Household Factors Research Articles

Utilization of Digital Financial Transactions and Perspectives of Digital Payment among School Employees

This descriptive-correlational research determined the utilization of digital financial transactions and perspectives of digital payment of the employees in one private higher education institution in the Philippines and correlated these to their demographic and household profiles. A total of 115 employees participated in this study. Contingency coefficient, Chi-square test, and Spearman rho correlation test were used to determine the association of the variables. Findings reveal that the majority of the participants prefer cash for their financial transactions. In general, they are confident in making financial transactions using digital devices. They often utilize digital payment to pay for mobile recharge/loads and cable/internet, and many of the participants have been using digital payment methods for more than three years and above. Findings further show that, generally, the participants have positive perceptions toward digital payment. Single individuals, graduates of education courses, and families with two to three household members below 18 years old prefer cash transactions more than the other groups. There are demographic and household factors that are significantly correlated with confidence in and frequency of making digital financial transactions and the time period of using digital payment methods. Findings may imply the inclusion of digital and financial literacy in the development program for employees to increase awareness and understanding of the benefits, safety measures, and convenience of digital finance.

The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020.

There is little understanding of the circumstances behind fatal pediatric opioid poisonings. Our objective was to characterize opioid fatalities according to child, family, and household factors. We used data from the National Fatality Review-Case Reporting System to describe the circumstances behind the deaths of children 0 to 17 years of age who died of an opioid poisoning (ie, prescription opioid, heroin, illicit fentanyl) between 2004 and 2020. Decedents were stratified into age groups: 0-4, 5-9, 10-14, and 15-17 years. The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child's own home. Prescription opioids contributed to 91.8% of deaths, heroin contributed to 5.4%, and illicit fentanyl to 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment. A history of maltreatment and substance use-whether on the part of the caregiver or the child-are common factors surrounding fatal pediatric opioid poisonings, the majority of which occur in the child's own home. Families with children of all ages would benefit from interventions focused on opioid prescribing, storage, disposal, and misuse. These findings also underscore the urgency of ensuring that access to naloxone becomes universal for families with a history of maltreatment and/or substance use.

Students’ perceptions of teachers and teaching as determinants of primary school completion in Ethiopia

Purpose This study analysed students’ perceptions of teachers’ behaviours, teachers’ management practices and the use of inputs by teachers and whether these are associated with primary school progression and completion.Design/methodology/approach School-level fixed effect analysis is conducted using cross-sectional data collected from 4,000 randomly selected primary school-aged students and their schools.Findings Our findings reveal that students’ perceptions of teachers’ behaviours are associated with the probability of grade progression during primary school, and whether students complete primary school. Particularly important are positive behaviours, like students perceiving their teachers to be engaged and being praised by their teachers while in primary schools. It increased the likelihood of school progression by at least 15%. The use of inputs such as worksheets/written handouts and reading stories/books in the language of instruction were also found to have a statistically significant positive effect on students’ primary school performance. These are important results which hold after accounting for school management, household and child-level factors and regional differences.Originality/value Our findings provide a deeper understanding of the teaching practices which pupils perceive as beneficial to retention. While we are unable to conclude that learning is taking place, our contention is that greater time in school could increase the opportunity to learn. In this respect, beyond its policy relevance in improving educational outcomes, the paper contributes to the limited literature on the student–teacher classroom relationships particularly when looking from the perspective of students’ perception of their teachers’ teaching behaviours in developing countries.

Long COVID Prevalence and Factors Among ethnically Diverse UK Healthcare Workers

Abstract Background Long COVID (LC), characterised by persistent symptoms post-acute COVID-19 infection, presents a growing public health concern. Data on prevalence among healthcare workers (HCWs) are lacking. Our study aimed to establish the proportion of UK HCWs with symptoms lasting beyond five weeks and identify factors associated with LC in a diverse cohort. Methods We conducted a cross-sectional analysis from December 2020 to March 2021. The main outcome was LC in relation to self-reported ethnicity. Univariable and multivariable logistic regression identified associations. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated with 95% confidence intervals (95%CIs). The multivariate analysis adjusted for demographic information, job role, household factors, health status, and existing long-term conditions. Missing data were imputed via chained equations. Results From 11,513 HCWs, 2,331 (20.2%) reported COVID-19, with 525 (22.5%) experiencing LC. 80.0% of those reporting LC were female, compared to 74.3% without LC were female. Participants with LC (median age 46 [IQR 36-54)]) were slightly older than those without LC (median age 41 [IQR 31-52]). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (aOR 1.76, 95% CI 1.26-2.46, p = 0.001) and allied health professions (aOR 1.42, 95% CI 1.05-1.93, p = 0.023) had higher odds of reporting LC compared to those in medical roles. Significant associations were also found with self-reported depression, anxiety, and asthma. There was no significant association between ethnicity and experiencing LC. Conclusions In this large ethnically diverse cohort study, there is a substantial burden of LC among UK HCWs. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted public health interventions, and understand the temporal and longitudinal dynamics of the condition. Key messages • One in five UK healthcare workers reported long COVID, indicating critical needs for targeted public health interventions. • Our study highlights urgent public health responses to address long COVID among healthcare professionals.

Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis

Abstract Background Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework. Methods First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis. Results From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability. Conclusions EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions. Key messages • PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. • EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.

Predictors of Food Insecurity and Food Assistance Program Usage Among Puerto Ricans Before and During the COVID-19 Pandemic in Holyoke, Massachusetts

Background/Objectives: Puerto Rican households often face elevated rates of food insecurity. Frequently, households experiencing food insecurity turn to federal and emergency nutrition assistance for urgent or prolonged aid. This study analyzes factors influencing food insecurity and food assistance program involvement among Puerto Ricans in Holyoke, Massachusetts, amidst the COVID-19 pandemic. Methods: Using a combination of community-based participatory recruitment, purposive sampling, and web-based tools, we collected 284 survey responses. Our paper employed Pearson’s chi-square, logistic regression, and hierarchical linear models to assess relationships between demographic and household attributes and food access outcomes. Results: Variables such as having children in the household and age significantly influenced food relief participation and food insecurity outcomes. Puerto Rican heritage and low educational attainment were strong predictors of obtaining federal food aid. Low-income participants disproportionately faced food shortages and depended on emergency food initiatives. Our findings indicate that demographic and household factors significantly influence food insecurity and accessibility. Conclusions: Our study demonstrates that the pandemic made it challenging for households to obtain consistent, safe, and affordable nourishment. The impacts were unequally spread; hence, Puerto Rican communities and low-income groups were most affected.

A Systematic Review and Meta-Analysis of Multilevel Analysis of Risk Factors for Stunting Among Under Five-Year-Old Children in Indonesia

The causes of stunting, according to the WHO Conceptual Framework, are divided into child factors, household, and family factors, and community and social factors. Databases were systematically reviewed from 2015 until 2021 in Google Scholar, PubMed, and ScienceDirect. The selection of eligible studies was conducted according to PRISMA. A meta-analysis of studies was performed to analyze the association between multilevel risk factors stunting(child, household, family, community and social) and stunting. Of 26.492 articles, 16 articles were included to review. The results of the meta-analysis show that there are various risk factors for stunting in children under five years in Indonesia, such as the individual level (child factor), male sex OR:1.21 (95% CI 1.12-1.31), birth length <48 cm OR:14.88 (95% CI 7.68-28.87), low birth weight <2.500 gr OR:2.43 (95% CI 1.68-3.51), history of infectious diseases OR:2.83 (95% CI 1.61-5.00), not exclusive breastfeeding OR: 2.39 (95% CI 0.72-7.93), household and family level: maternal height < 150 OR:1.86 (95% CI 1.26-2.77), maternal age < 20 OR: 5.17 (95% CI 3.01-8.09), bad sanitation OR:1.28 (95% CI 1.00-1.63), low father and mother education OR:1.58 (95% CI 1.14-2.18), unavailability of food OR:3.29 (95% CI 1.35-8.02), family size > 5 OR:1.41 (95% CI 1.09-1.82) and, community level and social factors, rural area (living outside Java-Bali) OR:1.41 (95% CI 1.09-1.82), wealth quantile 1 OR:1.39 (95% CI 1.23-1.56). The findings of the meta-analysis show that reducing stunting requires integrated health promotion, prevention, and intervention using a multi-sectoral strategy involving health professionals, families, the government, and the community.

Influencing Factors of Peasant Households’ Willingness to Relocate to Concentrated Residences in Mountainous Areas: Evidence from Rural Southwest China

Relocating poor people in mountainous areas to centralized settlement sites is an important poverty alleviation policy implemented by China and a key measure to promote stable poverty alleviation and sustainable rural development for the poor. Based on the survey data of 405 peasant households in the Panxi Area in 2021, this study constructed a structural equation model (SEM) to explore the influencing factors of peasant households’ willingness to relocate to a concentrated residence. The results showed the following: (1) Of the 405 peasant households surveyed, 20.98% were unwilling to move to centralized resettlement sites, making it more difficult to carry out the relocation policy for poverty alleviation. (2) Living environment, living conditions, important social groups, the economic benefits, living benefits, and survival benefits brought by concentrated residences, governments, and the village committees significantly influenced the willingness to relocate to a concentrated residence. In contrast, agricultural income, ecological benefits, and value benefits brought by the concentrated residence had little effect on the willingness to relocate to a concentrated residence. (3) Land force, human force, cognitive force, and national force significantly positively affected the peasant households’ willingness to relocate to a concentrated residence. This study is of great significance in promoting the implementation of poverty alleviation and relocation policy, improving the efficiency of relocation and promoting the wellbeing of peasant households.

The parental perspective of residential environments associated with children's self-regulation

BackgroundThe lack of early development of self-regulation (SR) skills in children can significantly impact their future success. Multiple theories emphasize the role of the environment on child development including SR skills, with income level influencing this relationship. The research used a framework that ties together theories on environmental design and establishes a relationship between the physical environment and a child's ability to self-regulate and manage stress. Limited research exists on addressing physical environmental factors in low-income households and how these factors affect children's self-regulation. PurposeThe purpose of this study is to identify physical environmental factors that can help children deal with stress. The study uses Shanker's self-regulation model and the ecological model to guide the study's data collection and analysis concerning the home environment in relation to child self-regulation from the perspective of caregivers. MethodThis research qualitatively explores affordances factors in the home physical environment in relation to child self-regulation. Data were collected through in-depth interviews and included participants from different income levels and diverse ethnicities. FindingsFifteen affordances factors in the home environment were derived from caregivers' perspectives. The key findings of the study include: (1) The more affordance aspects applied to the home physical design, the better the design is for the child's stress management; (2) Supportive environmental factors can be used to solve hindering effects generated by the environment.

The Influence of Household and Family Factors, Inadequate Complementary Feeding, Breastfeeding, and Infections on the Occurrence of Stunting in Toddlers

The Influence of Household and Family Factors, Inadequate Complementary Feeding, Breastfeeding, and Infections on the Occurrence of Stunting in Toddlers

Individual, household and institutional level predictors of waste sorting: Evidence for Ecuador.

The rapid increase in waste generation in developing countries presents significant challenges, necessitating effective waste management strategies. This study examines the influence of individual, household and institutional factors on waste sorting behaviours in Ecuador, employing an ordered logistic regression model. Data were sourced from the 2019 National Multipurpose Household Survey (NMHS) and the Census of Economic Environmental Information in Decentralised Autonomous Governments (CEEIGAD). The NMHS uses a two-stage probabilistic sampling methodology, with census sectors as the primary sampling units and households as the secondary units. After excluding outliers and selecting individuals aged 15-65 years, the final sample consisted of 8601 households, including 26,175 individuals. The findings reveal that personal attributes such as gender, ethnicity, age, marital status and environmental concern significantly influence waste sorting behaviours. Household characteristics, including urban or rural location, are also critical. Institutional factors, such as municipal regulations, waste collection fees and waste separation at source, play essential roles in promoting waste separation. The study highlights the necessity for targeted governmental policies. Recommendations include improving environmental education, increasing sorting infrastructure in urban areas and ensuring waste collection systems maintain the separation of waste streams.

Modelling the interrelationships between potential risk factors and childhood Co-morbidity of Malaria, Anaemia, and stunting in children less than five years in Burundi

BackgroundAnaemia, malaria, and stunting remain health problems, especially in children younger than five years, and those conditions are linked to morbidity and mortality. The main objective was to assess the relationships between anaemia, malaria, and stunting. Also, the current study aimed to understand the complex interrelationships between explanatory factors, and their direct or indirect relationship with childhood malaria, anaemia, and stunting in Burundi. MethodsThe study used secondary data from the Demographic and Health Survey in Burundi (BDHS) conducted on the March 7, 2017, with a weighted sample size of 13611 children younger than five years. A multivariate structural equation model (SEM) was used to evaluate the interrelationships between dependent variables and their direct or indirect relationship with childhood malaria, anaemia, and stunting. SEMs diverge from other techniques, as they look at the effects on hypothesised relationships from both direct and indirect perspectives (Takele et al., 2023) [1]. The variables with statistical significance were set at a p-value <0.05. ResultsThe findings from this study indicated an association between anaemia, malaria, and stunting (p < 0.001). The environmental and household factors were statistically significant (p < 0.038 and p < 0.001 respectively) and positively impacted childhood malaria, anaemia, and stunting. The results also indicated that the household factors were statistically significant (p < 0.001) predictors of childhood malaria, anaemia, and stunting. Furthermore, the findings from this study revealed that geophysical factors have a positive significant (p < 0.001) impact on childhood malaria, anaemia, and stunting via the mediating of the household factors. Contrastingly, with the environmental factors as a mediator, we observe a negative significant (p < 0.001) impact on childhood malaria, anaemia, and stunting. Lastly, the results showed that demographic factors had a negative significant (p = 0.004) effect on childhood anaemia, malaria, and stunting via the mediating of household factors. ConclusionThe findings from this study revealed an association between malaria, anaemia, and stunting, which imply that these conditions could contribute to collaborative improvements in child well-being. In addition, child demographic, household, environmental, and geographic factors were direct and indirect important drivers of childhood malaria, anaemia, and stunting. Therefore, improving sanitation, access to clean water, nutrition practices, and health care, especially for children from rural areas, and uneducated mothers with poor backgrounds could help to control and eliminate stunting, anemia, and malaria in children younger than five years in Burundi.

Affective experiences from school physical education in children and adolescents

Affective exercise experiences comprise a spectrum of memories, capturing both unpleasant and pleasant episodes. These can be assessed using the Affective Exercise Experience Questionnaire (AFFEXX, Ekkekakis et al., 2021), which examines three separate aspects: 1) antecedent cognitive appraisals (e.g., “incompetence vs. competence”), 2) core affective exercise experiences (e.g., “displeasure vs. pleasure”), and 3) the hedonistic motivation (“antipathy vs. attraction”) to engage in exercise. A German version, AFFEXX-PEG, designed to assess the affective exercise experiences from physical education (PE) in school-aged students, was used to investigate the correlations with PE school grades (as reported by the participants) and extracurricular sports participation (self-reported as the number of days per week spent engaging in at least 60 minutes of sports activities). This study analysed data from 569 individuals (Mage = 14.62, SD ± 1.84; 52% female) across grades 5 to 13. Nearly one-third (29%) of students reported unpleasant core affective experiences from PE in school, and negative experiences correlated with lower PE grades, r(517) = .52, p &lt; 0.001, 95% CI [.45, .58]. Less attraction or antipathy toward PE was associated with fewer days of sports outside of school, r(559) = .38, p &lt; 0.001, 95% CI [.31, .45]. Multiple regression analysis with negative core affective experiences from PE as the criterion and the six cognitive appraisals as predictors, showed that these experiences were primarily influenced by students’ perceived incompetence (b = .49, p &lt; 0.001; R² = .84, F(6, 500) = 436.52, p &lt; 0.001) in PE. Given the empirical evidence on the correlation between affective experiences and exercise behaviours in adults (Rhodes &amp; Kates, 2015), these findings highlight the potential role of fostering positive affective PE experiences. Such experiences may influence lifelong exercise behaviours, and early intervention may prevent the onset of an inactive lifestyle. A new study focuses on children’s (8-12 years) affective experiences from exercise and parent-child interactions, examining the influences of socioeconomic status, parental exercise involvement, and children’s self-perceived body esteem. Elementary school children will report their affective experiences on another, simplified version of the AFFEXX, while their parents will complete a survey on, for example, socioeconomic status and parental involvement in physical activity. By matching data from both surveys, the analysis will explore the relationships between household factors and children’s affective exercise experiences. The goal is to understand early negative affective exercise experiences, assess the impact of family structures, and offer strategies to promote exercise beyond regular school programs.

Factors associated with under-five mortality in Scheduled Tribes in India: An analysis of national family health survey-5 (2019-2021).

Background & objectives Under-five mortality is high among the Scheduled Tribes (ST) in India compared with the general population. This study examined the association of different maternal, child, socio demographic, and household factors associated with under-five mortality among Scheduled Tribes in India. Methods Data from the National Family and Health Survey (NFHS)-5 (2019-2021) for the ST, across all Indian States and Union Territories were used for analyses. Binary and multivariate logistic regression were performed to identify the association of maternal, child, socio-demographic, and household factors with under-five mortality among the ST population. Results Different maternal, child, socio demographic, and household factors were significantly associated with under-five mortality. The odds of under-five mortality were highest among women who gave birth to their children at home [Adjusted odds ratio (AOR): 1.42; 95% confidence interval (CI): 1.268-1.59] as compared with women who gave birth at institution. Literate women have lesser odds of under-five mortality than women with no formal education (AOR: 0.666; 95% CI: 0.501-0.885). The risk of under-five mortality was higher among four or more birth order children (AOR: 1.422; 95% CI: 1.246-1.624) compared with the first to third birth order children. The odds of under-five mortality decreased among children with a rich wealth index (AOR: 0.742; 95% CI: 0.592-0.93) compared to children with a poor wealth index. Interpretation & conclusions Analyses of under-five mortality among ST in India showed a significant association between different maternal, child, sociodemographic, and household factors. Grass-roots-level interventions such as promoting female education, addressing vast wealth differentials, and providing family planning services with a focus on reducing under-five mortality are essential in improving the survival of under-five children among the ST population in India.

Multilevel factors drive child exposure to enteric pathogens in animal feces: A qualitative study in northwestern coastal Ecuador.

Exposure to animal feces and associated enteric pathogens poses significant risks to child health. However, public health strategies to mitigate enteric infections among children largely aim to reduce exposure to human feces, overlooking transmission pathways related to animal feces. In this study we examine if and how children are exposed to enteric pathogens in animal feces in northwestern coastal Ecuador. We conducted qualitative interviews with mothers of children aged 10-18 months that owned (n = 32) and did not own (n = 26) animals in urban and rural communities. Using thematic analysis, we identified community, household, and child behavioral factors that influence exposure. We also compared child exposure by household animal ownership. Our findings revealed myriad opportunities for young children to be exposed to enteric pathogens in many locations and from multiple animal sources, regardless of household animal ownership. Animal feces management practices (AFM) used by mothers, such as rinsing feces into ditches and throwing feces into surrounding areas, may increase environmental contamination outside their homes and in their communities. Unsafe AFM practices were similar to unsafe child feces management practices reported in other studies, including practices related to defecation location, feces removal and disposal, environmental contamination cleaning, and handwashing. Findings suggest that animal feces may contaminate the environment along similar pathways as human feces. Identification and incorporation of safe AFM practices, similar to those developed for child feces management, would 1) mitigate child exposure to enteric pathogens by reducing animal feces contamination in domestic and public spaces; and 2) enable an integrated approach to address enteric pathogen exposure pathways related to animal and child feces.

Will a government subsidy increase couples' further fertility intentions? A real-world study from a large-scale online survey in Eastern China.

How many couples with at least one child under 3 years would like to have another one or more child(ren) in Eastern China and will an in-cash subsidy be conducive to couple's fertility intentions? In sum, only 15.1% of respondents had further fertility intentions (FFI) before learning about the subsidy, and the planned in-cash subsidy policy increased respondents' overall FFI by 8.5%. Fertility has been declining globally and has reached a new low in China. The reasons why the Chinese three-child policy was under-realized, and how couples will react to a planned monthly ¥1000 (€141.2) subsidy policy, are not fully understood. During January and February 2022, a cross-sectional online survey aiming to understand families' expenses of raising a child under 3 years old, and couples' FFI, was conducted. During the survey period, 272510 respondents scanned the QR code. This study reports the findings pertaining to questions on respondents' sociodemographic characteristics, household factors, FFI, and changes in intention from negative to positive after learning about the planned in-cash subsidy. After exclusion, 144893 eligible responses were included. Respondents' FFI, the effect of a planned ¥1000/month*36 months' in-cash subsidy (€5083.2 in total) on people with a negative FFI before the subsidy, and potential reasons for persistent negative FFI after learning about the subsidy were collected through an anonymous online survey. Stepwise binary logistic regression models were used to select associated factors. The potential fertility rate change and government costs were estimated. A stratified analysis by current child number and sensitivity analysis were also conducted. In sum, 15.7% (22804/144893) of respondents were male, 15.1% of respondents reported a positive FFI, and 10.0% (12288/123051) without an FFI at first changed their intention after learning about the planned in-cash subsidy policy. For those who still said 'no FFI', 46.5%, 20.6%, and 14.7% chose pressure on housing status, expenses on children's education, and lack of time or energy for caring for another child as their first reasons. FFI was strongest in participants receiving the most financial support from their parents, i.e. grandparents (OR = 1.73, 95% CI = 1.63-1.84 for the >¥100000/year group), and weakest in those already having two children (OR = 0.23, 95% CI = 0.22-0.24). For those with no FFI before learning about the subsidy policy, respondents with the highest house loan/rent (>¥120000/year, OR = 1.27, 95% CI = 1.18-1.36) were more likely to change their FFI from 'No' to 'Yes', and those with the highest household income (>¥300000/year, OR = 0.65, 95% CI = 0.60-0.71) were least susceptible to the policy. In our study population, about 1843 more births every year and an additional 0.3 children per woman were projected under a conservative estimation. Annual estimated cost at the provincial scale would be ¥817.7 (€115.5) million, about 1.02‰ of the total General Public Budget Revenue in 2022. The findings were generally robust in the stratified analysis and sensitivity analysis. Selection bias and information errors may exist in the online survey responses. The large sample size and detailed further analysis were used to minimize such biases. Fertility intentions in Eastern China are rather low. Policymakers should focus more on financial and childcare burdens for a better realization of the three-child policy, including housing, education and childcare services. An in-cash subsidy, which has never been used in China previously, shows promising potential for increasing FFI. However, the application of such policy should be in line with local conditions for better cost-effectiveness regarding fertility-boosting and fiscal sustainability for the government in the long run. This work was supported by the National Key Research and Development Plan of China (2019YFC0840702). The authors declare no conflict of interests. N/A.

Wealth polarization in western countries

This paper delves into the dynamics of wealth distribution across various countries, utilizing innovative methodologies to uncover patterns of wealth polarization and its determinants. Wealth, distinct from income, reflects long-term economic resources and serves as a crucial indicator of economic well-being. Employing the "relative distribution" method and Recentered Influence Function (RIF) regression, this study examines changes in wealth distribution and the factors driving wealth polarization across eight European countries, Australia, and the United States.The analysis reveals significant heterogeneity in wealth distribution trends among countries, with disparities observed over time. Wealth polarization, akin to income polarization, emerges as a phenomenon distinct from traditional measures of inequality, shedding light on the concentration of wealth within societies. Household composition, demographic factors, and socioeconomic characteristics significantly influence wealth polarization, echoing patterns observed in income polarization studies.The findings underscore the multifaceted nature of wealth distribution dynamics and highlight the need for comprehensive policy interventions to address wealth inequality and polarization. Policy measures such as progressive taxation, regulatory reforms, and asset-building programs for marginalized communities are crucial in fostering equitable wealth distribution and creating inclusive societies.

Characterizing school-linked and non-school linked SARS-CoV-2 cases in children and households: a retrospective cohort study using linked population-level administrative data from Manitoba, Canada

ObjectiveTo identify directionality of SARS-CoV-2 cases within households and schools, and characterize school, household, and neighbourhood factors associated with school and non-school linked cases. ApproachUsing linked administrative data housed at the Manitoba Centre for Health Policy, a cohort of 449,425 individuals from 126,670 households with school-aged children enrolled in Manitoba public schools between September 1, 2020-June 30, 2021 was created. Using population-based SARS-CoV-2 laboratory test results, education enrolment and household composition data, index and transmission cases were counted and categorized at an individual and household level as school or non-school linked. Logistic regression models examined school, household and neighbourhood factors associated with school- and non-school linked households. Results143280 individuals were tested for SARS-CoV-2 during the study period; 14712 individuals (10.3%) tested positive. Amongst positive cases, 1695 (11.5%) were school-linked; the remaining 13017 (88.5%) were non-school linked. 13.7% of SARS-CoV-2 positive households had ≥1 case linked to school; 86.3% did not. Preliminary results found higher incomes quintiles had lower odds of being a school-linked household, as did living outside the Winnipeg region. Having more children in a grade and more household members resulted in higher odds of being a school-linked transmission household. No associations were observed for having a child under age five in the household. ConclusionsTaken together, these data suggest schools were not a large source of SARS-CoV-2 cases in Manitoba and factors associated with school-linked households largely mirrored broader community transmission patterns. ImplicationsThese findings may influence public health approaches to future pandemic control.

Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people across four nations in the UK

Background and ObjectivesSARS-CoV-2 infection in children and young people (CYP) can lead to life threatening conditions including COVID-19, transmission to more vulnerable individuals, or even long COVID. Vaccination against COVID-19 reduces the chance of infection and transmission of the virus, but vaccine uptake in the UK has been shown to decrease with age. ApproachWe undertook a multistate-model approach to estimate hazard ratios on national cohorts constructed from linked health and administrative data, adjusting for several demographic factors. The models were applied to 3,433,483 CYP aged 5-17 years between 4th August 2021 and 31st May 2022. The results were combined in a random effects meta-analysis. ResultsUptake of the first COVID-19 vaccine in CYP was lower compared to older age groups in the UK, and diminished further with subsequent doses (34%, 20% and 2% for 1st, 2nd, and booster dose respectively). Age of the CYP and vaccination status of the adults in the household were identified as important risk factors. For example, 5-11-year-olds were less likely to receive their first vaccine compared to 16-17-year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19), and CYP in unvaccinated households were less likely to receive their first vaccine compared to partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29). Conclusions and Implications Our work highlights the need for targeted strategies to increase COVID-19 vaccine acceptance and uptake among CYP, especially considering the influence of parental consent and household factors. Further research could help identify risk factors in household types to investigate more direct associations, which may be influenced by factors such as living with vulnerable people, familial structure, or deprivation.

Individual, household, and socio-economic predictors of COVID-19 testing and vaccination outcomes: a whole population linked data analysis

ObjectiveThe COVID-19 pandemic has exposed numerous social inequities in health outcomes across nations, despite early warnings of their potential. Poorer outcomes for ethnic minorities, and to a lesser extent Indigenous peoples, have been widely reported, and may be explained in part by household conditions and poorer socio-economic circumstances. This study aimed to identify the effects of diverse individual and social conditions on COVID-19 outcomes within the New Zealand population. MethodWe conducted a whole population analysis of the association between individual (e.g. ethnicity, disability status), household (e.g. household composition), and socio-economic (e.g. crowding, housing quality, income) factors and four COVID-19 health outcomes – infection, hospitalisation, mortality, and vaccination status. We constructed variables of interest from linked administrative data in New Zealand’s Integrated Data Infrastructure, and examined associations within the 2018 Census usually resident population (analysis Ns = 518,571 - 3,216,696). ResultsAnalyses showed that Māori (the Indigenous people of New Zealand) and Pacific peoples, an ethnic minority, experienced worse outcomes than other New Zealanders across all COVID-19 outcomes. These ethnic group differences were persistent, yet reduced, when accounting for household and socio-economic variables. Factors including disability status, high housing mobility, poor quality housing, and household crowding were also widely predictive of worse outcomes. ConclusionEthnic inequity in a range of COVID-19 outcomes is present in a country where the overall impacts of the pandemic were relatively limited. Individual, household, and socio-economic factors are associated with diverse COVID-19 outcomes, and policy amenable factors may help explain the presence of ethnic inequities.