Household Education Research Articles

Association between long working hours and unmet dental needs in wage workers

BackgroundMany previous studies on the reasons behind unmet dental needs focus on economic issues. However, in this research, we aimed to investigate the relationship between long working hours and unmet dental needs while considering the influence of occupational factors in wage workers.MethodsThis study used data from the Korea National Health and Nutrition Examination Survey (2012–2018) and analyzed a sample of 12,104 wage workers. Unmet dental needs were defined as cases in which individuals did not receive dental care, despite their need for examination or treatment, within the last year. Long working hours were defined as exceeding 52 h per week, based on the standard working hours stipulated by the Labor Standards Act. A binomial model was applied to calculate the prevalence ratio through multivariate logistic regression analysis.ResultsThe prevalence of unmet dental needs was observed in 3,948 cases (32.5%), among which 1,478 attributed their presence to lack of time. The prevalence of unmet dental needs showed an inverse relationship with the education level and household income. The wage workers who worked long hours had the highest prevalence of unmet dental needs. Long working hours were found to be 1.18 times (95% CI 1.07–1.29) more likely to result in unmet dental care compared to working less than 40 h. The relationship between long working hours and unmet dental needs were statistically significant only in men (PR 1.24, 95% CI 1.07–1.43). However, the relationship between long working hours and unmet dental needs owing to time were in both men and women (men: PR 1.59, 95% CI 1.20–2.11, women: PR 1.90, 95% CI 1.48–2.43).ConclusionsThis study confirmed that long working hours and unmet dental needs are related when occupational factors are taken into consideration, despite the absence of oral health indicators. Using this study as a reference, further research is necessary to identify the underlying causes of unmet dental care and to improve access to dental services in the future.

Influence of performance feedback and academic performance on parent-family involvement and parent satisfaction in US schools.

Parental and family involvement in schools has been a concern for educators and administrators. The authors set out to assess the path directions and significance of the interrelationships between Performance Feedback (PF), Academic Performance (AP) on Parent-Family Involvement (PFI), and Parent Satisfaction(PS) in schools. This study utilizes data from the PFIin Education Survey 2019 under the National Household Education Surveys program done by the USDepartment of Education. The sample for this research is 954parents. Structural equation modeling was employed using AMOS. Results establish the three research propositions: influence of PFIon PS with the mediation of AP and PF, influence of AP on PS is moderated by PF, influence of AP on PFI is moderated by PF. The findings are important for school administrators and all stakeholders for ensuring greater PFI, improved PF and AP of students, and higher PS. This study is unique in assessing the interactional effects of the variables considered. The study also establishes mediating and moderating influences and offers new insights in understanding the influences on PFI and PS and some bidirectional effects.

Socio-demographic characteristics associated with COVID-19 vaccination uptake in Switzerland: longitudinal analysis of the CoMix study

BackgroundVaccination is an effective strategy to reduce morbidity and mortality from coronavirus disease 2019 (COVID-19). However, the uptake of COVID-19 vaccination has varied across and within countries. Switzerland has had lower levels of COVID-19 vaccination uptake in the general population than many other high-income countries. Understanding the socio-demographic factors associated with vaccination uptake can help to inform future vaccination strategies to increase uptake.MethodsWe conducted a longitudinal online survey in the Swiss population, consisting of six survey waves from June to September 2021. Participants provided information on socio-demographic characteristics, history of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), social contacts, willingness to be vaccinated, and vaccination status. We used a multivariable Poisson regression model to estimate the adjusted rate ratio (aRR) and 95% confidence intervals (CI) of COVID-19 vaccine uptake.ResultsWe recorded 6,758 observations from 1,884 adults. For the regression analysis, we included 3,513 observations from 1,883 participants. By September 2021, 600 (75%) of 806 study participants had received at least one vaccine dose. Participants who were older, male, and students, had a higher educational level, household income, and number of social contacts, and lived in a household with a medically vulnerable person were more likely to have received at least one vaccine dose. Female participants, those who lived in rural areas and smaller households, and people who perceived COVID-19 measures as being too strict were less likely to be vaccinated. We found no significant association between previous SARS-CoV-2 infections and vaccination uptake.ConclusionsOur results suggest that socio-demographic factors as well as individual behaviours and attitudes played an important role in COVID-19 vaccination uptake in Switzerland. Therefore, appropriate communication with the public is needed to ensure that public health interventions are accepted and implemented by the population. Tailored COVID-19 vaccination strategies in Switzerland that aim to improve uptake should target specific subgroups such as women, people from rural areas or people with lower socio-demographic status.

Determinates of participation in collective action of forest coffee management in Kafa zone, Southwest Ethiopia

Growing pressure on Sub-Saharan Africa's forest resources and their associated unwise use is attracting both scientific and policy concerns. Coffee forests are important natural resource settings exhibiting sustainability challenges related to governance, usage, and management. Collective management action measures, that center on the local community has been proposed to produce sustainable forests and forest communities through a more integrated, holistic approach to resource governance. This study was conducted to analyze participation in collective action of forest coffee management in Kafa Zone, Southwest Ethiopia where data were collected from 164 farmers using multistage sampling and analyzed by probit model. The coffee production experience, extension visits frequency, household education, off-income, market information, and boundary of users affect participation in collective action. Therefore, formulating accepted rules and regulations for forest coffee management, improving the frequency of farmers' extension visits, and increasing awareness of the negative consequences of forest coffee degradation among farmers enhance the chance of farmers' participation in collective action. Additionally, institutions related to defined boundaries of users had a positive outcome revealing establishments of boundaries that encourage local communities to have the right to enter, manage the resources, and have user exclusivity in forest coffee. The findings of the study show that market information influences participation in collective action. Increasing access to market information on the price and demand of forest coffee increase farmers' participation in collective action.

Household’s Stressors and Well-Being During the Global COVID-19 Pandemic

Home environments suffered a range of stressors during COVID-19 pandemic. This study examines the impact of these stressors on children’s well-being by households’ conditions. Participants included main caregivers ( N = 615) with a child under the age of 3 in a developing Latin-American country. We use multivariate analysis to explore associations between these shocks, the childrearing environment, and children’s well-being. We find that households with lower education and recipients of government assistance were more exposed to negative shocks linked to COVID-19. However, the most educated households were more likely to face an increased burden of childcare. Exposure to negative shocks was associated with a deterioration in the emotional well-being of adults, a higher prevalence of intra-family violence, and behavioral changes in children. Households that reported more time spent caring for children, as well as difficulties in combining care and work, showed higher levels of parental depression and worse indicators of parenting quality. We observe a drop in the frequency of parental involvement in didactic and socializing activities with their children, and a poorer mental health status for the main caregiver (mostly mothers).

Determinants of Household Education Expenditure in Uganda: Do the Poor Spend More on Education than the Rich?

This study estimates the Tobit and IV Tobit models using data from the UgandaNational Household Survey (UNHS) 2019/20 to analyse factors that influencehousehold education spending, and examine the impact of different income groups oneducation spending in Uganda. The findings show a positive relationship betweenhousehold income on the one hand; and the level of education of the head of household,household size, urban residence, female-headed household and education spending onthe other. Furthermore, higher-income households are found to have a high-incomeelasticity of demand than low-income households. An increase in total household incomefor high-income quintile households is found to increase educational expenditures by apercentage point than for low-income quintile households. Due to this disparity, thegovernment is advised to revise its cost-sharing approach to public education spending,which needs to be supplemented by household education spending.JEL Classification: D1, I21, I22, I24, C24, R20

A Psychosocial Model of COVID-19 Vaccination: Antecedent and Concurrent Effects of Demographics, Traits, Political Beliefs, Vaccine Intention, Information Sources, Mandates, and Flu Vaccine History.

To date, research investigating psychosocial correlates of COVID-19 vaccination has been cross-sectional, parochial, and/or reliant upon non-stratified international samples, resulting in difficulty in clarifying the contributions of various vaccination-related influences. The present study tested a novel integration of prospective and concurrent associations of demographic and dispositional tendencies, intervening illness and preventive beliefs, vaccine intention, illness experiences, and concurrent contextual vaccine-related influences with subsequent COVID-19 vaccination. The preregistered study used a stratified online U.S. sample (N = 500), with assessments aligned to (a) "15 days to slow the spread" in March 2020, (b) vaccine authorization and major case/mortality surge during December 2020 and January 2021, and (c) the period following full vaccine approval in August 2021 during the third major/case mortality surge during September and October 2021. Path modeling showed the absence of children in the household and greater education were prospective predictors of vaccination. Trait openness and less conservative political beliefs showed indirect prospective associations with vaccination via stronger intermediating vaccine intention. Contextual vaccine-related influences of vaccine-related information sources, employer mandates, and flu vaccine history also showed direct associations with vaccination. In contrast to expectations, lower conscientiousness showed a direct prospective association with vaccination. Controlling for interrelations among study variables, the results of the integrative psychosocial model clarified the unique contributions and pathways from antecedent characteristics to vaccination while accounting for vaccine-related contextual influences, providing further direction for refining the timing and content of public health messaging for vaccination.

Racial differences in long-term social, physical, and psychological health among adolescent and young adult cancer survivors

BackgroundThe current guidelines for survivorship in adolescents and young adults (AYA) cancer are based on studies conducted in the United States and European AYA survivors. However, previous studies have shown that the health-related quality of life in cancer survivors can vary depending on race, yet the long-term health differences among AYA survivors by race/ethnicity have not been fully explored. Therefore, our aim is to compare the psychosocial and physical health of AYA survivors and their matched controls across different racial and ethnic groups.MethodsWe conducted a cross-sectional study using US National Health and Nutrition Examination Survey (NHANES) and the Korea NHANES from 2007 to 2018. We included AYA cancer survivors who were diagnosed with any type of cancer aged between 15 and 39 years, and who were adult with aged over 18 years old at survey year. We then stratified the study population by race/ethnicity with Non-Hispanic White (NHW, n = 310), African American (AA, n = 42), Hispanic (n = 81) from NHANES, and Asian (n = 389) from the Korea NHANES. We also selected 5 times age-, sex-, race-, and survey year-matched general population among participants who had never been diagnosed with cancer (N = 4110). Variables were defined using questionnaire data, physical exams, and laboratory tests.ResultsCompared to NHW, Hispanics (aOR 1.15, 95% CI 1.00–1.32) had poor or fair general health, lower education (aOR 1.23, 95% CI 1.07–1.40), and lower household income (aOR 1.16, 95% CI 1.01–1.33). AA survivors were more likely to be non-coupled (aOR 1.35, 95% 1.15–1.60) and have hypertension (aOR 1.18, 95% CI 1.03–1.36). Asians were more former/current drinkers (aOR 1.21, 95% CI 1.05–1.40). NHW are more likely to experience psychological limitation. Compared to matched general, NHW and Asian survivors had poor general health and psychological health.ConclusionsThis study provides evidence for future studies concerning long-term health after AYA cancer survivorship that may vary according to race.

Spectacle Coverage Rate After Cataract Surgery in an Urban Area in Indonesia.

Uncorrected refractive errors after cataract surgery contribute to visual impairments. The aim of this study was to investigate the spectacle coverage rate (SCR) following cataract surgery and its relationship with socioeconomic factors in an urban city in Indonesia. This population-based cross-sectional study was conducted in 2015 in Jakarta. The former participants of the Rapid Assessment of Avoidable Blindness (RAAB) survey had a history of cataract surgery and met either of the following criteria: (1) wore spectacles with presenting visual acuity (PVA) 6/12 or (2) had PVA less than 6/12 regardless of spectacle use but achieved the best visual acuity (BVA) 6/12 with pinhole correction. Of the 2998 participants of the RAAB survey, 173 (5.6%) (252 eyes) had a history of cataract surgery, among whom 53 (86 eyes) met our inclusion criteria. The SCR was 69.8% and was associated with age group, household income level, education level, and physicians' recommendation of spectacle wear. Participants who were of nonproductive age (80%), had the highest household income level (88.2%), the highest level of education (87.5%), and had been recommended for spectacle use by their physicians (80.9%) demonstrated higher SCR. Participants with the highest household income had the highest SCR. Patients who had received a physician's recommendation showed a higher SCR and were 26 times more likely to wear spectacles (odds ratio [OR] 25.99, 95% CI 2.59-260.10). There is an unmet need for refractive errors after cataract surgery. Factors such as household income levels and physician recommendations were predictive of spectacle wear.

The effect of poverty on the relationship between household education levels and obesity in U.S. children and adolescents: an observational study

Although ample evidence has shown the link between childhood obesity and socioeconomic status including family income and household education levels, the mediating role of poverty in the association between household education levels and childhood obesity is unclear. This study aimed to quantify the extent to which family poverty levels contribute to the association between household education levels and obesity among US children and adolescents. This cohort study used the nationally representative data of 21,754 US children and adolescents aged 6-17 years (National Health and Nutrition Examination Survey 1999-2018). We applied mediation analysis of the association between household education levels (less than high school, high school, and college or above) and obesity mediated through poverty (≤138% vs. >138% federal poverty level), adjusting for demographic characteristics of household head and their offspring. Obesity was defined as age- and sex-specific body mass index in the 95th percentile or greater using the 2000 Centers for Disease Control and Prevention growth charts. Among 21,754 children and adolescents (weighted N=43,544,684; mean age, 11.6 years; female, 49%), 9720 (weighted percentage,33.0%) were classified as living in poverty and 4671 (weighted percentage,19.1%) met the criteria for obesity. Low household education level (less than high school) showed increased risks of poverty (adjusted relative risk [95% CI], 5.82 [4.90-6.91]) and obesity (adjusted relative risk [95% CI], 1.94 [1.68-2.25]) compared to high household education level (college or above). We also quantified that poverty mediated 18.9% of the association between household education levels and obesity among children and adolescents. The mediation effect was consistently observed across age, gender, and race/ethnicity. Poverty mediated the association between the low educational status of household heads and their offspring's obesity. Our findings highlight the importance of reducing obesity risk among the low-income population to minimize the burden of intergenerational health disparities due to socioeconomic status. Japan Society for the Promotion of Sciences (22K17392).

Pelatihan PHBS Bagi Masyarakat (Manajemen prilaku), di Kelurahan Petunas Kecamatan Kuala Tungkal Kabupaten Tanjung Jabung Barat

PHBS stands for Clean and Healthy Living Behavior, which is a set of behaviors that are practiced on the basis of awareness as an effort to keep oneself healthy and actively helping the health of the surrounding environment. This activity uses the PAR (Participatory Action Research) research method involving conducting research to define a problem or applying information into action as a solution to a problem that has been defined. In the study of participatory action research there are at least six types of approaches, namely formative, system improvement, problem solving, model analysis, participatory, and critical corporate self. -consciousness). The approach taken in this action study is problem solving and participatory, because they are considered the most relevant to community empowerment efforts. The results of this activity include; conducting PHBS education in households and in public places, conducting morning exercise activities with residents, establishing Integrated Service Posts (Posyandu), and conducting education on the Handwashing Movement and Distribution of Handwashing Tubs

Factors Influencing the Perceptions of Smallholder Farmers towards Adoption of Digital Technologies in Eastern Cape Province, South Africa

The objective of the study was to determine the factors that influence the perceptions of smallholder farmers towards the adoption of digital technologies. A purposively selected sample of 250 smallholder farmers who were cross-sectionally surveyed from Port St Johns and Ingquza Hill Local Municipalities in South Africa was used in the study. The Technology Acceptance Model (TAM) and the Attention, Desire, and Action (AIDA) model were used to analyse the data. The results showed that digital technologies were perceived to be expensive, cause a digital divide, and discouraged the use of Indigenous Knowledge even though they increased production. Positive perception towards digital technologies was associated with cattle rearing, with extreme negative perception for sheep and goat rearing. Educational level, employment status, monthly income, household size, being part of a cooperative (1% level), age, and source of income (10% level) were significant factors affecting smallholder farmers’ perceptions of digital technologies. In conclusion, there are economic, social justice, and traditional perceptions towards digital technologies by smallholder farmers, with socio-economic factors affecting the perceptions. The study recommends providing low-cost digital technologies that promote Indigenous Knowledge, which should target the youth and young farmers with less education in small households who are full-time farmers with moderate-to-high incomes and are part of farmer groups/organisations.

Household income and food security during the COVID-19 pandemic in the urban slums of Punjab, Pakistan

ABSTRACT The COVID-19 crisis has not only increased socio-economic inequalities globally but it also severely affected people's everyday lives. This study explores the impacts of COVID-19 on household income, food security, and food consumption patterns in the urban slums of Punjab, Pakistan. Using a multistage random sampling method, cross-sectional data was collected from 257 households through face-to-face interviews. Respondents were chosen randomly applying the random walk method. The data were analysed using Probit regression models. The household food security situation was estimated using the food insecurity experience scale (HFIES) developed by the Food and Agriculture Organization (FAO). Results show that household income and food security situations during the COVID-19 pandemic were significantly affected by education level, household size, daily-wage earnings, salaried employment, and household income slot-I. Household participation in social safety programs appears to help mitigate income shocks and decrease food insecurity. Due to the COVID-19 crisis, 73.92% and 54.86% of the surveyed households faced income shocks and worsened food security, respectively. The consumption of meat, poultry products, and seafood decreased by 21.01%, 17.50%, and 14.39%, respectively, during the pandemic, in comparison to the pre-pandemic period. The study recommends that authorities should consider continuously focusing on supporting existing national social safety programs and designing new ones by providing responsive packages during such adversities. Further, structuring robust financial institutions to aid business recovery and to ensure the availability of food to marginalised communities, particularly in urban slums, could sustain the masses.

Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China

The current epidemic status of diabetic retinopathy in China is unclear. A national prevalence survey of diabetic complications was conducted. 50,564 participants with gradable non-mydriatic fundus photographs were enrolled. The prevalence rates (95% confidence intervals) of diabetic retinopathy and vision-threatening diabetic retinopathy were 16.3% (15.3%–17.2%) and 3.2% (2.9%–3.5%), significantly higher in the northern than in the southern regions. The differences in prevalence between those who had not attained a given metabolic goal and those who had were more pronounced for Hemoglobin A1c than for blood pressure and low-density lipoprotein cholesterol. The participants with vision-threatening diabetic retinopathy had significantly higher proportions of visual impairment and blindness than those with non-vision-threatening diabetic retinopathy. The likelihoods of diabetic retinopathy and vision-threatening diabetic retinopathy were also associated with education levels, household income, and multiple dietary intakes. Here, we show multi-level factors associated with the presence and the severity of diabetic retinopathy.

The impact on climate change perception and adaptation of smallholder concepts: Evidence from a sugarcane community, China

Asia and Africa have large groups of smallholder farmers. They are the main body of the adaptation to climate change in regional agriculture. Because of small management scale and weak accumulating capacity, smallholder farmers generally lack the ability to resist natural disasters and adapt to climate change. Understanding what factors impact on smallholders' perception of and adaptation to climate change are critical to appropriate adaptation strategies to reduce damage. This study analyzed how individual, environmental factors and barriers affected the perception of and adaptation to climate change on Chinese sugarcane smallholders in the higher level of productivity and the traditional smallholder environment. We systematically collected data on smallholders' characteristics and climate change adaptation through questionnaires and household surveys from 750 sugarcane smallholders in five national key support counties in Guangxi, China. The results showed that the level of Chinese sugarcane smallholders' perception and adaptation was relatively poor. Only 69.9% of the sugarcane smallholders perceived climate change, and 42.0% of them had consciously adopted adaptation measures. The developments of productivity and agricultural technology in China could not improve the smallholders' climate change perception and adaptation. The Heckman two-stage model results showed that the groups of sugarcane smallholders with poor terrain, non-Yao households, younger ages, smaller household sizes, higher household education levels and no migrant workers were better able to perceive climate change. Young-aged sugarcane smallholders with rich planting experiences were more likely to adopt adaptive measures. Inter-villager communication was the main channel for sugarcane smallholders to perceive and adapt to climate change, and the positive correlation coefficients reached 0.247 and 0.225, respectively. Trapped in Chinese traditional smallholder concept, sugarcane smallholders in Guangxi lacked the willingness to actively adapt to climate change. Even if productivity and agricultural technologies were developed, information, technical and financial barriers of smallholder adaptation to climate change had remained. Therefore, it is believed that the local government and well-adapted sugarcane smallholders should play the main role and improve participation degree, to stimulate the enthusiasm of sugarcane smallholders in China to adapt to climate change. The results of this study have references for other regions where smallholders are widely distributed in Asia and Africa.

Variability in parenting behaviours during play and during mealtimes with toddlers

AbstractFew empirical studies have explored variability in parenting behaviours observed in a mealtime setting as well as in a play setting with young children. We analysed data from 282 parent–toddler dyads who participated in the Play & Grow study in the United States in 2017–2019. Parent–child interactions were video recorded during play in the laboratory when the child was 18 months old and then during mealtime in the home 6 months later. Standardised coding procedures were used to rate parenting behaviours (sensitivity, cognitive stimulation, positive regard, detachment, intrusive control and negative regard). We describe correlations and differences and variability in parenting behaviour between the two assessments and relative to child sex, gestational age, parent education level, household composition and household income. Detachment was lower on average during play at 18 months compared to during mealtime at 24 months (Cohen's d = −0.40), and the other five parenting behaviours were greater on average during play than during mealtime (d = 0.18–0.43). Sociodemographic characteristics were unrelated to the magnitude of individual differences across contexts in any of the parenting behaviours. Implications for research on associations between parent–child interactions and risk for childhood obesity are discussed.

Socioeconomic status may affect association of vegetable intake with risk of ischemic cardio-cerebral vascular disease: a Mendelian randomization study.

Previous studies found that increasing vegetable intake benefits are reduced after adjustment for socioeconomic factors. Using genetic variation as an instrumental variable for vegetable intake and socioeconomic status, we investigated the relationship between vegetable intake and ischemic cardio-cerebral vascular diseases and focused on whether socioeconomic status was a possible confounder. From three independent genome-wide association studies, we extracted instrumental variables reflecting raw and cooked vegetable intake, which were used to perform Mendelian randomization analysis. To evaluate the effects of socioeconomic factors on vegetable intake, univariate and multivariate Mendelian randomization analyses were performed using single nucleotide polymorphisms representing education attainment and household income reported in the literature. We also performed outlier assessment and a series of sensitivity analyses to confirm the results. Genetically predicted raw and cooked vegetable intake were not associated with any ischemic cardio-cerebral vascular diseases and lipid components after Bonferroni correction. Univariate Mendelian randomized analysis revealed that raw vegetable intake was positively correlated with education attainment (β = 0.04, p = 0.029) and household income (β = 0.07, p < 0.001). Multivariate Mendelian randomized model showed a positive correlation between household income and raw vegetable intake (β = 0.06, p = 0.004). Socioeconomic status was closely associated with eating habits and lifestyle related to the risk of cardiovascular diseases. Genetically determined raw and cooked vegetable intake was not associated with significant benefits in terms of ischemic cardio-cerebral vascular diseases while genetically determined socioeconomic status may have an impact on vegetable intake. Socioeconomic status, which was closely associated with other eating habits and lifestyle, may affect the association between vegetable intake and ischemic cardio-cerebral vascular diseases.

Modeling Spatio-Temporal Dynamics of BMPs Adoption for Stormwater Management in Urban Areas

Nonpoint source (NPS) pollution is a severe problem in the U.S. and worldwide. Best management practices (BMPs) have been widely used to control stormwater and reduce NPS pollution. Previous research has shown that socio-economic factors affect households’ adoption of BMPs, but few studies have quantitatively analyzed the spatio-temporal dynamics of household BMP adoption under different socio-economic conditions. In this paper, diverse regression approaches (linear, LASSO, support vector, random forest) were used on the ten-year data of household BMP adoption in socio-economically diverse areas of Washington, D.C., to model BMP adoption behaviors. The model with the best performance (random forest regression, R2 = 0.67, PBIAS = 7.2) was used to simulate spatio-temporal patterns of household BMP adoption in two nearby watersheds (Watts Branch watershed between Washington, D.C., and Maryland; Watershed 263 in Baltimore), each of which are characterized by different socio-economic (population density, median household income, renter rate, average area per household, etc.) and physical attributes (total area, percentage of canopy in residential area, average distance to nearest BMPs, etc.). The BMP adoption rate was considerably higher at the Watts Branch watershed (14 BMPs per 1000 housing units) than at Watershed 263 (4 BMPs per 1000 housing units) due to distinct differences in the watershed characteristics (lower renter rate and poverty rate; higher median household income, education level, and canopy rate in residential areas). This research shows that adoption behavior tends to cluster in urban areas across socio-economic boundaries and that targeted, community-specific social interventions are needed to reach the NPS control goal.

Socioeconomic and geographic variation in coverage of health insurance across India.

In India, regular monitoring of health insurance at district levels (the most essential administrative unit) is important for its effective uptake to contain the high out of pocket health expenditures. Given that the last individual data on health insurance coverage at district levels in India was in 2016, we update the evidence using the latest round of the National Family Health Survey conducted in 2019-2021. We use the unit records of households from the latest round (2021) of the nationally representative National Family Health Survey to calculate the weighted percentage (and 95% CI) of households with at least one member covered by any form of health insurance and its types across socio-economic characteristics and geographies of India. Further, we used a random intercept logistic regression to measure the variation in coverage across communities, district and state. Such household level study of coverage is helpful as it represents awareness and outreach for at least one member, which can percolate easily to the entire household with further interventions. We found that only 2/5th of households in India had insurance coverage for at least one of its members, with vast geographic variation emphasizing need for aggressive expansion. About 15.5% were covered by national schemes, 47.1% by state health scheme, 13.2% by employer provided health insurance, 3.3% had purchased health insurance privately and 25.6% were covered by other health insurance schemes (not covered above). About 30.5% of the total variation in coverage was attributable to state, 2.7% to districts and 9.5% to clusters. Household size, gender, marital status and education of household head show weak gradient for coverage under "any" insurance. Despite substantial increase in population eligible for state sponsored health insurance and rise in private health insurance companies, nearly 60% of families do not have a single person covered under any health insurance scheme. Further, the existing coverage is fragmented, with significant rural/urban and geographic variation within districts. It is essential to consider these disparities and adopt rigorous place-based interventions for improving health insurance coverage.

The role of environmental and financial motivations in the adoption of energy-saving technologies: Evidence from European Union data

This paper investigates whether households’ environmental and financial motivations affect their investments in energy-saving technologies. Exploiting a comprehensive dataset covering 30 European countries, we investigate whether financially motivated and environmentally minded households present different adoption paths. The results show that environmental and financial motivations play an essential role in the decision to adopt energy-saving technologies, thus paving the way for policy actions targeted at enhancing consumer awareness. Our analysis also reveals that environmentally and financially motivated households exhibit different socio-economic profiles. We find that environmentally minded, highly educated households living in urban areas with a large family size are more likely to adopt energy-saving technologies than their counterparts with low levels of education living in rural locations. In addition, their financial situation is an important factor in explaining the adoption patterns of financially motivated households. From a methodological point of view, our analysis exploits both parametric and nonparametric methods. We use stochastic dominance analysis to rank the distribution functions of household behaviours and the logit model to investigate the socio-economic profiles of different groups.