Household Environmental Factors Research Articles

Ambient PM2.5, household environment and preterm birth: A birth cohort study in Shandong, China

BackgroundThe associations between fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) and risk of preterm birth (PTB) are inconsistent, and the effect of household environment on PTB is largely unclear. AimTo investigate the association of ambient PM2.5 throughout pregnancy, household environmental factors and PTB, with further exploration of their potential interaction and joint effect on PTB. MethodsThe study included 5888 pregnant women between 2018 and 2021 in Weifang Maternal and Child Health hospital of Shandong, China. Maternal exposure to PM2.5 was extracted from ChinaHighAirPollutants datasets according to individual home address. Household environmental information including residential floor level, double-glazed window, heating fuel, cooking, smoking and window ventilation was collected by questionnaires at enrollment. PTB was defined as a birth before 37 completed weeks of gestation. General additive models were applied to examine the associations of PM2.5 exposure, household environment and PTB. ResultsOne-unit increase of PM2.5 throughout pregnancy was associated with significantly increased risk of PTB (OR = 1.069, 95% CI: 1.037, 1.103). In contrast, installation of double-glazed windows (OR = 0.763, 95% CI: 0.589, 0.990) and residential floor level of the 5th floor or above (OR = 0.746, 95% CI: 0.583, 0.955) were found to be associated with significantly reduced risk of PTB. The stratified analyses demonstrated that the protective associations remained among those with high PM2.5 exposure, urban residence, middle SES level and cesarean delivery. A negative interaction between residential floor level and PM2.5 exposure on PTB, and joint effect of installation of double-glazed windows plus residential floor level of the 5th floor or above on PTB were observed. ConclusionsThis study found the adverse effect of PM2.5 during the pregnancy on PTB, and identified protective associations between installing double-glazed windows, living on the 5th floor or above and PTB in relatively polluted regions.

How does eligibility for GusNIP produce prescriptions relate to fruit and vegetable purchases and what factors shape the relationship? A protocol for a secondary analysis of nationally representative data in the USA

IntroductionUS Department of Agriculture (USDA) Gus Schumacher Nutrition Incentive Programme (GusNIP) produce prescription programme (PPR) ‘prescriptions’ provide eligible participants with low income, risk for diet-related chronic disease and food insecurity...

Abstract 25: Association Between Household Sleep Environment and Sleep Health Characteristics: The Coronary Artery Risk Development in Young Adults (CARDIA)—Sleep Study

Introduction: Household environmental factors and sleep behaviors may contribute to poor sleep health. We identified associations between household sleep environment (HHSE) and sleep health characteristics. Hypothesis: Individuals with adverse HHSE will have poorer sleep health. Methods: We used cross-sectional data from the CARDIA sleep ancillary study at Year 35. HHSE (i.e., sleep disruptors and sleep behaviors) scores were derived from responses to questions in the questionnaire (see Table footnote), where a higher score indicated higher sleep disruptors or more detrimental sleep behaviors. Sleep outcomes were: 1) sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness assessed with the Epworth Sleepiness Scale (ESS) (N=699) and 2) sleep duration (minutes) and efficiency (%) measured by 7-day wrist actigraphy (N=574). Robust regression estimated differences in sleep outcomes corresponding to each 1-score increment in HHSE. We adjusted for age, sex, race, education, smoking status, body mass index, depressive symptoms, and comorbidities. Racial differences in associations of interest were examined by testing for interaction. Results: Participants mean age was 61.5 years, 63.1% were female and 35.9% were Black. Means (SD) of PSQI, ESS scores, sleep duration, and sleep efficiency were 6.2 (3.7), 5.5 (3.7), 414.6 minutes (SD=60.4), and 84.4% (SD= 6.7), respectively. After multivariable adjustment, both higher sleep disruptors and more detrimental sleep behaviors were associated with poorer sleep quality and greater daytime sleepiness. HHSE showed no association with sleep duration and efficiency (Table 1). Sleep disruptors were only significantly associated with daytime sleepiness among Black participants (p-interaction= 0.01). Conclusions: Adverse household sleep environment was related to poorer subjective sleep quality and daytime sleepiness. Future studies should investigate reasons why Black adults appear more susceptible to household sleep disruptors.

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BackgroundAcute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.MethodsThis case-control study was conducted at a tertiary-level children’s hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6–59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.ResultsSeveral household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52–4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14–9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.ConclusionIn-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

Impact of ambient air pollution and socio-environmental factors on the health of children younger than 5 years in India: a population-based analysis

Ambient air pollution and household environmental factors affect child health, particularly in low-income and middle-income countries. This study aimed to investigate the association between ambient air pollution (PM2·5) levels, socio-environmental factors (including household wealth, housing quality measures, smoking status), and the occurrence of respiratory illness in Indian children. In this retrospective and observational study, we analysed data from India's National Family Health Survey (NFHS-5, 2019-2021) combined with NASA's Global Annual PM2·5 Grids database. Bivariate and multivariable generalized additive models were employed to examine associations between key social-environmental factors and respiratory illness in children younger than 5 years. We analysed data from 224,214 children younger than 5 years, representing 165,561 families from 29,757 geographic clusters. Our results showed extremely high annual PM2·5 levels throughout India (median 63·4·g/m3, IQR 41·9-81·6), with higher exposure for rural and impoverished families. In bivariate analyses, PM2·5 was significantly associated with reported respiratory illness (p<0·001). Using generalized additive models and after accounting for key social and environmental factors, a monotonic increasing and non-linear relationship was observed between PM2·5 and respiratory illness (p<0·001), with increased likelihood of illness observed even at values near and below India's National Ambient Air Quality Standards of 40μg/m3. The study highlights the significant association of social-environmental conditions with health outcomes among young children in India. Efforts specifically targeting ambient air pollution and child health during monsoon season could have significant health benefits among this population and help achieve the goal of ending preventable deaths of children younger than 5 years. National Institutes of Health (NIH T-32-HL139443-3).

Outdoor Physical Activity and Play Among Canadian Children and Youth With Disabilities During the COVID-19 Pandemic: Findings From the National Physical Activity Measurement Study.

This study explored the association between socioecological factors and outdoor physical activity (PA) and play in children with disabilities during the COVID-19 pandemic. Parents (N = 133) completed a survey to report changes in their child's outdoor PA and play during the pandemic (from prepandemic levels), and child, household, and neighborhood environment factors. Children with a PA-supporting parent and from multichild and White households had lower odds of reporting decreased outdoor PA. Children from multichild, higher income, married couple households and a PA-supporting parent had lower odds of decreased outdoor play. Living in neighborhoods with higher urbanization (i.e.,high dwelling density, street intersections, and land-use mix) was associated with greater odds of decreased outdoor PA and play. Future research that uses larger and more representative samples of children with disabilities is needed to test for the multivariate effects of socioecological variables on outdoor PA and play.

Household environment and animal fecal contamination are critical modifiers of the gut microbiome and resistome in young children from rural Nicaragua

BackgroundEarly life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use, the role of household environments is still unclear. Furthermore, the development of the gut antimicrobial resistome and its role in health and disease is not well characterized, particularly in settings with water insecurity and less sanitation infrastructure.ResultsThis study investigated the gut microbiome and resistome of infants and young children (ages 4 days-6 years) in rural Nicaragua using Oxford Nanopore Technology’s MinION long-read sequencing. Differences in gut microbiome diversity and antibiotic resistance gene (ARG) abundance were examined for associations with host factors (age, sex, height for age z-score, weight for height z-score, delivery mode, breastfeeding habits) and household environmental factors (animals inside the home, coliforms in drinking water, enteric pathogens in household floors, fecal microbial source tracking markers in household floors). We identified anticipated associations of higher gut microbiome diversity with participant age and vaginal delivery. However, novel to this study were the significant, positive associations between ruminant and dog fecal contamination of household floors and gut microbiome diversity. We also identified greater abundance of potential pathogens in the gut microbiomes of participants with higher fecal contamination on their household floors. Path analysis revealed that water quality and household floor contamination independently and significantly influenced gut microbiome diversity when controlling for age. These gut microbiome contained diverse resistome, dominated by multidrug, tetracycline, macrolide/lincosamide/streptogramin, and beta-lactam resistance. We found that the abundance of ARGs in the gut decreased with age. The bacterial hosts of ARGs were mainly from the family Enterobacteriaceae, particularly Escherichia coli.ConclusionsThis study identified the role of household environmental contamination in the developing gut microbiome and resistome of young children and infants with a One Health perspective. We found significant relationships between host age, gut microbiome diversity, and the resistome. Understanding the impact of the household environment on the development of the resistome and microbiome in early life is essential to optimize the relationship between environmental exposure and human health.92Jf2w8Y_xc1zDLBRpWCqWVideo Graphical

Exploring associations between household environmental factors and handwashing with essential agents in sub-Saharan Africa.

3 billion people lack proper home hand hygiene facilities globally. Of these, 1.4 billion (18%) lack soap or water, while 1.6 billion (22%) have neither. This analysis explores the link between living conditions and the use of essential agents in sub-Saharan Africa. This secondary data analysis examines potential associations between the domiciliary environment and the use of essential agents in sub-Saharan Africa. Eighteen demographic and health surveys were used to analyze the association between household environmental factors and handwashing with essential agents. STATA version 16 was used to analyze data from 203,311 households across weighted samples. Using a multivariable multilevel mixed effect logistic regression analysis, it was possible to determine how each independent factor affected the outcome while taking the data clustering into account. The adjusted odds ratio and its associated 95% confidence interval were used to assess the independent factors' statistical significance. Only one in three households 34.84%, practiced handwashing with essential agents, with the highest prevalence in Angola (70.2%) and the lowest in Malawi (6.5%). Educational status [aOR = 1.77; 95%(CI = 1.68-1.86)], female headship[aOR = 1.09; 95%(CI = 1.06-1.2)], household wealth[aOR = 4.08; 95%(CI = 3.84-4.33)], not sharing toilets with other homes[aOR = 1.13; 95%(CI = 1.10-1.17)], having a fixed place for hand washing[aOR = 1.49; 95%(CI = 1.45-1.54)], not having regular access to water [aOR = 0.09; 95%(CI = 0.095-0.10)]and being a rural resident [aOR = 0.85; 95%(CI = 0.82-0.88)] were associated with handwashing. sub-Saharan nations are failing to demonstrate advancements in handwashing practices. There are still a lot of homes without access to basic infrastructure for handwashing and household water sources. For essential agent adoption programs to be successful in an environment with limited resources, Water, Sanitation, and Hygiene measures must be implemented. Furthermore, it is critical to include contextual factors from the current study as well as socio-cultural and psychological characteristics that dissuade people from using essential agents in intervention strategies.

Associations of urinary phthalate metabolites with household environments among mothers and their preschool-age children

Phthalates have become a matter of public health concern due to their extensive use worldwide and negative health effects. The evaluation of potential sources of phthalate exposure is crucial to design prevention strategies, especially for vulnerable populations. This study included 528 mother-child pairs in the Taiwan Mother Infant Cohort Study who were followed up at ages 3–6 years between 2016 and 2020. Each mother was interviewed by using a structured questionnaire containing questions on demographic characteristics and household environment factors, such as the use of plastic food packaging, residential visible mold, insecticide sprays, and electric mosquito repellents. Eleven phthalate metabolites were analyzed in urine samples simultaneously collected from the mother-child pairs. The phthalate metabolite urinary concentrations were higher among the children than among their mothers, except those of mono-ethyl phthalate (MEP) and mono-2-ethylhexyl phthalate (MEHP). Multiple linear regression analyses showed that urine samples collected during the summer showed higher concentrations of phthalate metabolites than those collected during the winter. Family income levels had negative associations with the concentrations of MnBP and metabolites of di-2-ethylhexyl phthalate (DEHP) in children. The use of plastic food packaging was positively associated with mono-n-butyl phthalate (MnBP) and metabolites of DEHP in mothers. Residential visible mold or mold stains were significantly associated with higher MnBP and DEHP metabolite concentrations in children. The use of insecticide sprays was positively associated with MnBP concentrations in children. Significant associations between household environmental factors and phthalate exposure were mostly found in children, potentially indicating different exposure pathways between mothers and their children. Findings from this study provide additional information for the design of prevention strategies to protect the health of children and women.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014.

Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

Household Environment Status and Infant Mortality: A Study of West Bengal

The factors influencing infant mortality have been documented in a number studies. A number of individual, biological and household environmental factors were found to be the significant predictor of infant mortality in any human setting. Most existing studies on early childhood mortality in India were based on census data. Using the data from second and third rounds of District Level Household and Facility Survey of India this paper assessed the pattern and degree of association of infant mortality with household environment status at the district level in West Bengal. The estimates of infant mortality rate for districts of West Bengal were derived based on birth history data. The household environment status for each district was determined based on three selected household environment factors, namely, availability of toilet facility, availability of safe drinking water and existence of pucca house. Key findings showed that the northern and western districts of this state were backward in terms of household environment status and mostly the districts of those regions had higher levels of infant mortality. The association of availability of toilet facility with infant mortality was found to be significant and stronger, compared to that of other two household factors.

Comparison of Household Environmental Factors among Children with Reported Asthma and Controls

The present research was part of a cross-sectional project involving children aged 8 to 10 years in Porto, Portugal. The project involved a first research part at primary schools where the health tests and a questionnaire were performed and a second research part concerning environmental conditions. Two groups emerged from the health questionnaire answers: one group that reported “asthma diagnosed by a doctor” and/or “wheezing or whistling in the chest during last 12 months” and another that answered negatively to both questions. After performing the health questionnaire based on ISAAC, the children responsible were invited to participate in the environmental part of the study. The outdoor and indoor potential risk factors were extensively evaluated in children's homes. This research aimed to compare housing characteristics and indoor behaviours as environmental risk factors in the two children group and investigate whether the risks found are common. The results indicate that windows open during cleaning, standard window frame material, animals at present, dog presence, cat presence, sweep, and vacuumed floor cleaning were associated with both groups. This demonstrates that home characteristics influence some risks and may be exacerbated by certain occupants' behaviours.

Assessment of Household Environmental Risk Factors for Falls Among Community Dwelling Older Persons in Thiruvananthapuram District of Kerala

Falls constitute a major public health problem among older persons worldwide. This study attempted to observe and identify the potential environmental hazards within and outside the houses that could have caused fall-related injuries of older persons. The modifications done to the house after the falls were also observed. Households of older persons who were hospitalised at a tertiary care centre in Thiruvananthapuram district of Kerala, India for complaints of fall related injuries (participants of a case-control study) were observed using a guide that was customized and adapted for the setting. The areas around the houses were slippery and had several tripping hazards. Marble, granite and tiled floors were found to be slippery. Door thresholds, door mats with no grip backing and plastic chairs were found to be potential tripping hazards. Steps/stairs were important in causation of falls. The bedrooms were often dark, small and cluttered with furniture. The bathrooms were frequently located outdoors and at a different level from the rest of the house. Lighting was a problem within the house, inside the toilet and bathrooms. Commonest alteration made to prevent falls was introduction of mats inside and outside the house. Changes that were needed for a safe environment for older persons are often challenged by the need to display status markers. Several potential hazards were identified within and around the house. They either precipitated the falls or modified the outcome of falls. Further research is necessary to work out a guideline for constructing safe and friendly houses for older persons.

Exploring an Applied Ecological Model of the Effects of Household, School, and Community Environments on Adolescent Mental Health in Japan

Adolescent mental health is an urgent global public health issue and is affected by household, school, and community environments. However, few studies, and none in Japan, have used applied ecological models to identify environmental factors that affect adolescent mental health. This study aimed to examine an applied ecological model of sequential association between household, school, and community environmental factors and their effects on adolescent mental health in Japan (ECO-AM model). This was a secondary analysis of data from the 2013 Japanese Comprehensive Survey of Living Conditions. Participants were 893 adolescents aged 12-14 years and their household heads living in Japan. Data for 728 adolescents were analyzed after excluding participants with missing values (valid response rate: 81.5%). Screening using the six-item Kessler Psychological Distress Scale demonstrated that 33.8% of adolescents had mood and anxiety disorders. Covariance structure analysis yielded a model with strong goodness-of-fit that described associations between mood and anxiety disorder and vitality, and household, school and community environments. The explanatory variables accounted for 36% of mood and anxiety disorder scores. The study emphasizes the importance of the relationship between different environments and suggests that a better understanding of environmental factors would help support adolescent mental health.

Exploring the infant feeding experiences of mothers living in selected Tshwane informal settlements: a qualitative study

Objective: The study aimed to explore and describe the infant feeding experiences of mothers of children aged 3 to 24 months, living in two selected informal settlements in Tshwane, South Africa. Design: This exploratory qualitative study gathered data via six focus-group discussions (FGDs). These were facilitated using a semi-structured questionnaire guide with probes. Data were then transcribed, coded and thematically analysed. Setting: The study was conducted in the two selected informal settlements in the west of Tshwane, South Africa. Subjects: Biological mothers (n = 28) of infants and young children aged 3 to 24 months, living in the selected informal settlements participated. The mothers had to be living with their child with some responsibility for their daily care and feeding. Results: Three themes with six sub-themes were identified following thematic analysis. First was the mothers’ experience of infant feeding, which included their interpretations and practices of exclusive breastfeeding and complementary feeding. Second, mothers received infant feeding support from their elders based on common beliefs. The support received from healthcare workers was sometimes perceived negatively. However, healthcare workers based at healthcare facilities were important sources of exclusive breastfeeding and complementary feeding information. Third were the setting-related factors that negatively affected the mothers’ ability to access nutritious food for themselves and their infants. These included household food insecurity, plus environmental and household factors affecting food storage and preparation. Conclusion: Mothers experienced several challenging circumstances affecting their infant feeding efforts. These findings highlight the need to strengthen targeted infant feeding counselling and support for mothers living in resource-constrained environments.

Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5

BackgroundTobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. MethodsUsing the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013–2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. ResultsThree tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. ConclusionsThe transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.

Use of insecticide-treated nets and other household insecticides for preventing malaria in six-year-old children in Benin, sub-Saharan Africa

BACKGROUND AND AIM In addition to early diagnosis and treatment of malaria, the cornerstone of malaria control lies in the use of insecticides such as long-lasting insecticidal treated nets (LLITNs), household spraying, mosquito coils or sprays. However, the quantification of other household insecticides use, including coils and sprays, was less assessed so far. The main insecticide used for LLITN, coils and sprays is pyrethroid. The objectives of the study were to describe the LLITN and other household insecticides used for preventing malaria and to determine factors associated with these different uses. METHODS Data were collected on 567 mothers from a birth cohort in the district of Allada, a semi-urban area in Benin. Mothers were interviewed using a standardized questionnaire when their offspring were 6 years of age. Associations between LLITNs, other household insecticide use, sociodemographic and environmental factors, were assessed using multiple logistic regression. RESULTS Eighty percent of mothers declared that their six-year-old child slept under a LLITN the night before the visit. Approximatively 23% and 7% of households used coils and sprays at home, respectively. When using coils, 62% of families were using them at least once a week. Being a girl, living with the father, having a high number of siblings at home, rainy season and non-use of coils at home were significantly associated with LLITN use. Use of coils was associated with non-LLITN use, having moved since child’s birth and absence of stove in the house. CONCLUSION Children at six years of age were frequently sleeping under LLITN. However, a considerable proportion of them was sleeping in proximity to coils, but not under LLITN. These coils have no proven efficacy in the reduction of malaria vectors so far and may potentially expose children to pyrethroids.

Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study.

This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15–49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.

Risk factors associated with the severity of pneumonia in a cohort of hospitalized children in a rural setting

Objectives: Pneumonia remains a leading cause of death in South African children under 5 years of age. Known risk factors for pneumonia have been the focus of public health strategies to mitigate disease. This study aimed to determine whether adverse household environmental factors were associated with severe compared to non-severe pneumonia in children admitted to Worcester Provincial Hospital (WPH), South Africa. Materials and Methods: We conducted a case–control study at WPH from January 1st to December 31st, 2019, including children aged 0–59 months admitted with pneumonia. Using the WHO definition, children were categorized as having severe or non-severe pneumonia. Structured interviews with consenting primary caregivers were conducted in both groups on weekdays throughout the year to collect demographic, social, maternal, infant, and household factors. We compared the odds of adverse household environmental factors including tobacco smoke exposure, indoor smoke exposure, and overcrowding in children with severe compared to non-severe pneumonia. Results: A total of 305 children were included, 134 (43.9%) cases with severe pneumonia and 171 (56.1%) controls with non-severe pneumonia. Baseline characteristics of children, including age (median 6.9 months; IQR 2.5–17.5), appropriate nutritional status (81.6%; n = 249), and HIV unexposed and uninfected status (81.3%; n = 248), were similar between groups. Caregiver characteristics, including age (median 28 years; IQR 23–33), secondary schooling (71.2%, n = 217), and HIV negative status (81%, n = 247), were also comparable between groups. There was no association in univariable or multivariable analysis between severe pneumonia and adverse household environmental factors including tobacco smoke exposure (aOR 0.73; 95% CI 0.44–1.21), overcrowding (aOR 0.65, 95% CI 0.39–1.08), and indoor smoke exposure (aOR 2.85; 95% CI 0.89–9.09). However, children with severe pneumonia had at least 5 times greater odds (aOR 5.42; 95% CI 1.10–26.65) of living in a household with a pit latrine toilet compared to any other toilet than children with non-severe pneumonia. Conclusion: Few factors were found to be associated with pneumonia severity, except for living in a household with a pit latrine toilet. This may represent socioeconomic vulnerability and the risk associated with developing severe pneumonia.

Health and household environment factors linked with early alcohol use in adolescence: a record-linked, data-driven, longitudinal cohort study.

IntroductionEarly alcohol use has significant association with poor health outcomes. Individual risk factors around early alcohol use have been identified, but a holistic, data-driven investigation into health and household environmental factors on early alcohol use is yet to be undertaken.ObjectivesThis study aims to investigate the relationship between preceding health events, household exposures and early alcohol use during adolescence using a two-stage data-driven approach.MethodsIn stage one, a study population (N = 1,072) were derived from the Millennium Cohort Study (MCS) Wales (born between 2000–2002). MCS data were first linked with electronic-health records. Factors associated with early (<=eleven years old) alcohol use were identified using feature selection and stepwise logistic regression. In stage two, analogous risk factors from MCS were recreated for whole population (N = 59,231) of children (born between 1998-2002 in the Welsh Demographic Service Dataset) using routine data to predict the alcohol-related health events in hospital or GP records.ResultsSignificant risk factors from stage two included poor maternal mental (adjusted odds ratio [aOR] = 1.31) and physical health (aOR = 1.25), living with someone with alcohol-related problem (aOR = 2.16), single-adult household (aOR = 1.45), ever in deprivation (aOR = 1.66), child’s high hyperactivity (aOR = 3.57), and conduct disorder (aOR = 3.26). Children with health events, whose health needs are supported (e.g., are taken to the doctor), are at lower risk of early alcohol use.ConclusionHealth events of the family members and the child can act as modifiable exposures and may therefore inform the development of prevention initiatives. Families with known alcohol problems, living in deprivation, experiencing child behavioural problems and those who are not taken to the doctor are at higher risk of early drinking behaviour and should be prioritised for early years support and interventions to target problem drinking in young people.