Household Covariates Research Articles

Indigenous Identity and Household Food Insecurity are Associated with Poor Health Outcomes in Canada.

Purpose: To examine whether Indigenous identity and food insecurity combined were associated with self-reported poor health.Methods: Data from the 2015-2016 Canadian Community Health Survey and multiple logistic regression were employed to evaluate the association between Indigenous identity, household food insecurity, and health outcomes, adjusted for individual and household covariates. The Alexander Research Committee in Alexander First Nation (Treaty 6) reviewed the manuscript and commented on the interpretation of study findings.Results: Data were from 59082 adults (3756 Indigenous). The prevalence of household food insecurity was 26.3% for Indigenous adults and 9.8% for non-Indigenous adults (weighted to the Canadian population). Food-secure Indigenous adults, food-insecure non-Indigenous adults, and food-insecure Indigenous adults had significantly (p < 0.001) greater odds of poor health outcomes than food-secure non-Indigenous adults (referent group). Food-insecure Indigenous adults had 1.96 [95% CI:1.53,2.52], 3.73 [95% CI: 2.95,4.72], 3.00 [95% CI:2.37,3.79], and 3.94 [95% CI:3.02,5.14] greater odds of a chronic health condition, a chronic mental health disorder, poor general health, and poor mental health, respectively, compared to food-secure non-Indigenous adults.Conclusions: Health policy decisions and programs should focus on food security initiatives for all Canadians, including addressing the unique challenges of Indigenous communities, irrespective of their food security status.

Children’s oral health and oral health care use during the first 2 years of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has been associated with declines in children’s oral health and oral health care use in 2020. The authors examined the pandemic effects on these outcomes into 2021. MethodsThis cross-sectional study used data from the National Survey of Children’s Health from 2017 through 2021. The authors compared parent’s or caregiver’s perceptions of the child’s oral health and reported dental problems and dental visits across years, adjusting for child and household covariates and state of residence. The authors evaluated potential heterogeneity across demographic and socioeconomic subgroups. ResultsIn 2021, parents and caregivers were still more likely to perceive children’s oral health as poor (odds ratio [OR], 1.90; 95% CI, 1.28 to 2.82) and less likely to report very good or excellent oral health (OR, 0.83; 95% CI, 0.76 to 0.92) than in 2019, similar to differences between 2020 and 2019. Dental visits were also less likely in 2021 than 2019 (OR, 0.74; 95% CI, 0.66 to 0.83). These differences between 2021 and 2019 were not explained by prepandemic trends and were observed across a range of demographic and socioeconomic subgroups. ConclusionsChildren’s oral health as perceived by parents and caregivers and oral health care use were still worse in 2021 than before the pandemic both overall and across demographic and socioeconomic subgroups. Practical ImplicationsThe persistent adverse effects of the COVID-19 pandemic on children’s oral health as perceived by parents and caregivers and shown through dental visits highlight the need to improve oral health care access and use and to evaluate the long-term effects of the pandemic on children’s oral health.

Effects of the COVID-19 pandemic on children’s oral health and oral health care use

BackgroundThe COVID-19 pandemic led to early restrictions on access to oral health care and social distancing requirements. The authors examined the early effects of the COVID-19 pandemic on children’s oral health and access to oral health care in the United States. MethodsUsing nationally representative data from the National Survey of Children’s Health, the authors compared several measures of children’s oral health and oral health care use early during the pandemic in 2020 with 1 year earlier. Logistic (multinomial or binary) regression models were estimated, adjusting for several child and household covariates and state fixed effects. Similar comparisons were estimated for 2019 relative to 2018 to evaluate prepandemic trends. ResultsChildren in 2020 were 16% (relative risk ratio, 0.84; 95% CI, 0.75 to 0.93) less likely to have excellent dental health as perceived by parents and 75% (relative risk ratio, 1.75; 95% CI, 1.14 to 2.67) more likely to have poor dental health than in 2019. In addition, children in 2020 had higher risk of bleeding gingivae (odds ratio, 1.46; 95% CI, 1.16 to 1.85). The likelihood of having a dental visit in the past 12 months was 27% (odds ratio, 0.73; 95% CI, 0.65 to 0.82) lower in 2020, including lower likelihood for preventive visits. The differences between 2020 and 2019 were observed across demographic and socioeconomic subgroups. There were no such differences between 2019 and 2018. ConclusionsThere was a widespread decline in children’s oral health status and access to oral health care early during the COVID-19 pandemic. Practical ImplicationsPrompt policies and oral health campaigns are needed to counter the pandemic effects and increase timely access to dental services.

Energy-related deprivation and housing tenure transitions

Energy poverty is becoming an increasingly important policy consideration in many countries. We empirically examine the relationship between energy poverty and housing tenure in Australia using HILDA survey data over the period 2005 to 2018. We employ objective, subjective and composite measures of energy poverty and control for other respondent and household covariates. Results from our study, which are robust to a suite of checks, suggest that being energy poor has a negative impact on homeownership and “rent to own” transition, and a positive impact on “own to rent” transition. We conclude by discussing the policy implications of our study.

Household mold, pesticide use, and childhood asthma: A nationwide study in the U.S.

To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S. Nationally representative data were drawn from the cross-sectional 2017 and 2018 National Surveys of Children's Health. Household mold and pesticide exposures during the past 12 months and physician-diagnosed childhood asthma were assessed by standard questionnaires administered to primary caregivers. Multivariable logistic regression models were used to calculate adjusted odds ratios (aOR) for current asthma, adjusting for child, caregiver, and household covariates. We also examined potential effect modification by child's sex. Sampling weights accounted for the complex survey design. Among 41,423 U.S. children in 2017-2018, the weighted prevalence of current asthma was 10.8% in household mold-exposed children, compared with 7.2% in non-exposed children (P<0.001). After adjusting for covariates including child's obesity, children with household mold exposure compared to those with no household mold exposure had a 1.41-fold (95% CI: 1.07, 1.87) higher odds of current asthma. Associations between household mold and current asthma were pronounced among boys (aOR 1.57; 95% CI: 1.03-2.38) but not girls (aOR 1.28; 0.90-1.83; P for interaction <0.001). No significant associations were observed between household pesticide use and current asthma, after adjusting for covariates. Our findings suggest that household mold is associated with current asthma among children, independent of other major risk factors including child's obesity status. Our findings may inform strategies targeting mitigation of household mold as an important indoor environment factor to address childhood asthma.

The WHO and UNICEF Joint Monitoring Programme (JMP) Indicators for Water Supply, Sanitation and Hygiene and Their Association with Linear Growth in Children 6 to 23 Months in East Africa.

The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children’s Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6–23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (β = 0.13, p < 0.01) and Tanzania (β = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (β = 0.07, p < 0.01) and Tanzania (β = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.

Improved Understanding of Interactions between Risk Factors for Child Obesity May Lead to Better Designed Prevention Policies and Programs in Indonesia.

The nutrition transition in low-middle income countries is marked by rising intakes of highly caloric, low nutrient-dense (junk) foods, decreasing intakes of fruits and vegetables, and sedentary behavior. The objective of this study was to explore interactions among fruit-and-vegetable intake, junk food energy intake, sedentary behavior, and obesity in Indonesian children. We conducted this school-based, case-control study in 2013 in Yogyakarta Special Province, Indonesia. The cases were 244 obese children aged 7–12 years having a BMI ≥95th percentile of an age- and sex-specific distribution from the Centers for Disease Control and Prevention. The controls (n = 244) were classroom-matched children with a BMI <85th percentile. Using conditional logistic regression, the relative odds (95% confidence intervals; OR: 95% CI) of obesity given reported frequent fruit-and-vegetable intake (≥3 servings/day), low junk food energy (≤1050 kcal/day) intake and low sedentary behavior (<5 h/day) was 0.46 (0.30–0.69), 0.61 (0.37–0.98), and 0.18 (0.12–0.28), respectively. Effect sizes were dose-responsive and appeared additive. For example, children with low sedentary behavior and frequent fruit-and-vegetable intake were 92% less likely (OR = 0.08; 0.04–0.15) to be obese than children not exceeding either of these thresholds. Similarly, children frequently eating fruits and vegetables and reporting a low junk food energy intake were 70% less likely (OR = 0.30; 0.15–0.59) to be obese. The findings were unchanged after adjusting for child, maternal, and household covariates. Preventive interventions for child obesity need multiple components to improve diets and raise levels of physical activity rather than just addressing one of the three types of assessed behaviors.

Looking Beyond the Household: The Importance of School Factors in Understanding Elementary Grade Retention in Rural Khyber Pakhtunkhwa, Pakistan

This paper contributes to the limited literature on the educational outcomes of children in rural Khyber Pakhtunkhwa (KP), Pakistan. It explores the impact of school-level factors such as physical resources, teachers and school characteristics on retention to the last grade of primary in the KP province for the time period 2007-12. Two sources of data were used to measure the retention rates. One of which is an official compilation of institutional data on education known as Education Management Information System (EMIS). The second data source, Annual Status of Education Reports (ASER), is a household data set with a rich set of household covariates, teachers’ characteristics and student performance data on reading and mathematics. The results from regression analyses indicate that children are more likely to complete primary education cycle when they receive instructions in local language and when the pupil-teacher ratio is below a certain threshold. Results also reveal that a continuous increase in school size beyond a certain threshold (&gt; 400 enrollment) is related to a decrease in retention rate. Further, mixed schools (all-boys’ schools having girls enrolled in them) were found to have better retention rates than boys’ schools.

Association between household unavailability of iodized salt and child growth: evidence from 89 demographic and health surveys

Background: Although a strong biological basis exists for a role of iodine in somatic growth failure in childhood, this relation has not been previously studied on a large scale to our knowledge.Objective: We investigated if a general association exists between the household unavailability of iodized salt and child growth across countries.Design: We used 89 nationally representative, repeated, cross-sectional and mutually comparable demographic and health surveys that were conducted between 1994 and 2012 across 46 low- and middle-income countries. We analyzed the data for the outcome variables of stunting (low height-for-age), underweight (low weight-for-age), wasting (low weight-for-height), and low birth weight in children aged between 0 and 59 mo at the time of the interview with the use of logistic regression models. Our samples consisted of 390,328 children for the stunting analysis, 397,080 children for the underweight analysis, 384,163 children for the wasting analysis, and 187,744 children for the low-birth-weight analysis. Models were adjusted for individual, maternal, and household covariates and fixed effects on the level of the primary sampling unit.Results: In the fully adjusted models, the unavailability of iodized salt was associated with 3% higher odds of being stunted (95% CI of ORs: 1.00, 1.06; P = 0.04), 5% higher odds of being underweight (95% CI: 1.02, 1.09; P < 0.01), and 9% higher odds of low birth weight (95% CI: 1.02, 1.17; P = 0.01). When India was excluded from the sample, the association was only statistically significant (P = 0.05) for low birth weight.Conclusion: Although we did not establish causality in our analysis, the findings might indicate that the causal effect of iodized salt on child growth, if it exists, is most profound in utero and is not universally effective across all countries with respect to longer-run child-growth outcomes such as stunting and underweight.

Understanding the Impact of Microcredit Expansions: A Bayesian Hierarchical Analysis of 7 Randomised Experiments

Bayesian hierarchical models serve as a standard methodology for aggregation and synthesis, used widely in statistics and other disciplines. I use this framework to aggregate the data from seven randomised experiments of expanding access to microcredit, assessing both the general impact of the intervention and the heterogeneity across contexts. The general impact on household profits is small, with a posterior mean of 26 USD PPP per year, and an impact of zero lies well within the central 50% posterior credible interval. Standard pooling metrics for the studies indicate 65-95% pooling on the treatment effects, suggesting that the site-specific effects are informative for each other and for the general case. Further analysis incorporating household covariates shows that the cross-study heterogeneity is almost entirely generated by heterogeneous effects for the 27% households who previously operated businesses before microcredit expansion. A cautious assessment of the correlations between site-specific covariates and treatment effects using a Bayesian Ridge procedure indicates that the interest rate on the microloans has the strongest correlation.

Does Ethiopia’s Productive Safety Net Program improve child nutrition?

We studied the link between household membership in Ethiopia’s Productive Safety Net Program (PSNP) and short-run nutrition outcomes among children aged 5 years and younger. We used 2006 and 2010 survey data from Northern Ethiopia to estimate parameters of an exogenous switching regression. This allowed us to measure the differential impacts of household characteristics on the weight-for-height Z-scores of children in member and non-member households. The magnitude and significance of household covariates differed in samples of children from PSNP and non-PSNP households and the supply of female labour seemed to matter for promoting child health in member households. Controlling for a set of observable features of children and households we found that children in member households had weight-for-height Z-scores that were 0.55 points higher than those of children in non-member households. We conclude that the PSNP is providing positive short-term nutritional benefits for children, especially in those households that are able to leverage underemployed female labor.

Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005-2006.

BackgroundCaste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth.MethodsA cross-sectional analysis of National Family Health Survey (NFHS) data of 43,484 children aged 6–59 months was performed. Poisson regression analysis was conducted to study the association between caste and childhood anemia accounting for various maternal, child, and household related variables. Caste was categorized as “other caste” (least disadvantageous), “other backward caste”, “scheduled tribe” and “scheduled caste” (most disadvantageous). Anemia was defined as mild (hemoglobin level 7-11 g/dL), moderate (hemoglobin level 5-7 g/dL) and severe (hemoglobin level <5 g/dL).ResultsWe found that children in scheduled caste had higher risk of having anemia [mild anemia: RR = 1.10, 95 % CI = 1.05-1.15; moderate anemia: RR = 1.19, 95 % CI = 1.14–1.24; severe anemia: RR = 1.87, 95 % CI = 1.51 – 2.31] after accounting for child, maternal and household covariates including adult education and household wealth. The interaction of caste with adult education and household wealth was not statistically significant for any level of anemia. Sensitivity analyses for children born to mothers of age ≥ 18 years at first child birth and body mass index (BMI) ≥ 18.5 kg/m2, resulted in similar findings.ConclusionCaste is an independent determinant of childhood anemia in India. The level of adult education and household wealth did not modify the association between caste and childhood anemia. The findings may be used for countering childhood anemia and it may be beneficial to target future public health actions towards disadvantageous castes in India.

Relationship between private schooling and achievement: Results from rural and urban India

This paper contributes to the important but small body of research on the role of private schools in Indian education. It uses a household dataset from India with a rich set of household covariates and student performance data on reading, writing, and mathematics. For both rural and urban India the results from regression analyses indicate that private school students perform better on tests controlling for covariates. In both contexts, however, the private school benefit becomes largely, statistically, insignificant after conducting multivariate analysis on data balanced using the propensity score matching technique. The paper also makes an initial attempt to identify ‘low-fee’ private schools; within the regression framework it finds that children in such schools may perform no better than their public school counterparts. The data and methods used in this paper are not without limitations; however these analyses call into question the claim that private school effect may be unequivocally positive and highlights the potential heterogeneity in private school performance in the Indian context.

Socio-demographics and the development of malaria elimination strategies in the low transmission setting

This analysis presents a comprehensive description of malaria burden and risk factors in Peruvian Amazon villages where malaria transmission is hypoendemic. More than 9000 subjects were studied in contrasting village settings within the Department of Loreto, Peru, where most malaria occurs in the country. Plasmodium vivax is responsible for more than 75% of malaria cases; severe disease from any form of malaria is uncommon and death rare. The association between lifetime malaria episodes and individual and household covariates was studied using polychotomous logistic regression analysis, assessing effects on odds of some vs. no lifetime malaria episodes. Malaria morbidity during lifetime was strongly associated with age, logging, farming, travel history, and living with a logger or agriculturist. Select groups of adults, particularly loggers and agriculturists acquire multiple malaria infections in transmission settings outside of the main domicile, and may be mobile human reservoirs by which malaria parasites move within and between micro-regions within malaria endemic settings. For example, such individuals might well be reservoirs of transmission by introducing or reintroducing malaria into their home villages and their own households, depending on vector ecology and the local village setting. Therefore, socio-demographic studies can identify people with the epidemiological characteristic of transmission risk, and these individuals would be prime targets against which to deploy transmission blocking strategies along with insecticide treated bednets and chemoprophylaxis.

Rural Roads and Local Market Development in Vietnam

We assess impacts of rural road rehabilitation on market development at the commune level in rural Vietnam and examine the geographic, community, and household covariates of impact. Double difference and matching methods are used to address sources of selection bias in identifying impacts. The results point to significant average impacts on the development of local markets. There is also evidence of considerable impact heterogeneity, with a tendency for poorer communes to have higher impacts due to lower levels of initial market development. Yet, some poor areas are also saddled with other attributes that reduce those impacts.

Individual Predisposition, Household Clustering and Risk Factors for Human Infection with Ascaris lumbricoides: New Epidemiological Insights

BackgroundMuch of our current understanding of the epidemiology of Ascaris lumbricoides infections in humans has been acquired by analyzing worm count data. These data are collected by treating infected individuals with anthelmintics so that worms are expelled intact from the gastrointestinal tract. Analysis of such data established that individuals are predisposed to infection with few or many worms and members of the same household tend to harbor similar numbers of worms. These effects, known respectively as individual predisposition and household clustering, are considered characteristic of the epidemiology of ascariasis. The mechanisms behind these phenomena, however, remain unclear. In particular, the impact of heterogeneous individual exposures to infectious stages has not been thoroughly explored.Methodology/Principal FindingsBayesian methods were used to fit a three-level hierarchical statistical model to A. lumbricoides worm counts derived from a three-round chemo-expulsion study carried out in Dhaka, Bangladesh. The effects of individual predisposition, household clustering and household covariates of the numbers of worms per host (worm burden) were considered simultaneously. Individual predisposition was found to be of limited epidemiological significance once household clustering had been accounted for. The degree of intra-household variability among worm burdens was found to be reduced by approximately 58% when household covariates were included in the model. Covariates relating to decreased affluence and quality of housing construction were associated with a statistically significant increase in worm burden.Conclusions/SignificanceHeterogeneities in the exposure of individuals to infectious eggs have an important role in the epidemiology of A. lumbricoides infection. The household covariates identified as being associated with worm burden provide valuable insights into the source of these heterogeneities although above all emphasize and reiterate that infection with A. lumbricoides is inextricably associated with acute poverty.

Does economic inequality affect child malnutrition? The case of Ecuador

Economic inequality has been hypothesized to be a determinant of population health, independent of poverty and household income. We examined the association between economic inequality and child malnutrition in Ecuador. Economic inequality was measured by the Gini coefficient of household per capita consumption, estimated from the 1990 Census. Childhood stunting, assessed from height-for-age z scores, was obtained from the 1998 Living Standards Measurement Survey (LSMS). We controlled for a range of individual and household covariates, including per capita food consumption, education, housing, ethnicity, fertility, access to health services, diarrhea morbidity, child care, mother's age and diet composition. Stunting still affects 26% of children under five in Ecuador, with higher prevalence in the rural Highlands and among indigenous peoples. Maternal education, basic housing conditions, access to health services, ethnicity, fertility, maternal age and diet composition were independently associated with stunting. However, after controlling for relevant covariates, economic inequality at the provincial scale had a statistically significant deleterious effect on stunting. At municipal or local levels, inequality was not associated with stunting.

Modelling Determinants of Participation, Number of Trips and Site Choice for Outdoor Recreation in Protected Areas

This is a study on demand for outdoor recreation in a national system of environmentally protected areas. The exercise is based on a nationwide survey carried out in 1996 from a stratified random sample of 5,574 Italian households. Data on socio‐economic characteristics and recreational choice behaviour of respondents were collected and this information was supplemented by a second data‐base containing information on 193 Italian EPAs in order to characterise the different outdoor destinations on the basis of their recreational attributes. These data sets are used here to model choices of outdoor recreation within environmentally protected areas, using a sequence of three different models: (i) a dichotomous choice logit model for the probability of participation conditional on household covariates; (ii) a count data Poisson model to estimate the household's expected number of trips per year; (iii) a conditional logit model to estimate the probability of site selection conditional on site attributes. We report the estimated per‐trip welfare changes derivable from an actual policy proposal which would extend the area under environmental protection by ten per cent.