Although the US foreign policy on Ukraine was not a central topic, it was constantly discussed by the parties and attracted the attention of citizens due to its relevance. In the course of the election campaign, the war issue in Ukraine became relevant, discussions about the strategy of waging the war, additional methods of support, the new world order and the role of the United States in it, etc. intensified. Both parties generally promoted mostly positive messages for Ukraine and contributed to strengthening the country's image in the eyes of the American public. Key words: elections, electoral culture, electoral system, Congress, war in Ukraine, electoral institutions.

The burdens of poverty during the COVID-19 pandemic.

Individuals living at-risk-of-poverty have an increased risk of poor mental health. The pandemic and its societal impacts might have negative effects especially on this group widening the gap between rich and poor and also exacerbate gender gaps, which in turn might impact social cohesion. The objective of this longitudinal study was to determine if people living at-risk-of-poverty were more vulnerable to economic and psychosocial impacts of the pandemic and showed poorer mental health. Moreover, gender differences were analyzed. We drew data from a sample of N = 10,250 respondents of two time points (T1 starting from October 2020, T2 starting from March 2021) of the Gutenberg COVID-19 Study. We tested for differences between people living at-risk-of-poverty and more affluent respondents regarding economic impacts, psychosocial stressors, as well as depressiveness, anxiety and loneliness, by comparing mean and distributional differences. To test for significant discrepancy, we opted for chi-square- and t-tests. The analysis sample compromised N = 8,100 individuals of which 4,2% could be classified as living at-risk-of-poverty. 23% of respondents living at-risk-of-poverty had a decrease in income since the beginning of the pandemic-twice as many as those not living at-risk-of-poverty, who reported more often an increase in income. Less affluent individuals reported a decrease in working hours, while more affluent people reported an increase. Between our survey time points, we found a significant decrease in these economic impacts. Gender differences for economic changes were only found for more affluent women who worked more hours with no change in income. Less affluent respondents were more impacted by psychosocial stressors, depressiveness, anxiety, and loneliness. Gender differences were found particularly with regard to care responsibilities. Our results indicate a widening in the gap between the rich and the poor at the beginning of the pandemic. Gender differences concerning economic changes affect more affluent women, but women in both income groups are more burdened by care responsibilities, which might indicate a heightened resurgence of gender role in times of crisis. This increase in inequality might have impacted social cohesion.

Satisfaction with dental care services in Great Britain 1998–2019

BackgroundSatisfaction with dental services can provide valuable insights into aspects of quality including access as well as changes in this over time. In the UK publicly funded dental services are ostensibly delivered by private sector general dental practitioners for whom private patients represent an opportunity cost to the provision of care to public patients. This study examined changes in satisfaction as economic circumstances and policy changed in Britain between 1998 and 2019.MethodsData were taken from successive waves of the British Social Attitudes Survey a representative cross-sectional survey of the population between 1998 and 2019. Descriptive statistics and a series of logistic regression analyses were used to examine the relationships between satisfaction and a range of socio-demographic characteristics over time.Results37,328 usable responses were extracted from the survey spanning 21 years of data. Over the course of the survey approximately 71% of the sample was very satisfied, satisfied or neither satisfied nor dissatisfied with publicly funded dental services. Satisfaction fell at the outset of the study period but rose following the economic downturn from 2008 which coincided with increased use of publicly funded services. Differences were evident in satisfaction between older versus younger respondents, more affluent versus less affluent respondents and better educated versus less well-educated respondents. Satisfaction did not appear to change in response to policy changes.ConclusionSatisfaction is an important outcome of service provision. Policies aiming to improve satisfaction with publicly funded dental care in the UK must take account of the competing demands on dentists’ time from private patients. At times of economic expansion or when supply has been disrupted, these may be particularly acute and require specific interventions to improve access for those who depend on public services.

European mature adults and elderly are moving closer to the Mediterranean diet-a longitudinal study, 2013-19.

BackgroundThe decreasing adherence in Mediterranean Diet (M.D.) during the last decades has been attributed to social, cultural and economic factors. However, recent efforts to improve dietary habits and the economic improvement might be reversing this trend. We analyze the changes in M.D. adherence between 2013 and 2019 among a sample of European mature adults and the elderly.MethodsUsing data from the Survey of Health, Ageing and Retirement in Europe for adults over 50 years old, we designed a longitudinal cohort study with a sample of participants from waves 5 (2013) and 8 (2019/20). Logistic regressions were used to model the consumption of M.D. adherence as a function of the year. We then stratified the analyses by education, age and transitions in economic status, employment and self-perceived health.ResultsThere was in 2019/20 a significant increase in the M.D. adherence (10.8% vs. 14.3%, OR = 1.367, P < 0.01). The rise was mainly related to the decrease of meat and fish (38.4% vs. 30.5%, OR = 0.703, P < 0.01) and growth of legumes and eggs intake (36.3% vs. 41.8%, OR = 1.260 P < 0.01). The results were consistent in all European regions and most sociodemographic groups. Younger people with higher income and education had a greater rise in adherence.ConclusionsOur analysis shows a generalized growth in adherence to the M.D. across most socioeconomic subpopulations and countries in Europe, suggesting a shift to healthier diet patterns. The more noticeable increase among affluent, educated and healthy respondents, may further entrench dietary and health inequalities.

Trusting COVID-19 vaccines as individual and social goal.

Trust in vaccines and in the institutions responsible for their management is a key asset in the global response to the COVID-19 pandemic. By means of a structured multi-scales survey based on the socio-cognitive model of trust, this study investigates the interplay of institutional trust, confidence in COVID-19 vaccines, information habits, personal motivations, and background beliefs on the pandemic in determining willingness to vaccinate in a sample of Italian respondents (N = 4096). We observe substantial trust in public institutions and a strong vaccination intention. Theory-driven structural equation analysis revealed what factors act as important predictors of willingness to vaccinate: trust in vaccine manufacturers (which in turn is supported by trust in regulators), collectivist goals, self-perceived knowledgeability, reliance on traditional media for information gathering, and trust in institutional and scientific sources. In contrast, vaccine hesitancy, while confined to a minority, is more prominent in less educated and less affluent respondents. These findings can inform institutional decisions on vaccine communication and vaccination campaigns.

Impact on Fisheries in Contaminated Water Discharged from Nuclear Power and Reprocessing Plants: The Cases of La Hague Reprocessing Plant, Sellafield Nuclear Fuel Reprocessing Plant, and TEPCO Fukushima Daiichi Nuclear Power Plant

This paper statistically analyzes residents’ understanding of problems related to radioactively contaminated water discharged from nuclear power and nuclear reprocessing plants. Moreover, this paper examines their impact on the surrounding fisheries by using the cases of La Hague, Sellafield, and Fukushima Daiichi Nuclear Power Plant. Survey data shows that more than 60% respondents disagree with the release of contaminated water, and this sentiment is particularly strong among both British and French respondents. Regarding seafood caught in the vicinity of the nuclear power and nuclear reprocessing plants, although British respondents noted that they hold it in high regard, many people do not purchase this seafood. In contrast, many Japanese respondents reported that they were less concerned, and thus, willingly purchase seafood caught off the coast of Fukushima Prefecture. In all three countries, many people did not trust government information on the release of contaminated water. Compensation to the affected people was provided by the central government, companies involved, and local governments, in that order. Japanese and British respondents reported higher expectation for compensation as compared to French respondents. Japanese and French respondents noted that they have knowledge of radioactive materials and contaminated water, and many of them purchased seafood caught in the vicinity of the nuclear power and reprocessing plants. British respondents were the most opposed to the release of contaminated water, whereas Japanese respondents were the least reliant on government information about the release of contaminated water. Finally, among those who trusted information from the government and retailers, French respondents were the least concerned about contamination. French respondents were also the least likely to expect any compensation for the fishermen affected by contamination. Both British and French residents around the affected plants expected the central government to compensate the affected fishermen, whereas those who did not reside around the affected plants did not expect the fishermen to be compensated. French respondents were more likely to expect compensation from the local governments; affluent respondents were more likely to expect the compensation to be funded by taxation, whereas less affluent respondents expected them to be funded by donations. Respondents who were more skeptical of government information wanted the companies involved to compensate the fishermen. British respondents reported a tendency for wanting the companies involved to provide this compensation, and did not support the concept of compensation provided through donations.

Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review

ObjectivesTo identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and...

Anxieties of Entitlement

Despite the rise of the “moral economy” as a frame for analyzing increasing inequality, few scholars have explored the moral dimensions of elites’ experience and interpretations of their own privilege. Based on in-depth interviews with 50 affluent New York parents, this paper focuses on how they manage the peculiar concept of “entitlement”. In U.S. political culture, this concept links individuals’ dispositions and behaviors to whether they deserve resources, as studies of welfare recipients have established. I argue that a similar analysis is needed for elites. These privileged actors want to interpret themselves as legitimately deserving of (i.e., entitled to) their social advantages, which means not being “entitled” in a behavioral and dispositional sense. They cast legitimate entitlement as depending upon moral worth in three areas: hard work, reasonable consumption, and “giving back”. They also feel a strong obligation to raise children who share the­se values. In invoking these criteria of worth, affluent respondents primarily attach themselves to the symbolically-worthy American middle class. The paper concludes with a discussion of how this relationship between dispositions and distributions justifies inequality.

The Effect of a Major Pandemic on Risk Preferences - Evidence from Exposure to COVID-19

The present paper studies the effect of the COVID-19 pandemic on risk preferences. Using real-time panel data from the year before the pandemic and from the first few months of the pandemic in Germany (April to July 2020), we provide robust evidence that exposure to COVID-19 reduces individual risk tolerance. We establish a causal link between the pandemic and risk tolerance by exploiting longitudinal and regional variation in infection rates. Our analysis shows that increased risk aversion can be observed in particular among better educated and more affluent respondents.We further provide suggestive evidence that economic concerns, health concerns, and self-reported health partially mediate the relationship of interest.

Absolute Income, Income Inequality and the Subjective Well-Being of Migrant Workers in China: Toward an Understanding of the Relationship and Its Psychological Mechanisms

No study has been conducted linking Chinese migrants’ subjective well-being (SWB) with urban inequality. This paper presents the effects of income and inequality on their SWB using a total of 128,000 answers to a survey question about “happiness”. We find evidence for a satiation point above which higher income is no longer associated with greater well-being. Income inequality is detrimental to well-being. Migrants report lower SWB levels where income inequality is higher, even after controlling for personal income, a large set of individual characteristics, and province dummies. We also find striking differences across socio-economic and geographic groups. The positive effect of income is more pronounced for rural and western migrants, and is shown to be significantly correlated with the poor’s SWB but not for the well-being of more affluent respondents. Interestingly, high-income earners are more hurt by income inequality than low-income respondents. Moreover, compared with migrants in other regions, those in less developed Western China are found to be more averse to income inequality. Our results are quite robust to different specifications. We provide novel explanations for these findings by delving into psychological channels, including egalitarian preferences, social comparison concerns, expectations, perceived fairness concerns and perceived social mobility.

Why Do the Affluent Find Inequality Increasingly Unjust? Changing Inequality and Justice Perceptions in Germany, 1994–2014

AbstractIn the wake of rising inequality in Germany during the last 20 years, we document a corresponding increase in perceptions of injustice among the population. Based on data from the cumulated German General Social Survey (ALLBUS), we show that this increase in perceived injustice is driven mainly by a rising share of affluent respondents who find society unjust, resulting in a convergence across income groups towards more critical attitudes. We try to explain this puzzling development based on outcome-related justice assessments and perceptions of procedural justice. We find that outcome-related justice assessments cannot explain the trend over time, but affect the overall level of injustice perceptions. The influence of perceptions of procedural justice, however, is more pronounced among affluent respondents and partly explains the increase in injustice perceptions within this group. These results are robust for different operationalizations as well as model specifications and are not due to compositional effects. Since we cannot account entirely for the rise in injustice perceptions among the affluent, explanatory factors not covered by our data are likely to exist. We conclude with a discussion of potential explanations that future research should address.

The Factors Affecting the Affluent Consumers Luxury Purchasing Behavior in China

China is fast becoming one of the most important luxury goods market. The purpose of this study is to investigate the determinants of luxury purchasing behavior in the Chinese affluent market. Based on the logit analysis of 618 affluent respondents, the results show that social-adjustive motivation and life satisfaction are significantly associated with the purchasing of luxuries. However, the value-expressive motivation, which has been verified that could drive the consumer buy luxury items, does not have significant effect on luxury purchasing behavior for the Chinese affluent consumers. In the meantime, the demographic characteristics of individual are significantly associated with his/her luxury purchasing behavior, and the younger affluent consumers with higher income and international education are more likely to buy more luxuries. It helps researchers and companies to understand the differences of the factors influencing luxury consumption between Chinese consumers and their global peers.

Determinants of municipal solid and hazardous waste management in the occupied Palestinian territory: a cross-sectional study

BackgroundIn the occupied Palestinian territory, accumulation of municipal solid waste is a serious problem, with substantial political and occupational issues needing to be resolved, despite limited resources. We assessed attitudes, knowledge, and practices related to hazardous and municipal solid waste and views on how waste should be managed. MethodsQualitative data were collected from 15 focus groups with men and women older than 18 years from different localities (urban, rural, and camps) and regions (north, middle, and south) of the West Bank and Gaza Strip. In 2011, we implemented a quantitative study in the West Bank and Gaza Strip on 1882 people representative randomised stratified three-stage sample The data were collected through a structured questionnaire including questions (derived from the focus group discussions) about the respondents’ role in disposing of their household solid waste, satisfaction of the collecting services, awareness regarding household hazardous waste, and willingness to treat organic waste. χ2 testing was used to check for significant associations of those variables with region, locality, age, sex, number of family members, educational attainment, employment, marital status, home ownership, socioeconomic status, region, and locality. Binary logistic regression was done to identify confounders. Data were analyed with SPSS (version 17.0). FindingsThe qualitative findings showed that lack of skilled manpower, irregular collection services, inadequate equipment, inadequate legal provisions, and resource constraints all compromised waste management in the occupied Palestinian territory. Quantitative results revealed that residents of the Gaza Strip were the least satisfied with municipal solid waste management (OR 2·410, 95% CI 1·627–3·569) and the least interested in encouraging composting (3·604, 2.679–4·849) or reusing solid waste (6·277, 4·587–8·589), but were most active in cleaning indoors (0·625, 0·431–0·905), and less likely to have basic knowledge of hazardous waste (1·626, 1·222–2·16) than residents of the northern West Bank. Compared with urban dwellers, rural and camp dwellers were more likely to clean their houses (0·738, 0·561–0·971 and 0·295, 0·157–0·552, respectively), and to know more about hazardous waste (0·616, 0·414–0·917 and 0·719, 0·576–0·987) and camp dwellers were more likely to encourage reusing solid waste (0·454, 0·296–0·695) whereas rural dwellers were more likely to compost organic waste (0·502, 0·402–0·626). Affluent respondents were less interested in encouraging composting municipal solid waste (1·769, 1·161–2·696). A positive association was found between completion of university education and participants’ ability to encourage reusing (0·490, 0·267–0·897) and composting (0·417, 0·242–0·720) municipal solid waste and their awareness of hazardous waste (0·378, 0·204–0·703) compared with uneducated participants. Three-member households were less willing to compost municipal solid waste (1·66, 1·009–2·730) than households with one to two members. Middle aged participants (age 25–34 and 35–44 years) were more likely to participate in cleaning indoors (0·572, 0·368–0.889 and 0·584, 0·338–0·889, respectively) and moving solid waste to outside (0·519, 0·370–0·726 and 0·486, 0·337–0·700) compared with the youngest participants (aged 18–24). Women were less likely to move solid waste outside than were men (2·551, 2·014–3·230). House owners were less likely to have basic knowledge of hazardous waste compared with house renters (1·431, 1·100–1·861). InterpretationAn implementation of existing policies for solid waste management is required on the national scale, combined with support for public education and training. In Gaza, there is a need for rehabilitation of the whole municipal solid waste system. FundingNone.

Financial hardship on the path to Universal Health Coverage in the Gulf States

BackgroundCountries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship. MethodsUsing nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors. ResultsWe found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001). ConclusionIn moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage.

The Effects of In-Home Displays—Revisiting the Context

In this paper, we investigate the extent to which the use of in-home displays affects daily practices and electricity consumption. Through two pilot projects, in-home displays were installed in 33 Norwegian homes, and we provide a qualitative analysis of the effects. The results point to the potential differences in the ways households interact with the in-home displays. The effects differed among various groups according to people’s previous experiences with monitoring and their level of affluence. In the sample, affluent respondents living in detached houses tended to be accustomed to monitoring consumption before the display was introduced. These families used the display for controlling that “nothing was wrong”, but they did not use the information provided by the display to initiate new energy saving measures. In contrast, among less affluent flat owners the notion of “control” was specifically linked to the family’s management of finances, and in this sense the displays empowered them. In addition, the results indicate that the in-home display for this group resulted in electricity savings. The study adds to earlier research on the effects of in-home displays by showing the importance of previous experience with monitoring electricity for the effects of feedback and by highlighting not only energy savings but also social effects of displays.

Tracking quicksilver: estimation of mercury waste from consumer products and subsequent verification by analysis of soil, water, sediment, and plant samples from the Cebu City, Philippines, landfill.

Source attribution of mercury (Hg) is critical for policy development to minimize the impact of Hg in wastes. Mercury content of consumer products and its subsequent release into the waste stream of Cebu City, Philippines, is estimated through surveys that employed validated, enumerator-administered questionnaires. Initially, a citywide survey (n = 1636) indicates that each household annually generates 1.07 ppm Hg (i.e., mg Hg/kg waste) and that linear and compact fluorescent lamps (17.2 %) and thermometers (52.1 %) are the major sources of Hg. A subsequent survey (n = 372) in the vicinity of the city's municipal solid waste landfill shows that residents in the area annually generate 0.38 ppm Hg per household, which is less than the citywide mean; surprisingly though, less affluent respondents living closer to the landfill site reported more Hg from thermometers and sphygmomanometers. Analysis of collected soil (0.238 ppm), leachate water (6.5 ppb), sediment (0.109 ppm), and three plants (0.393 to 0.695 ppm) shows no significant variation throughout five stations in and around the landfill site, although the period of collection is significant for soil (P = 0.001) and Cenchrus echinatus (P = 0.016). Detected Hg in the landfill is considerably less than the annual estimated release, indicating that there is minimal accumulation of Hg in the soil or in plants. As a result of this project, a policy brief has been provided to the Cebu City council in aid of hazardous waste legislation.

Leisure Travel: Implications for Airline Alliances

The rationale behind the formation of airline alliances includes the reaping of scale and scope economies and the acquisition of marketing and branding advantages. To really add value to the airline customer, however, alliances should consider the purpose of travel, i.e. they should appreciate and understand the derived nature of the airline product. The relevant literature seems to understate this issue or at best focus on business passengers. Given the rising importance of leisure travel and tourism in the world economy, its implications should be explicitly assessed. The emergence of low cost carriers and the subsequent simplifications in the holiday packages offered by charter airlines have played a major role in boosting leisure travel in Europe at least. Still, the intelligent management of frequent flyer programmes and the creation of a seamless network in long haul (or even intercontinental) air travel may induce leisure passengers to opt for an allied airline instead. This paper addresses the topic by undertaking primary research in the form of semi-structured interviews with airline executives and structured questionnaires addressed to passengers. The interviewees are supportive of the view that alliances of network carriers may offer benefits to leisure passengers although they do recognise the competitive threat posed by low cost carriers. Similarly, the statistical analysis of the questionnaire results reveals that frequent flyers and more affluent respondents are more knowledgeable about strategic alliances and have a tendency to prefer allied carriers for long-haul but not for short-haul flights. This outcome may add to the understanding of airline alliances and consumer behaviour and have important implications for airline strategy at a global level.